7. Rohit
“ R APID RESPONSE TEAM TO 10 EAST STAT. RAPID RESPONSE TEAM TO 10 EAST STAT.”
I jerk my head up at the sound of the overhead announcement. Quickly logging off my screen, I make eye contact with Rachel, one of the other nurses. She gives me a quick nod and I know she understands. She will cover my patient so I can go to the rapid response.
Today, I have only one patient in the ICU so that I can serve as the rapid response nurse. In that capacity, I attend all the rapid responses along with the ICU fellow and the on-call medical residents to attend to whatever urgent issue is transpiring. It could be that someone with a respiratory illness is decompensating and needs to be put on a ventilator, or someone with an infection is getting worse and is in septic shock, or any of a litany of other issues. Whatever it is, it needs to be handled as fast as possible and often ends up with the patient in the ICU.
Med bag in hand, I race down the two flights of stairs. When I get to the tenth floor, the unit clerk shouts to me, “1035, on the right!” I nod and proceed directly there. I freeze for a split second in the doorway at the sight. A young man is sitting up, gasping for air, holding a paper towel stained with blood in front of his mouth. I quickly shake myself and enter the room.
The medical resident on call takes command.
“Call anesthesia STAT,” he instructs the floor nurse. He turns to me. “22-year-old male, Goodpasture syndrome. Full Code. Probably alveolar hemorrhage. Needs airway protection.”
As the message is quickly relayed, it comes over the hospital loudspeaker.
“ANESTHESIA STAT TO 10 EAST. ANESTHESIA STAT TO 10 EAST.”
I spy Dylan in the corner, supervising everything in her role as Chief Resident. I know standing back and letting her residents take the lead is killing her a bit, as she’s always been one to micromanage.
I step up to the patient’s bedside. “It’s going to be okay,” I say, looking him in the eye, while simultaneously reaching to the wall to turn up his oxygen. He can’t talk, but his expression makes it clear his life must be flashing before his eyes. It’s too soon to let his life be complete–I can’t let it be over today.
I hold his hand while I explain, “You’re coughing up blood right now, and that makes it hard to breathe. We are going to have to put a tube down your throat and put you on a machine to breathe for you for a while.” His eyes flutter at me in understanding. “Do you have any family here?”
Just then, an older woman bursts into the room. “What’s going on with my son?” Tears form at the corner of her eyes as she takes in the sight. Her son starts coughing, staining his gown and bedsheets with blood, and then, he’s choking as the mother babbles, “He has Goodpasture syndrome, he coughs up blood sometimes, but this is—Oh god, is he going to be okay?”
A second-year medicine resident escorts her out of the room to explain the series of events that are going to happen very quickly. I turn my attention to his venous access. He has one good IV, which is a relief. I glove up and get to work placing a second IV.
Seconds later, Miley bursts into the room. She looks directly at me and nods to the med bag. “Prepare for rapid sequence intubation,” she orders while she unlocks the bed and pushes it forward to make room for herself.
I turn to the med bag and prepare syringes of etomidate to sedate the patient and succinylcholine to help paralyze him so Miley can intubate him.
Miley positions herself at the head of the bed, slips on gloves, then reaches for her GlideScope to help visualize the vocal cords.
“Now,” she says, cuing me to administer the paralytic medications. She inserts the GlideScope. “It’s too hard to see, dammit,” Miley whispers, “there’s so much blood.” She glances at the monitor and notes that his oxygen saturation is dropping. He’s paralyzed and not breathing on his own. He needs to be intubated immediately . The gravity of this situation is not lost on either of us.
Beads of sweat develop on Miley’s brow. Panic flashes through her eyes as she looks at me for a split second. Instinctively, I reach for the suction catheter and hand it to Miley just as she shouts, “I need suction!” She takes the device and clears the blood from the patient’s posterior oropharynx. I have the GlideScope ready to hand back to her since she has a small window where she will be able to visualize the vocal cords. She takes it from me wordlessly, and when she can see the vocal cords, she reaches her free hand out. I hand her the endotracheal tube and watch as she inserts it into the patient’s airway.
“Listen for breath sounds,” she barks. An internal medicine intern rushes forward and gives the affirmative. I look at the endotracheal tube and notice some frost developing. Both are signs that the patient’s lungs are getting air from the ambu bag that Miley is manually pumping. I lift my eyes to the monitor and register that the oxygen saturation is improving. Crisis averted. I take over bagging the patient while Miley cleans up the mess that is left in the wake of an urgent intubation.
Dylan emerges from her corner and shoots us a knowing smile. “Good work, both of you. You’re a good team.”
Miley startles. “I didn’t know you were here, Dyl. Can’t say I’m surprised though, always lurking behind your residents.” She wrinkles her nose at her friend. “How’d your ducklings do?”
“Ha, this was all you and Rohit. My flock took good care of the mother, though.” Dylan gives her friend one last smile as she leaves the room to rejoin her residents. No doubt she will take this opportunity to quiz them on Goodpasture syndrome.
Miley tosses her gloves into the bin and is on her way out the door when the overhead announcement clicks on.
“RAPID RESPONSE TEAM TO 8 NORTH STAT. RAPID RESPONSE TEAM TO 8 NORTH STAT.”
I look down at the patient I’m currently bagging and then at the med bag I’m in charge of bringing to all rapid responses.
“Don’t worry, Rohit, I can bag him. You go,” Miley offers.
“You sure? Bagging is below your pay grade,” I clarify, while maintaining a constant rhythm pumping the bag. I’m acting like the patient’s lungs right now, until a ventilator is brought to this room or the patient is brought to the ICU, whichever comes first.
“Don’t worry about it, hurry, they need you downstairs,” Miley reassures, as she returns to the head of the bed. Her hand covers mine for a split second as she takes over. A spark tickles my skin at her touch... must be some sort of static electricity or something. I shake off the thought and swipe the med bag.
“Thanks, Miley, I owe you one,” I say as I rush out of the room. If only I knew how that one line would change the rest of my life.