Lucky to be alive

The highlight of my last shift was participating in the code of a young man who had been shot multiple times in the head and neck, with a couple stray shots to the shoulder and one to the hip. When we heard that he was coming in over the radio, and that CPR was "in progress" we knew that this could not go very well--at least for the patient. Its a constant conflict of interest in medical education: what is bad for the patient is good for training. I knew when I saw this guy that he was not going to live, but I didn't want to miss the opportunity to start a central line in a high-stress code. Getting to do "procedures" like chest tubes and lines is all about being aggressive. There is an art to this. Anticipating the need for vascular access in this case, I took the left side and pulled the mayo stand with the kit on it close to me, gown in hand. I had pre-positioned a medical student with a bottle of betadine and instructed her to pour it all over the patient at my signal. Before the words "let's get a line" had completely come out of the mouth of the code leader I responded "femoral or subclavian?" and had a gown on. Femoral--I gave the signal to the med student and she dumped the betadine as instructed. I've done enough femoral lines to be comfortable doing them, but the movement from the chest compressions made things more of a challenge. What's more, I felt the need to hurry not because the patient needed the line (we did have peripheral venous access), but because I knew that it was probably a matter of time before they called the code and we stopped our futile efforts. Sure enough, portable head films showed that the position of the bullets meant that they had taken a path incompatible with life. My line was already in and infusing. Interestingly, in my haste I had successfully canulated the vein but had put my line through the inguinal ligament. Hmmm, a bit high, but it worked. It didn't make a difference for the patient--but it was good training, and hence will someday make a difference for someone else.

Later that evening, or was it morning, I was thinking to myself as it quieted down: later we'll probably have someone else come in half dead or dying, we don't know who they are, they don't even know who they are. Maybe there're starting to drink now, having a good time, getting in the car, turning the key. They have no idea that in a few hours they'll be flat on their backs on a backboard in resusc 2 covered in blood and vomit, getting their clothes cut off of them and having fingers and tubes placed in every oriface. And I'll be having a medical student pour betadine on them, and they'll be lucky to be alive.