When I was a resident at the VA, I once had a cardiologist as my attending for the month in the ICU. We always hear about how wonderful the VA is in terms of quality. Let me tell you a little story. Quality is dependent on who your attending is for the month and how many ventilators you could find in the storage closet. Remember those old knobby ventilators? They used to work just fine. No flat panel. No nothing. Just a canister of air and some turn knobs. Perfect for a cardiologist!
Back to my story at hand. When I was a resident rotating through the ICU at VA hospital, my attending was a cardiologist. A cardiologist who's entire ability to generate a rational plan on non cardiac events was, shall we say, interesting. Imagine for a moment a bunch of old smoking, drunkard veterans. Imagine for a moment the perfect storm.
- An abnormally high drunkard population for the month.
- A cardiologist with a low threshold to intubate all drunkards.
Yes folks. It happened. It happened on Happy's service. Every drunk who came in with alcohol withdrawal got the tube. Those words will always resonate with me.
"Put 'em down."
In a deep masculine voice with a hint of supremacy. The power to make that patient submit. I heard those words several times a day, for an entire month. I will never forget it. All the old drunkards got intubated. They all got put on a ventilator. Every single one of them.
You want to know how a cardiologist manages alcohol withdrawal? There you have it. During my month in the ICU, we managed, at one point or another to fill up every single available ICU bed with drunks. And every single one of them was placed on a ventilator. For days and days and days. We had so many intubated drunks that we ran out of the fancy ventilators.
We were forced to search high and low for the old time machines. The ones with turn dials and noisy canisters. Nobody felt comfortable using them. Nobody had ever seen them. We all tried to avoid that patient with the 1960's ventilator. But that's all we had. Simple in design. But effective for the task at hand.
There you have it folks. The quality VA care we always hear so much about. Experienced first hand by Happy himself. Some how I think this month was excluded from the statistical number crunchers.
"Put 'em down." LOL
ReplyDeleteMaybe it's just me, but I've always been under the impression that the quality of VA's isn't exactly one to be desired.
ReplyDeleteSometimes I need more explanation [I can wait until you all stop laughing]. Was this her idea of "detox," Phase 1? How did these patients come to you -- as alcoholics requesting help or as unwitting drunks who were scoping out the opportunity for a bed and meals? Did they come to the VA via the ER/Ed or was this an arrangement made through some substance abuse clinic? How did this brilliant cardiologist codify "success"?! Did you encounter many complications or even lose any of these folks to the process -- aspiration pneumonia, bladder/kidney infection, etc.
ReplyDeleteI am sure she arranged for stringent aftercare treatment...
Jeez. Sorry to be so dense. I did some case management at a homeless shelter that certainly had its share of "drunkard" veterans but have never heard of the "put 'em down" technique. Was there nothing you could do?
Hmm I thought that WAS the way to manage Alcohol Withdrawal...anyways, always better to intubate too early than too late. Anesthesia ventilators are pretty simple, just set a rate, tidal volume, I:E Ratio (What is that anyway??) tweak a little up and down till done..
ReplyDeleteUhh.. did we work in the same hospital? Heh heh. We did a lot of puttin em' down.
ReplyDeleteThat looks like a LP10 ventilator made by Puritan Bennet. I haven't seen one of those in years, and the last time I checked they don't make replacement parts for that particular machine either. By the way, if one does not know what the I:E ratio is or how to calculate that out then please ask a competent respiratory therapist. You do not want to screw that up on an old machine. Otherwise you will do harm to your patient.
ReplyDeleteBy the way Happy, the machine on the right is the humidifier.
ReplyDeleteYes, we have the technology but at what expense? Do we really need to add thousands upon thousands to the already enormous bill that will have to paid for by us?