1: An emotion variously combining dread, veneration, and wonder that is inspired by authority or by the sacred or sublime “stood in awe of the king”, “regard nature’s wonders with awe“
Yesterday was one of those days when everything falls magically into place and someone lives because of it all. I really don’t work in a major emergency room, we only have 14 beds and like I’ve said before there is a level 1 trauma facility mere blocks away. If something really bad was happening, where would you go? Yeah, me too. Yesterday we had a body in each bed when a man on the cleaning staff of the hospital came in the back door of the ER to the nurses station diaphoretic, clutching his chest, and looking a bit grey (and he’s a black man, so that’s saying something). Our charge nurse was in the process of kicking a patient out of her bed (I’m not even joking, she walked in and said “I need your bed NOW” lol) when one of our cleaning staff grabbed her and said “wait, I just cleaned room 4! It’s open” They started the chest pain protocol, performing his EKG, putting him on the monitor, oxygen… and really, his EKG didn’t look too bad. Some t-wave elevations, which not knowing anything about him could be an electrolyte imbalance, and some PVCs which aren’t the worst thing ever and aren’t totally abnormal in a 57 year old man anyway – at least not nearly as bad as the dreaded S-T elevation.
So everyone proceeded as normal our charge nurse took him as a patient (and at this point I had two patients, one who was with us for NINE HOURS and totally crazy -not even kidding: munchausen– Who was ringing the call bell every 10 minutes. No exaggeration. -I was so exhausted by the time I got home, she sucked all the caring right out of me) Our guy had been in the ER for maybe an hour or so when our secretary went in to talk with him, because she knows him from around the hospital. He told her he felt so terrible earlier he just left his cleaning cart in the middle of the hall and didn’t even tell his supervisor he was coming. So she offered to move his cart.
When she came back into his room and was talking to him, telling him she’d moved his cart, he pulled his arms into his chest and went totally unresponsive. She came tearing out of the room shouting our charge nurse’s name and the doctor’s name. I happened to be standing in the ambulance bay -I don’t even remember what I was doing now- but I immediately turned to my left and grabbed the crashcart pushing it into the room.
He was in Ventricular Fibrillation on the monitor, more commonly referred to in the medical world as Vfib. And when you click on that link you can read “Ventricular fibrillation is a medical emergency. If the arrhythmia continues for more than a few seconds, blood circulation will cease, and death may occur in a matter of minutes.”
We did a full code, called our equivalent of “code blue”, it was the first real-honest-to-god-cardiac-arrest I’ve ever participated in. (There was that one heroine overdose that arrived blue, but we got him up and alert real quick with some narcan) The charge nurse was doing chest compressions and I personally defibrillated him 3 times. Let me repeat that: I shocked someone. He got a couple doses of lidocaine we started a drip, and after the third shock his heart started beating on it’s own again. He was combative and disoriented for a few minutes after coming around, but then was alert and oriented. We repeated his EKG which showed he had just suffered a massive heart attack right under our noses. That S-T elevation showed up like a big waving red flag with blinking lights around it.
Our hospital doesn’t have a cardiac cath lab so we had him transported a few blocks away to the bigger hospital so he could have the blockage cleaned out emergently. Our medical director came by later to tell us that the cath lab said his coronary artery was 100% occluded.
So really if he had been anywhere else yesterday (home, in bed, in the car, at a store) he probably would have died. He was lucky enough to be scheduled to work, working mere feet from an ER, friendly enough with the people at his work place that our secretary went in to say hi to him… I’m just totally in awe over the whole thing. I had a long chat with my mom last night about the whole thing on the drive home as she’s a nurse anesthetist in the same hospital and she’s a firm believer in the philosophy of “when it’s your time, it’s your time regardless of all else”.
Yesterday just wasn’t his time.