And to think that I saw it...

The day seemed to have an unexciting end. I finished my last case around 5:15, did a couple post-op notes, and then walked out of the hospital at 5:45. The subway station is just a block away from the main hospital building.

Once downstairs beneath the street, however, I noticed a small crowd of people. Their attention seemed focused toward the middle of the crowd...where a woman was lying on the ground and others were performing CPR.

I worked my way into the circle, set down my bag, and said I was a physician and offered to help. Turns out the fellow doing chest compressions was a medicine attending, and there was a GYN fellow there too. The girl giving breaths had witnessed the entire episode: the patient had said she didn't feel so well before passing out. The girl eased her to the ground, and they weren't able to find a pulse.

I asked the medicine doctor to hold compressions while I felt for a carotid pulse. No pulse. "Resume compressions," I said, "no pulse." I was perplexed, however, when I realized the attending was giving five compressions for every two breaths the girl gave. The basic life-support I learned had ratios of 15:2, whereas the newer guidelines are 30:2. The thought is that since it takes several compressions to even get a blood pressure, it's better to go for longer stretches. The compressions themselves may also help with air exchange.

I felt like I should say something, but then I thought, "This is a medicine attending. Maybe he knows something I don't know." In retrospect, he was probably just rusty on basic CPR. Soon, I noticed the patient was starting to make respiratory efforts, so I reassessed the pulse (which I couldn't palpate). Soon, the EMS personnel arrived and attached monitors, started an I.V., and gave supplemental oxygen before wheeling her off to the Emergency Department less than a block away.

Thinking about the whole experience, a few things strike me...

• It all happened very suddenly. I was simply walking to catch my train, minding my own business, when all of the sudden I was caught up in this episode.
• It was more than an episode. This lady had some form of pulseless cardiac arrest. This was life or death.
• I felt very helpless without my monitoring equipment. No EKG, no pulse oximeter, no blood pressure cuff, no I.V. access, no cart full of medicines.
• Despite not having monitors, I was still able to gather a lot of information about the patient, from feeling for a pulse, to watching her respiratory efforts, to assessing her color.
• I probably should have taken charge, especially when I realized the medicine attending clearly didn't know what is the standard of care.
• It's kinda weird how the whole thing didn't rock my world more than it did. I would attribute this to the nature of anesthesiology: we take care of potentially life & death situations daily.

For someone whose heart may have stopped (she had regained a slow rhythm by the time the EMS service arrived) she didn't look too bad. She was breathing, and she didn't look too cyanotic. I hope she does okay.