Sunday, September 17, 2006

Chaos, Control.

The unit is like the double sided painting of Wassily Kandinsky called Chaos / Control in that John Guare play: Six Degrees of Separation, although it looked more like chaos all throughout and not a smidgen of control when I came this afternoon. They are about to tie the tube on patient’s mouth to keep the airway, whilst the doctor is bagging/hand ventilating him. Meanwhile, poor Galileo – our ever so reliable breathing machine is screaming low oxygen. I thought I could be useful by trouble shooting the bloody machine and hopefully shut him up. I’m not really sure if he [ the machine ] is a he as he sometimes get premenstrual and become so hysterical. You got to learn how to press the right buttons with him. I tried to check if any of the tubes are kinked, checked if the machine is plugged to the main oxygen supply, clicked menu screen, with that really annoying smug look, I thought I looked smart whilst I was doing it and I'm not really, so I clicked the buttons, hell - any button because I really didn’t have a clue what I was doing, but it worked. Man, I was good.

“Okay, Howler. You take charge of this one.”

“I’m not yet here, sister. Remember I’ve just arrived in the unit, [ thought I could have a cuppa tea but this bloody-ancient-heretic-piece-of-science-not-ashamed-to-be-called-Galileo is having a fit. ] I’m just trying to help.”

Sister gave me the Naomi Campbell look.

“Oh, okay. I don’t know this patient.”

“Neither do I. He came this morning, but he’s not in the system yet. The notes are with the doctors.”

I can see what seemed like notes scattered on the work station. “Yeah, right.”

“Honestly, we have been busy.”

Fair enough. It looked like they have done quite a lot indeed. The poor man appeared to have lots of invasive looking lines in various parts of his anatomy. Arterial line, CVP, Femoral cath, you name it, he’s got them.

“So what happened to him?”

“Oh, nightmare.” Sister hissed, then sashayed off and disappeared from the hallway like it was a catwalk. Lovely.

“They think he’s had PE’s whatever that means.”

“Blimey.” The curtain just spoke like that ‘voice’ that sometimes lent itself to cute farm animals or burning bushes in the middle of the desert. I opened it, and there she was. Student Nurse. Poor little bugger looked really terrified.

“You gave me a fright, dear.” C’mon in, and see what we have here."

Wished she hadn’t because she then asked me a barrage of questions.

“Hold your horses. I don’t really have a gift with translating gobbledygook either but let’s say PE is a plug, sometimes gunk, but mostly a blood clot that travels from your legs to your lungs then bugger off your heart, basically. I was told 10% of patients who develop PE die within the first hour and 30% die subsequently from recurrent embolism. They sometimes call it economy class syndrome. You know, you go to some beer festival in Germany, but you’re trying to save your booze money so you took the cheapest easyjet flight where it’s so cramped and you end up having a massive heart attack and a dead brain [ similar to what you get if you watch a lot of old american musicals, usually with Julie Andrews on it ] somewhere in the mountains in Salzburg where the Sound of Music was filmed in the 60’s.”

“Oh, DVT.” She said.

“You’re a rock star.”

I wanted to show her the PICCO machine as I was getting inspired, and I was explaining to her how you could inject cold saline to the patient’s heart and then the machine will pick up this cold saline at the end of the art line and be able to calculate cardiac output by analysing the thermodilution curve using this algorithm called the Stewart-Hamilton, when she looked at me terrified.

“What is it dear?”

“Is it like that Pulp Fiction thing? When they draw that circle on her chest with a lipstick and jammed a fat syringe of something into her left breast?”

“Naaah.”

“You inject the saline through the tube, of course. Then it will tell you the patient’s CI [ cardiac index ] which is basically cardiac output indexed to his weight. If it’s low, maybe patient is dry, so you give him lots of fluids. Or SVRI [ systemic vascular resistance index ] when peripheral blood vessels suddenly turn hip-hop and hang out loosely like a baggy trouser, so you loose that pressure. Then you need to give a drug called noradrenaline to act like a belt and squeeze that trouser up so you won’t have blood pressure down to the floor.

I was really enjoying it. It was like Beauty and the Geek. "My favourite is the GEDI…" And before I finished, I knew what she was going to say.

“Oh, I see. Obviously, you like Star Wars. I love them.”

Global End Diastolic Volume Index is the volume of blood contained in the four chambers of the heart.

“Bloody hell, you've seen way too many movies.”

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