What If Steve Jobs Ran the I.C.U.?
We'd like to think that medical intensity and competence in the real world mirror the intensity and competence of television shows like ER and House. But too often it is like the horrible surreal story told below. What if we deregulated medicine to open it to the product and process innovations of intense innovative entrepreneurs like Steve Jobs, Jeff Bezos, and Sam Walton?
(p. 7) Omaha -- I've been watching the monitor for hours. Natalie's asleep now and I'm worried about her pulse. It's edging above 140 beats per minute again and her blood oxygen saturation is becoming dangerously low. I'm convinced that she's slipping into shock. She needs more fluids. I ring for the nurse.
I know about stuff like septic shock because for more than 20 years I was a transplant surgeon, and some of our patients got incredibly sick after surgery. So when I'm sitting in an I.C.U. in Omaha terrified that Natalie, my 17-year-old daughter, might die, I know what I'm talking about. I tell the nurse that Natalie needs to get another slug of intravenous fluids, and fast.
The nurse says she'll call the doctor. Fifteen minutes later I find her in the lounge at a computer, and over her shoulder I see a screen full of makeup products. When I ask if we can get that fluid going, I startle her. She says she called the resident and told him the vital signs, but that he thought things were stable.
"He said to hold off for now," she says.
"Get me two bags of saline. Now," I tell her.
She says, "I'm calling my supervisor," and she runs out of the lounge.
. . .
I know I shouldn't be my daughter's doctor. They taught us the problems with that during my first week in medical school.
. . .
But right now, I don't care about any of that. I'm the one with experience taking care of really sick patients, and if I know she needs more fluids, she's going to get them.
I break into the crash cart, a box on wheels full of stuff they use to resuscitate patients. I pull out two liters of saline solution and run both into Natalie's IV in less than 20 minutes. Natalie's pulse slows and her blood pressure rises. An hour later, after the nursing supervisor and on-call resident finally arrive, I've finished infusing a third liter. Natalie finally looks better.
This wasn't the first time during Natalie's illness eight years ago that I broke my promise to just be her dad. It started a week earlier when she came into the den and showed me the blood she'd coughed up. I suspect a father without my experience might have chalked it up to flu. Maybe because I was a transplant surgeon, and always considered the worst possible cause whenever a patient had a hiccup, I took her to the hospital. I was worried the blood meant she had a bacterial pneumonia, a bad one. And it did.
On the way to the hospital, Natalie took a deep breath and looked at me. "Am I going to die?" she asked. I'm convinced that she would have been dead before morning had I not been a doctor, and one who could recognize septic shock when it affected a normal teenager.
For the full commentary, see:
(Note: ellipses added.)
(Note: the online version of the commentary has the date SEPT. 5, 2015.)
The commentary quoted above is adapted from the book:
Shaw, Bud. Last Night in the Or: A Transplant Surgeon's Odyssey. New York: Plume, 2015.