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For what it was

By signout on February 11, 2007.

This morning, I was writing in a patient's chart on a general medicine ward when I felt the energy around me shift. Everyone seemed to suddenly be walking faster and talking louder--something was obviously wrong.

I overheard snippets of conversations swirl around me while disaster built: "patient is unresponsive," "don't know what to do." There was a team of doctors already in the room, and I didn't want to be intrusive. I just watched and listened from in front of my chart until I overheard a nurse say, "Maybe we should call a code."

When I got into the room, there were eight people crowded around the patient, four of them feeling for a pulse. A monitor was on its way in. The bells sounded overhead, and quickly the room filled. The tide pushed me to the head of the bed.

She was a sick lady--a chronic heart patient who'd come in with a bad pneumonia. As someone shouted the details of her condition over the din, I noticed that there were a lot of attending doctors in the room: although codes are usually run by residents, there were at least three attendings at this one.

We administered the usual set of indignities. I did chest compressions, and for the first time, felt bones cracking and separating under my hands. (They tell us that means you're doing it right.) A friend of mine held the paddles that administered the shocks. There were bicarb, calcium, and epinephrine pushes through an IV. The whole time, the attendings watched calmly from a corner of the room. It was oddly quiet, for what it was.

At fifteen minutes, I opened her eyes with my fingertips and shone a light into her pupils. They didn't move. I shook my head at the resident at the foot of the bed. "Fixed pupils," she said. "It's been fifteen minutes. I'm going to call this code."

From the corner, from the middle of the group of attendings, came a shouting cry, and one of the cardiologists fell against the wall. I almost shouted, myself, when I realized she had the same last name as the patient, and the same blue eyes, and the same thick braid down her back.

It was a cardiologist I liked, one I had embarrassed myself in front of not two days earlier. I hadn't worried about it then because I'd known that in her good-natured way, she would forget about it. Now, I wanted to claw my way over the people standing between me and the door so I could run as fast as I could, away from this terrible room where this nice woman had watched her mother die in the most inevitable way I could imagine.

I didn't claw. I waited patiently for everyone to file out, and like everyone else, I patted the cardiologist on the shoulder on my way toward the door.

I think I understand why she did it. She must have wanted to pretend, as we so often do in the hospital, that someone who is dead can be brought back to life. And if her mother were to be alive again, even for a moment, she wanted to be there for that flicker.

I don't know this for sure. I did not wait to find out. When I got out of the room, I finished my note. Then, like a bad dog, I ran away.

I hope she has forgotten who I am.

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Yes, she was.

Or ... you could go out and buy a tastefully illustrated blank card, and write a note saying "I'm sorry that we were unable to save your mother and my thoughts and sympathies are with you", or words to that effect, and put it in the cardiologists mailbox.

This isn't a reverse advice column, you know. It's easy to put on your pageant smiles and talk earnestly about the need to leave an eddy of flowers, thoughtful notes, and smiling children in your wake. But the actual situation seems a bit more ambiguous. I appreciate the honesty of the original post.

A note would have been kind and not inappropriate, but I don't think it's required of every member of the code team. Much depends on context and the working relationships of the people involved. Given that this unfortunate cardiologist's anguished moments were on public display in her own workplace, there's also something to be said for circumspection.

Stunning post.

I was there with my grandfather the night he passed away. I was holding his hand when I noticed there was no pulse. Immediately, some vestigial instinct kicked in and I shouted to the nurse to call a code and started doing chest compressions myself. Later on the team came around and tried to revive him but he was already gone. Thinking about it now, I realise how little we could have done for him and yet, at that moment, all I could do was search desperately for that flicker on the cardiac monitor.

I completely understand how the attending felt. Thank you for sharing this post.

Why I hadn't heard about this publication before, I don't know. I can only hypothesize that I perhaps have been living under a rock.

For the record, a friend of mine is in psychiatry, and he's actually the sanest of our group of friends. I think the overal sanity level of psychiatrists is just a well camoflauged secret.

Is there reproductive isolation between Pinta turtles and the other islands? If so, it's worth a serious re-assessment of how different an ecological role George and his ilk would play as opposed to other tortises. If they aren't even isolated (e.g. not enough time has passed for evolution to change that most fundamental of machinery), and it is plausible that a tortise could be transported, than it is not beyond the bounds of possibility that such an event could happen anyway. Why not!