Code blue

I watched a man die tonight.

In a way, I feel partially responsible. While I know this is completely untrue and irrational, the guilt remains.

From the time I first learned CPR at the age of 17 to present day, I've wanted to be a part of the resuscitative efforts of a patient.

A few weeks ago, I participated in final practicals for EMT students and part of their practical exam was that midway through the "call" the patient goes into cardiac arrest and out comes the CPR dummy. Being the assistant to the student being tested, I performed fake CPR multiple times, thinking that in the two years I've been healthcare provider CPR certified, this is the closest I'd get to actual cardiopulmonary resuscitation.

As my summer has progressed working in the emergency department, I admit, I'd always day-dream about the opportunity for a real live CPR in progress case. Whenever a cardiac patient would present, I'd think to myself "Is this it? Is this person going to code?"

Today, I didn't want to work. I don't like working weekends and I was not in the mood to spend the whole day indoors. Strangely enough, I found myself taking mental notes throughout the day; what I'd blog about if something emergent actually happened. We had the routine emergency visits; lacerations, back pain, nausea, motor vehicle accidents, but nothing to really get the long desired adrenaline rush.

This afternoon during my downtime, I went through the stacks of paper held inside one of the desks in the emergency department. The first paper to catch my eye was the Organ Donor Authorization form. As I scanned through it, marveling at the morbidity of getting to choose eyes, various organs, and tissues, I admit: I thought to myself there was no chance I'd ever actually see that form being filled out.

And then the call.

Dispatch paged EMS to a local hotel, stating "CPR in progress".

Initially, I thought I misunderstood. CPR? Watching EMS rush out the door though, I knew that this would be the call.

Setting the trauma room up, I asked the nurse what to expect, what a code is like. She explained how it would be chaotic and oftentimes there would be more help than needed. Pulling out the bag valve mask, we discussed protocol and then, we waited.

Over the radio, EMS stated they were on their way, the patient was bradycardic, but that CPR was in progress. They said to expect them in four minutes.

It was a long four minutes.

The ambulance finally pulling into the bay, I hear the patients wife screaming "Baby, come back! You can do this, I love you so much. Come back baby, we need you".

One paramedic is on the side of the stretcher, doing CPR.

The patient is unresponsive, skin tone is gray.

A rush of staff; on hand we have lab, x-ray, multiple nurses, EMS staff and of course, the doctor. The scene of a code is maddening; people yelling, IV's being started, CPR being done, drugs being injected into the patient and the cardiac monitor screaming, seemingly more amplified than ever.

The patient is quickly hooked up to what is called an AutoPulse, a machine that in basic terms, wraps around the patient's chest, compresses, inflates and does CPR. Next to the patient, a bag valve mask is hooked up and every six seconds, we breathe for the patient.

Thump, thump, thump. CPR in progress. Everyone is talking over each other, orders being shouted left and right. "Get the piggy back tubing!" "Get the coflex!" "Got an arterial stick over here!" "It's been two minutes, check his pulse".

Checking both carotid and radial pulse, there was nothing. CPR was resumed.

Stepping out of the room to grab something, his wife grabs me, screaming "Please! Tell me if he has a pulse! I need to know! I can handle it if he doesn't have one. If I were in that room, I'd bring him back to life". I tell her we're doing all we can, well knowing that this man is pulseless. She starts screaming, pacing, crying out to God that this can't be happening.

I enter the room again, and nothing has changed. Glancing up at the monitor, I see that he has a "pulse" but this is only due to the CPR being performed. His rate changes from tachycardic to asystolic. Every two minutes, he's re-evaluated for a pulse, every time I expect to feel something, but there is nothing.

His skin remaining gray, I look at his face. In between the tubes, the suctioning, the bag valve mask, I see a man who is no longer there; his blue eyes non-responsive. He is intubated, but no matter what is done, no matter what drug is infused into him, there is no pulse.

His wife enters the room, CPR efforts still in full progress. She is instructed to stand in the corner and an EMT hands over the bag valve mask to me, instructing me to breathe for the patient. And every six seconds, I squeeze that bag, hoping that at some point, he will return, that at some point, his heart will beat for him, that his respirations will resume.

The doctor tells his wife that his pupils are unresponsive, thus indicating no brain activity. She rushes to her husband's side, kissing his face, telling him that he needs to live, he can do this, they have grandchildren, that God has too many wonderful plans for him on this earth and that he can't leave her, not now, not yet. She cries "You can't leave me baby, you didn't say goodbye to me. You can't leave me!"

I squeeze the bag. His wife jumps up and yells "He's breathing! I felt it!" But it was me who was breathing for him.

Moments later, the wife announces "This is a dream, this isn't happening".

And then, the code is called.

CPR is stopped.

I stop ventilation.

The machines are turned off.

Staff quickly exits the room.

And suddenly, it's the wife, her now truly deceased husband, the doctor, the nurse and me. The wife announces that she needs her family to come in, to say goodbye.

In a truly heart wrenching moment, family members stream in, crying, yelling, pouring over this man, mourning his untimely loss.

In the following moments, the police arrive, victims advocate comes to meet with the family, the coroner is called.

I help prepare his body for organ donation.

I continually check his chest, feel his arm, squeeze his hand, hoping that maybe he'll come back. Maybe he'll be one of those crazy ER stories of "the guy who came back to life" after dying.

But he's gray. And he's cold. Rigor mortis is apparent.

Closing his eyes and placing a wet gauze over them for possible donation, I say goodbye to a man I never knew.