My First Code Blue
This is a fictional piece of writing based on my first experience on the code team. Many parts of this story are fiction, although most of the accounts of the actual code are true as I remember them. All names have been changed.
12/03/12 1934: Beverly puts her call light on to get help going to the bathroom. "My God!" is her response to the toilet seat's temperature on her bare bottom. Bathrooms are never warm enough in hospitals.
12/04/12 0102: "Rapid response, 7th floor. Let's do it," Tony says to me. "Yes!" I say. I throw off my sweater, grab some gloves and head for the elevator. I can already feel my heart pumping harder. Nothing better than a shot of adrenaline to wake you up in the morning.
12/03/12 1950: As Beverly gets back into bed, she asks for the nurse to put the TV on The Voice. She follows the show religiously. She used to sing when she was younger, but never in front of anyone, she was too shy.
12/04/12 0104: A crash cart and a couple frantic looking nurses are our signals where to go. The unit is dim, decorated with a Christmas tree, ornaments and ribbon, and the ambiance of blue light reflecting the waves from a fish tank mounted in the wall. It's calm.
08/12/09 1634: David lights up the grill. He had bought 22 pounds of hamburger meat on sale and he planned to grill it all before it got too cold. He carefully placed 6 patties on the grill. Two for him, one for her, one for each of the girls, and one for Mongrel. Mongrel didn't usually eat what the humans did, but then again, David didn't usually buy 22 pounds of burger.
12/04/12 1257: Beverly isn't acting right. She's breathing too fast. Beverly's primary nurse is at lunch. The nurse looking over her patient's decides to call a rapid response. Good call.
11/29/12 1424: "Mrs. Bush, we are going to admit you to the hospital. Hopefully we'll just monitor you for a few days, but I think you need more fluids and some tests." This isn't what Beverly wanted to hear.
12/04/12 0105: Entering the room presents a black, overweight female, diaphoretic, extremely short of breath, showing spastic motion of extremities. Pt is sitting up, on 4L NC. HR 124, O2 sat 99%, Respirations circa 30/min, BP unable to be obtained by machine and manually. Pt intermittently c/o being unable to breath, and chest pain. Lung sounds have coarse crackles, audible without stethoscope.
08/12/09 1640: Smoke wafts in spurts from inside the grill. David is whistling. Beverly arrives home and comes out onto the back deck. David doesn't notice her at first, but when he does, he turns around and gives her a kiss on the cheek. She looks up at him. "He said it's cancer." She was never one for beating around the bush.
12/04/12 0112: Dr. R. arrives. I like Dr. R. He's young, smart, approachable, and attentive. "What's going on?" he asks. Tony explains that it's hard to get a definitive complaint from her, but we've given her a Nitro and 40 of Lasix before he got here. Dr. R. begins working her up. Patient begins stating, "Please don't let me die. Oh Jesus. Oh Lord."
10/07/12 2000: Jasmine and Shana are in their beds. They've shared a room most of their life, a living arrangement which they've loved and hated, sometimes even in the same day. Beverly walks in to kiss them goodnight. "Ya know girls" she says calmly, "I'm not always going to be around to kiss you goodnight." The girls look up confused. There's got to be a better way to do this. she thinks. She's again reminded that her life did not come with an instruction manual.
11/29/12 1824: Of course ER brings me a patient 30 minutes before shift change. Ashley RN thinks as she walks into room 715. She knows the admission questions by heart. "Do you have any allergies?" "Not that I know of," says the patient. "Do you smoke?" "Nope." "Are you afraid of anyone, or feel like anyone is taking advantage of you?" "No, not at all." "Do you have any spiritual needs while you are here? Like, would you like someone to pray with you?" "Um... yeah sure." Great. Ashley thinks, Now I have to put in a pastoral care referral. Add that to the list.
12/04/12 0120: Code Blue room 715. Code Blue room 715. A CCU nurse hands me the clipboard. It's my job to record. Pt's teeth are clinched and her eyes are rolled back in her head. A chaotic but intentional mess ensues as the team simultaneously prepares for intubation, places the Zoll pads, lowers the HOB and places a backboard. A large amount of dark brown, partially digested vomit expels from the patient's mouth. What a mess. As anesthesia attempts a blind, obstructed intubation, we check a rhythm. Normal sinus. No pulse. Begin chest compressions "Give one of Epi and one of Atropine." Dr. V is calling out orders. He's old school. Who knows if he's aware that Atropine is no longer indicated for PEA. I wasn't going to tell him otherwise.
12/04/12 0134: David is a heavy sleeper. So are the girls. The phone rings 4 times, and then goes to their answering machine. "Hi this is Jaclyn with Mercy Hospital. Please give us a call as soon as you can, it is an emergency. Thank you."
12/04/12 0137: We are running out of ideas. The patient has clearly aspirated large amounts of vomit. She's still in PEA and the electrical activity is declining. The members of the team are focused on their tasks. I look at Dr. R. He's looking at the patient. "How old is she?" I ask aloud. Mumbles of "I think 60's" and "Probably late 50's" are hushed by a definitive voice from the hall which states, "She's 42." A silence passes over the room. Everyone is thinking the same thing; that's young. "What's her rhythm?" Dr. R. asks me as we change CPR personnel. "I'd say a fine V-fib." "Okay let's shock her then." Dr. V. walks in from the hallway. "Okay I just talked to her cancer doctor and he says that he thinks we should call the code, that it's futile."
12/02/12 1945: "Hi I'm Pastor Mark." "Hi there," Beverly responds. She's a little nervous. She hasn't actually prayed with someone in a long time. They talk a little bit and get to know each other. "Okay, would you like me to pray with you?" "Yes" she says. As Pastor Mark began to pray, the nervousness went away, and very quickly tears started rolling down her cheeks. "Thank you" she said when he was done. He left and Beverly was alone in the room. She couldn't stop smiling. Smiling and crying.
12/04/12 0139: The decision is made. "Time of death, 0139. Good job guys." People begin to file out of the room. Tony, me, a GN and a student decide to stay and clean her up. My adrenaline is still pumping. I'm ******. I feel like I just lost. The room looks like a medical supply cart exploded. We begin to take off her soiled gown, wash her, and change the bed. Someone says, "That was a really good learning experience." I look down at the patient. Beverly Bush, 42 years old, covered in vomit, eyes wide open, died surrounded by strangers. She will never again watch another sunset, sneeze from sniffing the bubbles of a freshly opened Dr. Pepper, kiss her daughters on their foreheads, fall in love, eat a frozen ice cream sandwich in the bathtub, feel the august wheatgrass under her bare feet, or hold her husband's hand. I'm violently reminded of how fragile and fleeting life is. I'm reminded to truly appreciate the people I have in my life. Code blue's are not cool like I once thought. Yes they're exciting and amazing but all the while, they involve someone dying. A person. Not a patient, a person. A real person who loved and lost and lived just like me. So yes. You're right. This was a good learning experience.Last edit by Joe V on Dec 7, '12
Mully is a new graduate RN working on a busy Stepdown. He is frequently on the code team and often found working overtime. He loves his job.
Joined: Nov '10; Posts: 285; Likes: 890
SRNA; from US
SICUDec 7, '12Writing style is a little confusing at first, but your message is loud and clear.
Death is hard on all, even when it is the death of someone who's quite far up in years and has lived a long, long life. Even when the pt and/or loved ones have suffered for a long time and welcome death.
We nurses see it a lot, must learn to deal with it, learn to handle our emotions well enough to function when our patients need us to do the very last things for them that we can. It gets easier, don't you think?Dec 7, '12Nice use of en media res there! I love when writing styles are changed up....and this made me tear up. Thank you so much. From a nursing student.
Oh, and I saw a deceased person for the first time in the hospital last week during clinical (I assisted the nurses with post mortem care)....I thought to myself about how her family felt, how she felt about dying, what she liked to do when she was alive, what her job was like....and I noticed she was in decerebrate position, and I wondered how long she had had brain damage before she died. She wasn't just a patient to me, she was a person. I'm so glad to read an article like this. She wasn't my patient, but it got me thinking.Dec 7, '12Thank you for the article. Sometimes we need to step back and look at our patients, as people not a medical number.This reminder is a great example.Dec 8, '12I wonder if we ever forget our first code...I know that mine is still fresh in my mind, four years later. Sweet old guy in a SNF, very loving family, who was on dialysis. I had talked to him many times in the dining room, but this was the first time he my patient. I changed his hand bandages (he had fallen a few days prior), and he kissed my hand in thanks. When I returned from dinner about 20 minutes later, he was dead in the gerichair at the nurses station, but nobody had yet realized it. We tried CPR, to no avail, and EMS called it. I am still grateful that we had a chance to talk before he died - he expressed no complaints, denied pain, normal vital signs; he just closed his eyes and died. We should all pass so easily. The MD said that she kept meaning to discuss his code status with his family, but hadn't had the opportunity; she wasn't surprised by his death.Dec 10, '12I remember my first code quite vividly... Actually, all the codes I've worked have been ingrained in my memory. It's as if the situations are etched in my memory. I don't know if I'll ever forget those situations...
Also - where I worked as a med/surg nurse - we took care of a lot of DNR/DNI patients that may or may not have been comfort care only. Even knowing all about the patients, and even if they are at peace with their prognosis, it's still difficult to have a patient die during a shift at work.Dec 11, '12A wonderful, sad, read! Thank you for sharing...
I hope that I don't have to die in a hospital, and God willing pass away while reading a "good-book" like my great-grandmother did in 1971...
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