Respiratory Duress

We had just returned to the ER from the ICU after an attempt to bring a dead person back to life. It was disheartening to learn that the patient was scheduled to move out of the ICU and to the regular medical floor before developing an internal bleed. CT results had been resulted only minutes before his heart stopped beating.
It was our third code of the day and everyone was beginning to feel the effects. Things were beginning to back up. Patients had been waiting longer than what was typical and there wasn’t a whole lot we could do about it.
After going through labs and ordering new labs on those who needed it, discharging those we could, we went to see something ridiculous. I looked at the chart then at the doc. “Hair loss. Is this a joke?”
The doc rubbed his forehead and opened his hand in the air. He scoffed and said, “Probably not.”
The young man slowly removed his 49′ers baseball cap and pointed to a 3 inch diameter circle of baldness on top of his scalp. “It fell out this morning.”
The doctor merely glanced at it from a distance. “It’s a yeast infection.”
The patient’s eyes widened in disbelief then he sighed with relief. “Oh. So it’s not an aneurysm?”
Annoyed, the doctor flatly said, “No. Use Selsun Blue shampoo. If it doesn’t clear up, see your primary care doctor because this isn’t an emergency. Any more questions?”
Sensing the doctor’s mood, the patient shook his head and we left the room. The doctor only had a moment to rake a hand through his hair before a minivan wildly pulled up into the ambulance entry. A tech and a nurse met them outside and while returning with a stretcher, the tech called out, “I think this is going to be a code.”
“Yay,” the doctor muttered unenthusiastically.
The nurse, a big guy, carried the patient into the trauma room where we waited. There was no time to dilly-dally with a stretcher. By the time she had been moved from the van to the trauma room, she stopped breathing. A tech positioned his hands for compressions while a mask and bag was placed on her face. The doctor glared at him and asked, “Does she have a pulse? Have you checked for a pulse?”
“She has a pulse,” the nurse seemed shocked and the tech busied himself with other tasks, other than compressions.
“ABC’s, people. ABC’s,” the doc’s sharp voice had the effect of a whip being cracked. The mantra, “If you don’t have an airway, nothing else matters” rang in my head from an old instructor I had.

I noted the patient’s swollen legs. Her calves were as large as her thighs due to the amount of swelling. Her skin was so tight it was shiny. I expected a medical history of heart failure. By the time her husband returned to the department, we had her intubated, continuous monitoring, radiology was on their way with a STAT chest X-ray, blood work was started, and respiratory was getting ready to take over her breathing. Her husband peeked through the door of the trauma room and I waved him in.
From the head of the bed, the doc looked up. “She’s got a pulse, but she’s not breathing on her own so we’re breathing for her. Her blood pressure is good, her oxygen saturations have improved. Tell me what happened.”
The husband was a tall strong looking man with silver hair. His eyes remained on his wife and glanced at the doctor only a couple of times. He shifted his weight back and forth on his feet as he spoke. “She wasn’t feeling good this morning and said she was having trouble breathing. She has pneumonia…”
“How long has she had pneumonia,” the doctor interrupted.
The husband wrung his hands, “Three weeks? She was at the doctor just a few days ago and said she sounded better.”
“What medications is she on?”
“Um…some type of…I can’t remember,” he scratched his head as he thought. “I didn’t think to bring it with me. She started falling forward in the car and…”
“Does she have any other medical history,” the doctor asked, not allowing the husband to crumble at this very moment.
“High blood pressure, I think. She just wasn’t feeling good…”
“Who’s her doctor,” the doc asked. The husband gave the name to someone the ER doc had never heard of.
The patient was on the ventilator by the time the husband was finished being questioned. She was stable enough that most of the team was able to clear out and allow the husband some time with his wife. Radiology had already shot a picture of her lungs and looking at it, comparing it with her blood work, this was congestive heart failure.

We could hear the husband speaking to his wife. We had given him a chair to sit in and he rubbed her arm. “Why didn’t you listen to me? You wouldn’t be like this if you listened,” he said, and rubbed his eyes on his sleeve. His adam’s apple bobbed and I watched a mountain of a man slump and sob once before begging his wife, “Please don’t leave me yet. We’re supposed to go to France this summer, remember? God, don’t let her leave.” His face was red and had tightened with grief.
A lump formed in my throat and I had to turn away. I silently wished his stubborn wife to listen to reason. She had seen some weirdo alternative medicine person, who misrepresented their self as a medical doctor for a PhD, who didn’t have the medical training to adequately treat her, who stated that their diplomas were hung in the waiting room so there was no misrepresentation at all. The name of the office made it sound like a clinic and not some hippy quack experimental lab that it was. Alternative, or experimental methods have their place. But damn anyone who represents their self as anything but. Whether or not the patient deserved to get into a little bit of a pickle regarding her lack of researching someone providing her healthcare is arguable. But her husband certainly didn’t deserve this stress. He deserved to be out in the sun caring for a lawn he might love, playing with his grandchildren, vacationing in France.

We were able to remove her from the ventilator fairly quickly. She was awake and conversational by the time she went upstairs to her hospital room. The husband looked to have aged 5 years. Not only did he shake the doctor’s hand, but he thanked the entire team for saving his wife. He was certainly a very kind and likable man, one we hope will get to enjoy the rest of his life rather than being tied to a hospital bed, watching his wife.

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