Saturday, December 24, 2011

Two Intubations

Last night I was on call again, for Labor ad Delivery. I should have expected it--during the holidays, the regular docs have 'coverage' for their patients. They are not in, and substitute doctors take care of their patients so that they can enjoy time off with their family. Things fall through the cracks. And I end up being called emergently to manage airways and put the breathing tube in.

What struck me, in the morning, that after doing my thing in the ER yesterday (see last post), are the differences between the next two patients.

Patient One:  (I am fixing to intubate, and in the process of doing so)

Patient, annoyed, via telepathy, 'I am TRYING to DIE!!!'

Me, 'What's the point of that?' also via telepathy.

Patient, annoyed further, at having to explain her thinking, 'I was trying to go out with...with courage.' and it flashed into my mind the history of substance abuse, the hospital course superimposed on it, and the medical technology used.

Me, "What's the courage in that?' thinking, all the wasted time and effort and resources if she really wants to check out. 'You either just stay or go.'


Technically, there was a 'snaggle tooth' on the top right, everything else missing, and very anterior airway. With cricoid pressure (someone pushing on the bone over the voice box to help me see) and navigating the tooth, I got the tube in just fine. A 7.5, bigger than I thought, but good for the RT to suction and everything. When you see the color change from yellow to blue on the CO2 device that snaps into the circuit, the position is good, and you are done with it. RT tapes this commercial device in to hold the breathing tube in place.

Patient 2: (I am fixing to intubate, patient is clearly distressed, working to breathe, kind of out of it)

Does not want to die.
Has done everything possible, including loss of a part of the liver to cure cancer.
Also anterior.

My intuition helped me the most here. I kept asking--any paralysis? Any renal failure? Any weakness? before I worked. Succinylcholine, the muscle relaxant used to open the cords and make intubation easier, can be fatal for a burn patient or a patient with weakness/paralysis. The patient had been transferred to the unit for less than ten minutes, and the nurses really did not know. I could see by the clinical situation there was not time for me to go looking through the charts. This man needed a tube. NOW.

When I went to hang up my little white coat, I saw a leg brace for foot drop. 'What is this? Why is it here? Is it his?'

It was. 'He had a stroke'.

'Okay then. No sux. I will just use propofol and try to power my way in.'

His sats were not readable. He was clamped down. Pressures were okay, on the blood pressure. But really struggling to breathe. The first look in, he gagged. I waited about thirty seconds more, took a look and was surprised to see great globs of sputum everywhere in the airway. Once the tube went it, blobs started flying up the ETT.

This one wanted help with everything he had. He got it. This morning, when I went back to pick up my little white coat I had forgotten there, his vitals were much better, and the antibiotics and ventilator were just humming away.

Comparing patient one to patient two illustrates Free Will in the medical context. You really do write your own lessons. Medicine is just a part of it to help you get what you want, on a soul level. I can't think of a better way to pay off karma--either as a patient, or working on the holidays all night like me and my friends! LOL

Just know if you have family members and friends that are in the hospital, whether they are 'a fighter' or not, they are there for a reason. And that reason has LOTS to do with a soul script, life lessons, and exit points. Your desire for a certain outcome can only affect so much. Your love, nonetheless, is much needed and appreciated by all you are in contact with. Your loved one. Their caregivers. The hospital is a brutal place. Tread lightly, and take care to show kindness and consideration to all.


Reiki Doc