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kk095 · 5 years

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Janet's Acute Massive Pulmonary Embolism

I wrote a new story! I hope everyone enjoys it 🙂

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Acute massive pulmonary emboli are blood clots that become lodged unexpectedly in the arterial blood supply of the lungs, quickly causing cardiopulmonary dysfunction. Minor to moderate pulmonary emboli and pulmonary venous thromboemboli are typically treated successfully, but acute massive PEs have a considerably high mortality rate, ranging from 66% to 80% depending on the study. Unfortunately, our latest patient was a member of that 66-80%.

The patient was 52 year old Janet McNally. She was a white woman with blonde hair with a few grey strands, blue eyes, was 5'8 and average build, had a perfect suntan, didn't wear a lot of makeup since she aged well, and had a moderate amount of freckles scattered around her body. Janet had a busy life; she worked as a hotel manager and had 2 kids, both of which are in their early 20s now. Janet was a relatively active and healthy person, but she smoked a pack of Newport red shorts every day.

Janet's last day started off like most other days. She headed off to work in the morning and started off asymptomatic. Around 10:30am, she started to feel dull chest pains that would come and go every few minutes or so. Janet took a Motrin and continued her workday assuming the pain would dissipate.

Around 12:45 during her lunch break, she started developing shortness of breath. It started off mild, but began to grow increasingly worse. One of Janet’s coworkers called 911 after seeing Janet gasping for air.

Janet clenched her chest in pain, barely able to force out the words “I can't breathe.” The 52 year old's complexion was turning pale, and the color in her lips faded a bit. Initially, Janet and her coworkers assumed she was having a heart attack. “call my husband” whispered Janet as tears began to roll down her face from the tremendous amount of pain she was experiencing seemingly out of nowhere.

The ambulance arrived on scene about 10 minutes later. The paramedics escorted a frightened Janet to a stretcher and helped her sit down on it. The medics tried to reassure her while also giving her a nasal cannula to help alleviate her respiratory symptoms. Janet's top was cut off, only sparing her black bra. The medics also removed janet's shoes, revealing her size 10 feet with thick, prominent wrinkles in her soles.

On scene, Janet's BP was 88/59, her heart rate was within normal limits, her o2 saturation was down to 90%, and she became tachypneic. 2 large bore IVs were set up by the paramedics. Normal saline was hung, and a round of nitroglycerin was administered to help with her chest pain. After that, she was taken into the ambulance for transport.

Janet began to deteriorate during transport. Her BP continued to drop and her breathing became more labored. Janet started to feel cold and the meds only helped a little bit. “please…I don't wanna die” Janet mouthed to the medic in the back of the ambulance.

Approximately 1 minute later, Janet began coughing up blood. The blood clogged up her mouth and airway, so suction had to be applied. Janet was moaning, gasping for air, and had a frightened look on her face. The plastic suction tube made a slurping sound as it removed blood from Janet's mouth. Suddenly, Janet stopped moaning, became completely still on the gurney, and her blue eyes glazed over. The medics did a sternal rub on her to see if she was still conscious, but received no response. “she's not breathing. I need a 7.0 ET tube” said the medic.

The plastic tube was navigated into janet's airway over the following seconds and held in place with tape. Just as the medic confirmed proper tube placement, the heart monitors started beeping loudly. The medic placed 2 fingers on janet's neck to feel for a pulse, but felt nothing. With the heart monitors showing V-Fib, a code blue was initiated. The medic snipped off janet's bra and placed the defib pads onto her bare chest. A round of epi and atropine were pushed intravenously and a round of chest compressions were performed while the defibrillator pads charged.

The first shock was delivered moments later. Janet's body jolted violently on the gurney while the electricity ran through her limp body. The shock failed to convert her out of V-Fib, so the defibs were charged again. After a cycle of compressions and ambu bagging, Janet was shocked unsuccessfully for the 2nd time. She let out a grunt, which was an agonal respiration. Her arms and legs flailed around for a brief moment. The 2nd shock sent Janet into PEA, so CPR was resumed.

Janet's chest was pumped vigorously in a desperate attempt to restart her dying heart. Her head bobbed around in sync with each individual compression while her eyes remained half open. Janet's breasts jiggled and her belly bounced outward from the residual force of the harsh chest compressions she received. Janet's lips and nipples started to turn blue from cyanosis even though she hasn't been down for very long.

Janet remained in pulseless electrical activity for the rest of the ambulance ride. The medics performed chest compressions while wheeling Janet into the ER. “52 year old female, respiratory distress, chest pain, and hypotension. Intubated en route, then lost a pulse. Pushed 1 round of epi and atropine, shocked times 2. Down for 4 minutes.” Said the lead paramedic, informing the ER team.

Once in the trauma room, she was transferred onto the table. Janet was hooked up to the ER's heart monitors and the code continued. One of the nurses took over chest compressions and another nurse ambu bagged. Another round of epinephrine and atropine were pushed intravenously along with the first round of bicarb.

Labs were then drawn and the attending physician ordered a bedside echocardiogram. The echo showed right ventricular hypertrophy and an under filled right atrium. The doctor quickly took all of Janet's symptoms into account and realized what was wrong. “this looks like a massive PE. Push 5000 units heparin and start her on a drip.” Ordered the physician, realizing the severity of the situation.

CPR continued after the anticoagulant was injected. Janet's chest caved in rhythmically from the hearty, vigorous chest compressions she was receiving. The ET tube began to fill up with blood, so suction had to be applied to keep Janet's airway intact.

Resuscitation efforts continued on the attractive 52 year old. Janet remained in PEA another 4 and a half minutes before a shockable rhythm was obtained. Finally, the ER team was able to charge the defibrillator paddles. The paddles were charged to 250j and pressed up against Janet's chest, and a shock was delivered once everyone backed away. Janet's feet leapt into the air just above the table before crashing back down a second later, showing off the thick, prominent wrinkles throughout the soles of her size 10 feet. Janet was still in V-Fib, so she was immediately shocked again. Her back arched and her chest was thrust upwards. She flopped back down a second later while her beautiful blue eyes stared off blankly. A cycle of compressions were performed before Janet received another unsuccessful shock. Unfortunately, this shock sent her back into PEA.

The ER team resumed chest compressions on Janet, desperately trying to reverse what seemed like an inevitable outcome. Another round of drugs were pushed into her IV hoping to ameliorate the dire situation.

Another 3 minutes came and went and Janet was still in PEA. Her lips were cyanotic, she was cold to the touch, and her ET tube refilled with blood. CPR continued while the plastic breathing tube was cleaned out again. The attending physician decided to check Janet's pupils with their pen light to see if they were reactive. Sadly, Janet's pupils were fixed and dilated, likely due to the lack of oxygen and being down for just shy of 20 minutes. At that point, the ER team stopped compressions and detached the ambu bag. Time of death was called at 1:28pm while Janet was still in PEA.

The heart monitors were switched off and the EKG electrodes were disconnected from Janet's bruised and battered chest. The conductive defibrillator gel was wiped off her chest and her eyes were carefully shut for the final time. Janet's body was covered and a toe tag was placed on the big toe of her left foot, which dangled in front of her beautifully wrinkled soles.

The attending physician then made the difficult trip to the private waiting area to tell Janet's coworkers, husband, and 2 children that she passed away despite the best efforts of the paramedics and ER team. After allowing the family to view her body, she was taken up to the hospital morgue.

Janet's autopsy revealed that she had multiple large blood clots in the arterial circulation of her right lung, perfectly explaining all of her symptoms. Since Janet was a relatively healthy person, the only plausible explanation for this tragic cardiopulmonary event was her habit of smoking cigarettes. There's a link between blood clots and chronic tobacco use, but the pathophysiology of this phenomenon isn't fully understood currently.

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jojowritesstuff · 6 years

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Finally got to finish this up. Part one can be found here.

There’s not much happening in this part, it’s just a giant pile of fluff.

There will be more parts coming soon - I’ll split this up into multiple parts so it won’t become one large monster fic (which everyone would get tired of halfway through, haha) A lot of what’s coming will be for backstory purposes. I am still editing my drafts so I’m still unsure how many more parts will be coming but there’ll be at least two.

I hope this isn’t too long but if you want me to cut it into a read more let me know.

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“Shh, it’s okay. Just relax,” Hazel said softly, unable to even feel the tears building up in her eyes. “You had a blood clot in your brain, you needed surgery, but you’re okay now,” she said, brushing the hair back from Raya’s face…

Still affected by the anesthetics and several other drugs she was put on, Raya barely registered what Hazel was talking about. In a slow, nearly slow motion like movement she reached out towards Hazel's hand, laying hers on top of it.

That was when Hazel absolutely lost it, and made no attempt to hide her emotion, both of her hands holding Raya's. "Ry, I'm sorry," she choked out. "I was distracted, I should have been keeping a better eye on you, and you-" she squeezed her eyes shut, overwhelmed with guilt, worry but also relief that Raya made it through and unable to even form the words. "I love you," she whispered eventually.

Raya gave Hazel's hand a weak squeeze. She didn't fully understand what happened just yet as her mind was still way too fuzzy but judging by all the medical things connected to her body and Hazel's emotional outburst it must have been bad. She tried to speak but her voice was still raw and barely carrying a sound.

By that time Hazel was resting her forehead on the edge of the hospital bed, her shoulders shaking with sobs. She knew she should be keeping it together, but she had- for so long she had locked the floodgates. Ever since they had taken Raya into surgery she kept blaming herself, telling herself that it was solely her fault.

Raya kept holding onto Hazel’s hand while she cried – there wasn’t anything more she could do but lightly draw circles on Hazel’s warm skin with her thumb. "I need to go let the doctor know you're up, excuse me," Hazel sniffled as she eventually lifted her head, her cheeks still wet with tears, her red eyes magnified through her glasses.

Hazel tried to compose herself before standing up but a light tug on her hand and a raspy, barely audible “Stay.” had her stop in her tracks. She could hardly look at Raya- all she could see were how she hadn't noticed the signs of a concussion, how she hadn't monitored her closely enough, how she had nearly let Raya /die/- how she had failed in every way possible. Yet at the next light tug on her hand she sat back down – Raya was connected to all kinds of machines and monitors, getting a doctor in could wait another few minutes. She slowly lifted Raya’s hand, placing a feather light kiss to her knuckles so she wouldn’t disturb the IV. “Get some rest.”

It didn’t take long for Raya to drift off to sleep, with the anesthetics still heavy in her system she wasn’t even fully awake to begin with. Hazel stayed with her until eventually she began to stir. Blinking her eyes open she seemed quite a bit more awake and conscious than a few hours before, albeit still not completely herself.

“Hey, how’re you doing, Ry?” Hazel asked, pressing a gentle kiss to Raya’s forehead. “Ready to hibernate,” Raya rasped out and Hazel took her snarky remark as a positive sign – while Raya was still out her mind kept torturing her with worst case scenarios of permanent brain damage and every possible thing that could have went wrong and gone unnoticed.

“I’m gonna get someone to check you over – I will be right back, I promise,” Hazel said and left the room but returned with one of the doctors in a matter of minutes.

The doctor conducted a quick exam, and Hazel stayed, holding Raya's hand reassuringly. During the various tests it became evident that they had caught everything in time and there wasn’t any major or long lasting damage. The doctor put some notes on Raya’s chart while also talking to the two of them in fluent medical jargon and when he left, Hazel turned to face her girlfriend. "Did you catch any of that?" she asked, a smile quirking on her lips.

"You know I don't speak doctor." Raya said. She really had not the slightest idea what the doctor was talking about, all the medical terms appearing like an entirely different language to her. "Care to translate all that gibberish so a normal person can understand?"

"Yeah, course," she said. "Um, so when you fell, a little piece of your skull went into your brain. It was just in the dura, like a protective gel around your brain, but it eventually worked its way into a minor vascular structure- like an artery," she explained. "It gave you kind of like an aneurysm, blood clot situation- then /that/ made the pressure in your head go up, your brain swell, and it put excess pressure on the part of your brain that does things like control breathing and heartbeat. They took you in to surgery to fix it, and everything looks okay for right now," she finished, watching Raya's face closely. She knew it was a lot to take in but she also was aware that Raya wouldn’t settle until she knew.

Raya listened intently, slightly shocked about how severe things were. "But... it was just a concussion. How...? I didn't think I hit my head that bad, expected to get away with a bump and be fine."

"I should have seen it better... I looked at the scans too, symptoms looked... they looked just like a concussion. I should have been better, pushed for a cross-section or something with contrast, it would have been so much more obvious then..." Hazel said, listing all the ways hindsight was 20/20.

"Hazel... Don't do this to yourself, baby. You heard the doc, I am going to be okay." Raya said, giving her a light smile. "It is none of your fault that I knocked a piece of my skull into my brain. Apparently our sink is stronger than me." she huffed lightly. "Just please, don't work yourself up about this. Such things happen. I should have probably told you about it when I arrived but I thought I was just getting a migraine or something."

Hazel shook her head, a fresh tears welling up in her eyes. "No, I'm going into neurosurgery, this is something I should have been able to see," she said. "I just- God, Ry, I was so scared," she said, pressing her girlfriend's hand to her lips.

Raya gently caressed her thumb over Hazel's cheek, trying to brush away a tear. "Did you just finally make up your mind what you'll specialize in?" she teased, attempting to lighten the mood.

Hazel nodded, smiling lightly. "I was gonna tell you later - pediatric neurosurgery. The brain, it's just-" she shook her head. "I can't get away from it, it's beautiful," she said softly.

"Not visually though." Raya shuddered, an incident with a preserved brain springing back into her mind. "I am so glad you made your pick though. And a perfect one to go with your research," she smiled, gently tugging at Hazel's hand. "Come here."

Hazel smiled and gingerly climbed into the bed, laying parallel to Raya and letting her rest her head on her shoulder. "I was in the OR with you- legally, I couldn't do anything, but I needed to be in there."

"Of course you were." Raya hummed, trying to cuddle up to Hazel without disturbing any of the IVs and other things she was hooked up to. “Now I can finally do this..." she smirked and gently leaned up to kiss Hazel.

"Ry, you had brain surgery like six hours ago- how are you this chipper?" Hazel giggled, amused at her girlfriend's effervescent smile.

"Hmm, blame the meds?" Raya suggested. She was tired and still had a dull headache going on but she was trying not to show it. The cocktail of drugs flowing through the IV obviously did their job at keeping her mostly pain free.

"Oh yeah, I made sure they gave you all the good stuff," Hazel teased, kissing her girlfriend's temple- the one that wasn't stitched and bandaged. Raya’s head was growing heavy on Hazel’s shoulder as she heaved out a content sigh. Her eyes were starting to drift shut as her sudden boost of energy slowly began to die down.

"Get some sleep- no one is gonna be coming in to wake you up anymore," Hazel said gently, and stroked her girlfriend's hair. "Finally some good news," Raya chuckled lightly. She wrapped an arm around Hazel and nuzzled her face into the crook of her neck. It wasn't long until Raya's breathing was evening out and she was snoring softly.

Hazel couldn't help but drift off as well- Raya's surgery had been around five and a half hours, and she had remained stoically awake for the four it had taken her to come off the meds.

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Raya woke a little while later, smiling when she found Hazel was still with her. She pressed a soft kiss to the still sleeping girl's cheek. Hazel woke slowly. "S'everything 'kay?" she asked, her worry evident even before she was fully awake.

"I'm fine. Go back to sleep, hun." Raya said, once again laying her head on Hazel's shoulder. "No, 'm'up, I swear," Hazel said though her glasses were askew and her hair mussed. "You're okay?" she confirmed, wrapping an arm around her girlfriend.

"I'm okay." Raya assured. "A little tired and my head kinda hurts but it's not too bad." "I can see if they'll increase the oxy drip," Hazel said, already halfway out of bed. "Maybe you need to be switched to something stronger," she fretted.

"It's fine. Stay? Please?" Raya cut in. She didn't want Hazel to leave, even though she wouldn't be gone for long. "I'd rather just cuddle." "Okay, but if you need something- /anything/- you'll tell me," Hazel said empathically and settled back beside Raya. "I can do cuddles," she assured, pulling her in closely.

Raya pretty much wrapped herself around Hazel, resting her head on her girlfriend's chest. "I've got everything I need right here." "Mmm, me too," Hazel hummed, and this time she had the foresight to take off her glasses, setting them lightly on the table.

"Hmm, I love you." Raya's voice was already heavy with sleep again. She was drawing light patterns on Hazel's arm in slow repetitive movements. "I love you too Ry. So much that," Hazel said, closing her eyes lightly. "'m still gonna write you those letters, don't you forget it."

“Same with all those reasons why you love me?" Raya smirked, glancing up at her girlfriend. "Gave me the opportunity to scrub in on a six hour surgery," Hazel hummed, already halfway asleep. "Number 756," she teased.

"So there were doctors poking around in my brain for six hours?" Raya asked, not expecting that it would have taken that long. She wasn't even aware of how much time has passed since she was awake the last time before her surgery – the past two days have mostly just blurred together.

Hazel nodded. "Yeah, it was meticulous. You have the daintiest arteries, then there was a shunt debate, and just... complicated," she shook her head. "They almost kicked me out though."

"Hmm? What did you do?" Raya asked, her eyes already half lidded as she listened to Hazel. "I- blood pressure usually drops in surgery, and yours just dropped- really, really low," she stammered. "I yelled at my attending," she said shamefully, ducking her head.

"I guess she didn't take that so well." Raya said, sounding somewhat amused. "Hope I didn't get you in trouble for that." Hazel cringed. "She, ah… she hasn't spoken to me since," she said. It was a rash move, one she regretted immensely. "In my defense... it's a rule you shouldn't let family into the OR."

"This is so weird though. There's hours of my life I cannot even remember. It's like I wasn't even there. If it wasn't for you telling me about it and this room I'm in with all these monitors and whatnot I wouldn't even know what happened," Raya hummed sleepily.

"Miracles of the brain," Hazel joked around the lump in her throat. "It blocks out painful memories. You were pretty out of it," she said, unconsciously hugging Raya closer to her. She shuddered to think of what would have happened had she not been there, had Raya been by herself, or not come to see her... she never would have gone to the hospital, and likely.... Hazel squeezed her eyes shut, unable to even consider the possibility that Raya wouldn't be with her. "It's probably best you don't remember."

"I... I remember taking the train here. And you were at the train station to pick me up, I brought you some of your books too. We were walking back to the hotel. Don't really remember what happened then, it's all just really fuzzy." Raya said, concentrating hard. "Hey, are you alright? What's wrong baby?" she asked, feeling her girlfriend tense.

Hazel shook her head, taking deep breaths to try and calm herself. "I'm okay. You just- I was really scared, I've never hated a hospital as I did twelve hours ago," she admitted.

"Twelve? But you said the surgery was six hours." Raya was clearly confused, trying to make sense of what Hazel told her. "There's so much time missing from my mind, I think. You probably have to do a complete timeline for me to really understand. But, not now. For now I want us to just lay here."

"Anesthesia affects everyone differently... it took you a little while to come out of it." Hazel explained and kissed her tenderly, as if she were afraid the other girl would break. "Come on, you need sleep, I’ll be here," she promised.

Raya couldn't argue about needing some sleep, keeping her eyes open became harder with each passing minute. "You should get some rest too." she stated, moving a little so Hazel could lay down a little more comfortably...

TBC

#my writing #my characters #Hazel #Raya #tw:hospital

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