Friday, October 7, 2011

Code Pride

"Oh my gosh, what is that?" I peered down the ambulance bay tunnel and saw the EMS team running, one of them making compressions on the chest of a man on the gurney.  "There's a code coming!"

Charge nurse quickly pulled a patient out of critical care in time for us to pull a new bed for our new patient.  He was undeniably over 400lb, maybe even 500, and that's not counting the missing portions of his legs below the knees.  Foul, cloudy urine was everywhere and the tangy, musky odor saturated the air, causing more than one nurse to wretch.  The EMT was making half-effort compressions, trying to keep his already urine-soaked body far away from the patient.  He was visibly repulsed and his interest in pretending to do energetic compressions in front of us was waning.  "You wanna take over?" he asked hopefully.  "Not until he's transferred to our bed," I replied coldly.  It took six of us to safely move the large body over to the bed, whence I placed him quickly on the monitor and jumped up, straddling his shoulder.  His large arms were heavy and hung down the side, limiting the space I had.  A foul smell arose from my plastic garment as his sweat rubbed onto me.  "Begin compressions!" And so I began.

Meanwhile, the resident was right next to me with the attending. I could feel his excitement and nervousness at gaining the opportunity to intubate someone.  To young doctors, this was a learning experience and an opportunity to shine, never mind who the patient was.  They obviously didn't identify with this man, who lived a relatively short and limited life.  Huge and diabetic, he lost his legs a few years ago, and ever since, had been immobile.  As he repulsed even the ER team taking care of him, I wonder about the people he knew- whether anyone might have been kind enough to keep him company.  In his final days, he was filthy and had fallen a few times, as his injuries suggested. When he was found by a visiting nurse, he was on the ground.  I breathed rhythmically through my nose as I watched the monitor to make sure my compressions were deep enough though the smell was intensifying.  "Halt compressions!"

The resident had intubated, but there was something wrong.  The tube wasn't down far enough.  The attending moved over and tried to intubate. "Get me the glidoscope," she commanded.  "I can see the cords now." The nurses standing by were nervous- "we need to be doing compressions." "Hold compressions. The cords are *right* there", the attending commanded as she dug the tube down further.  Finally, she looked up, "give me a bougie." By now, I was commanded 3x by various nurses to start compressions, but the attending wouldn't have it. The struggle on her face didn't say whether she was more worried about saving the patient or looking a fool in front of the crowd of people around the bed, but I had my opinions at that moment.  It had now been over two minutes, maybe more since compressions were halted.  I had recovered my breath and was ready to go. "Aha." The attending smiled her beautiful smile- the CO2 detector turned golden- the tube was in, and the patient was still asystolic.

After a few more rounds of compressions, the attending asked, "does anyone object to me calling it?" She called it and everyone scattered, as was customary. Nobody wanted to be stuck with helping clean the crusty, smelly body.  The resident then noticed some blips on the screen that looked like ventricular activity, so he wanted to continue, but was unsure.  "Are you sure? if you want us to continue, then we will continue," the attending prodded, but we could tell she didn't really want to. The resident mumbled something in an embarrassed manner and we did not continue. I was left to clean the body to make it presentable for viewing.  It was just another day in the emergency room, but for this man, it was his last.  They say hearing is the last sense to go- I sure hope he didn't hear what was going on in his last moments with us.


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