Monday, June 27, 2005

Put your faith in resus...

Two am, that time of the night that normally gives rise to meditative thoughts. Thanks for the comments, by the way, will respond individually when I am back on normal schedule.

Well, today we had a resus. This is not a particularly unusual event, we have a few a day, but this one I was reasonably central to, and some other stuff went on, so it got to me a bit. Not that it ever doesn't. I think if resuscitations ever became mundane to you, it'd be a sign that you'd burnt out some vital part of something.

The box went off (we have this small black box in the middle of the "fishbowl", where all the doctors and nurses work) around twelve, and we all trotted towards the resus room, and a few minutes later the ambos brought in Mr Stone, a large-framed, sweaty man in his sixties who was struggling to breath.

There wasn't much Mr Stone could say, and we got lines in and started the appropriate therapy (intravenous salbutamol, which is the stuff asthmatics have in their puffers), steroids, high flow oxygen, etc., etc. And while we were doing that the others were scurrying around trying to get an ECG and making sure his airway stayed open and some of the nurses were trying to reassure him, and we stuck needles into him and cut his clothes off and put a hissing mask over his face.

He looked bad. His skin was mottled, his blue eyes were staring wide over the mask, he was sheened with sweat, and his chest was pumping but no air was moving. In pre-terminal asthma the air gets trapped in the lungs and no matter what you do, no matter how hard you breathe, nothing moves. His body lurched with each useless breath, like an animal out of its element.

Anyway, we were talking to Mr Stone, trying to reassure him, while one of the junior nurses was sent to fetch the notes. The notes documented that Mr Stone was not for resuscitation. What had happened last time is Mr Stone had come in, and had been extremely unwell, almost identically unwell, and had needed to be sedated and anaesthetised and paralysed, and had needed a plastic tube slid down his throat, and had eventually got out fo intensive care... and for some reason decided that he never wanted to do that again.

Mr Stone, by the way, had made that decision while in his right mind and in full command of his faculties. The signature of the medical registrar who had listened to him that night, three weeks ago, attested to that fact.

But that was then. This, unfortunately, was now. And in these cases, apparently the hospital policy is that we must bear in mind the possibility that Mr Stone had changed his mind. And in the evidence of any proof to the contrary, we must assume that he had changed his mind, and we must assume that despite his express instructions in an identical situation three weeks ago and his considered response to that situation, he now wished to be sedated and anaesthetised and paralysed, and have a plastic tube slid down his throat.

So that's what we did.

(You could ask why we did not ask Mr Stone himself, who was there before us, very much in the flesh. But his lungs were not working, and the level of carbon dioxide in his blood was enough to change his blood to Fanta, and under those circumstances the brain is not what it normally is. He was moving, and his eyes were staring, and he was taking those deep, useless gasps, but it was more like the random jiggling of atoms, a somatic version of Brownian motion. We spoke but he could not respond).

Anyway, someone tubed him and away he went. Presumably to start the whole process again.

I feel angry about this. I don't know who to blame, I don't know who to shout at, but I want to know.

Yesterday (strange sleep patterns on these shifts, I get up at eleven some days, the sky is bright and the birds are still in the trees), after this, I had a dream, a strange one, where I was walking around in a supermarket. I was trying to buy something but there were too many things to buy.

I feel sometimes we are allowed the small choices to distract us from our lack of choice in the great. We cannot choose if we live or die, if someone will shove a tube down our throat or not, but there are seventeen different kinds of toothpaste down at the local Bi-Lo.

I am going to start a popular movement about this. We are all going to march on Parliament House, chanting and shouting through megaphones and being an uprising of public opinion. Our placards will demand "Bigger cages, longer chains".

Well, enough morbidity. Things are actually going well. But there is something wrong with our attitude to death. in the end, death is not the enemy, pain and terror and indignity are the enemies. It seems often that much of medicine stops when it comes to actually considering death, as if we have run across a vast land and suddenly we are confronted by a shore, and we dare not even stick a toe in it. But death isn't the enemy - if it is, why bother fighting? It always wins.

I don't know. It's part of medicine. It's something we should be better at.


PS: Happy stuff next time. Seriously, things aren't bad, but last night did shit me.


Blogger Chade said...

Sometimes when the universe throws you a gut punch, you just have to respond in kind. Why is it hospital policy to ignore the wishes of a patient? when it is documented?
If suffering a respiratory attack and able to communicate, if you ask not to resus do you ignore because they are under undue stress and not in their right mind?
You certainly exist in a strange world. I wonder daily as to the adventures and twists that shall next grace my screen when I again view your blog.

4:45 PM  
Blogger Foilwoman said...

Here in the U.S. people do up "living wills" and "advanced medical directives" which are all well and good. You can put it on your driver's license that you want to donate your organs if your brain resembles stewed mushrooms after a motorcycle crash (in ERs in the US, probably aprocryphally, motorcyclists are referred to as "organ donors"). But unless you next of kin agrees, they tube you up, don't harvest the organs, making the whole process useless. Why?

8:24 AM  
Blogger Stoic Stranger said...

John, don't know what to say. I am sorry you have to deal with what you do. And I am even more sorry, that I am so glad, that you do have to deal with it.

2:38 PM  
Anonymous Camilla said...

Is it just that when faced with death, we always err on the side of life instead? It seems a very natural thing to me, to want to preserve life where it can be preserved.

And I think it's a very uncomfortable thing to acknowledge that someone might want death rather than to go through the indignities you describe. Many people might liken it to suicide, given that the tools to preserve life are right there, ready to be used.

We really do have a problem with death. We've pathologised it beyond belief.

12:02 AM  
Blogger Stoic Stranger said...

We really do have a problem with death. We've pathologised it beyond belief.

Indeed Camilla. We have to stop seeing death as some all encompassing moral entity and recognise the fact that it is merely a biological phase.

2:11 PM  
Blogger Benedict 16th said...

Hey Stoic, comments like that will put me out of business, you subversive!

I like the urban legend about the ex-nurse who had "Do Not Recuscitate" tattooed on her chest.

9:36 PM  

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