Case study #1: Life Saved.

Just as the outpatient department had packed up for its daily three-hour lunch break, and we were heading out of the hospital ourselves for a bit, a motorbike drove through the building entrance with three people on it.  A male driver in front, and a frantic old woman in back holding onto her limp, lifeless daughter who was tightly sandwiched between them. They began to lift her off of the moto when the nurses directed them to go to the ICU.  They drove across the campus to the ICU building, where it was clear that no one was ready for their arrival.  A man helped lift her off of the bike and cradled her waiting for a bed.  He set her down on one bed in the corridor, lifted her up, set her on another bed, lifted her up, and ultimately placed her on the initial bed.  The girl had overdosed on something.   Then, imagine a scene from any american ER drama series, with doctors and nurses running to help the serious cases, loud but confident voices, routine, deliberate decisions.  This was the opposite of that.  The nurses WALKED, slowly.  The girl's chest was still rising, but clearly she was not breathing enough on her own to sustain herself.  They brought out a cart filled with meds and some tools, one nurse did some chest compressions, three sporatic sets of maybe five compressions each.  The doctor had not even arrived on the scene.  After several minutes of this, Dr. Maha (the Stanford ER doc in charge of our research study), delicately stepped in.  He told them to bring out oxygen and a mask, and when it came, used the bag-mask to give her breaths. Meanwhile, a nurse was preparing an IV. Maha taught Darith (a cambodian man and former practicing doctor who is helping us with our project) how to apply cricoid pressure (to prevent gastric inflation and reduce the chances she will vomit) as he gave breaths.  When oxygen came, Maha hooked it to the mask. The nurses prepared an injection of a medication, but Maha intervened and told them to give her bicarbonate, quickly!  It took a minute for them to find bicarbonate from the supply closet, and when they did, the nurse gave the injection (slowly, of course). Faster, Maha told her. Maha showed Darith how to give breaths, and waved to me to take over applying cricoid pressure. At this point, a car pulled up in front of the ICU building and the doctor strolls up in slacks and a button-up.  Maha stepped aside to speak with the doctor.  He explained to him the importance of intubating her, and after some searching, the tools were brought out.  Humbly, he held the tools out to the doctor, careful not to overstep his boundaries and disrespect the cambodian doctor.  The doctor admitted being unfamiliar with the tools, and ushered Maha to go ahead.  Darith and I stepped aside. When maha tried to intubate, the girl (now pain responsive and with a gag reflex) squirmed.  When he tried again, her arms instinctively reached up and tried to pry him away.  "Good," Maha said.  "This is very very good.  The bicarbonate is working."  The girl was going to live.  Maha shook hands with the doctor and we left them to care for the girl.   Maha had us film the entire scene, footage that he claims is "golden," and will be a crucial teaching tool for this hospital in the next couple of years.  "This is why we are here," he said.  "This is why we are doing this research.  They are unprepared for this sort of emergency.  This project will help save so many lives."