We had a code at work today. I was heading to the chemo room anyway, and I heard, “Code Blue, Chemo Treatment Room. Code Blue, Chemo Treatment Room”. My doc, Dr. M, followed along behind me and we hurried up to see if we could do anything. You almost never can help, by the time you get there, there are a million people and you end up being a rubbernecker with no useful function.
Alas, today, my uselessness was not to be. It was a patient of mine and Dr. M’s. He was on the floor and a resident was doing CPR. I was the only nurse who had ever met his family, so I got the difficult task of escorting them to a quiet room away from the chaos. I asked them if they would prefer company or updates on his condition. They preferred updates, so I went back to the mayhem.
Turns out, the family became a little concerned when he was taking a long time in the bathroom. After a few minutes and some unsuccessful tries to get a response from behind the locked door, they broke in and found him, blue, on the floor. The CPR was started right there on the bathroom floor. Dr. M and a social worker went in to sit with the family. It wasn’t long before the ICU team showed up and intubated him and shocked his heart. After a good twenty minutes, they got a weak rhythm, and after a lot more drugs he was stable enough to transfer to a stretcher and take him to the ICU. The social worker took the family. I went back to work. The chemo room was left to clean up the mess. Someone put his dentures and his shoe, just one, that was found on the floor, into a bag and took it to the family.
I would be surprised to hear he was still alive right now. He was down so long. Who knows how long he had been in arrest before they started CPR. He was blue. Literally. I have seen some dead people before, but never one so blue.
I am so sad for the family. The patient was probably dead before he hit the floor, but his family will live with the image of him, blue, on the floor of a bathroom that wasn’t even his own. I think they were spared the sight of his shirt open and tubes hanging out of his mouth and a central line, all bloody, stuck in his neck. I’m sure he was clean and covered with a sheet before they were allowed to see him. But the shock of seeing him like that will stick with them forever.
I can’t stop thinking about it. I assume it’s adrenaline that kicks in when you are in the middle of something that dramatic. The nurse who found him was shaking, red and blotchy. She is a seasoned veteran, has been involved in hundreds of codes in her career. I’d bet she never had one like this. I was shaking for quite a few hours, and I didn’t really have a lot to do with it. It’s something you can’t really imagine, no matter how many episodes of ER you’ve watched, unless you’ve been there. You can only truly debrief with those who were.
It was especially shocking because we work in an outpatient facility. Things like this just don’t happen. Oddly, our patients are relatively healthy. They have chronic illnesses, not heart attacks (which this probably was). We are prepared for chemo reactions, which can be life-threatening, but this guy had finished his chemo and was heading home. When I got back to my desk, his chart was on the top of my stack.
Anyway, I’m feeling the tiniest bit PTSD tonight. I guess an adrenaline hangover lasts awhile. It’s pretty hard to let go of all the drama and emotion and just go back to work. It’s a good thing it was 4:30 pm, because I wasn’t all that productive afterwards.
It’s days like this that make it absolutely impossible to leave work at work. I will lie awake tonight for a good long time trying to banish the image of my patient on the floor being pounded on by the code blue team. And if I’m feeling badly, how’s the nurse that found him? How are his family? The sight of his wife and daughter sitting there, absolutely stricken, fearing the worst, might be the only image more endurng than that of the patient. Tonight they’re probably making funeral plans.
I could easily develop a drinking problem. In fact, I probably have one. A nice glass of Irish whisky is about all that stands between me and some sleep right now. It gives me perspective. I’m going to get some perspective now.