There are a lot of things that terrify me about medicine. But at the top of my list are Codes. A “Code” or a “Code Blue” is when a patient goes into cardiac arrest and needs CPR. It makes sense that these would terrify me because if a patient codes, it means that his heart stopped beating and he is basically dead. Maybe you can bring them back and maybe you can’t, but either way it’s a stressful situation and things need to happen fast.
The first Code I was ever involved in happened during my ICU rotation several months ago. It was well after midnight, and I was just standing around chatting with my senior resident and my attending. My attending was seconds away from saying goodnight and heading home when we heard a familiar sound over the paging system. My attending hung his head. He knew that he wasn’t about to go home, and he would have to apologize to his wife later for being late. There was a Code Blue.
We all took off running down the hall. A huge group had assembled in the patient’s room. We arrived to see a nurse administering CPR to a man in the hospital bed. He had developed a dangerous arrhythmia called Ventricular Fibrillation or “VFib.” I had no idea what to do. The room filled up with people. Nurses, techs, doctors, pharmacists. As the only medical student, I decided my role was to stand back against the wall and watch.
My attending began barking orders as nurses switched off and on doing chest compressions. They hooked the patient up to the defibrillator. Another physician began setting up to intubate the patient. My attending looked directly at me and came and put his hands on my shoulders. I was terrified. “Run to the ICU and get the GlideScope.” I nodded and took off running.
GlideScope. GlideScope. What’s a GlideScope?! I burst through the ICU doors and began looking around. Small? Big? What the hell is this thing!? I yelled for a nurse. “I need the GlideScope!” Luckily, she knew what I meant and brought it to me. It was a large monitor on wheels. I grabbed a hold and took off running as fast as I could wheeling it beside me. I returned to the room.
They were still doing compressions. The patient was still in VFib. I stood against the wall with the GlideScope. Seconds later the physician was able to successfully intubate the patient. They delivered a shock with the defibrillator, and the patient developed a normal heart rhythm. The Code was over.
We moved the patient to the ICU. Half an hour later he Coded again. Luckily, it didn’t last long. I stood at the foot of his bed with the Intern for the next 2 hours watching the monitor just waiting for his heart to stop. It never did. At least not that night.
Two days later during morning rounds the nurse told us his heart had stopped. His family had decided to make the patient DNR (Do Not Resuscitate). I walked over to his bed. My senior resident listened to his heart, checked his reflexes, and then declared him dead. His family had hung rosaries from his IV pole. I fought back tears as I watched them come, one by one into the ICU to say goodbye to their dad, their grandpa, their husband. I will never forget my first Code or the scene I witnessed that day in the ICU.
The next Code I saw was in the ER. We were given warning that a patient in cardiac arrest was arriving in 10 minutes. My attending told me I was going to help. I was, again, terrified. He said to me, “Just remember. You can’t kill a dead person.” When the patient came, I jumped in and started doing chest compressions. I tried to remember my training. Push hard, push fast. 100 times a minute. Sing ‘Stayin’ Alive’ to keep the rhythm. As I performed chest compressions, I looked at the lifeless body beneath me. He was turning blue. I knew he was already dead.
I grew tired after a minute and traded positions. My attending grabbed a central line kit and asked me if I had ever done that procedure. Of course not. So then and there, never having done one before, he helped me put as I put in my first ever central line. I kept reminding myself, you can’t kill a dead person. After 30 minutes we declared him dead.
The next time I helped with a Code, I was no longer terrified. I kept reminding myself that you can’t kill a dead person. Those words will always stick with me. It seems silly, but it’s so true. Codes have always terrified me because I’m afraid that I won’t know what to do and the patient will die. But the sad truth is, usually the patient is dead before they even get to you, and you can’t do anything about it.
The next two codes, I jumped in and intubated the patient – the first time using a GlideScope. When everyone heard it was my first intubation they began clapping and cheering for me. It felt so strange to have people applauding me while a patient was dying on the table. But despite the odd setting, it was a real achievement for me. I no longer cowered against the wall. It seems kind of sick to say it, but I actually like Codes now. I like the excitement. I like doing things like intubations and lines. But I don’t like telling the family that they’ve just lost a loved one. That part is never easy. Especially when they’re young. Especially when it’s unexpected.
But the more Codes I help with, the more routine it becomes. And I know I’ll help with a lot of Codes in my career. Especially if I decide to go into critical care. But no matter how many Codes I see, I will never forget my first. I’ll never forget how scared I was. And I’ll never forget those rosaries hanging from that IV pole.
my first patient 