Codes
signout | August 26, 2008One night last week, with not a whole lot going on, I strolled into the MICU to say hello to my friend Tom, who was working overnight.
"Wanna go for coffee?" I asked.
"Can't," he said, leaning against the nurse's station. "Probably gonna code the lady in room five sometime in the next half hour."
I thought he was kidding; people anticipating an impending resuscitation are usually too preoccupied to lean on things. He saw my raised eyebrow and explained: the woman had been terminally ill for months. At her daughter's insistence, she had had every life-prolonging intervention, even beyond the…
signout | July 22, 2007I stayed in the hospital late last night to finish some paperwork. As I was nearing the end of the pile, the code bells went off. I didn't have to, but I ran, anyway, and when I got to the room, I was the first one there.
I took a deep breath. "I'm with internal medicine. How can I help?"
I'm an upper-level resident now, and that means that when I find a situation requiring resuscitation, I'm expected to know how to manage it. A nurse practitioner holding the chart looked up and recognized this, and me. "Signout! She just went unresponsive. They were concerned she was brewing sepsis earlier…
signout | February 18, 2007I just talked to a regular reader of this humble blog, a good friend doing his residency in another institution. He brought up the code I mentioned here, and was appalled by the fact that procedures were still being done on a patient long after he'd died because the practitioners needed practice. "I've got some ethical issues with that," he said. "People donate their bodies to science so we can practice procedures on them. That's not what happened here."
I've got news, people. When you make yourself a full code in a hospital--namely, when you elect to have full cardiopulmonary resuscitation…
signout | February 11, 2007This 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…
signout | January 31, 2007At about 8 a.m. today, the code bells sounded. ("I love the smell of chaos in the morning," said a nurse nearby.) I ran to the code, but because I had to schlep over from the intensive care unit (the ICU), I was late, and I didn't make it into the room. Scowling, I trundled downstairs to get back to pre-rounding.
Half an hour later, the ICU fellow came and tugged on my sleeve. "The code upstairs? She's here, and she needs lines." I jumped up, gathered supplies, and went into the room.
The patient was lying in bed, her eyelids stained violet as if with makeup. I began to announce myself…
signout | July 31, 2006I 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…
signout | July 10, 2006You'll hear residents everywhere refer to "codes" as both the most terrifying and the most exhilarating experiences they have during training. "Code" is short for "code blue," or "code red," or whatever term each hospital applies to situations wherein help is needed in resuscitating a patient. It's used as a noun ("I wet my pants during the code today") and a verb, both transitive ("Rounds were so boring today, I nearly had to code my attending") and intransitive ("Your patient probably coded because of the Tylenol you wrote for"). Codes are often chaotic, and, I won't hesitate to tell you,…