ICU for Hire
Friday, April 22nd, 2005Live from the ICU (which is the operative word for most of these
patients): We’re sitting around at this point, too early to sleep
because of midnight rounds coming up in a few minutes. My senior
resident gave us another great lecture this evening while we ate some
chow: I learned that some 2% of MI (myocardial infarctions, although
I think you know this) result in some 30% of all medical-legal
payouts–these are the MIs that are missed in the ER for all sorts of
reasons: normal EKGs, atypical presentation (no chest pain, but right
shoulder ache or other unusual complaints), or people under forty who
have no risk factors and are sent home because they couldn’t possibly
be having a heart attack. In any case, my only words of advice are to
seek medical attention if you ever experience random shoulder pain in
association with new onset of shortness of breath, uncontrollable
sweating, and odd feelings of badness. Tell them you want the full
workup.
It’s this sort of thinking that is both exciting (for hearing it and
understanding the implications) and morbid. But enough. . . I didn’t
go into medicine just to have something to talk (or write) about,
although it might certainly seem otherwise at times. Ok…one last
thing. My intern a short while ago brought me into one of the cardiac
units where she had been asked by one of the service physician
assistants to pronounce a patient. The PA’s aren’t legally allowed to
do it, so we grabbed our stethoscopes, a flashlight, and a modicum of
decorum before walking into a room with a still warm body and assessed
it for signs of life. Pupils were non-reactive to light. No pulses.
No heart or breath sounds for two minutes. Two EKG leads (out of
twelve) demonstrated asystole (flatline). That was it. We filed out
and filled out the paperwork regarding the official time of death.
The family walked by, and, of course, we didn’t know them at all–we
were just doing a professional courtesy for the cardiac service. ICU
for hire, if you will. . .
My residents have given me permission to head home tonight instead of
sleeping over, simply because it was mentioned in conversation that
today was Friday and I didn’t really even know or realize it. It’s
all good. I’ll head home to sleep uninterrupted for five hours and
get back here for 7 a.m.
In the meantime, all my chores continue to be postponed. I’ll get there.