Here for the Patients

I am about to leave the hospital when I get a call from the nursing supervisor. A rapid response is called on a patient with no IV access who is hypotensive. Apparently, he has dialysis fistulas in both upper arms and has amputations of both legs. Yikes. No one can get access on him, and though he's talking with a pressure of 70/30, we're all worried he's going to code. Normally, floor patients have central lines placed by the emergency department or interventional radiology, but both of them decline. The ER is completely full and IR is not returning calls. The intensive care physician is at home. So someone thinks of me and calls the on call anesthesiologist.

I happen to really enjoy line placement, but when I arrive, I know this may be a nightmare. The patient has had multiple vascular accesses, from pacemakers to cardiac catheterizations to vascular bypasses to several dialysis fistulae. But as the only one who shows up who can place a central line, I gather my supplies. It takes me longer than any line I've ever placed. Even when I supervised residents and medical students placing lines, I don't think it ever took that long. I can get into the internal jugular veins, but due to stenosis or scarring or something else, I cannot pass a wire deep into the vessel. Ultimately, I go for a femoral approach, my least favorite (and in an amputee), but I am out of options.

Going home, I get a call from the hospital. I'm worried its an add-on that will bring me back to work, but instead it is the nursing supervisor thanking me. I say, "No problem, I'm here for the patients." The rest of the way home, it sinks in. The real incentive for me to go out of my way and place a line on the floor is the doctor's obligation and caring for the patient. I'm not expected to do this, I'm certainly not paid for it, and I incur risk in doing it. But the reason I obliged and never thought about turning my back is because I'm here to care for people.