A long time ago in a HIPAA-compliant hospital far away (as always, names/sex/surgery/dates/specific clinical situation changed so the meaning is the same, but the situation is not identifiable) I was in the cardiac surgical ICU, and we had a very challenging patient arrive, who was unstable from the get-go. I worked diligently to help them improve, and things got better for the first hour or so. But it didn’t last. I was called rapidly to the room (“I need help, someone help!” screamed out was the actual request), for severe hypotension to 40/20. That blood pressure is low enough that a pulse would actually not be palpable, and by typical ACLS guidelines, compressions should start. In a post-operative cardiac patient however, compressions (certainly), and even the full doses of medications advised by the ACLS rules can kill the patient. So…. things were not good.
I activated everyone I thought may be useful in the next 30-minutes including the cardiac surgeons, an ICU nursing team setting up for an arrest or a bedside chest-opening, the thoracic surgeon specializing in ECMO, and the cardiac anesthesiologists and their OR teams to prepare to get the patient to the OR. Thankfully, with the first interventions we got to a stable BP and – although it dropped precipitously one more time – we were able to get the patient to the operating room to have their chest open, left open, and offload the chest-wall pressure on the heart, to work slowly on fixing the heart over the upcoming days.
We rounded on the patient later that day, and my resident was working through things just like another routine presentation on rounds (interval events, examination, relevant labs, and so on), and the nurse was listening patiently, and I realized that something was lost here. While not one of us individually saved this person’s life, we all had saved them together. This wasn’t an average day, and it wasn’t a my-job-is-so-stressful and I hate it sort of day. This was a day that we saved someone’s life. I paused rounds and said “We need to take a moment. I just want to point out that we all saved someone’s life. Pause and think about that. The whole reason we put up with shift-work, administrative rules, and stress and the reason we work so hard and read so much for these patients just happened. What we do is really special, and we should be really happy, and really proud of ourselves.”
Too frequently in the massive learning requirement of medical school, and the constant emphasis on us “as a team,” and on learning and test-taking and the like, we forget that what we do is really, truly awesome. We also are constantly told to be humble. Physicians (or anyone else, probably, I just know my world) who claim they saved someone are viewed as arrogant. I’m not sure why that is. Kids are taught to be proud of their accomplishments. “I’m a really good singer,” my daughter said to me the other day – “Yes you are, I love listening to you, great job!” I replied. That pride isn’t always negative in adults, either!
And really, it sometimes is just as good as we thought it would be when we wrote our personal statements. And yes, I was just one part of the team, but I led the critical care team that saved someone’s life. The surgeon who brought them to the OR fixed a situation that was deteriorating and also saved the patient’s life. Neither the patient nor their family will ever know it was me, or my team, but I went home and told my wife that I helped save someone that day. And I was proud of myself, and happy that I picked this profession. Sometimes it all sucks, and sometimes the stress is overwhelming, or the constant fatigue makes me nauseas. But sometimes – just sometimes – I get to save someone’s life. Pretty cool.