Messed up medicine

How ridiculous is this?  A 20 year old comes into the hospital with three months of chest pain.  To use med-speak, his pain was atypical to say the least.  It didn’t sound cardiac.  It sounded like he was anxious.  Nevertheless his mother was anxious too, very anxious and she had read about young basketball players dropping dead at 20.  Her son plays pick-up once a while.  She worried he would be the next to go.  And she didnt want any risks taken, no stones unturned…Two months ago she bullied his doctor into getting a echocardiogram of her sons heart.  Normal.   One month ago she persuaded the same doctor to get order a ‘stress test’ for her son.  Completely normal. Last Thursday they both turn up in the ER sick to death that this pain is cardiac.  I take a full history.  He is healthy.  Never smoked.  Never used drugs.  No family history.  I examine him.  Plum normal.  In fact the only worrying signs are those of parental anxiety.  I tried to reassure the two of them – but nothing helped.  They wanted specialists, they want angiograms. Ridiculous as it sounds – they got both.  The former makes sense – after all, the quieting words of a cardiologist should dispell all their fears, right?  Wrong.  The cardiologist  - who makes money for every angiogram he can do – signed them up there and then for procedure. (And did nothing to reassure them – except to list – at frightening speed -the risks of angiography as he shoved the consent form in front of the boy). Now the implications of that may be lost on the non-medical – but essentially this MD scheduled him for an incredibly invasive test – not without serious risks- soley for the purposes of allaying their anxieties.  Their story illustrates some profound dysfunctions with the medical establishment.  First of all it demonstrates how patients can jeopardize their own health by thinking they know better.  However, medicine here is often dictated by  the adage that ‘the customer is always right’ …. even when it is patently not the case.  The mother and son were on a mission to have everything done – even when common sense and simple stats should have been enough to still their minds.   Someone should have just told the  kid that he was fine, that most of the tests needn’t have been performed and that the angio certainly didnt need to happpen.  Chances of a heart attack – 100 000 to one.  Instead the mother got what she wanted even when she shouldn’t have.  And though they never realized it someone somewhere else in the country  suffered.  That kind of needless testing hurts insurance premiums.  Secondly the case illustrates how dodgy medical decisions can be when they are dictated by $$$.  In this instance the cardiologist got paid to do the procedure – and so rather than letting good sense color his judgement, he let the color of money….  He should have sat them down and calmly reassured them that the boy was fine -he already had enough information to tell them as much.  Instead, he was prepared t put him through a dangerous procedure.   This kind of stuff happens all the time.  Its ridiculous and yet everyone thinks its fine.  Its not.  Its downright stupid and completely unethical….. 

Faces

I open the door, throw my stethoscope onto the bedside table and turn to face the mirror that hangs above the sink.  I stare at my reflection.  My face looks tired. My eyes are blood red and surrounded by gray circles.  It’s 5.30am and the on call room is uncomfortably cold.  I am too tired to care.  ‘Sixty minutes until rounds. Not enough, but better than nothing,’ I mutter to myself.  I then fall back onto the bed and pull the blankets over my body.  I can’t sleep.  Despite my weariness, my thoughts are filled with images of her.  I can’t get her face out of my head: the color of her skin, the sweat on her brow and the tattoos on his neck.  I can still feel my heart pounding.

 

I step hesitantly into the room.  The same room I have spent most of the night in.  It’s 4.16am.  Moonlight leaks in through the blinds.  The white walls look blue in the cold light of dawn.  They have both arrived and are stood either side of her.   She is holding her mother’s hand.  He is pacing the room.  Six foot six and three hundred pounds of grieving anger.  I try and break his angry silence with some kind of condolence, but before I have even opened my mouth, he strides across the room towards me.  He comes and stands in front of me, towers over me, and, through gritted teeth, growls slowly and deliberately, ‘Get – out – of – this – room – now.  Right – now.  Get out of this fucking room and get out of my fucking face.  Get out of my fucking face!   I said it and I mean it.  Get – out – of – my – fucking – face.’   His chin is inches away from my forehead and as he growls he sprays my glasses with spittle.  I can see the veins pulsing in his neck.  They are covered with tattoos of skulls and guns.  Not sure what to do, I try and look as compassionate as possible, stepping backwards out of the doorway.   His sister quickly stands and puts her hand across his chest to hold him back.  Black mascara stains her cheeks.  ‘Easy Kyle – he is just doing his job.’  She turns to me, ‘Sorry doctor we are just so…’ and trails off covering her mouth with her hand.   ‘I don’t give a shit what he is doing.  I want him out of this room and out of my fucking face.’  Pushing her away he steps towards me again.  I raise both my hands, palms facing him, and stutter, ‘All I can s…s…say sir is that I am really sorry.  I am so so so sorry.’  ‘Shit man, I don’t want your apologies; I want my fucking mom back.  Now get out of this fucking room and get out of my fucking face.’  

 

I am at the nurses’ station.  I take the scrap of paper out of my pocket.  He had scrawled a number on it and handed it to me as they were leaving.  ‘Anything happen to her – you call me.’   After sitting there for several minutes trying to figure out what I am about to say, I reach for the phone and dial the number.  As I dial I realize that I am still shaking.  My heart is pounding.  The events of the last two hours race through my head as I wait for it to ring.  Her labored breathing.  Her face, sweaty and gray.  The color of her skin.  My panic.  The code cart.  Chest compressions. The ensuing chaos.  Blood.  People.  Atropine.  Adrenaline.  Then, eventually, silence.  Her face lifeless.  The number connects and a distant voice answers.  ‘Hi, sorry to wake you.  Is this Mrs. Thomas’ son?’  He answers with a growl.  I imagine the tattoos on the side of his neck.  ‘Sir, this is Doctor Reid – I think we met earlier today.’  I pause, ‘Sir, I am afraid I have bad news….’  ‘What kind of bad news?’  ‘Well, I’m afraid that after you and your sister left, sir, your mother took a turn for the worse….’  I swallow hard.   ‘She appears to have…  We did everything we could, but she…’  He curses at me down the phone.  ‘Is she all right?  What have you fucking done to her?’  ‘I am afraid that her breathing got worse…  And…  and before we could do anything…’  He interrupts my stuttering,  ‘She’s alright now though isn’t she?’  His anger gives way to panic.  ‘She’s alright isn’t she doc?  You said she would be alright?  Oh, Jesus, she better be alright.  Jesus Christ, she better be alright…’  ‘Er, no sir, I’m afraid she’s…  We…we did everything we could, but I am afraid she’s….’ He interrupts again with a string of expletives.  I try and make compassionate noises as he curses.   ‘Don’t’ tell me this!  Don’t fucking tell me this.  I fucking warned you!  Didn’t I fucking warn you?  I told you to fucking fix her up…  Jesus Christ, what have you done to my fucking mom? What have you done to my fucking mom?  Oh, Jesus Christ, fuck!  Oh Jesus.’  His words then become muffled.  I can hear the sound of breaking glass and then silence.  The line goes dead.  ‘Hello? Mr. Thomas?  Mr. Thomas?’  No answer.  I call back.  It goes straight to answer phone.  I call again.  Answer phone again.  I leave a message.  It is 2.36am and my hands are still shaking.  

 

Midnight.  I walk back into the room. Even in the half-light I can see her face.  Her lips are blue and her eyes are empty.  Her skin is gray.  She is gasping.  ‘Shit,’ I curse under my breath and then turn to the nurse hovering behind me.  ‘She looks…  She looks awful.  Why didn’t you call me earlier?’

 

‘Mom is not a complainer.  Most times I have to drag her to the doctors.  So when she said she was in pain, well we was worried and brought her straight here.’ She throws an exasperated smile towards the bed and strokes the side of mother’s face with the palm of her hand. The sun slips behind the horizon and I turn to switch the bedside light on as the daughter adds, ‘we just don’t want the same thing to happen again.  Last time she was in the…’ Before she finishes her sentence her brother interjects, ‘Yeh, last time Mom ended up in hospital you guys messed her up real bad.’  His arms are folded and he looks like he is ready to break my legs.  He gives me a violent glare and speaks in a growl, ‘Man you betta fix her up, man.  Don’t be messin’ with us, man.  You betta fix her up or you are fucked.’  ‘Um, okay.’ I respond nervously, trying to ignore his threat.  I turn to the sister, ‘So when did she start feeling like this?’

 

It’s 6.15pm and I am admitting my fourth patient of the day.  I am stood in the doorway of a small room on the fourth floor.  A woman in a hospital gown and yellow socks lies limply on the bed.   Her face is hidden behind an oxygen mask but and her forehead is covered in sweat.  She doesn’t look at me when I introduce myself.  She is working too hard to breathe.  Her son and daughter stand either side of the bed.  They look anxious.  I explain that I am the on call doctor.   I have a few questions to ask.  The daughter begins to speak.  She pulls nervously at her own braids as she tells me how her mother ended up in the hospital.  Her brother watches silently from the other side of the bed.   

 

It’s 4.23pm and this is my first meal of the day: stale mashed potato and gravy soaked vegan cutlets. It tastes disgusting, but I am too tired to care.  The hospital cafeteria is empty and I eat alone.  Halfway though my plate of food, the pager on my belt vibrates me out of a weary daydream. I finish chewing my mouthful and look down to read the message.  ‘4114.’ Sighing heavily, I get up and walk to the phone in the corner of the dining area.  As I dial the number, I catch a glimpse of my reflection in the stainless steel paneling. My eyes are blood red and surrounded by gray circles.    ‘Hello, this is Dr Reid, you paged me.’  ‘Yes doctor.’ It’s the overweight ward clerk on North 4.  She speaks to me like I am still in kindergarten.  ‘Just wanted to let you know that your new admission is here.  Mrs. Thomas.  Shortness of breath.  She’s in 434A.’  ‘Okay, thanks.  I’ll be up shortly.’  ‘Don’t be long, doctor.  We are all very busy up here.’  I hang up and finish my cutlets, then pick my stethoscope off the table and trudge out of the cafeteria.  I am tired.  Too tired.

For your eyes only

So I am re-inventing myself.  Under cover.  Or at least under a more obscure alias.  For no better reason than I think my writings would benefit from a little anonymity.  For no better reason than I am not sure I can handle my mum reading my writings anymore.  For no better reason than the lack of readership may fuel rather than stifle my creative juices……  As for the new title.  Well its true, right.  I am Barabas.  I get off scot free for a crime I did commit.  Every day……   The agenda.  I guess that doesn’t change.  Angst and allegory.  Reid in a nutshell hopefully 

The Scotsman

There’s this guy I know. Mumbles. Has trouble ennuniciating words. His sentences trail off into conversational oblivion. 30 something and blighted by speech impediments.

You’ll ask him a question. Anything. And his answers will start with some kind of irrelevant whittering. The weather, Scotland, his wife. Self deprecation and misdirection. You wonder what an earth he is talking about or why his answer has anything to do with what ever his answer includes.

And then after minutes of circumstantial meandering you realise that his mutterings are full of light and gold and clarity and sense. The stuff of crumbly old men with years of insight. The stuff that you strain your ears to ear.

And at that point, it’s like he realises that he is making too much sense. He throws his hands into the air, and his wisdom turns to mumbles.

At least that’s how I remember my conversations with him. Its ages since we have actually spoken. He has a kid and a wife and lives somewhere in the West London ghetto. I am five thousand miles away, and the only wise words I hear these days are electronic or spousal.

All of that to say that I miss the likes of the Mumbling Scotsman. New York is a lonely place these days, even for us helmet-wearers….

My headache

Okay so I figured I would write something…. finally. Got knocked off my bike two days ago. 3 staples, a lot of road rash, 2 CAT scans, an MRI, a funny heart rhythm, an Echocardiogram and an embarrassing amount of amnesia later they let me out of the hospital.

For the record I need no sympathy. I am idiot. I jumped a red light and didn’t wear a helmet. So please no telephone calls of concern, no ‘get well soon’ cards, no fed-ex baskets of fruit… Unless of course you feel compelled! Just make sure your give me a hard time next time you see me. And yes I will wear head gear from now on.

So anyway, a ton of time has gone since I last wrote and I am still not convinced I have anything novel or nice worth writing about. So I am not sure my blogging returning is a permanent thing. But just thought you would all want to know the updates on my idiocies…

Farewell for now!

I have nothing to say. I am devoid of stuff worth writing about. My head is full of cotton balls and sleep dust. Writers block or over-worked cerebral myopathy, who knows?

Its the day after American Dependence Day and Marge and I did our finances this morning. We worked out that if we wear thrift store clothing, and bake our bread maybe we can pay off our debts by 2012.

I have a million ambivalent thoughts about how society cripples people with debt just when they are starting out in life. Especially doctors -many of whom have the noblest intentions to work with the poor but can’t afford to. But who wants to hear them….

I have several much more angry thoughts about Scooter Libby’s clemency and another example of George’s dodgy government. But who wants to hear them either….

So instead of ranting about the same things ad nauseam I am taking a break from blogging. I am not convinced that I am writing anything that you can’t find written more imaginatively in a hundred different places on the internet. Check out my list of co-bloggers if you are not convinced….

Anyway for a month or two at least: Cheerio!

Bad plumbing and being Sheep

I was on call and missed the last last church service.  Apparently it was beautiful and poignant- full of grace and optimsim.  Nevertheless it was the last meeting.  And ever since the plug was pulled on our little congregation two months ago we have been trying to work out whether we could stave off this last meeting.  Week on week we have met and tried to discern where we go without a leader. And week on week less and less people have come.   We started with 40, then we were 28, then 18, then 12, then 12 again.  And finally 15.

Apparently we are all sheep.  Apparently we do need leaders.  Apparently it is hard to commit to a community when you have no idea what you stand for or who stands with you.  Can’t say I blame anyone for moving on – but I would have loved to have seen this community flourish some more.  I had a sense of God in the midst of all of our brokenness.  And I still feel robbed by the way that it ended and the way that we were so thrown by all that plug pulling….

Anyway, Marge and are about to start church hunting all over agin.  To be honest the thought of road-testing another load of different places for another month of Sundays fills me with a heart sinking dread.  I guess at least it is summer, at least my intern misery is over (tonight in fact is my last night of my intern misery!).  And at least God is in all of this even in spite of the plug pulling and the sheepishness.

Dieing in Hospital

We are introduced in a one way type of way. I greet her and she stares back at me. For a split second I have the disturbing sense that she is staring into me. She stares deep into my eyes. She stares through me. She stares through the back of my head, through the hospital wall, through my words and my caring indifference. She then blinks and coughs and the moment is gone. I awkwardly interact with her body. I stutter out an introduction. She stares, blank and expressionless.

Her name was Margaret. She was three years older than me. She had beautiful olive skin, long Hispanic hair and dark brown eyes. She lay flaccid in the hospital bed. She had splints on both wrists. She lived through tubes. She breathed through a tube. She was fed through a tube. She was toileted through a tube.

She had come into hospital to die. Her husband and the high court judge had decided that she had had enough of her life. Or at least they had had enough of her life.

And I had planned to be on vacation so I wouldn’t have to be there. But there had been judicial appeals, Parliamentary rulings and delays. We met the morning I got back from ten days in the sun. I was very alive, refreshed and sun kissed.

Every day for the next ten days, as my tan faded and the on calls drained away my vitality, I cared for her helplessly. Every morning I would awkwardly interact with her body. She would respond to my empty questions with emptiness. She would stare and blink and occasionally cough. And then I would do nothing for her. No food. No water. No meds. No monitors.

Then on the eleventh day at two twenty four in the afternoon, I paid my last visit to Margaret. Her room was hot. The air smelt sweet. Her skin was sallow and grey. Her tubes were empty. Her breaths were deep and irregular.

I held her hand. It felt cold and warm. I watched as her lungs expanded and then collapsed shut. Her eyes were open. They were deep and dark. For a second I had the disturbing sense she was looking into me. I waited for what seemed like an age. She didn’t breathe again.

And then she was gone, if she hadn’t gone already. I sat next to her in silence. After what seemed like an age we were disturbed by nurses and family. And after more awkward interactions, I opened a window and caught my breath.

Things could be worse….

On call.  It’s Saturday night and the evening is dragging.  12 hours down.  14 to go.  I am pushing pieces of medical paper around the desk, answering pointless pages and trying not to look as bored as can be.

Things could be worse.  My penis could have been nailed to a burning building.  I could have fallen into a vat of boiling pork scratchings.  I could have taken a cocktail of cocaine and viagra and had a massive heart attack. 

Believe me, things could be far worse.  Mr Rodriguez would testify to that.

You see, Mr R is the  rather embarrassed Puerto Rican fella I have just admitted.  He checked himself into the ER last night.  But for rather too long was too shy to say why he had come in except that he had chest pain. ‘Like some fat man is sitting on my chest.‘  After a good deal of cajoling and once he had made it crystal clear that he wouldn’t say anything as long as the young nurse was still in the room, he started to tell me how he had fallen on hard times a couple of months ago. 

His wife had left him for a Dominican butcher and then a month later he had lost his job.  Things had gone from bad to worse.  He couldn’t pay the rent and was evicted from his apartment.  At that point he started snorting lines of coke to numb the pain.  Initially it helped, but lately it didn’t seem to make a blind  bit of difference.

Just last night he couldn’t take the loneliness anymore.  So picked up a working girl from down on Jerome Ave, took her back to his new place (an SRO off Gun Hill), popped a viagra, took another line of charlie and then got down to it.

Unfortunately for him it would seem that his heart couldn’t take the strain.  Just as he was about to come he was hit by a ten ton truck.  ‘The worst pain of my life – right in the middle of my chest.‘  He fell off the bed the pain was so bad.  At which the prostitute stole the rest of his money and left.  Him still lying on the floor in agony.  A big fat man still sitting on his chest.  Twenty minutes later, after much sweat and swearing he got up off the floor and called 911.

Not a moment too soon.   Another 20 minutes and he would have been a goner.  Instead he’s here - Bronx finest coronary care unit. 

Rather tragically he is consigned to a life time of cardiac therapy, more medications than you can shake a stick out and miserable insurance premiums.  Give me the pork scratchings any day.

Steve’s First Day

Any year, August the first is always a bad day to get sick. It’s the one day of the year when hospitals across the country descend into mayhem and confusion. More people die on the first of August than other day. There are more needle stick injuries on August the first than any other day. People wait longer in ER on August the first than any other day. More patients get lost in hospitals on August the first than any other day. Less phones get answered, less drugs get prescribed, less operations get performed, less patients get well on August the first than any other day. More nurses quit, more doctors commit suicide, more patients ‘go off’ on August the first than any other day. To put it mildly, hospitals are in carnage on August the first. Absolute chaos.

It’s the one day of the year when three thousands new doctors start work for the very first time. The assumption is that some how on August the first 3000 clueless naïve medical students will miraculously turn into competent health care professionals. The reality is far from that. The summer of 1998 was no difference. Carnage. Chaos. Mayhem.

Steve’s efforts to look calm and in control were a complete failure. Instead he looked and sounded ridiculously terrified. And as he walked onto the ward that would be his home for the next six months his head was spinning with a thousand anxious thoughts about worst case scenarios that could happen. His anxiety was worsened by the fact that he was on call. His first day as a doctor and he was on call. For the next twenty four hours he would carry a pager that could go off at any time – commanding him to go anywhere in the hospital to see any patient, no matter how sick they were, irrespective of how clueless he felt.

The prospect made him feel nauseous

What if someone stops breathing and I am the only there? What if someone has an epileptic fit…an angina attack…a thyroid crisis…anaphylaxis…t-wave inversion……dropping GCS…a GI bleed…cardiac arrest. What do I do then? Shit I can’t remember….oh shit, I am in the shit…Shit.

He wore a brand new white coat. The pockets were heaving with a million things that he was too scared to leave at home: four tongue depressors, three pens, a bright blue stethoscope, a miniature flashlight, a brand new palm pilot, a pocket size phone directory and seventeen laminated cards with instructions on how to treat epileptic fits, angina attacks, thyroid crises, anaphylaxis, t-wave inversion, dropping GCS and GI bleeds cardiac arrests….the list went on.

‘Hi, you must be Steve, the new doctor. My name is Jenny; I am the nurse in charge. We are pleased to have you with us’

‘Er…er…er…Hi…hi….ho…how are you. Please to meet you.’ Steve stuttered the words in an awkward formal tone, holding out a sweaty nervous hand to the Charge nurse who had greeted him. She had a motherly, sympathetic look in her eye. She smiled Steve onto the ward trying hard to help him feel less anxious. Her sympathy did no good. Steve was nervous as hell, and he could feel his neck flushing pink.

‘I am afraid your predecessor has left you a lot of work to do. And your first rounds with the boss will be in two hours so you will have to hit the ground running. Before he comes though perhaps it would be good if you met the rest of the team working on the ward.’

Jenny had a gentle manner about her. She took Steve by the arm and started walking down the corridor, showing him where the dressings and drugs were kept and then introducing him to the rest of the staff one by one.

‘This is Sandy – she is the ward clerk. If you need any paper work finding or X-rays filing, Sandy is the one.’

‘Hi there Steve –please to meet you. Hey, don’t look so scared we don’t bite.’

Steve, who had been mute since first arriving, smiled back. His mouth was dry and words wouldn’t come as he tried to open his mouth to speak. Instead he nodded, open mouthed, trying hard not to look so nervous. Jenny ushered Steve down the ward. But as they were moving away from Sandy’s desk, Steve’s worst nightmare was realized. The pager, clipped to his belt, suddenly started to vibrate. Unused to the sensation, Steve wasn’t sure for the first movement what it was. But a split second later began the pager to speak- a loud audible message –the kind of message Steve had been dreading ever since graduation day two weeks ago:

‘Cardiac arrest. Cardiac arrest. Cardiac arrest all. Ward four, third floor. Ward four, third floor.’ The pager message was loud enough for both Jenny to and Sandy to hear.

Jenny looked at Steve, he looked at the pager. She understood full well what this meant.

‘You better run, it looks like you are needed on the third floor.’ She smiled at him as Steve stood petrified. He could barely breathe with terror. ‘You’ll be fine, just hurry up and get there!’ For a moment Steve couldn’t move. His bladder all of a sudden felt uncomfortably full. His legs felt like lead. And his head had started to spin.

This can’t be happening. This is my first day –I know nothing about cardiac arrests. I am clueless. It’s my first day. I have no idea how to treat a cardiac arrest. I only graduated from med school two weeks ago. Shit this is a bad way to start.

‘Go on then…there’s no point waiting around. Fourth ward, third floor.’ Jenny spoke again in a effort to jolt him from his mute stupor.

Slowly, turning around, Steve paced reluctantly back toward the door, anxiously trying to recall anything he could remember about cardiac arrests.

Cardiac arrests. Cardiac arrest…What do I do? Shit. A… B…C…Airway, breathing…but what about the shocks? when do I give them?… I can’t remember. Shit this is bad.

Realizing that the patient on the third floor was probably on deaths door or had already passed through it, Steve picked up his pace and broke into a run. A thousand frightened thoughts raced through his head as he accelerated down the corridor.

This is all going to go so wrong. I can’t remember anything about cardiac arrests. I am going to get shafted for not knowing what to do. The patients going to die and I am going to get screwed for being clueless. I can imagine it now: BBC News headlines: ‘patient dies because junior doctor can’t remember….’ ‘Junior doctor fired on first day of work…’ ‘Patient’s family sues hospital for incompetent doctor.’ Shit, shit, shit…I am so in the shit. A cardiac Arrest on my first morning…shit this day is going so bad

Steve sprinted through the doors, toward the stairs. He started bounding up between floors, taking three or four steps at a time with panicked agility. He raced up on onto the third floor, turning out of the stair well and into ward four – and even as he ran onto the ward he could see the cardiac arrest commotion. Nurses were shouting things and two porters in blues were wheeling the ‘Arrest trolley’ down the ward corridor at speed

Steve followed the porters and their trolley towards the arrest scene. As he got closer to the scene he slowed down, slowly realizing what all of this meant.

Please don’t let me be the first doctor there. If I am the first one there, all the nurses will expect me to know what to do. Shit. Maybe if I slow down, some other on call doctors will arrive before me.

Steve slowed but by now he was only meters away from the scene. In the corner of the ward, a melee of nurses was gathered round a bed. On the bed lay a very lifeless grey body. There was a tube stuffed in its mouth, and two needles in each arm. It looked dead. The nurses were trying their hardest to revive it. One of them was leant over it pumping its chest, sweat dripping off her brow. Another was shouting from the end of the bed, telling people what to do. The two porters were setting up the trolley –one was putting the electric paddles on the dead chest. Steve stood, ten meters away from the commotion, paralyzed by fear, watching as they tried to resurrect the lifeless body.

‘Hey, doc. Are you here to help?’ It was the charge nurse who was standing at the head of the bed. She sensed his fear. ‘First day today? You will be fine. Look, we are going to need you sort this guy out. He has been in VF for the last three minutes.’

As the nurse spoke Steve’s fear were infused with another emotion. He suddenly found himself flushing with excitement. He stepped up to the body assertively. ‘What’s the story –what do we know about him?’ Steve’s assertiveness surprised even himself. All the nurses turned to him, as if taken aback by the Steve’s air of authority.

For the next three minutes, Steve led the arrest scene. The terror and excitement were more exhilarating than any experience he had before.

‘How long has he been like this…Past medical history? Previous MIs? Meds? Okay I think we need to try shocking… Shocking at 200 joules…every one stand clear….What’s the rhythm. Still VF….okay lets try 350 joules…no effect. Okay, are we ready to give the epinenphrine? Who is keeping time? When did we last shock?’

Steve’s legs trembled as he tried to think clearly and stay level headed. Everything he had learnt came back to him with surprising clarity. The nurses listened and worked silently, surprised by Steve’s composure. The body remained lifeless. No amount of electricity or epinephrine were going to change that. They shocked him twelve times. The smell of singed flesh and fresh sweat lingered in the air. Eventually Steve called the team to stop. By now, other doctors had arrived, but for the most part they had stood and watched –happy enough to let Steve run the show.

‘I think we should end things here. This chap is well and truly gone, God rest his soul.’ Steve stepped away from the bed, exhausted. He tried to stay level headed despite the euphoria of the last ten minutes.

‘Well done, Steve. She was a goner from the start – but good on you for trying. Great way to start your first day at work!. ’ It was Steve’s boss.