Arzhang’s Blog

2:30 AM

The night was going smoothly, the numbers of pages were few, yet the whole day I had this unsettling feeling.  Perhaps it was a lack of food.  I decided to order in.  I looked at my watch seeing it was around 1AM.  Even though it’s NYC even here the options on the Upper East Side are limited.

I decided to order some pizza from the only pizza joint that was open to deliver.  A half hour later the pizza man delivered my slices.  I walked down the dark halls of the hospital going to the front door to get my food.  I went back to my call room.  The slices were half cold, greasy.  I didn’t care.  It was late.  I had barely eaten.  I ate the slices feeling a bit of regret as the nausea had started to set in.  I was tired, still with an unsettled feeling in my belly.  I figured it was the food.  I hadn’t gotten any significant calls that night.  Things were going well.  I lay on the old, squeaky bed in the cold call room.  My eyelids were growing heavy, maybe I would get some sleep.  Just as I was about to dose my pager started buzzing.  I tried to open my eyes, clumsily dialing the number.  The nurse on the other end had a scared, cold tone: “The patient’s heart rate is in the 20s he is unresponsive.”

I ran out the door down the stairs trying to figure out what i was giong to do.  I was tired, confused, anxious.  As I walked to the floor it was official “Team 7000!”  It was a code.

A frail 80 year old African American man with a curly white beard lay unresponsive in bed as the nurses started putting an oxygen facemask on him.  I quickly grabbed the pacer pads to put onto his chest.  His heart rate was in the 20s.  I was confused, half thinking it was a dream.  Perhaps I was dreaming all this, I was just lying down a second ago.  Yet the look of urgency on everyone’s face told me this most definitely was not a dream.  The senior residents came rushing in.  One quickly started a femoral line.  Just then someone yelled, “I don’t feel a pulse.”

I did what was reflexive.  I started doing chest compressions.  My angle was off, my body tired, stomach naseated, I pushed on his chest.  I climed on top of the bed pounding down, feeling the deep crunching sound of ribs being broken.  I handed it off to my fellow co-intern.  Back and forth we went, each cracking ribs as we went on.

“I feel a pulse.”

He was back.  We called the ICU and waited for him to be transfered.  I looked over at him a breathing tube in his throat.  He had no family, some remote friend, maybe relative lived in Alabama.  Nothing.

I looked over only to see his left chest expanding like a balloon.  “Why is his chest like that?”  His lungs had been punctured causing air to leak around them into the subcutaneous tissue.  I quickly pressed down trying to force the air back into his chest.  The cardiothoracic surgeon came and looked in his lungs with the bronchoscope.  He had a tumor.  We knew it all along but it didn’t help his situation.  The surgeons put a chest tube to drain his lung.  A while later I dragged his bed to the ICU.  We dragged him through the dark halls, the same halls I was in a few short hours ago anxiously awaiting my food.  All the while to the ICU I was giving him breaths of air through the bag mask.

It was now 6AM and as I tried to collect my thoughts for the day ahead I realized my nausea had settled.  The feeling of uneasiness was gone.  I would like to think I knew that this was coming.  You never do.  You have an unsettled feeling, a sixth sense, mostly you have no warning at all.  Dinner at 2AM, CPR at 2:30AM.  Now it was time for a nap.  Luckily it was in my own bed at home.