Friday, February 27, 2009

Divine Interventions

"Wes, I need a pacer. This guy's temporary pacer wire isn't capturing reliably."

"I'll be right in."

Driving rapidly to hosptial, the microprocesor kicks in: Lab staff called? What's his INR? Antiplatelet agents? WBC count? Access issues? Patient size? Device rep aware?

Calls are made. Info gathered. People mobilized.

Upon arrival I note a very old gentleman with an intraosseous line in his left tibia, and a right internal jugular line in place with a temporary pacing wire at 35 cm, clothes askew with EKG leads attached. Telemetry monitor discloses 2 or three of every five impuses capturing. ("I hate when that happens," I thought.) Chest xray: can't see a thing due to poorly penetrated film. To advance or withdraw the wire... hmmm.... let's try advancing. Pacer spikes, no capture, patient makes strange jerking movements: nope, withdraw... pacer with unreliable capture and patient thrashing about, moving his head side to side. Right. Got it. Tape forehead to bed - have nurse facilitate the head-hold. Is the lab ready?? I need fluoro.

On our way.

Four hours later after a bit of a wrestling match, the pacer is installed and the temporary wires removed. Somewhere, the patient regains enough conciousness to remind us he's a priest. "Really?" He doesn't answer. Instead, he makes gestures top move his hand. "Sir, please hold still!" "But I need the books off my hand." "Sir, there are no books there." "I need the books off my hand!" "Sir, just hold still, just one more layer of stitches to go..." "The bible, please!" "Father, there's no bible there. Just hold still another minute and we'll get you off this table."

Later, the truth is told: 89. Found down. Heart block with ventricular escape rhythm at 15 b/min. Priest.

The next morning: "Can I say the rosary for you, son?"

Thank you, God.

* * *

Later the same week: Repetetive atrial tachycardia in patient with angina each time he has tachycardia. Medications ineffective. Patient 91, DNR, and a priest. Electrophysiology study done after passing catheters past the patient's two transplanted kidneys (first one failed), bilateral hip prostheses and bird's nest IVC filter.

Tachycardia localized. One burn: gone.

Thank you, God.

* * *

Sometimes I feel like I'm not sure if I'm messing with a higher power's plans or He's messing with me.



Anonymous said...

I think the nuns would tell you it's "Divine Intervention"...and those are two wonderful stories.

DrWes said...

anony 03:00 -
Correction made. Thank you. (Sometimes I think English is my second language...)