The ICU Team From Hell

I just read a newspaper article about how an elderly woman died on a British Airway flight and was moved to a free seat in first class. Even though the body had a seat belt on, she kept sliding out of the seat on to the floor which upset other passengers in first class. I don’t know what upset them most: that she was dead, or lay on the floor, or got a free upgrade, but upset they were. British Airways duly apologized, maybe for all these things.

I guess the crew on this flight was of the same variety as one particular team on the ICU where I did my residency enough number of years ago to make any crime they committed fall under the statute of limitations. Some of these nurses also worked in the ER on the night shift, and this is where the following story plays out.

On a dark and rainy night… a car crash trauma victim is admitted in pretty bad shape. Major blunt trauma to the chest, miscellaneous fractures and stuff, maybe neurological problems (I don’t remember), unconcious. Naturally, everyone just start doing their stuff, taking blood pressure, vital signs, arterial blood gases, putting in central IV lines, etc. We didn’t have oxymeters back then, but he definitely looked hypoxic.

After a couple of minutes, I get the blood gas results, and they confirm what I thought, namely crush lung. Low on oxygen, low on carbon dioxide. I was standing about 3 meters away from the patient explaining the blood gases to an intern while the nurses were working on the patient. I was talking in a normal to low voice, explaining how the blood gases showed bad oxygenation and hyperventilation at the same time, which indicates functional shunting, in other words almost certainly a crush lung, so we’d need a chest xray and almost certainly PEEP (ventilation with over pressure). We kept discussing different aspects of this for a while, maybe a minute or so.

Then I turned around and noticed the nurses had put a mask and balloon over the face of the patient, but hadn’t connected any oxygen line to it. They didn’t pump the balloon either. So I said, quite loudly, “hey, you forgot the oxygen line!”, whereupon the lead genius answers “You shouldn’t connect oxygen in these situations!”. So I said, “Of course you should!”. He says “No!”.

So I walk over there and ask them “What in the world are you guys doing? Suffocating the patient?”

Answer from the lead male ICU nurse: “You said he is hyperventilating, and when a patient hyperventilates you make them re-breathe in a bag. Everyone knows that!”.

So here they were, effectively suffocating a patient that came in to the ER already very short on oxygenation, because they overheard a discussion I had with an intern that they didn’t understand and acted on anyway. They had an unerring talent for doing the wrong thing for the wrong reasons, with a scary consistency.

When these guys worked nights, believe me, you didn’t have the luxury of sleeping while on call. Death by stupidity walked the corridors like a ghost.

Anyway, the patient made it. But certainly not thanks to that team.

Back to the regular programming now.