My introduction to “running a code” came early on my medicine rotation. At our school, the on-call medicine team is the group to carry the code pagers. When somebody on the floor at the hospital goes into respiratory or cardiac arrest, a “Code Blue” is called. When these special pagers go off, all hell breaks loose. There is a mad tear as residents, nurses, and other staff go flying off to try to bring somebody back from the edge.
My first experience was around dinner time one weeknight. As M3s, my buddy Shane and I were taking orders from our team for supper from a local establishment. While some M3s despise being called to gofer duty and somehow feel like it is an attack on their self worth to be asked to go pickup carryout, I actually like it. I would much rather spend a little time outside of the hospital tooling around town, rather than being in the ER, watching the intern take yet another history and physical from a homeless person with belly pain lasting for two months. Anyway, we were taking orders and collecting money from the senior resident, intern and M4 on our team when the dreaded call came. As I was running down four flights of stairs I realized that it was not a good idea to wear faux Birkenstocks while on call. I managed to get to the patient’s room without rolling an ankle and tried to blend into the huge crowd packed into the small private room.
Everybody on the medicine team has a role to play. The senior resident is the leader and gives direction. Another resident gets the patient intubated and an intern gets a femoral line in. The M4 is first in line to perform chest compressions and the M3s are supposed to standby to relieve him. In this case there were a lot more people involved. An ICU nurse was on the scene and was helping to get the defibrillator patches on. Everything was crazy. Apparently the guy had no pulse but an implanted defibrillator was going off constantly and confusing everybody. Somebody was yelling to get the “crash cart” plugged in because the defibrillator was out of juice. Somebody else realized that there were family members still in the room and a guy who I had never met pointed towards me and hollered, “get them out of here!” I looked around thinking, “Who, me? I’m not qualified. I’m just an M3.” Before I could form my action plan, a nurse tried to pull a couple from behind the door and out into the hallway. They refused, the guy declaring that he would never leave his brother. I kind of stupidly looked up and realized that a syndicated episode of Seinfeld was playing silently on the television mounted over everybody’s head. To my inexperienced eye, it seemed like total chaos. As someone took over on chest compressions, the M4 on our team backed out of the room with Shane and me. He was a whiz kid type. Very smart and impressive. It was hard to believe that he was only one year ahead of us in his training. He looked over the scene glumly and remarked, “I haven’t ever been to a code outside of the unit (ICU) that wasn’t just a cluster f@*#.”
It was looking pretty clear that we were losing and our patient was not coming back. As our senior resident formally called a close to operations, our cool M4 turned to me and pulled a $10 out of his wallet. “I’ll take the chicken strip dinner with fries and a coke.” And with that the guy was declared dead, and the adrenalin rush was over. People began trickling out of the room. The family was escorted to the waiting room to share the bad news with the rest of the clan. The naked dead man on the bed looked violated with the line coming out of his groin and the endotracheal tube jutting from his mouth like some weird pacifier. Because he had a lot of gold jewelry on, Shane and I were given the first job of the night that I felt competent to handle. We were posted out in the hallway with instructions to let no in go in without authorization until the morgue could arrive. We only had to wait a short time before we were released from duty and headed out to pick up supper.