Code blue

Abstract

I was in the viewing room of the emergency room today, trying to write a progress note on one of my patients. I was tired from being on call the night before and wasn't initially aware of all the commotion in the adjacent room. When I finally tuned in, I saw people rushing in and out, bags of intravenous fluids being hung, emergency medical services rolling in a stretcher. I heard a paramedic ask the emergency department physician if he should begin compressions. The physician nodded, the paramedic began cardiopulmonary resuscitation. I realized then: I was witnessing my first code blue. As I watched, I was surprised mostly at my sense of disconnect. Perhaps it was the large glass windows separating me from the resuscitation room. Perhaps it was one too many Hollywood code blues that had successfully desensitized me to the gravity of the situation. Perhaps it was the cold hard knowledge I possessed after 2 years of medical school, that once cardiopulmonary resuscitation begins very few patients ever truly come back to life. It was probably the latter. I knew the patient was dead before cardiopulmonary resuscitation ever began. Yet, I couldn't take my eyes away. I watched medical personnel taking turns compressing the patient's chest, cooperating so no one would tire. I watched the apparent lack of panic in the room. People moved quickly and efficiently. They likely all knew that in such a situation, one had to keep calm. Indeed, they had probably all been through it so many times before that it had become routine. A pair of nurses stood in the corner, chatting about their shopping while they kept an eye on the telemetry. As I watched, a life slipped away and I was taken aback at my own lack of emotion. Have I become detached and cold, I wondered? And then, just as quickly as it began, it was over. The staff physician thanked everyone involved and most of the people left the room. For a moment I thought the patient had come back, even though my better judgement told me that a man who just emerged from the brink of death would have more nurses milling about, more doctors barking orders. A nurse draped the body with a white sheet, covering his face and eyes. “That's the second death of the day,” she commented. And I returned to my progress note, more unsettled by my lack of a reaction than by the code blue itself. Had medicine already stolen my soul? Later that day, I returned to the same room to write yet another progress note. I looked through the glass windows, and saw that the man was still there. He was now surrounded on 3 sides by a partition, but I could see that someone had lifted his arms from underneath the white sheet. The arms were unmistakably dead. They rested in a stiff angle never known in life, their eerie stillness uninterrupted by the rise and fall of breathing. Only the arms of the dead lie that way. A blonde woman with a hospital badge slowly led 3 people into the room. They appeared to be a family: mother, father, teenage son. The hesitancy in their steps, the way they huddled close together as they walked, told me immediately that they belonged to the dead man and were here to identify the body. The blonde woman led them past me, into the resuscitation room where the dead man lay. I saw the woman nod her head, positively identifying the dead man as someone she knew. I heard her sob. My heart, still so alive within me, twisted. I knew then that my soul was safe. Radhika Dixit BSc Class of 2009 Schulich School of Medicine and Dentistry University of Western Ontario London, Ont. Figure Image by: Fred Sebastian