Specialties & Topics
- Arthritis/Rheumatic Disease
- Breast Cancer
- GERD/Peptic Ulcers
January 31st, 2011
The Real Breathless CPR
Greg Bratton, MD
Residency is hard. The hours are long, the work is grueling, and, simply put, hospital food is not good. Many days, we, as residents, walk the wards in a lifeless haze – coasting on the wings of our white coats, our fuel tanks pointing way past empty.
During these times, we find ourselves sitting in wheelchairs that are stored in dark remote corners, questioning whether or not all of this is worth it. For years, our nose has been to the grindstone, and our minds have been focused. Back in high school, our internal compass always pointed towards the Mecca of Medicine. And no matter how hard our roommates or fraternities or coworkers tried to veer us off our path, we stayed true to the course. In one way or another, most of us have followed the standard pre-med algorithm to medical success:
Step 1: Convince yourself that high school grades matter and study hard.
Step 2: Go to a good college. “Good” being based on the science department and not the social scene or sports.
Step 3: Sacrifice fun (parties, vacations, dates, etc.) so you can maintain a 4.0 GPA.
Step 4: Do research because you hear “med schools like it.”
Step 5: Nail the MCAT by staying true to Step 3.
Step 6: Never lift your head from a book while in medical school, even if you’re in the bathroom.
Step 7: Convince yourself to postpone marriage and family because there is “no time.”
Step 8: Nail Step 1 and Step 2 by placing Step 6 on steroids.
Step 9: Get into a good residency program.
Step 10: Don’t sleep. Convince yourself that it’s a sign of weakness and failure.
Then, when you allow yourself a second to take a break, you see your friend who graduated from college with a 2.0 GPA is running his own business; the guy who cheated off you in biology class has now graduated from law school and is driving a Mercedes; and the girl who was clearly in college for her “Mrs.” degree has opened her own boutique and has a home decorating show on HGTV. Moreover, you see yourself: tired, unshaven and in need of a haircut, pale from not seeing daylight, 20 lbs heavier – thanks to late-night McDonald’s runs – and $200,000 in debt.
And just when you think you can’t take it anymore, you meet the patient in room 533.
Mr. 533 is a 59-year-old man who presented to the hospital with a past medical history of diabetes mellitus type II and with the chief complaints of chronic diarrhea and 55-lb weight loss during the last 6 months. Mr. 533 is a self described “pain in the ass” who refuses to go to the doctor “unless I am dead.” This time, though, he presented at the insistence of his wife and is not happy about it.
On admission, Mr. 533 was a well-appearing man who looked older than his stated age. His skin was wrinkled from years of sun exposure, and his hands were calloused from the wear and tear of manual labor. Other than that, his physical exam was completely benign. His labs were negative, but a CT of the abdomen and pelvis showed “enlarged lymph nodes involving the retroperitoneum, pelvis, and the inguinal regions bilaterally; possibly due to a metastatic disease or lymphoproliferative disease such as lymphoma or leukemia; thickening of the rectum possibly neoplasm.”
He initially refused a rectal exam, so it was not until he went for colonoscopy that his rectum could be examined. To make a long story short, Mr. 533 was diagnosed with stage IV metastatic prostate cancer to the colon.
Staying true to form, Mr. 533 was resistant to treatment during his 3-week hospitalization. He refused insulin for his hyperglycemia, refused IVs, and never complied fully with physical exams. However, somehow we did get him to agree to begin treatment for his cancer with Lupron. “But once I receive the injection, I am leaving,” he said.
Mr. 533 received the injection, stayed the night and the next morning, and started to get ready to leave. But, while leaning over to tie his shoes, he fell to the floor in ventricular fibrillation. ACLS protocols were run, and Mr. 533 was shocked twice. Subsequently, he underwent bare-metal stenting of his left anterior descending artery for a subtotal occlusion and had an intra-aortic balloon pump placed for cardiogenic shock. He then spent the next 5 days in a coma in the ICU. Miraculously, the day after we talked to his family about withdrawing care, he woke up. And during the next week or so, he went from delirious to angry to appreciative.
On his day of discharge, I was post-call and tired. I had maybe caught an hour or two of very uncomfortable sleep on a couch and was mentally exhausted from the night’s events. I was without coffee and once again questioning, “Why do I do this?” Nonetheless, I shuffled my emotionally drained and vacant carcass into his room to make sure any questions had been answered and to wish him well.
“Do you have any questions, Mr. 533?”
“No, doc. But I wanted to let you know that you have impressed me and have given me hope like no one else ever has in my life. And I don’t say things like that to many people. So thank you.”
Like a wilted flower that receives water, I instantly felt my emotional tank fill up and my battery get re-energized. And I was immediately reminded why I do what I do. In that moment, just as I had brought life back to him during his arrest, Mr. 533 brought life back to me during mine. This is a true example of breathless CPR.