Friday, March 07, 2008

COR-0

Occasionally I get to work shifts overnight in a nearby hospital. COR-0 is the overhead paging code in the hospital that indicates a patient is not breathing and has no heartbeat. The team that responds includes the chaplain. These calls, in my experience, have been heartbreakers. I've responded to a couple where the patient is someone younger than I am, who has not survived despite massive resuscitation efforts. (I have seen ER techs standing on chairs to get a better purchase for CPR, and when the patient comes in by ambulance the team is waiting with medications, defibrillator, etc., at the ready.) There is one benefit to working primarily in hospice, and that is that I am used to dead people and I know what dead people look like. Thus, at the last COR-0 I attended, as the ambulance crew brought the patient in, doing CPR as they raced into the trauma bay, the back of my mind said: I know what that is, that is a DEAD PERSON. And it did help, because it let me get the deep breath and the mental preparation so that when the doctor came out to the family, I knew what the outcome was. And because I was not surprised by the word, I could be more ready to attend to the family. One of the ER docs that night told me that it always takes him awhile to get back to an even keel after a sudden death, especially when the patient was by all accounts a wonderful person. "That's good," I said to him. I should have explained--this doc was immensely compassionate to the family, and I think the fact that he lets the deaths affect him allows that compassion to come through.

A weird thing happened though one night. The page to a COR-0 in a particular room in the emergency department, but as I arrived the staff was cancelling the page. "Just a mistake," they said. I wondered: how do you make a mistake determining if someone is breathing and has a heartbeat? "Oops, never mind, I had the stethoscope backwards?" or did the patient, previously unresponsive, sit up and ask for a Diet Coke? I dunno.

Chaplains also respond to "cardiac alerts." A cardiac alert in this particular hospital is the code that means there is reason to believe that a patient is having a heart attack. When the patient is already in the hospital, a team descends upon the patient's room; when the patient is being brought in, the team awaits in the emergency department. It is awkward being the chaplain at these. I always wonder, while waiting with the cluster of doctors, nurses, lab, portable X-ray, EKG, registration, etc., what on earth I am supposed to do. The unholy part of me, which is the major part of me, has been tempted to say, "Welcome to the hospital. Would you like coffee, tea, or an angioplasty??" Cardiac alerts get cancelled if the cardiologist turns up, looks at the EKG tracing, and determines the heart is OK. That's a good news/bad news thing for the patient. The good news is, not a heart attack. The bad news is, "We don't have a clue what's wrong with you at this moment."

If the patient is having a heart attack, the team rushes her/him for an angiogram to see if there is one or more blocked arteries. In the best case, these can be fixed then and there. My job is to get the family to the appropriate waiting room, help with any calls, offer support and even prayer if they want, and wait with them for the doctor if they want company. Some of the docs kind of ignore the chaplain, while others involve us more, like the one who said to me (I'd stepped out for the doctor's report and the cardiologist caught me on the way back in to the patient), "We're doing a HIGH RISK (meaningful glance) angioplasty for this patient." I did not leave the one relative present until the procedure was over and the patient had survived.

Whew.

1 Comments:

Blogger Josue said...

I love this post, I like researching information related to this, when I was in college did a study about it called angioplasty surgery, where I learned a lot about this subject

2:00 PM  

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