"We Can't Kill Your Mother" and Other Stories of Intensive Care
by Lawrence Martin, M.D.
Table of Contents

NOTE: "We Can't Kill Your Mother" and Other Stories of Intensive Care can be downloaded in its entirety as an e-book from 1st Books Library ($4.95). The book can also be ordered in trade paperback format for $13.50. For purchasing the e-book or print versions, please go to 1st Books Library and enter part of the book's title or the author in their search engine. Below are the first few paragraphs of AS HIGH AS A GIRAFFE

The top line on Harold Boykin's emergency room ledger was cryptic: "31-yo AAm w/ cc severe ha and blurry vis p. wk. Hx from wife."*

The first step in ER triage is to obtain a chief complaint and take vital signs: pulse, respiratory rate, blood pressure. Adele, the ER triage nurse, checked Mr. Boykin's pulse at a regular 80 beats per minute, respirations at 18 per minute. Both were normal. To take his blood pressure she wrapped a cloth cuff around his upper arm and placed her stethoscope bell just below the secured cuff. She placed the other end of the stethoscope in her ears and pumped up the cuff to register 200 mm Hg** on the pressure scale.

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* Thirty-one-year-old African-American male with a chief complaint of headache and blurry vision over the past week. History obtained from the patient's wife.

**Millimeters of mercury, the units for blood pressure. Hg is the chemical symbol for mercury.

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This procedure is routine for taking blood pressure. At 200 mm Hg the brachial artery in the arm is occluded and no blood can get through. With slow deflation of the blood pressure cuff blood begins to flow through the artery and you can hear this movement with a stethoscope placed over the arm; what you hear is the gentle knocking sound of blood pushing through the partially constricted vessel with each heart beat. At that point the cuff pressure equals the patient's higher or systolic blood pressure, normally between 120 and 140 mm Hg. With further deflation of the cuff blood flows more freely through the fully-opened artery and the sounds become inaudible; that point represents the patient's lower or diastolic blood pressure, normally around 70 to 80 mm Hg.

At 200 mm Hg there should have been silence over Mr. Boykin's arm, but Adele heard the gentle "knock-knock-knock" of blood rushing through. This meant Mr. Boykin's systolic blood pressure was higher than 200. How much higher?

"Let me try again," she said, and she deflated the cuff to restore the circulation. Then she pumped the cuff up to 225 mm Hg. Again she heard: `Knock-knock-knock.'

Adele deflated and then re-inflated the cuff for a third try, this time to 250 mm Hg. `Knock-knock-knock.' Such an incredibly high pressure! Somewhat in disbelief, Adele looked at Mr. Boykin: "Sir, are you OK?"

Tall, strongly built, with jet black hair and thin mustache, rugged, intelligent face, Harold Boykin did not answer. He stared past the triage nurse, awake, eyes open and showing no distress but obviously unaware of her question. Mrs. Boykin, who had been standing nearby, saw the surprise look in Adele's face.

"Nurse," she asked. "What's wrong? What's wrong with my husband's blood pressure?"

Adele did not answer right away. Instead she reached for the intercom. "Dr. Randall, come to triage please. Dr. Randall, triage, please!"