I recently participated in a code-blue situation in which a doctor was having a difficult time intubating. At least 2 people (including the doc) remarked that the patient had a huge tongue. A comment was made by a male-nurse that : "I hear he was popular with the ladies..." A few people (including myself) laughed out loud to this comment.
There were probably 8 people in the room, 5 of whom were women.
If you were at bedside during this code, how would you have reacted? If at all?
Jan 2, '06
Technically, yes, I would say that it is inappropriate (esp. if family members were around, which I assume that they weren't)
Would I have laughed- yes.
I think that random comments such as this tend to be said during code situations because of the stress- I think it lightens up the mood considering the situation- I often find myself thinking or saying random things and hear others doing it as well- I find that I work more efficiently if the mood is calmer...I don't think that non-medical personnel would find this funny or appropriate in any way (they probably can't even understand how a comment like this would be uttered in such a situation) but I think that it is a way of coping with the situation...
Jan 2, '06
Yes, inappropriate. Would I have laughed, probably...with a combination of adrenaline, and nerves, very strange things get said during codes that would never be said anywhere else.
One day we were slammed in the ED, had patient being held for ICU all over the place, on drips and it was in general a mess, no one had beds and since we were the trauma center, there was no place to transfer to...
A code was called in one of the ICUs and the charge nurse sort of perked up her ears and said, "Well, maybe we'll get a bad after that." She then immediately got all red and apologized to all of us, but really it was the stress talking, not some sort of monstrous person wishing death.
Jan 3, '06
I do believe that during a code there has to be a bit of humor @ times to break the staleness in the air. But at the same time I am old school in the way that this person is/was someones father, mother, son, daughter ex. As professionals we owe this person respect even in the moment of death. I am not ridiculing you for your behavior because we all have to do what works for us and let's all be honest- what keeps us sane. This is a hard job we have Nurses.
Jan 3, '06
I've always said that the general public would be appalled at the things that are said by medical, fire, and police personel during a code. It is our way of dealing with the stress of the situation. If you can use sick humor to keep the tension down, then you don't lose get tunnel vision and go down the the wrong path. There's never any disrespect meant when silly comments are made during a code, so please feel free to laugh, as long as there isn't a family member around to take offense. Just my humble opinion though.
Jan 4, '06
I've said lots of things in codes and in crises that maybe I'll have to apologise for on judgement day. But I don't think that the BIG JUDGE will hold them to much against me. As has been said, in the circumstances--it keeps you thinking instead of reacting.
Wonderful book written many years ago (the SEVENTIES!!!) called 'the House of God'; s'posed to be an account of an Intern's year at a 'great northeastern hospital'. One of the rules of the 'House of God' that the hero had to learn was: In the event of a Cardiac Arrest, the first pulse you should check is YOUR OWN.
Once upon a time, yer old Papaw had his appendix rupture. I chose to go to the little community hospital (where I worked part time in the ICU) 'cause who needs a major referral center and level one trauma center (where I worked full time) to handle a belly ache? So we fiddled around with diagnostic this and that until I had a sudden blast of toxins and developed a fever to 104 or more and had rigors. This got me carted off to my ICU where all the ladies who worked with me had a chance to rip my clothes off and cool me with ice bags.
God knows what ribald comments were exchanged!!!
Then the surgeon thought the OR was a good idea--even though it was a Sunday in a little town in Tennessee and they had to call in the 'on-call' OR staff. Most of them also knew me.
"Hi," said this smiling face upside down from me over the top of the guerney, "I'm Jeannie and I'll be putting you to sleep!!!" I peevishlly replied: "Well I hope you're having a better day than I am!"
And maybe because I was a smart#*@, when she induced me--I was still awake enough to hear the comments made by the OR Staff about me. Which they do not ever need to apologise for--but which they would NEVER have said if they knew I was over-hearing.
So I learned the hard way (the only way I've ever learned anything, it seems) to always ASSUME THE PATIENT CAN HEAR.
Older and possibly a little wiser
Jan 4, '06
I am not a nurse yet, but I don't believe that person's comment about the man's tongue was inappropriate. I believe we live in a society that expects far too much self-censorship, which isn't healthy.
My dad has endured over 20 major surgeries during his lifetime, several of them emergencies. He has a staph infection that has almost killed him twice, for which he takes antibiotics every day to keep it suppressed. Luckily, he encouraged in his children a sense of humor that often veers into the irreverent, and this has sustained us through all of these ordeals.
If any medical personnel overheard some of the comments my siblings and I have made in jest as we cried and prayed in the emergency room or ICU for our father, they would think we were very cruel people, indeed. Luckily, Dad would never think that and would instead be grateful that even in the depths of stress and despair, we were able to find something to wisecrack about.
I imagine it's the same for medical personnel.
Jan 4, '06
That's nothing. You should here oce of our cario vascular surgeons. You can't be serious all of the time. You'll go nuts.
Jan 7, '06
We recently had this discussion at work. A new grad described my coworkers as unprofessional during a code. Apparently she felt we should never laugh, even when something really funny happens. She came to me for support since I was in charge and was really mad that I didn't support her. My response was that hopefully one day she would also be so competant at her job that she can code a person and be so relaxed about it. HHMM, if I code do I want the staff that knows their job so well that they aren't freaked out or the staff that is so overfocused that they can't actually think. Noone made any hurtful comments or anything it was just one of those long codes where the patient tries out every rhythm and you just think "what the hell". I am on the code team and I think a little joke goes a long way to decrease the stress of the situation.
Jan 9, '06
I was just wondering why you had to add that it was a male nurse. I don't think if you were talking about any other professional workplace you would specify what sex the person was. A nurse is a nurse am I correct?
Jan 10, '06
Personally, I feel the obviously sexual nature of that comment is very inappropriate. I am not a prude or a stiff and do get amused at codes everyonce in a while. In todays age of quick lawsuits, I would advise that rn (male or female) to at least be careful. In many hospitals that statement could get written up in a incident report and interpreted as creating an hostile work environment. He might get fired...especially if he is known for that type of humor. A lawyer would love this guy. If a DON found out and did nothing she could get named in a lawsuit also.
PS I probably would have laughed, but at this persons embarrassing statement at an inappropriate time. Some people just dont get it. People skills and being appropriate are good things.
Being relaxed at codes is ok but not to relaxed. Recent studies show we perform very poorly at codes with avg compression rates of 50 instead of 100.
Would you want your mom or dad resuscitated like that?
In this months critical care magazine, Max Harry Weil MD writes about the sad state of in hospital code blues. One of his main complaints is that we rarely follow all the guidelines. Should we relax more or less....
Advanced Life Support
Last edit by sirI on Jan 10, '06
: Reason: TOS
Jan 10, '06
Inappropriate? Yes? Would i have laughed, no.
Jan 10, '06
inappropriate, no it was not. i think the fact that it was a guy dose have a big affect on how it was perceived though. if a girl said the commit i would think it would be percieved in a more inappropriate matter. following guide lines and performing the procedures correctly has nothing to do with a one line commit. in fact the commit made here, IMO helps the others on the team by putting the current issue of the pt's tonge being big on the "top" of their heads. IMO this would get others on the team to think, if we cant get the pt intubated what can we do "trach or other" and be prepared to preform whatever needs that come up. IMO if we simply follow guidelines and focus on the steps we lose the critical thinking aspect of our job, which is what makes all the difference IMO. not that we should not use the guidelines to guide us, but we should not fall into the "routine" and just go though the motions. the commit made is not only a way to deal with the stress, but also a way to get everyone thinking of needed "adjustments" in our routine for a given situation.
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