On Call - Code 01
On Call
I was on call from 6am on April 11, until 12noon April 12 for surgery, and just like it has been every other time so far, it was an adrenaline pumping one. I think the thing that most intimidates me at this early point in my training is carrying the code pager. This pager is the alert pager that goes off when anyone in the hospital “codes;” in other words, needs CPR/medical resuscitation. My apprehension stems mainly from the fact that I’m still so early in my training, that I don’t have a great deal of experience in these emergency situations. Usually, during the day, carrying the code pager isn’t so bad, because there are so many physicians also carrying code pagers in-house to respond to the pager with more knowledge than I, who can help out. The difficulty, if there is any, usually comes in the night hours, when everyone has left the hospital except for the few residents who are on call. Not all of them are carrying code pagers, so there is a limited response. Anyway, I’m getting a little off topic.
It was about 3pm yesterday. I was visiting with the nurses on 6 south, mostly quoting Napoleon Dynamite back and forth with them, when the code pager alarms. I stop mid-sentence and run out the door and down the hall, not yet knowing where I’m running, as I grab the pager from its holster to read where I’m running to. “Code 500 on 4N-408.” Great, this is not a wing of the hospital used to seeing codes. As I arrive on 4N, the pager goes off again, announcing that the code had been cancelled. I turn the corner into the room, to see that I’m the only physician there, and no one else is likely to show up, since they have cancelled the code on the pagers. I walk in to get the story, since I’ve only first laid eyes on him about 10 seconds ago, and just to make sure everything is resolving, whatever had happened. The patient is rolled on his side in bed, panting / moaning, with a couple of nurses over him to support him. The nurses think he might have had a seizure, but no one is sure. It’s about this time that he stops breathing. Oh crapola! No other physicians are here to help me! Oh wait, now we’re not able to get a blood pressure reading on him, and his pulses are very slow (35bpm) and faint. Double crapola. Remember, no one else is coming because they had “cancelled the code.” Brilliant. I’m not sure why, but no one re-called the code, even after I asked for more help. I was the only resident in with this guy for about 20minutes. My armpits were sweaty; actually all of me was sweaty. Thankfully, through this all, there were “rapid response” nurses present, who have critical care experience, who provided me with some much needed help in this case. This guy needs to be intubated, since he’s not breathing, and he’s actively tanking on me. I take my position at the head of the bead, to see this guy has vomited all over the place…..perfect. I hear vomit is really good for the lungs once it gets down in there. Normally, a little medication is given to sedate and paralyze patients before they are intubated, but this guy was so unresponsive that he needed nothing. There was no movement when I stuck the laryngoscope blade down his throat. Grabbed the suction tip to clear out his throat of vomit so I could see his vocal cords. There’s the epiglottis and the vocal cords. Held out my right hand, the ET tube is placed in my hand, and I place it through the cords into this man’s trachea. Ok, so he now has an airway; time to move on to fixing this low heart rate and blow pressure. Still, have no idea why this gentleman is crumping. Still, no other residents have arrived. Still, just another day in paradise. Quickly hang fluids and give 1 of atropine to jump start the heart rate, which seems to work. At this point, I have a second to get upset that they haven’t re-called the code to get more help in the room. I politely, I think, but firmly ask the nurse, again, to re-call the code, and do whatever she needed to do to get more experienced help available. I move over to the patient’s right side to try an arterial line to measure blood pressure, since we weren’t able to with the cuff. This involves feeling the pulse and sticking a needle into the artery and hooking it up to a machine capable of measuring pressure waves. Only one problem: you need a pressure to feel a pulse. Crapola, again, this guy has no pressure, and I can’t feel a radial pulse. By this time, the pulmonary fellow has showed up, and is starting a femoral central line on the left side. Most of the acute resuscitation is finished, and we are just trying to get this guy packaged and ready to go to the ICU. I abandon the a-line, after several unsuccessful attempts, and we head out to the ICU. As we’re rolling out the door, a couple more residents show up……thanks. We roll him to the ICU, at which point I turn over care to the ICU physicians, thankfully. It’s over, for me. Still, no idea what’s going on with the patient.
I stopped by this morning to check on him in the unit. He died yesterday evening, from an apparent intra-abdominal bleed. I found out he had liver cancer that was advanced to the point of eroding some abdominal vessels, which subsequently led to bleeding. The cancer was beyond curative treatment anyway, so this was expected at some point soon.
I don’t know what I feel about this event. I guess I experienced a sense of awe, as I do everytime I see someone die. Life is so fragile, and we can do nothing to preserve it. Only the Lord holds the power to preserve or take life. I wish more people saw this.
I have more thoughts brewing, but I don’t want to write them currently, because I think they might sound a bit forced, until I’m able to ponder them more in depth. There might be more to follow.
I was on call from 6am on April 11, until 12noon April 12 for surgery, and just like it has been every other time so far, it was an adrenaline pumping one. I think the thing that most intimidates me at this early point in my training is carrying the code pager. This pager is the alert pager that goes off when anyone in the hospital “codes;” in other words, needs CPR/medical resuscitation. My apprehension stems mainly from the fact that I’m still so early in my training, that I don’t have a great deal of experience in these emergency situations. Usually, during the day, carrying the code pager isn’t so bad, because there are so many physicians also carrying code pagers in-house to respond to the pager with more knowledge than I, who can help out. The difficulty, if there is any, usually comes in the night hours, when everyone has left the hospital except for the few residents who are on call. Not all of them are carrying code pagers, so there is a limited response. Anyway, I’m getting a little off topic.
It was about 3pm yesterday. I was visiting with the nurses on 6 south, mostly quoting Napoleon Dynamite back and forth with them, when the code pager alarms. I stop mid-sentence and run out the door and down the hall, not yet knowing where I’m running, as I grab the pager from its holster to read where I’m running to. “Code 500 on 4N-408.” Great, this is not a wing of the hospital used to seeing codes. As I arrive on 4N, the pager goes off again, announcing that the code had been cancelled. I turn the corner into the room, to see that I’m the only physician there, and no one else is likely to show up, since they have cancelled the code on the pagers. I walk in to get the story, since I’ve only first laid eyes on him about 10 seconds ago, and just to make sure everything is resolving, whatever had happened. The patient is rolled on his side in bed, panting / moaning, with a couple of nurses over him to support him. The nurses think he might have had a seizure, but no one is sure. It’s about this time that he stops breathing. Oh crapola! No other physicians are here to help me! Oh wait, now we’re not able to get a blood pressure reading on him, and his pulses are very slow (35bpm) and faint. Double crapola. Remember, no one else is coming because they had “cancelled the code.” Brilliant. I’m not sure why, but no one re-called the code, even after I asked for more help. I was the only resident in with this guy for about 20minutes. My armpits were sweaty; actually all of me was sweaty. Thankfully, through this all, there were “rapid response” nurses present, who have critical care experience, who provided me with some much needed help in this case. This guy needs to be intubated, since he’s not breathing, and he’s actively tanking on me. I take my position at the head of the bead, to see this guy has vomited all over the place…..perfect. I hear vomit is really good for the lungs once it gets down in there. Normally, a little medication is given to sedate and paralyze patients before they are intubated, but this guy was so unresponsive that he needed nothing. There was no movement when I stuck the laryngoscope blade down his throat. Grabbed the suction tip to clear out his throat of vomit so I could see his vocal cords. There’s the epiglottis and the vocal cords. Held out my right hand, the ET tube is placed in my hand, and I place it through the cords into this man’s trachea. Ok, so he now has an airway; time to move on to fixing this low heart rate and blow pressure. Still, have no idea why this gentleman is crumping. Still, no other residents have arrived. Still, just another day in paradise. Quickly hang fluids and give 1 of atropine to jump start the heart rate, which seems to work. At this point, I have a second to get upset that they haven’t re-called the code to get more help in the room. I politely, I think, but firmly ask the nurse, again, to re-call the code, and do whatever she needed to do to get more experienced help available. I move over to the patient’s right side to try an arterial line to measure blood pressure, since we weren’t able to with the cuff. This involves feeling the pulse and sticking a needle into the artery and hooking it up to a machine capable of measuring pressure waves. Only one problem: you need a pressure to feel a pulse. Crapola, again, this guy has no pressure, and I can’t feel a radial pulse. By this time, the pulmonary fellow has showed up, and is starting a femoral central line on the left side. Most of the acute resuscitation is finished, and we are just trying to get this guy packaged and ready to go to the ICU. I abandon the a-line, after several unsuccessful attempts, and we head out to the ICU. As we’re rolling out the door, a couple more residents show up……thanks. We roll him to the ICU, at which point I turn over care to the ICU physicians, thankfully. It’s over, for me. Still, no idea what’s going on with the patient.
I stopped by this morning to check on him in the unit. He died yesterday evening, from an apparent intra-abdominal bleed. I found out he had liver cancer that was advanced to the point of eroding some abdominal vessels, which subsequently led to bleeding. The cancer was beyond curative treatment anyway, so this was expected at some point soon.
I don’t know what I feel about this event. I guess I experienced a sense of awe, as I do everytime I see someone die. Life is so fragile, and we can do nothing to preserve it. Only the Lord holds the power to preserve or take life. I wish more people saw this.
I have more thoughts brewing, but I don’t want to write them currently, because I think they might sound a bit forced, until I’m able to ponder them more in depth. There might be more to follow.
posted by Frank Bob at 10:43 PM
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