Monday, December 17, 2007

The Concertos

"Why on earth do we try to do all this each year when we know it's going to be so crazy?"

"Honey, I really didn't think your son's holiday concert followed by a little dinner party would kill you."

"But I have to get there an hour before the concert just to find a seat, for goodness sake."

"Take the Tribune, get comfortable, and reserve me a seat. Now, go!"

So off I went. My sixth year in a row of the high school's annual holiday concert. But this high school has four thousand students, and forty-five thousand parents and grandparents and brothers and sisters and aunts and uncles that all have to arrive at least an hour before the concert to clammor for a seat. Holiday cheer goes out the window in such circumstances. Bah humbug.

My wife, bless her soul, having placed the finishing touches on the dinner preparations before attending, arrived five minutes before the concert and experienced the same shock and awe that I had when she saw the crowds.

But all was forgiven when the music started. It was quite a show.

At least until my beeper went off.

"Call the ICU STAT," it read. Two seconds later: "Code Blue, ICU."

I looked at my wife. Her eyes rolled as she whispered, "Go." I grabbed by coat and quietly slipped out of the concert hall and ran to the car, calling as I went.

"That lady's heart stopped again. No clue why. We had to use the external pacer to get her back."

"I'll be there in 10 minutes."

After setting new land speed records through a construction zone on the way to the hospital I arrived to find her attached to a ventillator, hair beautifully maintained, husband and teenage daughter at her side. A daughter not much younger than my son. Standing tall, unwaivering, but clearly concerned for her mother, trying to keep it together.

"It'll take me just a few minutes," I explained after reviewing the details of placing a temporary pacing wire. The nurses, meanwhile, had assembled the necessary instruments and drapes; a well-rehearsed concert they carry out many times each week.

As I worked, it became eerily silent, and I looked up to see her pupils dilate as she stared blankly toward the ceiling, her arm reflexly bending skyward with uncanny strength for the few muscles remaining on her bones. She was unresponsive and the monitor showed delightful P waves dancing across the screen, while the more important R waves were on holiday.

"Uh, mind turning on the temp pacing pads for a bit?" I asked, as calmly as possible. Her chest began to twitch as she slowly regained conciousness and I felt a pulse again, this time bounding vigorously due to the catecholamine surge that accompanies such moments.

The needle entered the vein on the first pass.

"It's okay, Mrs. Smith. We'll have that wire in place in no time." And like our own miniature concerto, with the soloist at the forefront of the stage and the nurses acting like the orchestra behind, the semifloating pacing wire advanced to the heart and started a new cadence that was all our own. R waves danced again on the screen. The audience roared.

Well, not really.

But it was our concert. My patient and me. However brief. Never heard, but appreciated.

Just like my son's concert.



Anonymous said...

Had a similar event happend to me. Interestingly enough...a Sprint Fidelis lead attached to a Concerto (no pun intended) failed, resulting in an concert of temp. wires and external pacing. Patient lived but can relate to your event. Happy Holidays

Anonymous said...

Dear Dr. Wes,

I got a question for you. The difference between heart attack and sudden cardiac arrest is not well-known to a layman, and sometimes press gets it wrong as well. However, today on the news I've heard a report on someone being revived by external defibrillator and then later that day having a 99% clogged coronary artery opened up in a hospital. So did the patient had a heart attack or SCD? How common are they to come together?

Well, that's two questions, not one :)

Thank you.

Kb said...

Beautiful music Dr. Wes!

DrWes said...

Anony 08:52AM - And to think I could have had a perfect trifecta...

Anony 1:18 PM - A heart attack which causes sudden blockage of the blood flow to a portion of heart muscle sometimes (but not always) causes the heart to develop ventricular fibrillation - a rapid, irregular heart rhythm that causes the heart to stop effectively pumping blood, and the person can die from this heart rhythm. The rhythm causes "sudden death" (sometimes called "cardiac arrest") in that circumstance, unless it is corrected with an external (or internal) shock.

The media often confuse these two events, but they sometimes occur concurrently.

Hope that helps.

kb -
Thanks. Happy Holidays to you.

Margaret Polaneczky, MD (aka TBTAM) said...

WOnderful post!

Anonymous said...

Thank you for you answer on my question about heart attack and SCD. I get it now :)

The Happy Hospitalist said...

Dr Wes, I loved it. Your own concert. What a great visualization.

Out of curiosity, who ran the code before you got there?

A hospitalist?

Cathy said...

That is some story Dr. Wes. I think it's beautiful!

DrWes said...

happy hospitalist -

It was an intensivist who "ran" it, but it was the nurses who saved her life...

ah, the wonder of a little electricity....

DavidA said...

"ah, the wonder of a little electricity...." isn't that the EP motto

-David (EP/Cath Lab tech)

Richard A Schoor MD FACS said...

Very nicely written. I have but one question: does she have a foley?

Anonymous said...

As one of those nurses who prepares, organizes, and cleans up after concerts of this nature on a daily basis. I want to take a moment to thank all the team members who makes events like this possible. It truely takes an army for hospitals to function smoothly. Take a moment to think about how that wire got into capable hands... from the factory, to the shipping, to the hospital, to the shelf please take a moment this holiday season to thank those who bring us the tools of our magic. Without them there would be no concertos.