Just a normal day
It was August 2011. My first week 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. There was no response and they beckoned me over.
My heart started pounding. I didn’t even know the poor guy’s name. “He’s not one of my patients, I’ve never seen him before” I thought to myself, panicking internally. I asked the nurse his name.
“Mr Weasley? Can you hear me Mr Weasley?” Still no response.
I’ve been trained for this
It’s OK, I’ve been trained for this. Try to keep calm. ABCs.
A. Hmm A? A?! Airway. Phew yes. Airway. His mouth is open. I take a quick look inside, but there’s not much to see. His airway appear to be patent. 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. Bollocks. I left my stethoscope back at the nurses’ station. No time to go and get that now. There doesn’t seem to be much respiratory effort. His chest isn’t moving. I can’t feel any breath on my cheek.
‘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, pleased to have something useful to do.
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! I look around. I can’t see any doctors . Oh. Now I realise – she’s talking to me. I’m the doctor. It’s only been a few days and it still hasn’t sunk in yet. ‘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, then… 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. I stare down in disbelief. What is going on here? Then I’m distracted again. My foot feels warm and wet, and there’s a vaguely familiar pungent smell. I look down at the floor to see a yellow puddle. I can feel my heart pounding and hear a rushing in my ears. I’m becoming very hot. My brain just can’t put together all this dissonant information.
Wait a minute… I know what’s happening here. This is 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. I forgot about the wet floor. I take a quick look down and it appears to be seeping up my trousers from my knees rather than down from my groin. Phew, at least I’m not responsible. Ron seems to have lost control of his bodily functions and who can blame him. He might have just died and now a 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. I pull up his t-shirt and begin chest compressions. The BeeGee’s “Staying Alive” rushes through my head.
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. Am I doing it right? Do I stop? Rather broken ribs than failed heart – I had better keep going. I manage a full 30 compressions, complete with 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 yelled. Shrieked even. 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. Dead people don’t usually vomit. That’s a good sign. And he’s doing it all over somebody else and not me, which is a bonus. I’ve been soiled enough for one day thank-you.
Then I notice a terrible smell. He’s suffering from faecal incontinence for good measure. He starts mumbling. He’s gone red in the face, and he’s trying to sit up. 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! An anxious looking, very sweaty new doctor, grinning gingerly, kneeling on the floor in a puddle of urine and vomit, the smell of faeces in the air, 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 contorted beyond the laws of physics. “Oh no don’t worry – they’re plastic.” I give the crash team a quick run down. Members of the team 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 various other nosey-parkers. In fact, everyone who works in the vicinity seems to be coming to have a look at the kerfuffle.
I get a sympathetic hug from another junior doctor, before they quickly realise they might have preferred not to. 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. Did I just do 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 particularly effective CPR!
The patient survives
Now the ECG splurts out of the printer. It’s completely normal. Mr Weasley is back in bed, sitting up. Perfectly alert. He says that 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 pulse even now – despite his current and obvious 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 junior doctors are all supportive, but also very giggly. Apparently this whole scenario is extremely funny. 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 like 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. A total of 16 ribs – 8 on each side – were visible on the poor quality film. All of them were broken.
The next day, his wife Hermione brought me a box of chocolates and a thank you card because I had “saved his life”. Ron and Hermione were so very grateful, and Ron 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 been the victim of a cardiac arrest. Despite my nagging self doubts, I actually did my job properly. In the months and years that have followed, I have realised that I did exactly what was expected of me, and events such as this are a common occurrence in busy hospitals. Much better to have a living patient sitting up in bed several minutes later, than a dead one and years of guilt along with some stern questions to answer as to why you didn’t perform prompt CPR.
Maybe next time though, I’ll try not to remove any limbs during resuscitation.
News of the story spread quickly. And, as always, certain details were mis-recalled, exaggerated, and lost as the story became a myth. I would go to visit friends at distant parts of the country and bump into other junior doctors at social events. “Oh you work at Hogwarts Hospital! I heard that a junior doctor working there broke someone’s legs doing CPR?!”
Not too far from the truth I suppose.