Just a normal day
It was August. My first month as a real qualified doctor. I was walking down the main hospital corridor when my pager went off. I quickly slipped onto the nearest ward to find a telephone.
As I lifted the receiver at the nurses’ station, out of the corner of my eye I saw a patient drop his glass of juice and slump back into his chair. A couple of nurses ran over, and began shouting in an attempt to rouse him. No response. They beckoned me over.
My heart started pounding. I don’t even know the poor guy’s name. He’s not one of my patients. I’ve never seen him before. I ask the nurse his name.
“Mr Weasley? Can you hear me Mr Weasley?” Still no response.
I’ve been trained for this
Ok. Try to keep calm. ABCs.
A. Hmm A? A?! Airway. Phew yes. Airway. His mouth is open. I take a quick look inside. His airway seems patent to me. He was just having a drink, but he’s not coughing so I doubt he’s got some particularly viscous juice lodged in his trachea. In fact he’s not really doing anything since he groaned and slopped his drink all over the place.
B. Bugger. I’ve only ever seen one patient die before my eyes, but it did look an awful lot like what’s happening right now.
Ok. B – Breathing. There doesn’t seem to be much respiratory effort. His chest isn’t moving. I can’t feel any breath on my cheek.
Bollocks. I left my stethoscope back at the nurses’ station. No time for that now. ‘Can we get him on 15L of oxygen through a non-re-breathing mask please?’ Where did that come from? Oh it was me!
C? Ah, circulation. Let’s check the pulse. Oh dear. I can’t feel too much down at the end of his arm.
Let’s try the neck. Nope not too much going on there either. Oh fuck. This is all happening rather quickly.
‘Nurse, can you put out the crash call please.’ One of the rather panicked looking ladies busying themselves around me rushes off to the phone.
Don’t worry, the doctor is here
Mr Weasley is still sitting in his chair. ‘Can we get him onto the bed?’
‘I think he’d be better on the floor, doctor.’ Oh thank God. My panic fades away and a wave of beautiful warm relief floods through my body. The doctor is here! Then I look around. I can’t see any doctors . Oh. Now I realise – she’s talking to me. I’m the doctor. ‘Erm, yes of course, let’s get him on the floor’.
Four of us go to manoeuvre the gentleman to the floor. I grab his legs. “Pop!” Oh dear look what I’ve done now. I’ve pulled his legs off. Both of them. In my hands are two firm calves, no longer attached to the patient. What is going on here? Wait a minute… I know whats happening. Its a dream. Nothing this bad could ever happen in real life. Its just a terrible bad dream and now I’ve realised its a dream I can wake myself up. Except, I can’t wake myself up. I’m trying, but nothing is happening. Then, I notice that something in my hands doesn’t quite feel right. These legs feel unusually light and firm. Realisation dawns on me. Thank goodness, they’re not his real legs. They’re plastic. Its not a dream. I leave his prosthetic limbs, still attached by his elasticated trouser legs, dangling at impossible angles and continue to assist in moving him on to the floor.
I kneel down next to him. Oh dear. The floor is wet, and yellow. I take a quick look down at my trousers. Phew, at least I’m not responsible. Ron seems to have lost control of his bodily functions. Who can blame him. He might have just died and a now doctor has pulled his legs off. Anyway, I can’t worry about that now. His eyes have rolled up. He looks a bit blue. Oh this doesn’t look good. This is what dead people look like.
Right, here goes. Am I really going to do this?! Well I suppose I’d better do, if I’m going to do my job properly and whatnot. I pull up his t-shirt and begin chest compressions.
This is definitely not what resusi-Anne feels like. Oh for God’s sake this poor man is not dying with any dignity, is he? At this rate he’ll have flail chest by the time I reach 10 compressions. Anyway, I had better keep going. I manage a full 30 compressions, complete with 30 rib-destroying sound effects. Ronald still isn’t doing very much.
Wait a minute. He’s gurgling. Is that agonal breathing? I’m not sure. I haven’t ever seen it before. ‘Where’s the bag and mask?’ I ask. Well actually I think I shouted. My normally cool calm collected self was left at the nurses’ station about 75 seconds ago.
There’s no time for that, he’s about to vomit. I quickly roll him. In the direction away from me (obviously). Ah yes he’s vomiting. That’s a good sign. And he’s doing it all over somebody else and not me.
Then I notice a terrible smell. He’s suffering from faecal incontinence too, for good measure. He starts mumbling. He’s gone red in the face. Oh this doesn’t look like the kind of thing dying people do. He seems to be getting a very lot better, extremely quickly. Wow I must be a terribly good doctor!
The crash team arrives. What a scene they are greeted with. An anxious looking new doctor, kneeling on the floor in a puddle of urine and vomit, a smear of faeces (and all the accompanying odours), and a patient sitting up looking around wondering what is going on, with the entire staff of Building 5 gathered around to watch.
“What have you done to his legs?!” the Registrar exclaims, seeing Ron’s limbs posing at impossible angles. “Oh no don’t worry – they’re plastic.” “What’s happened here?” I give the crash team a quick 10 second run down. They all busy themselves around the patient and quickly take over care. Mr Weasley is talking again now. I ask if they need me anymore – they don’t (maybe I’ve caused enough damage already), and then quietly slip away.
There’s a bit of an audience gathered at the entrance to the patient bay. A few passing doctors, some medical students and a few others. In fact, everyone who works in the vicinity seems to be coming to have a look at what’s going on.
I get a sympathetic hug from another FY1. I’m all sweaty and flustered and covered in the bodily fluids of a stranger. One of my friends helpfully adds that he’s “never seen me this shitted up before”.
What on earth just happened? A terrible flush of thoughts and self doubt rush over me. Oh dear. I think I just did traumatic chest compressions on a man having a pleasant nap. I hear someone say he’s epileptic. That information might have been more useful before I had just finished destroying his rib cage.
Then, more rational thoughts emerge. Stop being so hard on yourself doctor! The patient is very alive and well right now but a few minutes ago seemed very dead. Perhaps you just performed the most effective CPR ever recorded!
The patient survives
The ECG has just printed out. It’s completely normal. Mr Weasley is back in bed now. Sitting up. Perfectly alert. He says his chest is a bit sore (surprise!). He’s a vascular patient – which I probably could have discerned from his deficiency of real limbs. This is why it is rather difficult to feel his pulses. The Med Reg is having trouble detecting a peripheral pulse even now – despite his current consciousness.
The crash team come to write up some notes. The registrar says she thinks he had a ‘vasovagal’. My self doubt and churning guts immediately return. Ah right. Yes. That makes me feel so much better. That’s just one step up from nap. He fainted. I called the crash team, and caused multiple fractures on a man who got a bit light headed. Great. Did I remember to pay my MPS subscription this year?
After thoroughly documenting the events in the notes (of course), I went for a cup of tea and a sit down. My fellow FY1s are all very supportive. And also a bit giggly. Apparently this whole scenario is hilarious. But they do agree that they would have done the same. The matron also congratulates me on what a brilliant job I did. She tells me that she has never seen anyone look like quite that just because they have fainted. And, whatever the crash team says, ‘he definitely wasn’t breathing when we arrived’ she assures me. But I still can’t help feeling a little over zealous.
Continuity of care
Later that day there was much anticipation amongst the junior doctors of the hospital (news spreads quickly) to view Ron’s chest x-ray to see if there was any trauma. In fact, I believe there was even a sweepstake amongst staff as to the total number of broken ribs that may have occurred. Of the 8 ribs on each side which were completely visible on the poor quality film, all were broken.
The next day, his wife brought me a box of chocolates and a thank you card because I had “saved his life”. Ron and his wife were so very grateful, and he never complained about about his sore ribs.
So, what did I learn from all this?
Well. It was terrifying! But actually, I did what I should have done. Maybe I could have listened to the chest with my stethoscope, maybe I could have felt a bit longer for a pulse. But none of that is in the ALS protocol, and at the moment I started CPR I genuinely thought he had a cardiac arrest. Actually, despite my nagging self doubts, I actually did my job properly.
And maybe next time, I’ll try not to remove any limbs during resuscitation.
News of the story spread quickly across the country. And, as always, certain details were mis-recalled, exaggerated, and lost as the story became a myth. I would go on nights out with friends at distant parts of the country and bump into other junior doctors. “Oh you work at Hogwarts Hospital, don’t you? I heard that a junior doctor working there broke someone’s legs doing CPR?!”
Not for from the truth I suppose.