Author Christopher Yerington
The patient in the preoperative area had been a nurse at this hospital. She told me that she remembered me since I was an intern in the same hospital. She was so happy that I am her anesthesiologist! I vaguely remembered her despite all these years. She joked with me about my “innocent” attitude … when some young nurses called me to the floors to “control” the patients in the middle of the guards at night (to get an order from Tylenol) and she laughed, “Honey , they just wanted to talk to an attractive boy! “
Judge for yourself, it was 20 years ago:
Young, I was, attractive, I do not know.
The surgeon entered the pre-op room and said that we would perform local anesthesia for this procedure because her kidneys and liver were “in poor condition”.
I had just finished telling her that. We smiled at each other as the surgeon walked away after signing. Now I remembered her more clearly and her smile that did not leave you indifferent. I gave her very little sedation, maybe 20% of a light sedation dose.
She was a “pro” of surgery. This was her 38th procedure in just three years. Bad kidney disease This one would be a little painful. The surgeon will try to remedy the blocked traffic by restoring the flow in her arm. I gave her extra medicine, but in doses for baby. Total time, 45 minutes, we were done and she was motionless and silent. Once the operation was over, we removed the surgical blue sheets. The operating room team was on site and we spent less than a minute on the recovery bed.
I would normally have plugged all the same anesthesia monitors on it for transport (I was very riding about it, very litigious about the proper processes and I followed them to the letter), but we were in the room. just outside the SSPI. It was less than 10 meters from where she was physically. It was not a general anesthetic. I put the oximeter (as always) and it had between 86 and 87% of sat- that is not great then … I added O2 to 3 L / min via the nasal cannula – it took a while because the O2 bottle in the cart was almost empty, so I had to take a new one in the back of the operating room. I also thought about the electrocardiogram and the blood pressure monitor, but since she did not have a general anesthesia, I had the “feeling” that it was better to wait a bit with her so the Nurse and I decided to wait a little while she became a little more awake before moving.
A minute passed. We just waited calmly. The pulse beep was steady.
One more minute. I remember being totally calm at this moment. Oddly calm. Years later, I still remember this calm and I talked to my wife (she is also anesthetist) several times.
Brandi, the room nurse said to me, “Chris … I …”
I came out of my thoughts suddenly, I had already understood what was happening when Brandi began to speak … something was wrong and my hand went to her jaw. I lifted her chin to free her airways and tried to feel her breath on my hand. I hurriedly put on my stethoscope and put it on her chest.
I did not hear anything ! I listened more carefully. Thin. I grabbed it and returned, then tapped on it – the sound blew my eardrums!
The stethoscope back on her chest … “Chris, she does not breathe. “
“Brandi, there is no beat. Go get help and the trolley. Start the blue code. “
When you announce the blue code in the operating rooms, EVERYTHING is literally already in the room or just outside to maximize chances and people arrive in seconds. We started the Advanced Cardiopulmonary Resuscitation protocol and I intubated it in 2 seconds, the respirator was set in less than 5 seconds and the CPR could begin.
The surgeon returned to the room and said a few words, followed by: “Stop. Stop everything. She has a Non-Resuscitation Order. “
Oh no. How could I not be aware!?!
He said, “She changed it this morning. I knew it, but it was a private case … following the visit to her doctor. He paused as if reading something in the file. “We had surgery, I mean … I mean we did it to calm her pain in that arm. Long pause. ” What happened ? His voice became strong again, on the verge of anger.
” I am not sure. Her saturation was 86% with a heartbeat but when I listened, it was not a case of asystole. I do not know what happened. I do not know. My voice was louder now.
We stopped. I took out the breathing tube. The surgeon noted the time of death and then went to see the family. We did what we usually do, clean and dress the body. New sheets. Everything has been cleaned. I had never really thought about it but watching things unfold, I was kind of comforted. I also felt a little disoriented. Had I messed up? How?
I filled in a lot of paperwork and then headed for the recovery area called the SSPI (Post-interventional Monitoring Room). My next case was transferred to another operating room with another anesthetist. I took a look at the case, the nurse made a thumb up. I closed the door. I checked my previous case to free others. Signature done, I searched the file of my deceased patient by asking me how I had missed the damn ONR (Do not resuscitate or Order of Non-Resuscitation).
The surgeon came to see me, he came in my back, put his hand on my shoulder and said, “The family would like to see you. No emotion in his voice.
My mind was frustrated because I did not make a mistake, my heart was heavy because it hurt to lose a patient, no matter the patient, no matter the circumstances … And now, I have to go face the family , which the anesthesiologists do not do, even in the event of death in the operating room. In general, the surgeon manages the family and the different questions. I had been working in palliative care for a while. I was good at patient-family interactions, even in tragic cases.
They were nine in the waiting room … way too much to fit in one of the small conference rooms. The daughter of the deceased patient, her spitting image, barely thirty years old, approached and … arms outstretched … embraced me. Gently, she says, “Thank you for being here with her. Thank you very much “in a whisper. She squeezed me hard and I felt my chest tighten inside by reflex, I was confused and moved.
The other members of the family approached during the hug. I was enveloped by … love, that was it … love. When they had finished with this hug, I stood there, a doctor all in white surrounded by nine members of the family all in black. It was almost as if I could all see each other, as if I was looking at the ten people from above.
So it was not the patient who said something that hurt me inside … it was her daughter:
“My mother told me about you 10 years ago. She would ask these young nurses to call you for little things because you always get to see her and you care. I was so confused inside by what was going on. I briefly thought that maybe I was in a dream. I had tears in my eyes.
I recognized her daughter at that time, she is a nurse in the intensive care unit. She kept talking, very calmly, “I checked who would be in the room with her and when I told her it was you, she was so happy. Mom had seen angels all day yesterday. She changed her ONR because she knew she was going to die today. She said it was going to be with you. She said she was ready. She said she was happy. She then cried. I cried. I cried even more. They hugged me. I felt deeply confused.
They said “thank you”. When it was over, I was left stunned by the depth of what had just happened and by my human limitations of understanding this journey called Life. I felt myself go away and I entered the elevator. It was empty. When the doors closed, I cried and at that moment a small piece of me that I had built for years to be strong, waterproof and resist the difficulties of medicine … had just died.
This part of me never came back, I never rebuilt it. After this case, I felt more. More of everything in life. Over time, this has made me a better doctor and perhaps a better man.
To date, it’s been a year … exactly one year, that was my last day of operation as an anesthetist. My left arm failed, my left hand stopped working properly and a few months later I was forced to admit that it was a permanent disability.
I have cried many times for losing my career, but I do not think I have been so deeply emotionally touched by something as true as this girl’s words that day … I felt so small in a world that I may not understand despite my education and dedication. I was so small.
Whether you believe or not in something superior to the human in the universe … the universe sometimes shows you things that can not be asked and do not need to be explained to this part of you are more than what the mind and body can not understand … something deep in us appreciates and learns from those moments … and sometimes even, yes, a part of us dies in our life so full.
Dr. Christopher Yerington
Bio: Having retired as a clinical anesthetist due to a disability in 2010, Dr. Yerington put his love of teaching and serving others to his family, colleagues and the community. He speaks, exchanges and educates various medical groups and directs programs on the importance of major disability and disability insurance, as well as basic medical and financial skills and a fair balance between work and private life. Chris also helps and advises young doctors on stress, burnout and suicide in this area. After studying law and business schools, Chris remains a lifelong student of human life, a scientist and an optimistic futurist in his heart.