Ramblings of an Emergency Physician in Texas
Especially when you’re trained and conditioned to Do Something. Hallway Four tells the story.
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Wow, I’d be hard-pressed to give this guy a chest tube, but not even a needle decompression. That’s tough. Shitty thing to watch. Thanks for the post, GD.
Thanks for the referral, GruntDoc. It’s nice to know that somebody (besides my mom, that is) occasionally stops by and reads my blog!
You’re welcome! And thank you for the nice post.
As a nursing student, the very first code I ever witnessed was on a man who was a DNR. As we all stood there watching this man die, the presiding doctor hesitated a minute and then said: “Let’s just shock him once….” They did but the man still died. I always felt badly for that doctor because I know he wanted to help–and I know he felt helpless. I learned something there, although I didn’t know it at the time…
I have actually only witnessed the deaths of two babies in the year and 7 months or so that I’ve worked in the NICU. Both of those times, I have thought later about the hardest part for me was watching the neonatologist decide to stop and turn off the monitor – even when there are still traces of life fading away. Inside, I always want to scream, “NO!!! Don’t stop!! DO SOMETHING!” But in my heart, I always know that this is the best thing – that the baby couldn’t have recovered – that their life would have been painful without chance of ever improving their status. I often think about certain cases where the baby should be let go, but when it comes time to finally do it, there is this primal instinct that says, “Please don’t stop….just do something.”
It’s so very hard to let go…
The hardest thing I’ve been through like this was after discussing about the options for a brain dead patient, and the family deciding to remove life support. They requested to be at the bedside for the extubation process.
When someone is well-ventilated the dying process takes some time, as CO2 levels rise, oxygen falls. There was never any effort to breath, but somewhere near the end, there was a shrug-like movement, presumably as the spinal cord became ischemic.
I realized that one mistake I made was leaving an EKG monitor on, with the family easily able to watch it. Eventually everyone was staring at the monitor as we slowly, inexorably waited for the development of bradycardia, some PVCs, finally asystole. At some point I had the nurse turn off the monitor — it made the process too artificial in my mind.
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