BANG. Start Chest Compression’s. Wires. People Charge in. Pads on. ZAP. “WE’RE LOOSING HIM DOCTOR. Thump Chest with Mighty Fist- I’ll stop there because it’s not like that at all but you could be forgiven for thinking otherwise we’ve all seen an episode of ER or Holby City or in Hollywood films where someone close to the main character suddenly falls to the floor (often during an argument or significant event).
But I’ll say it again, it’s not like in the movies.
It was mine and my clinical partners 1st day shift in A&E, the Consultant was showing us where the all the cannulation and venepuncture equipment was kept. As he was about to show us the computer system his bleep announced
“Cardiac Arrest Call in Resus”
Last week I had passed my Intermediate Life Support (ILS) Course, I was feeling confident and competent about my skills and so arriving I let the Consultant who was leading the Cardiac Arrest Call know that I was able to assist. Within seconds I was ready and then changed places with the tiring Nurse to begin Chest Compression’s on the patient.
So what the movies don’t illustrate quite accurately is that there is no mad flurry, there is no scramble for chest compressions, there is no panicking but rather an air of urgency. The Team Leader oversees the Cardiac Arrest handing out tasks to the team involved in hopes of identifying and remedying reversible causes. Every team member fulfills their job and reports back to the team leader.
The bellows in the films of “HE’S NOT RESPONDING DOCTOR…. DO SOMETHING” are replaced with effective communication regarding checking the rhythm. When the defibrillators involved there’s less Frankenstein type dramatics but more clear instructions as to when to stop the chest compression’s and step away from the bed to allow a shock to be administered (and also avoid being zapped with 150J of energy).
In the films you’re on tenterhooks willing the doctors to bring the patient back to life and that does translate into reality. Every time I compressed the chest I was aware that there was a patient beneath my hands, a person not a model dummy. I focused on what I was doing, very aware it was important for me to get it right, be in the right position, apply the right amount of force and really try for the patient to produce effective compression’s. As I was performing compression’s other member of the team were ventilating the patient, taking bloods, blood gases and getting the results back. Everybody working together to really try and get this patient going again.
But it didn’t work. We did the very best we could and carried on as long as possible until the collective decision was made to stop. Sometimes the patients respond but this time they didn’t.
That was my first Cardiac Arrest Call. I’ve since been to another (where the patient responded) but I will always remember how efficient the team worked together and how it shattered even my notions of what a Cardiac Arrest is like.
As a Medical Student everything is a learning curve to becoming a competent compassionate Doctor, rising to the situation and accepting that sometimes despite everything patients do die.
Afterwards we resumed our activities in the Emergency Department taking histories, helping with jobs and practicing examinations. It’s the nature of medicine, particularly Emergency Medicine that one morning you’re chatting to someone about their infected toenail and another morning a patient in front of you begins to drift in and out of consciousness. In the end that’s what all the studying, workshops and simulations are for- to prepare you for whatever challenge you’re faced with. As finals are approaching I am beginning to feel that actually “I can handle this” or even more importantly “I am aware I can’t handle this on my own and I need to call for someone who can”. That feelings pretty awesome. I’d say that’s probably what 5 years of medicine will feel like come graduation time!
Till next time,
P.s. That evening I definitely had to have a sit down with a cup of tea and biscuit and call mum (Mums are great remedies).