- Joined
- Apr 11, 2005
- Messages
- 2,723
The nurse told me his glucose was 17 that morning, and they were ranting about a finger stick level of 0, so I went to make sure he wasn't in a coma. He was just laying there in bed like always. I asked how he was doing this morning just like the last 2 days. He looked at me and shouted, "PERFECT! GET ME UP!" Now low glucose will do this to you. Make you agitated and almost with it but not quite there. I need to check three things for someone with a low blood sugar. First, their mental status. If it was 17 he'd be nearly dead. You check their pulses. His were normal, not high, not bounding. You recheck their sugars while hanging dextrose and demanding that they drink orange juice laced with sugar.
"DAMNIT THIS STUFF TASTES LIKE ORANGE JUICE! SIT ME UP!"
His wife just looked at me, shook her head and kindof half-smiled. There's no freaking way his glucose is 17, I thought as I listened to his potbelly to finish up the exam.
Then he threw up. Dark brown liquid. Seen it before. Cirrhotics tend do that. They swallow blood that bled from their esophagus, and it comes out black from one of two holes. Got the pan and the intern to get the scope ready to diagnose esophageal varices. Again, no big deal. We find em, we band em they stop bleeding. No big deal. His wife doesn't like this, she starts crying. I give a hug. It's no big deal to me, but I can see why she could be freaked out by a little black puke.
Then he shook a little, and it started coming out his nose. Okay, that's an escalation I say to myself, but I've thrown up out my nose many times. Just to be sure, I put my finger on his radial artery while trying to get his attention. Okay, so I'm bad at finding pulses. I can't feel one and he's just tired. I try again, I get no pulse.
Now I have to either mention that I THINK he has no pulse in front of his wife and get it wrong, or mention that he has no pulse and start the OHSHIT code. Either way, this is going to suck because sooner or later someone other than me is going to realize that he's in ****ing asystole.
So he crashes right then and there in front of his wife, the intern and me with all the rights and privileges thereunto reserved. He sucks that dark brown **** into his lungs. We remove that and breathe for him with a bag. He was dead for 8 minutes. I'm sure I broke one of his ribs, but he got a pulse back in return. He goes to the ICU where eventually there's nothing we can do for him.
He was next in line to get a new liver. The only thing that would make him better was a new liver. He didn't get one in time. Now he's basically in a coma, drifting further and further down the transplant list. By tomorrow he'll no longer be a candidate for transplantation because there's no way he could survive the single biggest surgery in the world. It's way too late.
We tell the family that we got his heart to beat again but that he was in a coma. That he would not be getting a liver. That we don't know how long we can keep his blood pressure stable. His sister asks me if she can give him her kidney. "No, ma'am, he needs a liver" is all I can say. His wife adds that the sister has a bad liver anyway and that no one would want it. She gets it. She understands everything we're saying. She was there when he died the first time, she knows. We continue the family meeting. This is getting sadder and sadder the more family members finally get the picture that we were probably a day or two too late. The wife's cell phone rings.
We Wish You a Merry Christmas was the ringtone. It had 2 minutes of talk time left. She explained the situation to whoever called better than I could have, then hung up. We continued. Phone rang again, same ring, but this time her phone dispassionately quit when it was told to. I handed her my cell immediately. She declined. I about lost it.
Be dentists.
"DAMNIT THIS STUFF TASTES LIKE ORANGE JUICE! SIT ME UP!"
His wife just looked at me, shook her head and kindof half-smiled. There's no freaking way his glucose is 17, I thought as I listened to his potbelly to finish up the exam.
Then he threw up. Dark brown liquid. Seen it before. Cirrhotics tend do that. They swallow blood that bled from their esophagus, and it comes out black from one of two holes. Got the pan and the intern to get the scope ready to diagnose esophageal varices. Again, no big deal. We find em, we band em they stop bleeding. No big deal. His wife doesn't like this, she starts crying. I give a hug. It's no big deal to me, but I can see why she could be freaked out by a little black puke.
Then he shook a little, and it started coming out his nose. Okay, that's an escalation I say to myself, but I've thrown up out my nose many times. Just to be sure, I put my finger on his radial artery while trying to get his attention. Okay, so I'm bad at finding pulses. I can't feel one and he's just tired. I try again, I get no pulse.
Now I have to either mention that I THINK he has no pulse in front of his wife and get it wrong, or mention that he has no pulse and start the OHSHIT code. Either way, this is going to suck because sooner or later someone other than me is going to realize that he's in ****ing asystole.
So he crashes right then and there in front of his wife, the intern and me with all the rights and privileges thereunto reserved. He sucks that dark brown **** into his lungs. We remove that and breathe for him with a bag. He was dead for 8 minutes. I'm sure I broke one of his ribs, but he got a pulse back in return. He goes to the ICU where eventually there's nothing we can do for him.
He was next in line to get a new liver. The only thing that would make him better was a new liver. He didn't get one in time. Now he's basically in a coma, drifting further and further down the transplant list. By tomorrow he'll no longer be a candidate for transplantation because there's no way he could survive the single biggest surgery in the world. It's way too late.
We tell the family that we got his heart to beat again but that he was in a coma. That he would not be getting a liver. That we don't know how long we can keep his blood pressure stable. His sister asks me if she can give him her kidney. "No, ma'am, he needs a liver" is all I can say. His wife adds that the sister has a bad liver anyway and that no one would want it. She gets it. She understands everything we're saying. She was there when he died the first time, she knows. We continue the family meeting. This is getting sadder and sadder the more family members finally get the picture that we were probably a day or two too late. The wife's cell phone rings.
We Wish You a Merry Christmas was the ringtone. It had 2 minutes of talk time left. She explained the situation to whoever called better than I could have, then hung up. We continued. Phone rang again, same ring, but this time her phone dispassionately quit when it was told to. I handed her my cell immediately. She declined. I about lost it.
Be dentists.
