I have always referred to this event as "my big code", and I don't think I'll ever forget it. Several years ago, on night shift, I was charting at the nurse's station. It had been a quiet night. I have a habit of sometimes just staring at our telemetry monitors up front when I'm bored. I like to glance at each patient's heart rhythm and try to interpret it. I have caught abnormal things numerous times by doing this, and this night was no different. I glanced over at the monitors and looked them over until my eyes fell on the monitor for 368. Telemetry can be hard to read sometimes, but one rhythm that's pretty hard to mistake is V-Fib. For readers who aren't familiar with this, V-Fib, or ventricular fibrillation, is a life-threatening heart rhythm in which the heart is literally quivering, not pumping. There's no pulse with V-Fib, and the patient is considered to be in cardiac arrest. The patient is dead. Visually, it appears like small squiggly, chaotic patterns on an EKG and is pretty hard to mistake. That was the rhythm I saw that night on 368's monitor.
I'll be honest, the number of "false alarms" created by our tele monitors makes it easy to second-guess ourselves when we think something looks bad. So many times, the monitors alarm for something fatal, but it's simply "artifact," or essentially the equivalent of static on a radio. As a result, my instinct was to go and check on the patient rather than sound alarms, but I do distinctly remember yelling over my shoulder as I ran off, "Guys, that looks like V-Fib!" Unfortunately, I apparently did not say it very loudly and said it as I was running away from everyone towards the room. No one heard me, and no one came.
I sprinted down the hall to 368 and raced to the patient's side. An elderly woman laid peacefully on her side. She honestly looked like she could be asleep.
"Ma'am, ma'am can you hear me?" I shouted as I shook her vigorously and turned her on her back. Immediately, my worst fears were confirmed. She didn't respond. I tried shaking her again and giving her a sternal rub, but nothing. I felt for a pulse. No pulse.
Don't laugh at me, but in the heat of the moment and with the building excitement, I'll admit I completely forgot about the code blue button on the wall. The code blue button summons the entire unit to the room. Instead, I did some good old-fashioned screaming.
"Help! Help!" I screamed as I started compressions on the patient. If you know me, you know I don't have a loud voice. I continued screaming for help as I felt the disconcerting sensation of ribs cracking under my hands with each compression. I probably broke 4 or 5 of her rib bones. It gets me every time, too. I usually audibly cringe at the feeling... But it never makes me stop because, unfortunately, it means I'm likely doing compressions right.
Thankfully, another nurse appeared in the doorway, and she was smart enough to hit the code blue button. Moments later, there was a flood of people in the room, and one of the reasons I call it "my big code" is because my instincts took over like a badass. I started telling people what I needed and what to do in the absence of the ICU team leader. For the lay person, you know how in movies you see them yell, "CLEAR!" and they shock the patient? That only works on certain rhythms. Fortunately for us, V-Fib is one of those shockable rhythms. We connected the AED and immediately shocked the patient and then continued CPR. The code blue was called over the hospital public announcement system, and pretty soon the ICU team arrived.
I remember after another shock or two, the patient started moaning and moving. I was doing compressions again at that point, and asked if I should stop. The critical care doctor snapped at me, and I never made that mistake again.
"Do NOT stop until I say stop!" he hissed.
Eventually the patient came to and, understandably, started screaming in pain and confusion. I mean, we just broke half her ribs. I can't imagine she was very comfortable. They rushed her off to the ICU to be stabilized.
Okay, I'll be honest, it doesn't really end happily. But, I figured out how to see it in a positive light. It turns out that she coded a couple more times in the ICU before she was finally stabilized, but when her family arrived, they decided together to put her on hospice, and she died a couple days later. She was in her 90s. At first, I felt pretty crappy about the outcome, like my efforts didn't make a difference. But then I realized that I and the others in the code gave her a wonderful gift. We gave her a chance to see her loved ones again and make a conscious decision to say goodbye and pass on from this life. When I realized that, I found peace.
Moral of the story: Sad endings don't have to be sad. Sometimes, a patient is perfectly happy having the opportunity to say their goodbyes and die with dignity. Ninety years is a long time. We gave her and her family the closure they deserved as human beings, and I'm okay with that now.
- Bella, RN
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