Not Quite Like the Movies

We've all watched them...the so-called “medical dramas”...more drama than anything medically related. Accuracy is sacrificed for the sake of a good story line. I actually have a hard time watching most of these types of shows just because they are so off base from what actually happens. The majority of my days don't play out like TV shows but there are rare exceptions when things are so surreal, it feels like you are blasting through an unscripted movie scene. Here is my most recent one...

The page came out as heart problems. Dispatch went on to inform us that the “patient was coding”. My preceptor chuckled smugly. “I bet he is,” he said.
We are en route to the dialysis center which, ironically, is adjoining the hospital. Since the dialysis is a free standing operation and technically unaffiliated with the hospital, we are called upon to “transport” the patient to the ER. Strange but true.
We pull up right in front of the doors and are met by the captain of the fire crew that is also responding. He helps grab some of our gear and we deftly make our way inside. Within seconds, we find ourselves in the middle of the treatment area where several firefighters are indeed performing CPR on a middle-aged man. Several dialysis patients are staring at the scene wide-eyed and horrified. I glance around for a privacy curtain but there is none that will encompass the unfolding chaos. Much to my chagrin, the unfortunate patients in dialysis are forced to witness the entire ordeal.
The dialysis physician is hovering nearby and I quickly ask him for a report. He is minimal with information but I find out what I need to know and direct my attention back to the patient. A panicked nurse is feverishly attempting to ventilate the patient using a face mask. The look on her face is a mixture of terror and nausea.
I drop to my knees near the patient's feet while my partner attaches the cardiac monitor. I turn it on and watch anxiously as it boots up. We all stare briefly as we watch mis-shapen electrical signals march across the screen. The electrical activity of our patient's heart is insufficient to actually pump blood so we immediately jump back into giving chest compressions.
My preceptor moves to the patient's head and within moments inserts a breathing tube in our patient. I plug in a monitoring device and watch with relief as an ideal ventilation waveform crawls across the screen.
It is again time to check our patient's electrical activity so we pause our compressions and again fixate on what the monitor is showing. This time a chaotic zig-zag pattern dances across the screen...Ventricular Fibrillation. This time, we charge our monitor to shock our patient's heart. I know you've seen it in the movies and, yes, that is what it looks like in real life too. Once the shock is delivered, we get right back into chest compressions.
This pattern continues for several cycles. We check the monitor, deliver a shock, do CPR and give medications as needed. The decision is made to move our patient onto a gurney and get him up to the ER. As we wheel him past the other dialysis patients and through the waiting room, several people gasp or sign the cross over their chest. From out of nowhere, a security officer appears and states he has an elevator holding for us. He leads the way, shouting to unwary bystanders to get out of the way as we push past. My preceptor climbs onto the gurney to continue chest compressions while we race down the hallway toward the ER.
I have trekked the halls of our hospital many times but they never have seemed so long as they did on that day. Although everything seems different while you are running backwards counting off 6-second intervals to breathe for your patient.
After what seems like an eternity, we are in the elevator. As the doors slide shut, we pause again to see what our monitor is showing. We again have to shock our patient. So there, in the tiny confines of the elevator, seven of us sandwiched together over our patient, we defibrillate him once more.
The doors open and the mad dash to the ER resumes. Although the distance was longer, this trek takes seemingly less time than our previous race down the hallway...possibly because there are far less bystanders.
Once in the ER, our patiently is quickly lifted from our gurney and placed in a hospital bed. A code team is anxiously waiting and as soon as our hands are off of him, twenty people swarm in to take over. I move to the back corner of the room to watch briefly. After a short while, I grow restless and wander off to review things with my preceptor.
In spite of the chaos that was the call, he has relatively little criticism. I am relieved. Once we have finished, I return to my patient's room, hoping to find that he has started breathing again and his heart is once more pumping blood on its own. Instead of the frenzy that I walked away from just a short while before, I find the room silent and deserted...all except a still form covered in white sheet in the middle of the bed.
No movie or TV show can prepare you for that moment...the moment when you realize that, in spite of your best efforts, that man won't go home to his family or see his loved ones again. I somberly make my way to the ambulance to put it back in order for the next call.
Life (and death) are not like the movies. And although my job is riddled with moments of cinema-worthy drama, the realities that I face at the end of the day are far from anything that can be captured by even the best of acting skills or script writing. It is part of the reason I do what I do. It's not always easy but it certainly is an experience unmatched by anything else.