Because Sometimes I Just Want to Talk About My Day...

I'm an innate debriefer, I always have been. It's a trait that often comes in handy as a teacher, but sometimes stinks when all you come home to is a cat. I'm not in the habit of talking to animals as if they were people unlike some folks are. Sometimes I just want to talk about my day.
I went to work this morning and got assigned to a male patient in his 40s. He had been admitted during the night from a rural hospital where he had presented to the ER with chest pain and difficulty breathing. On xray they had found a widening of the mediastinum and determined that the man had an aortic aneurysm. After all, he is have a history of marfans (a genetic connective tissue disorder that makes people prone to aneurysms).
Upon more testing at our hospital we found the aneurysm was 10.5 cm (the biggest I had ever seen) and so large that it was compressing his trachea (hence the difficulty breathing). When I arrived on shift, I was immediately asked to order and transfuse blood products, draw labs, complete an echocardiogram and prep. for surgery. Unfortunately I didn't the blood products hadn't arrived before I had to bring my patient to surgery. His airway had become so tenuous that we just couldn't delay any longer. I can still see the look on this man's face as we emergently wheeled him into the OR, he knew his chances were slim.
I had no sooner returned from the OR after dropping off my patient when I heard another nurse calling for help. I entered the room to find her manually ventilating her patient who was in respiratory arrest. During and after a rather chaotic intubation, the patient vomited the dreaded coffee ground emisis, the signature of a GI bleed. Only minutes later we found ourselves doing CPR and pushing ever vasopressor known to man. Ultimately the patient was resuscitated, but I'm not holding my breath about his long term outcome. Resuscitation is trauma in and of itself, one that I'm not sure a 91 year old man would want to or should have to endure.
Then as if multiple rib fractures from compressions weren't enough, we just had to go and start a central line in his neck. I'm all about working at teaching hospitals, but I have to say my arms and my back are still aching from standing in awkward positions with my hands under a sterile drape holding some guys head for over an hour.
My original patient never returned from OR before change of shift this evening. As I was setting up the room for his return I happened upon a "get well" card from his young son. It said: "I love you daddy. I hope you don't die. Could you please stay alive for me? I'll give you my whole allowance." (There was a wadded up dollar bill inside the card)