The words drifted around the room as everyone stood quietly engrossed in their own thoughts. The air conditioner rattled then chilled air touched my shoulders prompting goose bumps all over my body. Surrounded by people, the atmosphere was desolate. Pulling the blanket up to the patient's neck, I looked at her face. Her mouth was open, eyes closed. Death is hollow. In the absence of breath, no amount of warm blankets can bring back blush to the skin.
With my mind racing I thought of the hour long code we had just finished. I replayed it in my head, marveling at how in an instant death claims us. Gazing at her face I saw the patient exhale. I could have sworn I saw her chest move, but I know the mind can play tricks on us, especially in highly stressed situations. I drew my hands back to my chest and stared. I had seen dead patients do that before, but this disturbed me. Had she really just exhaled, it looked like she had inhaled too, but that wasn't possible. Looking at my co-worker to my left, I whispered, "she just exhaled, I know they do that sometimes but . . ."
My co-worker was staring at her too, but then he got a confused look on his face. The next thing I knew, he reached down and put his fingers on her neck and said, "she isn't dead."
Scanning the faces of the doctors, CRNA's, and nurses in the room with me, I momentarily panicked. I tried to make sense in my head of what was happening. How could she be alive?
Hand still on her carotid, my co-worker said, "Yeah, she has a pulse! I saw her tongue move and thought . . . wait a minute, she ain't dead." The anesthesiologist running the code looks at the CRNA after he felt the patient's pulse for himself and tells her to re-intubate the patient and that the code was resumed. The patient was re-intubated and the heart monitors reapplied, the IV drips had not been turned off. Everyone in the room seemed to come back alive and stood alert for further orders. Poised to continue giving compressions, I felt a slight soreness in my shoulders.
The patient's pulse remained strong enough that compressions were not necessary. The patient was transferred to ICU as soon as it was appropriate. Unfortunately the patient passed away later that day.
Reflecting on what has transpired, I helped clean up the room and get ready to continue doing cases. Just like that, the room was vacant of the signs that trauma and death had created. I thought to myself how quickly we are gone from this earth. The body is so strong and resilient, but at the same time very fragile.
I was the one who went to get the patient from her room. Her nurse had told me she was ambulatory and that she had taken all of her prep for her colonoscopy. However, while waiting for her to get blood drawn we had a chat. As we chatted, she told me she had not finished her prep and that she had not had any results from what she had taken. The phlebotomist struggled to find a vein, finally opting for a finger stick. Observing the patient's arms and legs, I saw she was extremely edematous. "Are you able to get up to go to the bathroom?" She cut her eyes at me, "Who told you I could get up? I haven't gotten out of bed in months!" I admired her spunk, and appreciated the attitude. I explained to her that I was going to take the stretcher back, then come back and take her to the department in her bed.
Later, as the procedure was in progress, something prompted me go into the room to check on her or my co-workers, I don't know. Things didn't feel right. I went into the room and shut the door, crossing my arms I began making small talk while watching the screen. As the EGD was finished, the tech began setting up for the colonoscopy, and the CRNA asked for someone to call the anesthesiologist. Things progressed quickly from there and soon we had the code cart open and ready and the patient was intubated.
Everyone took a role without much being said, someone stood by the code card and found the drugs that were needed, the CRNA used the ambu bag. One person began recording and another called the supervisor. The patient had a pacemaker, and the monitor showed a rhythm but there was no pulse. "Let's begin CPR," said the anesthesiologist. I was one of the compression people. I felt something give at the sternum, a crunching sensation and I cringed on the inside.
There was a striking calm throughout the entire code. I enjoyed being a part of the process. Usually once you hit the code button the room gets swarmed with people and you get pushed aside. Since we had everyone present that was needed, we did not hit the code button, at the request of the anesthesiologist. This time I was able to push medication, do high quality CPR and observe the whole process first hand. Putting my ACLS skills to work felt good, the head knowledge knitted together with the hands on skills. Everything was done according to protocol, with fantastic communication, professionalism, and level headedness. I am very proud of my department for a job well done.
We were all shocked that the patient revived after an hour of no response. We figure that the drips and the pacemaker combined help do that, however, it was not enough. Knowing that we had done everything possible helped me personally deal with it. I will never forget her, or her spicy words and self advocacy.
