The Code That Shook Me

As I mentioned in my "About" section of the Nurse's Refuge website, there was a particularly troubling code at work lately that took me almost a week to process. I remember feeling angry and sad about it, while also feeling ashamed about the fact it was troubling me days later. After all, I've been a nurse for over 5 years now. I've been in enough codes by now to be a little more used to it, right? And honestly, usually they don't hang around in my head for days. But this one was different; I just didn't realize how it was different until days after it happened.

For years, like 4 years, every code I've been in has ended similarly. All the ones I've been in achieved ROSC, meaning we got a pulse back. To be completely honest, at least half the time, they end up passing away in the ICU within the following days. But, in every code I've been in for years, I helped bring the patient back and ship them off to ICU. I always get to go home feeling good, like I made a difference. Not this time. That was the difference.

It was another normal night shift not even 2 months ago now. I had found, to my delight, my favorite orange sherbert ice cream in the kitchen freezer, a rare mini pleasure. I was halfway through eating it when that familiar, chilling ring suddenly started. The code blue alarm, a truly terrifying sound, came from my phone and the call bell receiver at the front desk, as well as the phones of other staff nearby. I looked at my phone. CODE BLUE RM 353. I felt a wave of adrenaline as I dropped my half-eaten ice cream and took off towards 353, joined by other responding staff.

The code blue alarm only goes to the staff on my unit. Calling a code announcement requires a phone call to the emergency line, which I hadn't yet heard announced. I wondered if this was real. As I rounded the corner before 353, my eyes naturally lifted to the light outside the room flashing blue, and then lowered to the many other staff members running to the doorway. I reached the open door and looked in. Sure enough, Megan was doing compressions on an unresponsive man in bed, while his bedside nurse Troy was on the phone calling the emergency line. Moments later, the code was announced over the public announcement system to the whole hospital.

I rushed in and offered to take over for Megan. She agreed and we switched out. Another wave of adrenaline came over me as I stepped forward and began doing compressions on the patient. I felt multiple rib bones break and audibly grimaced at the feeling.

We got the AED hooked up to him as the charge nurse asked Troy questions.

"When did you last see him awake?" It turns out, this patient was being discharged that morning and was no longer on telemetry (remote cardiac monitoring), and as a result, it was impossible for us to know exactly how long he was in cardiac arrest. I remember feeling my heart drop when I learned he was found unresponsive during a routine vital signs check and wasn't on tele. Last time someone was with him was an hour prior.

The AED read asystole, and announced in a robotic voice, "No shock advised. Perform CPR." You know how in the movies, someone yells "Clear!" and they shock the patient? That only works on certain rhythms. Asystole is the so-called "flat line" and cannot be shocked. If you ever see actors shock someone who is "flat-lining", this is completely unrealistic and inaccurate. Charlie St. Cloud and New Amsterdam come to mind off the top of my head.

Anyways, ICU showed up quickly, since they are right across the hall from us. I recognized the doctor from previous codes. A young, confident man probably in his 30s, he took over as team leader and started ordering meds to be given and praising CPR efforts. My charge nurse suddenly spoke up.

"Um, I think there's vomit on the bed." Realizing this could mean the patient vomited and aspirated it (it went into his lungs), respiratory entered a scope and suction equipment in his mouth. Sure enough, he was literally drowning in his own vomit. The doctor intubated him, and, much like my traumatic first code ever, vomit started flying with each compression. It got in the hair and face of the respiratory therapists, and to my great admiration, they barely flinched and continued to work on the patient. The doctor had to order them to stop so someone could put a blanket between them and the patient to protect them. I don't know about you, but to me, that was pretty hardcore.

I was taking a break from compressions at this point and looked at Troy. He stood there waiting his turn, visibly beside himself and distraught. I gave him a hug, as it was pretty clear we were not going to succeed in bringing this patient back. I did 3 rounds of CPR, around 10 rounds total, and after about 20 minutes, the doctor decided it was time to call it.

We debriefed at the patient's bedside, and the doctor had nothing but good things to say about everyone's efforts. It just wasn't meant to be. I helped Troy clean up and checked on my patients. This whole event stuck with me for days, and it took me days to realize that it was bothering me so much because of the fact we didn't get a pulse back this time. For the first time in years, I was in a code where my efforts made no difference. That was eating at me, and the only way I found peace was by writing about it.

Moral of the story: Healthcare is a brutal profession. You have to be able to switch from traumatized by one patient to happy for another patient being discharged in minutes, stay focused even when ugly things happen, and hold in the emotions until you go home. It's critical that healthcare workers find their way of coping. Mine is writing.

RIP 353.

- Bella, RN