Op-Med is a collection of original articles contributed by Doximity members.
It was business as usual in the high acuity core of the emergency department. Patients coming and going. The early morning hustle and bustle of nurses, techs, respiratory therapists, residents, and attendings. The hum of monitors, the beeps of various alarms, and the buzz of fingers feverishly typing at computer stations. Overhead, we hear the monotone hospital announcer’s voice through the intercom system, “CODE BLUE, first floor, short term cardiac care unit, room 1008…”
This announcement was followed by a brief pause throughout the entire emergency department core as those words sank in to everyone’s understanding: First floor. That’s us. An explosion of noise and motion follows the stillness of that moment as nearly everyone drops what they are doing and sprints down the hall toward the short-term cardiac care unit. My senior resident tells me to grab the airway box. I do so and follow suit, running down the hall.
Less than a minute later, everyone arrives at the small cardiac observation room where CPR had already begun. We pass the patient’s loved one outside, held by a nurse while she cries silently and covers her mouth with a hand, shocked and not knowing what may happen.
Providers pour into the room. Jolts of movement pass through the patient’s body with each violent chest compression. A resident is beginning to work on accessing an airway. My senior resident quickly establishes herself as leader of the code, and all information and decisions will pass through her. No pulse. No breathing. ABCs…. Airway, breathing, circulation. Put the patient on the monitor and intubate. Two minutes go by, give epi. Still no pulse, “BACK ON THE CHEST.”
I rotated in to pick up where the last compressor left off, pushing on the center of the patient’s chest, trying to remember my Basic Life Support class — “Ah, Ah, Ah, Ah, Stayin’ Alive…,” two whole inches down and allow for recoil. I feel the resistance of the patient’s chest increase as he laryngospasms with the passage of the breathing tube down his trachea. I think to myself, “Is this really happening?” I look to my senior resident for any commands and wait for the two-minute mark to rotate back out of CPR.
“Hold CPR! Another round of epi! He’s in v-fib, prepare to shock! Back on the chest while the machine charges up…. Everybody clear?” We all respond, “Clear!” The patient’s limp body jumps as the shock is delivered, and CPR continues immediately afterwards. My senior resident consults with the cardiologist at her elbow, and they decide what medications to proceed with as the ACLS algorithm continues to unfold.
After 15 minutes in cardiac arrest, with multiple shocks, multiple doses of epinephrine and amiodarone, an intubation, and consistent CPR, the patient returns to a sinus rhythm delivering blood to his body without the help of our chest compressions. Color begins to return to his blue face and extremities. My senior resident, leading the whole way, dismisses many members of the resuscitation team no longer needed to protect the patient. She and several other providers stay to ensure the patient is stabilized and transferred quickly to the cardiac catheterization lab and then the cardiac ICU.
And just like that, it is over. I return to the emergency department to pick up seeing patients where I left off.
What a mix of emotions. I felt the rush of adrenaline during the resuscitation. I felt exhilarated afterwards thinking, “So this is what it feels like to help bring someone back to life.” I felt the anxiety mixed with excitement as I delivered my first chest compressions to a real patient. And after, everyone just seemed to go back to work as if nothing happened.
There was a strange tension on which my mind lingered between the excitement, rush, exhilaration, and frankly, enjoyment of participating in a code with this patient’s reality. His impending death in that moment, the impact of the experience on his loved ones, and the possibility that the code could just as easily end with a time of death pronouncement. The fact that it did not end that way, what would this patient’s life look like now? Would he make it to the end of the day? If he did, what sequelae of his arrest would he have? How would his brain function after being deprived of normal amounts of oxygen for so long? I could only hope that our medical interventions were successful and this patient had a little more precious time to spend with those that loved him.
It was also a stark experience of the reality that in medicine the dynamics can change so dramatically from one moment to the next. For example, saving a patient’s life during a code only to return to the emergency department and share a new diagnosis of cancer with another patient. What a unique profession where we have the opportunity to participate in such significant moments in people’s lives.
Even now, I do not know whether that patient ever made it out of the hospital alive. I hope he did. But, I am grateful for having had the experience. I am grateful for the chance to be a part of his care and a part of the team that responded to his cardiac arrest. It was an amazing experience and I learned so much from our brief interaction. I will take the experience moving forward in hopes that I can take what I learned to respond appropriately when I eventually find myself as the physician having to lead the team and decide how best to try and save a patient’s life.