Progress Notes

The first code

Anup ShahBy Anup Shah, MS3

What do you think of when you think of doctors on TV? Definitely not the hours spent writing notes in the call room or the daily morning pre-round routine. What most people expect is the code blue. All the doctors in the hospital dropping whatever they’re doing, rushing to the patient’s bedside (maybe even in dramatic slow motion if the show is corny enough). No response from the patient. No pulse. Shocks. Chest compressions. That five minute adrenaline rush seems to define our profession in the public eye. If TV and real life were the same — you’d think we see this everyday.

But as medical students, you come to realize that you may only have one chance at being part of a code blue before you become a certified MD (one intern I met had never been part of a code in medical school). Of course we’re trained in basic life support regularly, but the chances of an actual code occurring during our clinical years requires several elements to come together at once: 1) you being on call that day or night, 2) the patient decompensating during that time, 3) your team holding the code pager, 4) you (a medical student) being around when that pager is paged. That’s why when it happened to me the other day, as soon as I heard my intern’s code pager go off, I knew this could be my only chance (update: 3 months later, I have yet to participate in another).

As my intern and I raced into the ER, he quickly turned to me and said “You’ve done this before right?” I shook my head but I told him I’d done the training and knew what to do. I knew my only job was going to be chest compressions – so I started mentally preparing myself for that. There were several female nurses around and one of the senior residents was leading the code. The patient was heavyset, and my intern, another male intern and I were the only people who seemed to have the height and weight behind us to apply enough pressure to pump this man’s heart.

I got in line behind my intern and the other intern who was already doing chest compressions. I was observing how the whole code was being run (while filing it in my mind) and got out of the way. But when my turn finally came up, I was thinking only 3 things:

  1. Block out every single thing that everyone around you is saying except for “Hold Compressions”
  2. Push down on this man’s chest harder than you’ve ever pushed anything in your life
  3. Start playing “Staying Alive” in your head

As I started doing my compressions, I looked down into the patient’s eyes. I wondered if he could see us. I wondered if he knew these could be the last seconds of his life. As I pumped this man’s chest with all the force I had, I heard one of the residents say “Great compressions man keep it up.” This just got my adrenaline rushing even more. That two minutes of compressions felt like the hardest workout of my life — but I was determined not to give in an inch. When my turn was up, I got back in line and stretched a little bit. I knew I’d be up again soon, this time feeling much more confident.

In the end, the patient didn’t make it. As soon as it was called I stood there in shock. The resident leading the code called the patient’s daughter (and did a great job of breaking the news to her if you ask me). But then it couldn’t have been more than two minutes after calling it that everyone was back to their normal duties. I couldn’t stop staring at this patient who was just laying there alone in the hospital bed but somehow everyone proceeded to resume their normal activities without a flinch. I don’t think it’s that they’re all callous human beings — I think they’ve just come to realize that death comes with the territory. I’m sure I’ll learn this one day. But on this day I would remain in shock for a few hours.

The next day one of the senior residents came up to me before morning report. “Are you the med student who was involved with the code yesterday?” Not sure what was coming next, I meekly told her I was. She says “Your chest compressions were amazing! Those were the best med student compressions I’ve seen.” I thanked her and walked away feeling marginally better. Even if the patient passed on, at least I know that I did my part to the best of my ability.

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