Hello Lamppost

It was only several weekends ago that I spent a Saturday doing CPR, running Megacodes instead of sleeping in. There we were, in casual clothes (which happens so rarely - I go from clinic clothes/scrubs to pajamas pretty much everyday of my life), around rubber torsos, trying to bring them back to "life". The task seemed daunting at first, but after awhile, you get into the rhythm. Running through the algorithms seemed just like routine, and slowly is starting to become second nature. By the end of the day, my arms and hands were sore, but I felt that if someone had an arrest in front of me, I wouldn't be totally lost. (In fact, I had a dream a couple nights ago in which someone went brady and I ran through the code beautifully.)

So anyway, my grandmother was recently admitted to the hospital. Visiting over the weekend, I could tell that she was headed that way. Chest wall pain from a recent fall compounded with chronic constipation and some type of interstitial lung disease meant that it was almost guaranteed that she'd get some atelectasis. I knew it was probably just a matter of time before she'd have a pneumonia and there would be no way she could fight that off herself. To be honest, I was not surprised, but of course still upset when I heard that she was admitted. It came as a bit more a shock when she went into CCU.

I sent my "contact" out to check things out. I wanted to know how she was getting her oxygen, was she sedated, how she was getting her antibiotics, and just generally how she looked. I was assured by a good report and rumours that discharge back to the ward was imminent. It took me by surprise, then, when I received news that she had been admitted to the ICU. Getting news second hand, there was something about CO2 retention and a cardiac arrest. It took 3 defibrillations before they shocked her back into some type of rhythm. Interestingly, they were only going to try three times before they stopped.

I can't help but think what was going through the physician's head when they were running this code. What did they think about running a full code on a late 80's woman with multiple comorbidities, with a relatively recent history of multiple resuscitations? And how did they feel after the first two shocks were delivered with no response? What was the conversation during the last cycles of CPR? How did they react/feel when that last shock was delivered?

And then I remember: though she is my grandmother and I love her dearly, to these people attending the code, she is just another patient with whom they had likely not met before she went unconscious. They are just running a code, going through the algorithms just as I had that weekend (probably with a bit more feeling since this was a real person).

I realize, that when you're doing the same job day in and day out, it's easy to get into that routine and not remember what patients/families are going through. In a busy clinic, I probably see about 15 patients, but each patient sees one doctor (and a bumbling medical student, of course). On a daily basis, it's hard to resolve that difference, but I suppose, every so often, I need to take a step back and remember what it is like to be a patient to keep myself in check.

Maybe I've gotten the algorithms for ACLS (almost) in my crystallized memory, but the thing I haven't mastered is talking to families, arguably the most crucial part. And again it becomes apparent - medicine is both art and science.