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Wells-next-the-Sea - Norfolk, UK

You don’t forget days like yesterday.

Part 1

The cardiac arrest bleep goes off and, like the other doctors carrying pagers, I proceed to run across the hospital to assess the situation and ensure if required, CPR and other interventions are started as soon as possible. I’m the tenth person to arrive. I’ve been here a few times before, and I think to myself how I can be of most utility, processing thoughts in the ensuing flurry of activity around the patient. Twelve, perhaps fifteen of us including doctors, nurses and members of the critical care outreach team are processing and coordinating actions in a disorientating form of organised chaos. The patient’s heart has stopped and compressions have been taking place for minutes. It’s a violent process and good quality compressions can be distressing to watch. The restoring cardiac output is the absolute priority. Limbs will flail with every oscillation as her limp body appears literally lifeless.

There’s so much movement, absolutely nothing in the immediate vicinity is still, but I somehow secure intravenous access via the lower leg as there are too many of us around the chest. We’re now in a position to give intravenous adrenaline as per the protocol but it’s already looking bleak. She is fading. The more experienced around me rule out all the reversible causes as they piece the puzzle together and try to figure out why her heart stopped in the first place. The femoral pulse is weak, and successive pulse-checks reveal nothing at all. She is fading further. Blood pressure readings are dropping and she’s totally flat. The decision is taken as a team that after failing to get the heart going again, after a prolonged period of not beating that we can do no more more her and any further effort would be futile. We stop.

The intensity flips again. The motionless state of the deceased and the feeling of hollowness of the medical staff around her is now a juxtaposition to the last twenty minutes. We take a moment to pay our respects and clear up the mess of cables, discarded medical packaging, defibrillator stickers, and used vials, flushes and syringes that lay strewn all over her.

We debrief for a few moments, away from the patients, to figure out what happened and the likely causes, and to make sure each of us is okay and settled after a frantic, immersive and overwhelming ordeal. It takes some getting used to but looking around I see that even the most experienced among us are taken aback. Nobody saw this coming.

And back to work I go, to something entirely less animated yet important in some other way. As I leave the ward, I see the relatives arrive expecting to see their family member. They see all of us outside the bay looking withdrawn and dejected, and in turn a look of confusion and dread manifests on their faces. In that moment I’m reminded how much more this loss will hurt them than any of us. The ward nurses escort them to a room at the side. As I exit, I hear the piercing sound that always sends a chill down my back, the wail of a relative wrecked by the shock of a loved on passing. They never had an opportunity to say goodbye.

From the moment my pager went off, she had a 19% chance of leaving hospital.

correctivesurgery
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So on the freeway I usually drive on getting across the city there’s a bridge over a river… If your in the far left lane the road sinks a bit so it makes it a big bounce as you cross… each time I cross that bridge I want to be in that lane because it gives me the feeling of being shocked by a defib, and in my mind I always go “no pulse, resume cpr “ in a daydream :)

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The pair simply stood and admired the handsome Trent for a few minutes, and how lovely he looked all rigged up to their monitors. His vitals were again stable as he slept.

Adam, who had his arm around Xander’s back and waist, turned to face him. He placed the stethoscope around his neck in his ears, and placed the diaphragm on Xander’s chest.

“… how’s it sound?” Xander asked sheepishly, as he continued moving it around in proper exam form.

“It sounded close to your resting rate, but it got excited knowing it was being given attention alla sudden,” Adam teased as he turned the bell around to listen at his apex properly for a few moments. “Sorry. Just really wanted to check up on you.”

Xander chuffed, and made like he was play-slapping him on the chest. His palm lingered over his heart. “It’s okay. It’s cute and I don’t mind.”

“Well, what do you want to do now?”

“Hmm…” Xander shifted his weight to one foot as he thought on it for a bit. “Let’s load ‘em up with more drugs. He’s recovered from straight defibrillation pretty easy, wouldn’t you say?”

“It’s fascinating,” Adam said on that point. “But yes. Let’s do that.”

Xander grinned deviously. “Alright. Let’s start a line on his hand, first of all. I’ll let you do that.”

Adam nodded and gathered the necessary supplies. He inserted the line seamlessly and without waking Trent in the process, and then taped it in place on the back of his hand.

Xander had been busy where the pharmaceuticals were. He turned shortly after Adam had finished, and was tapping a syringe with a clear substance with his fingernail.

“What’s that, love?”

“Adrenaline. After he wakes up, I want to give him more fentanyl. See where it goes from there.”

“Wingin’ it. I like it,” Adam remarked. “Well, you go ahead.”

Xander took the prompt and plunged the drug into Trent’s line. It didn’t take long for it to take effect. He woke with a gasp and wide eyes, and tried to sit up as well, but was held to the table.

“Trent. Sleepy sleepy Trent,” Xander said in a sort of disappointed, sing-song voice. “I’d prefer it if you were awake.”

“Fuck.” That’s all he could manage to say as everything returned to him at once.

Xander observed him for a moment. Droplets of sweat had appeared on his face, and he seemed to be vibrating sporadically every few seconds. Adam was also observing Trent’s body as it seemed to go back into withdrawal.

“Are you ill, my lovely little patient?” Xander continued in his weird, psychotic voice. “Are you used to taking these drugs so often, this is where you’re at right now?”

“And how would you know about that?” Trent snapped back, assuming Xander too was an addict like he was.

“Oh, don’t get me wrong. I am fully capable of taking or leaving it. I’m just lucky in that way,” Xander moved to the pharmaceutical counter again as he said this. “Adam here used to be a hardcore IV user too, but he’s mostly recovered now. Isn’t that right, my darling?”

Adam only nodded solemnly. “Yes. Xander keeps me in line.”

“You know what? I’m sorry I asked,” Trent continued to try to sass him.

Adam let out a heavily annoyed sigh. “Get moody when you’re sick too, don’t you?”

“Yes! I do! Okay?” Trent was near yelling. “I’m also not happy about… about my heart being shocked, maybe? Or being tied down? Or fuckin’ kidnapped?”

Xander laughed at his sarcasm and presented him with a syringe. “Here. This is some acetyl-fentanyl dissolved in an injectable solution.”

Trent eyed it carefully. “I… can’t exactly give it to myself, right now.”

“So you do want it.”

Trent sighed in defeat. “Yes. I want the injection.”

Xander grinned his devious grin, and plunged the second syringe of the night into the line. It really was the acetyl analogue, but a very high dose. As soon as it had worked it’s way through his system, his heart slowed down dramatically, to the mid-40s, and his breaths per minute decreased steadily as well.

“Still awake?” Xander asked him.

“… Yes,” he replied, sounding distant and groggy through half-closed eyes. “Not sick…”

“He didn’t ask if you were still sick,” Adam interjected sternly.

“Whatever yalls have… it’s outta this world…” he said, seemingly ignoring Adam.

The monitor began displaying an alarm then. His heart was not responding well to the high dosage well beyond his tolerance. He was in bradycardia, and it was pretty irregular.

“Trent?” Xander again tried to quantify how awake he was.

He seemed to need to consciously remember to breathe before he could respond, but his eyes were nearly closed now. “Yes.”

“I want him on nasal oxygen,” Xander said to Adam as he briefly felt Trent’s abdominal pulse.

“Thass’ just gon’ make me more high…” Trent said with a delirious smile on his face. “That oh-two… makes you fucked.”

“Oh, so you know that, but not what a defibrillator is,” Adam taunted as he wheeled over their tank and attached it to the necessary tubes. He recalled how he didn’t know what it was going to do to him at the beginning of the night.

“What’s a defibibator,” Trent slurred, becoming more intoxicated by the second.
Adam aligned the output tubes with Trent’s nostrils and looped it around his ears, and then around the head of the table itself. Trent began sniffing a few moments later.

“Whass’ that weird-ass smell…?”

“Does he ever shut up?” Adam half-joked. “Have you decided on how you’re going to treat him, doctor?”

Xander flushed at being called 'doctor’ again. He was looking in the drawers of the crash cart for pacing pads, and finally found them. He turned and held them up. “Yes. I’ve always been too chicken-shit for this myself. Let’s give him cardiac pacing.”

Adam smiled with pride and excitement as he took one pad and peeled off the backing. Xander dropped the other, and grabbed a roll of shop-cloth on the counter to give Trent’s chest a good pat-down to get rid of the gel residue. Adam placed the first one under his right clavicle, and the other was placed around the apex of his heart. As Xander plugged them into the defibrillator and fiddled with the settings, Adam auscultated him again out of habit to confirm the trace was showing everything he needed to know.

“Alright, don’t touch him,” Xander warned, and he promptly finished up. Trent had either run out of things to say or was barely conscious anymore.

The first shock delivered. Then the second. A third. And so on, at 60 beats per minute. It was a low voltage discharge, so Trent’s chest twitched along with each corrective shock.

“Uuuhh…hhh….” Trent made a groaning sound around the seventh shock, which was interrupted by the one following it. 

“Ha!… Are you really still awake, Trent?” Xander asked, incredulous.

“Uuhhh… heart… hurts.” He said in between shocks.

“Wow. You are so resilient,” Adam remarked. 

“Urgh…” Trent didn’t really respond that time, and his head rolled off to the left as he closed his eyes all the way and lost consciousness.

“Oh… maybe not,” he changed his mind upon seeing that.

They let the pacing run it’s course, and combined with the oxygen, his less-than-optimal respirations were enough to keep his blood oxygen level stable. After a bit, Adam suggested he switch it off to see if it had done its thing.

Xander did just that. There was a pause. Then it became too long, and gave into that alarming flatline tone.

“Shit,” Xander cursed. He climbed up on the table, and settled his knees one either side of Trent’s body before locking his elbows and launching into deep, perfect compressions. Adam was already preparing an ambu bag that was also connected to the oxygen stream, and soon joined him by holding it over his mouth.

Xander completed the cycle, and Adam delivered two oxygen-rich artificial breaths. Trent continued to lie lifeless, with both his heartrate and respirations now zero.

“Come on, Trent. Breathe.”

Xander was internally startled to hear Adam say this, even if it was only with the faintest hint of emotion. “You okay?”

“Yes, dear. I just didn’t want him to die yet,” Adam admitted in a voice that was both small and a touch confident.

Xander accepted that, as he shared the sentiment. He kept his upper body stiff as he crushed Trent’s heart under his palm with increasingly violent compressions. After he completed another 30, Adam gave him two more squeezes from the ambu bag, then he set it aside and quickly went for something in the top drawer of the cart. It was a pen light, and he shined it over Trent’s icy blue eyes in a swift, professional movement.  

“His pupils are still responsive, babe, but barely,” he reported, and tried very hard not to sound worried. “It might be too late now, but we should try naloxone.”

Xander immediately ceased compressions and took the small device he too had forgotten about out of his back pocket. It was for nasal administration only, so he bent down, stuck one end up Trent’s nostril and plugged the other before discharging the spray.

The flatline still blared.

“Give him another dose, fent sometimes takes more than one,” Adam advised gently.

Xander followed his direction, but did it in the other nostril this time.

This caused Trent to gasp very dramatically, which startled Xander enough that he couldn’t catch himself from falling off the table. Luckily, Adam’s reflexes kicked in and he caught him, and placed him upright on his feet with ease.

Xander wore an embarrassed look, his cheeks flushed. “Thanks.”

“Mhm,” Adam murmured, as if it say, 'it was nothing’. In addition to Trent taking several fast, deep breaths, his heart had started beating again, on the lower side of normal right at 49 beats per minute, but the couple were grateful for signs of life at all at that point. This time, Xander took his stethoscope to confirm the ECG instead of Adam, and savored very much the sound of Trent’s heart in sinus rhythm once more.

[Part 6 of 9]

Part 1, Part 2, Part 3, Part 4, Part 5, Part 7, Part 8, Part 9

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A squeezing sensation around his arm roused Trent from his unconsciousness. He noticed the shrill, steady beeping from the heart monitor next, and then opened his eyes. He saw the many bulbs of a blindingly bright surgical light above him, and the wooden planks beyond them, but upon looking downward more, he saw Xander, now shirtless and without his mask. He was using the stethoscope to listen as he took his blood pressure.

“I’m…” Trent tried to speak upon remembering where he was and why, but his voice was strangely hoarse, and the pain in his chest made it difficult to breathe. “You… you bastards haven’t killed me yet?”

Xander replaced the teal-coloured stethoscope around his neck after the cuff released a moment later. He smiled at Trent, but the smile did not reach his eyes, and it was unnerving. “No.”

Adam entered his field of vision again. He was still wearing his surgical mask, but his shirt was now undone. He idly wondered if they’d had sex while he was asleep, and the thought disgusted him thoroughly.

“I’d bet you do anything for another hit right now,” Adam taunted him. “Anything to dull the suffering of being here.”

Trent didn’t answer verbally, but it was written all over his face as he frowned and turned his head to look away. 

“It’s okay, we know,” Xander said. 

“What, like you’d actually give it to me now?” Trent suddenly yelled. “You’re just here to torture and kill me!”

“And because of that, we don’t have compassion?” Xander mockingly whined at him. 

Trent stayed silent for a moment as he tried to blink back his tears. “N-no. You don’t. You think I’m a monster for selling opiates, but fuck, you two freaks are out here kidnapping and doing… whatever the fuck this is.”

“… How many people, have bought shit from you, and then died as a result of taking it?”

The iciness of Adam’s voice quickly silenced his sudden insolence. He actually knew the answer to that question. And it was more than he could count on both his hands.

Adam moved in closer to his face, his thick brow knitted tightly. Xander watched with an idle grin as he intimidated him. “Answer me.”

Another tear crept out the corner of his eye and wet his temple. “Twelve… that-that I know of,” he finally stammered out.

“Well guess what,” Adam straightened again as he said this. “You’re our first. Guess your body count is technically higher.”

Trent opened his mouth to refute, but Adam interrupted by striking him in the fashion of a precordial thump, but with extreme, unnecessary force.

“Ugh! Fuck!” Trent cried out. His heartrate increased as the pain rippled throughout his already-battered torso.

Adam chuffed at him. “Serves you right. Mouth off to Xander again and see what that gets you.”

Xander laughed, again approaching the table, on the opposite side Adam currently was. Trent was silently weeping, and trying to will this all away by shutting his eyes, once more. He put the stethoscope in his ears, and placed the bell on Trent’s chest.

“Take a deep breath,” Xander instructed coldly.

He met his gaze with a defiant look of sharpness. “No.”

“I said, breathe,” Xander insisted. His voice rose in volume with each word.

Adam gave him a few seconds to comply, before removing his mask too. He again leaned down to his face, and in the same rough movement, pinched his nose and tipped his head back simultaneously.

“He said breathe, you little shit!” Adam screamed at him, before he put his mouth over Trent’s trembling lips and violently expanded his lungs for him. He coughed out the excessive forced breath afterward, and Xander continued to listen, outwardly pleased with his husband’s brutal support.

He moved the bell to his other pectoral. “Again.”

Trent quickly drew a deep, shaky breath this time, before Adam could move in on him. Forcing his lungs to expand that much had hurt like hell. He repeated the process a few times more as Xander completed the anterior lung examination. Trent was panicking, and trying to think of a way out of this. Maybe compliance was the best way. Perhaps they’d eventually let their guards down.

“I think you need to learn your place again,” Xander hissed, interrupting his thoughts.

Trent’s eyebrows creased, his entire expression pleading no to whatever he was thinking of right now. “I know my place! I exist for your pleasure!”

“Adam.”

“Yes, dear?”

“Put the defibrillator in sync mode, don’t change the voltage.”

“Please, no,” Trent weakly pleaded, remembering the absolute searing pain of the first shock. He couldn’t quite recall the second, having lost consciousness before then.

Adam passed him the paddles, and watched as Xander settled one paddle onto his sternum, and the other on the left side of his torso. His movements were slow, deliberate, and sensual. His thumb grazed the charge button, and the machine quickly made five joules available.

He waited then. Five seconds, ten seconds. He savored how Trent was simultaneously trying to brace himself and suppress his panic. But, just before the automatic disarming, Xander silently pressed the discharge buttons.

“Ugh!” Trent cried out as his chest and arms contracted involuntarily. The shock passed from one paddle to the other in a split second, but the pain was intense and blunt, even as it passed quickly.

His heart paused, then slowed down as a result, from about 140 BPM to 55. Both Adam and Xander watched the monitor as it displayed this change. 

“Does it hurt, Trent?” Xander teased.

The helpless patient met his gaze again, this time with a look of complete resignation. He wasn’t sure if it was a rhetorical question or not.

“Haha, just kiddin’. I know it hurts,” he continued after giving him the opportunity to respond. “Turn it up to ten jays, please.”

Adam had never heard him call ‘joules’ by that slang, but found it silly and endearing. He did as he was told, and then his hovered his forefinger in front of the sync button. “This too?”

He nodded, and as soon as the button was pressed, he charged again.

“Clear!” Xander exclaimed.

Ow! Augh, ah ha…” Trent’s reaction to ten joules was a bit more pronounced as more electricity passed through his heart muscle. He struggled against his shackles afterward, desperate to get away from this. “Please…”

“Please what,” Adam said sharply, at the same time leaning closer.

“Please.” Trent repeated, unable to complete the sentence through stifling his sobs. His heartrate steadily increased as he seemed to lose his grip again.

“Oh, you want another one now?” Xander maliciously misinterpreted him. “No problem. Fifty this time, my love.”

Adam was already knowingly turning up the dial, and reset the sync mode as well.

“Clear!” Xander yelled out again a few seconds later, with a maniacal tone in his voice.

“Auuugh!” Trent’s groan was louder and more intense as his torso contracted with the syncronized shock. Afterward, he lie far limper than he did before, and his breathing became shallow and rapid. “Please…” He managed to whisper again, before his consciousness lapsed once more.

Adam stepped up to the table then, his serious brown eyes locked to the monitor as he watched him enter cardiac arrest. He pressed his stethoscope to his chest very briefly to confirm the condition.

Xander stroked his chin with one hand and held both paddles with the other as he tried to figure out what had happened before Adam said it, but he was unable to.

“He’s tachycardic. Here,” Adam said gently, and gestured for the paddles.

Xander handed them off silently, and watched with intense interest as the trace displayed Trent’s heart quivering helplessly at 267, 271, 255 beats per minute. It changed rapidly second-to-second.

“What do you need?” Xander asked as Adam positioned the paddles.

“200.”

He turned the dial and pressed charge for him as well. It took the machine a little longer to prepare 200J, but Xander loved every moment of seeing his large husband hunched over their patient, razor-focused, and waiting.

The audio tone changed, and Adam immediately pushed down with force. “Stand clear!”

Trent spasmed helplessly under the paddles, and the shock even jostled his legs this time around. There was a pause, and then sinus rhythm returned.

“He’s got a really strong heart, considering everything,” Adam remarked as he set down the paddles on top of the unit.

“He does,” Xander agreed. “And I, for one, can’t wait to see how far we can push it before it gives out once and for all.”

[Part 5 of 9]

Part 1, Part 2, Part 3, Part 4, Part 6, Part 7, Part 8, Part 9

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one day I’ll hope to find someone to share this with, I crave for understanding and passion, maybe some tenderness won’t hurt.

For the first time in the 30something years I’ve been around, I am trying to build something for me, something that is just my own…in order to share it, because I’ve been alone for far too much part of that time span.

Again, and forever again I am glad to be part of this community…

image

Originally posted by contac

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I got in contact to get a BLS/BLSD certification, the course should begin at the end of March, can’t wait !

Also a friend/colleague of mine showed up today with a Holter monitor…❤❤❤

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TAT: Time is crucial when you're pulling a drowning person from the water. How long have they been under? The rescuer wonders while they perform CPR, frantically trying to breathe life back into their friend's unresponsive body.

Can you say whumperflies??

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