Monday, October 05, 2009

Don't Silence the Alarms. . .

My thoughts in the last couple of weeks has increasingly been turned back toward the world of medicine of which I have somewhat lost touch with in the last 4 years. In January 2006, I had the great opportunity to leave the field of medicine and devote myself to the role of being a full-time pastor. What turned my thoughts back to that venue was my oldest son having graduated from the RN program that my wife and I both graduated from 24 years ago has gone to work in one of Intensive Care Units at Flowers Hospital in Dothan. His orientation process has caused me to think of several instances over the years that taught not only valuable lessons about medicine but about life in general.

While I have been able to be involved in a host of good things there are also some instances that horrific outcomes took place. As I look back in retrospect I realize now that they could have been prevented. One such experience happened early on when one of my co-workers was admitting a fresh open-heart from the OR. The common practice is that within the first 30 minutes of admitting a post-op heart is for a naso-gastric tube to be inserted. This involves taking a tube made of firm plastic and placing it in one of the nostrils and advancing it through the nares into the esophagus and down into the stomach. It is then hooked up to an intermittent suction device that gently keeps the stomach empty of air and fluid preventing vomiting that may lead to aspirate pneumonia which is never good. During this time the patient is unconscious and on a ventilator because of the effects of the anesthesia used during the procedure.

Leading up to the point of NG tube insertion that patient had done well. They had been attached all the appropriate monitors, the Swan-Ganz catheter had been successfully placed by the CV surgeon, and all seemed well. However, the person taking care of the patient had grown tired of hearing the alarms on the cardiac monitor and had overrode the cardiac monitor completely silencing the monitors. On a side note, the vast majority of cardiac monitors that are made today can only be silenced for a two-minute maximum before they reset and start again. This has helped to prevent bad patient outcomes.

One of the potential complications with the insertion of an NG tube is that a vaso-vagal response can occur. This means that a patient will have a sudden drop in heart rate and blood pressure and often leads to the patient “passing out” (in laymen’s terms) if they are conscious. They become cold, clammy, and at best their pulse is weak and thready. If the patient is already in a state of compromised health, this vaso-vagal response can even lead to their heart going into a fatal rhythm. This is what happened to this patient but the difficulty in all of this was the alarms had been silenced and the person inserting the NG tube was not aware that the heart rate had dropped from the 90’s down into the 30’s. It then deteriorated into an ominous ventricular fibrillation. This means the heart of the patient was turned into a mass of writhing worms (as I had one physician characterize this condition to me many years ago). The heart in this condition cannot generate a blood pressure and therefore it is in full-blown cardiac arrest. How long the patient was in this condition is unknown and I doubt it was more than a minute but it was long enough for the patient to go from normal to Code Blue.

It ended up that the patient had their chest opened at bedside which is always incredibly chaotic. They were “shocked” directly to the heart with some special paddles and a host of cardiac drugs were given in an effort to save the patient. To our great disappointment the patient ended up expiring after we worked well over an hour in our efforts to resuscitate the patient.

In the post-code debriefing that generally occurs with all Code Blue situations in all hospitals across the nation, it was determined that the silencing of the alarms were very costly to our efforts to save this patient. We were already behind the trying to climb out of a deep hole before we got started. As it turned out from that point on there was a zero-tolerance policy concerning the silencing of the alarms no matter how annoying they were to the intensive care staff. Alarms can save the lives of patients but they only work when they are not silenced.

There are a lot of alarms that we can choose to silence in our lives simply because we find they are annoying and perhaps even a bit confining to us. There are alarms in your relationship with God that are silenced when you neglect prayer. Far too often, our prayer is spent in hurried trips across the parking lot to school or work, prayer is sometimes confined to our drive to and from different places that our attendance is required, and you can get the picture. The alarms of the soul are neglected when we do not get down on our knees (or some posture of prayer) and stop the world for a bit so that we interact with God! People who have spiritual problems and are always full of doubt and fear are those who are not praying.

We silence soul alarms when there is no interaction with the Word. It has to go beyond simply a “verse for the day” mentality. I am currently working through a series on the Old Testament Tabernacle and through the Sermon on the Mount. I just thought I was spiritual until the pattern of the Tabernacle began to play itself out. I also discovered that a depth of character could be born out of Matthew 5-7. A superficial approach to Scripture will lead to a very shallow spiritual life and I am pleading with you to get involved with your Bible (whether you are a minister or not!). The more I read the Book, the more I grasp that the path to Heaven follows a very narrow path.

We silence the soul alarms when we have a lackadaisical attitude toward public corporate worship. It is important for you to get out of bed on Sunday morning and go to church. It is important that you put Sunday night on hold and go to worship. It is important for you to go to a mid-week Bible study and prayer meeting and I do mean Bible study and prayer. As in Bible study that requires note-taking, systematic teaching, and provoking Scripture that forces you to think. I also am an ardent supporter of corporate prayer—as in the get-down-on-your-knees sort of thing either in the pew or at the altar and as in out-loud-everyone-around-being-heard kind of prayer. This kind of worship will cause your spiritual life to grow as never before.

We have alarms in our marriages that are silenced when we refuse to listen, to care, and will not compromise our plans for our spouses. Alarms in our families occur when we neglect them for the so-called purpose of making a living. There are some who get so busy making and living that they kill the very life most important to them—the life that resides with them under the same roof. Our children desperately need for us to be parents. Being a parent will require you to set boundaries, to discipline, to encourage, and to just be there. Don’t fall into the trap of “quality” time versus “quantity” of time spent with your children. In the case of raising kids, quantity always equals quality.

One final plea is reserved for pastors and ministers, don’t silence the alarms of true ministry. Just in case you may not have read it in a while, you will find a very detailed job description in 1 and 2 Timothy and Titus. You will also find in 2 Peter 2 and in Jude what happens to those who neglected to do their job and silenced the alarms.

Keep the alarms on!

(Please note: The details of the patient account above were changed and actually represents a variation of details and conditions which I have been exposed to in multiple patient experiences over a 25 year time frame and numerous facilities I have been associated with. While fictional the account resembles what occurs in hospitals around the world on a daily basis.)

2 comments:

Anonymous said...

Thank you Bro. Harrelson for a timely reminder as we cut into the future.
G Salinas

Paul Nolan said...

Bro. Harrelson,

Thank you for the stout call to be at attention and to be ever-vigilant.

Let he that hath an ear, hear the alarm that the Spirit is sounding.

Bro. Nolan