Redwood Memorial Hospital

THIS paper reviews common-bile-duct injuries treated at the Henry Heywood Memorial, a 120-bed hospital,1 from January 1, 1941, through December 31, 1950, during which there were 539 consecutive operations on the gall bladder or biliary tree, with 4 cases of loss of continuity of the biliary tract. In a review of our experience with gall-bladder surgery, it was disturbing to find that in each of 4 cases, a patient entered the hospital with biliary disease that appeared to be a straightforward problem, only to go through a long period of additional surgical procedures crippling to his health, morale and financial . . .

It was a bright fall morning and Ms. H, 78, had been with us for just over a week. Her sweet disposition and quiet resolve to recover from her admitting diagnosis of left lower lobe pneumonia made her a unit favorite. During my morning assessment, I auscultated only mild inspiratory wheezes in her left lower lobe. She needed only supplemental oxygen at 1 L/min via nasal cannula at this point, and her SpO2 was stable at 95%. Her white blood cell count was back in the normal range, confirming the clinical observation that Ms. H was getting better. Feeling confident in her recovery, the nurses joked about how we were going to miss our favorite patient when she was discharged to home later that day. What happened next made me appreciate the value of teamwork in a crisis. Sudden change I had just left Ms. H's room and started my next patient assessment when my pager went off. I could hear Ms. H across the hall trying to answer the unit secretary's cheerful, “How can I help you?” “I. Can't. Breathe,” I heard Ms. H gasp. This was clearly not the woman I had just left. Apologizing to my current patient, I practically ran across the hall. I found Ms. H sitting on the edge of her bed, gasping for air. She was tachycardic, tachypneic, and hypotensive, and her SpO2 had dropped to 85%. I auscultated her lungs and heard bilateral inspiratory crackles up to the apices. I quickly activated the rapid response team (RRT) while continuing to monitor and support Ms. H. Quick action When the RRT arrived, I quickly gave the hospitalist a summary of Ms. H's history. One nurse obtained a second peripheral venous access, while another placed Ms. H on a cardiac monitor and obtained another set of vital signs. The respiratory therapist placed Ms. H on a 100% non-rebreather mask and an ECG, chest X-ray, and arterial blood gases were obtained. Ms. H's attending physician arrived and we promptly administered I.V. furosemide as prescribed. As Ms. H's clinical status stabilized, we all began to relax a little. Although I continued to reassess Ms. H frequently, I was able to finish administering my morning medications and continue my other patient assessments. A team victory Somewhere in the middle of this crisis, I could see we were all working as a team, and I was very proud to be part of that team. Each of us was able to anticipate what to do next to help the patient and each other, and did it without being asked. With heartfelt gratitude, I thank all my colleagues who helped save Ms. H's life on that bright fall morning.

In Brief When a previously stable patient “crashes,” this clinical nurse appreciates the value of teamwork.