Published in “Advance for Respiratory Care Practitioners.“ Vol 4, No 4, Jan 28, 1991, p. 30.
The Unsung Heroes of Modern Medicine
Desmond Allen, PhD, MBA, RCP
A PhD in health administration and a credentialed Respiratory Care Practitioner with 35 years experience. The author of A CURE IS NOT WELCOME: America’s Successful Failing Health System, as well as several other articles and books.
When the terse command, “If you don't want to be zapped, leave now!" bellows across the room usually there is a rapid mass exodus of doctors, nurses, therapists and technicians. But of the dozen or so present only two leave.
As the X-ray plate is placed along the patient's neck a doctor attempts to start a second IV even as a nurse pushes a medication through the first. Another nurse stands in the corner recording every movement. One respiratory therapist controls ventilation, while another is preparing to draw arterial blood.
Off to the side, a surgeon is donning his sterile gloves, anxious to check for blood in the abdomen. Several other doctors, nurses and assistants stand by doing any number of small but important tasks. The technician yells, "X-ray." Everyone freezes momentarily; the familiar beep sounds and action resumes.
Their patient is Cindy, a 13-year-old who had been on her way to the convenience store to buy milk for dinner. She didn't look before crossing the road. The EMT's brought Cindy to the ER in full arrest, CPR in progress. There are several lacerations and broken bones. A cervical collar is in place to stabilize her neck, and the inflatable plastic trousers, that splint her broken bones, also shunts blood to her vital organs. These are the two major concerns at this point: her neck and her blood volume.
The lab work returns and confirms a major blood loss. The X-ray returns as well and confirms everyone's worst suspicion. Her neck is broken at the C-1 level. It is a lethal injury. Her respiratory drive has been permanently disabled. Spirits drop.
Everyone present imagines their own child lying on the gurney. Then the dreaded moment arrives. The family insists upon seeing her. It is a pitiful sight. The situation is too intense for privacy. The staff must remain in the room to continue their tasks. The grandparents enter, then the mother. They are in obvious pain, half crazed with fear, grief, remorse, sorrow, and whatever else grips one at such a time. Everyone in the room is fighting back tears. Few are successful. Heads turn in a feeble attempt to give them some semblance of privacy.
After several more procedures and medications, Cindy is placed on a mechanical ventilator and admitted to the surgical intensive care unit. But there is no hope. Everyone knows she will die within a few hours. As the staff stands by helplessly, Cindy's vital signs begin to deteriorate. Suddenly her heart rate begins to decrease. Her blood pressure drops. Now there is no pulse. Within minutes the blips on the heart monitor stop altogether. The ventilator is turned off. Tubes and IV's are removed and Cindy is prepared for the family's final visit.
The chaplain enters to see if we are ready for the family. We are. Although now there is some privacy for the family, still the SICU staff witnesses the same pitiful scene that the ER staff had witnessed little more than an hour earlier. Again there is not a dry eye in the room.
Cindy died at 7:35 P.M.; at the end of a 12-hour shift that had begun that morning with the sudden and unexpected death of Ronald, the 35-year-old brother of one of the SICU nurses. He had been in the SICU for several weeks, on the ventilator, critically ill from undetermined causes.
There had been numerous life threatening situations during his stay, but over the last few days he appeared to be making progress. At 7:45 A.M., however, he began bleeding profusely, blood gushing from his endotracheal tube. Within seconds his heart rate and blood pressure dropped. CPR was initiated; but with the bleeding so severe it was in obvious futility. As his chest cavity filled with blood, both ventilation and chest compressions became impossible. Ronald, who only minutes earlier was alert and in good spirits, was dead.
The family was called. The scene was similar to the one that would end the shift in 12 short hours. Ronald's nurse, a veteran of 10 years in emergency and intensive care, was visibly shaken. With tears, she stepped out to comfort the family. An autopsy later that day revealed a cancerous tumor that had eroded into his aorta and trachea; thus the profuse bleeding. As with Cindy, this too was an irreversible, lethal injury.
Emergency and intensive healthcare is not a job for everyone. It is not glamorous. The hours are long and often under staffed. There is blood, body wastes, gastric juices, sputum and death on a daily basis. It doesn’t pay all that well; and when yearly evaluations roll around supervisors seem to have compiled as many complaints as possible in order to diminish merit raises. The work is extremely intense and technical; thus emotionally stressful. Needless to say, the burnout ratio is high.
Too often, it is also thankless. Situations occur frequently, almost routinely, where you will solve a problem, take action and literally save a person's life; but the event goes virtually unnoticed. Only those few associates working with you on that particular day realized its significance; and even then it is soon forgotten, left it to the annals as another mere routine emergency.
It is not all defeat. Many patients die, but many more survive. There is the frequent satisfaction of seeing success and knowing that you had some small part in it. Although I speak with some bias, still I must say that these underpaid, overworked healthcare providers are the unsung heroes of the medical community. The general public’s image of the hero is the physician. Those standing in their shadows are simply overlooked. However, if I may be colloquial, those seemingly in the shadows are actually on the front lines, often provided the emergent care long before the physician is even present; and, as one famous broadcaster would say, "They know the rest of the story."
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