Three Codes

Its a strange pager sitting on my hip. A loud, piercing BEEP-BEEP-BEEP, then it crackles with static like a CB radio and a woman's voice emerges from my scrubs' waist band: "CODE BLUE SIX BRAVO, CODE BLUE SIX BRAVO." Static, crackle, crackle.

The week started off pretty rough, I struggled to get the language down, let alone the concepts behind everything. Fortunately, ICU nurses are a special breed who ensured my actions didn't contribute to the demise of the patients. The mortality rate in our ICU is apparently 32%. 1 in 3 doesn't sound all that good to me.

On call last weekend mid-morning a code blue was called on a patient whose lung had collapsed (incidentally because of a line the internal medicine team had put in his jugular vein... oops). Sweat rolled down my face and trickled off my knee caps behind my mask, eye-shield and gown as I cut into the side of his chest, tunneled my finger through his tissue and squeezed between his ribs to tickle his lung. Air hissed out quickly as my finger wiggled around in his chest cavity and his lung re-expanded... way cool. We stabilized him and brought him to the ICU. "Good save," said the attending as he patted us on the back.

Another code was called for an SVT, a rapid heart rate causing the patient to drop their blood pressure. Hook up the defibrillator pads, a few shocks and some drugs later she was back to ticka-ti-boo. That's two saves and counting! As the day goes on I but two arterial lines and a central line in the internal jugular successfully on a few patients. My chin is held up a little bit, my walk develops a bit of a swagger. Maybe I'm not so bad at this after all, maybe this running to the rescue ain't so bad.

Its 'tuck-in rounds' at around 10pm when the third code of the day is called. The selected ICU staff drop what they are doing and run like clockwork. A small army emerging through the automatic double doors, past the ICU waiting room scattered with worried family members. There is a certain intensity and purposefulness to their gait, urgency with every movement. My senior and I walk behind the running respiratory therapists and nurses as they roll the cart down the hall. I've been told never to run to a code, you need your brain and heart rate functioning normally when you get there.

And the rest was a blur. He looked dead. I suppose he already was. We never got a pulse back on him, his heart just twitched with electrical activity. I was kneeling up on the bed, heels of my hand pounding his chest down. Sickening crunching and cracking of his ribs and sternum with each movement. I was exhausted after two minutes and we traded off and on. Nobody seemed to know much about his history and flipping through the chart wasn't helping. I botched a femoral line as his body bounced around with the CPR. Intubated and bagged, we gave him every drug we could think of, racking our brains to think of anything we were missing. The senior even stuck a needle into his heart (well, pericardium) and after 35 minutes we stopped. Everyone in the room agreed, there were probably 10 of us. And that was it. He was 58.

It was a lesson in humility and futility. We don't get decide when people live or die, we are sometimes just tricked into that illusion.