My first code blue
Time when I witnessed my first patient die: From doctor's perspective
Stepping into a hospital for the first time as a medical student is a strange dichotomy. It is becoming a part of learning process to become a physician and experience life-and-death situations simultaneously. Many times, you will need to step back and observe and stay out of the active personnel’s way. This article which appeared in KevinMD was written by Jenny Hartsock; She is a hospitalist who blogs at "Doctor of a Certain Size." In this article Jenny shares her first-hand experience of witnessing her first patient die in the initial workdays.
The familiar sound of ambulance
In one of my early shifts in the Emergency room at the hospital, an ambulance brought in a man to the trauma bay during shift end. A patient in his 50's had collapsed suddenly while mowing lawn at his home. He was rolled in on the gurney with the EMT kneeling over him doing chest compressions.
The ER staff swung into action as soon he was transferred from the gurney to the table where one nurse was doing chest compressions while another was trying to place a peripheral IV line with several more gathering medications and supplies. The ER resident and doctor were intubating the patient in between the violent rhythmic jerking movements of his body with the chest compressions. Another resident was trying to get a femoral IV line at the patient’s groin.
The bowels evacuated, filling the room with the smell of feces followed by the scent of blood from an unsuccessful femoral line attempt. The team would pause in between and check to see if any signs of life were present, pulse or signs of cardiac activity. The patient’s heart was in ventricular fibrillation, so the attending doctor yelled “all clear” and a jolt of electricity shocked through the patient and then the staff resumed their compressions.
Code blue approaching
Reviving someone is messy, physical work — and the staff called me up to do chest compressions. I concentrated solely on the strength and rhythm of my compressions while standing atop on stool. During revival, blood filled up in the tube and was seen bubbling out with each compression. The respiratory therapist suctioned to clear the bloody secretions and allow for air to move resulting in splattering of blood on everyone in the room.
Time seems to slow down during a code blue. Knowing how brain is deprived of critical oxygen with every single passing minute; the patient had been down for approximately 10 mins before the arrival of ambulance. By the time our ER team was working on him, he had been without oxygenation and cardiac activity for 25 minutes. As time in a code goes on, it slows down even more.
The attending called the time again - 45 minutes had passed since the patient was found down in his yard. “Hold compressions and check for pulse,” said the attending. Silence. No electrical activity of the heart, no pulse, no breathing. In those last seconds, silence overtakes the room. “Time of death 1746.”
The moment that followed by
What I saw and heard after the patient's death was beyond words: doctors cleared quickly from the room to attend other patients; the nurses went about removing invasive medical equipment from the patient’s body, cleaning the body fluids and debris efficienctly with no or little display of compassionate gestures like closing the patient’s eyes and resting their hands on his forehead for a moment.
The attending physician was speaking to the family in a room next door and next moment, I could hear wailing seeping through the walls of family. The wails and cries grew louder when his family gathered around patient's lifeless body for one last time....
As I sat in my car in the end of the shift, I couldn't hold back my emotions and started sobbing in the garage. I had just witnessed my first patient die. I couldn’t forget the sound of the wife’s wailing screams, the violent physicality of the resuscitation attempt with the forceful chest compressions, the invasive devices being inserted into the patient, the body fluids commingling in the room. To know his life was gone in an instant and that his family would never see him alive again hit me like a truck. And then I did what everyone in medicine does - I went home, and I came back the next day and did it all again!
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