Doctors Cluck, Doogie, Toddler, Linder and the Blanketrol of Death.

Sunday night in the MSICU (Med-Surg ICU)



I have two patients. One has an excellent night. Obviously, we won't talk about him.
Patient number Two is a lady who is what we call a train wreck. She's a two pack a day smoker who developed pneumonia bilaterally, rapidly progressed to ARDS (very bad lung condition) and is now on the ventilator doing even worse with her oxygenation than the Misfortunate Fellow in Trauma. She also has a clot in her lower leg (Smoking also causes blood to clot easier. Just Say No) and her right foot is rotting off. I could put it more clinically, but that's what's happening here.
She does have a super weak pulse you can hear if you use a doppler, (a handheld device that amplifies sound)put your ear against her ankle, stand upside down, do a backflip, say a prayer, close your eyes, count to ten, and strain with every ounce of your being. Said pulse is no longer audible three hours later.
This is very bad, for several reasons. 1) I am hungry, and I would like to heat up my sphaghetti and meatballs. 2) Cluck and Doogie will have to be notified- the lady's under Internal Medicine 3)the neurovascular intern/resident/retard-of-the-night will have to be notified and 4) I will have to actually speak with the aforementioned people.
If you think I'm heartless for not listing that the lady's going to lose her foot, that was a done deal long before the pulse disappeared. The foot is purple, mottled, and cold; and has been for two days.
Doogie and Cluck respond to their summons with all due haste-making the usual beeline for the chart and managing to trip over the cord to the blanket warmer and pull it out of the wall.
Cluck: Damn it Doogie! Watch out!
Doogie (sullenly): I didn't do it. You did it.
(Neither of them plugs it back in.)
Cluck (frantically surveying my nurse's notes): It says RIGHT HERE this patient had an audible pulse at the beginning of the shift!
Me (patiently): I know. I'm the one who wrote that.
Doogie: (accusingly, while clutchin his lab coat in despair) Did you TRY THE DOPPLER?
I do not respond to this. (The doppler is lying on the bed next to the patient's foot.)
Cluck (attempts intimidating stare): Well? WELL? DID YOU?
Me: I'm going to go heat up my sphaghetti. You two might look at the patient while I'm gone and see if you can find the answer.
(I go heat up the sphaghetti and return with it in a tupperware bowl)
Cluck (triumphantly) We SEE the doppler IN THE BED! THERE IT IS!
Me(chewing on sphaghetti) Great. You guys make me proud.
Doogie(who is too young to appreciate sarcasm) beams.
Neurovascular appears now, in the form of an intern who is a skinny, bespectacled fellow with wild hair and a petulant expression.
Let's call him Toddler. You'll see why.
Toddler (petulantly) Why wasn't I called FIRST?
Glares at Doogie and Cluck, who glare back. He's just an intern too)
Me (bored voice) You were. They got here first.
I'll give Doogie and Cluck props for promptness. You've got to find the positive in people.
Doogie and Cluck give him smugly satisfied looks that clearly state they are much better doctors than he is.
Toddler (irritably) You can't dopple a pulse? You can't dopple a pulse?
(Apparently there's an echo in the room)
Me: (finishing off spaghetti) Nope.
Toddler snatches up the Doppler with a determined expression. Toddler (angrily): We'll see about THAT. GET ME some JELLY!
This is what you put on the skin before using the probe)
Me (politely) I'm so sorry. I don't think I heard you say please.
Toddler (stomps foot, face turns red) I said GET ME SOME JELLY, DAMNIT!
Me (deciding it is definitely time for a diet Coke) Get it yourself.
(I leave the room.)
Doogie, Cluck, and Toddler all begin frantically searching the room for said jelly (which is on the bedside table right at Toddler's elbow) and when I peer back in, they're all yelling at each other; and Doogie's tripped over the Blanketol (warmer) cord again, since they never bothered to plug it back in.
Doogie (desperately): She's gonna die! She's gonna die!
Cluck: (sternly, to Toddler- he's a First Year Resident, you know, and Toddler's just an Intern) That foot has to come off! You've got to get it off tonight.
Toddler (outraged) We're not taking HER TO SURGERY! Are you CRAZY? She'd DIE ON THE TABLE!
(He's right about that)
Doogie: (apparently this woman's his long lost mother, or something) She's gonna die if you don't! She's gonna die! She's gonna die!
Doogie flings himself on the floor and bursts into tears.
(okay, I made that part up- but he looked as if he wanted to)
Cluck (to Doogie, in a tone of utmost gloom): Will you SHUT UP? We KNOW THAT. We're gonna have to call Linder.
Despair etches their countenances. Apparently this Linder is a quite frightening fellow indeed.
Toddler (nastily) That's right. I'm putting in my note this patient is too unstable for surgery. You can consult us again when she's stable.
(which will occur precisely at midnight on the Twelfth of Never)

Toddler stomps out of the room and I flip him off behind his back. Childish, yet satisfying. And it makes Doogie stop looking tearful and laugh.
Doogie and I exchange a conspiratorial smile as Cluck trips over the Blanketrol cord. We may possibly become friends.
Cluck (irritably): This cord is a SAFETY HAZARD!
Me (sighing) I know.
(Said cord is stretched from bed to wall, where it is plugged into outlet. Everyone has been tripping over it. I get some duct tape and tape it down to the floor.
Cluck and Doogie, who apparently are so terrified of calling this Linder fellow they're going to pee their pants, both rush for the bathroom at the same time.

After pacing nervously at the desk for a few minutes, Cluck boldly snatches up the phone and punches in Linder's pager number.
(Shouting is heard from the other end of the phone)
Me (mildly) Gosh, he doesn't sound too happy, does he?
Cluck (sulkily) Yeah, well, he's gonna yell at you too.
Me (clutching my chest melodramatically): Oh NO. What ever shall I do?
I start charting; and Doogie and Cluck drop to their knees and crawl under the bed.
(once again, I added that last part; but that's what they wanted to do)
The door to the unit opens with a bang;and here's Linder.
Seriously, this guy has white-blond curly hair, is about five feet tall, and is yapping like an angry little poodle. Doogie and Cluck look like they're about to pass out with fright; so he turns on me.
Linder: What? WHAT? What HAPPENED HERE?
(Gives the three of us accusing looks)
Me (sighing): This lady's foot is dead but she's too unstable for surgery.
Linder: (to Doogie and Cluck) HOW DID THIS HAPPEN?
Doogie (desperately to me, trying to distract Linder) Did you TRY THE DOPPLER?
(I put my head in my hands and pray for patience. Linder snatches up the Doppler; stands on his head, does various mamba-routines, but cannot hear a pulse)
Linder: (yelling) THERE'S NO PULSE!
Me (quickly losing patience with this yapping idiot) WE ALL KNOW THAT. That's why I CALLED THEM in the first place. That's why they CALLED YOU. Tell us something WE DON'T KNOW.
Linder storms out of the room.
Doogie and Cluck: What's he doing? Where's he going? Is he coming back? When's he coming? What's he doing? Where's he going?
Me: Who cares?
(I get up and start doing all the hourly checks of the lines, drips, tubes, etc., repositioning the patient, etc) Cluck paces around nervously, unsure if he should leave or stay. Doogie has discovered Saved by the Bell on the lady's TV.
Doogie (happily) I love this show!
Doogie sits on the Blanketrol and starts watching the show.
Cluck finally gives up in despair and charges out of the room; but Doogie hangs around and chats about his favorite TV shows, his new Ipod, his super cool cell phone, his totally awesome shiny new glow in the dark backpack; and his mom's new boyfriend that he doesn't really like.

Six a.m.- Actual Real Doctor comes to doorway and states in officious tone, "The patient has no pulse in her foot."
Me: No, it doesn't seem that she does.
Actual Real Doctor looks irritably at the Blanketrol.
A.R.D.(more irritably) what's the point of this? Wrapping her foot up in a warm blanket? Who thinks that's going to save this gangrenous foot? This is stupid. Who ordered this?
Me: Not me. I guess the Vascular guys thought they had to order something.
A.R.D.: (apparently the Blanketrol has offended him greatly) Well DISCONTINUE IT! WRITE IT AS AN ORDER! GET THE DAMN THING OUT OF HERE!
He stops and glares at the floor.
A.R.D.: And WHAT IN THE HELL IS THIS DUCT TAPE FOR?
Me: Would you rather trip over the cord?
A.R.D. (practically screaming) CORD? CORD? I told you to GET THIS THING OUT OF HERE! THERE SHOULDN'T BE A CORD IN HERE!
Me (losing all patience- it's reeeeally time to go home and go to sleep) Well, I seem to have lost my powers over the Time-Space Continuum. Since you told me that approximately thirty seconds ago, I haven't had time to unplug, detape, disconnect, and remove the loathsome Blanketrol from the room. Perhaps you could come back in five minutes and it'll be gone.
A. R. D. (menacingly) My TIME is worth MONEY.
Me: (stomping over and ripping the duct-taped cord off the floor) Not my money.
A.R.D. storms out of the room.

Happy Note of the Morning- at seven a.m., actual real vascular surgeon appears. He asks politely if he can sit in my chair. He smiles and tells me good morning. (I am staring at him in shock)

He reads the nurse's notes and EXAMINES THE PATIENT. Shakes head sorrowfully and appears Genuinely Concerned. States, "This is a shame." Adds nicely to me, "Thank you for taking such excellent care of this patient."

He leaves the room, and I trip over the Blanketrol that I have sitting outside the door. Actual Real Vascular Surgeon hurries to help me to my feet.

So, you see, Good Guys do exist. Blanketrols and cords can be hazardous to your health. Smoking really is bad for you. Three heads are not necessarily better than one. And Doogie's got a shiny new backpack. Things could be worse.