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patient. She was the finest urologist in the city. Her attitude was,
"if we havethe tools to help a patient, then don't hesitate, use them!"
After Mr. Chang'skidneys failed, she had applied all the tools available and a decade of hermedical training and experience to keep him on outpatient dialysis and at homefor over two years. If she were with us at the bedside, she would
"pull out allthe stops."
No reason not to. He had done well so far, no complaints, nocomplications.
"We'll pull him through this episode and keep him goinganother two years."
Knowing Carsten's attitudes, when Chang "went bad" the nurse immediatelycalled a Code Blue, activating the cardiac arrest Team. Members raced from allover the hospital to Mr. Chang's room. When I heard the Code call I dashed tothe sixth floor, leaving a patient in mid-sentence.I could still hear her recounting her hypochondriacal tale of woe as the stairwelldoor slammed behind me.
"No problem. She's so self-involved she'll still betalking when I get back. I wonder if she'll notice I've been gone?"
The nursing notes surprised me. They were concise, accurate and, in spite of the Code, had somehow been recorded by the R.N.by the time she handed methe chart. I was impressed, since most recording of urgent care is done afterthe fact. The notes said Mr. Chang had been in outpatient surgery the afternoon before.Dr. Carsten had asked a general surgeon to insert a new shunt catheter in hisleft arm to make continuing outpatient dialysis possible. The patient'shemoglobin was low at the time of surgery and he had experienced a littlebleeding post-op. As a precaution, they admitted him to a room on the sixthfloor that afternoon.
"We'll give him three units of packed cells,"
"to get his hemoglobin up and watch his blood pressure overnight. Youcan take him home in the morning."
Mrs. Chang seemed reassured thateverything was going smoothly. Who knows what she was actually thinking.He was not in apparent distress when they rolled him into a his room. He wasnotably untalkative, although he thanked the nurses and the orderly for beingso nice to him. Mrs. Chang stayed with him during the afternoon and evening,sitting dutifully at the bedside, ready to get him anything he needed, just asshe had done for over 45 years. She left after dinner and anticipated returningin the morning to take him home.At 4 a.m. he was fine according to the notes. At 5 a.m. the LPW noticed he waswheezing and complaining of pain. She called the RN to check him, look at hisrecord and review his medication. He had requested Tylenol with codeine, buthad asked for it two hours early.
"I need to know about your pain. Right now, Mr. Chang. Where is your pain?Mr. Chang!?"
the RN shouted. She pushed for an answer. Silently he rockedback and forth from side to side. He was wheezing more with each breath andshe knew he shouldn't be doing that. He didn't have a history of respiratoryproblems and had not been given a general anesthetic in surgery.A whisper finally worked its way from the back of this throat:
"Over here ... onthe right side ... and straight through to my back!"
He was pointing to hisabdomen, not his operative site.
"Why would he be having pain there?"