This is a guest blog post written by Chase Christy, an accelerated BSN student at Marian University in Indianapolis.
The first thing I remember about that night is standing in a patient's room in an isolation gown. I was still pretty new, and I was so focused on getting a blood glucose reading without contaminating myself or the Accucheck machine I was using that I didn't even notice when the voice came across the PA announcing a code blue two doors down from me. A code blue is the clinically appropriate way to say that someone’s heart has stopped beating or they have stopped breathing.
In complete ignorance, I just kept going with my little task when one of the nurses popped in and casually said, “Hey buddy. Whatcha doing?” I will never forget those words until the day I die. She was completely nonchalant, as though there was not a care in the world. Of course, she was being facetious to highlight the fact I was completely unaware of my surroundings at the moment. When I turned to look at her, I noticed a parade of people running into the room behind her. One of the parade floats was the crash cart. On TV when they shock people, the device that makes the charge is called a defibrillator. The defibrillator sits on top of the crash cart.
The nurse made sure I knew there was a code going on two doors away. The last thing I remember her saying is, “You might want to get in there."
When I walked into the room, I could not believe how many people had shoved themselves in this very small space. It was wall to wall people like a clown car without wheels. Some of the nursing staff was lined up to aid with compressions. Others were responding to the doctors orders and pushing medications. I knew from my training that the nurses prefer the techs to do the compressions, especially if they are men. This allows the nurses to be available to push meds and monitor the situation. Knowing my place, I got in line.
When it was my turn, it was seriously one of the most surreal moments in my life. I would put it in the category of getting married or the moment your first child is born - one of those “you just can’t believe it is happening to you kind of moments." Along with disbelief, I was filled with adrenaline and a solemn readiness to save this person. I stepped up, put my hands in the correct position and started compressions. And just like that, my life would never be the same.
I want to avoid the details about the actual experience, because it is pretty gory and I want to show respect. In the meantime, I will give you some other code situation observations I’ve had over time. I have now been involved in four different codes.
As I said before, people are always struck by how many people are there. I suppose it is better that more people respond than too few. I think in every code I’ve done, someone has said at one point or another, “Can we clear the room?”
Even so, there is a line to do compressions. As you stand in line, the person actively doing compressions lets the next person know when he or she is tired. To give you an idea of how physical it is, I happen to be six feet tall and an endurance athlete, so it is not very difficult for me to do compressions for several minutes. I estimate when I am in good shape, I could complete a thirty minute code on my own if I absolutely had to (though this would certainly not be ideal). However, if that perfect angle is not right at all, you won’t make it for more than three to five minutes. In one of the codes I did, I was giving compressions and the doc wanted to intubate the patient. To do this, they raised the bed to my chest level, so I was basically completing compressions with only the muscles in my shoulders and arms. I was “can barely move” sore for days.
Another thing that you don’t think about is how a little tiny nurse could do compressions on a very large person. They actually climb up onto the bed to get high enough to use their weight to complete compressions. People who do this are heroes in my book. Often there are fluids on the bed that would normally be completed avoided. They are often taking a considerable risk to save their patient.
On TV, they always shock people. Why? Because it makes for good TV. I think it has to do with the fact that just about everyone harbors a deep-seated desire to shock someone else with lethal voltage. In reality, there are only a couple of shockable rhythms - Pulseless Ventricular Tachycardia and Ventricular Fibrillation, to be technical. When there is no rhythm (a flat line on the monitor) it is called Asystole. It is not a shockable rhythm, though this is the rhythm they are always shocking on TV. In real life, when they shock, they do actually say clear. This was a surprise to me. Why? Just like on TV, if you have your hands on the patient, you can get shocked with the same voltage. That voltage is enough to change the rhythm of the patient’s heart. Do you really want it changing the rhythm of your heart? I’ll answer that for you. No, you do not. In the words of my wife who has been a nurse for some time, “It may not change the rhythm of your heart, but it will definitely throw you across the room." So hands off when they say clear. I’ve actually knocked someone’s hand clear when he wasn’t paying attention, just in the nick of time.
Back to the story. Several times during the code, the patient would get a weak pulse, but it would just fade out over and over again. After about 30 minutes or so, the doctor called it and the patient was pronounced dead. On TV, the patients tend to make it. In reality, patients who code often do not make it, especially if they are already in critical care. Artificially beating someone’s heart does not lead to very good perfusion throughout their bodies. So even if they come back after a long code, there can be severe brain injuries and other damage.
Even though the patient died, I was immediately overcome with a sense that I had never loved doing anything else more in my life. In the words of my favorite historical figure, Theodore Roosevelt (yes, my son is named after him), I felt like the man in the arena “who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat."