Condition: Guarded

1/13/2010
Day 8 part 2

Right after I posted the last entry I had a feeling I should go back over to the hospital and check on Jane. My team had kindly kicked me out of clinic earlier in the day around 3 pm so that I could go home and sleep a little. All I could do, though, was mull over Jane’s case. And I figured afternoon sleeping was the last thing I need now that I’m recovered from jet lag and have a quasi-normal diurnal-nocturnal cycle. I headed over to the ICU around 6 pm to find it all a-flurry around Jane’s bed. She apparently had been looking worse since around 4 pm, unable to maintain her oxygen saturation with the face mask at maximum capacity. I walked in to find my peds attending, 2 anesthesiologists, the ICU resident, and the ICU nurse preparing her for intubation. They looked up, saw me, and asked if I wanted to do it. There no time to contemplate, and I moved up to the head of the bed and took the reins.

The good news is that I intubated her without difficulty while 10 pairs of eyes stared me down. The bad news is that now she’s intubated (and I learned that the extubation rate here is actually 30%, not 50% as I had thought). I am very worried she is going to die soon. That just seems to be the way things go around here. At Swedish, I often struggle with not really knowing a patient’s prognosis and being hesitant to give them any kind of timeline for end of life. Patients back home often surprise us and outlive their prognoses. Here, though, it is much more cut and dry. If you are sick, getting worse, and we don’t know why (which is frequent given the paucity of diagnostic capabilities), more likely than not you will die in a few days.

I am filled with mixed emotions. She looked so frightened right before intubation (I would too if 5 large white people were coming at me with crazy medical implements) that I nearly cried. I am worried for her and her family. But at the same time, I am proud of myself for diving in and not having the opportunity to second-guess myself or pass off the opportunity to someone more experienced. Afterwards, the ICU resident said to me, “How many intubations have you done in Sweden?” (I am STILL reminding people that we are not actually from Sweden) I said, “um, none.” He was quite impressed, and I have to say it felt pretty darned good. It is really a privilege to be able to do medicine in a place where you just have to step up, trust yourself, and go for it.