Odler Robert Jeanlouie, MD
"Get the doctor!". "Bring the code cart!". The commotion was
coming from Room 7. I rushed to the site. The patient was lying
livid, lifeless. I glanced at the monitor. Flat line! In the fraction of the split second that followed, I had to decide whether
she will live or die. I decided she would live... I would try... I
had 20 minutes to do it. Beyond 20 minutes, she would be irremediably
Norma was 37 years old. About a year earlier, while undergoing a
work-up for a recurrent sinusitis, she had an MRI which revealed what
looked like a tumor of the blood vessels in her brain, an hemangioma.
Usually a benign tumor. But, she was advised to remove it anyway.
The risks of the intervention were minimal.
She discussed the matter with Chantelle. Chantelle's love and
affection were Norma's sole worthy possessions. Chantelle, her 17
years old daughter, was her roommate, her playmate, her confident,
her life companion... They, together, decided that Norma would go for
The operation went uneventful, smooth. When she was wheeled a few
hours later in my unit, she was off the respirator, alert, in good
spirit. She was young, healthy. There should have been no
complications... So, what happened? Why was she lying in front of me
with no respiration and no heartbeat?
I jumped in the bed and started CPR (cardio-pulmonary resuscitation).
A nurse pushed the alert button to call the code team. In no time,
the room was full. Norma received one shot of epinephrine and one
shot of atropine. No response. I was pumping like crazy.
An intern panicked and started shouting orders. I barked at him.
He shut up. I pulled him in CPR position. He had the right muscles
for pumping. I grabbed a laryngoscope. In three minutes,
the patient was intubated. We were able to make her breathe
At 5 minutes, the cardiac monitor still showed a flat line. Asystole.
Three shots of epinephrine. I did not want to take any chance. I
opted for the escalating doses.
At 10 minutes. Last dose of atropine. Still no response.
At 12 minutes, she went into fibrillation. I grabbed the
defibrillator. Three shocks. I brought her back to a normal rhythm.
But, she still did not have a pulse.
At 15 minutes. She had a pulse. A weak one. But, her blood
pressure was still zero.
At 17 minutes, she had a blood pressure of 70 over 40. Too low. Bolus
some fluid. Start an infusion.
The blood pressure came up... Send blood for chemistry and other
studies. And, a chest X-ray. And, an EKG. No one will ever learn
what caused her heart to stop. We had 20 minutes to save her life.
We did it in 17. We made a difference. That was medicine! In all its
glamour and glory. I smiled and walked away...
These events happened last December. Six months later, I met
Chantelle on the wards. She was visiting a young friend. Another
case of teen-age pregnancy gone a haywire. I did not recognize
Chantelle. She turned 18, graduated from high school and was
accepted at John Hopkins.
"Thank you, Doctor.... Now, my mom will see me graduate from
college" says she. I smiled and walked away....
(Odler Robert Jeanlouie, on Thursday, June 3, 1999.)