“Turn It Up To 300 and Hit It 3 Times!”

Defibrillator
Circa 1965

I met and worked with some outstanding doctors and surgical residents during the 4 years I took my surgical training at Charity Hospital in New Orleans between 1965 and 1969. One of the surgical trainees with whom I did a large number of operations was Dr. John Piker who was from Clinton, Louisiana.

John and I rotated together from “Big Charity” in New Orleans to “Little Charity” in Lake Charles, Louisiana during my 3rd year of training and spent 3 months operating together at that facility. We were responsible for all the general surgical procedures done at the hospital under the supervision and assistance of a staff surgeon. John and I seldom asked the staff surgeon to scrub with us as we had become very confident in our operating abilities and self-sufficient in our management of surgical patients.

John Piker was a few years older than most of us and had lots of other experiences outside of his medical training. He was an excellent story-teller and could spin some of the funniest tales I had ever heard from a Cajun. One of his funniest involved an episode when he was a medical student at the LSU School of Medicine. I will tell the account in the first person just as he told me:

“I was in my senior year of medical school and had a 2 weeks-long clinical rotation on anesthesia. My job was to assist an anesthesiologist in the operating room for that 2 week period, and it included taking night call for emergencies when he was on call. The anesthesia resident whom I will call Dr. Smith (not his real name) had the reputation of being especially hard on medical students. Perhaps he had been treated this way as a student and wanted to continue making life as miserable as possible for hapless and gullible students. He had a way of calling me “Piker” with a few added unmentionable adjectives which constantly irritated me, but I had to keep my mouth shut and my attitude hidden as much as possible. It was by far the worst 2 weeks rotation I had in medical school.

We had an on-call room with comfortable chairs and a TV to watch to help pass the time when we were not being called out for an emergency. I tried to use the spare time to read and study, but Dr. Smith had the TV on so loud it was difficult to concentrate. On this particular night we were between emergency surgical cases when we got a Code Blue call from 5th floor which was the medical floor. The patients there had various medical problems including MI (heart attacks), CVA (stroke), and diabetic emergencies. There were no surgical problems on the 5th floor.”

Dr. Smith said, “Piker, get your lazy butt off the couch and bring the crash cart with you. We’re going to 5th floor. Be quick about it!!” The crash cart had all the supplies necessary for a cardiac arrest, including a very large and antiquated defibrillator. The modern ones were compact, but this one was about 10 years old, stood tall on the stand and required 2 people to operate it. One person had to set the dials on the console while the other one held the paddles to the patient. The one on the console was responsible for firing the electrical charge by means of  a firing button located on the console.

When we finally got to the 5th floor and the patient’s bed, we found a typical scene for a person who had a cardiac arrest. It was a large open ward with approximately 12 beds, and this person was in a bed in the middle of the ward. The beds were all metal with wire springs. They were not like the modern beds which have electric controls to raise and lower the  bed and the head of the bed. A few beds had a manual crank for raising the head of the bed, but most did not even have that feature. The mattresses lay on springs which precluded any effective chest compressions should they be needed. This patient was a large woman in her late 60’s in age, and had probably had an MI (heart attack) which caused her heart to start fibrillating. There had been several failed attempts to start an IV, and there were small puddles of saline on the floor beside the bed. In order to apply the paddles effectively to the patient, she had to be rolled slightly on her side to apply one to the front and the other to the back. Because of her size Dr. Smith was stretched out almost to his limits and his knees were touching the side of the bed. He didn’t notice he was standing in a small puddle of saline.

When he was in position he said, “Piker, turn the power to 50 volts and hit it once.” I did what he said and nothing happened. “Turn it to 75 and hit it again”, which I did with the same result. “Come on Piker give me some power quick! Turn it to 300 (maximum for this machine) and hit it 3 times.” When I pushed the firing button after setting the machine to deliver 300 volts, the electricity made an arc with Dr Smith touching the side of the bed and standing in saline, and it was Dr. Smith instead of the patient who got the full charge. The electric shock lifted him up on his toes, caused his facial muscles to grimace and his arm muscles to straighten in spasm. You could hear air being sucked into his lungs with the spasm. I saw what had happened, but had my head turned slightly away from him toward the console and pretended I didn’t see him being shocked. I hit the button the second time with the same results, and then for a third and final time!

When he finally came back down to neutral, the air rushed out of his lungs as he said with a grunt, “Don’t hit that button again!” He thought I didn’t see him being shocked and knew I was doing what he had told me, so he didn’t blame me or punish me for shocking him. He did have a whole new respect for me though, and not once after that did he ever criticize or belittle me. I guess he was afraid I might think of something worse to do in retaliation. Maybe the shocks just made him sweeter.  🙂

Dr. John

 

 

 

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