Spiga


Trau·ma  Junk· ie  ( 'trau-m&  'j&[ng]-kE) n. Slang
  1. One who has an insatiable interest, devotion or addiction to responding and assisting people with serious injury or shock to the body, as from violence or an accident.

0327

"What time is it? I'm calling it."

The physician was sweating, and his voice was faint as he spoke the words that every doctor hates to say.

From across the room, the charge nurse spoke up, "O three twenty-seven, Doctor Jameson*." She scribbled the time down on her records.

And with that, the entire room was clear. Members of the code team dispersed back to their respective departments. Floor staff resumed care of their own patients. And it was almost like it never happened, like Mr. Smith never even arrested, because there were still other patients who had to be taken care of.

********

James Smith, Sr., was well-known to the staff at Memorial Hospital. You could say he was what is colloquially known by nurses and doctors alike as a "frequent flier." Just about once every month or two, Mr. Smith would return with a different medical issue than he present with before. He always ended up being admitted, and for some reason, he was always placed on Unit 3B.

Aside from being about the nicest man you could ever know, Mr. Smith was a man of God and man of the service. He was a captain the United States Air Force, attended church twice a week, and would be more than happy to tell you about the time he spent in a church or overseas.

It was fascinating just to hear him talk about any of it. He had been places that no one could imagine, from Paris to Germany to a makeshift prison where he thought he was going to meet his end many nights during World War II. He'd tell you that he never figured he would live to tell about any of it.

Mr. Smith never smoked, never drank, and never did illicit drugs. When asked, he would tell you he was, "As straight as an arrow..." So, needless to say, it was hard for Mr. Smith to understand why he developed so many health problems later in life. And to be quite honest, I don't think anyone else knew the answer either.

This particular time, however, he was in with community acquired Pneumonia.

*****

I just finished rounds at 0300. All of my patients were resting in bed, with no complaints. I headed back to the nurses' station to begin documenting from earlier in the night.

As I began to circle various things and check boxes on the documentation flowsheet, I start to get an uneasy feeling.

Something
was out of place. Something wasn't right.

I had only been a CNA for two days at this point, and this was my first time working in a hospital. It could have been anything.

But something told me it wasn't a mistake in charting or something as simple as forgetting to move the patient's bedside table within their reach.

I couldn't quite put my finger on it, so I decided I would start vital signs a little early. I knew that Mr. Smith wouldn't be asleep yet, so I went to his room first.

There, laying before me, was the body of Mr. Smith. There was no smile, his eyes were closed, and he was cocked off to one side, almost like he was stuck in that position.

You don't have to be a CNA for long to realize that something was wrong with this picture. This wasn't Mr. Smith-- not how we knew him.

Ten seconds. You can do it. Look, listen, feel.

The CPR class I took for the first time two days ago was playing in my head.

No pulse. No spontaneous respirations. I called the code.

I pulled the ambu bag from behind the bed, hooked it up, and gave two rescue breaths.

Where the HELL is the code team? (It had only been 20 seconds at this point.)

Still no pulse. Start compressions, I thought to myself.

Somewhere during the first cycle of compressions, entered a large group of people to include nurses, doctors, and respiratory therapists. I don't even really remember them coming in, but I do remember making eye contact with the doctor, and he gave me an affirmative nod.

"Just keep doing what you're doing. Let's get him on the monitor." Dr. Jameson's voice was calming. When he spoke, the entire room became silent, awaiting his orders.

I watched the cardiac monitor as I circulated blood through Mr. Smith's body and I couldn't help but think that this man was talking to me not even thirty minutes ago. His heart was circulating its own blood. He was breathing. He was alert, awake, and oriented.

Don't you die on me, Mr. Smith. You've got grandchildren who love you. James...

I pretended for a second that he could hear what I was thinking as I pumped on his chest then I snapped back to reality. The room was loud again, full of people talking, everyone's eyes affixed on the monitor.

"Stop CPR. Let's see if we have a rhythm," piped up Dr. Jameson over all the commotion.

It was clear that when the compressions stopped, Mr. Smith was still asystole.

"One milligram of Epi in. Resume compressions."

And again, I began pounding away at his chest, pumping my arms up and down. I knew the compressions were truly effective at the point in which I was forcing blood into the syringe with each compressions as the respiratory therapist obtained an ABG from his femoral artery.
One...two...three...four...five...six...

I counted. I'd worked in health care for a long time before becoming a CNA and I had heard stories of people gasping violently for air and opening their eyes during CPR, only to return to this earth fully recovered and move on with their life. Part of me thought that would happen. Part of me wanted him to wake up and look at all of us.

Mr. Smith received two more doses of epinephrine just about five minutes apart.

Dr. Jameson spoke up, "How long was he down?"

Seven... eight... nine...

"Hard. To. Say. Ten minutes at most. I was just in here." I was out of breath at this point, but I didn't want to stop. I couldn't stop. I could feel my entire body aching.

"Are we still asystole?"

I stopped compressions long enough to glance at the monitor.

An ICU nurse spoke up, "Yes, still asystole."

"Let's get in one more set of compressions."
*****

On that particular morning, at 0327, CPR stopped. Mr. Smith's heart wasn't beating and he wasn't breathing on his own. I'd like to be able to say that we left the room for a few seconds and the monitor showed Sinus Brady with a rate of 20. I'd love to be able to say that Mr. Smith saw his grandkids again. I'd like to be able to say that Mr. Smith got a second chance at life. But you know I can't do that.

What I can say, however, is that he is in a better place. If I could talk to him now, he'd tell us he appreciated everything we did. Our perseverance, our determination, and our empathy.


This, my friends, is the day I became a trauma junkie. I'll never forget 0327.


blog comments powered by Disqus