2/15/06 Wednesday, February 15, 2006 I went to see the woman tonight before my shift. She's in the ICU, trach in place, and the nurses are talking about weaning her. They're small thinkers, though, these ICU nurses: they rotate through the unit, work at other hospitals, have a few days off coming--they aren't thinking about discharge condition, they're thinking about the plan for this shift. But I want to know what her docs think her neurologic outcome will be and that information isn't available. Ahhhh--damn it. I've been thinking about it. I feel decent about it all. I could not have lived with myself if I has waited on her and then had to cric her--that would have been crushing. She came in breathing and talking, but her tongue was swollen up and protruding from her teeth. She was drooling and had to tilt her head back to talk. I knew she had to be tubed: if I wait on her and her airway occluded then I would have no excuse for inaction. But I was afraid, and I hoped I could just hit her with meds and hope for the best. You know that feeling--that hope that if you just close your eyes and hold your breath and pretend then maybe, just maybe the problem will go away on its own. I knew I was looking for a way to avoid the issue. But that's not the job I have: I rallied myself and went for the tube. Hindsight is 20:20, but suffice it to say that in seconds I found myself watching her turn blue and knowing only a cricothyroidotomy would save her. Terrifying. A really sickening feeling. My voice and my hands were trembling. I cut and cut and cut in this poor woman's neck. Horrible. I got my scalpel where I needed it, blindly feeling about in the bloody pool I had carved in her neck, and I hooked the trachea. I got the tube in and by the grace of God it was in the right place. We got her oxygen up and it was done. Sure---the bleeding needed to be controlled and the surgeons needed to be called, but this horrible moment had passed and, mercifully, I had suceeded. It didn't feel like other heroic interventions. There was no thrill of challenge, no excitement, no out of body awareness of what I was doing and amazement that it was me--Me!--doing it. Just terror and desperation. I hope I never have to do it again and I wish I hadn't had to do it this time. Ahhhhh....what a job. U-561