Environment of the room during a code

[RN2Bn2006]

First let me say, I am a labor and delivery nurse, so do not witness codes very often, in fact I've only been in on two - one in nursing school, and one in our ICU when we had enough RN's in our department for me to go and assist.

My question is - what is mood/environment like during codes that you've experienced? The two that I witnessed, it was strange to me - the nurses and medical personnel were just chit-chatting about their week, etc... while they did CPR - of course there were orders of meds being given and administered - with great care - but no one seemed sad, upset, serious, etc...... Now I must say - both of these were older people who had been sick - so maybe it's because of that - they no-one seemed to care? Maybe it's because I've not been around that end of it much, and death still seems so devastating to me. I could not help but stare at the person, and think that this is someones loved one - the most dear person in the world to someone - and their life is slipping away - someone's daddy, husband, brother, son. How would I feel if that was my loved one laying there, and yes - protocol and ACLS guidelines were followed, and everything possible was done, BUT - there was no evidence of concern in the people who worked on them - like it didn't really matter the outcome - it's just a procedure.

I just find this disturbing. I'm sure if was in ER, and someone came in and coded, there would be a sense of urgency and seriousness - I hope anyway. Maybe it's because the medical personnel knew these particular people were very ill, and it was better that they passed. I totally understand that. I guess I just can't understand how anything could seem funny or humerous, or trivial, when a life ends.

All I know is when we have a bad baby - one that requires complete resucitation, It is the most important thing in the world to me in that moment. Everyone ounce of me is seriously doing everything I can for my patient. Even in a situation where you almost KNOW the baby has really no chance, or will have severe brain damage. I believe it my job to try 100%, and out of respect for the family/patient, I could not imagine talking about what party I attended last weekend, while I was doing compressions!

Please, I am not trying to criticize anyone - I am just wanting to know how others feel about this, and what you have witnessed.

Also when I re-read this - I realized I sort of implied that the nurses in the code weren't trying 100% - that is totally not what I mean. Like I said - I believe good appropriate medical care was given, it was just the atmosphere/attitudes that I was wondering about. - Just to clarify.

[gonzo1, ASN, RN]

When a code comes in we have to get to work and do our stuff even though the outcome isn't usually good. One day one of our nurses was coding a family member and didn't even know it until the end because although we chat and it may sound superficial we are all very intent on trying to save the person.

I think most of us that are in a lot of codes have one that haunts us. For me it's a 6 y/o boy that died of an asthma attack.

Thank goodness I am not haunted by all of them.

A word of caution. One day we were coding a guy in female clothes, saved him and after the fact when he got better he told all of us everything we had said while we were working on him.

[RN2Bn2006]

A word of caution. One day we were coding a guy in female clothes, saved him and after the fact when he got better he told all of us everything we had said while we were working on him.

wow, that's interesting!

[pinksugar]

I agree with what the other posters have said. You just have to be detached from it all, or you can't do your job.

To the OP - I can absolutely see where you are coming from with this. You deal with babies. Babies are different, IMO. The way I see it is that most (older) adults have lived their lives and have had a good run of it. A little baby has had no chance to live or experience anything. For me, coding a baby (or a young mother for that matter) would be a truly somber event.

[flightnurse2b, LPN]

wow, that's interesting!

its true and its really freaky actually. we had a patient who used to come in the hospital all the time for dialysis, young woman all of maybe 26... who was blind. she came in unresponsive/resp arrest one night and i was doing her intubation. she miraculously survived and was in the ICU on a vent for almost 3 months before she got a kidney transplant. anywho, one day i got this call at work and it scared the living daylights out of me. i never spoke to this woman or told her my name, but i was carrying a conversation while transferring her upstairs to the ICU. she was clinically dead when i met her. "allison, this is (name). i just wanted to say thank you for helping save my life, and i hope you had fun at your birthday party." i seriously almost pooped in my pants. the next time she came thru the ED, as soon as i walked in the room, she recognized my voice and called me by name. i guess its true that hearing really is the last thing to go.

[Dental Hygienist]

Remember that TV is scripted...

So, do you mean to tell me that there is NOT dramatic music that starts playing when a patient codes?

But all kidding aside, this is a good thread, thanks for all the insight from experienced ER and trauma nurses...

[Blee O'Myacin, BSN, RN]

When a code comes in we have to get to work and do our stuff even though the outcome isn't usually good. One day one of our nurses was coding a family member and didn't even know it until the end because although we chat and it may sound superficial we are all very intent on trying to save the person.

I think most of us that are in a lot of codes have one that haunts us. For me it's a 6 y/o boy that died of an asthma attack.

Thank goodness I am not haunted by all of them.

A word of caution. One day we were coding a guy in female clothes, saved him and after the fact when he got better he told all of us everything we had said while we were working on him.

Hey, at least he was there to complain about it!! I think that one takes the risk of surprising others if they cross dress and code. No reason to be rude, but I imagine there was some tension breaking giggles when the nurse went to insert the foley. (Not saying it's professional, but we aren't robots!).

And for the record, any of the pedi codes I've been unfortunate to be a part of are never "routine". We expect our elderly population to die - it's a natural part of life. Having a kid in the trauma bay puts everyone on edge.

Blee

[Blee O'Myacin, BSN, RN]

So, do you mean to tell me that there is NOT dramatic music that starts playing when a patient codes?

But all kidding aside, this is a good thread, thanks for all the insight from experienced ER and trauma nurses...

And the doctor doesn't start beating his hand on his chest, wailing "NOOOOOOO!!! Take me instead!!!!!"

I'm getting a lot out of this thread too. I think that we are very demanding of each other as professionals, perhaps due to misunderstanding across specialty lines - perhaps due to our own sensitivity towards public perception of nurses - and it's all muddied up by the portrayal of nurses as nothing more than STD vectors (season 1 of Grey's anyone??)!

I think that as a student or other observer, it is very important to remain well after the code and discuss it with the staff if possible. We all do talk about it - no matter how futile the attempt going into it is - or how things take a sudden turn for the bizarre. We all do a share of reflection, and run things by one another throughout the day - especially if you are running to the next trauma room to do it all over again.

Blee

[EmmaG, RN]

Blee O'Myacin posted a wonderful response. I don't have much more to add.

I can appreciate what you're saying. And peds codes / neonatal resuscitations are different. And I appreciate that you say you believe good care was given. But that "good care" and good use of ACLS protocols requires a certain level of detachment, not staring at that the patient and thinking that he/she is slipping away. That is an emotional luxury which has no place during the code.

I don't mean to minimize the emotional impact --just saying that it's for later.

I participate in an average of 2-3 codes per week. Anything that you do that often becomes familiar. Yes, I sometimes do chat with coworkers during a code.

I've had other nurses comment on how low key and calm I am during a code. Little do they realize that after it's all said and done, all that excess adrenalin hits hard and I shake like a leaf.

[harley007]

When we have a full out code in the cath lab it is intense ... every time. We already have basic blood work complete, a 12 lead EKG up & running and the ultimate IV - a catheter to the heart, we don't even break open the crash cart because all of the equipment and meds we need are in our everyday drawer supplies - we just use the intubation tray. We can be coding anyone from a 98y/o cardiomyopathy patient to a woman that has just come down from the delivery room. The cardiologist is scrubbed in at the table and runs the code in a very rapid fire way with no conversation between the staff. We do continue to communicate with the patient as though they were awake and we struggle to just keep up with all of the med orders. Any extra staff is pulled from the other labs to help (Usually 6 staff max and perhaps a cardiac fellow) and most times we are jumping right into a temp. pacer and the balloon pump. As everyone on this thread has said the younger and more unexpected this is the more intense it becomes. We also come in from home "on call" at night or on weekends - nothing like that to wake you up in a mad hurry! Like any other prolonged CPR picture it is not very sucessful. My heart really gets tugged by the younger patients. Actually considering the volume of cases we do we do not have many deaths. I survive by realizing that this is one of the reasons I choose to work in this department and every code is a test of my best technical skills. As so many people have said as emotionally difficult as this is you have to accept this as a part of life or you wouldn't be able to come into work each day.

[AlabamaBelle]

I do Peds ICU. so I can only speak from that standpoint. Generally, the conversation is limited to exactly what is going on with the patient at the time, no extraneous conversation. We are all PALS certified, know our algorithms. The mood is controlled chaos - you just never expect/know when. We have a "well greased" MD/RN machine. We have pre-printed code sheets with med calcs already done. Roles are assigned quickly. We have the bedside RN administering the meds that the med RNs are drawing up. We have somebody recording the code. If possible, we have 2 "gofers". And always, if family is present, an RN is with them (as well as pastoral care/family reps). Many times, the person with the family is our NM if she's there.

We look calm and controlled on the outside, but the insides are quivering like nobody's business. It is nothing like TV, we all have our role and we perform that role.

It doesn't get easier, you just learn to deal with it better.

We also tell our secretaries that though the pleases and thank yous aren't verbalized at the time when we get down to one to two word "commands", they are there!

[SICU Queen]

I had a manager who used to get totally PO'd when he'd hear "chatting" at the bedside during a code. He said it was "unprofessional." I disagreed vehemently, of course. Most codes are run professionally and proficiently, and if people chatter it's because they use that as their mechanism of defense against what is usually a negative outcome. Oftentimes, immediately after the code is over, I do actually LOOK at the patient, silently offer my respects to their passage, and then go about my day. I simply cannot afford the heavy emotions that would weigh me down if I allowed every single code to seep into my brain and bones, you know?? But some DO stick around.

The worst code I've ever been in was a young pregnant mother who had an undiagnosed heart condition. Her mother found her down at home and began CPR. I was working L & D at the time and we were called at first to do a stat set-up for a c-section. Then they called back and said bring the trays down to the ER. We rolled down there and our OB was finishing up an ultrasound while the ER team was doing CPR and working the code. The baby still had a heartbeat so the OB elected to do an emerency c-section in the ER.

It was horrible... just awful. We did the c-section while CPR was in progress, which was no easy feat. We could hear the woman's mother sobbing uncontrollably outside the trauma bay while we were doing it, and EVERYONE was in tears, from the ER doc all the way down to the housekeeper (who was on the periphery trying to keep up with the massive amounts of "code trash"). There was not one word of idle chit-chat.

It didn't end well... both mom and baby died... and then I had to go back upstairs and be happy for the rest of the day while my patients delivered their babies. I still tear up when I think about it - I'll never forget that woman's slack, dead face, her tiny baby girl (that the nursery cleaned and swaddled for the family), and how the OB cried while she stitched up her patient's belly after the code was called.

What we do is HARD, and I try to never judge anyone for how they attempt to cope.

[TiredMD]

I was trained that brief chatter during codes is acceptable as long as it doesn't make it difficult for code members to communicate with each other. Also, an occassional joke (from someone senior enough) is always fun.

An Anesthesiologist explained to me once that at Hopkins (where she trained) the ability to crack a good joke while doing chest compressions was a highly valued skill, and the mark of a good physician.