Tuesday, August 01, 2006

Nurse Follies: Heather's First Code

Another weekend, another peptic ulcer.

Saturday night was busy, Sunday night the Hellmouth opened. I knew it would someday, I just didn't think that I would be the welcoming committee.

The shift started innocently enough. I saw my first patient. A very nice lady, did my assessment, briefly charted, moved on to the next room. I had these same patients the night before, so I was pretty familiar with them.

Moved on to the next patient. A little sicker than my other ones, but not critically. He liked his meds with chocolate pudding, so I grabbed a pudding cup out of the fridge, and breezed into the room. There was an aide in there. Her job (other than holding a chair down) was to make certain the patient didn't climb out of bed.

The patient looked different to me than the previous night. For one thing, he wasn't responsive. I stuck my head out the door to have the on-call resident paged. The charge nurse perked up, hearing the apprehension in my voice, and asked me what was wrong.

"Something is not right." I replied and ducked back into the room. Charge Nurse followed. A respiratory therapist (not Paul) followed us into the room.

From there, everything snowballed. We watched the oxygen numbers on the patient monitor start to decline. 91...88...81...76.

"Call a Rapid Response!" the Charge Nurse and myself cry out in unison.

Then we see the heart monitor numbers start to drop...very fast. 68...57...45...25...0. Asystole. The monitor starts flashing, beeping and generally going apeshit. At this time, so does the staff.

"Call a Code!!" Charge Nurse and I again cry out in unison. I start throwing blankets off the patient and into the corner. Charge nurse and RT are also doing things. A couple nurses plow into the room with the crash cart, almost taking out the aide, who is standing in the doorway, her eyes as big as paper plates. We've got a full blown code!! We get things in order and proceed...patches, ambu-bag, compressions. The Code Team arrives minutes later.

I have to tell you...what might have been a few minutes, seemed like an eternity. All the nurses on my floor are trained in Advanced Cardiac Life Support. In the event of an emergency, we could technically run our own code...but that doesn't mean we want to.

See this obviously staged picture of a Code Blue? This picture is complete and absolute bullshit. In a real code situation, you would need to add about 25 more people (various nurses, residents, and a circus midget) in the room, plus about a half dozen observers out in the hall (various staff, visitors and a pony). The crash cart wouldn't look that neat and tidy after it is opened, and then you would see the nurse who was actually caring for the patient (me) in the far back of the room, jumping up and down so she can try to see what's going on.

Plus there is yelling. Lots and lots of yelling. Everyone is barking out orders and asking questions. The chart is passed around more than Paris Hilton...well...maybe not that much.

Papers, plastic, and boxes fly everywhere as the crash cart is emptied of everything we can use. After codes are done and everyone has left the room, the room looks almost identical to the Superdome after Hurricane Katrina hit.

The rest of the code passed in a blur. I think it lasted 30 minutes, maybe a little less. The patient was "brought back" and subsequently transferred to the ICU. The rest of my night passed in a blur because I was still traumatized. Code blue is never pretty. Code blue is very scary, although it shouldn't be. The patient is dead, so there is nothing you can do to harm them. Your task, however, is to reverse it.

No pressure whatsoever!!

In the two years I have been a nurse, and the many years I have worked as support staff in hospitals, I have never had one of my patients code on me. Oh sure, I've been in code situations where the patient belonged to someone else. It's different when it is your patient. I've had patients who have come close to coding, but I have never been in the situation where I have witnessed a patient actually dying before my very eyes, and then brought back to the world of the living. When I came home the next morning, all I could see was that heart monitor flatlining whenever I closed my eyes.

So, what have we learned from this? While some nurses are adrenaline junkies and thrive on such scenarious, I am not. If I want a rush, I will take up skydiving. I hate codes. I don't ever want to be part of one ever again, but with my area, it's almost a guaranteed certainty. I don't think I will ever get over the fear that grips me whenever I have to answer that call.

I don't know what ever became of the chocolate pudding cup either.


Mrs. McMitchell said...

Yeesh...I'm not even a nurse and it freaks me out. At the hospital I work in (which is very, very small on the hospital scale) as soon as I hear those tones over the PA I know to get the hell out of hallway because people are going to plow me down in the corridor with the crash cart.

Then I worry about it all night. I can't even imagine being in the thick of it. BRRRR!

I have enormous respect for people like you who do this every day. I know I could never be a nurse in a million years. And especially not after hearing tales of "digital fecal removal".

"The D" said...

Wait a sec you have circus midgets in you hospital?

Marti said...

Big hugs to you, darlin'. Rough stuff. Hope things go smooth as silk the rest of the week/month/year/career!

SmedRock said...

I want a pony!