“Have a good break!” I said, half meaning it, half wishing I didn’t have an extra patient for the next hour.
“Oh wait!” My break buddy said, turning on foot, “I have the code pager.” She held it out toward me expectantly, but then hesitated and pulled it back toward her, “oh wait! Are you done the training? Are you certified?” She asked.
“I sure am!” I said proudly, “I’d be happy to hold it!” It was true, it did excite me. The novelty hadn’t worn out yet. I took the pager from her so that she wouldn’t have to worry about it while she was on break.
I had been certified to be a part of the code blue team for a couple months. I had carried the pager for many twelve-hour shifts, but it had never gone off while in my care. I was starting to joke that if all of our beds were full, I was the obvious choice to carry the pager. Nothing ever happened while I was on the code blue team.
So, I clipped the pager to my scrubs, displaying it proudly, and went on with my job. I was sure there was no chance a code blue would be called.
Overhead, I heard the rapid response team called. I took note, since these “pre” codes often turned into full blown code blues.
About five minutes later, at approximately 01:00, in between dumping urine and typing the amount into the computer, the pager cried out.
Beep beep beep beep beep beep beep beep
I slowly turned the pager over–It was flashing green.
Flash flash flash flash,
The pager said: Code blue, unit 138
“Code Blue Unit 138, Code Blue Unit 138″ The hospital speaker system shouted.
OH SHIT!!! That would be me!!!
I turned around and ran toward the crash carts, passing the unit clerk who was turning the key at her desk to lock all the hospital’s elevators, I heard the unit clerk’s familiar voice calling out over the PA system, “Code blue Unit 138, Code blue unit 138!”
I was met by two RTs, an NA, and two other RNs at the crash cart. I started the timer and grabbed the clip board with the blank forms for charting: a little too eager to ensure that I would be the charter, and nothing else.
Another nurse unplugged the cart and someone else grabbed the elevator keys. And we were off! At some point, the junior resident had joined us.
Now I was calmer. From here on in, all I needed to do was chart. If for some reason I needed to do more, I knew exactly what to do and when. I just had to go into automatic mode.
The elevator was full of laughter as we all rode up to the thirteenth floor with the crash cart. Nothing like a little levity to diffuse a crisis.
We arrived on the unit, and, guided by the floor nurses, turned the corner into the room. The rapid response team was already hard at work. CPR was in full progress, and the defibrillator pads and ECG leads from the rapid response team’s crash cart had already been attached.
“Wow” I thought to myself. “That floor nurse is giving some of the most impressive CPR I’ve ever seen.
I saw another nurse, a young woman, possibly 23 years old. She was absolutely stunned. She moved like the air was made of drying cement. Her eyes were red as though she had been fighting back tears. She looked on in horror. I knew she was the patient’s primary nurse. I have been in her shoes before. It’s horrible.
I looked down at my blank page. I had gone through this a million times in my head, but I was still drawing a blank. What the hell do I write? Yes! I remembered. Start with the time we arrived, and the elapsed time on the clock.
He was already intubated. Later I discovered that there just happened to be an on-duty anesthesiologist on the unit when the code was called. I’m sure he was intubated in no time.
“What was the initial rhythm?” I asked the rapid response team?
“Asystole”
“Shit” I thought as I checked it off.
The ICU fellow, who was our code leader had also arrived before us and started ACLS, “Can we check the rhythm again? Stop CPR.” he asked, incredibly calmly.
The rhythm looked like sinus tachycardia
“Someone check for a pulse.” I saw several fingers reach for different possible pulses.
There was no pulse.
“Looks like we have PEA.” The ICU fellow stated, “Resume CPR”
One of our nursing attendants took over CPR–it was faster and harder. I suddenly realized how quiet the room was. Just the quick, staccato THUD THUD THUD of the CPR.
I dutifully wrote it all down, along with when meds were ordered and when they were administered. The first half of my charting was ridiculously messy with webs of arrows, crossed out items, and illegible scribbles. By the second half I had created a system (how’s that for adaptability!) and things started looking great.
I turned to the primary nurse, still in shock, “Have you called the family?” She shook her head no, “Have you called his attending physician?” She shook her head no again.
Another nurse behind her said, “I’ll call both.” She said it with a sense of duty and ran out. She must have been the charge nurse, although she wasn’t possibly any older than the primary nurse. I realized at that time that there was an audience of all the unit’s nurses standing there watching us.
I heard the cart nurse yell out, “Can someone prime me a normal saline line, mix a bicarb infusion…and I need some flushes!” I saw them scatter.
Orders kept getting called out calmly, “epi, bicarb, atropine. ” And I kept writing them down.
One of the floor nurses asked me where she knew me from. I showed another my neat combination pen/pen light. A couple jokes were told. Again, levity in a crisis, but it was still surreal.
“Stop CPR and check the rhythm.” It looked like sinus tachycardia.
“I feel a pulse!!!” Someone cried. It was the RT who had been bagging the patient the whole time. His hands must be cramped! He had reached down to check the carotid artery.
“Me too!” Shouted someone with their fingers in his groin. “I have a femoral pulse!”
“Geeze,” said our ICU fellow, “I was just about to call it. Someone call the ICU and make sure our bed’s ready. How long was he down?”
“Almost fifteen minutes.” I croaked. I knew this man was very old and chronically sick. I was secretly hoping we could let him go and spare him the torture of ICU.
I heard the breaks on the bed flip off, and away we went. ”I need the primary nurse to come with us!” I yelled out.
“OK” the primary nurse said nervously. I knew just how intimidating it was to come down to the ICU and give report. Especially on night shift when you have ten patients and you’re expected to know every last detail about this one patient–which you never do.
We silently travelled through the bowels of the hospital. The only noise was me continuing to question the primary nurse. “What’s the primary diagnosis? Allergies? Was it witnessed?”
Arrival back on the unit was like returning from war; everybody’s heads popped out of their bedsides to see what was coming down the row, curious about the code blue. The rest of the shift was spent telling the story over and over. ICU nurses are such a curious bunch.
We settled him into bed.
“I can’t feel a pulse!” Someone says.
“Shit!” I yell.
“No no no, I have a femoral pulse.”
“I think I will make sure the code cart is at the bedside.” I say.
“Good idea” Someone else said as I ran for the cart.
I gave a report to the patient’s new nurse, detailing the events of the code. It was at this point I started to feel amazed that it was me giving report. A year ago, as a floor nurse, I dreamed of being on the code team, but now it was a reality. It was still incredibly surreal.
And then I went back to work as though nothing had happened. I inputed the amount of urine I had dumped just before the code was called into the computer.
I gave the code pager back to its rightful owner.
Twenty-four hours later, he still hadn’t woken up. Anoxic brain injury was clearly present and extensive. Studies showed a massive heart attack, with barely any cardiac function remaining. Treatment was withdrawn and he died quietly and quickly.
Today I found his obituary. It was possibly the smallest obituary I have ever seen. Still, I cut it out as a keep sake to remind me of my very first time I was called to a code blue.
