Wednesday, February 3, 2010

A Code in the Night

For the first time in what felt like a very while, there were no patients waiting to be seen at 0330.

My carts fully stocked and the trauma bay empty, I took advantage of the rare downtime to catch up on some readings for class. A nurse at the computer next to me shopped for some new shoes online, a resident and a med student huddled around an EKG looking for ischemic changes, and the sound of some large fans could be heard as the maintenance guys waxed the floors in the back hallway. Even the drunk bigot in the room farthest from the nursing station had finally fallen asleep.

And then the radio crackled for an incoming cardiac arrest four minutes out. A minute later, EMS arrived with a mid-30s male undergoing CPR. Journal articles, Ebay, and EKGs were all set aside as the critical care area filled with more staff than was necessary. Nurses started more lines and drew up resuscitation medications, I grabbed the defibrillator pads (does anybody but House use the paddles anymore?), respiratory bagged, and the senior resident checked suction before intubating the patient. We cycled through a few rounds of compressions and meds, giving the med student a chance to practice real-life CPR, but there was nothing on the monitor, no cardiac activity on ultrasound, and no pulse without compressions. We continued long enough for the intern to be guided through a central line insertion, but with nothing left to try, time of death was called at 0352. Unwitnessed arrest, with no information on medical history.

Talking with some non-medical friends the other day reminded me of the emotional and dramatic portrayal of codes on television. In reality, life rarely imitates art. We all took notice of the patient's age, and felt bad that he died so young. We all felt terrible watching the patient's loved ones cry as the chaplain led them to the family room. But then we went back to work.

After cleaning up the body, I stuck around to replace the suction canister, grab a new ambu bag, and throw some new saline flushes in the IV cart. Gradually people drifted back to whatever they were doing beforehand, and resumed the countdown to morning.

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