Thursday, April 4, 2013

Adagio For An Unplanned Exit

Work in Emergency long enough, and you'll find out the hard way that the worst way to end a shift is with the arrival of a patient in full arrest.

Once you start living the dream, you learn that the nurse who goes to get a shroud kit, and pre-rig the gurney to bag and tag the patient isn't a cynical burn out, but a coldly practical professional applying logic and experience to a very, very low percentage effort.

Less than half an hour before handing off to day shift, and in comes the parade of firefighter/paramedics, summoned to the scene when the patient got to the end of the commuter line this morning, in more ways than one.

God bless 'em for doing everything right by the numbers. They arrive with a guy doing full-court press compressions like they just started their shift a half hour ago, instead of 23 1/2 hours ago. It helps that this is a guy in his 40s, not some tortured octogenarian trapped in a used-up body and longing for release.

We pick up where they left off, the patient is intubated, drugs are pushed, labs drawn, around and around the cycle. Someone even has time to get a foley placed, while a new resident gets a femoral line going too. But we watch the faintest fibrillations turn into PEA, and then asystole. And that is simply that, for this guy, forever. Time of death: unfortunately still on my shift.

Now the other work begins. Tidy him up, D/C fluids and leave IVs and tubes intact. Collect clothes and belongings. Tag everything. Try to find ID, cell phone, something. Hope you don't, because what a crappy way to start someone else's day than to tell them a friend, relative, spouse, or child is in the emergency department, no I can't tell you how serious, but you need to come down to the hospital as soon as you can manage it. Make mandatory notifications to coroner, organ donation banks, etc. Then wait those last few minutes until the next shift comes out to take over.

And this guy is dressed for a day at work. Shirt and tie, briefcase, backpack. And the medics left the gadget he was listening to, and his earbuds that they took out to work on him.

So Nameless Guy (he had ID, but we couldn't find contacts' phone numbers - fortunately) was sitting back on the morning train, and somewhere between settling into his seat, and the end of the route, he was sitting back, eyes closed, rocking to the rhythm of the wheels, and listening - I played it - to a CD of some of the most beautiful Mozart music ever composed and performed. And then, without disturbing his fellow passengers, nice and relaxed, just...had the big one, and checked out without even a peep.

As opposed to screaming at the walls in an Alzheimer's psychosis, withering while agonizing through metastasized cancer, or screaming in panic going off a cliff, not really a bad way to check out, though judging by his apparent age, certainly far too early, I think, for anyone.

But a gentle reminder for all of us left behind that nowhere, in any graveyard, on any tombstone ever made, is graven the final epitaph, "If only I'd spent more time at work..."

It's spring time once again outside right now.
Whether with someone whose company you enjoy, or all by yourself, please, go out and enjoy some of it.

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