Coded

The senior resident was only too happy to hand the instruments over. Dr. Joe was moving quickly and Joan was passing him instruments as quickly as she could. “Suction – show me the cystic artery – Joan gimme a clip please – another please – cautery – suction – suction again – why is the pulse ox going down? – what’s her pressure?” “Hey Joe, I’m going to give her a couple units of unmatched blood. Her pressure’s falling and you’ve got about 400cc’s in the suction canister.” “OK – more suction – cautery – suction – clip – what’s going on up there?!” “Her pressure’s still falling – I’ve started a second IV and I’m running normal saline wide open – she’s oozing from her IV sites too.” “Give her a couple units of FFP” FFP, or fresh frozen plasma, had the body’s natural clotting factors in it. Joe had to make a decision: “I’ve got to open her. Joan, get some help. Nancy, get me some Averene please.” Averene stopped bleeding about as well as anything Joe knew. It was tested and proven in Iraq and Afghanistan; and it was expensive – but it worked. “FFP’s running Joe” said the anesthesiologist. “OK, I’m going to decompress her abdomen, get ready to deal with her pressure.” Letting the air out of Marjorie’s belly would likely cause a significant drop in her blood pressure which was already low. “I’m going to give her some dopamine.” “Just don’t kill her kidneys! Here we go” as Joe let the air out through one of the trocars. Just as fast “Give me a 10 blade – get a couple lap pads up here – cautery – suck smoke” as the cautery burned through fat and divided the muscles down the center of Marjorie’s abdomen. “Pick-ups and Metz” as Joe grasped the peritoneum and used the Metzenbaum scissors to cut it. Marjorie’s belly was full of blood. It seemed to be coming from everywhere. “Nancy, do you have the Averene yet? No? OK, let me have it as soon as it gets here. Lap pads please” as Joe started putting the large surgical sponges into the bloody mess in front of him just to put pressure on the tissue in hopes of stopping the bleeding. He sure hoped Nancy had counted them. “What’s our blood loss?” “Over a liter – second unit of FFP going in now. Her pressure’s barely holding – what do you see in there?” “She’s just bleeding from everywhere. No discrete bleeders – everything’s bleeding.” The monitors reached their critical settings, and now instead of beeping, alarms were going off. The surgical team was working together perfectly – there was no wasted motion, no yelling, no outward panic. Each member of the team knew exactly what they needed to do, and for Dr. Joe they would have done anything. The surgical team was doing everything and doing it right, but Marjorie was having a very bad day. Dr. Joe heard it at the same time the anesthesiologist said it: “She’s coding!” Joe filled the wound with surgical sponges “start compressions!” Nancy started the clock, marking the time they started resuscitation efforts. Half an hour later she stopped it. “Time of death, 13:17” said Dr. Joseph Ianarelli.