AMAZED

Lately I've been amazed at what medicine can do. And how fast it can work. Here are some of the things I consider medical miracles:

• I had a patient go to surgery and "code" (meaning her heart stopped beating and she lost all perfusion). While doing CPR, they brought the patient to me in the ICU (I was told later I looked the same color as the patient when I saw them coming). We quickly found the patient had a "tension pneumothorax" (pneumothorax is a collapsed lung. It becomes a "tension" pneumothorax when the pressure from the collapsed lung pushes the heart and vessels. Hers was bad enough that they were too far shifted and compressed to pump at all.) A surgeon put a chest tube in to relieve the pressure and walaa! She had a blood pressure, a heart rate, and her color went from dusky to rosy. Within a few minutes she opened her eyes and was trying to talk to us. Wow!
• Another patient went into "a-fib with RVR" (atrial fibrillation with rapid ventricular response. Basically, his heart was beating twice as fast as it should and less than half as efficiently). I called the doctor and got orders for an amiodarone drip (a strong heart medication) within 3 minutes of onset. I let the pharmacy know and within another 3 minutes I was giving it. Another 3 minutes, his heart rate was back within normal range and he had a blood pressure. Again, Wow!
• Still another patient had lost almost all circulation to one foot. It was cold and white as white can be. And she had a sore on her ankle that had been there weeks, unable to heel.  She was taken to surgery. They took a little piece of a healthy vein, hooked it on to the artery and "bypassed" the blockage. She came out of surgery with an incision from her hip to her ankle, but with a pink foot. And she could feel when something touched it--a sensation she claimed to have not had in months. (And this was just for a foot--imagine doing that to the vessels of the heart!)

I could go on for hours. Every time I titrate a "pressor" (medication to improve blood pressure), I'm amazed at the immediate effect. When I watch a patient get electrically shocked out of a dangerous heart rhythm, when I give sedation and suddenly the patient is out cold, when I give a little fluid to a patient whose numbers just aren't right and they suddenly all resolve...it's always amazing to me. (It's daunting, too, as I realize the impact a mistake can have.) But I love having some immediate gratification in my job!