Two thoughts for the day

Thought 1: New Yorkers are surprisingly patient.
There are normally four large elevators that carry passengers up from the subway far below ground at the hospital’s stop, though today there were only two functioning. When I came in at 0900 this morning (after being at the hospital late last night on “short call”), there were hundreds of people waiting in the narrow hallway and the underground bridge over the tracks, just waiting for an elevator. For such a fast-paced city filled with power-walkers in business suits and streets made cacophonous by blaring horns, the faces I saw in the crowd were strikingly pleasant and patient. There was no pushing, no rude comments, no rolling of the eyes. People seemed to quickly assess and accept the situation, and then patiently wait their turn for the large metal freightlike elevators.

Thought 2: I saved someone’s life today.
Since I was assigned to come in late (0900) today, my task was to write post-anesthesia notes on yesterday’s patients and to respond to cardiac arrests and stat intubation requests. We went all day without a single peep from the arrest pager until about 2:45. The first year anesthesia resident had just beat me to the medical ICU, and we quickly assessed the patient. 60 year old with pancreatitis and worsening respiratory distress. No significant cardiac history. High potassium. Although his blood gases, when last checked, were okay, at a glance I could tell that he was quickly heading to decompensation.

I’d been to many “stat intubations” last year, but this was my first time to be a senior resident and to direct my new anesthesia colleague! We gathered our equipment: larnygoscopes, breathing tubes, oral airways, CO2 detector, and arranged for a free-flowing IV and suction. After applying monitors (there were none when we first arrived since the patient had just been transferred from the floor!) and preoxygenating, I gave repeated doses of propofol until the patient was adequately relaxed with intermittent doses of phenylephrine. I wanted to get the patient deep enough so we could intubate without paralyzing him, since his high potassium meant we couldn’t use the very short-acting drug succinylcholine.

This we were able to do. The first-year resident took a look with the laryngoscope while I applied cricoid pressure. I could feel the tube slide through the larynx, and we quickly inflated the cuff and checked for CO2 return and breath sounds as we squeezed the bag. Success!

This was followed by the anticlimactic job of some rather vague and broadly-brushed charting. “Good job!” I told Lynn as we headed back for the security, order, and comfort of the anesthesia lounge. And then I realized that not only was it exciting to be the senior and directing the emergency proceedings, we just potentially saved this man’s life as part of our day’s work! I’d say it was a good day.

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