Goodbye to All That C.P.R.
While wandering through a department store one Saturday afternoon during my sophomore year of college I turned a corner and saw a middle-aged man drop dead. In those pre-cable television years a live event such as this was profoundly shocking, and I recall standing there frozen with fear, wishing I knew emergency medicine. Before I could even call for help a nurse rushed to the victim and began performing CPR. I felt ashamed that me, a pre-med student, was nothing more than a meddling bystander during this life-or-death struggle. I promised myself that someday I would be in charge of advanced life support procedures - known as codes - and would conduct them as masterly as seen on a television soap opera. I yearned to be in charge - to wear the special red beeper on my belt like a gunslinger patrolling Main Street. I wanted to be the Marshall Dillon of Heart Attack City - the Code Resident.
Har-de-har-har - what a difference a few years makes. These days I would no more run a code than rush the stage during the singing of La fleur que tu m’avais jetee and challenge Don Jose to a duel. Now whenever I hear the hospital operator scream over the intercom I crawl under the secretary’s desk, produce a blankie from the folds of my lab coat and cry “I want my mama!”
Good Heavenly Days! Is this an acquired trait of all oncologists, or just a quirk of your moderator? How did this former rescuer of the vital-sign depleted become such a coward? I suppose the answer to this psychological condundrum, as with many neuroses in our modern world, can be found by delving deep into the patient’s past using a painstakingly complex combination of hypnosis and Dr. Phil-like gobbledegook.
Nah, that ain’t it - it’s just that when I reflect on my record of running smooth, orderly, successful codes I always come to the same conclusion:
Perhaps by revewing a few highlights from my former life I might be able to explain how I adopted this pusillanimous attitude. As described in a previous post, my first attempt at assisting in a resuscitation will never be written into the Annals of Brilliant Medical Decisions since I inadvertantly electrocuted my attending, but that was when I was only a lowly medical student. Surely as my billing on the marquee rose my exploits would match it.
Well, during my internship I attended many a code but always as a bystander due to the fact that every student, resident and visiting professor of ichthyology crammed into the room eager to kibitz, or just catch up on the social intrigues of the hospital. It wasn’t until my junior resident year that I actually got to wear the firecracker and be the boss-man. I quickly got into it and relished the opportunity to yell at a room full of fellow doctors as if they were carrying my rickshaw a little too slowly. Things went well, even when I was brutally awakened at 3 A.M. by the banshee howl of the red beeper.
Things went well, and I began to swagger around the place when on call [cf. inferiority complex -Ed.], until one night while running a code I discovered that the female patient, aged approximately 80, had no breath sounds on one side. The overall findings seemed to confirm the presence of a tension pneumothorax, and I had a team member insert an I.V. needle to relieve it. Somehow the patient ended up with needles in both sides of the chest and then developed subcutaneous emphysema from all the chest compressions.
The effect was unnerving. She seemed to get younger by the second, until after a few minutes her formerly atrophic breasts were inflated like two dirigibles straining to break free from their moorings. Somehow I was to blame for this unfortunate complication, and given the epidemic of black humor that had infected the hospital in those days I broke the house record for “number of jokes made at one doctor’s expense”. My erstwhile superhero status was fatally crippled , and I began to draw comparisons to some of the less dignified roles played by Jerry Lewis.
My love affair with the code was beginning to wilt - much to the benefit, I believe, of scores of future patients.
Next: Goodbye to All That C.P.R., Part Two
Truly a cringe-inducing post.
Comment by Ali — April 29, 2005 @ 7:03 pm
Yes, that it truly cringe inducing. I have to say that I’ve never seen that happen. I did see one code where a guy was pumped full of drugs, but his heart didn’t start beating until after he was declared dead and the nurses were starting to clean him up (they saw a pulse in his neck). I have to say, the face of the code resident when the nurse called the code AGAIN was very funny, at least if you’re in to very dark humor. (The pt went to the ICU and “lived” 3 days.)
The reason that I wince every time I hear a code called are my experiences when working in outpatient dialysis centers. Running a code there is…I haven’t really got the adjectives to tell you how bad it is. Several hundred mls of their blood are in the dialysis machine and have to be rinsed back IMMEDIATELY, while the pt is simultaneously placed on the floor (can’t really do compressions in a recliner. This takes 5 or more people-to lift the patient, hold the really big needles that are often in their arm, (which, if they come out will cause the patient to bleed like OLd Faithful), move the chair, etc. (I had a friend who had a patient who was so big that when she arrested they could not lift her out of the chair-had to run the whole thing with the woman in the recliner). And while all this is going on every one is desperately hoping that EMS will show up NOW, because they know what to do!
But that’s probably just me. (BTW, I can’t wait for part 2!)
Comment by Abby — April 30, 2005 @ 1:11 pm
You brought back bad memories of the few adult codes I’ve participated in. I much prefer neonatal codes. The survival rate is much higher — of course they are nearly all witnessed and very seldom full cardiac arrests. We don’t have nearly as many drugs to remember and the umbilical vein makes for easy IV access if you need it.
The parents are often in the room, though, and not always processing information very well. We had one mom demand to be allowed to breastfeed before we did anything to her baby. Her tox screen came back positive for multiple drugs, so that wasn’t happening even a week later when the baby was finally extubated.
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Comment by guile — May 3, 2005 @ 6:15 am
Working in the ER, I obviously get the opportunity to run a few codes, both in the ER and on the floor. I remember getting called to the ICU three times in five minutes for the same patient. I didn’t even have time to get back to the ER. The patient was fine each time I got to the room. The nurses just gave a little epinephrine and he was OK. I told them to give the epi and if it didn’t work, call the code. Also, call the admitting doc and ask for a drip.
TIP: The first thing I do after I call a code is turn the monitor off.
Comment by DrTony — May 3, 2005 @ 3:37 pm
Grand Rounds 32: A Day in the Life
9:00 AM
Careers in Medicine Lecture:
Dr. Tony describes life in the emergency room in a typical night patient in the EC (part 1) and Part 2. For another perspective on life in the emergency room, Mad House Madman reminds us of why we should always…
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