Code. Blue.

A friend asked me the other day if it bothered me to see people who had devastating injuries and weren't going to make it. I answered not usually. Then he asked if it bothered me that it didn't bother me.

As an individual, it's rather rare to have a patient that codes and dies, unless you are one of those brave people who takes those patients frequently. I haven't quite made it there yet with my whole 11 months of vast knowledge and experience. But it has happened to me. And it is why I work where I do. That might sound strange so let me explain.

Whenever I have a sick patient, my mind focuses on certain things and I work almost completely in tasks. Look at the blood pressure. Titrate the levophed (a pressor that helps keep the blood pressure up by constricting your vessels). Send for the blood. Check the blood. Hang the blood. Talk to the doctor. Receive an order. Implement the order. Etc.

When a patient codes, multiply this approach times ten. The patient is bradycardic to the 40's, blood pressure 65/40. (Hopefully you've already realized what's happening before the pt's BP is 65/40 but sometimes it happens pretty quickly). Call for help. Get the crash cart. Someone else is putting on the defibrillator pads as you break open the med drawer. Tear open the atropine box. Connect the plunger. Give the drug. Flush. Check your heart rate. Still dropping. Heart rythmn is an indistinguishable loose wave. Check a pulse. Not there. Start compressions. Someone is writing down all the times that you give the drugs so that you know when you can give the next one. Etc.

You receive the cooler of blood for massive transfusion protocol and someone checks and hangs the first unit through the Level one infuser (a machine that pumps blood in under pressure so that it goes in very quickly). You hang 8 units and nothing has changed. You've been doing compressions for 25 minutes and nothing has changed. You've given all your epi, atropine, and vasopressin and nothing has worked. The doctor calls the code. Everyone stops. It's done.

Undoubtably, this is a horrible and devastating experience. But I can go home and sleep at night because I know that everyone did all that they could. Death isn't an uncommon or even feared outcome in the ICU. Sometimes patients have been in the unit for weeks and everyone is relieved when the family chooses to withdraw care because there was no quality of life, for anyone.

I have seen the attending doctors come and take a patient back to surgery as a last ditch effort even though usually they just code them in the unit. I can honestly say that they did every single thing they could but the damage was too great. That makes me proud of where I work and also you better send me there if I am in a life-threatening situation.

It's this crazy adrenaline rush as you move from task to task with your mind running a mile a minute. I would liken it to the feeling a marathon runner has at the end of a race. Or a mountain climber when he reaches it to the top. The journey itself wasn't necessarily pleasant but you feel accomplished and purposeful at the end of it. And you know you've done something that's bigger than yourself.

It doesn't happen often, but when it does you have to pull out everything you've learned and use it. You have to put your emotions aside and focus. Because this is the end of the line for this person. It doesn't get more serious than this. And I work here? That still amazes me.

Sometimes I go home all worked up and eat my dinner in about 3 minutes. I can't seem to calm down but it helps to talk to a friend or watch tv to get my mind off of it. If I go out after work, my mind is still processing the events of the day. It does bother me. But it can't while I'm at the bedside because that's my job- to try and save a life.

I've never cried about it. Maybe one day I will. Maybe I should cry. Or maybe it's simply a self-preservation technique so that I will indeed come back the next day. And without fail, I do come back for more. It's the addicting paradox of the ICU. And I love it.