Somehow I picked up some bug in Hawaii. God willing it's not Avain Flu. It's nothing serious, but I'm coming into a three day run of night shifts and that is a grim grim prospect. Last night I went in for my evening shift at the Valley. I felt bad. My hope was for a quiet night and on a Thursday there was a chance, albeit slim, of having one a quiet night. Mercifully, I did have a good night. Part of this was the slow pace (until 8pm when it got ugly, but by then the shift was almost over) and part of it was that I had a decent resident. I had in the back of my mind the fear that we'd get a code; it's the sort of situation where you want to be at your best and I knew I wasn't. We did, of course, get a code. A guy went down and the medics were called. Typical FUBAR bullshit where the time on scene goes on and on and on and brain and heart slowly dies. He got to us with the tube in and a wide complex slow rhythm but no pulses. We pile it on. He has an internal defibrillator which periodically fires--this is incredibly unnerving the first time it happens. We're doing compressions, runnign through ACLS and suddenly the guy jerks off the gurney, his hand sweeps up and grabs a nurse and the guy on his chest screams like a girl and falls off his stool. We push it to the point of futility. The family arrives. I send the nurse to see if they want to witness the resuscitation. This is the new little fad in Emergency Medicine--very au courant and forward thinking. It promotoes "closure" and "helps the grieving process" and "de-mystifies the medical process" and "decreases the barrier between physician and patient" etc. Only the surgeons have the courage to openly oppose it on the grounds that it is bad for the patient. That argument is, I firmly believe, true--and this "family presence" movement is all part of the trend of serving the family and not the patient. A wise trend--families sue, call administrators, complain to their friends, and as a rule dead men don't--but a shitty way for medicine to be practiced. That argument aside--and Oh, I wish organized Emergency Medicine had the confidence and courgae of the surgeons to enter the debate in a meaningful way--this guy was dead and with that reality established, a llittle theatrics may help with the grieving process and obtaining closure, etc. The poor little wife is wheeled in with some friends. We do CPR, push meds, check pulses and I, for one, am acutely aware of the sensation of playing at being a TV doc. I do the ultrasound of the static heart routine, call it, express my condolensces (sp?) and ask the nurse to call me if the family has any questions. Rest of the night passes without too much pain. I get some good sleep and I think I'll be allright for the night shifts. U-561