Saturday, September 3, 2011

Sweet Escape

With the help of attendings, ICU nurses and ancillary staff, ICU interns, and the patient's family, he kept improving. He was tolerating more and more tube feeds all the time. His blood pressure was better controlled. We were weaning off pain meds. We were even weaning off the vent, to the point that he didn't even need the ventilator during the day!

We were doing less, and HE was doing more.

Finally, three weeks to the day, my patient was transferred to a skilled nursing facility! Yep, that means he had improved enough that he no longer needed our ICU. He still needed very close monitoring and still has some issues being addressed (but not life-threatening). But he's better, and he's alive, and he's got a long (but likely successful) road ahead!

On August 31, he was discharged. And on August 31, my current rotation at the hospital was over. I had succeeded. HE had succeeded. I had saved a life! I don't think I really took credit for it until I spoke with the accepting physician at the new facility. The day prior to his leaving, I discussed all of his injuries, current treatments, etc with his soon-to-be primary physician.

I had to relinquish care! If you only knew how territorial I had become! I even told my chief when I had my days off to avoid messing with him too much. This was MY patient. My chief never had to see him until four days into his stay, and only saw him a couple more times while he was in our hospital. Otherwise, it was me and the ICU team (attendings, interns, consultants, RTs, RNs, etc) getting this guy through.

After relaying all of his primary injuries and findings during our initial visit to the operating room, her response was "So basically, he should have died?". At that moment, I realized, had we not intervened on time, had my attending not helped me through his first ex lap, had neurosurgery not placed the bolt, had we not watched him like a hawk night and day...he would have died. He could have died. But, the only thing I'll correct about what the new physician said, is that he certainly SHOULDN'T have died. And he didn't. Personally, I count this as MY first big save (obviously not something I could do by myself but you get the gist). I feel proud. Most of all, I'm reminded why I gave up a life in dermatology (working maybe 40 hours a week with minimal call) for surgery (working 60 hours a week plus with frequent, stressful call). It's those moments that your patient's father's eyes well up with tears and all the ICU nurses come by to say their goodbyes as your patient leaves for the next step. That's why I became a surgeon.

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