Code Blue

Last week I participated in my first code. First a word on codes in the hospital.

Each night my team is on call, we carry code pagers, which as the name suggests, only go off when someone is coding. A code is called when a patient stops breathing, or either doesn't have a pulse or has a life-threatening arryhthmia. When the code pager goes off, there are a series of distinctive beeps, and then the operator says what kind of code it is, and where in the hospital it is happening. When we are on call overnight, our team is responsible for any code on the wards or in the ICU, which means my senior resident (who is a second year resident) is responsible for running the code. Every one on the team is supposed to have a designated role which ideally has been discussed before the pager goes off. Obviously, code pages are urgent, and when the pagers sounds, everyone goes running.

It was about 4:45 when I was awoken from sleep by the code pager. I took one second to make sure I wasn't hallucinating, and then put on my shoes as fast as I could, grabbed my scrub top, and took off out of the call rooms running toward the ICU. Unfortunately, the medical student call rooms are across the hospital from there, and after a rapid trip up the stairs, I found the ICU (running up stairs in Queen Anne definitely paid off).

It wasn't hard to find the code. The patient's room was overflowing with nurses, respiratory therapists, and numerous other people. I caught the eye of my senior resident right away, and he told me to put gloves on and break the nurse who was doing chest compressions. He told me to do them like her, but faster.

Before this, I had only done chest compressions on mannequins in CPR class. You hear that it is hard, but it doesn't really sink in until you have to do it. As I did compressions, I had no idea what was going on with the patient, nor had I ever seen him before. I focused on what I was doing and kept my ears open for further instructions. It was chaos around me. Hovering over everyone was my senior resident and a cardiology resident, managing the chaos, trying to determine why the patient is coding, and what algorithm they should be following to correct it.

Fortunately, the residents did figure it out, the patient was given some medications (this is another story), and he soon had a pulse again. I no longer had to do compressions, which was good because I was exhausted. From start to finish, the code took about 25 minutes (I did compressions for only a couple minutes) and as far as I know, the patient stabilized and recovered.

It was my first code, and though it ended well, it is a traumatic, even brutal, experience for the patient. It's hard to convey the chaos of the code, with the alarming sounds of the monitors, the resident giving orders, the nurses giving meds, the anesthesiologist having a hard time intubating the patient, the surgery resident seemingly stabbing blindly into the patient's groin with a giant needle, and the patient's unconscious body absorbing chest compressions and these other insults. Fortunately for everyone, this code ended well. It's frightening to think that in a couple years, I'll be a resident in the hospital overnight, responsible for running a code like that one. It's exciting but intimidating to realize how much we're expected to learn in a short time.