I really never liked taking call. Taking call meant I would be in the hospital, the only anesthesiologist in the building to cover any surgery, OB delivery, and respond to any emergency, like an in-hospital cardiac arrest, that might arise. I would always have 2 residents at my disposal and could call in a third if that were really needed, but that truly would be seen as a sign of weakness. More often than not it would be me that was deciding which cases were really emergencies and needed to be done immediately or which could wait a couple of hours so we could empty an operating room and make room for the next add-on case.
Weekend call was particularly ugly because when you were on weekend call, i.e. Saturday or Sunday, you did a 12 hour shift – 7:00 AM to 7:00 PM; 7 PM to 7:00 AM. You never really knew what might cross your path from one minute to the next.
Late 2013 early 2014 was quite a memorable time for me. In September of that year I underwent heart surgery to repair my mitral valve which had ruptured. The fancy word for the condition that led to my bum valve was a myxomatous valve – a degenerative heart valve – interestingly, my twin brother had exactly the same problem in exactly the same valve which was diagnosed about a month after my diagnosis that we had both been born with. After years of faithful service the little tendons holding the valve in place had given way and my valve was leaking significantly. Over the 6 or so weeks prior to me surgery I had been having less and less energy. It seems my valve had failed and only about 1/3 of the blood my heart was pumping was actually going forward and the rest was going backwards, the wrong way. I guess it was no wonder I was a bit tired. Anyway, rather urgently I was schedule for surgery, which went rather uneventfully thankfully. I spent about 8 weeks recovering and then could return to work on a limited schedule. At 12 weeks I was allowed to ride my bicycle again, so began riding it in to work. Of course winter had started, and I think on the 3rd day of riding my bike, it slipped out from under me right in front of the hospital and after about 5 hours of trying to ignore the severe pain in my elbow went down to the emergency room and was found to have a fracture of my ulna at the elbow. I was out of commission for several weeks again, but by early March I was back to working full time once again.
About 2 months after I was back full time I found myself doing a Saturday call – ugh! Started at 6:45 AM. Had to do a number of labor epidurals, a cesarean section. The main operating rooms were pretty quiet. My resident and I were well in to the afternoon when a call came in that a patient needed intubating in the ICU. I was always cold when I was on call so I had the usual operating room scrub pants and short sleeved shirt on, but in addition I had a long sleeve scrub jacket on as well. I contacted my resident and we were off to do what we do best. It took us about 20 minutes to get there, get the patient intubated and tucked in. The resident stayed to finish up and I headed back to my little call room/office.
As I was walking through the medical ICU the intensive care doc who was in that unit, a very nice woman whom I had worked with for many years, stopped me and said she needed a consult from me. She told me she had a relatively large gentleman who had been in the unit for a number of days, was on intravenous medications and they were struggling to manage his blood pressures. They had tried to put a special IV (an arterial line) into one of his arteries in his wrists and arms so they could monitor his blood pressures second by second, but were unsuccessful. She was wondering if I had time to try to slip an arterial line in him someplace.
With all the confidence in the world, since this was one of the things I was particularly good at, I said “sure, have you tried putting one in the top of his foot”. She said, “what, never heard of that”. It is not unusual for anesthesiologists to be asked to put an arterial line in for the docs in the ICU, but we would generally be asked only after they had destroyed nearly all of the potential sites, so over time we usually get very good at finding that very small artery in the top of the foot and became skilled at getting a line into it. So I told her, “I would be happy to try”
She showed me to the room. It became apparent the guy was in a bit of trouble. He apparently was no longer able to control his body temperature so he had a special blanket that was blowing warm air over his body, called ‘The Bair Huggler’, so the room was noticeable warm when I entered. In addition, he obviously had some kind of very communicable ‘bug’ because anyone entering his room needed to put on a personal protective gown, gloves, and mask. That did not strike me as unusual or worrisome, many of the patients anesthesiologists were asked to help with would be in very similar conditions.
I quickly put on a surgical cap, an insolation gown, gloves, and a surgical mask with a built in plastic face shield – lol, I felt quit at home actually.
I gathered the required supplies. The bed was in its highest position for some reason, so I simply got a stool, brought it to the end of the bed, sat down on the stool, uncovered his left foot, laid out my supplies and set out trying to find his artery with a special little pencil doppler that would produce a whooshing sound every time the tip of the device passed over the artery. The small artery in the top of his foot was easy to find. I marked it with a pen, and put the tips of my fingers of my right hand over top of the artery and felt a very nice pulse.
Just as I was getting ready to insert the arterial line I started feeling a bit odd – it is hard to describe, but, dizzy, ringing in my ears and an usual feeling in my chest. Following my surgery I had several episodes of atrial flutter. Atrial flutter was an abnormal heart rate that I hadn’t tolerated well and one that can cause my blood pressure to drop low enough to cause me to pass out. I remember being concerned that for some reason I had gone into a similar rhythm.
Since I was concerned that for some reason I had gone in to atrial flutter I decided to lean back and take a few deeps breaths. I was sure I could make it go away, after all I am a doctor! As things didn’t seem to improve I remember reaching down and trying to take my own pulse to see if it was exceptionally fast or irregular.
In the next second I remember I had an incredible feeling of warmth all over my body. I was aware of a very blurry bright yellow light but above me. I could hear voices but wasn’t able to clearly see anyone. The voices seemed to project a concerned tone but I didn’t really understand what they were saying and actually I didn’t really care, where I was was wonderful. All I really remember was thinking I wish people would be quiet and just leave me alone, I was so comfortable.
The first thing I actually remember was finding myself lying on a gurney in the emergency room not really knowing how I gotten there. One of the anesthesia residents was standing at the side of the gurney near my head next to the attending anesthesiologist who was to take over for me at 6:30. My replacement was talking to the intensive care doc whom I had been helping in the ICU. He turned to the resident and said that he needed to get back upstairs to the OB floor but… and then pointing his finger right at his face … said to him, “do not leave Dr. Ross’s side until all of the tests come back and you report the results to me, you understand!” “Yes sir!”, was his answer. I was still a bit confused by all of this. I knew I must be the Dr. Ross they were talking about but not sure why.
I think I napped a bit and then all of a sudden there was Sue, my wife, standing by my side. She was talking to the ICU doc and the ER attending. I was finally alert enough to understand what they were talking about. They were unsure what had really happened, either I had gone into an abnormal rhythm or I simply became ‘vagal’, a term for when ones vagal nerve goes in to overdrive and slows your heart so much that your blood pressure falls and your pass out. To make sure it was not related to my heart surgery they chose to send a few cardiac labs and observe me in the emergency room for a couple of hours. Through most of that time the resident assigned me stood faithfully at my side until the relief anesthesia attending came back to the emergency room and released him.
While my wife and I waited in the emergency room I had a chance to ask the ICU doc what had happened – was a bit embarrassed by the whole thing actually.
She said we had both gone in to the room, she went to one side of the patient while I was setting up to put the line in. As I was getting started she looked over and thought something odd was going on with me. I looked pale to green and was sweating like crazy. She said she looked at me and said, “Brian, are you OK, you look like hell”. I looked up at her and said, “bbblllll, aaaa, blg blg blg, or something like that, something completely unintelligible ”. She knew that something was happening and as she walked toward me she saw what looked like I was taking my own pulse. She asked, “Brian, are you taking your own pulse? !” I responded with a similar unintelligible response as when she asked if I felt OK. As she got to my stool I fell off my perch and she caught me part way to the floor. Because she knew my history of heart surgery she asked that a code blue response be activated. Like I have said, I have just a few fleeting memories of lots of voices and noise, a bright yellow light, people pulling on me, and an overwhelming feeling of warmth. The code response explains how the anesthesia residents and my relief attending got involved. Sue asked the doc if the patients family was there, if they were concerned about something bad going on with the patient. She said the wife told her she was confused a bit. She knew that the ICU doc had asked another doctor for assistance and that I had gone in to her husband’s room, but she was confused when everyone went running in to the room and then they were hauling one of the doctors out on a stretcher.
The day ended by Sue taking me out to the car and announcing in as gentle as voice as possible she was getting tired of meeting me in and taking me home from the Emergency Room!
Brian's Blog 