Chapter 3
Rapid Response
DISCLAIMER: This is my true story, with adjustments for artistic license. To protect their privacy, I changed names and biographical details of any individuals depicted. All patients are fictionalized and inspired by my aggregate experience as a physician.
Any views expressed are mine alone, and do not represent the positions of my employers.
My writing is not graphic, but it does describe medical details.
Throughout these events Kathryn and I exchanged text messages. I learned that my oldest, Brandon, was sitting in the stands, watching the basketball game intensely, giving off “Bernie Sanders” vibes. Wally had scored a basket, and his team actually won—the first win of the season!
Great! Tell him Daddy is sorry he missed it.
Later,
Well, they took me back immediately
I’m glad I didn’t wait longer before driving in
Flu positive
Then,
They’re admitting me, I’ll send you the contact information for the floor when I get up there. Love you honey.
Love you too. For better or worse, because they have been admitted before for asthma they are relatively unphased by your admission
That’s good
Your wheezy trio
No kidding
Now knowing that I would be admitted, I texted one of the pulmonologists I knew in the hospital. I had worked here during training and then as a young attending for a year.
Hey...sorry to bother you on a Saturday. I’ve got the flu and it’s kicked up my asthma. In the ED and getting admitted. Who is on today?
Yikes. Sorry to hear.
It’s Izzy on consults.
Wait...not ICU...right?
Not sure yet
While I was in midst of another round of nebulizers, I saw the pulmonary consult attending peek into my room. It was Izzy, who I knew.
“Ian! Long time no see. Sorry it’s like this...”
Taking the nebulizer briefly out of my mouth, I replied, “Yeah, this flu...kicking my butt.”
“Where are they admitting you?”
“Not sure...didn’t discuss triage.”
“OK, I’ll talk to the ED doc. Don’t worry, no matter where you go, we'll be keeping close tabs.”
“Thanks Izzy.”
I later learned I would be going to an intermediate care unit—not a low-acuity medical floor, but not the ICU. The resident who would be admitting me came in to take a brief history. I can imagine as a resident, it felt odd to be admitting a pulmonary attending for an asthma exacerbation. He outlined a basic management plan, largely to continue nebulizers and steroids.
I felt well enough after another nebulizer to take a break. Disconnected from the wall, I could go upstairs, opening the ED room for someone else in need. The respiratory therapist would meet me upstairs to finish the rest of the treatment.
Will stopped in one last time to check in.
“Thanks so much for taking care of me, Will.”
“Anytime. Well, not anytime—let’s not do this again. But yeah, it’s my job.” He smiled.
A transporter wheeled me through the hallways and into an elevator up to the intermediate care unit. We stopped in front of a private room, because I was positive for influenza. I walked from the stretcher to the bed, using the bathroom on the way.
Into the room strode a young nurse, whose birth year definitely started with a “2.”
“Hi! I’m Danielle, and I’ll be your nurse this afternoon.”
“Hi Danielle...I’m Ian.”
“I’m just going to get a set of vitals,” she said, as she hooked me up to the monitor and placed the blood pressure cuff on my arm.
“How do you like it...here?” I asked
“Oh, it’s great. It’s my first job out of nursing school. I graduated last year. And they’ve been so nice to me. We work great as a team.”
As we talked, I was aware of my breathing and continued tachycardia.
This might be a busy afternoon for you, Danielle
Danielle asked her admission assessment questions, during which I confirmed I felt safe at home and had not fallen. And confirmed my wife as my emergency contact. She left the room, and the respiratory therapist from the ED came in to get the rest of my treatment started.
After another twenty minutes, my breathing was feeling easier, and I called Kathryn.
“Hello my love.”
“Hi, Ian. How are you feeling?”
“Better. Finishing a nebulizer, and it’s helping.”
“That’s good. How long do you think you’ll be admitted?”
“Probably just a couple of days...to turn things around, with more steroids. Chest x-ray clear, no pneumonia, so that’s good.”
“Well, that’s not too bad. Maybe we can FaceTime later, depending on how you’re feeling.”
“Yeah. Love you honey.”
“Love you too.”
Unfortunately, my reprieve did not last. My chest started to feel tight again, and I pressed my call bell. Danielle returned.
“Danielle...I’m starting to feel tight...could you get respiratory?”
“Yeah...of course,” she said, seeming slightly on edge as she listened to me speak.
Looking up at my monitor, she added, “I’ll page the doctor too.”
A few minutes later, in came a different respiratory therapist, named Jill. She looked familiar. I realized we knew each other from the year I had rounded here as an attending.
“Dr. Barbash! I was surprised to see your name on my list.”
“Me too, Jill,” I smiled faintly.
“Let’s see if we can get you a little more comfortable,” she said, getting another nebulizer started.
As she waited in the room for a few minutes, I saw unease in her eyes, gaze moving between me and the monitor. I heard it alarming but could not see—it was behind me.
“What’s wrong?” I asked.
“You’re pretty tachycardic. Almost 150.”
“Oh,” though I was not that surprised, given my palpitations. I was lying still, but it felt like I was running.
Jill looked at me, leaning down so I could hear her over the nebulizer, “Dr. Barbash, I think we need to call a condition. Is that OK?”
I felt terrible. “Yeah...sounds good,” I managed to get out between breaths. This was getting real.
Having been on the other side many times in my own role as ICU attending, I knew there was about to be some excitement in my room. I listened as the “Condition C,” the term for a rapid response in our hospital, was called overhead with my room number.
Ironically, this was not the first time I had been on the business end of a Condition C at my place of work. When I received the first dose of COVID vaccine, I started to feel woozy and tachycardic while sitting in the observation area. After I called one of the observers over, they lowered me from my chair to the ground. I stared up from that position, as I was surrounded by two senior pulmonary and critical care physicians, another attending physician, and two nurses I knew. It was an experience I had no intention of repeating. Oh well.
The rapid response nurses arrived in my room. With efficiency and care, they placed pads on my chest and back, hooked me to the portable monitor, and flushed my IV to make sure it was functional, speaking reassuringly as they worked. In another minute the rapid response intensivist arrived. Tom Marshall was an experienced ICU attending under whom I trained as a fellow, and with whom I worked as an attending years ago. It was reassuring to see his face, but I could tell he was not excited to see me in the bed. Though, I’m not sure Tom’s face ever looks excited. He’s an even-keeled kind of guy.
He listened to my lungs and my heart, watched me breathing, and saw my heart rate rising intermittently above 150 on the portable monitor. Without needing any more information, he asked “Ian, would you be OK going to one of our lovely ICUs? We’re holding a MICU bed with your name on it.”
“Absolutely”, I agreed immediately.
How am I going to tell Kathryn about this?