Sunday, January 07, 2007

Thanks, Resusci-Annie(tm), wherever you are...

The good: I performed CPR on a real live person recently. Okay, I did the chest compressions. We're a full-service emergency department, and we have people in charge of the breathing part. Since the patient had an endotracheal tube down his or her windpipe at the time, I let the respiratory therapist just keep on squeezing the purple bag.

Besides, I'm not putting my lips on patients. They give us lectures about that kind of thing.

The even more good: that real live person I mentioned above had a totally crappy heart rhythm when I started, and a good one when I stopped. Honestly, we were breathing for this person, and all he or she had to do was keep that heart pumping. Flutter and fibrilation do not a heartbeat make, people. But after a little while, the patient got it together, with the help of various chemicals poured into IV lines and circulated around his or her cardiovascular system by... why, me, actually!

It happened innocently enough. I was bringing the little silver steppy-stool thing to the staff MD who started the compressions. The table was a little on the tall side, and this doc is, well, not so much. He looked over his shoulder and instead of saying, "ah, cool, put that right here for me," he said, "you wanna take over here?"

And I said, "..."

Then I willed my astral form to stop trying to bolt from my body and said, "sure."

To be fair to the doc, I imagine it's hard to be the guy in charge of the guy who's running the code, if you're busy seesawing up and down with your hands pistoning somebody's chest. Much of the time, the staff docs are frowning and nodding, or joking and nodding, and doing other such supervisory things. This was work. So whether he looked at me and thought "aha, sharp, capable young go-getter" or "overeager and willing sucker," it didn't matter. He had stuff to do, and I was in, dude. I put down the stool and stood atop it, because it's all about leverage. I've seen people taller than me do it like that. Plus I brought the thing.

And ya know... it pretty much feels, no it does feel, just like the training dummy we used in high school health class. Sure, it's a real rib cage. Sure, you can kind of feel the heart going squoosh between the sternum and the spine... or maybe that's just the anatomy textbook in my head filling in details. But it's the same. CRUN-kahh, CRUN-kahh, CRUN-kahh...

I did not count out loud, because again, hi. Roomful of people to help with the breathing; this includes saying "stop CPR" and "start CPR" when needed.

During the first stop interval, I swiveled the vital sign monitor just a bit, so I could see the EKG pattern I was making. And I hope it's not toolish of me to say this, but it was frickin' beautiful. 97 beats a minute. Regular. Nice little T waves, coming at a discreet distance after a pointy -- but not too pointy, mind you -- PRS complex. Was I disappointed when I stopped again, and the patient kept it going on their own?

Fuck no. That was even better. Are you nuts?

I like to be cool with the stuff that's less life-and-death, thanks. But as milestones go, it's very reassuring to do something big, and do it well.

Medical education seems to be built on the careful replication of these kinds of moments. Here's hoping.

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