Code Blue: Where Do I Stand?

Jacqueline.Damm

A bed alarm went off. A chair alarm next. Silence. Then the code blue alarm. I didn't make the connection until I arrived in the room. It was the patient I had seen only mere hours earlier, a close friend really, and they weren't moving. They were laid flat, unresponsive and gasping with their eyes wide open. I shuddered, thinking about those piercing eyes, engaging me on multiple occasions over the last two years in many a room on my home unit. I hated that I was here in this moment, tearing the Ambu-bag from its plastic encasement to place forcefully, flush to that sweet face.

The room was chaotic. Every second, every movement, every choice was personal at this point. I could feel that our brains were simultaneously clouded and afraid. We were upset and unaware of the turmoil that was billowing from our joined essence. The room was powerful enough to explode in that moment. All forms of controlled demeanor and professional cordiality were out of the window in a screaming frenzy. Chaos. Utter chaos.

I couldn't think until we had our dear friend and patient on their ventilator in the ICU, echoes of their family wailing outside in a holding area for the unit. It was one thing after another.

I stayed behind with my charge nurse and one other nurse who had been caring for this angel all day until now. We waited, assisting in setting up equipment and placing a familiar frail form in the safest, most comfortable position we could muster. The oncoming ICU nurse was caught in another room, so we waited, watching heart rhythms dance across the monitor screen. I checked a pulse after what felt like every 30 seconds because I knew what was coming. I could feel it. I could sense it. And I hated it entirely. I knew it wasn't my call, but still I fumed in total selfishness knowing that this was a battle this tired body was going to lose. In the end, it was triumphant. This wonderful being was released from an exhausted, strained fleshy envelope. But still it stung. And it stung deeply.

As soon as everything ended, everything was over, immediately my mind was turning over each second, examining it with undeniable scrutiny. If it wasn't for the debrief that occurred shortly after, looking back at those high strung moments would entail an entirely different emotion in the pit of my stomach.

I write this to you not only to educate but to also heed a warning, or a thought perhaps. This code was unorganized. We were so stunned at the situation, so blown by our emotion when it happened. Amazingly, they lived. For a little while at least. In reflection, we did not assign roles, our voices raised and at one point, some egos came out to suggest outcomes and action beyond our control.

Yes, my friends, the ACLS video is possibly one of the most mind-numbing repetitive videos for education out there. But I have to tell you, it does this so that you remember your role. So that you remember what has to be done. It is performed in order that you see how well a code can be performed if you just take a breath and allow the situation to unfold. For this, I love that video, the education, the step-by-step guidance.

Just a few weeks ago I participated in another code that happened two days after I had recertified with my ACLS. The situation was extremely drastic and the patient's history was cumbersome. Two nurses had beat my arrival to the room and they were already bagging the patient and compressing the chest as the alarm sounded above. I arrived with the code cart and cracked that piece of metal with an odd calmness that had my mind humming with clarity. The patient's chest was covered by two alternating nurses, there was a nurse Ambu-bagging, one nurse recording, the nurse who cared for the patient was reporting as I was manning the cart and meds. We cared for that patient through three rounds of CPR and the first dose of epinephrine before a physician arrived. The second round of epinephrine clutched in my hand as I saw the white coat in the corner of my eye. When clutter attempted to ransack our flow I yelled and told those who did not belong to remain at the door until necessary. They all listened.

With fluidity, we near emptied the code cart from its entirety of medications. This patient had lost a pulse, respiratory effort, had seized on and off and had used up two Ambu-bags due to severe bloody regurgitation blocking the airway. Blood squirted to the high heavens as the warning rang out in the air through the calm voice of a very controlled respiratory therapist. EKG was able to come in, IV therapy and lab, all the while others remained at the door waiting their turn. Just like the story before this, the patient was able to return to spontaneous circulation and we hustled down the hall to the ICU for an open ventilator awaiting a great and terrible need.

Yes. The code concerning our friend could have gone more smoothly. We all knew what could have been better. But as we debriefed, when we wrote down what went well, someone powerfully and plainly noted, "they lived". As our rapid response nurse, and close friend, read this Earth-shattering, yet simple information, everyone exhaled and bit their lips. It was true.

Beyond it being personal, beyond our hang-ups, the patient lived. We all fell into silence as our friend continued her debrief, "just because you felt a way about a certain situation doesn't mean that was how you performed." The light went on. We knew the code stung, and that it was going to sting. We knew this patient. We loved this patient. We called this amazing person a friend. Yet everything we heard, despite our better efforts and every hang-up, were all true. They lived.

None of this, my friends, is being told to you and written in vain. Immediately after this code, I emailed my boss, our patient care supervisor, and our shared governance president, specifically asking a call of action on this front. We needed this situation to happen to know that even though we have the power to change the circumstances of a person's life, ultimately, it's not our call. On an emotional front and skills front, our lives had been shaken. Our resolve had been tested.

We have the power to make ourselves as ready as possible so that when the tide comes we refuse to sink and be overtaken, but rather swim and fiercely so.

It is our duty and our honor to be everything for those who wish to have every precaution taken every stone unturned.

This duty is furthermore calling us to be as educated, dedicated and as willing as our faith and abilities allow us.

Keep fighting the good fight.

Code Blue: Where Do I Stand?

About Jacqueline.Damm

More Like This