Posts Tagged MASH

How to Save a Life

M*A*S*H

Henry explains the rules of war

“Look, all I know is what they taught me at command school. There are certain rules about a war, and rule Number One is young men die. And, rule Number Two is doctors can’t change rule Number One.” Henry Blake

While I can’t say that M*A*S*H is the reason I went into medicine, I can say that I loved the series, and that several times during my training I have found myself going back to certain episodes that seem especially relevant to a recent patient experience.  Like the one from which this quote is taken.

It’s upsetting to have a patient die after knowing you did everything you could.  It’s especially frustrating to have a patient die and not know why.  What did you miss?  What could you have done differently?  What else should you have done?

I recently had an experience like that.  A patient with multiple medical problems came in with a cough… and, chest pain.  I grabbed the chart and thought, “Oh, great.  Pleuritic chest pain.  Tessalon perles and a chest x-ray.  Probably a pneumonia.  No problem.”  Two hours later as I was writing for a Dopamine drip and calling the ICU, my pulse still normalizing after coming very close to having to do a surgical airway, I was thinking, “What the heck is wrong with this patient?”

Even after the intensivist took over, I continued to keep up with the patient’s progress.  Labs gave no answers.  X-rays and scans gave no further information.  We had cultured every fluid possible, sent off a rapid flu, and empirically started antibiotics, but somehow it didn’t seem like enough.  As my shift progressed, I heard as another pressor was started.  A few hours later, another.  This patient was dying, and I didn’t know why.

Due to bed availability, the patient ended up boarding in the E.D. and died early the next morning.  I came in a day later and asked if the family had asked for an autopsy.  They had.  No saddle embolism, no major coronary blockage, no missed dissection.  Some labs and cultures were still pending.  Still no answers.

I’ll check cultures during my next shift.  I kept a sticker from the patient.  I keep stickers from all my patients.  They help me log my procedures.  They make me think about what I did and what I could do better.  They make me follow-up and see if I missed anything.  They make me remember and not forget certain cases… as if I could.  I fight the war against Rule Two every day.

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