Conflicted with Authority

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Conflicted with Authority

Postby Harbinger » Mon Apr 28, 2008 1:28 am

Taken from my blog. Not edited or proof-read, and more of a rant, but I figured this forum needed some attention.

Perhaps it's simply the fervor of youth, but I feel like some ER Physicians give up a bit too easily. As I'm on the code team, I see alot of things go down. Yesterday we had this woman bradied into respiratory failure and ventricular tachycardia while she was undergoing and endoscopy procedure. I knew she has a tension pneumothorax, but other than that no details. She was also a dwarf/midget, so I'm guessing she was just in a generally unhealthy disposition.

It was actually a rather small team as 4 of the 8 people were doctors. After we had worked her back towards a normal sinus rhythm, none of the particpating doctors could intubate her. Nobody could establish her airway at all, they just kept aspirating her stomach. Granted, she was a midget with odd anatomy (almost no neck) and she had a tension pneumothorax causing her treachea to arc, but seasoned ER Doctors should be able to intubate someone in their sleep. None of them could simply do it. None of them used cricoid pressure, and they even had a SCOPE, yet she couldn't be intubated.

After 10 minutes without oxygen, they should have done an emergency Cricoidostomy, which they only mentioned after 30 minutes had passed. In the meantime, he kept saying how there was nothing they could really do for her. I asked why they simply didn't use a pediatric combi-tube, and one of the nurses replied that they couldn't because of her strange anatomy. This made absolutely no sense to me, but I could tell there was going to be no arguing. At that point I talked with the primary care provider (MD) about inducing hypothermia and using K+ channel blockers to reduce the oxygen demand while he tried to establish her airway. He liked the idea, and we implemented it.

So we're slightly over half-an-hour into the code and still have no airway. Her heart occassionally slow to a stop and has to be brought back, but is easily done so with CPR. Despite the lack of oxygen, she's giving one hell of a fight. I was so proud of her. Finally, when it came time to use the cricoidostomy as final resort, the ER MD said that it would be too difficult for him to do and that we'd need to call a trauma surgeon to perform it. That's utter bullshit. I could have performed the "cric" but don't have the scope to legally/medically do so. I was getting irritated inside during this code.

So 45 minutes later she's having trouble keeping her heart going but she's still kicking. The husband arrives on the scene and one of the doctors convinces him to let her go after he refused twice because even though she was alive, she'd probably be brain dead. The worst part was that the consent to cease was given right as the trauma MD walked into the room. I had to contain my irritation. Even though there was a probability of serious damage, she was being so resiliant that a near-full recovery could have been possible. At the very least, she could have been taken off life-support at a later date if that were so. To tell the truth, if he had just established an airway, she would have only needed supportive care. She should have fucking made it, but that ER doctor just reeked of a quiter to me. She was on the ropes, but still very much alive if you ask me.

I felt so awful leaving that code. Not simply because life was lost, or that I felt it was needlessly so, but her husband was a double-amputee (legs) and thus in a wheel-chair. Typically with disabled couples, eachother is all they have. Now this poor guy who probably has had a rough life as it is will forever be alone because the ER Doctor was a fucking quitter, the Endoscopist was incompitent, and the primary care was too timid to make any real decisions. I'm still amazed that he responded to my suggestion.

Way back when I took my first medical lisensure class (EMT-B), my instructor (a seasoned Paramedic) told us that the only way to move past losing patients is if you did everything within your power and ability to save them. I don't think this was done, but with so many doctors around I wasn't really in a position to say much. In the hospital, doctors are law--even when they quit. This is the third time I've seen doctors just not give a shit.

The prestige and title is nice, so is the reliable note-worthy income, but those are merely perks--not the reason you practice medicine. When I'm finally an ER MD, I am not going to quit anybody no matter who they are or why they are there. That is the job, and it's what you do. At the very least I'll then have the authority to tell anybody with a different opinnion about that to get the fuck out of my ER.
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Postby Egaladeist » Mon Apr 28, 2008 4:13 am

I think it's great that you intend to do everything within your power to save life...and I agree whole-heartedly that many Doctors do not care...

maybe even most of them...

but...at the same time we all have to die...the moment we are conceived we are sentenced to die...so...there are points where you have to let go.

Most people see death as some evil, dreadful, thing that must be avoided at all costs...death is not evil, nor should be avoided at any cost, and in fact in some cases should be embraced.

As odd as this will obviously sound...death is not only not evil it is in fact good.

Now...having said that...suffering should be avoided at all cost...suffering is something that many Doctors don't seem to be overly concerned with either.
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Postby Harbinger » Mon Apr 28, 2008 7:46 am

Trust me, I am a proponent of death. I see it on a daily basis, and generally believe it is that individual's time to go. While I whole-heartedly believe in the advance of medical science, it turns many elderly into abominations. It's premature death that I find reprehensible and combat at all costs.
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Postby Aspman » Mon Apr 28, 2008 9:36 am

Heart attacks are underrated. I intend to go quickly with a massive coronary rather that rot away dribbling piss in a care home.

I can't understand why you wouldn't just throw the works at a dying person. There is nothing to lose.
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Postby Maverick » Mon Apr 28, 2008 1:31 pm

Wow Harb.. Not sure I could deal with seeing things like that. Hats off to you for actually giving a damn and enough concern to try and rally support for the patient. The end result is unfortunate though, but as they say, death is a part of life - but that doesn't mean doctors should give up so easy..
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Postby THE Doctor » Mon Apr 28, 2008 1:41 pm

The difference between Professional and qualified.. One gives a damn..
Your jaded co-workers there are paralysed by fear.. the fear of taking a step out side their area of expertise.. in case something goes wrong..and their ass gets sued into the stone-age ..

hey.. you looking for work experience in Aus.. I may have a bit of back work working its way forward..
.. The trouble with life is there's no background music..

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Postby snakedog » Mon Apr 28, 2008 3:07 pm

An old client of mine is an ER doc. He's a good guy. If they act like they don't care,
it's generally because they're overwhelmed. Along with the nurses. Not only do
patients with legitimate needs show up in ER's, but a lot of dickweeds looking to
play the system. Years ago I did an evaluation of a hospital and was stunned at
the nurses' patient loads.
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Postby dinowuff » Mon Apr 28, 2008 3:30 pm

I dated a Nurse that worked at Walter Reed in Washington many moons ago.

Now this being a military facility, er was (I hope) a tad different from the civilian world.

"i don't give a fuck" was the motto - at least I'm pretty sure that's what it is.
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Postby Aspman » Mon Apr 28, 2008 3:40 pm

Relevant

http://news.bbc.co.uk/1/hi/health/7363525.stm

Eight out of 10 nurses say they have left work distressed because they have been unable to treat patients with the dignity they deserve, a poll suggests.
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