Right This Way

CW: Depictions of medical trauma

“Right This Way

Frances Crane’s stretcher made the hard left turn into Trauma Two, full CPR in progress. Abbey Roth, EMT on the ambulance crew, addressing the ER physician on duty, launched into her well rehearsed spiel; “Frances Crane, 86. We were called by a neighbor who heard a loud thump coming from the apartment upstairs. On arrival patient was found down on the floor, minimally responsive. O2 sat 84% on room air, sinus tach at 130, pressure 94 over 52. During transport patient went totally unresponsive, no pulse. No code status to the contrary, so we began CPR.”

Dr. Max Carter, just beginning his night shift in the Emergency Room turned to his assembled team, thinking, ‘She’s lucky. I’ve got a good crew tonight. She has a chance' while overhead the rhythmic cadence of “Code Blue, ER, Code Blue, ER. Code Blue, ER” blared through the speakers of Reliant River Hospital.

Actual cardio pulmonary resuscitation, CPR, unlike the sanitized version on TV dramas, is loud and violent. Someone or something, is pushing down on the rib cage hard enough to press it down two inches so it compresses the heart to circulate the blood. While this is happening someone else is trying to stick the biggest needle possible into whatever vein they can find maybe in the arm, hand, neck, groin or in Frances’ case her shin bone. Often there will be an endotracheal or ET tube in the throat allowing for a ventilator to handle breathing, as well as a Foley catheter, another plastic tube, this one inserted into the bladder to monitor urine production. Yes, it’s inserted exactly how you think. And, by the way, most of this will probably happen while the patient is naked as they’ve cut off the clothes on arrival!

Dr. Carter stood at the foot of Frances’ bed assessing his patient, the resuscitation now at full throttle. Starched white shirt and lab coat, red bow tie, wire-rimmed glasses, salt-and-pepper hair and beard he screamed “kindly doctor” when he walked into the room.

“What have we got for lines, Jill?” he said to Jill Parsons, Nursing Supervisor for this night shift at RRH.

“EMS put in an 18 in the right AC in the field. By the time they got here the only thing anyone could get in was an IO in the left leg.”

“18 right AC, IO left leg, got it. Thanks, Jill” Dr. Carter replied indicating he had heard and understood what the nurse had told him. Picking his way through the crowd of people, wires and tubes he worked his was to the head of the bed. “Pause CPR for rhythm check!” halted compressions and he placed the bell of his stethoscope over Frances’ left upper chest, searching for a heartbeat, all the while intoning the ER mantra, “Just stay with me, Frances. Just stay with me.”

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Post-code debriefings are common place in most hospitals. They can be anything from 5 minutes around the nurses station to a formal presentation. Today found Dr. Carter looking out at seven other members of the RRH staff in the ER break room. No back slaps and high fives today, however. Despite their best efforts, they’d lost Frances Crane.

“OK” he began, “ We’ve got to make this quick. We’ve only got two nurses at the ED desk. First off, thanks everybody. Good work today on the Crane code. I think everyone did their very best. Anything we did especially well?”

“Excellent teamwork” piped in Miguel, the Respiratory Therapist. “Everyone seemed to have a clear, defined role. Not a lot of confusion.”

“Thanks, Miguel. You’re right. Good job with that” the doctor said. “How about things that could have gone better?”

It got quiet in the room, uncomfortable looks passing back-and-forth before Eileen LeClerc the ‘Grand Dame’ of ER nurses spoke up.

“Everyone in this room knows the answer as well as I do. It’s the same problem, over and over. Code Status.”

The uncomfortable silence briefly returned, before Sonja Charles, another of the ER nurses agreed. “Eileen’s right. There was no reason for any of that tonight. Frances wanted to be a DNR but nobody knew. Now she’s got broken ribs from the CPR, a plastic tube down her throat, another up her…well, never mind up where. ”

Conversation turned to a verbal free-for-all. Rapping his well-worn ‘World’s Cutest Doctor’ coffee mug on the table Carter regained control saying ”You’re right, everyone, you’re right. I thought we were all set for a minute when I checked the heart beat at the rhythm check. There wasn’t one. She was reaching out for me. She was halfway between us and the mortal world. I thought she’d make it. But then they restarted compressions, bumped up the fluids, hung another presser, and the next thing you know, they got circulation and we lost her!”

“Sometimes it just can’t be helped.” Eileen, starched nurses cap matching the whites of her uniform said as she lifted up from her chair, “Sometimes we just can’t hold ‘em.”

Running his hand through his hair, a long sigh escaping his lips, Dr. Carter said, “I’m going upstairs for a minute to check on Frances. Anyone else want to come?” Turning to his left he walked through the break room wall, Eileen, Sonja, Miguel and the rest of the code team following.

-0-

Kendall Mitchell sat on the floor of ICU room 415. A precocious four-year old, he had already used a chair and several boxes he'd found around the room to fabricate a small town for him to drive his Matchbox fire truck around on the floor of “Auntie Frances’ ” room. Kendall’s mother, Sheila, Frances’ grand niece, and only living relative in a 100 mile radius, had gotten “the call” from the hospital searching for someone to provide guidance on further care.

“I really don’t know France’s very well at all” Sheila said, talking to Robert Doyon, the night shift doctor covering the 10 bed RRH ICU. “Do you think she’s going to make it? I mean she’s got so many tubes and wires. They told me that machine over there is breathing for her. Seriously, does she really stand a chance?”

Dr. Doyon drew a breath, preparing to answer, but was cut-off by Kendall saying, “Auntie’s dead.” never pausing his play on the floor. Both adults turned their heads to look at the child, just as the cardiac monitor began to alarm for asystole. Covering the distance to the bed in two steps the doctor reached for a carotid pulse. Nothing.

“I need some help in here” he shouted. “Call a Code Blue!”

With his mother collecting him in her arms and taking him to a corner of the room, Kendall Mitchell looked at his Auntie Frances who was now out of bed and standing in the opposite corner with the group of people that had just walked in.

“Can all kids see us?” Sonja asked.

“Not all of them, no, but a lot” said Dr. Maxwell. “They seem to lose the ability around six or seven. Too much ‘real world’ I guess.” Turning to Frances he said, “Well, Frances, are you ready to go?”

“I’ve been ready for a while now. I’m sorry to give you so much trouble earlier. I really thought I was with you, and then…”

“Don’t worry, dear” Eileen said, gently holding her hand. “Sometimes that happens. But, you’re here now and that’s what matters. Would you like a minute to say goodbyes to Shiela and Kendall.”

“Will they hear me” she asked?

“Sheila might.” Eileen replied. “Women are usually more receptive than men. I’m betting on Kendall, though.”

Skirting the end of the bed as the chaos of the futile resuscitation effort unfolded Frances first placed a kiss on Sheila’s cheek. There was no reaction that Frances could see as she moved on to Kendall. With his mother’s attention focused on the Code Blue it went unnoticed when Kendall waved and softly said, “Hi, Auntie” as Frances bent down to child height, giving him a kiss and hug.

“You be good for you mom, Kendall. Promise.”

“I will, Auntie. I promise.”

Turning back to Dr. Maxwell she said, “I guess I’m ready. Can I go now?’

“If you’re ready, Frances, so are we.” Maxwell said. It’s right this way.”