The First Code...and the Brownies That Followed

It was turning out to be a typical weekday morning. I had just seen a patient and was working on a progress note when the overhead speaker announced a CPR code. My mind instantly went to the Emergency Medicine lecture from last year when my professor warned us that medical students help out with the manual labor in crisis situations - cutting clothes off of patients in the emergency department, checking any and all pulses, and chest compressions. As soon as I heard the code overhead, I knew what was expected of me. The intern I was working with was already halfway to the exit when she turned around and saw me frozen to the nurses' station.

"Come on, that's us."

I snapped out of my musing and followed quickly behind her, weaving in and out of the hallways until we reached the mass of people filing into the room. It was eerily calm. I remember thinking how it was nothing like what I saw on tv. No frantic running down the halls or dramatic music playing in the background. Everyone knew where to stand, what to say, and how to do it. Everyone, that is, except me. I slid my way through the physicians and nurses talking to each other, consulting ACLS pamphlets and scrutinizing the readings on the machine, until I was in front with the other medical student on my team. We both stood there, just watching and trying to absorb the situation. There was the patient in the middle of the room, surrounded by white coats, tubes, and a caucophony of buzzes and beeps. One nurse was stationed at the patient's bedside in charge of administering the medications, while another nurse was at the patient's head providing air via the ambu bag. A physician was already doing chest compressions, with another doctor behind him ready to take over.

No one had to tell us what to do, we just instinctively grabbed a pair of gloves from the side and got in line. My entire body was shaking with the adrenaline rushing through my system. I watched each person before me as they lined up their hands with the patient's sternum and pushed down. Forceful and fast. As my turn approached, I thought back to the practice scenario during the Medical Simulation course last year. I had been in charge of the chest compressions, and they weren't good. I was too slow and I hadn't compressed enough. Our team's efforts had saved the med sim robot's life enough to put him into a vegetative state. Thankfully that was a pretend situation and I had learned from my mistakes so that in this very real moment with this very real patient I could do better.

The fatigued student who was working on the patient turned his head, his widened eyes locked on mine.

"Are you ready?"

I stood next to him, by hands clasped together and my elbows locked, ready to take over his position. Without hesitation, without thinking about what was to happen, I went into automatic "get your act together because this is an emergency" mode and exclaimed, "Ready!"

With each compression I felt the patient's sternum and ribs give way, grunts escaping from the patient's bagged mouth. I mentally apologized to him in my head, "I'm so sorry this is hurting you but we want you to live." The patient was a heavier-set male, so I used whatever upper body strength I had to forcefully pound away at his chest, his edematous abdomen shaking in response. My muscles were soon on fire and I looked behind me to the next person in line.

3-2-1-swap

I took my place at the end of the line, praying my arms would recover in time for my next turn. I kept thinking that this was nothing like ACLS class. Only months ago our instructor had made jokes and kept us amused to stay engaged for the 8-hour training session. We re-enacted bizzare scenarios on dummies that clicked when the compression was correct. But in this moment there were no jokes and no clicks from a plastic chest. Is anyone ever prepared for the rapid transition from pretend to reality in the third year of medical school?

I was set to take over chest compressions when a female resident shouted at me from across the room, "Make sure there's a guy after you to take over." For a brief moment I felt my feminism blood rise within me. I wanted to shout back, "I'm just as good as any other guy in this room." But then I quickly understood what she meant. In fact, I wasn't as good as the other guys in the room - physically speaking. My upper arms were puny compared to the rest of the males in the line behind me, and chest compressions are all about upper body strength. So, I was just relief for the male physicians and students; a pause for them to catch their breath and rest their weary arms. But as tiny as that role may have seemed, I was ready to do what I could to help out during the code.

Round 2 - I turned my head away from the patient's face as I resumed chest compressions. I stared at my hands and focused on pumping his heart. It was then that I overheard some of the residents point out the mottling on the patient's extremities. Both of his legs were purple/blue up to his knees, and both of his hands looked as if he was wearing gloves in a matching color. The human body was doing what it needed to do to survive - shut of blood supply to the extremities and channel it to the vital organs. The signs of death were making its way up the patient's body, and I was doing everything I could to fight them off each compression at a time.

My arms ached after four rounds of chest compressions. Nearly 40 minutes of an entire team of medical professionals working together to save this patient's life. There was nothing else that could be done. The patient was pronounced. Time of death...

We fell silent and filed out of the room. I was halfway out the door when I heard a nurse exclaim, "He's got a pulse and his face grimaced!"

Resume CPR

I stood back and watched as a new team of energetic chest compressors lined up to take their turn. Only after a few minutes the cardiologist confirmed that the patient had his own rhythm. The code was over, the patient was alive.

The doctors and nurses returned to their work, everything went back to the way it was...except for me. Was I the only one who felt shell-shocked about what had just happened? The patient had been a fighter the entire time and came back from death. We had beat on his chest for 40 minutes and pumped him full of meds to keep him alive. But no one was talking about it, no one seemed phased by what had occurred. The daily routine returned to what it was before the code. There are, after all, many other patients in the hospital that need care.

I felt foolish for feeling, well, just about every emotion after that code. I tried to follow everyone else's lead by seeing my next patient and writing a progress note before rounds, but I had to take a few minutes first to quietly sit in the lounge, collect my thoughts, and recover. The patient I was about to see was nervous about her upcoming surgery, I didn't want to add to her anxiety.

I was thankful for the end of the day when I drove straight to the market, picked up a box of semisweet chocolate, and returned home to my awaiting kitchen. After a couple of hours I had two batches of what I called CPR brownies sitting on my counter. In complete me form, I had baked the traumatizing experience out of my system and it resulted in a pan of cream cheese brownies and an experimental recipe of cinnamon/espresso brownies. They were a hit the next day at rounds.

I guess there really isn't a "typical" day at the hospital, and that's one of the many reasons why I enjoy medicine. Each day is different, and there will be plently of the unexpected. Unexpected situations and unexpected reactions to whatever happens. That's third year for you...