Half a dozen people clustered around the treatment table, and the 20-lb tan and white dog lying unconscious in the center of it. One nurse performed chest compressions; another smoothly squeezed the rebreathing bag every six seconds like clockwork. Other techs adjusted monitoring equipment, prepared drugs for injection, or stood ready to assist if needed. A few feet away, the dog's owners sobbed and called out to him to stay with us, not to go. As the time-keeper counted down the last 10 seconds of the CPR cycle, I stood there with the paddles in my hands, the steady keening of the defibrillator announcing its readiness.
At the two-minute mark, all activity ceased, except for one doctor ausculting the dog, and all eyes turned to the ECG. "Still in V-fib," I said, calmly. Two nurses positioned the dog in dorsal recumbency as I stepped in and held him in place with the paddles on either side of his chest. I looked carefully to make sure no one was in contact with the table and called out: "Clear!"
Several disparate thoughts went through my mind at that moment. Mostly, I was focused on the task at hand, making sure I followed all the necessary steps, making sure that no one got hurt and that I gave the patient the best possible chance to recover. Part of my mind thought about the owners, and about how painful this experience must be for them. They brought their pet in for diarrhea, and he inexplicable arrested in the waiting room. Now a horde of strangers were brutalizing his unconscious body, trying to wrestle him back to life. I knew the violent spasm of the defibrillation would startle and frighten them even more. But perhaps the most incongruous thought was something along the lines of, "I sure am going to look stupid if I push these buttons and nothing happens!"
Experience and inner dialogs
I am a pretty experienced clinician. And I am pretty well-prepared to perform CPR. I've been certified in both Basic and Advanced Life Support according to the RECOVER guidelines for years, and I just recently completed my biennial recertification.1 I have been trained as a RECOVER instructor and taught the guidelines to other doctors and nurses at my practice. We see many critically ill patients, so codes are not uncommon at my practice, and I am probably involved in at least one a month. So why was I worrying about whether the defibrillator would function, whether I was going to screw up?
