TALES FROM THE MICU: Miracle Kid
TALES OF THE MEDICAL INTENSIVE CARE UNIT
INTRO
Let me start with a brief intro into the way we do things in the ICU. As a sub-intern, I basically function as an intern with less patients (or in my case, the same amount, lol) and we have to be in at about 6:30AM to see them in the morning, chat with the nurses about anything that happened overnight, and write our medical progress notes (basically, a brief update on the patient, their meds, and the plan for their admission/discharge). We start rounding at about 8AM, which means an attending (or senior physician) meets with us to discuss the patients. We do this near every patient’s room and the nurses join us. This can last hours and we usually finish at noontime. Then us baby docs go for lecture with lunch provided, come back and follow up on our patients and proceed with the plan as discussed during rounds. If you’re on call, you stay in the hospital and admit new patients into the ICU while taking care of your own. You also respond to all codes, but I’ll get into the details of codes in a later post.
And now for…
MIRACLE KID
My first week on the ICU was madness. Not only had I not seen a patient since September, I was super rusty on my medical knowledge. I swear, if you don’t use it, you lose it, and I think that applies to life in general. But I quickly got the hang of things and got back into gear.
There was a particular patient we discussed on rounds during my first day that totally intrigued me, so even though I wasn’t his “assigned intern”, I followed him during the course of his stay. Let’s call him Mark for the sake of HIPAA. Mark is a twenty-year-old (I repeat, TWENTY) Hispanic male who had suffered a massive heart attack. From the story I gathered during rounds, he had partied the night before, drunk a ton of booze, and experimented a little with ecstasy. He felt fine enough the next day to go to work doing manual labor with his dad. He came home and began to clean his car while a few of his buddies were in the garage. Part of the way through cleaning, he suddenly felt like he couldn’t breath and he had this terrible pain in his chest. He came out of the car gasping and clutching his chest, and his buddies rushed towards him, firing him with questions. He couldn’t seem to get a word in before he collapsed to the ground unconscious, and his buddies called 911.
When the paramedics arrived, they intubated him in the field (placed a breathing tube down his throat), gave him shots of epinephrine (or adrenaline), and started CPR. After twenty minutes (I repeat, TWENTY), they managed to get his heart restarted and rushed him to the hospital. In the hospital, the ED team continued to stabilize him until they could get him to the ICU. He was still unresponsive and in a comatose state when he arrived. Once he was admitted, we started hypothermia protocol, which is actually very fascinating.
Hypothermia protocol is initiated when a person has compromised blood flow to their brain, i.e. during a massive heart attack where it took a long time to resuscitate the patient, like in Mark’s case. What we do in the ICU is drop their body temperature to 90-93 degrees F or 32-34 degrees C (normal human body temp is 98.6 degrees F or 37 degrees C) by either invasive means (inserting a catheter through their femoral vein and pumping them with cold saline) or by wrapping them in a body suit filled with ice cold water (that is constantly circulated through a machine). For Mark, we did the latter, since it has less complications than the former.
So why do we do this? Because when you lose circulation to your brain (even briefly) serious brain damage can ensue. Dropping someone’s body temperature slows the brain’s metabolic processes and prevents the inflammation that can occur when your gray matter starts to die. Also, hypothermia decreases your brain’s need for oxygen (which is supplied by your circulation, of course). This is a form of “neuroprotection” and it is actually a fairly new form of treatment. When I first learned about this, all I could think of was Walt Disney and his supposed icy grave and it made me grin. I actually use forms of this concept in my current WIP A Beautiful Lie, since my protagonist has the ability to manipulate water and freeze it.
Okay, so back to the story. I visited Mark the next day to find his room full of weeping family members. He had dozens, and I mean dozens of people visiting him throughout his stay. At one point, there were fifty people there to see him, so it was obvious he was well loved (not that the amount of people who visit you on your deathbed is a good estimate of the kind of person you are…it isn’t).
ANYWAY, when I first walked into his room, his family bombarded me with questions. I did my best to answer them (since I hadn’t even seen him yet!) and the major question at that time was why he was shivering so much. When I finally got to Mark, he was laying there, wrapped in this white body suit, shivering violently. He even had a mouth guard to keep his teeth from cracking. You will start to shiver once your body temperature drops below 97 degrees F or 36 degrees C. He was hovering at 92. There are medications to decrease this or even prevent it, but they weren’t working too well on Mark. This was very scary for his family to see since they didn’t understand what was happening. I explained the hypothermia protocol to them and many of them started to cry again-I did my best to comfort them and ease their fears. I think everyone was just so overwhelmed (even me!) and having someone explain Mark’s treatment seemed to provide at least some relief.
One person who had never left Mark’s side was his mother. I was on call one night and came by to see him when the room was finally empty. She sat in a corner quietly, staring out the window at the night sky, tears rolling down her face. The cardiac monitor beeped on and the ventilator continued to whoosh in the silence between us. She spared me a brief glance and smiled sadly before staring out the window again, her thoughts obviously in turmoil. I looked down at Mark and noticed an old bible lying on his pillow beside his head and a wooden rosary curled up on his chest, right over his heart. His skin was freezing and he was still shivering pretty hard, but it had improved from the last time I’d seen him. He had a praying hands tattoo on his upper right pec that I hadn’t noticed since it was usually covered. My eyes were drawn to it and I just stared at it for a while.
His mother then suddenly asked me, “Why would God do this to my son?”
I didn’t know what to say. I’ve never been a religious person, and although I’m a former Catholic, I stopped believing in “God” a long time ago. I’m agnostic-I’d like to believe there’s something out there-but I don’t believe in the God she believes in. My cynical self would say, “God does plenty of bad things,” but I didn’t dare say anything like that out of respect for her and her beliefs.
So, all I said was, “We’re all put through challenges and hard times. Maybe this is Mark’s greatest challenge and he must fight through it.”
She just nodded and kept crying, satisfied with that. I wanted to say or do something else to reassure her, but I was at a loss and just left. Sometimes people need time to process things and I think she needed to be alone with her son for a while.
Two days later (my day off was the next day), I dragged my ass into the hospital since I’d come in from NY late the night before. I checked up on all my patients and then ventured over to Mark’s room, and what I saw made me stop halfway across the unit. My breath escaped me like I’d been sucker punched in the gut.
Mark was out of bed and sitting in a chair by the window, bathed in sunlight. He was in a johnny, no longer wrapped in the body suit, and he was smiling and laughing at his mother. She too was laughing, with tears still in her eyes, but they were now tears of joy.
WHOA.
The expression on my face must’ve been priceless. Apparently, after I’d left for the night, Mark woke up and started breathing on his own. They extubated him (removed the breathing tube) and started the process of bringing his body temperature back up to normal (which is the riskiest part of the protocol and takes over 24 hours). He tolerated everything really well and was virtually back to his normal self, plus some minor heart dysfunction and short-term memory loss (which both should improve over time).
Guys, I was floored! I said hello, introduced myself, and spoke to him for a while. The last thing he remembered was cleaning his car and that was it. He didn’t remember passing out or any of the last five days in the hospital. I explained what had happened to him during his stay and he just listened intently and nodded. He asked if this could ever happen to him again and I told him possibly. We still weren’t sure what had caused his heart attack in the first place (whether it was the ecstasy, a possible genetic defect or congenital heart abnormality, an acute arrhythmia (or erratic heart beat), or just some freak occurrence) and that he needed close follow-up with a cardiologist to work him up more thoroughly. He agreed and told me he was just glad to be alive.
His mom pulled me aside later and said, “Looks like my son beat his challenge,” with a deliriously happy smile on her face.
I just grinned back at her and said, “Looks like he did.”
On the next episode of TALES FROM THE MICU…
SMOKE AND BOOZE: They feel so good but are so bad. Two stories about a long time smoker with severe emphysema and a chronic alcoholic with multi-organ failure and how one received a second chance at changing her ways while the other died a horrible death.
P.S. I would love any feedback on this! Please let me know if you found this interesting and if you want me to keep going with these posts. Thank you for reading and I hope you enjoyed it! :D
This entry was originally posted at http://intothenight.dreamwidth.org/13293.html but comment wherever you'd like!
INTRO
Let me start with a brief intro into the way we do things in the ICU. As a sub-intern, I basically function as an intern with less patients (or in my case, the same amount, lol) and we have to be in at about 6:30AM to see them in the morning, chat with the nurses about anything that happened overnight, and write our medical progress notes (basically, a brief update on the patient, their meds, and the plan for their admission/discharge). We start rounding at about 8AM, which means an attending (or senior physician) meets with us to discuss the patients. We do this near every patient’s room and the nurses join us. This can last hours and we usually finish at noontime. Then us baby docs go for lecture with lunch provided, come back and follow up on our patients and proceed with the plan as discussed during rounds. If you’re on call, you stay in the hospital and admit new patients into the ICU while taking care of your own. You also respond to all codes, but I’ll get into the details of codes in a later post.
And now for…
MIRACLE KID
My first week on the ICU was madness. Not only had I not seen a patient since September, I was super rusty on my medical knowledge. I swear, if you don’t use it, you lose it, and I think that applies to life in general. But I quickly got the hang of things and got back into gear.
There was a particular patient we discussed on rounds during my first day that totally intrigued me, so even though I wasn’t his “assigned intern”, I followed him during the course of his stay. Let’s call him Mark for the sake of HIPAA. Mark is a twenty-year-old (I repeat, TWENTY) Hispanic male who had suffered a massive heart attack. From the story I gathered during rounds, he had partied the night before, drunk a ton of booze, and experimented a little with ecstasy. He felt fine enough the next day to go to work doing manual labor with his dad. He came home and began to clean his car while a few of his buddies were in the garage. Part of the way through cleaning, he suddenly felt like he couldn’t breath and he had this terrible pain in his chest. He came out of the car gasping and clutching his chest, and his buddies rushed towards him, firing him with questions. He couldn’t seem to get a word in before he collapsed to the ground unconscious, and his buddies called 911.
When the paramedics arrived, they intubated him in the field (placed a breathing tube down his throat), gave him shots of epinephrine (or adrenaline), and started CPR. After twenty minutes (I repeat, TWENTY), they managed to get his heart restarted and rushed him to the hospital. In the hospital, the ED team continued to stabilize him until they could get him to the ICU. He was still unresponsive and in a comatose state when he arrived. Once he was admitted, we started hypothermia protocol, which is actually very fascinating.
Hypothermia protocol is initiated when a person has compromised blood flow to their brain, i.e. during a massive heart attack where it took a long time to resuscitate the patient, like in Mark’s case. What we do in the ICU is drop their body temperature to 90-93 degrees F or 32-34 degrees C (normal human body temp is 98.6 degrees F or 37 degrees C) by either invasive means (inserting a catheter through their femoral vein and pumping them with cold saline) or by wrapping them in a body suit filled with ice cold water (that is constantly circulated through a machine). For Mark, we did the latter, since it has less complications than the former.
So why do we do this? Because when you lose circulation to your brain (even briefly) serious brain damage can ensue. Dropping someone’s body temperature slows the brain’s metabolic processes and prevents the inflammation that can occur when your gray matter starts to die. Also, hypothermia decreases your brain’s need for oxygen (which is supplied by your circulation, of course). This is a form of “neuroprotection” and it is actually a fairly new form of treatment. When I first learned about this, all I could think of was Walt Disney and his supposed icy grave and it made me grin. I actually use forms of this concept in my current WIP A Beautiful Lie, since my protagonist has the ability to manipulate water and freeze it.
Okay, so back to the story. I visited Mark the next day to find his room full of weeping family members. He had dozens, and I mean dozens of people visiting him throughout his stay. At one point, there were fifty people there to see him, so it was obvious he was well loved (not that the amount of people who visit you on your deathbed is a good estimate of the kind of person you are…it isn’t).
ANYWAY, when I first walked into his room, his family bombarded me with questions. I did my best to answer them (since I hadn’t even seen him yet!) and the major question at that time was why he was shivering so much. When I finally got to Mark, he was laying there, wrapped in this white body suit, shivering violently. He even had a mouth guard to keep his teeth from cracking. You will start to shiver once your body temperature drops below 97 degrees F or 36 degrees C. He was hovering at 92. There are medications to decrease this or even prevent it, but they weren’t working too well on Mark. This was very scary for his family to see since they didn’t understand what was happening. I explained the hypothermia protocol to them and many of them started to cry again-I did my best to comfort them and ease their fears. I think everyone was just so overwhelmed (even me!) and having someone explain Mark’s treatment seemed to provide at least some relief.
One person who had never left Mark’s side was his mother. I was on call one night and came by to see him when the room was finally empty. She sat in a corner quietly, staring out the window at the night sky, tears rolling down her face. The cardiac monitor beeped on and the ventilator continued to whoosh in the silence between us. She spared me a brief glance and smiled sadly before staring out the window again, her thoughts obviously in turmoil. I looked down at Mark and noticed an old bible lying on his pillow beside his head and a wooden rosary curled up on his chest, right over his heart. His skin was freezing and he was still shivering pretty hard, but it had improved from the last time I’d seen him. He had a praying hands tattoo on his upper right pec that I hadn’t noticed since it was usually covered. My eyes were drawn to it and I just stared at it for a while.
His mother then suddenly asked me, “Why would God do this to my son?”
I didn’t know what to say. I’ve never been a religious person, and although I’m a former Catholic, I stopped believing in “God” a long time ago. I’m agnostic-I’d like to believe there’s something out there-but I don’t believe in the God she believes in. My cynical self would say, “God does plenty of bad things,” but I didn’t dare say anything like that out of respect for her and her beliefs.
So, all I said was, “We’re all put through challenges and hard times. Maybe this is Mark’s greatest challenge and he must fight through it.”
She just nodded and kept crying, satisfied with that. I wanted to say or do something else to reassure her, but I was at a loss and just left. Sometimes people need time to process things and I think she needed to be alone with her son for a while.
Two days later (my day off was the next day), I dragged my ass into the hospital since I’d come in from NY late the night before. I checked up on all my patients and then ventured over to Mark’s room, and what I saw made me stop halfway across the unit. My breath escaped me like I’d been sucker punched in the gut.
Mark was out of bed and sitting in a chair by the window, bathed in sunlight. He was in a johnny, no longer wrapped in the body suit, and he was smiling and laughing at his mother. She too was laughing, with tears still in her eyes, but they were now tears of joy.
WHOA.
The expression on my face must’ve been priceless. Apparently, after I’d left for the night, Mark woke up and started breathing on his own. They extubated him (removed the breathing tube) and started the process of bringing his body temperature back up to normal (which is the riskiest part of the protocol and takes over 24 hours). He tolerated everything really well and was virtually back to his normal self, plus some minor heart dysfunction and short-term memory loss (which both should improve over time).
Guys, I was floored! I said hello, introduced myself, and spoke to him for a while. The last thing he remembered was cleaning his car and that was it. He didn’t remember passing out or any of the last five days in the hospital. I explained what had happened to him during his stay and he just listened intently and nodded. He asked if this could ever happen to him again and I told him possibly. We still weren’t sure what had caused his heart attack in the first place (whether it was the ecstasy, a possible genetic defect or congenital heart abnormality, an acute arrhythmia (or erratic heart beat), or just some freak occurrence) and that he needed close follow-up with a cardiologist to work him up more thoroughly. He agreed and told me he was just glad to be alive.
His mom pulled me aside later and said, “Looks like my son beat his challenge,” with a deliriously happy smile on her face.
I just grinned back at her and said, “Looks like he did.”
On the next episode of TALES FROM THE MICU…
SMOKE AND BOOZE: They feel so good but are so bad. Two stories about a long time smoker with severe emphysema and a chronic alcoholic with multi-organ failure and how one received a second chance at changing her ways while the other died a horrible death.
P.S. I would love any feedback on this! Please let me know if you found this interesting and if you want me to keep going with these posts. Thank you for reading and I hope you enjoyed it! :D
This entry was originally posted at http://intothenight.dreamwidth.org/13293.html but comment wherever you'd like!