Emergency! by MD Mark Brown

right now and done right. It is used in an extreme emergency. Like this.
    The woman continues thrashing. My two assistants are holding her down. The husband continues screaming at me. The blade and the tube are in my hands.
    In an instant, I recall all the times during my training when I’ve intubated old people whose hearts have stopped and who are no longer breathing. I think of the dead and the near dead who have undergone intubation at my hands as part of that last dance of resuscitation. All the Code Blues. Full arrests. Although it seemed urgent at the time, I now realize that all those intubations were just practice for this moment. I must now do this procedure right or she will die. I also note how badly I have to pee. I think, This is why people wet their pants when they’re scared.
    The screams grow distant. The room fades away. Events slow. There is just me, the blade, the tube, her throat.
    I flash on an image from college. A dog caught a squirrel and crushed its chest. A bunch of us watched as the squirrel lay gasping, dying. An anguished young woman yelled at us: “Do something!” Do what? I thought. We’re just kids. I am now called back to that moment. Do something! Now I’m a doctor but I still feel like a kid. I wish a grown-up would arrive and take over.
    The tube slides in easily. I squirt medication directly into her lungs and ventilate her with a bag. She begins to improve. Her husband stops screaming and clutches her hand.
    The movie star has been watching from his monitored bed. He is the only one without a job to do. I ask if he would please call 911,which he does. He must wonder about his own safety, having just been asked by his doctor to call 911. The ambulance arrives, and the woman and I ride to the hospital. She is much better now, awake and calm. She’ll do fine.
    As I drive home that night, I’m depressed. I wonder why I’m not elated. I just saved a life. I had prepared for this moment for years and tonight it all came together. I should be elated, but I am not. I am depleted. Drained. I realize why.
    I never want to be that scared again as long as I live.
    MARK BROWN, M.D.
    Malibu, California

LASTING IMPRESSIONS
    I t was, as Saturday afternoons go, fairly typical. Busy but in control. I barely noticed as one of the local paramedic units rolled in with a healthy-looking young man, his knee propped on a pillow, his mother close behind. Within a few minutes, one of the nurses requested that I see him because he was in quite a bit of pain. Obligingly, I went to his room. David was a handsome, athletic high school kid. In spite of his discomfort, he stoically explained that during an afternoon game of pickup basketball he felt his knee go out of joint. Indeed, he did appear to have an obvious dislocation of his patella.
    I approached him with confidence and enthusiasm. After all, his problem was simple and straightforward. “We’ll give you a little something for pain, and after a screening X ray of your knee, I’ll just pop it right back in place,” I informed him. My reassurances weremet with a look of skepticism and panic. His mother, standing by the bedside, frankly and calmly informed me that she was a nurse. She asked if I would consider performing the treatment under conscious sedation, a short-acting anesthetic that would place her son in a tranquil, comfortable state during which he would be undisturbed by the minor procedure.
    At this point in my career I had had limited experience with conscious sedation. As I was of petite, feminine stature, I decided that anything which would assist my finesse would be an asset and agreed to Mom’s request. Following a discussion of the pros and cons, and after obtaining consent and administering a generous dose of narcotic, the nurse and I began to prepare for the procedure.
    Within twenty minutes we were poised and ready. IV, monitor, and pulse oximetry were all in place. The anesthetic was