Clinical Experience Creative Writing

traumatic experience with a patient a few years ago that still left me with a bad feeling. It was a hit-and-miss instance, and the fact that it was so, more closely being miss than hit, has stayed with me ever since. It was the first time that I ever came so breathtakingly close to being implicated in causing another to die. I hope it will be the last. As to the lessons that it can teach me -- there are several.

The story was the following: It was one fine, not especially busy Saturday morning when this patient was wheeled in for a percutaneous transfemoral aortic valve implantation. While the cardiology team was inserting the femoral guide wires and sheath for valve placement the ventricle was perforated. Usually we have more time and can proceed more placidly, but in this particular case, we had to rapidly respond and open the sternum due to the patient's unstable hemodynamics.

Unfortunately, the equipment needed for the conversion i.e. sternal saw, retractor and miscellaneous supplies to achieve homeostasis were not available, and none of us could move from the patient.The critical condition necessitated that we all be there.

Meanwhile, the patient's arterial blood pressure were 60 systolic / 40 diastolic and rapidly declining without adequate management. Two 16 gauge IV's were placed and rapid blood transfusions were administered, but, despite, our hardest and most strenuous attempts, we depleted the entire blood bank with this patient. At the same time, we were afraid to overload the patient with the volume.

Suddenly the patient's arrhythmias became erratic from PVC'S to VFIB and we were at our wit's end: we had no form to defibrillate the patient due to the fact that it was still a percutaneous approach. More so, the R2 pads had been placed incorrectly. It seemed as though everything was going against us. The placement of the pads was too inferior and lateral to the apex of the heart for proper shock (conversion) defibrillation, and, before we could catch our breaths, the next thing that went wrong was….....