“When you get to Hell, tell them I sent you.
You’ll get a group discount.”
– Caleb in the game Blood2

That last call had been more hectic than usual. Three CPRs that night. The first two of which died with their hearts technically still beating, but not strongly enough to get the blood flowing to their owner’s brains. After 20 or 30 minutes (depending on my mood) if you still don’t have a detectable pulse or natural respirations, then you’re dead.

Page the God Squad, what they’re called here, to have a chaplain comfort the family. The Tall Man is my favorite “Father.” He’s the young one with the darkly dry sense of humor. His beeper number really is “6660″ … that guy is funny as Hell.

He’s not allowed to marry, have children, or have sex. What does he do besides tell families that their loved one has gone to a better place? No wonder he always looks gloomy and sad.

After I talk to the family, they call the morgue, in the basement of course … aren’t they all? They send up a steel slab on wheels with a large black or burgundy (the color of dried blood) covering. Then shortly thereafter they take their new guest to the morgue … sometimes for an autopsy, but most times not. Bag them, tag them, and slab them.

But wait, you exclaim, didn’t you say in that first paragraph that their hearts were still beating when you pronounced them dead?

Well, yes, but by the time they are bagged their cardiac muscle is probably too burnt out from the lack of oxygen to pump anymore. But, who knows, maybe their hearts were still beating, even after they got zip-locked up. It’s beating. It’s not. It’s beating. It’s not.

It’s like this … the heart is registering some electrical activity on the monitor, but if there is no pulse, then the blood isn’t going anywhere. Maybe there’s a massive blood clot in the lungs sitting there like an Ohio state patrol roadblock. Maybe there’s too much fluid around the heart squeezing it like a fist and not allowing it to pump. Maybe the person doesn’t have enough blood in them to pump around in the first place. There are other reasons, too. Whatever the reason, the blood isn’t getting to the brain. When the brain dies, and the lungs don’t work, then bang, you’re dead. All that epinephrine we injected will keep the heart beating a little longer than the rest of the dying body. The heart will get the memo soon enough.

But HOW can you pronounce someone dead if their heart is beating?

Okay, look at it this way. The Terminator walks up to you and rips your heart out of your chest. You see it beating in front of you. The blood drains from your head in seconds and then you’re dead.

Your heart is probably still beating though. You’re still dead. Lesson over.

……………………………………..

The first patient to CODE was talking to a neurologist about her headaches when she suddenly fell over in her hospital bed mid-sentence. The neurologist hit the red CPR button. The CPR Swarm was there in seconds, myself included.

She had the same problem I talked about above. Heart’s beating on the monitor, but you could have fooled the rest of her body. Someone else got there first but I get to do the chest compressions. Compressions are usually the job of the intern, the student, or the nurse. Nobody likes to do them for some reason. Eventually whoever is up on the chest gets tired and someone takes their place. When I get up there, I never tire of it. I like doing compressions, it feels like I’m doing something and I can see it on the monitor. Each time I press down on her chest it caves in a bit, as her limbs bounce in the air. I think the guy before me broke her ribs … or maybe I did.

In some states people can sue doctors who break their ribs during a CPR. I think if you save someone’s life in a CPR and they come back and sue you for breaking their ribs then you should be able to take their life back, in whichever way you see fit.

This one won’t be complaining of broken ribs though. She died.

Afterwards, the neurologist uncharacteristically hung around and said, “Well, at least we cured her headaches.”

He said it smiling, but his eyes were sad.

The second CPR was a renal patient. The only remarkable feature of that fatality was the fact the surgical resident, Ghastley, started berating the nurses in the middle of the CODE for not being able to find a suction catheter. Ghastley is a surgical resident in the same year as me (I’m an Internal Medicine resident). He is a gaunt skinny man who looks more like a weed grown in some subterranean cavern rather than a human. He also ordered someone to push calcium in the I.V. without knowing how high or low any of the patient’s levels are.

This one died too. Later my intern shows me the potassium/calcium levels after the surgical resident ordered the extra calcium. I ask him if we have a level before it was given, but to no avail. That’s too bad. I really wanted a reason to yell at him for calling stupid orders during my CPR.

<begin gross understatement>

I have been somewhat emotionally unstable this week

<end gross understatement>.

The third CPR was stupid. The guy practically woke up in the middle of it and he had a pulse the whole time. He lived.

Terminal Girl died the next morning. I’ll tell you about it next time.