Full Code… Full Throttle

Right now, I’m rotating through my Medicine clerkship, one of the most comprehensive and intellectually stimulating rotations of medical school.  And this Saturday, I experienced my first coding patient.  Who knew I’d participate in the hands-on resuscitation efforts of a dying woman, just like how you’d see it on TV?  Literally, HANDS-ON!!!

I was doing a weekend call on the telemetry floor, where patients come in with shortness of breath and/or chest pains and are on continuous cardiac monitoring. I was seated at the computer station, doing my notes so I could get out early.  Next thing I knew, people were running and huddling down the hall.  My partner and I wiggled ourselves into the commotion and found ourselves amidst a full code.

This 99 year old lady was in asystole – aka, “flatlined.” Her heart was not beating, she did not have a pulse. The way to resuscitate this poor lady was to do chest compressions to massage the heart back into electrical activity and IV vasopressors like epinephrine.  Residents and nurses were bunched around the bed, in this tiny room, shouting orders and poking the hell out of the patient’s veins and arteries.  Everything was flying by so quickly; it was utter mayhem.

Asystole-LARGE

As medical students, we were delegated one simple, yet essential, task within our limits of muscle power and intellect:  mad chest compressions.  We lined up to alternate every 2 minutes of chest compressions and to check the pulse.  I went first.  I ripped off my white coat and stethoscope.  Then I jumped on the bed, fists out, arms straight, and pumped the hell out of the patient’s rib cage.  This was the very first time I did live chest compressions on a human being; previous practice sessions were on plastic dummies, and boy was the live version a workout for my nonexistent biceps!

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It was the longest 2 minutes I’ve experienced.  You are on top of the patient and pumping your arms with all your might and stamina.  You look to your right and you see the respiratory specialists working on the patient’s airway and oxygenation.  You look to your left and see the residents attempting to obtain arterial blood and femoral access.  You are rocking the patient like an earthquake, while other members of the medical team are intubating or sticking needles into vital vessels.  After my round of CPR, I was tachycardic and diaphoretic and very much fatigued.  Yet, it was the greatest feeling in the world, knowing you participated in the resuscitation efforts of a dying patient.  Even as a medical student, you can be useful in a life-death situation.

After almost 40-45 minutes, the patient got a pulse, got a heartbeat, got a stable blood pressure.  She was whisked away to the ICU.  Soon after settling in the room, she decompensated again.  Round 2 of CPR commenced and chaos broke loose again. Except this time, the residents in ICU took turns with compressions, and they did not last very long.  She was deemed a futile resuscitation, and family was offered to consider a DNR/DNI.  And the patient died that afternoon…

Indeed it was a crazy day.  It was also a sad day because a patient did not make it, despite the hard work and efforts of the medical team.  There’s the indescribable feeling of satisfaction, knowing you were a valuable member of the medical code team. As a medical student, when you feel like you belong somewhere, you feel wanted.  You feel good.  You are important, especially when it involves patient care.  And you could save a life…

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