A bad day at the office.
Keith was “kicking off” again. His project wasn’t going right. His suppliers were letting him down, his transport was late and the people in China didn’t know what they were doing. But Keith was often like this; every problem was a drama. He wanted everyone to know he was having a bad day and that his project was critical to the company. He swore at the person on the phone and then slammed the receiver down as hard as he could. He took the pen from behind his ear and threw it at the window. Hauling himself out of his seat he announced “I’m having a bad day at the office and it’s still only ten thirty; in fact I’m having a very bad day at the office!”
I ignored him and smiled to myself. Did he really know what it was like to have a bad day at the office? I thought. My mind went back to the worst “day at the office” I could remember.
I was fifteen minutes early for the start of my working day in the Cardiology dept. of Cardiff Royal infirmary. I walked in to the dimly lit foyer from the dazzling sunshine out side and missed the porter waving at me. He had to shout to gain my attention. “Kerry left this here for you” He held up my white dentist style jacket, “There’s a bad one in the crash room they need you there now,” he explained. I ran down the corridor unbuttoning my shirt as I went. By the time I arrived at the crash room I was ready to go. I smiled at Kerry and threw her my shirt, “put this in the back of the machine,” I said. Turning to the doctor and glancing at the blood soaked patient, “So what do we have?” I asked.
“This is Rob. He’s thirty five and a roofer. He was cycling to work when a dog ran out in front of the car ahead of him. He hit the car and came off the saddle with some force, landing on the crossbar of his bike. Unfortunately he was carrying a slate tied to the frame of his bike and he came down on the edge of it. He has severed his left femoral artery, opened up his scrotum and cut his penile artery. He was doing well until he saw where the blood was spraying from and then he arrested through shock. Take over masage from Jenny this is her first day with us and she looks ready to pass out. If you’re going to fall Jenny remember to go backwards, not onto the patient.”
Rob had a drip line fully open in each arm with a unit of blood on both of them. He had another line in his subclavian vein with a pressure bag forcing in saline to boost his blood pressure. The blood had soaked out through the sheet beneath him and was dripping like red rain onto the floor. I began massage immediately. Cardiac massage is hard work the chest of a fit man in his mid thirties resists pressure but has to be compressed at least two inches to be effective. Kerry was calling the shots from the E.C.G. and a sister was calling out the monitor.
“Asystole!” Kerry kept calling, “Still asystole”
“No B.P. registering,” the sister called.
“Get me an intracrdiac canula with a shot of adrenaline” The doctor asked in a calm but firm voice.
“He took the syringe with its needle as thick as a carpenters nail and plunged it through the fifth intercostal space deep into Rob’s left ventricle. He pulled back on the syringe and the clear liquid clouded red. Satisfied he was in the right place he pushed hard emptying the syringe into the patient.
“V” Kerry shouted optimistically, and then “Dying heart complexes, we’ve lost him.
“Thanks everybody,” the doctor said, “Time of death recorded at nine o five.”
As I stood upright I felt a warm stickiness across my chest. I glanced down and my white coat was red from just below my chin to my waist. I took it off and put it in a patients property bag but before I could ask Kerry for my shirt our bleep was going at a rate that we both knew meant another arrest.
Kerry pressed the button and held the bleep to her ear. “Cardiac arrest William Diamond Ward” the crackling voice announced. We grabbed the ECG trolley and ran out of the door and down the corridor towards the lifts. The wheels of the trolley rattled across the uneven corridor floor and then suddenly locked. The trolley went over and the ECG machine became airborne. It crashed upside down on the floor ahead of us. Kerry had gone over onto the trolley and the bottom shelf had cut her shins. We both scrambled to our feet and ran on without the machine. “I hope the ward machine is working,” I said.
We arrived on the ward where a medical student put a plastic apron over my head. Other members of the team were arriving and they received an apron as well. “Wellcome team” the consultant announced, “this is John, He’s twenty nine and a structural engineer for the sewerage department he has contracted leptospirosis, we believe from rat urine in the sewer. He has been showing signs of left ventricular failure, kidney failure and reduced liver function. This mornings obs showed bradicardia and hypotension. He has now slipped into V.F. so if you can charge the defib we’ll see if we can jump start him. While Kerry set the defib I connected him to the ECG as I attached the right arm lead his head rolled towards me and he vomited over my hands. The smell hit me like a smack in the face. I swallowed hard, focused on my task and shut it out of my mind.
“Stand clear, electronics off,” the consultant commanded. There was a low thud and the patient twitched violently.
“Still VF” Kerry called.
“Shock him again, same level. Stand clear.” Another low thud.
“Still VF,” Kerry called again.
“Up by fifty percent, and again,”
“I think we’ll wrap up there, thanks everyone, time of death nine forty five, see the med student on your way out.” The consultant concluded.
The oriental med student had a serious expression on his face, “Did you have contact with the patient?” He asked,
“What do you mean?” Kerry replied.
“Did you touch him?”
“No,” she said.
“and you?” he said turning to me,
“Yes,” I replied, “he threw up over my hands”
He wrote furiously for a few seconds and then tore a page off his pad, “Go straight to pharmacy and give them this. Take the two large tablets within the next few hours and then take the small ones twice a day for the next two weeks.”
“you’re serious?” I replied.
“Penicilin kills the leptospirosis in the first two weeks, but it usually doesn’t show any symptoms until the third week by which time penicilin does not work.”
“and then it’s dangerous,” I said.
“Ask him” the med student said pointing to the corpse we had just left.
We put our aprons in the bin provided and walked off down the corridor. “while we are in pharmacy you’d better get your shins sorted out.” I said.
“I’m so high on adrenaline I hadn’t noticed how bad they are, but now that you mention it” At that point the bleep went off again.
“Cardiac arrest in theatre suite,” Our walk turned into a run up to the next floor. People in green pyjama suits with cloth hats and facemasks pointed us to the neuro surgery suite. The patient was curled up in a ball.
“Steve is a thirty one year-old epileptic who has just had minor surgery. He reacted to the anaesthetic and began fitting as it was wearing off. His fits have caused VF.” The surgeon explained.
I wired him to the ECG as Kerry charged the defib.
“Clear!” the surgeon called. There was the familiar low thud.
“Sinus rhythm!” Kerry called.
The patient began to relax.
“Tachycardia with muscle tremors, I think he’s going to fit again.” She said
His arms thrashed around wildly. His head rolled from side to side. Two nurses grabbed his arm and found a vein. The surgeon injected him, but it hadn’t been quick enough.
“VF again!” Kerry shouted and the struggling stopped.
“Recharge and shock. Clear!”
The process repeated itself, after four defibrilations there was the faint smell of burning flesh, by the seventh it was overpowering. The eighth ended it with dying heart.
“Death at ten past ten. Thanks everyone,” the consultant said.
We made our way back to the office via the pharmacy where I was given my tablets and Kerry had her shins dressed. We closed the door sat down and cried. My white coat was in the sink having the blood soaked out of it; a two thousand pound ECG machine was in pieces in the corner I was on penicilin for a lethal contagious disease; Kerry had both her shins in dressings; we still had the smell of burning flesh in our nostrils and the mortuary had three new residents the oldest of which was thirty five. We were having a bad day at the office and it was still only ten thirty.