Rapid Infuser

The numbers:

1 fourteen hour shift
10 units of packed red blood cells
10 units of fresh frozen plasma
10 units of cryoprecipitate
3 units of platelets
2 hours in interventional radiology
10 liters of crystalloid fluids
3 pressors, maxed
2 daughters
1 sister
4 people who had to change their scrubs
1-5 registered nurses, depending on the moment
0-3 physicians, depending on the moment

Last week, I learned to use the rapid infuser. I had been wanting to for a while, so that when an emergency came up I would be quick on the draw. That day, the emergency just would not quit, so I learned as we went. Now, I'm a pro. If you're wondering, the rapid infuser is a device that warms fluids or blood products and delivers them, using pressure, very rapidly. It's for when your patient needs that volume and/or blood about twenty minutes ago. It is how you keep up when your patient is bleeding out-- treading water while trying to identify, pinpoint the location, and hopefully fix the problem.

After all those blood products, the hemoglobin was 4.6. The intervention to stop her bleeding, while apparently successful initially, had not been effective. It was a very, very hard day. One thing I do know is that, if she could have been resuscitated, she would have been. We did the right things, we did them fast, and we did them well. I was mildly impressed with my own work that day; I didn't know I could handle something like that yet. I was far, far, far from alone and utterly awed by the seamless cooperation of my colleagues that day, but I also contributed more than ever before. So, now it's time to raise the bar a little more.

Sheila's family let her die before anyone had to start cracking ribs, and that felt like a real blessing. Periodically, I leaned close and explained where she was, what was happening, and who was there with her. I reminded her she would not be alone through this, no matter what. And she wasn't.