Wednesday, July 16, 2014

high stakes

The transfer team are perfectly nice about it. They make encouraging comments, useful suggestions, jokes to ease the tension. But there’s an increasingly steely undercurrent to the banter that grows as horribly as the delay until the anaesthetist is driven to say: If this doesn’t work, I think we should take the patient off again and into resus.
It doesn’t work. For whatever reason, the trolley clamping mechanism just will not engage. Five millimetres would do it, but nothing, no creative cheating of the angle, no subtle variations on force downwards, upwards or any-wards – nothing we can think of makes any difference. I’m down on all fours trying to figure out what’s wrong, but everything seems okay, and I’m completely stumped.
Reluctantly, we set about off-loading the patient. We unplug everything, swap the ventilator oxygen back onto cylinder, untangle all the leads and drains and drips, re-organise the blankets, and then carefully begin manoeuvring the whole unwieldy package back out of the cabin, onto the tail-lift, and, mindful of the snag risks, the closing gaps, the tight spaces and every other hazard, we move the patient in through the A&E doors and into resus.
‘So what shall we do?’ says the anaesthetist, smiling pleasantly but red in the face. ‘Order another truck?’
‘Give us a few minutes to have one last look, then if that doesn’t work we’ll get you another.’
I’m mindful of the fact that if we stand down from this job, our friends who’ve just this moment cleared in front of us will almost certainly have to do it, and as they finish in half an hour, it would mean a significant over-run.
They’re more than happy to lend us their trolley so we can check the clamping mechanism again. It clicks in smoothly – as it has done all day. There’s nothing bent out of shape, and no other signs of damage or failure to account for the difficulty. We can only think that the patient load is affecting the trolley balance. Maybe if we take off all the apparatus just before we push the trolley fully home, it’ll work.
I explain the theory to the Anaesthetist.
‘If you think that’s it,’ he says. ‘I’m happy to give it another go.’
His smile is a little less certain, though. The patient needs to be with the vascular team right away, and we’re all conscious of time passing. The beeps of all the life support machinery couldn’t measure out the stress of the scene any more emphatically.
‘If you’re absolutely sure,’ he says.
‘It’s going to work.’
‘Let’s do it.’
We unplug the patient, set him up for the short trip back out of A&E and onto the truck again. Once we’ve risen up on the lift and moved into position, we take off as much of the equipment as we can, getting as many hands on board to hold it all and keep the trolley clear. Then I manoeuvre more fully into position, introducing the trolley bar into the mouth of the clamping mechanism.
One millimetre only, and it still doesn’t work.
In desperation, I sit on the floor, put the heel of my boot onto the bar, and push as hard as I can.
‘Excellent!’ says the Anaesthetist. ‘Phew! Thank God for that!’
The ODP bends down and slaps me on the shoulder.
‘Well done,’ he says. ‘I never doubted you for a second.’


Davidss said...

I wonder a little about the vehicle bodyshell distorting with the weight.
Sometimes though it has to be about the intelligent application of force.

Presumably the lock released OK at journeys end?


jacksofbuxton said...

If in doubt,give it a kick.

Well,that's what Mrs Jack does to me...

Anonymous said...

I've seen trolleys bent out of shape by the larger patient. Just how big was this person? Or was there another reason?

And ODP?

Spence Kennedy said...

Hi David. Yep - all fine the other end. The trolley wasn't going in because of poor weight distribution - something I hadn't encountered before (but once bitten and all that...)

Jack - the kick helped, but I was mindful of the sensitivities involved i.e. having a critically ill patient on the trolley and resorting to a brutal right foot!

Anon - The patient was heavy but not massive. It was just a combination of their weight and all the equipment. Thank goodness it eventually went in, though. I think I would actually have died of embarrassment if it hadn't!
(ODP = Operating Department Practitioner)

Thanks for the comments!

Cassandra said...

Wow. Talk about your pressure! Sometimes a well placed kick is what it takes to make it go. What's that line in Pirates of the Caribbean about "the proper leverage"?

Spence Kennedy said...

I love that line! You can't beat a good movie / TV quote.
Cheese it! (Bender / Futurama)

Blair Ivey said...

‘Well done,’ he says. ‘I never doubted you for a second.’


Spence Kennedy said...

There was a long line of doubters - with me at the head of them! :/