Tuesday, May 26, 2009

A Reminder

I apologize for the lapse in postings, but things haven't been going so well for me lately.

My second semester of organic chemistry proved to be more demanding than I anticipated, and while I still await my final grades I know full well that they are less than what is required. To make matters worse, I was rejected from a postbaccaleurate program that would have given me opportunity to right my academic record, and my application for a preceptor position at work was also turned down. In addition I've been fighting through a slump of mundane calls in the city, two weeks ago working through thirty-two calls in a row without a single patient in need of ALS.

Frustration and disappointment have truly been the norm, and it has taken a heavy toll. Lately I have found myself questioning my willingness to continue this drive towards medical school, and feeling overcome in way that I haven't experienced in years. I have recovered from stumbles in the past, but it seems to me that my mistakes are begining to aggregate into something worse. It has taken conscious effort to keep my eyes pointed foward, and even when I do, I find that the light at the end of this tunnel remains maddingly distant.

As if on purpose though, luck has granted me a few interesting patients over the past few shifts that have helped to lift my spirits. I have found myself amazed by how my job still has this power over me: to challenge and intrigue in a perspective-changing way, to make me feel new again so that I might again experience first-hand those things that so strongly motivated me to pursue these goals.

This elderly woman suffered an unwitnessed cardiac arrest, had no immediate bystander CPR, and was being resuscitated by another paramedic by the time I had arrived. I intubated the patient, and was surprised to see my monitor print out the following:

A pretty sweet looking rhythm (considering the 10 minutes of aystole that preceeded it), and end tidal CO2 readings over 100mmHg for the duration of my care (please excuse the lapses as we had to disconnect the monitor for an especially tough carry-down). Nevertheless, the woman remained pulseless and even though we worked furiously, we simply could not get her to show any signs of life. I shook my head as we continued our rounds of drugs, CPR, and ventilations. CO2 output like that should mean this patient is viable. A rhythm like that should have pulses. Still, nothing.

I want to know why. Why was the CO2 so high for such a prolonged period? If this was a typical hypercapnia secondary to a respiratory arrest, why didn't the excess CO2 blow off as we continued to resuscitate? Should we have more aggressively hyperventilated? Why did the PEA continue happily for so long, yet refused to produce pulses? Was there mechanical activity producing an undetected hypotension? How could we have known if it was? What exactly was going on here?

I don't have the answers yet, but I am intrigued, and I will find them out. The potential to learn about something new has piqued my interest, and rendered me involved anew in a job that was begining to slip down a slope of disinterist and dispair. Just a few calls like this, and I remembered. I remember why I wanted to become a doctor, my facination with the unknown, and that thirst for new information. I remembered why I once felt so strongly that all of this work was worth it.

I remembered a reason to press through.