Tuesday, May 7, 2013
Just to give her a chance
Yesterday, I had just brought a patient into the hospital and was making light conversation with a couple of the nurses and one of the nurses, Mary, had asked if I had worked on Saturday. I replied that I hadn’t. She related that she had gotten several emergency patients in a row; one in particular was a teenager that was in ventricular tachycardia. Unusual, but obviously possible. I commented about a particular transport I had more than a few years ago, a young lady with an underlying congenital heart problem of dextrocardia. Again, unusual but possible. As I was driving home from work later that evening, I relived that call in my mind. It made it a bit hard to continue driving.
I had just brought an emergency patient into St. Joe’s West and was preceded by another crew who had transported a 19 year old in respiratory distress. Upon arriving at the emergency room, I was informed by my dispatcher that I would be transporting a critical patient from the emergency room to Children’s Hospital Emergency Room. Stat.
After I finished transferring my current patient’s care over to the staff, I went to the ER doc and nurse to receive my reports and orders for my critical patient. A 19 year old female had collapsed, in respiratory distress, while playing soccer, if my memory serves. She then went into respiratory arrest and bradycardia and was transported by a fellow crew. All of her treatments over the years and all of her primary doctors and surgeons were at Children’s. That was where she needed to be.
Her main medical history was dextrocardia. Dextrocardia comes in two forms. The first form presents with the heart on the opposite side of the chest, usually with no other side effects except that medical professionals have to reverse the ECG leads when obtaining an ECG. The second form is a bit more radical with all visceral organs reversed. My patient had the first form but with an added twist. As it was described to me by her parents, she was also born with her heart pumping blood in the opposite direction, from the left side of the heart to the right. She had undergone more than a dozen surgeries as a child to correct this, but ultimately she still had a heart that was effectively running in reverse, usually causing her to be chronically fatigued.
I went into the trauma room to observe my patient and to see what exactly I was dealing with. A pretty-as-a-flower young lady was laying on the gurney, sedated. I remember her parents being in the room, looking very worried. She was intubated and on a ventilator, and her heart was being paced by a transcutaneous pacemaker (the hospital version of our LifePak ECG Monitor/Defibrillator). She had several medications running, including a sedative (probably Propofol) and Levophed (a vasopressor medication that encourages the heart to be more active and pump more forcefully so as to increase blood pressure). I was also made aware that the staff had been slowly increasing the gain (milliamps) on the pacemaker to maintain heart capture. Plain and simple, this kid’s heart was failing. This transport wasn’t going to be an easy one.
I made all my preparations. Got all my medications switched over to our medication pumps, obtained my ventilator settings and prepared the ventilator. We moved our patient to our stretcher and switched to our ventilator. I synchronized our pacemaker with the hospital’s and made the switch. So far, so good.
“Fly like the wind” was the order from the doc and from me to my partner. Mom was accompanying us, secured in the passenger seat.
We hadn’t even made it all the way to I-94 before I was already increasing the gain on the pacemaker to keep her heart going. I kept Mom informed of what was happening, but to be assured that I wouldn’t give her daughter and her anything less than my very best.
By the time we were sprinting past St. John’s, the gain was maxxed out and I had already increased the Levophed to its maximum limit. My mind was racing, trying to think of anything else I could possibly do to help this beautiful kid with a whole life ahead of her. She made up my mind for me. She arrested. Too far to turn back to St. John’s, we narrowed our sights on Children’s and told my partner to pick it up, speed limiter be damned. I honestly don’t think my partner was ever doing less than 80 mph once we entered on to the freeway.
I started my CPR compressions and ventilations, and started dumping Epinephrine and Atropine into the IV. I remember telling her to keep going, even yelling at her to not give up. Anything to give her a chance. We rolled into Children’s ER and immediately into the Trauma Room to the awaiting trauma team. I stayed and helped until the last, CPR or ventilating or administering medications, whatever was needed. An hour and a half later, we finally stopped.
Afterwards, I went to the quiet room where her mother and father had been waiting to express my condolences. I finally broke down and cried. I had finally left everything on the table that day. Her parents were so grateful for what I did for their daughter and hugged me, trying to console me when I should have been the one consoling them.
It was a quiet trip back to the service area. I was truly exhausted, physically and mentally.
I went to the funeral home a few days later to pay my respects. It’s not something I usually do, but I do occasionally. I’ve found over the years that it helps lessen the burden on the soul and keeps my perspective in check. I found that, regardless of this young lady’s heart problem, she defied the odds, living life like a normal kid should, with an abundance of energy and optimism. She had many friends and family and it appeared to me that she never let something like a broken heart stop her from living every day to the fullest.
As I finished my drive home yesterday, thinking about all of this and through blurry eyes, “The Fire Down Below” by Bob Seger came on the radio. Coincidence? Probably, but maybe not. I realized that that young lady approached her life with a fire and a spirit that kept her going years after what many thought was possible. When she arrested, I felt like I claimed that fire, if only for a little while, so I could do what I needed to do. She deserved nothing less. I needed to give her nothing less than my best. I realize now that I also did it for myself. So I could go back the next day and the next day and every day. Just to give someone else that chance.
Okay, that’s enough for now. I’m an emotional wreck right now. God bless and Bring it!