My First Code

Ruby Vee, BSN

I hadn't been a nurse for very long, but I was asked to team lead, do charge and supervise nursing students. "Don't worry," I was told. "These are our students, so they can help you out." As the first BSN grad ever hired in our hospital, I took a lot of grief from the diploma nurses who went to the hospital's nursing school and graduated knowing more than I knew after a year of nursing. Those nursing students did teach me more than I taught them, though.

I worked in a smaller community hospital surrounded by farming community, and many of our patients came into the hospital straight from the milking parlor without stopping to clean up first. Consequently, it was common for admission orders to say something to the effect of "bathe patient before seen by a physician."

The day that Mildred came in straight from milking and smelling of manure, I was the team leading. My team consisted of two student nurses from the diploma program, both of whom were city born and bred. The odor of manure wasn't something with which they were familiar or wished to become familiar. They didn't even wait for the "bathe patient" order before starting to plan their attack.

Mildred was in her late fifties and her admitting diagnosis simply stated "work-up." work-up for what, I don't know, but it may have involved the fact that at nearly six feet, she weighed over 400 pounds and had to be weighed on the livestock scale. In those days, patients that heavy were extremely rare. She was alert and oriented and very, very embarrassed when she had to explain to the students that the reason she hadn't bathed herself when they set her up with soap and towels was that she couldn't fit into the extremely small shower in the patient bathroom.

"We figured it out, Ruby," the students explained to me breathlessly. "There's a tub in the back of the equipment room, and if we move all the equipment out, we can get her in there to use it. It's a really big tub!" after attempting to assess Mildred, I was in favor of any attempt to clean her up. Evidently, she didn't fit into the shower in her own bathroom, either. The dirt was so embedded that it was obvious she hadn't bathed for a very long time. Her skin was dry and flaking, and the students had Keri oil and Keri lotion, clean gowns and a pile of fresh towels. I continued on with my meds and treatments, confident that two senior diploma students would have no difficulty bathing even a very large ambulatory patient.

My first clue that there was a problem came when one of the students rushed up to me breathlessly. "She's stuck, Ruby" she wailed. "We can't get her out!"

What? How could even a 200 kg patient get stuck in a tub built for two or three or four? (It was a really big tub!) by the time I got to the tub room, a crowd was beginning to congregate and Mildred was gasping for breath, her skin an alarming shade of grey. Allison, one of the students had ahold of an enormous arm, that was suspiciously shiny. "She's stuck!" she cried. "When we couldn't get her out, we poured in some Keri oil so we could slide her out."

"How much Keri oil?"

"The whole bottle."

"The whole 12-ounce bottle?"

"No, Ruby. One of the big bottles." (This being before unit dose made it to that community hospital.)

So now we had an enormous, grey patient stuck in the bathrobe and oiled up like a pig at a greased pig catching contest. No one could get a grip on her. Meanwhile, the crowd in the doorway grew, inflated by the odd patient and visitor wanting to know what was going on. Twice, we almost pulled Mildred out of the tub, but both times she slipped out of our grasp and plopped back into the tub. Finally, someone got the idea of sliding bath blankets underneath the patient and pulling on the bath blankets. Success! Out popped the patient and only two of the staff went to the er with back injuries.

But now we had a different problem. Our enormous and fully lubricated patient was no longer breathing at all! We pulled her out of the equipment room and into the hall where there was room to work. Unfortunately, the crowd had grown -- everyone who had any reason to be on our floor had stayed, entranced by the unfolding drama. Someone started CPR, doing just fine until they got to the part about the chest compressions where they slid right off the chest. Someone else gamely took their place, also sliding off. The addition of some towels helped, and CPR was officially underway, the code cart was coming and one of the bystanders happened to be the patient's attending wearing a very nice, brand new suit. (No doubt you see where this is going.)

Shocking a patient lying in a 1:1 mixture of Keri oil and bath-water (ok, it wasn't quite that bad -- but almost!) is a bit problematic. Electricity was arcing all over the place, and the intern, a very nice and very young woman named Jennifer or Jessica or something to that effect was out of the action when she intercepted rather more electricity than the patient.

We worked on that lady for what seemed like hours but to no avail. Probably we should have been giving rescue breaths while trying to drag her out of the tub . . . And there's a lesson in that. I was young, devastated by my first code and the mistakes I had made and hurting for my patient's family. At the time, it seemed like a freaking disaster. But now with the benefit of 30 years or so of hindsight, I can look back and laugh at the whole scenario. As unfortunate as it was, it was pretty darned funny. Especially the look on that attending' face when he stood up after the code and surveyed the ruin of his once pristine brand new designer suit!

My First Code

About Ruby Vee, BSN

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