Read Online When the Air Hits Your Brain: Tales from Neurosurgery by Jr. Frank Vertosick - Free Book Online

order a bolus of epinephrine (also known as adrenaline) and the fibrillation reverted to a normal rhythm. The blood pressure went up to ninety. Breathing a sigh of relief, I went to the nurses’ station and called Maggie at home, informing her of the successful resuscitation.
    “What do you want, a medal?” she croaked. “What is it, two A.M. ? You got hours to go before she’s stable…and go easy on the epi; her perfusion is poor as it is and I don’t want her fingers to die. Push the fluid harder.”
    My ego deflated, I went back to the chair. Maggie was right about the epinephrine. B.G.’s fingertips grew more discolored by the hour. Like Mephistopheles, epinephrine will do your bidding—for a price. The increase in blood pressure and heart contractility after an epi infusion comes at the expense of blood flow to the limbs. Too much epi and the hands and feet will become gangrenous.
    Another hour passed before the hypotension and fibrillation returned. More CPR, more albumin. Some lidocaine and bretylium. A blast from the miniature defibrillator. Nothing worked. I gave yet another bolus of epi. Again, the pressure shot up, the heart rhythm stabilized. B.G.’s fingers and toes became darker and more mottled.
    To prevent another round of hypotension, I increased the intravenous infusions drastically, but her lungs filled with fluid and the oxygen level in her arteries fell dramatically. To counteract this, I gave her Lasix, a strong diuretic. The Lasix, had no effect. The urine output slowed, no doubt due to lack of blood flow to the kidneys: another side effect of the epi.
    The fibrillation came again.
    They are all counting on me. The words rang in my tired brain. Her mom and dad, Hartley, Maggie…they are counting on me to keep this baby alive. I ordered another bolus of epinephrine. Take this child’s fingers, Satan. Faustus selling his soul for another hour of stability, another hour of fitful sleep in the chair…
    The epi kept the devil’s bargain: the blood pressure soared and a sinus rhythm once more hammered its way across the monitor screen. I glanced at the clock: four-thirty. Time for rounds soon. My eyes closed.
    Maggie grabbed my arm. Disoriented, I jumped from the chair and to B.G.’s bed. Empty. The heat lamps dark. Looking again at the clock, I realized that I had been asleep for over two hours! Panic overcame me. What had I slept through? They had been counting on me.
    Maggie chuckled at my frenzy. “Relax.”
    “Where’s the baby? Did she go back to the OR?”
    “No, I shut off her ventilator an hour ago. She’s in themorgue. Actually, her parents wanted her shut off last night before I left, but I forgot.”
    “In the morgue? You forgot what? What do you mean, they wanted her shut off last night?” I was confused, furious.
    “Hartley met with them after surgery. You see, we couldn’t repair the right ventricle. All we could do was enlarge it with a Teflon patch, but Teflon doesn’t pump blood, you know. We knew she was a goner when she left the table. The family was very reasonable—the mother’s an ER nurse across town—they couldn’t see prolonging things and they gave us the okay to halt support. I just figured we could wait until morning to do the deed.”
    “Why didn’t you tell me all this last night? Why did you let me sit in this fucking chair all night thinking I was making some baby’s fingers drop off?”
    Maggie’s smirk vanished. “Your night wasn’t such a waste, was it? You learned how to resuscitate a baby, how to face crisis, what drugs to use and what problems they can cause. I bet you won’t forget the doses of those drugs for a while, either. They are burned into your brain. You did a good job. Not many people can keep a Teflon heart beating for ten hours. Now I know I can count on you to handle a baby with a real chance of living.”
    “You could have told me that she was a goner—I was crapping in my drawers.”
    “No. Then you wouldn’t have