Wednesday, March 14, 2007

Now Hear This

The other day, I was working in the critical care/ trauma room -- the part of the department where the TV-like stuff happens. I did some more CPR this week, actually (and I'd like to thank another patient for not dying in our care). This time was trickier, because this person started out with Pulseless Electrical Activity (Paramedics say PEA stands for "push Epi, Asshole!") which turned to atrial fibrillation and back again more than once. The patient did indeed get a bucket of atropine, and enough shocks to drive George Clooney's car to Vegas, by the time all was said and done. I couldn't tell what tempo I was compressing at, because this person's heart went from 82 beats to 145, and then ran itself at 140-some for the next hour. I think I was doing about 100 beats, but who knows?

One of the first-years claims that Queen's "Another One Bites the Dust" has a tempo of 100 beats per minute. I like the idea of humming that as you're compressing somebody's ribs; it's morbid, but snappy, and if it's true, it's useful. But I'm not convinced; I thought 100 was a nice Sousa march tempo. Anybody out there know? I was in junior high band, but if I scour my neurons for that info, I'm afraid something more recent, which might show up on a test, could fall out.

EDIT: A quick Google search tells me that it's about 110 bpm. Sweet! Still morbid, so maybe another song would be better. Or learning to not hum it out loud.

Another fun moment in that room was having a pit boss* borrow my stethoscope twice. Hey, I've been the Human IV Stand, holding a bag of fluid up like the Statue of Liberty. I've been the Human Retractor in the OR, doing work that can otherwise only be done by a little metal contraption with screws and clamps. Why not be an equipment-carrier for somebody I actually like, right?

So I was in the critical room, doing my tech stuff; we get patients exposed, hook them up to monitoring, and make sure blood gets drawn and sent to the lab. We activate the pagers for consulting teams (and try to be polite but firm when some dork from Pediatrics or Medicine calls back rather than seeing the number on the pager and just coming down, the way everybody is supposed to. No, I can't have a conversation about this now. First, I'm not a doc, and second if I don't have time, you can bet they don't, either). The doc needed to listen to the patient's lungs, and swiveled his head around until he saw me. "Hey, can I borrow this...?" he said, lifting my scope while I maneuvered a syringe full of blood into tubes. "Sure," I said. "That's basically why it's there."

And what's weird is, that's true.

None of the stuff I do on a daily basis really requires me to carry a stethoscope. Once out of every 50 or so blood pressure readings, my little computerized machine on a wheeled stand can't get a good reading, so I do it the old-fashioned way, with the hand-pumped cuff and the stetho-thingy. But really, I could keep it in my locker, or just borrow one of the nurses'. Slinging it around my neck is pretty much just a costuming move. It makes me look "medical" to non-English speakers, little old ladies, and irrationally anxious people of all ages and ethnic backgrounds.

Sometimes I'll get tired of it, and leave the thing at home. At the end of the day, I'll wonder if I needed it, and the answer is "nope." This goes on for about a week, max, and then there will be a day when it really would have been useful to have the damn thing. If I were scope-less last week, the pit boss would have found one on somebody else in the room. But hey, one of the best things about mine is that I probably won't need it. Oddly enough, it would seem that's a good reason to carry it.

Another will, I suspect, reveal itself in school, when we get to the class where they show you how to interview and examine patients. I still see students get a little flustered and nervous when they take their stethoscope out of a pocket and tentatively step toward a patient. If I'm to the point where I'm sick of carrying an item around, surely that means I'm way past that point of view, right?

The trauma shears still rule, though. I'm constantly cutting stuff.

* The pit boss is the third-year resident, which is to say a doc in their final year of residency training, and therefore someone who will soon be out in the world, working as a staff physician in emergency medicine. Maybe they'll work in a teaching center like the one where I work (kind of a "Top Gun" kind of a thing), or maybe they'll kick back in some small-town ER where they're the only person in a 200-mile radius who can stabilize and package patients for a helicopter ride, after they've tussled with a nasty piece of farm equipment, or just had too much eggs benedict for the past 30 years. Probably something in between.

The pit is the area where the docs keep their computers and books, their Xray reading screens, and it's where they hold their discussions about what to do next. So the pit boss is the nominal person in charge. There's a staff doc overseeing the area, too, but part of completing training is getting to the point where the staff start giving you opinions and advice instead of instructions.

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