Friday, August 22, 2008

Accidentally on call

(Which, if you didn't know, is a reference to this song. Good song. Weird video.)

So I got home today around noon. I didn't have any patients scheduled, so I went in for lecture, did some stuff, called some people, faxed some things, and then left, because, why just stick around? I got home, played with Maggie, checked my email, and, well, I was just going to lie down while I watched TV...well, maybe I'd take a little nap...

I woke up when Fang called me at 3:30. Poor guy's been sick as a damn dog all week, and was supposed to take call tonight. And he'd been feeling better, know, as those things often could I take his call tonight?

Of course. Except, because he woke me up, "of course" turned into "Yeah, yeah...sure....okay, wait, what time is it? Oh. Um, yeah, of course I can, yeah. Wait, um, let me think about what I, I, um, have to get some stuff together. Yeah. Okay. Let me do that. I'll be there by 4:30. I think I will. Yeah, okay..."



I figured, what the hell, right? It's not like I had anything else pressing to do with my Friday night (sad, I know). I'd had a nap. Plus, I'm on with Renee tonight, so, that can't be bad.

It started out as one of those nights that was weirdly busy - like, there's still only one person on our call sheet (but there's two more in the ER we're going to get called on), but, that totally undeerrepresents the amount of work we've had tonight. Between the crisis pager, floor calls, other random shit...lots of fires to put out, stuff up in the air, etc.

And then, as my friend Barb would say, then the bulldog showed up.

So, I'm sitting in my office, finally eating my dinner that I had to order twice (because they somehow didn't get the order the first time), and I hear this tiny little voice in the distance...and it seemed to be saying, "Adult Rapid Response, 3 Neuroscience". Over and over again. A rapid response is like a step below a code blue. And the Neurosciences hospital is the one in which I live, er, in which all my patients are contained (psychiatry has floors 1 and 3-5; Neuro has 6 and some clinics on G. So Neurosciences. Plus, the ER's in the basement). So, I thought, wow. Shit. I probably should go. And so I open my door and Renee is standing in the hallway about to knock.

Turns out this is her very first rapid response.

So we hurried upstairs (you run to a code. You move quickly to a rapid response while hoping the medicine team will beat you there) and this patient of Ruthie's had a seizure. So he's lying on the ground drooling, having fallen out and conked his head on the chair on the way down (and yes, I did use the words "fallen out" and "conked" when conveying this to the medicine team that showed up. It's how we roll in the Dirty South). We got an IV started, we ordered some tests, we got him off the floor, etc. We fussed around like we knew what we were doing (and, okay, on this one, I actually did). I argued with neurology over whose service he should be on (theirs. But, knowing the resident on call as I do, he wasn't going to take him. And he's probably in better hands on our floor).

And then, right in the middle of all of this pandemonium, Renee grabs my sleeve and says, "Hey, can you help me with this?" Dr. Morgan, who supervises my psychotic disorders clinic, had paged her to find out some information on a patient from our clinic.

She killed herself tonight.

Apparently, her husband called Dr. Morgan at home (how he got that number, I don't know) to tell him. Dr. M was calling to get some information from the records from our ER. We couldn't find her in the ER census. We called the ER; they didn't know about her. So I called Dr. Morgan back, and it turns out she never made it to the ER - she was dead at the scene. I don't know the details, but it was like a bucket of cold water.

Wow, I hate it when they do that.

It reminded me of the first patient I disconnected from life support at the Emerald Palace (have I told y'all this story already? I can't find it, but I didn't look very long, either). I was on my ICU rotation, and this woman came in having run her car off the road. Her abdomen was still open because her liver was hamburger and she was too unstable to do anything but pack off her liver and run her up to the ICU. There's actually a much longer story attached to this event, but the short version is, her family finally faxed us her living will (which was handwritten and signed with a peace sign and a heart before her name - peace and love), and they decided that they didn't want to come in, because "that wasn't her anymore." Well, maybe, but she'd only been in the ICU a few hours and this was sudden and unexpected. And I wrote the order to turn off support, and then I walked into her room. And the nurses were like, it's okay, this could take a while, we'll call you when she's dead. And I said, no....someone needs to be with her when she dies. And the social worker overheard this, and he came in with me. And I held her hand as they turned off the vent and the meds keeping her pressure up and she didn't even try to draw a breath. It was over in less than two minutes. Quiet, peaceful, just like that. I pronounced her. I turned, and I walked out of the room, and I filled out my paperwork (there's always just so much paperwork), and I called the medical examiner (with whom I would be on a first name basis by the end of that month. I was the friggin' Angel of Death that month, I swear to God...).

And then I went into my call room, curled into the fetal position, and bawled like a frightened child for three hours. Or until I had to be a grown up again.

I can't imagine dying like that. Alone, in some big sterile place, with some strange woman holding my hand because she didn't want me to die alone. Not that I would begrudge my family for not coming - they were right, that probably wasn't really her anymore. But it still felt so...discarded. Oh well. What's for dinner?

I remember looking at her chart later and finding a whole bunch of psych notes, talking about her depression and including one admission for suicidality. And I felt this chill run down my spine.

I tried to convince myself that, because she'd had her dog (who, by the way, came through this whole crash unscathed, at least physically) in the car with her, it couldn't possibly have been a suicide attempt. But I still don't believe that. And I guess we'll never know the truth of whether or not it was,, I just don't understand.

I had that same feeling tonight, trying to deal with this issue in the vacuum of the expanding chaos that surrounded me on the unit right then. That same cold emptiness and confusion at the pit of my soul that I felt that winter night in the call room. Except it was more solid and contained, because I was still the person in charge, I was still dealing with the seizure guy, I wasn't in the quiet solitude of my ICU call room. Or severely clinically depressed, like I was that cold November day.

It's 1:15 am now, and I'm still dealing with the seizure guy, in case you were wondering. All sorts of fussing. It's ridiculous. I think I finally have it straightened out, but I think I'm giving up and going to bed soon....

All I can hope is that Ms. J found her peace today. That she's liberated from her pain, and her voices, and the demons that haunted her. I can only hope she's in as beautiful a place as we all hope to find beyond this life. And I hope that where she is, her husband, her children can finally understand, have moved beyond their grief and resentment and confusion. That she's finally free in the arms of her God.

Rest in sweet, sweet peace tonight, Ms. J.


penguinshrink said...

Damn. ::hugs::

Barb said...

God Damn, Ralf.

God damn.

(I'd been spelling it wrong all this time.)

Anonymous said...

Do you get in trouble when they kill themselves? I hope not.

DK said...

P - thanks, hon.

B - Really? Ralf? That's sort of unfortunate...

D - no, fortunately. She wasn't actually *my* patient, either. The sad reality is, often, if they really want to kill themselves, they're going to....