Right Now

    "The ambu(lance) is here, now, with the patient you were expecting from the aged care center!" a slight sense of urgency in one of the practice nurses voice as she pokes her head into my exam room.

     "I'll just sign a script for this kiddo and I'll be able to come now", is my reply, aware of the experienced concern conveyed by our nurse.

    Right now a busy day on the acute side of the clinic is going to become a whole lot busier.

    As we enter the resuscitation room I now recognize the patient as a gentle Maori soul from the aged care center whose stroke 2 years ago at age 65 left him with ambulatory deficits, tremor, and a seizure disorder.

    I saw him a week ago, after he had a break through seizure.  Now I wondered if his recent drug levels and urine culture were available.

   Right now his gentle soul is hidden in a combative world of delirium, fending off carers, calling out forcibly and sometimes acting out violently.

    He now has a fever with a temperature to 39.1 and a heart rate of 118, infection headed towards sepsis, the cause of his delirium.

    This man needs an IV started, blood cultures, IV fluids, foley catheter, oxygen, antibiotics....and now that I am in New Zealand, the IV start falls to me. 

    "This man needs and IV now....I need to start an IV now...right....now" thoughts run through.

    Thin spider veins hidden beneath his dark skin...right now I wish I had spent more time practicing my IV skills before leaving the US of A.

     This man would be better off if I had a central line kit and an ultrasound machine, as I am more experienced with those tools than this IV catheter...but right now, those tools are not funded in this health centre.

    Steady now as I give a go at a vein in his left arm...a moving target...I have always respected the skills of the EMT's and paramedics who have brought patients to the ER's in which I have worked...they have to start an IV in even more unfavorable conditions...I respect them even more now!

    A poke...a flash of blood, an attempted advance....Curses!  Blown vein.

    Curses? Right now it has been over seven years since a malpractice suit started in a small Pacific Northwest town...who else's mind is wandering now?  Should not have checked my email earlier today...communication from a lawyer as a source of delirium can be worse than sepsis.

     Now I need a new IV catheter, and begin a search for another vein.

     This man's delirious soul is being tormented by the person with the tourniquet and needle, from which he now tries to flee.   Help, restraint, extra assistance arrive. 

    The four year old boy in the cubicle next store, awaiting his immunisations, starts to cry. The disruptive level of noise, now starts to rise.

   Noise! Disruption!  Deception?  Much like expert witnesses deciding the value of a persons life.

   Right now, the US government pays $6000 USD to the family of an Afghani father killed as a result of collateral damage, a value given to a human life.
   In your malpractice case, the lawyers have started the bidding at $5 million USD, said the email that I received.

    Now, at a time like this, why is the Declaration of Independence running through my mind?  " ....We hold these truths to be self-evident, that all men are created equal, that they are endowed by their creator...."  

   Right now, as is customary in malpractice litigation in the US, those same lawyers doing the bidding, may receive a windfall equal to thirty percent of the settlement.  Not a bad income for seven years work.

     "endowed by their creator..."  In his delirium this man is now praying to his creator in a haunting voice.  "Take these needles away from me, dear God!"

     In my own mind I am silently praying to the same God to guide my hands and technique to be true, so that this man can receive the help he needs right now.

    Steady now, the IV is in, blood draws back, fluid goes in.  Hurry and secure it now.  Tape, dressing a moment of relief. 

    Why did the poor kid have to get his immunisation jab right now?  The scream and cry of the child occurs, further agitating this man.

    Now, from what medications do I have to choose, to help calm his soul?  Thank goodness for another nurse with the IV medication tray at the ready.

    It has been several months since the battle over health care reform took place in the US. The battle in which the general public and legislators were convinced that malpractice litigation does not add to the cost of health care.

    Right now, I wonder if the taxpayers in a small Pacific NW hospital taxing district know that they have already contributed nearly $300,000 USD to a the cost of a single malpractice case. 

     Choices of medication to help calm his soul.  Diazepam (Valium) too long lasting, and respiratory depression for this man while on a long ambulance ride to the hospital will be fatal.  Right now the paramedic that can intubate is not on with the ambulance crew that has arrived.

     Ghosts in my head reminding me of the last time I ever ordered IV Valium.  Again, whose mind is wandering now?

    Haloperidol.  We have that.  Ah, now I remember that 3am discussion I had with an ICU nurse way back in my internship..."Do you like to use benzodiazepines or haloperidol to sedate your ICU patients, doctor?"  Doctor (DOK TUR) said with a hazing tone at the hands of an experienced nurse to create humility. 

     The medication is drawn up now.  Let's get it into this patient so he can settle.  The medication is flowing.

     Humility and a sense of calm.  The lessons that served me well.   Helped me survive through two days of being twisted and hazed by lawyers in a deposition.  

     Right now I need all my fingers and most of my toes to count the colleagues who have been put through... no hazed? Maybe ...Tortured? by the same malpractice process.  All of them are people to whom I would entrust my life for their medical care.

    Is anyone else wondering right now what purpose medical malpractice has in our health care system?

    The medication is working.  IV fluids, antibiotics.  Heart rate improving, blood pressure improving.   He is ready to be moved on to the hospital for additional care.

    The delirious voices are quieted....for now......