Hot potato

There’s a certain kind of patient in the ICU who crashes early and hard, who comes in from the medical floor, nursing home, or community clinging to life by the frailest of threads, and who only through aggressive resuscitation is kept alive. These patients are so sick that there is no hope of meaningful recovery. They are doomed from the outset; critical care interventions have been initiated too late to have a chance of reversing the process already set in motion.

When you have one (or more) of these patients, and you are one of four residents rotating and trading call and code responsibilities, the patients represent a constant source of anxiety. If the family is understanding, and the patient is made Do Not Resuscitate for the inevitable cardiac arrest, the situation is defused. If not, passing the patient becomes a frenetic game of hot potato. As laboratory markers and vital signs tell you that the game is nearing an end, each pass of the code pager grows more desperate, as each resident frantically tries to temporize the patient just long enough so that the whistle doesn’t blow on his watch, so that his hands will not be the ones to futilely pump and crack that stiff chest.

posted by Wyatt @ 2:52 AM Comments: 0