Please Save My Life

When I step back, when I really look at the place I work, it never ceases to amaze me. Its an intricate network of organized chaos. Its a well oiled gear set on an ever rotating cog of illness verses wellness. It seems we all have a very pivotal role, a very distinct part to play, in this theatrical production of therapeutic remedy. Often I imagine we are a cast of players in this strange episode of "Please Save My Life".

From time to time, I like to take the role of the observer (director). I like to step back, when the opportunity arises, and watch my fellow teammates function. Individually, they are amazing, each knowing the other's strengths and weaknesses. When you have a good crew, you can almost palpate the pulse of their collective heartbeat. They don't have to speak to each other, they just know by a simple nod or half sentence. "April, will you get...". "Got it right here". "Mark I need...". "Here you go, I brought two".

It seems that each person wears his or her specific role like a hand tailored suit. What fits one person well, does not fit another at all, much like the perfect role in an academy award winning film. I have learned that this works well, so long as each person can put the appropriate suit on and wear it well at the right time. It then becomes an ensemble of Armani clad players, so to speak.

As an observer, I have found one true fact which carriers across the board in any ICU setting. We (the collective entity that is an ICU team) are obsessed with labels. Not in the above mentioned name brand sense, but in the "if there is a line anywhere near me or my patient, I will label it at least three times over" sense. We have a habit of paying extreme attention to detail and then controlling that detail by placing a slick little color coded name tag on it.

I remember a specific instance when this observation played out in expert detail. It was like watching a opening night performance of a play I'd seen rehearsed for months. I remember thinking, "this must be what its like for a director when he watches his film for the first time."

Allow me to recap the performance. One night I, the director if you will, was taking care of this particularly sick patient. As the leading lady, she was sick when I started and only became sicker as the night (play) progressed. I had a great team (cast) on that night. Andrew was my leading man. He played off the patients actions with the ease and grace of a calloused veteran. My supporting cast included April, Rey, Jo, and Josh. They all put on their suits and got into their places, not missing a mark or que. April did chest compressions as if fate of the free world depended on her performance. Jo was my scribe, the one writing vitals and events in perfect penmanship. Josh played the gopher, the one sent to gather all the props we would need to successfully act out this play. Rey ran blood and fluid. He was the keeper of the keys, so to speak. Andrew, not leaving his lady's side, ran the drugs. Once my doctors (extras) showed up, it was all I could do to keep each informed, sterile, and equipped. Dr. W put in chest tubes. Dr. M, the attending, called out the emergency drugs. There were blood draws, lab checks, pulses dopplered. Each player laying it all out there, unafraid of the reviews. Each knowing exactly what they had to do and how to do it. There were applauds from the audience when we got a pulse back. There was a hush when the hematocrit came back at 8. There was a silence when asystole fell across the monitor. The production reached a crescendo when Andrew delivered his Oscar winning line. In an effort to control a situation he knew he couldn't get a hold of, we all heard his deep voice quiver as he said, "For the love of Christ, will someone please hand me a label for my Epi drip!?"

You could feel was a cumulative intake of breath; from the cast, crew, and audience of curious onlookers. It was then, at the peak of the performance, the point of no return when Dr. M called a time of death. For all our efforts, we could not save her. Each person slowly peeled off their blood covered Armani suit. Heads held low, they lined up outside the room and took an invisible bow. They exited; stage left, stage right, stage center.

After the code (show), with the curtains drawn and the seats again empty, I was left alone with the lady. She, unfortunately, was unable to leave her role behind. She, like so many others, will be one of the leading ladies we will never forget. She should have won an academy award for her performance...