Nighttime

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Last night, I began the first of a month of nights.

I go into the hospital from seven in the evening until eight in the morning admitting patients into the hospital, running codes, and helping the intensive care and cardiac care service.


Last night we brought a woman back from the dead. That was kind of exciting. She cycled through nearly every known arrhythmia, from asystole to bradycardia to pulseless electrical activity to ventricular tachycardia to ventricular fibrillation, even into Torsades de Pontes—the most French of the arrhythmias. Halfway through the code the senior attending started laughing at me.

‘It’s like she’s testing you—making sure you know how to deal with everything in the book,’ he said.


I admitted two or three crack chest pains. This is typical for a night. Cocaine causes coronary arteries to spasm and about twenty percent of our cardiac patients are there because of crack.

As the ED folk like to say, to laconic effect, ‘Crack Kills!’


I had a few straight forward admits, and then I had the big guy.


A member of the 500 club, weighing in at over 500 pounds. His feet were so hugely swollen that he didn’t own shoes that would fit him. It didn’t really matter, because he couldn’t really walk much anyway. He stank of fungus and mildew, because the saprophytes feed on the oils and sweat that accumulate in his fat folds.

When he started to crash, thankfully, I was somewhere else, and someone else had to intubate him. When I got there though, I placed the Nasogastric tube because the nurse said ‘good luck with this,’ and handed the tube to me. I placed it through his nostril and—kids don’t try this at home, I had him paralyzed—stuck my fingers down his Jaba-like craggily-tooth orifice of a mouth, and guided the tube down into his esophagus.

When his blood pressure started to drop and we needed central venous access, I had one nursing student pull his right breast out of the way, while I applied a tremendous amount of pressure to the fat around his clavicle and drove the needle into his subclavian. I had to bury a four inch needle through his fat all the way to the needle’s hub, compressing the fat as much as I could, just to reach the vessel. This is typically an easy inch and a half journey, with minimal compression needed.

The worst part is I had to use such a tremendous amount of pressure to the fat that I could not remove my left hand to place the guidewire. When I tried, the fat bounced up and I lost the vessel and had to rebury it to find it again. I tried this three times before I got another physician to act as my left hand, so that I could continue holding the fat down while we secured the access.

My arms still hurt. But he’s alive.




I return home to a bath and a mug of warm milk and fall into a deep—admittedly tormented—sleep. I feel like Batman.


I just wish I was an affable millionaire during the daytime.