Wednesday, April 6, 2011

Self Service

I've been doing this medicine gig for over 14 years, if you count medical school it's been about 20 years that I've been living, drinking and eating medicine. During these two decades, I've seen some pretty astounding things. And every time that something extraordinary presents itself, I say, "That's it, now I've seen everything. I will never be surprised again." There is a limit to how many surprises one can encounter.
Every time something else pops up. And it leaves me scratching my head in wonder. So yesterday I was on call in the OR. The surgeons were bringing down a guy who had stumbled into the Emergency Dept.  a few days ago drunk as a duck after having been savagely beaten by, as he put it, "some very bad people".
The CT scan found some sort of cyst or hematoma in the area of the pancreas and an intimal flap (a small tear in the inner surface) of the aorta.  He was in the ICU and so I prepared the room for an anesthetized ventilated patient. These preparations are actually quite simple since they come from the ICU fully monitored. I call these patients, "plug and play". Just hook 'em up to the anesthesia machine and the monitors and let the games begin.
The intercom crackled that the patient from ICU had arrived, so I hastened to the entrance of the OR. Not surprising, the patient was intubated. Not surprising, the patient was not sedated. Most patients develop a tolerance for the breathing tube, after a couple of hours if there is no other indication, they need little or no sedation. 
The BIG surprise, the thing that made this patient unique, the thing that made my jaw drop and rub my eyes in disbelief, was that the patient was not connected to a ventilator. Well, that's no surprise, I often transfer patients to and from without a ventilator and I ventilate by hand with an ambu bag. However, in this case, the accompanying physician was not ventilating the patient. In fact, the patient was being ventilated by ...

The patient! 

There he was, sitting upright in the bed, an ambu bag connected the the endotracheal tube, and he was ventilating himself.

Now that's  Self Service!
Now I've seen everything...until next time.

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