Why we persevere despite a poor prognosis

Last night, I responded to a code blue while working the night float at the hospital. The patient was a relatively young female who had just completed a coronary artery bypass procedure. Per training, I began compressing her chest to induce blood flow to the rest of her body.

As I pushed, the incision reopened and blood began spewing everywhere. I could feel her ribs giving and cracking from the force of my weight, yet she still remained asystolic for approximately 15 minutes. From the look in the eyes of the cardiothoracic surgeon running the code, her prognosis was not good.

After a fourth set of compressions, the team and I were able to shock her back into ventricular tachycardia and she produced pulses bilaterally. We continued to follow the ACLS protocols and stabilized the patient. As things looked better, I quickly signed off from the code and left to continue my other duties, barely stopping to think about what I had just done. As I left the ICU, a resident pulled me aside and told me that the patient’s son and daughter were in the room for the entire code.

My insides felt queasy and my heart seemed to fall into my stomach.

“How were they reacting?” I asked.

“Okay,” the resident responded.

After completing evening rounds, I went back to checkup on the patient.  Her family was huddled around her bedside and holding her hand. But something didn’t look right on her monitor. I pulled the ICU nurse aside and asked how the patient was doing. She told me that despite all our efforts to save her life, the patient’s family decided to withdraw care.

A second uneasy feeling overcame me.

“My scrubs and watch were covered in blood and I sweated like I just ran a mile!  The team spent at least 45 minutes coding this patient, and yet all the family wanted to do was withdraw care?” I thought to myself. “But her heart is pumping blood again!”

Dumbfounded, I looked away from the nurse and gazed back into the patient’s room.

In medicine, we say that there is always a silver lining that families and loved ones search for to help them cope with each loss. For some, it is organ donation. For others, it is knowledge that the patient passed peacefully. As the patient’s family peered out the door back towards us, her daughter mouthed the words, “thank you.”

And then it hit me. For this family, it was the chance to say one final goodbye.

In life, we are taught to carry on when all seems lost.  We might not be able to save every patient, but we always persevere despite a poor prognosis.  This is why we play the game.

Andrew Ho is a medical student. 

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