Here’s a NSFL story for you.
I’m a young medicine attending making my rounds in the hospital; a code blue is called over head. I’m not on the code team that day (there’s a dedicated team for that), but I’m a hallway away and the code team is probably on the other side of the hospital…. i would hope that if my dad/mom were in the hospital dying and a code were called overhead, that a doc a few meters away would just show up rather than continue walking away (even if it weren’t “his job”), so i go in. We’re on a gen Med floor, there’s not a whole lot around.
I walk in and anesthesia is already at the bedside with a young surgery resident; never a good sign at our hospital since anesthesiologists are rarely sighted outside the OR (we’re a very large hospital with a lot of other folks who usually respond to emergencies/do difficult intubations…anesthesia only comes for the really really bad ones).
The patient is definitely not dead, but he looks like he’s about to be- his face is turning blue and he’s holding his neck gurgling, he is definitely losing his airway. This is a rapid response call, not a code (yet) since clearly his heart is still beating. Surgery resident fills me in, patient had recent neck surgery and was about to be discharged when he suddenly started complaining of sudden difficulty breathing. Based on his neck size, he’s clearly bleeding into his neck space, so he called anesthesiologist and his chief – good move, but patient is now rapidly decompensating (hence the code call). We’re trying to bag him- not going well, lots of airway resistance. Anesthesiologist already wanted to intubate, meds are reportedly on the way stat from pharmacy, but we needed them yesterday. Guy is gasping, oxygen sats are dropping, running out of options.
Surgery resident and i hold patient’s arms down. We tell him to stay calm and try to cooperate, we need to get the tube in now or you’re going to die. His eyes are panicked and wide, but he gives a quick nod.
Anesthesiologist tries to intubate him while he’s awake, we’re out of time. Can’t see anything, patient retching and writhing. Typical, that’s why we usually need meds. Abort first attempt, O2 Sats are down in the 60-70s. RT starts bagging again, Surgery resident is calling trauma chief, he’s stuck in a surgery with attending (surgery doesn’t routinely come to codes), i got a hand on his pulse. Sats are back up to low 80s, anesthesiologist tries one more time- gets a view of the cords, but there’s too much swelling past the vocal cords and he can’t get the breathing tube through.
By now patients face is a deep shade of purple and his heart rate is in the 50’s, this dude’s about to fuckin die. Bagging getting harder. I tell the surgery resident we need to prepare to do cricothyrotomy or something- this guy is going to be toast. First year critical care fellow shows up with the code team. Somehow still no meds here…it seems like an eternity, but it’s probably been <5 minutes at this point since all this started. Someone runs to the ICU to pull meds from a Pyxis machine, but that’s on the otherwise of the hospital, and these other meds are getting tubed over from the pharmacy which takes time….more than the 5 min we’ve already had.
Guy’s neck is huge now, we can’t bag anymore, still no meds, we’re beyond fucked here. Surgery intern is still the only surgeon here and the critical care fellow is new- no one has ever done a cric in this room.
No time to worry about that- we have to make a move or he’s dead. Somehow this poor bastard is still conscious- we each take a limb (there’s a lot of people here now) and hold him down. Surgery resident cant find cricothyroid space- too much swelling, we just need to evacuate the hematoma. Patient loses consciousness. Surgery resident looks confidently terrified (I’m sure we all do), he fuckin bibs this guy to evacuate the hematoma and find cricothyroid space- suddenly he’s awake again and thrashing on the bed, me and three large dudes are struggling to restrain him. His eyes are so wide- panicking, crying. He’s trying to scream but he has no air to scream so it sounds like a raspy squeak. Those eyes man. I can still see him staring, pleading. There’s blood everywhere, whatever was bleeding was (or now is) arterial. Coming out in spurts. Critical care fellow gets a finger in and clamps what’s bleeding; hematoma evacuated. But this guy is super fat, there’s blood everywhere, and he is still moving- no way to safely do the cric, not now at least.
Meds from pharmacy getting in- somehow only succinylcholine (a medication for paralysis) here at the moment. No sedative or pain meds here yet. FUCK.
Patient is going ballistic on the bed, can’t get a seal to try and bag, there’s blood everywhere. Sats still low, i can’t believe he hasn’t coded. I can’t believe he’s still conscious! Anesthesiologist orders to paralyze or he’s going to die just from inability to vent. He stops moving. Before we try cricothyrotomy with hematoma out, anesthesia wants to try and intubate again. Swelling less with hematoma out, he gets tube through. RN back from MICU, we have sedatives. Get the guy comfortable. Meds from pharmacy here. Sats are better, still bleeding like a stuck pig. We run him down to OR and vascular surgery meets us there, i leave him in the hands of my colleagues.
All that happened in like 15 minutes or less. All this happened at about 9AM, i still had another 10 hours of my day left to pretend like i didn’t just see some guy get his throat slit while i held him down.
Dude lived. Was very grateful. Remembered everything. I can still see his face as i held down his arms as they cut his throat to this day. I’m sure he has nightmares.
The point is this: if you work in medicine odds are you’ve been traumatized already, several times. I have a handful of fucked up stories just like this one, and I’ve only been practicing for 5 years. The difference with COVID is the added stress of self preservation and the threat to my family. That on top of the stress of people dying and not being with their families with the visitor ban has made it all the more difficult. But let’s not pretend like most of us weren’t already carrying some baggage, we just don’t talk about it.