e 3 a s h i g R E F L E C T I O N S

My First Cardiac Arrest

I have a confession to make. When I started my career, I somehow managed to go for 8 months in the hospital being a fully grown doctor and not taking part in a single cardiac arrest. If you are a doctor or soon-to-be-doctor and want to know the secret, here is what I did; 4 months of surgery followed by 4 months of psychiatry. Some will no doubt know that a surgical house officer (HO for short) is pretty much an upgraded version of a secretary. You are the team’s dog. You clerk in patients, fill out forms, chase results (that are going to come automatically anyway, but late no doubt), consent them for surgery, get abused by nursing staff who are unhappy with your consultants and SpR but take it on you and on occasions, talk to moaning families. You don’t really do any of the glamorous doctor stuff, you don’t save lives, and you certainly do not, in a million year, take part in cardiac arrests. Not even your SHO, SpR’s or even, God forbids, Consultant have anything to do with Cardiac arrests. For that - there is a crash team!

And obviously in psychiatry, needless to say, people rarely arrest.

I feel little shame in admitting that when I started my medical rotation, I probably knew less medicine than when I graduated from med school (which is very little medicine to start with anyway). Shortly after starting, I was on call. This was the second most nerve wracking hospital experience for me (the first being my first day in hospital). You really need to know your stuff to be on the medical on call team because you are a proper doctor. Even worse, being on call for medicine means you ARE in the crash team. If any forsaken heart in the entire hospital decide to stop (even when there are doctors around) its your responsibility to ditch whatever you are doing, run as fast as you can, use the magical powers bestowed upon you by virtue of being in the crash team to shock the patient back into life. This is one part of hospital medicine that does look a bit like a TV show. When you start running from wherever you are, the corridors are suddenly cleared, people stop and move to the side to give you space to run. Sometimes even there are people at junctions ushering you in the right direction “this way doctor”. Unlike TV shows however, you rarely do get anyone back into the fullness of life once they arrest.

My hospital has this bizarre Crash Bleep system that they don’t tell you about when you start. If it is a normal call, it goes “beep-beep-beep”. If its a crash call, it talks to you: “Cardiac arrest. B4. Cardiac arrest. B4″ except if it a cardiac arrest in Coronary Care Unit it goes “bebebebebebebe”. Now, why wouldn’t anyone explain that to new doctors I do not know. I was sat at a nursing station busy writing in someones file at 2:00 AM when the crash call came and a strange “bebebebebebe” filled my ears. I didn’t even know where it was coming from. “What the hell is that”. “I think it is your crash bleep, doctor!” one nurse exclaimed. “Oh SHIT - WHERE?” and started running towards the door. Luckily I heard someone say behind me “CCU”. By the time I got there (almost having a heart attack myself), my SHO, the NP, and two nurses were busy putting tubes and needles into the patients while the SpR stood at the side issuing orders and going through the patients’ notes. I honestly did not know what to do. I was kind of shaking inside but managed to stand frozen looking at my SHO and waiting for her to rescue me from how dump-folded I must have looked. To the rescue she came indeed: “We need ABG’s. That would be…” and she moved her eyes around the room looking for a pair of free hands (I now know that was an act) and then fixed her eyes on me and continued “.. YOUR responsibility”. Bless her. She saw right through me and she knew I didn’t have a clue. I mean, every doctor knows what they should do in a cardiac arrest but there were many people there and what a HO should do is not really clear. Should I intubate? stick needls? take over the defibrillator? administer drugs? asses the patient? There were already more senior people present (and thank god for that) and even the least qualified nurse in CCU knows more about the heart than the best new HO so the military hierarchy of hospital ranks goes down the drain. The roles get quite blurry in the real thing.

When I grew up and became an SHO myself, I used the exact same line on my new shaken house officer. “We need ABG’s and that is… your… responsibility” and with a smile thought to myself “We’ve all been there”.

PS: This post dedicated to Nadd for requesting more hospital anecdotes.