I got a spot of blood on my dress today. It happened as I was on my way out of the hospital and heard the code bells ring. I ran, cursing, past two women clutching each other in a hallway, into a room where a man was lying unconscious in a chair, blood trickling from his mouth. He was a pre-transplant patient-a man about to get a new liver.
Ideally, a code is a carefully choreographed disaster. No one expects the outcome to be good, but everyone expects the process to be organized.
This code was a disastrous disaster. I didn't participate this time-just tried to stay out of the way. The anesthesiologist shouted over and over again for suction, cursing as she pulled streams of clots out of the patient's mouth. The respiratory therapist, who was ventilating the patient with an oxygen bag attached to a mask on the patient's face, got himself and about 7 other people sprayed with a fine aerosol of digested blood. The transplant surgeon ran in a silent, heartbroken panic in and out of the room, his face twisted with worry.
At fifteen minutes, the charge resident said, "Anyone opposed to ending this code?" and the patient suddenly developed a heartbeat. The surgeon finally spoke: "You want to call a code on a patient with a beating heart? Push bicarb! Push epi! What's wrong with you people?"
There was an exchange of meaningful looks: a code is supposed to be run by only one person at a time. Amid the carnage at the head of the bed, the anesthesiologist said, without much pride, "We have an airway." There were a few more minutes of chest compressions, and then it was over.
I don't usually cry after these things. But this time, I came home and sat on my sofa and sobbed. I can't clear my head of the image of the two women standing in the hallway outside the unit, and I can't clear my ears of the sounds of their terrified crying. There was no triumph today-just a sick man dying in a way he couldn't have wanted to.
I doubt that in this case, the outcome would've been different if the code had gone more smoothly. But there would have been, as there usually is, something reassuring in the well-executed process. When that process breaks down, the thin membrane that contains all the physiological chaos of a resuscitation is torn, and the futility and ugliness of it all spills and is smeared all over the place.
I, for one, feel dirty.
There was a free lunch, and the nurses were really nice to us. Plus, now we have real responsibility.