blue light, part deux

There I was sitting at the back of the ambulance - the only time I was actually chilled, after a really busy night drawing up drugs, chasing up blood results and doctor referrals. Then there’s the most challenging bit, I think. Reassuring family at bedside. You wouldn’t send a family home when there is a possibility of ‘movement forward’ to another facility, need for involvement in a significant decision making process and quite possibly termination of therapy if deemed futile.

I felt weird (I always do, anyway) that there I was running around pushing drugs and fluids to preserve or keep organ function stable and restoring a family member’s confidence every time the machine beeps, but at the same time painting a rather bleak picture as quite often, it is better to offer little or no hope to prepare them for any negative outcome. You would have to continuously assess the family's emotional stability and intellectual capacity to understand the situation obviously.

It is during these times (early morning) when Consultants are hard to come by and decisions become really slow. The family have also decided to go home at this point which I thought was fair enough since they were practically up the whole night. We haven’t heard from the London hospital and dispiritedly, I was looking after a patient with a very unstable blood pressure and not blowing off his carbon dioxide despite of all the tweaks done on the ventilator. A high CO2 concentration on a head injured patient is basically, a ticking time bomb.

So I was quite happy that by six in the morning, we were whizzing our way to London. I didn’t mind that I had to catch a syringe flying in my direction from an ever so sprightly young doctor who can’t be bothered with her seat belts. These things happen. Once not so long ago, it was a sickie bowl.

I phoned up the patient's wife explaining to her that they might place a bolt through her husband’s skull to monitor the pressures inside and they may or may not operate on his brain depending on the degree of the damage. And that he may or may not survive the operation. I really felt sorry for her and she was really grateful for all the care and the honesty. I have omitted that part where we ask if the patient is on the organ donor register.

I apologized extravagantly when I handed over to a colleague. I know, I passed the buck.