Earthquakes and Medical Emergencies

I started my MICU rotation yesterday, and while it's my second time being in the unit as a resident, I still get nervous in the MICU. One of my more "stable" patients was a 54 year old man with end stage liver disease with peritonitis who is still on the liver transplant list despite all his current comorbidities. My attending even asked if we could call him out to the PCU today, but the fellow disagreed, saying that every time he was called down to the PCU, he always returned quickly due to hypotension.

Thank goodness he stayed, because shortly before 10 a.m. I got a call from another resident saying that he was coughing up "lots of blood." I broke from rounds to see what was going on, and there was my patient, his gown and sheets drenched with bright red blood, and there was more coming out of his mouth and trach. My first thoughts: "Holy $#&!" Even worse, he recently had all his central lines removed due to fungemia, and all he had was one peripheral. This was the worst thing that could ever happen to this guy, and I was in fear for his life.

Fortunately one of the MICU attendings was already in the room, yelling for the fellow to get a central line kit and at us to order octreotide drip, Nexium drip, and above all, blood products. Rounds were completely forgotten in light of this emergency. While the fellow put in a central line and the attendings put in a Blakemore tube (which I'd never even HEARD of until today), the rest of us tried to handle everything else from running to the blood bank for blood products, putting in orders, making phone calls, etc. The first year GI fellow was nervous about doing her first scope for a variceal bleed (the patient had known varices and had bled in the past), and the GI attending tried to make it all sound exciting. In the first two hours we transfused 8 units of RBCs and who knows how much FFP and platelets (remember, end stage liver), and through it all the patient remained conscious. He knew very well what was happening, and that, I thought, was the scariest thing of all. Knowing that he was in trouble, and that he could die.

The GI attendings couldn't find an obvious source of bleed, but went ahead and banded what varices they did see just to be safe. Once he was stabilized, it was nearly lunch time, so several of us went to the lounge to eat. Suddenly, the floor started moving up and down, almost like we were on a ship, and a closet door started swinging. "What is that?" someone asked. "You guys feel it too, right?" "Is that an earthquake?" It certainly FELT like one (I'd experienced earthquakes in Asia before), but whoever heard of earthquakes on the East Coast? "I love how we're all just sitting here," one girl half-joked, but it was surprising how calm we all were. The earthquake only lasted about 20-30 seconds, and after it ended another girl (who happened to be from Cali) ran into the lounge and said, "Did you guys feel that?!" Yup, sure did.

For a lot of people this was their first earthquake (my college roommate was in DC and told me that she immediately ran out of her building when she felt the first tremors), so it was pretty frightening for them. One of my friends initially laughed when her ER patients told her that the ground had shook and thought they were just high on crack; only later did she realize that there was an earthquake and she hadn't felt it. Our lounge was on the 12th floor of the hospital; I'd always experienced earthquakes while in a high rise so I have no idea whether it's safer to evacuate the building or just stay put. At any rate, an earthquake on the East Coast was certainly bizarre. And now there's a hurricane on the way? What the heck...