Routine gone awry.
C F Coppola · PubMed · 1991
It was late at night, probably after 2 AM.Brittany, my 1- year-old daughter, was crying and wanted a bottle.Often I sleep through her crying, and my wife, Patti, tends to her, much to my wife's consternation.But tonight I woke up easily and slid out of bed before Patti could get to her.This night I especially wanted to hold her because by the time I had arrived home from work Brittany was already in bed.I picked her up in my arms, and she immediately settled down in anticipation of a warm soothing bottle.The micro- wave chimed, signaling that all was ready.With bottle and child in hand, the two of us nestled down on the sofa in the peaceful dark.It felt so good to cuddle with her.With her rhythmic sucking, my mind began to drift.Today's events played back like a bad dream.It was Saturday, the first of the month, and I was on call, starting my three-month rotation at Children's Hospital.I am a fourth-year resident in otolaryngology.Already I had con- siderable pediatric experience, a fact that gave me confidence in my new assignment.I met my predecessor at 7 AM on 6E to pick up the beeper and assume the service.She looked tired, as though she had been up all night."You have a foreign body to do in a little while.She's I1/2 years old with a coin at the cricopharyngeus.Should be routine.Why don't you do the case and then catch up with me on the wards?"We agreed, and off I went to the operating room.After changing into scrubs, I found my patient in the preanesthesia holding area.Her name was Kelly.She had long brown hair and big brown eyes.She had a vivacious personality and was oblivious to the fact that she was the patient.She reminded me of my own little girl.Kelly kept talking away as we rolled her into the operating room.At this point most kids are frightened, but she thrived on the atten- tion.She was very cooperative, which made anesthetizing her easy.I have removed several dozen esophageal foreign bodies, mostly from children.Coins seem to be a particular favorite, especially pennies.We often try to guess the date, hoping to add a little adventure to a fairly "simple" case.Kelly's vital signs were stable, normal sinus rhythm, 100% on the pulse oximeter, and completely paralyzed.My attending gave me the nod to proceed.Sure enough, it was a penny.I had it out in ten seconds.As was customary, I rein- serted the esophagoscope to look for any erosions or other foreign bodies that might be lurking.Suddenly all hell broke loose!Kelly's oxygen saturation fell, and an abnormal cardiac rhythm appeared on the moni- tor.I pulled the scope out and we ventilated her.Her chest * * * "Lessons From the Practice "presents a personal experience of practicing physicians, residents, and medical students that made a lasting impression on the author.These pieces will speak to the art ofmedicine and to the primary goals ofmedicalpractice-to heal and to carefor others.Physicians interested in contributing to the series are encouraged to submit their "lessons" to the series' editors.