code blue

at 23:36 tonight, I watched a man die...

0700: Morning rounds

We visit Mr. Walker. He is not looking well. He has leukemia, and
had been doing better. His leukemia should not be at the point to
make him sick yet, but he has had several surgeries for other
conditions and his body just hasn't responded well. We're treating
him for a lung effusion.

As we walk in the room we see him holding a pan up to his mouth. He
is vomiting horribly, and the vomit smells terrible. It is not normal
vomit, this is vomit that should be going out the other end. He was
supposed to go home today, but obviously something is wrong. He's not
going home today. Maybe tomorrow if he stops vomiting.

He looks like a ghost. As I leave, I think to myself, "wow, I'm not
sure he's going to make it."

23:08

I'm working on the computer, reading up on some of my patients,
checking their most recent lab data. "what is the padres score?" I
get on the internet and see that the padres are tied going into the
bottom of the 9th. "dang. I hope they find a way to win."

Tommy, the other medical student on my team walks in. "what are you doing?"

"just reading" i tell him. "i hope i can get this crap done at a
decent hour so I can get some sleep. I'm going to be ticked if I
don't get a few hours of sleep, but I have a lot to do before morning
rounds."

Just then, Nnenna, one of the the interns, walks in. "Tommy, you need
to go see Mr. Walker... NOW!"

Tommy is tired, and doesn't want to get up: "Why?"

Nenna: "Because he's going somewhere."

Tommy: "where's he going?"

Nenna: "south. go now!"

Tommy and I sprinted out the door of the dr's work room and headed for
Mr. Walker's room. As we run down the hall we hear a bell ringing.
Several interns and residents are running down the hall with us.
Somebody yells, "he's coding."

We enter the room and find a team of nurses trying to resuscitate him.
One is doing compressions on his chest while another is trying to
hook up a battery of medical monitoring equipment.

Orders are flying around.... "I need a femoral line!" "Does anybody
have an ABG?" "Where are those paddles?" "What's his code status?"

Allison, one of the critical care interns, enters the room and begins
to place the femoral line. He is totally naked now, except for a
diaper protecting his modesty, with a team of probably 12 people
surrounding him, each performing a task to try to save his life. The
questions begin to fly... "What's his story?" "What's going on with
him?" "Is he full code?" Tommy answers the questions. I stand
behind the crowd, observing, wishing I could somehow help the team.
What do I know? Nothing. Watch and learn. The doctors worked on a
dying man like a mechanic works on a blown engine. The only
difference was the pace. The pace was rapid. There was no pausing to
think, only action and decisions. And questions. "What did his last
KUB look like?"

Just then, one of the interns points at me and asks, "Can you do
compressions?" I step behind the dr. doing the chest compressions,
and wait for him to get tired.

"hold." He steps back and I step forward. "Anybody have a pulse?" nothing.

"resume compressions." I begin to compress just like I learned when I
was in boy scouts and took first aid CPR. Just like they taught me my
first year of medical school. 1.. 2.. 3.. 4.. 5.. 6.. 7.. 8.. 9..
10.. 11........ 44... why am I counting? 1... 2.. 3.. 4.. 5.. 6.....
20... 1.. 2.. 3.. "wow, this really is tiring," I think to myself. I
realize I'm counting not to count, but to pace the beat.

With each compression there is a grunt coming from the man's mouth.
He is intubated, and somebody is puffing air into his lugs with a
squeeze of a small plastic bag. There is a very foul odor in the
room. I look at the team. Allison is still working on the femoral
line. Blood is now pouring down his leg. We get an ABG reading.
"hold compressions." pause... I'm not thinking about anything...
just watching. My arms are getting very tired. There is a little
sweat on my forehead.

As I look around the room, I realize that this whole team of doctors
is nothing but a bunch of kids really. In fact, they're probably all
younger than I am. The nurses are older of course... they have a
weathered look. They have seen this many times before. One of the
nurses looks at me. He's about 45 years old and shakes his head
slowly. I know what he's saying.

5.. 6.. 7.. 8.. 9........ 35..... 50.. start over... 1.. 2.. 3.. "HOLD"

I step back... The intern who seems to be barking orders steps up with
a syringe. He sticks it right in between the ribs and directly into
the man's lungs.

"HOLD"

"resume compressions"... 1..2..3..

The smell is foul. The man's body jerks every time I pump his chest.
He is making noises like he is coughing, but by now I realize it's
only because we are pumping his heart and his lungs for him. His body
is cold. Each doctor is focused on their task. Allison has placed
her femoral line. Now she's reading ABG values. Several other
doctors have placed various syringes into various arteries. One in
each leg, one in each arm... They're injecting chemicals to try to
jumpstart his heart and taking blood out of various sites to measure
critical values. Nothing. The doctor who has taken charge shakes his
head... He looks younger than me.

"HOLD"

he looks around the room... "anybody have ideas? I'm out of ideas.."
Nobody says anything. "does anybody object to me pulling the code?"
Nobody says anything. He watches the monitor... there is no response.
He pauses. He looks up around the circle one more time. My eyes
were first. I don't move. Then several of the other interns and
residents just kind of make a soft approval. Nobody says it
specifically, but there is a soft sound... the sound of
agreement--agreement without anybody actually saying a word.

He pulls the monitor plug.

"What time is it?" 11:36pm.

The room slowly empties. People filter into the hallway. I walk out
into the hall and wash my hands.

A man walks up to me and asks my name... "The Wolf."

"are you MD?"

"No. MS3."

"I need your name on the code. I need everybody who was in the code."

I look back in the room. There is a pale body lying on a bed. The
room is a mess. There are wrappers and papers all over the place. It
looks like somebody died in there.

I make brief chit chat with a couple interns before I walk back to the
work room with Tommy and our two interns. "He was suffering." "It's
probably best this way." "That was no way to continue living."

I sit down at the computer... I have lots of work to do, but instead
of writing a patient report, I write an email.