The medics brought in a middle-aged woman who was in cardiac arrest. Her husband had found her down and called 911. The medics found her in arrest, started CPR, injected her with adrenalin and brought her to us.
When medics bring in such a patient, it causes quite stir in the emergency department. Pretty much everyone stops what he is doing and goes to help. The patient has to be transferred onto our gurney, chest compressions continued and oxygen has to be blown down into the lungs. The patient has to be hooked up to the cardiac monitor and checked to see if there is any sign the heart has started beating again. All of this has to be done as fast as possible and the more hands helping, the faster it gets done.
As everyone was pitching in doing all these things for this lady, I turned my attention to her airway. It was obvious right away that, during CPR, she had vomited and there was liquid vomit in her mouth and the back of her throat. I suctioned that out, looked in with a laryngoscope* which is a curved, lighted blade designed to move the tongue out of the way to be able to see the vocal cords**. Once the cords are seen, a tube can be passed through them in order to get oxygen-carrying air down into the lungs and keep vomit out***.
As soon as I had got the tube in place, I turned my attention to the patient’s heart. I asked that CPR be paused while I looked at the monitor, listened for heart sounds and felt for a pulse. Not finding any evidence the heart was beating, I put an ultrasound probe on the chest wall, over the heart, and confirmed no cardiac activity. She was dead.
I took a minute to look over her, to make sure I hadn’t missed anything. I thanked everyone for helping so efficiently, then went to write a note about what had happened.
As I was sitting at my desk, the registration clerk came to me and told me the patient’s husband had arrived with a boy who looked to be about twelve years old.
“He knows,” she said.
In reply to my quizzical look, she told me the husband had asked her if his wife was alright. When she told him she had not been taking care of the patient but she would have the doctor talk to him, he turned to the boy and said, “She’s dead.”
After the husband and son were escorted to the Family Room, I went to meet them. I introduced myself, made sure he was the husband, then told them she was dead. I told them the medics had done everything they could to revive her but that she was already dead when she got to us.
“No!” the man hollered as he stood and threw his head down into his hands. “No!”
He then collapsed back onto the couch and moaned with his eyes closed and his hands on his pained face.
The boy leaned over his father, put one hand on his arm, patted him gently on the back and said, “It’s OK, Papa. It’s OK.”
Going and telling someone that his or her loved one is dead is one of the worst parts of my job. I never know what to expect. I certainly was not expecting this and it made my interaction with them especially poignant.
* This is an image of such a scope:
** Here is what I see when I get a good look at the vocal cards. The endotracheal tube is passed between them, through the opening.
***Here is what the tube looks like.
