Wednesday, June 17, 2009

One thing Leads to Another

One thing led to another, that day in the late afternoons of early summer. Holding hands on an unchaperoned date led to heavy petting which then led to some very heavy anal sex.
That little toke off that marijuana cigarette led to IV heroin with dirty needles. Like shooting hoops on the city court with some friends leads to the Lakers winning ANOTHER goddamn championship (along that plump vein- a team winning a championship leads to numerous cars getting rocked off their fucking shocks and stores burned wide open). Billy shooting a pistol at the Beverly Hills Gun Club leads to Arnie "Ahmadinejad" Iran posessing nuclear weapons. Like sending your kids to college leads to Bernie Madoff, like telling your Mom your love her leads to homosexuality if yur a dude, lesbianism if you're a chick and it's yur dad. One thing leads to another. One small thing leads to the motherfuck of all things.
Pre-WWII German's wanted government subsidized healthcare and ended up with six million jews dead, 3 million of them doctors so that fucked that whole thing.
An enthusiastic go-getter of a Jedi, Anakin Skywalker, thought he was being passed up for promotion too often so he turned into Darth Vader.

It's a scary fucking world.

A few weeks ago a pharmacy tech at Long Beach Memorial Hospital in Long Beach California killed two employees (both of whom were his managers). I used to work at that hospital and I knew that man. Not well, but it was he who handed me my first few bottles of legal speed, Adderall. One pill of Adderall leads to a blog called licensed2 ill.

Management at Long Beach Memorial is positively viscious. Disgusting. What did it take for him to snap? How much dignity did they make him dole out in handfulls before he found out that they were going to ditch his already overworked ass. One thing leads to: BOOM!

Last night my patient was an 88 year old man. Shortness of breath leads to intubation> leads to sepsis> Leads to ARDS> Leads to sedation with fentanyl and versed>leads to levophed> leads to CPR> leads to death.

But lets back up. This 88 year old man happened to be one of house anesthesiologist's father.

Here's the kicker: She wanted everything done to her pop possible to save his life despite the fact he was a DNR. Do Not Fucking resuscitate Under Any Goddamn Circumstance unless you want to lose your license, get sued, go to jail. But when push came to shove, and even though the old man had the DNR because he saw his wife go the same way a few years ago and a) couldn't live without her and b) didn't want the same treatment. But when the time came and death grabbed the old man by the ballz the daughter, Dr. anesthesiologist did what she could only do in a moment of grief. Jump in and intubate his demented ass. (He may have dementia as well no one knows). Fuck me.

Here's the other kicker. The two pronged double kicker: She is an anesthesiologist-the stoner of medical specialties-she orders no sedation, no pain meds, nothing to make him more comfortable. Father is totally on ventilator, restrained, cannot move shitting in bed with not a single opiate or benzo for his ass. For those of you who don't work in the field, being awake on a ventilator has got to be one of the most hellish and violent experiences a human being could go through. A machine tells you when to inspire and expire, every hour some dipshit like me is sticking a tube deep inside your lungs to suck the mucus out. It is excruciating. But no pain meds. Per her strictest orders.

So at 0400, after asking him 20 times all night if he was in pain, each time he said yes, each time I asked him if he wanted pain meds he said no, I said is it because of your daughter he said yes, I said does it feel good when I have to reposition you every two hours he shook his head no. Enough.

Enough. I could help but feel in my heart to the it of my gut, my son, my two year old in thirty forty years making this decision. Me old, sick, dying in bed. My life, my youth robbed from me by the same clock that has taken it away from all others. A selfish scary view of mortality that keeps knocking me upside the head, more and more lately. Enough. MY sweet boy. Her father. His age, his eyes, they looked like the anesthesiologist's eyes, his nodding and shaking his head. MY job. My license, my beautiful wife. Her body is still young, so is mine I guess, HOW LONG HAVE WE GOT?

But here's the second part of the kicker: He came in filthy with bed sores all over his body. He was being neglected at home. He had over nine documentable wounds - wounds severe enough we had to document them with pictures on his 88 year old body WHY KEEP HIM ALIVE WITHOUT PAIN MEDS? Enough. I called the intern. Gimme morphine for the old man. Hell no the intern said, it was his ass. Give him tylenol intern tells me. Fuck you Brian. I gave him tylenol. It didn't do shit. Silence. 2mg of morphine slow as fuck. Thank you. Done. I gave it like sloe gin joe. He slept for the first time in days.

Jesus on vent, nailed to the Hill-ROM ICU bed with nothing for pain or sedation. The next day he did so well on his CPAP trials he was extubated.

How did his daughter know? How sick is it she knew the drugs of her own trade, given in our protocol doses would have killed him, kept him from getting better.

How did she know there was a lonely isolated male nurse taking care of him who eased his own futuristic uneasiness by medicating her pop. Whatever. That's the second time I've seen a train wreck come back when the physician parent declares a "no opiate rule no matter what" with the patient and a miraculous recovery is scored with in days. Like going from your deathbed to cooking breakfast for every nurse in the ICU.

God there is so much I don't know, like waking from the nightmare in a room with your eyes open but its still too dark to see.

Like Ben n' Jerry's Cherry Garcia leads to morbid obesity.

Like depression and burnout lead to apathy and disgust.

(I know the holocaust joke is a bit much but goddamn it people- the shit I see- thie shit I see)