On codes...

In a recent post over at Emergiblog, the always witty Kim jokes that she will have "Do Not Resuscitate" tattooed across her chest after the age of 80.

A few nights ago, I was twiddling my thumbs during a rare instant of calm between deliveries when a code blue in the radiology department was called overhead. The residents at my hospital are allowed to go to any and all of the code blues so that when we're lone rural docs in small towns in the middle of nowhere, we'll feel mighty comfy running codes. So I dashed downstairs and stood with the internist running the code and tried to feel calm and useful.

The patient had suffered a massive heart attack and had what we call "tombstone" ST segments, thus named because they are thought to represent extensive damage to the heart muscle which is often fatal. The picture of the EKG I found online shows tombstone segments in just a few of the leads (especially V4, V5 and V6). My patient had tombtsone segments in all of the leads except one.

We ran the code for 40 minutes. 40 minutes of brisk CPR (no wussy Grey's Anatomy chest compressions here), of pushing epinephrine and atropine and various other drugs through her veins, of ventilating the patient using a bag and mask. Finally, the internist decided to call the code. He asked us to continue our efforts while he went to locate the family in order to give them the option of saying goodbye. There were no family members or friends pacing anxiously in the waiting room for this man. We stopped CPR, stopped the IVs, removed the blood pressure cuff and the EKG leads.

And then, one of the ER nurses, a gruff, older lady who I've always been a bit scared of, leaned over the patient and gently stroked her cold, mottled forehead. "Mrs. Y," she said, clearly and reassuringly. "We're going to get you off of this hard bed, and we're going to take you back to the ER and get you some nice warm blankets. And we're going to try to make you as comfortable as we can."

I'm kind of like Kim. I don't want to die alone, cold and exposed, with strangers shattering my ribs and digging at my veins in a desperate attempt to secure IV access. I don't want to struggle to take my last breaths through a tube shoved hastily down my throat. But if that's what happens, I hope there will be a gruff ER nurse by my side who touches my forehead and allows me to die as a human.