Less depressing stuff

Last week we had a patient who came into the ER with chest pain. 33 years old, otherwise previously healthy, though with a significant family history of cardiac disease. Chest pain, and in the ER, he went into V-fib, and was shocked back. It doesn't happen all that often, but what made it even more exciting was that because he had no other comorbidities, he was a candidate for our hypothermia protocol. I had never heard of it before, but lo and behold, a day after we dropped his body temperature to 33 degrees Celsius, I saw this article on CNN.com: Cooling is catching on for cardiac arrest patients. (No, I do not generally get my medical news from CNN; however, I was post-call and just doing some fluff reading on the Internet.)

Our patient did great! He was cooled for 24 hours, then rewarmed slowly. He slowly came to and did well neurologically, and we transferred him from the ICU out to a regular floor bed later that day. The other night I was walking through the floor units and saw him -- sitting in a chair outside his room reading a book. Totally normal. He's definitely shaken by what happened -- imagine waking up in a hospital having no idea why you were there, and being told that not only did you die for a minute, but that your body was then frozen (OK, not really frozen Austin Powers style, but you know...) and rewarmed. Crazy! He'll do fine physically, but I hope he follows through with his emotional/psychological counselling, because boy, will he need it. In any case, I thought you'd enjoy a slightly more happy story from the ICU.

And here's a Can You Believe It story: I have an 87-year-old woman who is on a ventilator because she developed respiratory distress the other night. She's a sick woman, and when it came time to think about intubating her, we needed consent from someone, and since she was unable to give consent due to her respiratory distress, we called her son, who consented over the phone, saying she would want to be intubated. So she was intubated. The next morning, another son contacted us and said he was her healthcare power of attorney and she did NOT want to be intubated. Uh oh! The first son, when approached with that information, maintained that there was a newer document in which HE was named power of attorney, and she DID want to be intubated. And when we told him to go home and get the papers, he came back and said he couldn't find them. Hmmmm. And of course, it turns out the two brothers don't talk to each other. So we scheduled a family meeting and waited. And in the meantime, one of the nurses found out the scoop: The first brother, the one who initially consented to the intubation, is apparently $1.5 MILLION in the hole from gambling debts. And he continues to gamble. He has multiple sclerosis and lives with his mother, and he uses her social security money to continue to gamble! So of COURSE he wants to keep her alive and on the ventilator -- he wants her money! Juicy, juicy.

In the end, papers were found at the lawyer's office, in which the patient had checked off that she did want to be resuscitated and did want to be intubated, so we will continue to treat her. But I can't look at the son the same way anymore. The gall!

And finally, I walked home today via the Italian Market and stopped to pick up a couple lemons and some bread. Dinner plans tonight are for chicken scallopini and bruschetta (home grown tomatoes ripened yesterday!). Sarcone's was sold out as usual (they sell out first thing every morning!), so I walked down to Talluto's, where I've also gotten bread before, about 10 minutes before they closed. Alas, the bread bin was empty, but the woman behind the counter said there was some at the register. I peered into the large brown bag full of rolls and as I asked for a couple short rolls, the woman shoved the whole paper bag into a plastic grocery bag and pushed it toward me. "Oh," I said, a little confused. "How much for the whole bag?" "Have a good day," she replied. And when I looked even more confused, she explained, "We don't sell day-old bread so we won't sell them tomorrow, so you can have them." Wow! What luck! Yay for the Italian Market.