Saturday, September 9, 2000:
Bathroom Reading: The Pen
& Ink Book
Current Comic Book: Strain by Ryoichi Ikegami
Wishing: I knew HTML a bit better.
Watching: SNL
HI
Welcome to the first entry in my second attempt at an online journal. I'm horrible with introductions (and goodbyes) so bear with me. I'm back because this sort of thing is kind of fun, and addicting even, and I do miss that special contact you get with people over the ether when you post your soul online.
Update: Amy and I are quite happily married still. We've restarted our search for our first house. We never got another cat. Maybe we will with the new house. Oh, and ... The LIGER! is sleeping by the window. Not much has changed since February.
For those who knew my previous E-ncarnation, this site will be both the same and different, in the same ways that I am the same and different from the person I was at that time and place.
Obvious differences are
1) the lack of
RED CENTERED TEXT,
2) the intricate dragon-lady tattoos I've gotten over every concealable inch of my body,
3) and NO hair gel.
I've caved in to all the Font Nazis, and you know who you are. I'll suppress my passive-aggressive non-conformity in this one aspect, and lash out with it in other ways to be determined. Further changes will come when the whim changes.
As for the tattoos ... anyone know the number of a good derm abrasionist?
Give me a chance to get used to writing again, since the bathwater is a little redder than I remembered. In the mean time, I'll try not to be too pompous, dull, melodramatic, macabre, self-inflating, or funny when I have nothing funny to say.
Too late.
THE INEVITABILITY INDEX
It's around 17 after last month, give or take a corpse or two. There have only been 4 or 5 deaths with my name as the Primary Attending since I quit writing the journal. Mostly because I've been on consult services or Backup Service and my name doesn't go on those charts as the Primary Attending. (Not because I haven't been jotting down notes while my patients were crashing.)
17 (... +/-2).
THE TROUBLE WITH RINGS
BEEPBEEPBEEP.
GOLDENAGE: "Hey Scott, we got hit with quite a few new patients last night. Thought I'd let you choose one."
(I successfully prevent my dread from coming through the phone, and respond in a cheerily masochistic tone.)
ME: "Sounds great, what have you got?"
GOLDENAGE: "Well, one's a 45 year old with a DVT (deep venous thrombosis, or clot) in her leg ... and the other is an 87 year old who CPR'd twice in the field, pretty much brain dead now. The family's already made her NO CODE and no further tests or meds. They're waiting for the son before they disconnect everything."
(Both cases are relatively low work load. The 45 year old requires anticoagulation meds and some studies but otherwise those younger cases go fairly smoothly.
The 87 year old is an easy case in her own way since there's nothing for me to do, other than talk to the family and show up to the extubation, and subsequent expiration.)
ME: "Huh. Tough choice."
(Plus, the 87 year old brain-dead patient is in the MICU and Amy is working there today, so I'm inclined to take that patient. She's a ... ahem ... No-Brainer.)
GOLDENAGE: "Well, since you're going to be here this weekend anyways, the 87 year old will be good since the funeral home can come by tomorrow (Saturday) to have you sign the expiration papers. What do you think?"
(Author note: The 87 year old isn't dead yet.)
ME: "Sounds convenient. I'll take her."
(But we both know she soon will be.)
GOLDENAGE: "Thanks. You should probably see her earlier if you can ...."
(Like before she dies, he means.)
ME: "Yeah, thanks."
And I skip off to see the No-Brainer.
By pleasant coincidence, Amy is her nurse today. The assignment board says "Husband" and "Wife" under the "Doctor" and "Nurse" columns, referring to Amy and myself. One of the nurses always finds that amusing enough to write. I read the chart, then talk to the daughter who flew in last night. Her suitcase is still outside the glass and metal ICU door.
DAUGHTER: "I heard there was blood around her mouth and in her pants. She has no medical problems. What could have caused this?"
I tell her there are lots of things, possibly a ruptured artery from a stomach ulcer, maybe a cancer that finally eroded a vessel somewhere. Only an autopsy will tell us for sure. If the patient dies less than 24 hours from admission, then an autopsy is mandatory policy here. I tell her this but it doesn't seem to register. She still weighs the pros and cons of autopsy. I let her have that sense of control.
DAUGHTER: "Is she dead already?"
(Yes.)
ME: "Well, I wouldn't say that, but once we disconnect the vasopressors and the respirator, I think she will probably go pretty quick."
DAUGHTER: "But she just had a complete physical last year."
(Oh great. Here we go again. Blame the outside doctor. An easy game with no rules. The worse I make the other doctor look, the better I make myself look. It's an unfair game which I don't engage in though. The physical exam is better than nothing; sometimes it can pick up early warning signs, but sometimes not.)
ME: "A lot of cancers can't be detected until it's too late. Some people don't even know they have it until it's fairly large or widespread."
The daughter is a quite pleasant, even charming 50-something. She remains surprisingly jovial, as she explains,
"I'm all cried out."
The son (and power of attorney) finally arrives, right on cue. He looks more his age (50s), with white hair, and flushed red skin, eyes are just beginning to get moist, as he runs in and says, "Momma!"
His sister consoles him and another middle-aged man breaks down in front of me. I leave.
Later, the MICU senior resident, Dr. Toreador, pages me.
TOREADOR: "Hiya Scott, family is ready."
ME: "Okay, I'll be up in two minutes."
(Dr. Toreador is post-call, finishing up 33 stressful no-sleep hours, and probably dead tired. The sooner I get there, the sooner we can extubate Mrs. No-Brainer, the sooner he can go home and just sleep. Yet he still says ...)
TOREADOR: "Take your time."
I don't miss the good old days.
Five minutes later, we're in the room. The daughter is asking Amy if she can remove the wedding band off of Mrs. No-Brainer's hand (she's a widow).
AMY: "Sure, let me get some soap. The respiratory therapist is here so we'll have to ask you to leave. We'll call you when she's disconnected."
Believe me, it's better this way.
The ring isn't coming off. Mrs. No-Brainer's fingers are already far too swollen. Amy tugs and tugs.
AMY: "She must have been already too swollen in the ER. They usually take all the jewelry off before they get here."
ME: "They'll get it off on the autopsy table, one way or another."
They send a special device up from the ER made for such occasions. It’s the ring cutter. It works like a can-opener and slowly cuts through the band of just about any ring. It works this time. For once, Amy understands why I am constantly fidgeting with my wedding band at home. All rings feel too tight on me.
The respiratory therapist suctions the patient and thick brown coagulant gets vacuumed. Dr. Toreador shuts off all the I.V.s himself while the therapist pulls the tube out of her throat. Obviously, Mrs. No-Brainer doesn't seem to notice.
Some deaths are more disgusting than others, and after you've seen a few, the fascination and curiosity dies also. Hence, that's when I notice the TV in her room.
Donnie and Marie's show is on, with some attractive singer guest. She sings beautifully but I can't hear a note because the volume is down. I try not to look for too long.
I turn toward Mrs. No-Brainer. She looks like she's melting, literally. Her chubby wrinkled face deflates into her neck.
ME: "I think she's sliding down the bed. Lower the angle."
Clear yellow secretions pulsate out of her mouth.
AMY: "What the -- ?"
Amy moves her on the bed and we both distinctly see her right arm reach up. Amy's bright eyes are filled with dark surprise as she looks at me. Dr. Toreador is silent.
ME: "Maybe she's stiffening up."
Amy pushes her right arm down and the left one slowly pops up, as do both of Amy's eyebrows.
ME: "It's reflex. Let her arms fall naturally. We can't have her moving around when the family comes in. They'll think she's waking up or something. It's just the final reflexes."
TOREADOR: "Should we give her some morphine? I'll push it."
It's a tough call. She's already brain-dead, and the family will be freaked if she starts showing bizarre reflex activity. But even so I don't feel comfortable with hastening things at this point. Amy feels the same.
AMY: "I don't think she's in any pain to require morphine."
ME: "Yeah. Hold off on the morphine for now."
Amy suctions the last of the yellow secretions from Mrs. No-Brainer's mouth. Her arms finally rest at her side and we prop her head up. Those primal reflexes promise nothing but false hope.
The singer on the screen above us is really straining, veins in her lithe neck show, as she belts out the last words of her pop song. The makeup and lighting make her look every bit like an angel on TV, which means she could very well be a whore. Honestly, it matters not to me or Mrs. No-Brainer though.
We let the family in.
It takes about eight minutes for her heart rate to go from 90 to zero. That's pretty fast. Sometimes it takes a couple days … that’s worse than death itself for the family. It just goes to show how you can keep a heart beating without a mind or soul to accompany it. It’s false hope on an artificial level.
The family agrees to the autopsy, not quite realizing they never had a choice (the Less Than 24-hours Rule).
I leave wondering if I’ll get my own televised angel singing to me in my last hour. I slide my ring off and on again.
( ... Hmmm. Sounds like a lot of other past entries, I know. They all do. Believe me.)
At least tomorrow is another day.
Autopsy day.
Is the font too big? Any comments are appreciated.
NOTE: That singer on Donnie and Marie was Lara Fabian, I learned later.
