In response to a KevinMD blog post about a doctor’s perception of having a black cloud in residency, I wrote the following in response:
This post reminds me of my own black cloud experience:
During my ENT residency, one of my fellow residents had a bleeding black cloud. He had an unusually large number of patients with bleeding and hemorrhage issues. I had the airway emergency black cloud, which followed me into private practice.
One night, while on call as an attending for a major NYC hospital, I was called STAT from the ER about a woman who was found unresponsive. While walking briskly to my car, I slipped on ice and suffered a nasty abrasion on my right elbow, right down to the bone.
EMS attempted to intubate her, but was unsuccessful. They had difficulty ventilating her using a face mask. When she was brought into the ER, due to an inability to secure her airway, the surgical intern was called in and she ended up performing an emergency cricothyrotomy. Unfortunately, they still had trouble getting her oxygen levels up.
When I arrived, there was a large group of doctors and nurses working frantically to save her. They were bagging her and her oxygen levels were OK, but not great. As I approached the patient, I was told that there was another airway emergency in the next stall, where a tracheostomy tube had popped out and they couldn’t place it back in and he was desaturating. I ran over to that patient, popped the tube back in over a catheter, and ran back to the first patient. Just then I got another call about a patient on the oncology floor who was found unconscious and they couldn’t secure her airway. I ran up to assess the situation. She had oral cancer and due to her surgery and radiation, they couldn’t open her mouth adequately. They were bagging her easily, but the doctors wanted an emergency tracheotomy.
I called downstairs to see what was happening to the first patient, and they told me to come down STAT. Seeing that the third patient was being ventilated well, I had her transferred to the OR for a controlled awake tracheotomy.
I ran back down to the ER, and since the patient was desaturating severely, I looked with my laryngoscopy and saw that the tube was in a false passage. The location of the incision and entry into the trachea was not in the proper place. At this point, I decided to re-do the cricothyrotomy, and was able to get her oxygen levels up to acceptable levels.
I ran back up the the OR and performed the awake tracheotomy uneventfully. The next day, I had to go back the the hospital to covert the cricothyrotomy to a trachoetomy.
I sometimes wonder if all my experiences in dealing with airway issues is what subconsciously lead me to specialize in surgical management of sleep-breathing disorders. Needless to say, that one night on call left me scarred for life. I’m reminded of it every time I look at my elbow.