Anaphylaxis is not funny, yet I have so many examples of humour in resus, while using a nebuliser or waiting for an ambulance. I can’t decide if its just that I hang around with people who have a dark sense of humour, or if it is just a really great coping mechanism. Either way, I thought I would share some of the finest examples with you today. Don’t get me wrong, in no way are the following anecdotes meant to trivialise an emergency situation but you know…..where there’s humour, there’s hope.
It was a beautiful autumn night in London and a long overdue catch up with four friends – all Midwives. We found a small but bustling Italian restaurant in SoHo and tucked ourselves away at quiet table right at the back. The restaurant was tiny and narrow, with soft music in the background. Whilst in there I felt a little like I was back in Rome. I browsed the menu, checking what is safe and what is not. We ordered.
Conversation and laughter flowed through starters and main course and then the waiter took picture of us, one I look back on fondly.
Dessert came and, two bites in I knew I couldn’t finish it. Over the next ten minutes I experienced extreme flushing of my face and neck and several trips to the bathroom (which no one wants in a restaurant). This was followed by shortness of breath, wheezing, tongue and throat oedema, which is how my anaphylactic reactions usually present. There were no hives, my lips remained the same size. Its essential to be cautious when scanning for signs and symptoms in people, its not TV and no two people present the same. What occurred next felt like a seamless transition from an obstetric emergency to an ER sitcom with an added twist from my four amazing friends. One took the role of getting the oral medication from my handbag, one took the role of doing my observations and administering adrenaline, the third was the scribe and the fourth was giving a very succinct handover to London Ambulance Service. The ambulance crew arrived and pretty much everything had been done bar a nebuliser, second shot of adrenaline and oxygen. It was calm, my friends had my back and as the paramedics said, it was the best SBAR handover they had ever received. I still have the selfie they insisted on taking as I was loaded into the ambulance! Turns out you can take the Midwife out of clinical practice but you can’t take the practice out of the Midwife!
More recent events saw me admitted to hospital having had an anaphylaxis in the morning. I spent an afternoon in resus and, given my history of rebound reactions and having tracheomalacia, a joint decision was made between myself and the consultant to admit me. Six hours later I walked to the bathroom and on the way back my airway occluded and I couldn’t swallow my saliva. It was sudden, it was scary and it presented differently to other anaphylactic reactions I had had. It could have been the tracheomalacia mimicking the anaphylaxis but that’s something we will never know. One thing it did was demonstrate how it can sneak up and catch you off guard.
The peri arrest call went out next and I knew that was for me. I’m a clinician, I know what that call means. I knew it was one step before a cardiac arrest call and I knew the difference was the presence of a pulse. Things were fairly unstable.
I was sitting upright on the bed, leaning forward with all my airway drugs in front of me. Just FYI if you are ever dealing with an anaphylaxis, don’t try to lie them down (unless of course they’re unconscious!). Nobody likes to be laid down when they can’t breath. In came around 15 Medical Doctors, Anaesthetists and Nurses. A couple of them were looking more petrified than I felt, but two wonderful Student Nurses at either side of my head had the most excellent communication skills and so I just focussed on them. Until…….the consultant announced ‘we need to give adrenaline’. What I heard was, ‘Kizzy, we need to give adrenaline’, and so I did.
I forgot I was the patient. I forgot I should have been panicking about the fact my airway was trying to kill me again and, instead I just picked up that adrenaline (my own!), stabbed my thigh, raised my right hand and said “adrenaline given at 17:25”. Granted it didn’t come out as eloquently as it would have if I could breath, but nontheless, the whole crash team stopped talking and turned to look at me, eyes wide open. I didn’t stop there, I then turned to the Student Nurse and said, “pass my nebulisers please”. In my mind, if this was an anaphylaxis then the adrenaline would do its thing, if my trachea had collapsed then my nebuliser is a PARI PEP machine delivering positive airway pressure creating resistance during exhalation, so in essence it would force my airway open.
Its challenging to stop being a clinician and its easy to treat and manage yourself when you know your body so well. To have the right equipment and the right medication enables me to feel empowered to take control of my own health. I am not sure it is just the anaphylaxis that makes one feel scared and panicked but the lack of power to take control of a situation.
There is a line though when you need to recognise that because of the likely hypoxia you may not be making the most rationale decisions. Going back to that tiny SoHo restaurant before things really got dramatic, I had had (lots) of Ventolin and my friend just took my hand over the table and said, ‘What do you want us to do now.?’ My response was, “I don’t know” and at that point she knew it was time to take over the decision making and take that control from me. It is that team work, and trust in others that creates a safe environment, that keeps you alive and allows you to reflect with that dark humour on the situation, because as I’ve said before….. where there’s humour, there’s hope.
Kizzy x
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