A very sick person, sick with H1N1, sick with the cascade of infections that seem to come with a several-week-long ICU stay. A fresh trach and sudden ventilator alarms, a quick and systematic troubleshooting of the problem, diagnosis of a leak -- a cuff leak -- the cuff in my fresh new tube is blown and I can no longer make this person breathe.
They talk in CPR about this ABCs phenomenon. Eventually, when you've done it enough, it becomes like second nature. I lose an airway and I'm scrambling, grabbing ready-made kits stocked with every necessary piece, tearing my carefully wrapped-and-signed-and-dated (accountability you know) package asunder, ethylene-oxide sterilized parcels falling in the bed like clumps of snow outside the window.
Alarms are forgotten for a minute -- the "shut up" buttons all pressed, I have two minutes of relative silence, wherein I can tear the bagger off the wall and crank up the oxygen to its highest whooshiest setting. I have not yet used my brain. This is all pure reaction, reflex, muscle memory. I have prepared for this many times and I am ready.
Some feel it's okay to be lackadaisical about emergency preparedness. Why put a bagger within arm's reach when there's one 30 feet away? Because sometimes that 30 feet mean the difference between a deft rescue and a resounding, thundering crash.
A new airway. Breathing established, finally, again. Circulation preserved with minimal interruption in systemic oxygenation. I'm restocking. We are laughing about some other subject, perhaps a vented patient without the ability to communicate winking at me. It's only later, hours later, when alone, preparing for the next time, combing through the details, that I can truly internalize how close we were to catastrophe.
One clearly labeled emergency kit away from the newspaper headline adding another number to the H1N1 death toll, and it seems to me about as ordinary as what I'm going to have for lunch. Thinking of the what-ifs and what-could-have-beens. Had we done this one thing that they'd been considering earlier in the day, we would have been up shit creek without a paddle. Had we not had this one particular doctor in the building as backup, once up shit creek without a paddle, we would have discovered it ends in a waterfall. We could have drowned. And it's only quick reflexes that prevented the fall.
So many in their CPR classes fear paralysis, the paralysis that in the second, the moment they realize, they will not know what to do. That's the thinking. The thinking about what-to-do before you do it in the moment when your mind goes blank, when your hands go wet and your mouth goes dry, when you forget the answers to all of the questions on all of the tests and just circle A, B, C.
The answer is don't think. Just follow your mantra. A, B, C. Are you lost? Go back to the beginning. A, B, C. Repeated enough, it becomes a reflex, as divided from your conscious decision-making as the urge to stretch or fidget. Action, reaction. And later, much later, with everyone safely tucked into their beds, you too will know just how close you were, and shudder a little at the thought.