My first code

A real code deviates from what they depict in medical dramas like Grey’s Anatomy. Television chest compressions are usually too slow and superficial – they are nowhere near forceful enough to sustain blood flow throughout the body. There is no foreboding soundtrack to hint at what’s coming – only the numbers that appear on the monitor that suddenly dip in the wrong direction.

Although I understood the magnitude of the situation as it unraveled before me, the monitor deceived me into believing that our fluid and pharmacologic interventions were enough. I watched the numbers bounce around, then steady at a reasonable value. They sat there for a short stint, before starting a slow descent.

I felt the air in the room change.

Everything moved faster, except time. The seconds dragged on as I watched more people filter into the room. More supplies were requested. More fluids and drugs were administered. Everyone’s motions were hurried and purposeful as I stood at the end of the table with my hands together.

I remember watching everything but not really hearing it all. There were orders being called and more groups assembled to assist, but I processed it like a silent movie. Everything was surreal up until I saw that chest compressions had begun. The stoic, lighthearted facial expressions that the room started with had all faded into concerned, determined ones.

I notice the time – only minutes have passed.

Shocks were administered between bouts of compressions. Indeed, they do call out “All clear” prior to defibrillation [Grey’s got that right]. Abruptly, all the hands abandon the patient for a split second as the body receives a jolt. Everyone resumes their work immediately.

I study the compressions – they are exactly as we were taught: at least 100/minute with 2 inches of depth. There are three people switching off, but they look tired. To my left, someone asks, “Have you done compressions before?” I slowly nod my head and am nudged to assist.

The individual doing CPR looks relieved as I step forward. During the administration of a shock, we quickly switch positions. My heart raced and adrenaline coursed through my vessels as I stepped up toward the patient. At that moment, it was as if someone else took over my body – I felt myself approaching the patient, but then I saw myself rhythmically pumping the chest. Everyone continued to work around me, but all I really registered was the patient and my motions.

It seemed like I had been giving compressions for at least five minutes before someone else took over; in reality, it was only a minute or two. The motion really wipes you out – I stepped back breathing like I had just run my fastest mile. My second round of compressions was tough, but I pushed on.

The code continues to run. After what seems like hours, it comes to a close.

In medicine, we fight time and nature with tests, drugs and surgeries. Over the years, we have been successful in extending life, however, we haven’t discovered a magic formula to live forever. The reality is that sometimes we delay nature’s course, but there is no stopping the inevitable.

Every single day of life should be lived to the fullest – even if external forces put up road blocks, we need to realize that they are temporary and sometimes out of our control.

I have wasted a lot of time and generated a hefty amount of cortisol worrying about things that I cannot predict or change the course of. But this, and the events of the last week, have shown me the importance of letting go. Not to say that I’m going to forget this patient or the experience – they will undoubtedly stay with me forever – but there is a stark contrast between healthy reflection and incessant “what ifs.” I wasn’t responsible for this code, but someday I will run one and if I continue down the path that I’m on, I will never be able to move on from nit-picking at details for years on end or forgiving myself for things that I could not alter, nor foresee.

I need to change.

I don’t expect a sudden personality shift, but I’m working slowly toward peace – as corny as this sounds, I think it’ll do me [mind & body] a lot of good.

Wish me luck moving forward.


Today’s inane image of the day:

Summertime is opportune travel-time. A couple weeks back, I made an impromptu trip to Milwaukee to celebrate my best friend’s birthday.

Remember that “exciting news” I had way back when? Well, now that things have finally settled, I can announce that I am expanding a bit and will also be writing blog entries for the Kaplan Medical blog, Med School Insight. With the exception of the first entry posted on the site, there shouldn’t be any repeat blog entries.

What does the new blog mean for this one? Well, the plan is to write more general medical school entries over there and stick to more personal narratives and OUWB-specific entries here. Hopefully it will all fall into place.

The surgical intensive care unit [SICU]

I open the heavy, wooden door to the unit. On my left are the patient rooms, equipped with minimal privacy; to my right are members of the healthcare team shuffling around. I continue toward my destination – a small room containing a couple desks and computers dedicated to mid-level providers – but cannot help but notice how eerie the unit is. Although there are at least fifty individuals within this space, it is relatively quiet, aside from the occasional blips emitting from the numerous machines all the patients seem to be hooked up to.

As I peer into a patient’s room, I notice infusion pumps, a ventilator and an endless spanse of tubing coming from all directions. A monitor displays various waveforms floats at the head of the bed. The bedding has a wallpaper-quality pattern on it that feels oddly comforting, despite the patient’s weak body sprawled upon it.

I watch the patient’s chest rise and fall in a rhythmic, forceful manner. There is a line straight down the center where the surgeon gained access to the heart. A wave of awe washes over me as I think back to the open-heart surgery I witnessed earlier that morning – it never ceases to amaze me how we can stop the heart completely and miraculously bring it back to full function.

Turning my attention to the bustling healthcare team, I see a group of nurses, physician assistants and physicians discussing patient care. …should this drip be stopped? …my patient is in a-fib, what’s our next course of action? …I think this patient is ready to be transferred up to the floor. Every workstation monitor is filled with the EMR [electronic medical record] software, with its plethora of tabs, buttons and drop down menus.

I walk into my target room and start to read up on the patients we will be rounding on. CABGs [coronary artery bypass grafts], AVRs [aortic valve replacements], MVRs [mitral valve replacements]… these open-heart surgeries have become a part of my knowledge. Although there are non-cardiac patients within the unit, they are outnumbered.

Rounds begin when the cardiac surgeon appears; most of the time it’s at 9AM, but it can vary. He reminds me of the “stereotypical-surgical-type” – confident and assertive. But over the course of my time in the SICU, I grow to appreciate his personality. Most importantly, the teaching is top-notch.

We assemble our team outside of the first patient’s room. One of the physician assistants presents the case and paints a numerical picture of the patient’s status [vitals, ABG, electrolytes]. The surgeon probes for more information – …why was this patient extubated? …what can we do about these pulmonary pressures? – until he is satisfied. Then, the group walks in.

“How are you feeling today?”

“Much better. When am I leaving this place? I want to take a shower!” We chuckle and assure the patient that a shower lies within the immediate future.