holiday code

around 4:30 yesterday evening, there was a code on my unit.  i was hanging blood in a patient's room when i heard the irritating alarm sound.  it goes off frequently.  but more often than not, it's an accident. so we don't always take it seriously.  but when it kept sounding, i excused myself from my patient's room to check out what was happening.  

sure enough, someone was grabbing the code cart and running down the hallway.  when i got to room 12, i saw one of our patients looking gray and still; a woman whose room i had been in only hours before to help give a bedbath at which time she was alert and oriented, chatting with her children.  she was a bariatric patient (meaning she was large in size and required a ceiling lift to get her from a bed to a stretcher).  and apparently she coded during this transfer (i believe they were trying to get her downstairs for a CT of some sort).  the room was crowded by a cot (for her two daughters to sleep on), an oversized bed, AND a stretcher.  there was hardly any room for people, let alone a code cart.  CPR started.  commands were being yelled.  and in the midst of a code, i recognized a school friend of mine shouting orders (we went to high school together and she is now a fellow at UW, doing a rotation with heme onc); we made eye contact and she waved.  

there wasn't much for me to do in the way of helping.  there are usually TOO many people in a code situation.  lots of gawking and curiosity.  i like to make myself useful.  so when i saw her 21 and 22 year old daughters crying in the hallway, i got them folding chairs and kleenex (small gestures).  and brought liters of fluids be administered.  and saline flushes to push drugs.  i grabbed the doppler machine to find pulses (that never became present).  and chatted with a brand new nurse who had a dear-in-the-headlights look about her, as if she will never be the same after having worked this particular shift and having witnessed this situation.  

is it appropriate to say a code ended well, even if the patient died?  apparently, as CPR was being performed and life-sustaining efforts were being made, the family discussed that their mother would not want to be on life-support.  her longterm prognosis was poor.  and her quality of life had already not been good.  so with courage and great sadness, they gave permission to stop.  with the nod of a head and the words, "time of death..." a woman passed.  there were tears in the hall.  amongst family.  and one nurse.  the patient's nurse.  mine welled in my eyes, but never dripped down my cheeks.    

as a side-note to this already sad story, i couldn't help but be aware of the fact that the patient's nurse (who might i add carried herself very professionally) must be suffering in a big way.  it's always terrible to lose a patient; to have cared for someone so intimately and then to witness their death - especially when it is such a gruesome end.  but this nurse holds a special place in my heart.  i mentioned her earlier this year.  at eight months pregnant, she went into labor and delivered a dead child.  she held her tiny one in her arms, breathless and heartbeat-less, just a few months prior.  and as i assisted the nurse in post-mortem care, wrapping a lifeless body in plastic and sealing a human life in a body bag, i couldn't help but worry that the nurse would not be okay.  that she would go home and crumble.  that even though she is courageous, she may not be able to return to work.  because who can function after such great loss.  

my fourth of july was nice, up until the code.  and it ended in a nice way, after work.  but for a few hours, it sucked.  codes on the fourth of july are not good.