Nathan Yee, MS4 at UCSD SOM
I walk into the hospital, it’s still dark outside. I doubt I’ll see the sun today, but hey that’s life, another day in the ICU. We begin rounds, the patient who was crashing last night looks surprisingly good. The resident presents the swan numbers, the vitals, the labs, the trends, the list of medications, the exam, the plan, another day in the ICU. On to the next patient, probably not much to see here, after all the patient was relatively young and suppose to be on his way out of the unit, out of the hospital soon so he could schedule his bypass. It was suppose to be just another day.
We walked into the room. The patient was pale, diaphoretic, complaining of some chest pain. Sublingual nitro stat. His blood pressure plummets, he’s not tolerating it. Fluids stat. His blood pressure rises, the patient feels better, no more chest pain – everyone breathes. The team steps out for a minute. I stay in the room pumping the pressure bag to keep the fluids going wide open. The last 100ccs go in, the patient starts to look uncomfortable again. The beeping of his heart rate begins to slow, within seconds 90 to 60 to 40 then flatline. Chaos. A nurse yells “Call a code”, the team swarms back in. The compressions start, the bed drops, the crash cart arrives, the backboard is thrust in place, the monitors attached. Everyone scrambles to their place, the code leader, the code nurse, the code pharmacists. I rotate in for compressions trying to remember the training from one week ago. Push harder, faster, not that fast. We lose his IV. I’m trying to focus on pushing to the metronome in my head while the cards fellow is dropping a fem line, anesthesia is trying to secure an airway.
I remember the adrenaline, the dry mouth, the surprise at how utterly exhausting real compressions were. I remember rotating in and out each time trying to push for as long as I could to give the other people in the rotation time to recover as they tried to do the same. I remember how his chest felt like a piece of floppy cardboard after a while and how with each push I was praying for any sign he was coming back. I remember walking out of the room to get a quick breather. I will never forget seeing his wife sitting just outside the room witnessing it all, sobbing uncontrollably with a helpless crazed panic that shot through the chaos and hit me in the gut.
The code lasted nearly an hour. It was my first code, it was my first failed code, and it was the first time someone passed in front of me. I remember my hand falling on the patient’s leg when the coded ended and how cold it felt, I remember the solemn dejected faces of the team, I remember the pit in my stomach as I walked out of the room and how my stomach sank further when I later saw his wife holding his lifeless hand as the rest of his family looked on.
I think about this incident frequently, about how medicine can be so chaotic and exhausting and exciting and adrenaline provoking. I think about this frequently, about how we so often get bored with the routine and lost in the excitement. I think about this and about him and his wife and I wish it had just been another day.