So I haven’t blogged in nearly two months but in these months everything has been very routine. Go to work, come home, eat, sleep. Repeat following day. In March however my friends did return from uni for Easter and we had a good catch up, including going to restaurants and cafes, having a stir fry night which was good, not to mention a few nights out!
In terms of uni, I have been to visit my firm choice again and loved it! It’s such a lovely place with people who seem so nice and welcoming, and I can’t wait to start! I have become queen of research, finding out all I can through Facebook pages and forums about the med school and university. At the moment I’m just completing all my paperwork, ready to go so hopefully my conditional offer will turn to unconditional soon 🙂
I think the main reason I decided to blog today was because I had my first ‘real’ experience of a crash call, and I suppose it’s put me in a reflective mood. I say my first ‘real’ experience of a crash call as I have attended a few as a work experience student as a part of the anaesthetic involvement. But anaesthetists tend to arrive quite late into the call, partly because theatre’s and ITU are so far from the general medical wards where these mainly happen, so I never really experienced them fully. I suppose there are going to be a few firsts, ‘the first as a med student’, ‘the first as a doctor’…
It was altogether an intense experience. We had two critically ill patients on the ward, patient A and patient B. As bleak as this sounds, patient A seemed to be nearing the end of his life so our main priorities were to make patient A comfortable as they were ‘not for twos’. This patient’s family were contacted and on arrival a relative of patient A fainted in the middle of the bay, due to sheer grief. We managed to catch the relative and place them on a chair. However at the same time, Patient B’s breathing, which was noisy, ceased and they lost all colour. We realised they had a pulse but it was very weak and the crash bell went. Patient A’s relative was still in the bay at this point and could see their very very ill relative as well as the emergency of Patient B. I ended up pulling this relatives chair out of view as they were far too weak to stand themselves. Meanwhile, a stampede of nurses ran out of the handover room and to the bedside of the patient B. In a sense we were lucky that this occurred during handover so we had two shifts worth of staff on meaning resus was efficient as we all slipped into roles. Directing the crash, directing relatives off of the ward, directing crash team to our ward (hardest ward to find in hospital), and making sure the other patients were not in any distress. Luckily the resuscitation attempt was successful and whilst Patient B was recovering, I sat by their bedside to monitor them in these crucial moments.
I felt like I was going to cry in the moment of it all to be honest (I didn’t!), and felt so helpless and panicked and shocked all at once. Looking back I suppose I was helpful in the sense of removing any obstacles to the situation; relatives/lost doctors! But at the time, as I wasn’t involved directly in the resuscitation of Patient B I felt just awful. I didn’t even know the patient’s name as I had been working on the other side of our ward all day which to me seems all so impersonal. I don’t know, I don’t even know whether I’m explaining this well. It’s the most intense and surreal situation to be in, another person so close to death.
Here are other (more comprehensive) responses to the first experience of a crash call:
“Today I witnessed my first crash call. To be honest I did not actually realise what was happening till I saw nurses running around shouting ‘where is it?’. I followed the general stampede, and with a move worthy of a rugby forward about to score a try, dodged past two health care assistants trying to stop me adding to the numbers in the already crowded room. I was not going to miss this, perhaps my one opportunity to attend a crash call during my training. Doctors and nurses swarmed around the unfortunate patient who had suffered a massive MI on returning from surgery. I was alarmed at how disturbed I felt about the experience. This was real exciting medicine, but somehow it did not feel like that. I felt sad for the old man in obvious pain and distress amongst a room of strangers who did not even know his name. They fought to save his life, but in a strange way he, the man, was forgotten in the process. I knew it was important for my training, but I felt slightly ashamed to be a spectator intruding on this private tragedy.” http://blogs.bmj.com/ebn-confessions/2009/05/27/my-first-crash-call/
“Well it was about 6am on this chilly winter morning and I was looking forward to the dawn and the end of my shift. I was doing my usual 6am rounds, checking the all-important fluid balances and doing observations. The patients were rousing sleepily about me. As I headed towards my favourite patient I could immediately see that something wasn’t right. He was lying on his back and I could hear gurgling noises coming from him! I moved quickly and the first thing I did was roll him onto his side and grab the suction equipment as I thought he was choking. But as I started to suction I realised that he was arresting. With a hot and frightened rush of adrenaline and with shaking hands I grabbed his buzzer and buzzed 3 times. The ward emergency signal.My favourite patient was a big man and I was a rather petite teenager, but at that moment I seemed to have added strength and with some effort I rolled him onto his back. With a racing heart and sweaty palms I realised that the CPR was up to me and so I started it, all the while silently hoping the RN would answer the emergency buzzer as quickly as possible.Time seemed to stand still and I seemed to move in slow motion while I initiated CPR. I remember feeling hot and cold flushes as I desperately tried to remember all I had been taught. I hadn’t even seen an arrest before let alone be the nurse to find someone having an arrest and be the one to begin CPR! Fortunately I remembered what I was supposed to do, and even though time seemed to drag, the RN and the other nurse were with me within a very short time. The code was called, the RN took over, the resus team arrived and I faded into the background to finish my shift, shattered and shaking. I went home feeling as if I been in a car crash! When I returned to work that night I found out that my favourite patient didn’t survive his arrest and I felt as if I had let him down and hadn’t done a good enough job in trying to resusitate him. Fortunately, even though debriefing wasn’t something that was commonly done, the RN was able to reassure me that he had been a very sick man and that I had done exactly as I should have. And that was the end of it. I saw and participated in quite a few more arrests after that one and I have to admit that I never got used to them and found them all a nerve-wracking experience. However, all those subsequent arrests have faded from my memory, but the arrest of my favourite patient is as clear today as it was 35 years ago. My memories aren’t just because of my fear and anxiety over participating in my first medical emergency though that of course is a big part of it. It was also because a patient I had connected to died and I couldn’t help him. This particular experience really brought home to me what nursing is all about. It’s the sort of experience that made some of the 17 year-olds I worked with hand in their resignations!” http://www.nurseuncut.com.au/cardiac-arrest-the-first-time-i-saw-it-happen/
Hopefully with experience and the ability to be directly involved, coping with crashes will get easier, but I don’t want to lose that sense of humanity towards the patient and become emotionless in them. It’s difficult.
Ahh sometimes I do think, ‘I’m only 18 – most people my age are out clubbing multiple times over the weekend but I’m dealing with people’s lives, I’m too young for this.’ But again after a chance to reflect, it kind of makes me more determined to be a doctor so I can directly help in these situations. (I bet I’ll eat these words when I attend my first crash as a doctor!)
What a day! I feel drained. I’m, back at work tomorrow and hope both patients are still with us and are more stable but have to be realistic with these hopes.
Sorry for such a depressing post after being away for so long, but I’ll try to blog again soon (within the month at least haha)
Until next time…