This is from the twentieth chapter from my best-selling book, Bryson City Tales. I hope that you’ll enjoy going back to Bryson City with me each week, and that if you do, you’ll be sure to invite your friends and family to join us.
FISHER OF MEN (PART 1)
Louise and I were completing our paperwork on a minor emergency we’d just handled in the ER when we heard someone moving quickly up the hallway toward the nurses’ station. Carroll Stevenson, the head technician of our radiology department, came into view and announced urgently, “Louise, the rescue squad’s bringing in a full code from Fontana Village.”
Don and Billy soon appeared, with a heart attack patient in tow. As the gurney came through the door, I saw a stocky man alongside the rolling stretcher, performing chest compressions on the patient.
“Louie,” Don shouted, “John had this controlled with nitroglycerin and morphine before we arrived, but now the patient’s not responding.”
John Carswell was the head of security at the Fontana Village resort and a trained paramedic. He handled most of the resort’s medical emergencies until the county rescue squad got there—nearly a forty-five-minute drive down the winding road on the south shore of Lake Fontana, a deep lake that began at Fontana Dam and ended where the Tuckasegee River flowed into it at the western outskirts of Bryson City.
Don continued the patient’s history as he and Billy guided the gurney into an ER bay. “His name is James. He’s sixty-four years old. According to the wife, he has a known history of coronary artery disease, is status post two MI’s, and has mild con- gestive heart failure and stable angina. No hypertension or diabetes. He’s never smoked. Strong family history of heart disease. His last MI was one year ago. Takes Lanoxin 0.25 mil- ligrams a day, Inderal 40 milligrams every eight hours, Isordil 10 milligrams every eight hours, and sublingual nitroglycerin PRN. He’s had no cardiorespiratory symptoms in months, was at Fontana for a family reunion. After supper he had a sudden bout of severe chest pain, broke out in a sweat, vomited, and then fainted. Carswell was first on the scene.”
John Carswell and I quickly greeted each other as he con- tinued the chest compressions and elaborated on the history.
“Doc, when me and my boys got there, the family had started CPR and had put a nitroglycerin tablet under his tongue. I called for backup and for the rescue squad. Normally we’d have called for a chopper out of Knoxville, but the fog was just too bad tonight. Had to transport by road.”
John paused, almost as though he knew that a long trans- port dramatically reduced the patient’s chance of survival. “Doc, when I got to him he had no pulse or respirations, but his pupils were reactive. I started an IV and some oxygen and took over CPR. After about ten minutes we got a pulse, and then a few minutes later he began to cough and to breath on his own. His BP was 60 systolic, and then he woke up. He was complaining of a lot of chest pain. We gave him another nitro under the tongue and a small dose of IV morphine.”
Don took over the story. “Then we arrived, Doc.” He gave me a brief summary as the team continued its work in ER. “We titrated morphine for the pain, which helped at first. We loaded him into the unit and took off for here. His family should be here soon. His systolic actually climbed to 80, but we could never get a diastolic. Then, about fifteen minutes out, he began having severe pain and became diaphoretic and nauseated. His BP and pulse got really low. I gave him another nitro and some more morphine, but he went into V fib and then he coded on us. Billy was driving and John and I worked on him. We’ve shocked him twice with the defibrillator, but he never responded. We’ve been doing CPR for ten minutes.”
During the history, Louise and Carroll were helping to transfer the patient to the ER bed and hook him up to the monitors. Louise flew through a quick and cursory exam. I was surprised to see her doing this—in my training, it was the role of the physician. Was this local custom, or was it insubordination? I didn’t know, but almost in amazement I watched her perform the exam with not a single second or motion wasted.
“Pupils eight millimeters dilated and fixed,” she shouted, to no one in particular. “Extremities cool to cold.” She took a reflex hammer and quickly assessed his reflexes and pain response. “No response to deep pain,” she continued. Everyone on the team knew she was describing a dead man.
As Louise did the exam, the other nurses and the respiratory therapist arrived. In only seconds the patient was hooked up to the ventilator. The EKG monitor began to blink to life. It was just a flat line.
Despite television shows to the contrary, rare was the patient, at least in those days, who came into the ER in full code and who later walked out of the hospital. This one didn’t either. After working feverishly for forty more minutes, I called the code and pronounced the man dead.
Louise said, “I’ll call the funeral home. We’ll need an autopsy. The family is in the waiting room.”
“Thanks, Louise. Thanks, all. You all did a great job. I’ll go talk to the family.”
As I left the ER cubicle, Louise followed me out. She looked as though she had something to say.
She dropped her head a bit. “Dr. Larimore, I’d be glad to go with you to talk to the family—that is, if you need me.”
I thought this was an unusually sweet and thoughtful gesture. Yet, just for a moment I became suspicious. Doesn’t she trust me? Doesn’t she think I’m capable—that I may not do it like an experienced doctor? Then I thought, Has she been asked by the older docs to spy on me? Is she looking for evidence of my ineptitude? I quickly abandoned those thoughts. No, I concluded, she just was a good nurse who cared and wanted to help. At that moment my appreciation for her grew enormously.
We walked from the ER to the hospital lobby. We had no ER waiting room per se. Although the lobby is normally full during the day, at this hour it was empty.
I walked slowly, trying to gather my thoughts, rehearsing my lines—lines given so many times during residency, lines so very difficult to render with care and compassion, lines always rehearsed, at least by me, at the same time as prayers for wisdom and strength were silently whispered. These moments are never easy for the doctor—or for the family.
I introduced myself to the family. “I’m afraid I’ve got some bad news for you.”
Then I paused. This was what the family had been dreading. Now their worst fears had been confirmed. Some cried. Others just looked numb. All were quiet—overcome by shock. I waited for any questions. None came—which isn’t unusual at such a dramatic moment.
- The Murder (Part 1); (Part 2); (Part 3)
- The Arrival (Part 1); (Part 2)
- The Hemlock Inn (Part 1); (Part 2)
- The Grand Tour (Part 1); (Part 2)
- The Interview (Part 1); (Part 2); (Part 3)
- Settling In (Part 1); (Part 2)
- First-Day Jitters (Part 1); (Part 2)
- Emergency (Part 1); (Part 2)
- The Delivery (Part 1); (Part 2)
- The “Expert” (Part 1); (Part 2)
- The Trial (Part 1); (Part 2)
- Shiitake Sam (Part 1); (Part 2)
- Wet Behind the Ears (Part 1); (Part 2); (Part 3)
- Lessons in Daily Practice (Part 1) — Anal Angina; (Part 2); (Part 3); (Part 4)
- White Lies
- The Epiphany (Part 1); (Part 2)
- Becoming Part of the Team (Part 1); (Part 2)
- Monuments (Part 1); (Part 2)
- My First Home Victory (Part 1); (Part 2)
- Fisher of Men (Part 1)
© Copyright Walter L. Larimore, M.D. 2017. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.