Heart Surgery in America: Wednesday 1.3
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24 Hours… of ECMO
Wednesday 1.1
@ 9:00 pm
Well it’s about that time. The PICU is closed for business, onlookers, rubber-neckers, and pretty much any visitors not directly related to your patient, are ushered away- and the staff is settled in for the long haul.
Typical “nesting” behavior…
To be in the PICU- organization is EVERYTHING. So each person has their own plan (always better than the rest of ’em) on how to renegotiate whatever mess was left to them prior, and shape it like clay, into something shiny and pretty to pass off to the next rabid clinician.
So when finally in the confines of your comfort zone, the reality of your patient’s condition manifests in reams of charting, hourly ACT’s, syringe pumps that need recharging or more medication, and the most “sacred ECMO cow” of them all- the I & O (Intake and Output).
We found ourselves in the midst of a campaign to get “negative” (in other words- take off more fluid in total, than the 4 liters the patient had received during the initial stages of the ECMO run). And as of tonight, we were starting to win that particular little battle.
A little here, a little there. 60 cc’s of SCUFF (ultrafiltrate from the “kidney”) removed per hour, active diuresis for the patient’s own kidneys, and a constant dialogue back and forth between the ECMO tech, the coordinator, and the patient’s nurse.
We verify, and then we really re-verify. It’s what we do…
@ 10:00 pm
A Father confronts technology and the life of his son …
It is an odd fellowship that we have with our patients. We surrender all of our passion for the preservation of life to that one patient immediately in front of us. It is a funnel we go through, and a 1:1 bond that borders on mother/child when in the PICU. The parents rights are always respected to the utmost ability, as long as it doesn’t conflict with the prime directive to ensure the outcome of your patient. (at least that’s how it usually starts).
But as you develop a relationship with those parents, something clicks and something changes. All of a sudden they emerge by proxy as a metaphor for you (if you are or ever want to be a parent) and your relationship with your child or loved one. It usually takes the oddest things that you and the parents may have in common, a school, a teacher, a friend, or time in the same military branch of service.
But there is always something that pulls and tugs away at that clinical security blanket we wrap ourselves in- so that we can maintain distance, objectivity, and professionalism. And then it happens …
You start to see it “through their eyes”.
That’s not to say that empathy is the first sign of the first crack in your professional armor. It doesn’t imply that all of a sudden you have been immobilized into paralysis due to a little bit of subjectivity creeping around the periphery of your basic code of ethics…
What it means is that your human. And so are the parents. And that you share the same concerns (the patient), and the same fears (patient failure to thrive), and it’s ok, because ultimately if a critical issue rears it’s head, all that training and repetition you have had? Well it works.
Caring does not mean you are in quicksand.
To fail to care is to fear to fail… That is usually what it boils down to. I think anybody that’s been here for awhile, can figure out how and when it applies (or has applied) to them.
