Tales of Survival: Putting out Fires

November 14, 2008

bellevue.jpgWelcome to “Tales of Survival,” a new feature of Clinical Correlations.  Bellevue Hospital, the nation’s oldest public hospital and the heart of our residency program, provides unique and unforgettable training for new physicians.  It is probably safe to say that every resident who trains at Bellevue graduates with a lifetime of stories about the experience. “Tales of Survival” was created to convey some of those experiences.

Written by Deborah Shapiro MD 

Nightfloat is one of the most thankless jobs of internship. And, in internal medicine, it is the closest experience we have to shift work. The typical night involves arriving at work somewhere between 8-10 pm, being told by the day-time team who is sick, and then waiting to hear that those sick people need help. The intern spends his/her night putting out proverbial medical fires throughout the night.

During my second month of internship, I was on night-float at the private hospital. My co-intern, Pete, and I were sitting in the nurses unit when an alarm went off on the monitors indicating that a patient was having a new sudden possibly deadly arrhythmia. Pete is six foot eight. He is a very good soul, but he is a very large, loud man. His voice booms, his feet make a very distinctive thud as they smack the floor. He never enters a room un-announced.

We saw that a little old lady had gone into ventricular tachycardia, a rhythm that can kill. It also can often be fixed by a slight shock to the chest. Pete and I jumped up and ran into the room. The patient was in the far bed, awake but obviously uncomfortable, and she was a very little, very old lady. Our way was barred by the patient who belonged in the other bed. She was sitting in front of her bed in her over-sized wheelchair because her girth was so wide that she could not fit in a regular one. She claimed that she was too sick to move out of the way.

Pete climbed over this large lady and screamed to the little lady, “Ma’am, I’m going to punch you now!” in the loudest Pete voice I had ever heard. With that, his enormous fist went up in the air and slammed down with a crack of ribs onto this 85 year old, 85 lb. of a woman’s chest. The monitor immediately went from “ring, ring, ring!” to the more comforting and quieter, “blip, blip, blip”.

The little old lady looked up at Pete with a huge smile on her face and said “that was very good young man!”. She was Pete’s save of the evening. We rapidly transferred her to the cardiac care unit for further care.

Within the next few hours, an emergency was again called from the same room. We were still close to the area and ran into the room. The old lady’s bed was vacant. In the closer bed, was the “fat lady”. Her bed was smoking, and there were flames coming for the wooden bed-rail. We watched this patient haul herself out of bed and run down the hallway away from the fire just as quickly as Pete climbed over her hours before. I guess she wasn’t that weak after all.

We unplugged the electronic bed from the wall and put out the fire.