Christopher Davis - Compassion Amidst the Chaos: Tales told by an ER Doc

Compassion Amidst the Chaos
Copyright 2020 by Christopher Davis

All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review.

ISBN (Print): 978-1-09834-069-8
ISBN (eBook): 978-1-09834-070-4

Dedication

Emergency Department providers are now engaged in the massive struggle against the Covid-19 pandemic. In my long ER career, I have never been exposed to the risk of contracting such a fatal disease or bringing it home to my family. I offer a special salute to these hard-working, dedicated and courageous healthcare professionals and their loved ones as they fight this peril that is unprecedented in modern times.

Prologue

For thirty-plus years, I worked as an emergency medicine physician in a job I loved. Over this time, I cared for well over 100,000 patients. Motivated by my own desire to better understand what it was about Emergency Medicine that made it such a perfect fit for me, Ive described in this book a selection of my actual case histories and related experiences. These stories portray the myriad ways Ive been able to contribute to my patients medical needs as well as the emotional impact these experiences have had upon my growth and development as an ER doc and as a human being.

My Emergency Medicine career has been gratifying for many reasons. This book is about those unusual cases that I remember in detail many years later. Each of these patients gave me reason to pause and reflect. More specifically, in each of the stories that follow, I have shared a lesson I learned about medicine, empathy, humility and compassion.

Christopher J Davis, MD

Seattle, Washington

August 18, 2020

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All the names in this book, except where specified as real, have been changed to protect privacy. The dialogue is my best recollection of what was actually said years ago.

Cold Delivery

One early January morning during my last year of emergency medicine residency at the Johns Hopkins University Hospital in Baltimore, a new beginning brought an unusual challenge and reminded me how much this work was the right fit for me.

Outside, brilliant sunshine bathed the city but was accompanied by an icy blast of Northwest wind. The temperature was in the low twenties. The only direct access to the ER was through the ambulance entrance, which had two sliding glass doors. As you might expect, when an ambulance crew brought a patient to the ER, their stretcher and equipment would open both doors simultaneously, flooding the department with a blast of icy air. Howls of protest would erupt throughout the department with demands of shut the goddamn doors! I was fortified by a thin polyester vest that I wore under my white coat. I worried about losing the vest to a spurt of blood, but fortunately that never happened.

Outside those emergency doors, the sound of blaring horns signaled the crush of the early morning Baltimore rush hour. Inside the ER, everyone was whining, moaning and groaning about the winter blast. Suddenly, a man entered through those double doors yelling at the top of his lungs. Hurry! There has been a minor accident at the corner, but a woman is giving birth RIGHT NOW in the back of a taxicab.

Upon hearing this mans cry for help, I crashed my coffee cup onto the desk, grabbed a towel from the rack and ran outside to help. Instantly, I felt a blast of arctic air temperature, but I shrugged it off. I ran along the sidewalk, pumped up and eager to get to the taxi. Ahead of me, half a block away, the drivers of a group of jammed cars were all honking at each other. The bystander who had alerted us to the problem was running ahead of me and pointed to a taxi in the middle of the intersection. The auto accident was a minor fender bender, but loud screams from the back of the taxi clearly directed me to the back seat.

I opened the rear door to the taxi and found a young lady in the agony of late labor. I could see a bulge developing in the groin area of the ladys jeans and it was clear that the babys birth was imminent. In those days, I always carried a leather holster on my belt. Similar to an electricians gear kit, my holster, well-worn like an old catchers mitt, held two surgical clamps and a pair of serrated trauma scissors designed to quickly cut through clothing and also a tourniquet in a small, clean plastic bag. Between screams, I announced to her, Im Doctor Davis and Im here to help you. That introduction was necessary as I whipped out my trauma scissors to cut away her blue jeans. Worried that my scissors might cut the babys scalp, I proceeded delicately and slowly. She screamed, Hurry! Hes out!

Two more chop-chops from the serrated scissors and her vaginal area was fully exposed. Just a blink of an eye later, the baby was propelled into my hands just as though I were a quarterback receiving a snap from the center. Out popped a gorgeous, full-term baby boy covered with blood and assorted other fluids. I had no suction bulb to aspirate the fluid from his nose and mouth. I was worried until he took a deep breath and let out a cry that rivaled his moms.

After most vaginal deliveries, the newborn babies are placed in a heated incubator to make sure their temperature does not drop to dangerous levels. Jeeesus! The temperature outside the cab was still in the twenties with a stiff wind blowing. The umbilical cord is the blood vessel that provides the fetus with a rich supply of blood and necessary nutrients. Normally, after a vaginal delivery, the baby should be held at a level lower than the mother for 13 minutes. This provides the baby with an additional supply of iron rich blood, which the baby will need to make his own red blood cells. The cold frost on my breath urged me, Forget the iron. This baby is about to freeze to death! Immediately after the birth, a rich flow of maternal blood spilled into the taxi. Now the taxi driver was pissed. He was yelling and hollering about what was happening to his car.

I cradled the baby in the towel and reached for the trauma scissors that I had tossed onto the rear seat. Fortunately, they were in easy reach. Designed to cut through clothing and not living tissue, they are not sterile. I took two of the curved Kelly surgical clamps out of my holster and applied them to the umbilical cord several inches above the babys belly. That stopped the blood flow through the cord. His crying was starting to weaken and now I was panicked about the baby dying from the cold. I quickly cut the umbilical cord between the two clamps, thus freeing the baby from mom. Without waiting to rub away the variety of fluids that covered the baby, I wrapped him in the towel and ran for the ER. I ran through red lights, ignored all of the honking cars and ran faster. I sprinted with every ounce of breath I had. As I dashed through the ER doors, I was welcomed by a pediatric delivery team with a warming bassinet. The anesthesiologist gently delivered oxygen to the baby and the team dashed off to the delivery suite. I crashed into the worn-out chair at the desk and started a search for my much-needed cup of coffee.

The obstetrics resident entered the ER and looked around. Hey guys, wheres mom?

Oh shit! I jumped out of the chair, grabbed an ER stretcher and with one of the techs, pushed the stretcher at a run back to the intersection. Cars squirmed to get around the tiny space between the curb and the taxi; they effectively blocked access to that yellow and black vehicle. By this time, fortunately, several paramedics had arrived and were tending to mom in the back of the cab. She was still bleeding but the paramedics had put in an IV and were giving her fluids. With two paramedics at each end, they lifted the stretcher with mom aboard and shuffled their feet sideways to get the stretcher past the blocking cars. The paramedics charged up the gentle hill with mom on the stretcher. A nurse met them at the door and took them to the Labor and Delivery area to reunite mom with her newborn.