Reflections after a medical student’s first code blue

We were in the middle of the morning routine – sign out between mouthfuls of eggs and homefries – when the call came in overhead, “Code Blue, 9 West.  Code Blue, 9 West.”  Just like that, our team snapped into action, the continued banter only thinly concealing a change in demeanor: backs straight, jaws set, we walked with a sense of purpose.  There was a life on the line.

By the time we arrived at the room, there was already a crowd spilling out into the hallway. A tapestry of healthcare providers extended from the patient’s bed, woven together with the blue scrubs of the nurses, reds of the medical assistants, grays of respiratory therapy, and of course, the steel-blue of the residents.  The code team worked in perfect synchrony.  At the head of the bed, the respiratory therapist peered down a laryngoscope, ducking under the outstretched arm of the pharmacist, who handed bicarbonate to the nurse, who sidestepped the resident lining up to administer next round of compressions. It was well-practiced choreography, playing out under the familiar cadence of a code. “10 seconds till pulse check! … ah, ah, ah, ah, staying alive, staying alive.”

In the repetition of each failed resuscitative attempt, I started to piece together what the team needed, when, and where to find it.  Suddenly I too became a member of that life-sustaining macrocosm, swept up in the thrill of our collective mission. Backs straight, jaws set.  There was a life on the line.

With dogged persistence, our code team reached its bittersweet conclusion.  The patient’s heart resumed its normal rhythm, her lungs expanded and contracted to the beat of a mechanical metronome, but her brain had been starved of oxygen for too long.  The stable vital signs belied the fact that this was now just a body, stripped of the cortical function and neural networks that made her, her.

Shoulders slumped, faces worn, we realized that there was a life on the line, and we had lost it.

We have been warned about this moment from the first day of our training.  Death in medicine is an inevitability, a matter of when, not if.  With this in mind, I prepared myself for what I would encounter when I returned to the patient’s room later that morning.  Everything was just as we left it.  Pooled blood by the wall, a ransacked code cart pushed to the corner, discarded packaging littering the floor like fallen leaves in winter – it was a pristine crime scene in which this patient had been robbed of her life.

I made my way over to the windowsill, where a loved one had carefully arrayed “Get Well Soon” cards and photos of a happier time.  I had never met the patient, so I found myself staring at her face in the photos, trying to imagine it on the body I glimpsed under the mess of equipment and providers.  I braced myself to feel a rush of emotions, to be sucked into the vacuum left by her loss, but instead, I just felt empty.  The windowsill mementos stood testament to a life well-lived, a person well-loved, and yet her final moments were spent in the company of strangers who could never appreciate who she was to those she left behind.

This thought continued to haunt me throughout the day.  When I chose to pursue medicine, I knew that I would be there for some of the most vulnerable and inglorious moments of patients’ lives, but I imagined that I would earn this right by getting to know the patient and establishing a strong physician-patient relationship.  What right had I to be there with a patient I didn’t know?  Certainly, when this patient contemplated her mortality, she didn’t picture me at her bedside, staring down as a pair of trauma shears sliced through her hospital gown and exposed her bare chest to a room full of strangers.

I don’t know that this question can ever be answered, although I hope my future practice will at least help elucidate the issue.  For now, I’ll content myself with what I did later that day – talking to the friends and family members who came to pay their respects, and trying to appreciate the privilege of being there for her final moments.  There was a life on the line, and it deserved to be recognized.

Danielle Verghese is a medical student.

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