Late Thursday morning and a Code was called to the hospital residences, where patients and relatives visiting from interstate can live on campus for a few days. The residence are located in a building on the opposite side of the main hospital to the emergency department. Walking at ‘code pace’, it takes only a couple of minutes to get over there.
Entering the foyer of the residence, we turned left passing the small plastic TV that always seems to be showing Dr Phil.
The fact that the Code was up on the third floor, and that we were pushing a crash cart that carried our defibrillator, drugs and intubation equipment left us with little choice but to use the slowest lift in the known universe.
It is quicker to fly from Vladivostok to Auckland than to elevate to the top floor of our hospital residence. In fact it is so slow that they have installed food vending machines on the inside.
In a rush of unconsidered stupidity, I decided to leave the doctor and nurse waiting at the lift and scoot up the stairs to see what was going down.
Scampering out onto the third floor I could see down the length of the corridor to where a cleaner was frantically waving me in to an open door.
A large man was laying on the floor of the small room, crumpled into the space behind the door. His wife was sitting on the bed holding a ball of red wool against her mouth like a handkerchief.
The man was blue. The ball of wool snaked down to a small cabled jumper hanging unfinished from a knitting needle that had somehow become wedged between two of the mans toes. He had very long uncut toenails.
Stepping over the man to kneel beside him I remember feeling the warmth of the in-floor heating under my knees and the cool clammy skin of the man. I could see from his glazed, half open eyes that he had a good head start on us.
Opening his airway, I drew my face down real close as if listening to something intimate he might whisper. For a few moments, there was nothing in the world but the cold breathless vacuum that hung between us.
I was so close that as I turned my head to face him, I could feel his coarse bristles rub against my cheek. His lips were dry and cracked and caked with something white.
At this point two things became evident. Firstly, my friends with the crash cart were not even within earshot. Perhaps they were fogged in at New Delhi.
Secondly, I am a total idiot. Hanging off the side of the crash cart is a bag/valve/mask device. The reason it hangs off the side of the trolley is so you can grab it in a hurry in order to manually ventilate a patient. Which is exactly what I needed to do, and exactly where it continued to be hanging.
I did not want to put my mouth on this mans mouth, so I felt for a pulse.
Nothing. OK, lets move along.
I began chest compressions. Center of the chest. 100 per minute. Basic life support. Which is a great oxymoron really, because it feels the total opposite of basic when you actually find yourself trying to squeeze blood from the stone of a dying mans heart.
Thirty compressions later, I am supposed to give two more breaths. Looking across at his wife I could see that she knew it too.
No sign of the team. I bobbed forward, squeezed his nose between my thumb and first finger, placed my other thumb between his chin and lower lip and opened his mouth.
I drew a deep breath and sealed my mouth firmly over his. I could taste nicotine and toothpaste.
The moment I blew into him, he vomited violently.
The contents of his stomach shot up his gun barrel oesophagus, into my mouth, out my nose, and with all probability, up my Eustachian tubes and out my ears.
Jolting upright I already had a mouth full of bacon and eggs and soggy toast and cold coffee and stomach acid. Suppressing the urge to swallow, all I could do was let it all wash back out onto the mans chest.
A few seconds later, and I had a second mouthful, this time Muesli, some more soggy toast, orange juice and Vegemite.
So when the crash cart arrived, there I was. CPR in progress. An ocean of vomit. His breakfast. My breakfast.
In retrospect, I should have grabbed the bag/valve/mask, and I might have used a sheet to put across his mouth, and I could have been carrying one of those small disposable face shields on my key chain. But what it was, was a messy, smelly, unpleasant and ultimately sad resuscitation attempt. Sometimes, that is the way it goes.
Something to think about. Would you be prepared to give mouth to mouth during a resuscitation attempt?
The risk of infectious transmission is small (but not non-existent), and there are no reported cases of anyone getting HIV or Hepatitis following mouth to mouth. What is your own back-up plan?
Then there is the whole mouth to lunch scenario, which believe me is no fun at all.
My personal advice is that if you find yourself needing to ventilate a patient and you are without a bag/valve/mask or pocket-mask or similar device…skip it completely and concentrate on quality chest compressions until assistance arrives. In the hospital setting, such equipment is never far away.
Unless, of course, the elevator gets fogged in.
[Original photo credit: assbach ]