B Positive

A few weekends back, I got called in to do an emergency spine surgery on a 40-something year old guy who flipped over his handlebars while riding his bicycle in the countryside. I came in and set up for the surgery: I coordinated with the anesthesiologist, the surgeons, the vendors whose surgical technology we used for the procedure, the surgical tech, the radiology tech (who took x-rays throughout the procedure), and the ICU nurses taking care of the patient.

I met the sweet man who was about to have his fractured back repaired. He was extremely healthy and had a surprisingly positive attitude (and he even chuckled when I told him his blood type was B Positive).

The surgery went well and the surgeons were satisfied with their work. The anesthesiologist was satisfied with the status of the patient as he emerged from general anesthesia. We headed from the operating room suite over to the recovery room. We were greeted by the recovery room nurses and while they applied monitors to the patient, the anesthesiologist and I began to give the nurses a report.

Vital signs stable.

Then, in the midst of reporting to the recovery room nurses, the oxygen monitor began to alarm, the patient’s oxygen levels fell steadily from 98% down to 92%, then 89, 84, 80, 85, 70, 68…

I panicked.  I have never seen a number drop that quickly and I’m pretty sure my heart was about to pop out of my chest. I felt so responsible and yet so useless. I wasn’t sure what to do next. Luckily I wasn’t alone.

The seasoned nurses, techs and MDs around me were swift to take the next crucial steps. The ensuing 30 minutes taught me so much. As the ICU nurses, respiratory therapists, and radiology techs joined us as the patient’s bedside, it became clear that this man had experienced negative pressure pulmonary edema. All the classic signs were there, it was actually quite a textbook scenario: assisted ventilating attempts were unsuccessful, he remained unresponsive, re-intubation was performed and pink, frothy sputum was suctioned from the endotracheal tube, a flat plate x-ray was taken and displayed “whited out” areas of infiltrates. An array of medications were pushed through his IV, yet his status didn’t change too much. He was finally transferred back to the ICU on a ventilator with his oxygen saturations still around 86%.

At that point, I had to get the ball rolling for another surgery. No time to reflect on what just happened. No time to debrief. No time to check in with the family members of the patient. No time to check in with the person who felt personally responsible for this drastic change in status: my dear anesthesiologist (who also, by the way, is one of the sweetest gentlemen I know and I get all school-girl-giddy when I get assigned to work with him).

Get yourself together and be positive. We moved forward. Our team completed the next surgery and went home after the next shift came in.

During my lunch break the next day, I went to the ICU to visit my patient. A wave of relief flooded through me as I saw the resilience of the human body exemplified. He had the tube out of his throat and was breathing on his own. His oxygen saturation was at 97% with 2 liters of supplemental oxygen. He was talking with his parents who were at his bedside. I visited with them for a short while and then returned to my shift.

I also followed up with that anesthesiologist. Surprisingly, I learned that this was his first case of negative pressure pulmonary edema and that it would have been difficult to prevent. I asked him if he ever ‘got over’ those kinds of situations. “No,” he candidly expressed with a concerned, yet warm smile. He gave me a reassuring pat on the shoulder. It felt good to know that doctors don’t always have the perfect outcomes and sometimes they feel powerless too.

I connected with his humility. Although we can’t always fix the right things the right way at the right time, we can – at the very least – aim to do right by our patients. And when the results are still discouraging, we strive to be positive, not just because it’s part of our job performance evaluation, but because there’s always another surgery to do, another patient to help, and another lesson – and maybe even a miracle – to be revealed.

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