I need to talk about my first real code. I’d watched codes and rapid responses before and they were exciting. I walked away feeling empowered, like a goofy superhero. “We did it!” racing through my heart, I would go home and tell my mommy what I had accomplished. I did compressions, I started an IV – the little things. Naturally, I assumed my first real code as a real nurse would be so much more empowering. To know that I have the intelligence, education, and speed to make a difference. I was so wrong. I was focused on the whole “bringing them back” and forgot you have to see them die first.
We were understaffed. I was getting threatened with an 8th patient. Some floors are quiet enough to give a nurse 8. There are 22 rooms and 3 nurses. One tech. My floor should only have 5 or 6 patients per nurse and two techs. Two patients needed their H&H watched with a possibility of stat PRBCs. I had Foleys, PCAs, PICCS, centrals, a gastric decompression tube, 4 wounds, 3 isolations, a brand new C Diff diagnosis needing teaching, a chest pain, a drug seeker, and withdrawing alcoholic, and the list goes on. I hadn’t slept before getting asked to take this extra shift.
At 0345 I walked into his room to help the lab pull blood from his PICC and found him limp with blood pouring from his mouth. I called out his name and grated my knuckles across his chest. He gurgled as he slumped over, eyes rolling in opposite directions and my stomach twisted. Ripping the cord from the wall I called for my charge nurse and our “nurse on a stick.” As soon as charge got in she called rapid response. I told lab to stay nearby because we needed her soon. I grabbed a pair of gloves immediately, something I learned the hard way in my first code my senior year of nursing school. Charge shoved me out of the room to go grab all my paperwork on him and his chart, warning me the doctor would want to know everything. 30 seconds later with my prewritten SBAR and computer I returned and wove my way to the doctor past so many people. They handed me leads to the AED and suddenly, I forgot where to put them. RA, LA, RL, LL. Those are the limbs right? Or is that Right Atrium, Left Atrium? No, definitely limbs. Damn it, which side’s right? Put the shock pads on first, then it will come to me. Snapped them in. The monitor screams on and my feelings finally fade out. My mind is numb and clear. I filled in the doctor. He was AxOx3 at 0230. Surgical repair of perforated gastric ulcer on xx/xx/15, continuous gastric bleed from unknown source, last 2 Hgb 7.1. We can’t get a BP. I tried both lumens of his PICC and the line on his central and I could only get 1ml of blood. His type and cross expired 4 hours ago. Then the beepbeep on the monitor flattened. Compressions. Epi. Levophed. 2units O- stat. 2L NS bolus. I finally take a good look at who’s here. My favorite ER nurse. My favorite pharmacist is here. That’s good. Focus. We only have one pressure bag so I became the other. I felt afterwards like I broke my hands holding onto that bag for the next hour. My right hand and wrist is visibly bruised the next day.
I watched helplessly as everybody buzzed around my patient. What did I do wrong? I analyzed my entire night looking for what happened. Maybe I should have checked on him earlier. Maybe I missed some lung sounds. I should have done my ACLS before now. Looks like I’m studying when I get home. My hand hurts. I readjusted my grip to increase pressure. I watched them intubate him and contemplated the gracefulness of it all. Hear the sarcasm? For all my non-medical friends, hold onto your chairs. In order to intubate, we stick a very long L-shaped piece of metal into your mouth, pin your tongue down to your throat and pull UP to stick a tube the size of your thumb into your airway. For all practical purposes it looks like hooking and holding up a fish. His head started floating up off the bed, his jaw jutting forward, rosey-gray tongue sticking out the side. I could see the lighted speculum outline through his throat.You know when you find a dead animal on the side of the road and the swollen tongue is sticking out? The wide-eyed gaping of the bass you pulled in?
I can’t hear what RT is asking for. Oh a smaller suction cannula. There is already over 400ml of blood they suctioned from his lungs sitting next to his bed. In fact, now that I look, there is blood everywhere. The amount is unnerving and this is a GI floor. I’m used to GI bleeds filling the commodes. There has to be a couple pints in here. His Hgb came back: 4.something low. How did he drop so fast?
All dignity has been stripped, there are 4 hands checking for a femoral pulse, a doppler crackles in a search for any kind of blood movement. Tubes everywhere, needles and wrappers, 6 IV lines, Telemetry and AED leads, 2 oximeters, a blood pressure cuff and a lab tech desperately trying to get an ABG.
RT finishes up their suctioning. Suddenly, a rhythm. 69bpm and it’s decently regular. O2 99% with RT bagging. It takes 7 of us to transfer him to the ICU where my two favorite ICU nurses take over. It’s still a mess, and I’m still clueless. I stand in a corner and wait to be asked questions. I’m trying to soak it in, trying to remember everything, hoping the paperwork won’t be bad. Trying to think of my other 6 patients and what they might need, hoping someone is watching them. I take and sign orders. I answered all their questions and left my name and extension. I stopped to see the family and answered their questions.
I ran back to the unit. It’s a little after 0500. He will be DNR. I know in my heart he will never wake up. He’s done this too many times. I watched my patient die today. I helped bring back his body, but I did not save him. I did not go home a bloody hero, I am not proud of myself, I am not a superhero. I returned to his room for his family’s belongings. Blood, chaos, oddly Instagram-worthy. I handed out the rest of my medications, helped restock the crash cart, finished the code sheet, passed off my patients, did all my paperwork, and went home. Being a nurse is never about saving lives in a dramatic fashion. That thought was foolish. That day, it was about losing someone and still having the strength to fight for the others.
I lost him. His heart restarted but he will never speak to his wife and children again. He will never crack a joke. He will never push his call light and ask for another blanket. He is gone. His death was void of grace and ease. He drowned in his own blood.
They say war heroes rarely completely agree with their honors. They say medal of honor recipients struggle with feeling they didn’t do enough to deserve it. I never could understand it. But now that someone’s life is in my shaky little hands, I can begin to understand.
My favorite security guard swung by afterwards. I call him cowboy. You would too if you walked behind him. He looks like Clint Eastwood walking into the sunset. Except he smiles. I didn’t say much, but I guess most nurses try to blame themselves because that’s what he told me not to do. He told me not to beat myself up over it, but I have to wonder if I could have done something more.
There is no such thing as a clean victory. I will never have done enough. I will try to save you, I can keep it together, but please.
I’m just a nurse.