Death at 30,000 Feet and Other Random Notes

(I’m still sick. I Still can neither think coherently nor marshal my thoughts into orderly battalions but must instead send them out in little raiding parties to do whatever damage they can. -PB)

Let Me Through, I’m an Interventional Cardiologist

Let’s be fair. Interns and residents occasionally have trouble running codes. I know that it took me more than a few times to get the hang of it and I still sometimes have to think hard about what to do next. And I have an entire team of experienced nurses, techs, and respiratory therapists helping out, not to mention some of the finest Emergency Medicine attending physicians riding herd over the whole shooting match. For all that we still sometimes lose the patient. We can usually avoid it if the patients goes down in the department, say from a heart attack that happens right before our eyes, but we have a lot of medical firepower to bring to bear on the target and that’s got to count for something. And you also have to remember that if the patient makes it out of the department alive we put them in the win column even if they die in the ICU several hours or weeks later.

So you see, it’s silly to second guess the American Airlines flight crew who did the flight attendant thing but were still unable to prevent the death, apparently from a heart attack, of one of their passengers. I mean, seriously, what do you want them to do? Wheel the lady into the Coronary ICU that they keep in the back of the plane? Start a heparin drip, find an interventional cardiologist among the passengers, and jury-rig a cardiac catheterization lab from a plastic spoon and a bag of airline peanuts? The know-nothing media of course are reporting that the flight attendant and the hapless doctor and nurses who happened to be aboard let the lady die, first refusing her oxygen, then discovering that none of the oxygen bottles were full, and then not saving her with the Automated External Defibrillator which “appeared to be ineffecive.” Apparently nobody in the media knows that some rhythms detected by an AED are not shockable. For all we know the thing may have been working perfectly and didn’t deliver a shock because the lady was in asystole. We don’t shock that rhythm, even on the ground.

No doubt the family of the lady are going to sue the airline. And they’ll probably win because in our death-averse society, there is no place under Heaven were we expect to be at the mercy of nature, not as long as there is someone around with a uniform and deep pockets. Someone has to pay? Don’t they? John Ritter taught us that. Even a major aortic dissection, a killer so fearsome that even when discovered there is often nothing to be done but hope the sucker doesn’t dissect over something vital before the patient can be rushed into the operating room for a highly dangerous, do-or-die, vascular procedure that is usually too late anyways, even a major act of nature like that has got to be blamed on someone. Can’t sue Mr. Ritter’s vascular endothelium so the Emergency Medicine physician, acting with limited information and required to make a split-second decision, will have to do. They’re hoping for 67 million dollars. That’s a lot of money. Three’s Company wasn’t that good of a show. We try to be compassionate to the families of patients but in this case, they are just an obnoxious pack of post-mortem gold-diggers, trying to make one last killing off of Mr. Ritter.

Coulrophobia

In one of the last scenes of the movie “Patch Adams,” the eponymous hero stands on the edge of a cliff and contemplates jumping to his death. All of his dreams of bringing laughter to medicine have failed. His Girlfriend has been murdered by a psychotic patient who he had befriended. He is in danger of being dismissed from medical school because of his unorthodox methods. His illegal clinic, providing bootleg medical care to the poor inhabitants of Appalachia and staffed entirely by like-minded third-year medical students, is failing and things look exceedingly grim until a butterfly brings him to his senses and he proceeds to work all kinds of medical miracles, noteworthy among them obtaining four of five cubic yards of noodles in which to immerse an elderly anorexic patient who has dreamed of this since she was a little girl. Finally, he graduates to become the kind of doctor that Hollywood thinks we all should be. I like the movie very much. I watch it whenever it comes on and, like a bad automobile accident, I can’t tear my eyes away. And yet, I find myself urging Mr. Adams to jump, to end it all, just to spare us the inevitable orgy of self-righteousness at the end of the picture, foreshadowed in almost every scene, that is, paradoxically one of the reasons I love this movie and would recommend it to anyone interested in medical school.

Folks, it just ain’t like that. Patch Adams, as portrayed in the movie and who is based on the real Hunter “Patch” Adams, is about as self-centered as is possible for one human being to be without being an outright psycopath. It’s Patch’s way or nothing. You’re with him or against him. The one constant thread in this movie is that everything is about Patch. Patch’s feelings trump everything else. Your kid has cancer? Patch has got to clown around to make himself feel better about it. Old lady won’t eat?  Nothing to do about it but procure the aforementioned noodles. Got to do it, man. There’s no other way. Compassion uber alles.

Match Day is Coming Up

Match day is a big day, there’s no denying it. I know the cool thing is to pretend that you aren’t excited but I’m not that cool. Two years ago when I was waiting to see not only where but if I had matched into Emergency Medicine I was a wreck for the whole week. Three years ago when I didn’t match I was devastated and was seriously considering quitting medicine entirely for my old career in Structural Engineering. So good luck to all of you folks nervously waiting for match day. Don’t lose heart and remember, a match into your specialty is a win. Don’t sweat not matching into your first choice. These things happen and it is now officially too late to do anything about it. You’ll probably like or hate wherever you match without regard to how high you ranked them or how much you thought you liked the program. The interview and even an away rotation doesn’t really give you an accurate picture of the program so there is a huge element of luck in how well you’ll like the hospital and program where you match.

Death at 30,000 Feet and Other Random Notes

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