Close Encounters with Science: Picks
I.V. Liquid Plumber by Robert MacKenzie
There was consensus. Her death was inevitable.
She would die in a small, rich, mid-Michigan community hospital.
In 1973 the technology used to confirm her dismal diagnosis didn’t exist in most large university settings but we worked in a hospital apparently unconstrained by acquisition budgets and protocols. We floated and wedged a Swan-Ganz catheter into the unfortunate woman’s pulmonary artery and attached it to a bedside monitor; aka “the Black Box”.
“They don’t even have one in Ann Arbor”, bragged an earnest young manager-administrator.
Wildly abnormal pressures and barely detectable arterial oxygen deepened our gloom. A squirt of dye down the tube put a period at the end of her death sentence. The liquid contrast material outlined a large saddle embolus, a clot that had probably travelled from her traumatized legs to straddle the junction of the arteries feeding her lungs.
The surgeon hugged his chest, stroked his chin and rumbled, “Well that’s it”. The consulting internist nodded in reply.
I thought out loud. “Too bad we don’t have any Urokinase.”
The surgeon glared at me. “What did you say?”
“I just read an article by a guy in Chicago. He’s working on thrombolytic agents in rats with deep vein and pulmonary clots. If we had some maybe we could use it like i.v. Liquid Plumber.”
“What’s his name?” I told him and he almost roared with glee, “I know that guy from when I was at Cook County.” He grabbed the i.c.u. phone.
He stabbed at me with his index finger. “Meet the plane and pick this stuff up. Take it right to the pharmacy and they’ll reconstitute it. Follow the protocol to the letter or he won’t be reimbursed for the ten vials. Each bit of powder costs $3,000.
The small cooler arrived, plastered with a variety of garish warning stickers. I trotted back to the borrowed car wondering if I might somehow be held responsible for the cost of its contents. It was the equivalent of my resident’s salary for the next year and a half.
The staff men left me to the task. I drew the preliminary platelet count. Those little buggers had to be watched the closest. They were already being sequestered by the expanding clot so the absolute number was lower than average. Too many platelets meant too much clotting; too few, she’d probably bleed to death. Ten vials of liquid sat on the nursing station desk and with each one I administered my mouth dried out a bit more. After vial five her platelets vanished. “Oh no, I’ve killed her.”
I waited for her to exsanguinate. Although her wounds leaked more than usual, she eventually healed, breathed deeply and rejoined her family.
I called the researcher, explained that we had $15,000 dollars in unused Urokinase and a case we couldn’t write up because it deviated from protocol.
I felt him shrug on the other end of the phone. “She lived didn’t she? Send me what you’ve got. I’ll give it to some mice.”
Robert MacKenzie is from Clearwater, BC.