DOA II

I got into the ICU at around 1:30 am. I checked the wall mounted computer screen to see if I could figure out where the patient was, but due to the privacy restrictions now in place (I believe the regulations are called HIPPA or some such bureaucratic nonsense), we can no longer write the patients' names on a board displayed on the wall, so that the doctors can actually find their patients. The screen had a bunch of room numbers and initials next to them. Useless.

I found the HUC and grumbled "Where's the new one. From the ER."

HUCs are ever cheerful and polite, and for some reason all named Heather. She responded "Oh, Hi Doctor! Your new patient is in 371!"

I grumbled some more and walked down to the room. The patient was indeed ancient, pale, thin... and tilted on her head.

Seriously.

This is a patient position called Trendelenburg. Some doctor, named Trendelenburg of course, realized that if you tilt a shocky patient head down the blood drains out of the capacitance veins in the legs and into the central circulation. This auto-transfusion raises the blood pressure to a certain extent. The nurse had put the patient into Trendelenburg because her BP was around 60 systolic despite high doses of two pressor drugs.

I walked in and started to examine this poor old lady. The nurse was highly agitated about the abnormal labs and started frantically reciting them to me. Without looking up I raised a hand in the universal symbol for "Shut-the-fuck-up". She mistakenly thought that this was a medical care situation when in fact it was simply medical ritual. The ICU doc examines the patient, reviews the notes from the ER and the labs, talks to the family and then allows the patient to die. There was nothing we could do or should do for this woman whose time had come. The Angel was waiting.

I finished my exam, checked the drips and the ventilator and went to the station to sit in front of the computer. I reviewed the labs, wrote my note and then got a cup of coffee before calling the daughter. She was in another state and mercifully agreed to withdraw support once I explained that the situation was clinically hopeless. Sometimes reason prevails.

We stopped the infusions and took her off the vent, removing the tube from her trachea. A few minutes later she stopped breathing and the monitor went flat. I returned to the station and dictated an admission note and a death summary.

I sat for a moment and listened to the sounds of the unit. Nurses chatting, phones ringing, monitors alarming. I took comfort in this background noise and a job well done. We had helped our patient leave this world and enter the next, with a minimum of pain and discomfort.

Home, bed, sleep.