just before 8pm. And guess what, it was on my patient. I was somewhere eles, doing my vitals. He was the last person i was gonna go to cuz i thought he was fine. I mean he was the last time i saw him, thinking about it now it was about 3 days ago.
The last time i worked, i was gonna blog about a patient of mine who came back here just when my co-op is over. I was gonna write that he looked good, he had hair this time, last time he was here he had a chest tube. I was gonna write how good of a shape he was in.
Ironic cuz he's the one who coded.
Thing is they did not call a code but a rapid response. Was suprised to hear them call it to my floor and i kept asking which room. I did not get report on him before i started doing my vitals cuz my preceptor was here yesterday and she gave me the low-down on him.
What i heard was that he was found unresponsive. Why not call a code then?! Later on, i heard he was breathing but unresponsive. Go figure what the real thing was. I went into the room early on and my preceptor kicked me out. Who else but her? Of course, if she hadn't commonsense woulda told me to come out cuz there were soo many doctors plus the nurses on the rapid reponse team and those here that i woulda gotten out.
I couldn't see much of the action when i came out. All i saw was people doing serious CPR and taking turns with that. Anesthesia was called and the thing is anesthesia would have been here if a code had been called instead of a RR. So yeah, they came, too. I wasn't really hearing anyone calling out anything like Heart rate blah blah blah or respiration so or so or anything. All i did hear was the call to pharmacy for meds, one i couldn't figure was "Amio." I was like huh?! so i looked on the vial and it was amiodarone...didn't occur to me the short name was amio. Also, some of the meds they asked for weren't here and i saw the pharmacist call down. Part of me wonders if that woulda made a difference in the outcome of the code had the meds been up here.
So yeah, after seeing ppl take turns doing CPR, I heard one resident or intern, whatever she was, she's still an MD, say over the phone that "we have 10 seconds!" Earlier on, i'd heard them say there was a bed in the MICU for the patient and i had been praying while standing outside that he'll make it. So in about 9 seconds after the MD said what she said, people started coming out of the room. Expressions on the faces had changed and there was this awkward sorta silence. I heard an MD say over the phone when he came out that "he died during the code." I thought to myself i didn't herar that right.No one was saying that much and i wasn't sure what was going on. So i asked a nurse infront of me about what was happening and her response was "they called the code." I wasn't sure if that meant they've stopped the rescucitation or if it meant they were finally declaring a code instead of the RR that had been called earlier. I think the later is a little dumb on my part but i can't be too certain, can i? I heard them ask for a doppler and part of me thought this thing is still going on but basically, all the docs were out and almost everyone was out except 4 or so nurses, one of 'em trying to apply pressure to the femoral line that had been used for the ABGs, i guess. But yeah, it was all over.
Boy, i took a long break after that last paragraph but where was i? Well, there was this MD fromt the "cardiology division" who i saw come in somewhere in the middle of the code. I noticed him cuz he wasn't wearing the regular green scrubs like the others, had this sort of interesting dark blue and black combination. But anywho, after the whole hiatus was over, he came out,and we sorta had this oval circle of nurses and MDs and i think 2 pharmacists or one...can just picture the younger looking one (picture a dinner table with people sitting around it except remove the table with the people still there - that was the arrangement), so he stood at what i'll call the head and asked everyone to comment on what they thought coulda been done better to help with the whole event. He started off saying he thought there was a communication problem. Everyone did go around saying their piece of mind. I did leave that circle cuz i had no comment and i didn't feel my place was there. I just thought what he did was really great...i mean having people reflect on the whole thing to see what could've been done better. (off topic but my preceptor just asked me to "get some tubes" so i ask what tubes to find out. For crying out loud, she's standing by a phone, all she has to do is call a different floor to tube us one, pretty simple huh? thought so but i'm sure it isn't for her.)
Oh, somewhere towards the end of the code, i heard my preceptor insisting that we call the patients family. The MD was really, if not super hesitant to call the family. So my preceptor had to tell her how close the guy was to his niece and how they'd want to know and blah, blah, blah before the MD called. I actually found that a little puzzling cuz even when i did my last co-op, i had to call the emergency contacts when something happened to a patient, whether it's a fall or whatever. And i know when my other patient fell that one time, the MD had to call the family so why was this lady having a hard time calling the family when their loved one was coding? I mean...i just don't get it! But anyway, after the guy had been pronounced dead i heard her asking for opinions as to whether to call the niece and let her know or wait for her to get her because the lady had said she was getting a ride her and she, the MD, had told the niece she'd call with any updates. Well, she waited till she got her.
When the niece came in, she looked like she'd been crying. She went to the room and called the patient by name in a way a child will say "mommy" to a sleeping mother and keep saying it as her voice lowers with each "mommy" she says and finally it just trails off. Except in this case, you could hear the tears in her voice. Yes i was outside the room at the nurses station just out of curiousity. I heard her wail. The gentleman who'd come with her stood outside, his eyes looked red but he wasn't showing any outward expression of emotions but it was obvious that he'd been crying. The charge nurse directed the lady to the confrence room cuz the docs were there. It was just a sad senario. Sad because i heard the whole family was here last night and they had a blast. The guy looked a lot better this time, he came in with fevers and he wasn't even febrile the night i admitted him. He was ambulatory, everything was fine. Of course he's on oxygen but this is someone whose had a lobectomy, and everything else to his lungs and still smoke. The last time he was here he had a chest tube and he'd still go out and smoke...and he was on oxygen back then. When i was taking his things out of the drawer and saw the cigarrette, i thought for a second there whether quitting smoking woulda made a difference.
Anywho, i forgot to say i finally did get to go to the room after the whole thing was done and see the dead guy. Didn't even get to do his vitals or do anything on him tonite. I did clean up his drawer, saw some money, a pack of cigerrete and forgotten what else i'd pulled out. His bag was open and atop of everything was a "Holy Bible." When i saw that, i thought to myself...i hope he read it today. I didn't even know he had a Bible. I did shove the stuff i found in the drawer on top of it. I took a good look at him, and the nurses had managed to put his red shirt on him and made him look presentable. At that moment, i don't think everything was real to me. It's still not real to me, part of this feels like a dream. I mean, most of the people here who die pretty much know they're gonna die. They come in their conditions worses and wham! out you go. The only surprises are people who are walking around, have massive GI bleeds, go down to the MICU and die later and even those you know they're gonna die, the only surprise stems from how sudden and unexpected the bleed was. You don't have patients who are perfectly fine and ambulatory 2hours ago and unresponsive when u check them.
I guess it reminds us man is but a breath in the site of God, quickly it comes out and quickly it vanishes into the air. I hadn't planned on having a code tonite, i mean who plans for that sorta thing. But as it's written, in his heart a man plans his course but the LORD determines his steps. I've been pretty lucky during this co-op. I know those who worked here last year had a couple of deaths. This is my first patient dying. I did have a 24-year-old die when i first came but he wasn't my patient. I decided to help with the post morterm thingamajig cuz i figured i was gonna have a lot of 'em ahead of me. Interestingly, everyone seems to die on the nights when i'm not here which is not bad at all. So today, just one more night before i'm done with my preceptor, it hit us, unexpectedly. I don't think she's had a death before cuz she made the expression we get to do post-mortem care. Like myself, she's been pretty lucky but i guess there's a day for everything and tonite was our nite to get hit with ti.
Reflecting on the family, a good number of them did come here and i've had to pause for a second to think of how it would feel like to be called and told someone whom you'd seen the previous day perfectly healthy just kick the bucket? How hard that must be. My heart goes out to them and i'm not super emotional now, i'm sure i will be once all this sinks in.
Poor guy died with an ET tube in his mouth.
May his soul rest in peace
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