That Time I (Almost) Killed a Man with a Tube Up His Urethra

Every doctor remembers their first code. Maybe they remember sprinting there, shoving people out of the way. Or maybe they remember being pressed against the wall, watching everyone else who seemed so competent and in control while they felt useless. Some people say their first code was when they realized how little they actually know, while others say it was the first time they felt like a real doctor.

All I know is that my first arrest was the first time I ever had to say the sentence, "He peed everywhere and then stopped breathing."

Sunday night, 1 am: Day 1 of my week of nights. Trauma Ward calls, saying Mr M needs a Foley catheter because he hasn't passed urine since 5 pm. Grumble grumble, I wanted to sleep, but fine. Bladder scanner shows something in the neighborhood of 800 mLs. I try a 16 Fr, no dice. Try again with a 14 Fr. This time it drains, but the patient starts urinating with such force and gusto that the catheter actually flies out before I have a chance to anchor it. The patient probably voided all 800 mLs all over the bed, destroying my meticulously arranged sterile field. As I walked off to wash my hands and get ready to start again I realize that Mr M isn't speaking anymore, just making grunting sounds.

Me: "Mr M? MR M? CAN YOU HEAR ME? ARE YOU ALL RIGHT?"

Nothing. I felt for a pulse. Nothing.

Me: "CRAP. Okay call the arrest bleep, I'll start CPR." I started compressing his chest, feeling his actual ribs break under my inexperienced hands. The nurses ran around, taking the bed apart and putting him on O2.

Anesthetist arrives.

Anesthetist: "What happened?"
Me: "Umm I was catheterizing him and peed everywhere then he just stopped breathing."
Anesthetist: "What's his medical history?"
Me: "Broken hip. Right side. I think."
Anesthetist: "MEDICAL history!?"
Me: "Oh, ah. Hmm..."
Anesthetist: "Why the FUCK doesn't he have IV access?"
Me: "He does...in the left foot."
Anesthetist: "WHAT?! WHY ON EARTH?!"
Me: "...He has difficult access and that's where I put it..."

At this point I think the anesthetist was ready to murder me because he very rudely pointed out two allegedly excellent veins in the dorsum of the hand. He and the medical reg both tried to cannulate Mr M at that point (and both veins blew. Ahem).

Fortunately the anesthetist was as competent as he was furious at me. Mr M woke up, transferred to HDU. Diagnosis: vasovagal asystole 2/2 micturition. Wash hands, walk away.

Wednesday night, 2 am: I've now been on nights for a few days and am getting the hang of things. Nothing can touch me, for I am the Super Intern. Until I get a bleep from Trauma. Mr M is back, he is now post-op, and in urinary retention. Can I please come place a catheter?

Feeling a tad traumatized, I decided to ring the Medical Reg who was present during the arrest and who can advise on the safest measures.

Me: "Uh, hi. This is Caitlin, from the other night. Mr M needs a catheter again..."
MR: "You're taking the piss."
Me: "I wish I was. Any advice?"
MR: "Put him on O2 before you start, keep him talking, bring the crash trolley with you. Maybe pull the bed out from the wall as well."

In my head at this point I can hear a prosecutor demanding the maximum sentence for criminal negligence. I can hear my own lawyer demanding to know why I thought catheterizing for a second time was a wise move. I can hear my career falling down around my ears.

In the end I brought three nurses and another doctor with me, all to keep Mr M talking and to monitor his vitals the whole way. At one point he stopped talking (probably to breathe) and my stomach dropped. I glared at him and just said (quite sharply), "keep talking!" and proceeded. Urine flashback, catheter anchored, documented.

And thus ends the story of my first code. Here's hoping I can afford a good lawyer someday.

From artizans.com. Scarily accurate. 

xoCaitlinK