The Prayer

The Prayer

I was a third year resident in Internal Medicine at a large Teaching Hospital. I was in the middle of my Medical Intensive Care Unit rotation. This was one of the toughest rotations in our residency. It involved working in the intensive care unit with many critical and seriously ill patients.


I had a wonderful team. They were four young interns, and a fellow senior resident. This was an awesome team. Everyone was dedicated, hard working and extremely smart. It was fun to work with them, and my life was easy. We had excellent attending physicians as well.


One morning we were rounding on a very ill elderly obese woman. Her blood pressure had dropped to very low levels, to the point that she had become dependent on dopamine, a medication that maintained her blood pressure. However the reasons for this were not clear.


We need to put in a Swan Ganz catheter, our attending pulmonologist said. This is a special catheter that is put all the way into the heart and can tell us if her low pressures are coming from her heart or other reasons. The process of putting it is technically demanding.


My intern on that day was a smart young woman. She was a very hard working and dedicated person. We determined that while the patient had a triple lumen central line in place - in order to put in the Swan Ganz, we would have to change the access to a ‘port’ that will allow both the Swan Ganz as well as the central line. This was going to be tricky, as the patient was dependent on the access we had to maintain her blood pressure.


The attending told us to change the line to a port over a wire. In this process a thin wire is put in through the old line, then the line is withdrawn and the new port is placed over the line. This would be accurate and hopefully quick. The patient had no other intravenous access, and attempts to place another line had failed previously. Since changing a line over a wire is considered a fairly simple procedure, our attending left to see another patient. He would be back in 10 minutes to help us put the Swan Ganz in.


We put on our gloves and gowns, and stopped the dopamine drip. My intern carefully threaded the wire through the existing central line. The patient’s blood pressure started dropping immediately. We had a very experienced completely unflappable nurse assisting us. She started reporting the blood pressure as it dropped. 90, 85, 80.


The wire was in and I instructed the intern to pull out the line. She says to me – I don’t think this is right. The wire does not feel like it is properly placed. Please pull the line I reply. We don’t have much time. She pulls the line out and out comes the wire too!


This was a disaster. I had made the mistake of using a wire that was designed for the shorter port and not the longer central line that the patient had. Suddenly we had lost all intravenous access. 75, intones the nurse as the blood pressure continues to drop.  She raises the foot of the bed to try to maintain the blood pressure.


At this point, I said some colorful words under my breath and asked for another kit for a new line. My intern looked at me disapprovingly. Getting a new line can be difficult in normal circumstances, but in this situation seemed almost impossible. My intern hands me a new kit and says to me, it will be okay. She looks absolutely calm and I can see her silently saying a prayer. I am not a very religious person, but I felt an instant sense of calm.


I make the first stick and am immediately rewarded by a return of dark red blood indicating a successful attempt. I quickly thread the new port in and the nurse resumes the dopamine. The blood pressure which had dropped to 60 gradually starts climbing back again.


At this point our attending shows up. Oh good he says, you have the port in place, oblivious to the drama we just went through. He subsequently guided the intern in putting in the Swan Ganz catheter. I do not recall the eventual outcome of that patient, but we had stabilized her in the acute setting.


Afterwards, I marveled at the fact that we got the line back in so quickly. My intern said to me, “that is the power of prayer”. Now many people do not believe in prayer, but I have no doubt that her prayer at that time made a difference.


On that day, I learnt the immense power of prayer. I thanked my intern deeply.

Swan Ganz catheter