In the Bible, Jesus raises Lazarus from the dead. In medicine, a ‘Lazarus patient’ is one who spontaneously starts circulating blood.
That afternoon, on 7-North, the cardiac ward, I quickly saw three CCU outliers, patients who had been stabilized and no longer required intensive monitoring. When I sat down to write my notes, it was almost 3:30 p.m. How limited our interactions with patients, I thought.
We see them for a few minutes, then pen a quick summary and leave directions for the nurses to follow. To whom are we speaking in these inky chart drizzles? Doctors, patients, a phantom lawyer (“I spoke with the patient at length, but he is still refusing…”)? Or perhaps we are just talking to ourselves, regurgitating the patient’s history to create a tidy narrative. The audience shifts, patient to patient, note to note, even sentence to sentence.
At four o’clock, while I was finishing up my last note, Ethan, the CCU fellow, paged me. “Mr. Richardson just dropped his pressure,” he said nervously about the brain-damaged patient in the CCU. “I tried going up on the Levophed and the Neo-Sinephrine, but it didn’t work. When I turned on vasopressin, his pressure dropped even more.”
I thought for a moment. This was the kind of situation I’d feared most as an attending, when I had to respond almost reflexively. (And how hard should I try to save a severely brain-damaged patient anyway?) All the medications Ethan had mentioned had half-lives, so it was hard to know how to interpret the results. “I would back off on the vaso,” I said carefully. “Just start some dobutamine at 2.5 micrograms per kilogram per minute. I’ll be there in a couple of minutes. Did you call the wife?”
“I got through to her a few minutes ago,” he replied. “I told her to come right away.”
When I arrived back in the CCU, the code had already begun. A group of doctors and nurses were at the bedside. The rhythm on the monitor was ventricular fibrillation, random electrical oscillations. An intern was doing chest compressions. Saline was running wide open through an IV. Defibrillator pads adhered to Richardson’s hairy chest. His body jerked up and down with every administered shock.
Because his heart had effectively stopped, his lungs had filled with pink, frothy liquid, mostly blood plasma, like beaten-up Jell-O, which came up through his breathing tube. The compressions sent the nurses scrambling for face masks and yellow gowns to protect themselves from the red spray.
“This is a conspiracy to prevent me from getting my afternoon coffee,” quipped a doctor who had shown up to help. I chuckled at the wry shoptalk.
After a couple of adrenaline injections, Mr. Richardson regained a pulse; but it immediately started to die down, and within a few minutes it disappeared. It seemed his body had finally given up. The sequence continued: shocks, chest compressions, and drugs. He got four doses of adrenaline at 1 milligram each, then 5 milligrams, then 10, but the pulse did not return. He received several ampoules of sodium bicarbonate. By then he was blue in the face, a sickening color, like an old hematoma.
We continued CPR while I called for an echo machine, which takes ultrasound pictures of the heart. “Let’s take a quick peek before we call it,” I said. When the machine was wheeled in, I pulled the window shades closed and applied the ultrasound probe to his chest. The heart was in standstill, hazy clots filling the ventricles. I pressed a button to take a picture. The room was quiet as I pronounced him dead.
Gowns and masks were stuffed into a trash bin, and people started filing out of the room. Then a strange thing happened. My gloved fingertips, soaked with blood on his pulseless groin, started to vibrate. Wait, I ordered the group.
In the Bible, Lazarus is raised from the dead by Jesus. In medicine, Lazarus is the patient who, believed dead, spontaneously starts to circulate blood.
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