Saturday, July 12, 2008
I plan to lose some money at partypoker...
I have No AVM's to report... thats good news!
i think that i have to youtube you...
I am sorry... NOT
I keep losing my connection. DAMN!
Ok now I'll try it again.
I used to think tham cool... lame.
I don't remember this Song... but it is cool... a little.
Now here is a group of songs that youtube should have the Videos for... oh well.
its just to bad that youtube can't have the videos that they use to have... now I am all for Artist protection.. but G-damn it... I wanna Rock!
I just love the 1980s...
Oh here have another.
See all the bands that Didn't rock?
Ok thats it... I will see you when I see you....
Thursday, July 10, 2008
ok that was lame!!!
My day has been good so far...miscreation? WTF!!!arteriovenous HUH!!!
ok lets do headache, shall we?
okay thats headache...
Now lets do some porn... oh sorry you can't do that. But i'LL get you close.
okay, that should bring you close. And now let's see whats on youtube... shall we!
I use to know a lot of girls that looked like Boy George!!
okat thats just a bit of 1984...
Pitt-led research gets to the heart of common problemsBy The Tribune-Review
Tuesday, July 8, 2008
The team found that a gene called unc45a plays a critical and previously unknown role in the formation of aortic arch vessels. The vessels contribute to several of the body's major arteries and often develop improperly, causing a wide range of vascular defects.
The team also found that arteriovenous malformations, or AVMs, happen when an artery fuses with a vein, diverting blood flow, and result from genetic and physiological factors. Previously doctors had believed its origins were solely genetic.
The research is published in the journal Developmental Biology. Scientists at Georgetown University Medical Center and the National Institutes of Health also participated."We discover AVMs in humans when something goes wrong and we can never go back and trace the shunt's development," co-author Beth Roman, assistant professor of biological sciences at Pitt, said in a news release. "Only when we fully understand the mechanisms leading to these malformations will we be able to develop better diagnostic tests and preventative treatments to pinpoint the best time to intervene."
A Hartcliffe boy has defied medical experts by walking again only a month after a life-threatening hemorrhage caused a stroke.
Three times, Kray Mundy's parents were warned to fear the worst after he was taken ill on June 7.
The 11-year-old, from Hartcliffe, was paralyzed on his left side and doctors told his mum Soniya and dad Adrian that it could take two years for him to get his mobility back.
But the Teyfant school pupil has amazed his family, nurses, doctors and other medical staff by getting back on his feet.
He is recovering so well that he has already been allowed a weekend visit to his home in Pavey Close to see his sister Shannon, 13, brother Kydis, eight, and baby brother Harry, aged two.
"He is an absolute miracle," said Soniya, 32.
"He was so determined to pull through and to take his first steps. Now he is working hard with physiotherapists and occupational therapists to get movement back in his hand and arm."
The family say they are immeasurably grateful to all the NHS staff who have helped them over the past few weeks.
Soniya said: "Without the amazing consultant paediatric neurosurgeon Mr Mike Carter and his team, our son would not have survived.
"We cannot thank the wonderful nurses and staff in Frenchay's high-dependency unit and the Barbara Russell unit, their counterparts at the children's hospital and the paramedics enough.
"We are forever in their debt."
The drama began shortly after 5.30am one Saturday when Soniya and Adrian, 48, were woken by their toddler Harry.
They heard an odd sound, which they soon discovered was Kray trying to call for help.
They dialled 999 and their son was taken by ambulance to the children's hospital, then, after a CT scan revealed a bleed in the brain, to the specialist unit at Frenchay.
His condition worsened, although he was still conscious.
Soniya said: "All he could say was, 'I love you mum'."
Further tests showed that a blood vessel malformation, known as an AVM in Kray's brain, which he might have had since birth, had ruptured and caused an acute stroke.
"He couldn't speak, feel his whole left side or see," said Soniya.
Doctors had to operate immediately, putting in a drainage system to the brain and a device to measure pressure. At that time they felt it was too dangerous to operate to remove the clot or AVM - but by Sunday night Kray was deteriorating and doctors opted for further surgery.
Senior staff nurse Jo Jones supported the parents throughout the eight-hour op. Soniya said: "She was our guardian angel.
"But it was tough. They could not give me the answers I wanted to hear. They couldn't tell me whether Kray would be all right. They didn't know what would happen."
After the operation Mr Carter was confident that the clot and AVM had been removed and things were looking up. But a few days later, Kray began to feel very ill.
"He was ventilated again to allow the brain to rest and stop swelling and he was transferred to the children's hospital. Then, on the Saturday, another amazing doctor, Daniel Low, took a chance on taking Kray off the ventilator. He even played him the Star Wars theme on his mobile phone to help him come round."
Back at Frenchay, Kray was in a lot of pain and there were fears that the stroke had done permanent damage to nerve endings - but in fact it was the feeling returning to his limbs.
Soniya said: "Things took a turn for the better from then. At first he was like a jelly baby, he had no strength in his body, but he was so determined. Every day he has just got stronger and stronger."
Soniya paid tribute to her son for his quiet bravery and spirit.
"He has never cried and never once complained. He has just taken on every challenge," she said.
Soniya and Adrian have received great support from extended family and from friends. Imperial Rugby Club, where they are members, held a fundraising event to help them.
Kray has also had dozens of cards, including many from school friends, and one from his heroes at Bristol Rugby Club. Pals George, Jack and Danielle have been especially supportive.
"Our lives have been changed for ever by what has happened," said Soniya. "We never left the hospital in 15 days and I didn't think I would ever see Kray walk again. We are so lucky to have had a positive outcome.
Wednesday, July 09, 2008
My head felt like it was splitting open, but I still drove 20 miles to take a baby bird to a wildlife refuge, and went to two separate stores looking for hula-hoops for one of my kids, wondering all the while if I was going to drop dead in the process. By time I got home (after three temper tantrums--the baby's, not mine), I am bitched out by my older child about the sub-par hula-hoop. She followed me around the house, hula-hooping and moaning, making faces and stomping her feet to demonstrate what a terrible hula-hoop her mother had imposed on her. I was curled up, holding my head in my hands, and I tried my best to think of a way to constructively ask her to stop, but that came out was: "Will you please fuck off?"
I am thinking about writing a book about my AVM experience, but if that doesn't work out, maybe I'll give Lynne Spears a run for her money and write one on parenting instead. I will call it: "Profane Parenting: Nurturing Through Expletives for the Vascularly Challenged"
Who else has used this technique?
Monday, May 26, 2008can't do if you want to get things through customs. An affirmative idea is infinitely more powerful than a negative. Imagine if you asked my how to roast a chicken, and I said, "Don't boil it." Not very helpful, although technically true.
Lately I have been inspired by this concept as it relates to personal healing, both for my brain and my spirit. I don't want my AVM to bleed, I don' want to have gamma knife again, I don't want a craniotomy, I don't want a seizure, a migraine, or an anuerysm.
These are all really general thoughts and fears, diffuse and tress induceing. They don't really address my hopes, my wants or desires. From now on I am trying to channel my thoughts into the affirmative. I want the AVM to be obliterated. I want my brain to heal. I want to relax. If I give my brain clear instructions, I am hoping to remove the barriers to healing. A treaty, if you will, to root out the sneaky processes that undermine progress. And while Ross Perot might disagree with my logic, I'm hoping the benefits will lead to better relations between my body and mind...after all, they're stuck being neighbors, they might as well get along.
The downloaded pictures are of a man who works for the US Forest Service in Alaska and the bear he had to kill. (killed in self defense).
He was out deer hunting last week when a large grizzly bear charged him from about 50 yards away. The guy emptied his 7mm Magnum semi-automatic rifle into the bear and it dropped a few feet from him. The big bear was still alive so he reloaded and shot it several times in the head.
The bear was just over one thousand six hundred pounds. It stood 12' 6' high at the shoulder, 14' to the top of his head. It's the largest grizzly bear ever recorded in the world.
Of course, the Alaska Fish and Wildlife Commission did not let him keep it as a trophy, but the bear will be stuffed and mounted, and placed on display at the Anchorage airport to remind tourists of the risks involved when in the wild.
Based on the contents of the bears stomach, the Fish and Wildlife Commission established the bear had killed at least two humans in the past 72 hours including a missing hiker
The US Forest Service, backtracking from where the bear had originated, found the hiker's 38-caliber pistol emptied. Not far from the pistol were the remains of the hiker. The other body has not been found.
Although the hiker fired six shots and managed to hit the grizzly with four shots (the Service ultimately found four 38 caliber slugs along with twelve 7mm slugs inside the bear's dead body), it only wounded the bear and probably angered it immensely.
The bear killed the hiker an estimated two days prior to the bear's own death by the gun of the Forest Service worker.
Think about this:
If you are an average size man; You would be level with the bear's navel when he stood upright. The bear would look you in the eye when it walked on all fours! To give additional perspective, consider that this particular bear, standing on its hind legs, could walk up to an average single story house and look over the roof, or walk up to a two story house and look in the bedroom windows.
I don't care who you are... that was one BIG bear!
Converting Your Car to Run on Water
I've been getting emails from Britisher Chris Whatisface - another one of these "send me $97 every month and I'll show you how to get rich working online" types. He's the guy behind Google Assassin, Day Job Killer and some other programs whose wacky names always elude me - "How to Sell Your Grandmother for Small Change on Ebay" or something like that. I'm a sucker for this stuff. I love reading the copy. I love the carrots they dangle - the seductive words they use. Notice how "Guru" seems to be the flavour of the month? Along with "reverse-engineering". All these guys are banging on about "The Gurus Won't Like What I'm about to Tell You" or "How the Gurus Make a Grand a Day from Affiliate Marketing"..."What Adwords the Gurus Ate For Breakfast"..."We Reverse-Engineered the World's Best Affiliate Program...
So Chris has been drip-feeding me information about a new get-rich scheme of his utilizing the Google Adwords program - you know, Pay For Click Advertising. He says he'll give me all the details to some hot keywords that are pulling $1500 a day from Clickbank in affiliate commissions. Yep $1500 a day. He says at the very least you can make $100 a day and he's going to go all altruistic and give this to me on a platter. Tomorrow when his Grab the Gurus by the Throat program or whatever its called - see I've forgotten already. Maybe it's called Nemesis or Google Nemesis. Anyway...
Here's part of what he say in the email -
"Inside this very important e-mail, I am going to...
==> give you a $1500/day PPC campaign
==> show you proof of my income - to the tune of $2.35 million.
...In a moment, I am going to let you "steal" a Google ad that has
dumped over $10,000 into my ClickBank account in the last week.
...But before I take a final hammer-blow to the gurus, before I debunk
all the myths about wealth-building on-line, I want to answer a few
of the questions I have been fielding all week..."
I've checked out his video. He does what all these guys do and takes us through his supposed Clickbank accounts. And yeah, it shows he's been making around $1500 a day. Now here's where it gets interesting. He tells us the keywords for this campaign. Apparently the best-performing keywords on Clickbank. And here they are in bold -
Water Fuel Cells
Apparently they are the keywords that are getting the most hits for Affiliate campaigns. All to do with - again in bold -
Converting Your Car to Run on Water
There are some other hot keywords too. Like Water to Fuel, Water to Gas, Running Your Car on Water, Kits to Convert your Car Engine to Run on Water - like that.
So come Tuesday, Chris-baby is going to show me exactly how to pull $1500 a day out of this Water to Fuel Scam...I mean program. I can hardly wait. What a concept - Converting Your Gas-Guzzler to Run on Water
Just noticed there are 141 Million results on Google for the keywords Water Into Gas. ;-)
Complete bullshit as I expected. So much for the "Give" bit. He's asking you to sign up for $67 a month. Has one of those pop-up windows that says something like "Want a Discount? A live operator would like to speak to you now". And then a bot craps on about all the money you're going to make and "there are only 9 spots left and they will go in the next three minutes...you must hurry". I went back thirty minutes later and the fool thing repeated the exact same spiel. Don't be conned by this. Ask yourself one question: If he's making $1500 a day from this program why would he want to share it with the world? Here's the URL so you can check for yourself - Nemesis
Characterized by headaches and seizures, an arteriovenous malformation (AVM) of the brain is a derivative of arteriovenous malformation, a disorder of the body’s circulatory system. An AVM of the brain, also known as a cerebral AVM, is a malformed group of blood vessels composed of an intricate tangle of arteries and veins. Though localized, cerebral AVMs can lead to severe neurological problems. Research in the field of arteriovenous malformation is growing particularly with noninvasive treatment options.
What are cerebral AVMs?
Cerebral AVMs may form during prenatal stages of a child’s development, either during embryonic or fetal growth. Studies have found a certain number of cases form shortly after birth; however, the condition frequently presents in adults in their 20s or 30s. Cerebral AVMs are commonly misdiagnosed, with most cases found only incidentally through the performance of CT (computed tomography) scans on the brain. Patients complain of regular headaches and seizures before diagnosis.
Other neurological complications can develop including speech and visual difficulty, dizziness, memory deficits, confusion, hallucinations, dementia and difficulty with event planning. Physical side effects range from loss of coordination, numbness, tingling and spontaneous pain to permanent paralysis. Patients’ symptoms are directly associated with the location of the cerebral AVM with certain sites causing hydrocephalus. Hydrocephalus is caused by a cerebral AVM preventing the circulation of cerebrospinal fluid thereby causing fluid build-up in the skull.
What are the potential health consequences of cerebral AVMs?
Hemorrhaging is the most common side effect of patients experiencing cerebral AVM. The size and location of the cerebral AVM determines the patient’s likelihood of experiencing hemorrhaging. Research has found between 2 and 4 percent of all AVMs to hemorrhage each year with most episodes going undetected. Minor hemorrhaging does not cause neurological damage, hence the reason patients and doctors remain unaware it takes place. On the other hand, massive hemorrhaging has been documented with some cases being fatal. Once a cerebral AVM bleeds, the risk of hemmorahaging again within the next year is nine times as likely. Though research has grown extensively, doctors are still unable to predict whether a patient with cerebral AVM will or will not experience hemorrhaging.
While there is no definitive research, doctors have found certain cases to have a higher likelihood of causing bleeding. Though it may seem contradictory, smaller AVMs have a greater chance of hemorrhaging than larger ones. Increased blood pressure and blood volume from being pregnant also increases a patient’s potential for bleeding. Lastly, deeply situated AVMs with extremely narrow veins impair proper drainage leading to an increased risk for hemorrhaging.
Once again, the location of the hemorrhaging AVM is directly proportionate to the side effects of hemorrhaging. Bleeding AVMs situated deep within the brain, called intracerebral or parenchymal cerebral hemorrhage, cause the most damage.
In addition to brain hemorrhaging, AVMs on their own can inflict harsh brain and spinal dysfunctions. Patients who experience severe side effects are typically victims of one of three problems. Aside from hemorrhaging, AVMs reduce oxygen reaching neurological tissues and compress and displace parts of the brain. The larger the lesion, the greater chance of the latter problem occurring with certain AVMs reaching up to 2.5 inches in diameter. Certain lesions have been documented to distort an entire hemisphere of the brain.
How is an AVM of the brain diagnosed?
Brain AVMs can be diagnosed using a few methods, with the most non-invasive techniques being CT and MRI scans. Both scans reveal lesions while CT scans are particularly helpful in showing hemorrhaging. Three dimensional representations of cerebral AVMs can be detected by CT and MRI imaging.
A more intricate process in identifying an AVM of the brain involves angiography. A contrast agent, or water-soluble dye, is injected into the brain allowing an x-ray to deliver more precise images that highlight blood vessel structure. This procedure carries the risk of causing a stroke, but more research has led to vast improvements with angiography thereby reducing stroke potential.
What treatment options are available?
Endovascular embolization is growing in popularity as a non-invasive treatment option for patients with cerebral AVMs. Dr. Alejandro Berenstein, the director of Beth Israel's Hyman-Newman Institute for Neurology and Neurosurgery (INN) at Roosevelt Hospital in New York City, is a pioneer in the field of endovascular embolization. Using research-driven methods, Dr. Berenstein performs embolization prior to surgery reducing the risk of complications.
Endovascular embolization involves guiding a catheter through the arterial pathway into the site of the AVM. A substance is injected into the site reducing the blood flow through the lesion. Blood flow reduction is a proven method in making surgery a safer process for patients.
Conventional surgery follows endovascular embolization whereby the central portion of the AVM is completely removed causing minimal to no invasion of surrounding neurological structures. Deeply situated lesions typically are not considered for conventional surgery. However, experts in endovascular embolization such as Dr. Berenstein are finding significant success in reaching deeper AVMs, which can be followed by conventional surgery. In this case, the risk of mortality and complications are further reduced.
Radiosurgery is another option for patients with localized lesions. Radiosurgery involves targeting the center of the lesion with a radiation beam damaging the blood vessel walls. Over several months following radiation treatment, the vessels begin to degenerate and ultimately close.
The method of surgery performed is thoroughly evaluated with each surgeon identifying the best option on a case-by-case basis. Left untreated, cerebral AVMs can cause severe hemorrhaging, which may lead to serious complications or death.
What is the outlook/prognosis for patients after treatment?
Embolization and radiation therapy often lead to temporary results. When a cerebral AVM is large, radiosurgery takes months to heal leaving the patient still at risk for hemorrhaging.
Research in the field has found endovascular embolization coupled with either conventional surgery or radiation therapy to have the best results. The risk of complication or death is minimized with duel therapy treatments.
Disclaimer: This article is for informational purposes and should not be considered a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any question you may have regarding a medical condition.
About the Center for Endovascular Surgery
The Center for Endovascular Surgery is a division of Beth Israel's Hyman-Newman Institute for Neurology and Neurosurgery (INN). The Center for Endovascular Surgery is a world leader in using minimally invasive techniques to treat vascular disorders throughout the body, including brain AVMs, hemangiomas and cerebral hemorrhages. To learn more please visit: www.vascularcarenyc.com.
R.L. Fielding Bio
R.L. Fielding is a freelance writer who has written on a wide variety of topics, with special expertise in the education, pharmaceutical and healthcare, financial service and manufacturing industries.
Researchers create first outline of aortic arch development and of subsequent deformity; they also find that arteriovenous malformations (AVMs) result from combined physiological and genetic factors PITTSBURGH—University of Pittsburgh-led researchers could provide new insight into how two common congenital circulatory problems—aortic arch deformity and arteriovenous malformations (AVMs)—develop in humans, as reported in the June 15 edition of Developmental Biology.
Led by Beth Roman, an assistant professor of biological sciences in Pitt’s School of Arts and Sciences, the team created the first complete published description of how aortic arch vessels form and, in a separate finding also described in the paper, determined that AVMs—wherein an artery fuses with a vein and diverts blood flow—can form as a result of combined genetic and physiological factors and not solely because of genetics.
The team created the aortic arch vessel development model from zebrafish embryos, which develop similarly to humans but more rapidly. In humans, the aortic arch vessels contribute to several of the body’s major arteries and often develop improperly, resulting in a wide range of vascular defects. The model could allow for a better understanding of the genetic program that governs aortic arch development, and therefore help in predicting abnormalities and determining when and how to intervene.
From the model, the team discovered that the gene unc45a plays a critical and previously unknown role in the formation of the aortic arch vessels—and that mutations in that gene can result in AVMs. In zebrafish harboring the mutation, two aortic arch vessels failed to connect properly to the body’s major artery, the dorsal aorta. Instead, dead-end vessels formed then swelled with blood until they touched and fused with a nearby vein.
AVMs typically form embryonically, but the particular AVMs Roman’s team observed did not form in the absence of blood flow, indicating that they were not genetically hardwired, she said. Additionally, AVM formation was inconsistent in terms of location on the aortic arch vessel, Roman said. The mutants randomly developed AVMs on the side of the dead-end vessel—left, right, or both—that happened to receive blood flow first.
While AVMs in humans are generally thought to form in utero, they typically are discovered only when they cause a serious health problem later in life. AVMs can form in various organs, including the brain, lungs, spinal cord, and liver. By diverting blood, the misconnections rob parts of the body of nutrients and oxygen. The fragile fusions are prone to rupturing and hemorrhaging; a ruptured AVM in the brain can cause a stroke.
“We discover AVMs in humans when something goes wrong and we can never go back and trace the shunt’s development,” Roman said. “Only when we fully understand the mechanisms leading to these malformations will we be able to develop better diagnostic tests and preventative treatments to pinpoint the best time to intervene.”
Roman worked with Matthew Anderson, a Georgetown University Medical Center graduate student and lead author on the paper, and Van Pham, Andreas Vogel, and Brant Weinstein from the Laboratory of Molecular Genetics, National Institute of Child Health and Human Development, National Institutes of Health.
The full article is available on Science Direct at www.sciencedirect.com.
Monday, July 07, 2008
Sometimes there is a little ball of fear hiding deep down inside my chest. Those wily “what-ifs” come sneaking around like jackals sniffing a foul feast. I have to will myself to turn away, stop my ears up, and run in the opposite direction. “Resist and FLEE.”
Projections into the future are forbidden territory. There are times when the only thing you can do is the right thing. Living in the moment....one day at a time....just floating. That is how it must be now. Attempting to live any other way produces unbearable stress. There is a peace that comes from the freedom of fewer choices. Too many choices have always done me in. The grocery store is a nightmare; Walmart is the 6th circle of Hell. But now simplicity is not a choice, it is the only possible condition of existence. A rhythmic pattern must be established within the chaos of uncertainties.
And so I try to establish my little rituals of comfort and familiarity, attempting to redefine ‘home.’ But I am reminded that “the Son of Man had no place to lay his head.”
Just days after the AVM rupture, Sherry, one of Katherine’s agents, send me a copy of the print from one of her modeling jobs. The shoot was for a book cover. A confident-looking blonde with cool shades is at the wheel of a shiny convertible, hair blowing in the wind, a big black lab hanging over her shoulder. The slight grin on her face indicates that she is a woman who knows exactly where she’s going as she cruises out into a world of beautiful blue skies. The name of the book is Learning to Float (a woman, a dog, and just enough men.) Boy did we get a laugh out of that one...Katherine is not a dog person, and has always thought one man was plenty. Although it might seem a little strange to have received something funny like that at the time I did, I thought it was perfect on many levels. Katherine will be that confident, smiling woman again one day. She is on a journey. Blue skies will return. And we will all learn to float.
A year and a half ago, I had a unique experience which I am only now beginning to understand. It was a time of intense pain. I was praying with my former pastor’s wife, when we both began having the same visualization. It had started with me. In my mind, I saw an old ship floundering in a storm, being ripped apart as it crashed on the rocks. The words “Abandon the ship” came to me. That scared me. I didn’t want to jump into the dark, cold waters. These words were impressed upon my spirit: “Jump in. I will not let you go under. Just float. I am the living water. Immerse yourself in me.” By this time, Sandy said “Kim, I feel as if I’m floating in an ocean.” We began describing what we were sensing in prayer to each other, entering into the experience together. We both felt ourselves relinquishing control as we ceased our struggling in the sea. We just floated there in the gentle waves of God’s presence. At the same moment, we sensed the sun coming out, warm and bright, sparkling on the dancing water. Words floated down to us: “Do not be afraid. Storms and floods may come. Don’t fight and flail. Let go. Float with your face turned up towards the Sun of righteousness. There is healing in my wings. Waters that seem as if they will drown you are for your healing. Come into the healing waters.” Waves of love flowed over us and kept us safely buoyed on the surface. We were being held. We rested.
Then we both seemed to be moving. We were lovingly carried along by a strong but gentle current. A vague questioning entered my mind. These words came to my friend and me: “The waves are carrying you to far-away places, places you’ve never been before. But don’t be afraid. It is at my direction.”
God, help me really learn to float.
Can we just print this out, post it on the fridge, and be done with it?
You know it's going to be a bad day when you walk in and somebody immediately calls a code.
Except this one wasn't a code. It was, technically, a "Rapid Response Team" situation, but given that the patient ended up intubated and 100% ventilated, it was a code. But I'm getting ahead of myself.
A lot of families hate the idea of signing a DNR (Do Not Resuscitate) on Grandpa or Grandmother. They think that a DNR means "Do Not Treat" or "Ignore" or "Hasten the Death Of" rather than what it actually means.
To wit: Grandpa was not in the best of shape when he came to us X days ago. He'd had two major ischesmic (clotting) strokes and a large, horrible bleed in his brain and was breathing irregularly and gaspingly when he was delivered to us by a relieved ambulance crew. Grandpa hadn't moved on his own or responded to anything short of pretty intense pain for days. Grandpa was a full-code, or a "Do anything and everything to save this person's life" when he came to us.
Let me be totally clear here: Grandpa was in no way, shape, or form, ever going to get better. The best neurologists and neurosurgeons in the country had already determined that. Okay? Okay. You got it. Grandpa's gonna die; the only question left is how.
So I wander in to work, already tired and strung out from the sort of weekend nobody wants to have. After I'd been there not three minutes, somebody hollers out of Grandpa's room to call the RRT...so I did. Despite not being on the clock and not officially there yet, I called RRT. (My compassion continues to overwhelm me, as I'm sure it does you.) Then I wheeled myself and the code cart into the room and took a good look at what was going on.
What I saw was an 87-year-old man in the last stages of life. Agonal breathing, cold extremities, you name it--this guy had a bus to catch and was running after it as fast as he could. Family, being in the room, was flipping out and demanding we "do everything".
So we did. Those of you with relatives who are in the "do everything" camp might want to cut this bit out and show it to those relatives. Here's what we did:
We started three large-gauge IVs in the man's arms and legs. We called an anesthesiologist (who just happened to be wandering past) into the room to intubate, as Grandpa was not breathing well on his own and bagging him (ie, providing artificial respirations with a manual device) wasn't working.
The anesthesiologist had to try four times to intubate Grandpa. His airway had been damaged by people suctioning it out in a ham-handed fashion. When I finally got a 16-French (read: small) bougie up, Anesthesiologist guy managed to get it down Grandpa's throat at the cost of a whole lot of blood being shed from those damaged throat and airway tissues. There was blood everywhere.
At that point, Grandpa stopped breathing on his own, following the natural course of things, and we had to do chest compressions. You could hear the sound of his ribs breaking outside the room. I broke at least three of them myself, straddling this ancient man and counting "one-and two-and three-and...." and trying to get three inches depression with each push.
There were people bagging and cursing and blood flying everywhere as Grandpa's arms jerked with the compressions, ripping the needle that the respiratory guy was using to draw labs out of Grandpa's arm.
We pushed drugs you've never heard of more times than is interesting to tell about in an attempt to get a heartbeat, *any* heartbeat, on this man. You can't shock a flatline, and we didn't...but we didn't get much of anything out of him. IVs in his arms blew as we pushed drugs too fast, raising enormous discolored lumps on his arms. We replaced the IVs with ones in his legs and a central line in his groin, the only place we could find a vein that was engorged enough to poke.
Every time the doc who took over compressions from me pushed, more blood would squirt out of the various holes we'd made. This was not natural bleeding; this was artificial bleeding from a dead person that was caused by us forcing his heart to squeeze.
Finally, finally, with family in tears in the hallway, we managed to get a shockable heartbeat. And finally, finally, we put on external pacing pads that would deliver a mule-kick through the man's shattered chest every few seconds in an attempt to remind his heart to beat. And finally, finally, *finally*, with blood bubbling out of the breathing tube (from the broken ribs) and oozing out of the various holes I and my colleagues had made in him, we managed to get him stable enough to take him up to the ICU and put him on a ventilator to breathe for him and drugs and drips to keep his blood pressure stable.
That, my friends, is what a code is like.
That is what you're wanting for your family member.
And this was a clean code. That's the horrible thing: we only coded this guy for a total of about five minutes; the rest was all pre-code intubating and sticking.
If you come in with a DNR, I will bust my balls to save your life. If it comes to it, though, and you stop breathing on your own, I will not torture you in order to get a few extra minutes of fake "living" out of your cooling carcass.
If you come in as a full code, I'll bust my balls to save your life, even to the extent of breaking your freaking ribs in the process. I'll hate it, but I'll do it.
Talk to your families, people. Decide how you want to go. But please, please be aware of what you're asking when you ask for it.