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.

[jackson145]

I work in the ED and during a code most people walking by wouldn't even know a code was taking place. The bosses tell us this is a sign of our success. We have other patients in the ED, often right on the other side of the curtain, so we always carry on as if it's "business as usual". Also, no matter how it ends, we have to directly to the next patient and give them the same 110% so you have to be able to stay steady.

[CaLLaCoDe, BSN, RN]

Someone told me of a recent code where the MD was struggling to communicate with the patient's RN and he held forth with: "My name is Dr.Y. ! I am trying to gain important information from the patient's nurse. Please be quiet!" Dead silence from then on...chatter bugs please leave the room!

[rnmomtobe2010]

It took me to learn the hard way that dying is a part of living. I am still taking pre-req's and I too am very sensitive to something like that. I think I would cry my eyes out and think that the ones who talk during codes are in fact rude. I have a deep respect for the dead or the dying. That's just my wo cents.

[SICU Queen]

I think I would cry my eyes out and think that the ones who talk during codes are in fact rude.

Do me a favor, then... stay the hell out of my room if I'm so sick that I might code. I don't want my resuscitating nurse crying over me - give me a chatty Cathy anytime.

Also, get back to me in ten years, after you've gotten some experience - then we'll talk about rudeness.

[flightnurse2b, LPN]

It took me to learn the hard way that dying is a part of living. I am still taking pre-req's and I too am very sensitive to something like that. I think I would cry my eyes out and think that the ones who talk during codes are in fact rude. I have a deep respect for the dead or the dying. That's just my wo cents.

then you may be very quickly, and very rudely, be asked to leave the room. hysterics, not chattering, will interrupt a code.

i understand that death is hard to see. i understand that it takes time and experience. but the best thing you can do, if you feel this way, is to let other people handle the situation and not be nasty because they are talking.

at first, i was shaky and unsure, and yes i cried after my first two or three unsuccessful codes like a baby. heck, i still cry at a pedi-code. but i realized, that death is a part of life... and you can do one of two things:

1. cry at every code, get burnt out and hate nursing... OR...

2. realize that yes, this person is dead, but what we are doing is a miracle. we are attempting to bring their life back. if the code is successful, celebrate. you have helped bring someone back from death....you do realize how amazing that is? even if its unsuccessful, giving your all and trying to revive someone is something to really be proud of. you should celebrate and be proud that you have the gifts and the skills to participate in a code. if that means smiling or talking during a code with the other members of the team so i dont lose my mind, thats what im going to do.

i am known to chatter, smile, or even hum when in the middle of a code. everyone knows im kinda wacky and unconventional, but i know my stuff. but if relied on my smarts alone, i would have lost my mind and quit the medical field a long, long time ago. my silliness allows me to be laidback enough to concentrate and do my job correctly and efficiently. and as a street medic, i have participated in numerous successful codes without a doctor present.

but skill and education is only part of what make a code successful.... teamwork, confidence and morale are components that come with experience and are so very important.

please dont be so quick to judge. life and death, in almost all fields of nursing, is something you will need to come to terms with in your own heart before you can help anyone else. being uptight only leads to exhaustion.

[patwil73]

In my job I have the priviledge of helping to run the code with the residents. I have seen many different reactions from those involved in the code. Mostly the younger a patient is the higher stress level (and hence less side talk) going on. However, after the codes I usually round back with the nurses to talk with them about what happened - and almost always, the ones that are silent during the code seem to be filling that silence with self-doubt.

They constantly blame themselves for failing to see warning signs (when there probably weren't any anyway), they beat themselves up for taking care of their other 6 patients instead of spending their whole time with the one that would eventually code, etc. Convincing them that they did everything they could have is almost more stressful than the code itself.

So please understand how beneficial idol chit-chat can be. It keeps the team relaxed enough to think through all those differential diagnosis and come up with solution after solution to correct the coding patient's problem. Also understand that although I may be "light-hearted" during the code, there are many nights after I get off that I come home, crawl into bed with my wife, and bawl my eyes out to release all that emotion codes create. Then I get up the next day and go in and do it all again.

Caring is not determined by the "front" people put up, but by their actions - and code teams care. If they didn't they could never stay involved in these situations.

Hope that helps,

Pat

[pinksugar]

It took me to learn the hard way that dying is a part of living. I am still taking pre-req's and I too am very sensitive to something like that. I think I would cry my eyes out and think that the ones who talk during codes are in fact rude. I have a deep respect for the dead or the dying. That's just my wo cents.

I have a lot to say regarding this post but I will hold most of it back because I don't think that you realize just how offensive this post is.

What I will say is that all of us have respect and concern for the dead and dying. That is not something that is unique to you. However, as you see more of these dead and dying folk (like many of us have), you will likely develop some of your own coping mechanisms to deal with them.

If you start crying during a code, please leave the room and please do not let the family see you. If the family sees you falling apart then they will fall apart also. Patients and families need medical staff that are cool, calm, and collected on the outside, even if they aren't on the inside.

[UM Review RN, ASN, RN]

Yes. There's plenty of time for tears after the Code.

Sometimes, they'll be tears of joy.

I tell you, even though I deal with geriatrics, I always feel like I've witnessed a birth when someone who survived a Code comes strolling down the hall to say hello to me.

It's happened a few times. I guess that's what makes me go flying into the room when I hear a Code called. There's always a chance.

[time4meRN]

After many years of critical care nursing I have become somewhat cold during situations like this. It's not that I don't care about the pt , and the family, it's just become a way of coping. When I first started ICU, I always tried to think of the pt as my mother or a loved one. After a while , that plays havic on your ability to continue in critical care for years on end. We do things that are terrible to our pt's every day.(vented pt's , tubes everywhere, edema, seepeing, all kinds of gtt's, pooping, sore butts, sore mouths, throats, gagging , restrained etc,,,it's really terrible if one realy thinks about it) but non the less nearly every one of our pt's are in this situation. It's usually not a happy, send the pt home with a new baby, oh happy day situation ! Most pt's die and there is much greif to deal with. As a nurse if I take each case to heart I would be unhealthy my self. Don't get me wrong, I love to care for my pt's and families, but we have to put it in prospective for my own good. There have been many times I cry with faimileis and there are those pt's that will always stick with me. But usually, because of the He@# they went through before they died anyway. That's really hard to deal with on a daily basis.

[MBsGirl]

I worked in ICU for 16 years, went through more than a few codes. I admit to having a more casual attitude towards them in my early years..not uncaring, but focused on the process at hand more than the person that was going through it. In more recent years I started thinking more about what a profound spiritual moment death can be, and feeling more respect for the person being coded. I've heard coworkers talk about how thrilling it is to be involved in codes..I used to feel that way myself. Now I remember that there is someone trying to die underneath all that excitement. I'm not criticizing anyone here, by any means...these were just thoughts I needed to ponder on in my own life and practice.

[oneofHIs]

I'm not a nurse (yet) and I haven't witnessed a "code" but I have helped with postmortem care as a CNA. My first time was in clinical, our instructor came and gathered about 6 of us to watch postmortem care. I had never seen a dead body except in a casket at a funeral. I felt very strange walking past the family standing in the hall while we filed in the room. They were cleaning her up and changing clothes and linens while they were talking to us students. The Pt was literally "flopping" around as they moved her to change linens. Her arm slipped off the bed and I reached to put it back on, when I felt how cold she was. I did not expect to feel that emotional about it. I instantly thought "this woman is standing before God at this very moment". I started to well up with tears so I stepped out of the room so my instructor would not see me. As I stepped into the hall, the family was standing right there. The daughter (probably in her 40's) said to me "Aww, she's crying. Is that your first dead body honey?" I was floored! I did not answer and went to the break room as quick as possible. Later, my instructor told me I needed to be more "professional about these things. Then, about 2 years later, I had a sweet elderly woman pass away while I was working night shift. Her family was expecting it and they were all gathered around her bed and singing her favorite hymns. We could hear them at the nurse's desk at 2 o'clock in the morning. They came out and told us she opened her eyes (which she had not done in a week) and looked up, smiled, then passed. The nurse and I went in to "prepare" her as the family left to make phone calls. That nurse was so caring! We gently changed her clothes, removed all tubes, changed her linens, combed her hair, positioned her peacefully, lowered the lights, removed everything but the bed, brought in more chairs for the family, and we talked about what a wonderful life she must have led to have so many loving people around her at her death. So far, those are my only two experiences with death in the hospital setting.