Saturday was a great call day. Most of the day was quiet, and I curled up in the residents’ lounge with my cross-stitch, alternating between a spy story and Advanced Surgical Recall. Beautiful. Since the lounge is provided with oversized leather recliners, it was even more comfortable than being at home.

Then, just as the intern prepared to join me and enjoy the baseball game on TV, the ER started calling. We had finished the first admit (a serious chest pain, no cocaine – we were delighted, especially since the patient wasn’t dangerously ill) and had just walked into the next patient’s room (another patient with an actual problem, for a change) when a nurse announced overhead: “Code Blue, ICU, Code Blue, ICU. . .” We hastily excused ourselves from the patient’s room and ran upstairs while blaming the intern for having lamented not having a code all month so far.

We arrived in the far corner of the ICU to find several nurses, the code cart, and a surgery resident who’d been in the ICU at the time it happened. I stood against the wall and tried to match events with what I remembered of the ACLS book. The patient was an elderly lady who’d been conversing with her family, then all of a sudden became unresponsive. Some of the family members were now standing in the hallway, while we desperately tried to figure out -what her electrolytes were -who her primary doctor was -what her code status was -what to make of the rhythm on the monitor.

I won’t go into every detail, because for those of you who know, the specifics don’t matter, and those of you who don’t know don’t really want to hear. But, it went on for more than an hour, getting her intubated, then her pulse dropping in and out, various arrhythmias showing up on the monitor, all disappearing into asystole or sinus before defibrillation was called for. I helped with CPR; I know I broke some ribs, and it doesn’t bother me, because that means I was for sure doing it right, unlike the last time I tried to help. I stayed with the residents as the extra nurses one by one filtered back to their main jobs, and the patient’s pulse continued to play hide-and-seek with us. I proved to myself that I could accurately tell when there was a pulse and when there wasn’t (not so easy – even the ICU nurses were sometimes puzzled; she had such severe vascular disease that one femoral pulse wasn’t palpable even when everything else was ok).

Things I learned: running a code isn’t impossible. In spite of the chaos, as people duplicated the same job, shouted back and forth, missed instructions, and so on, I could tell what was happening, I could see the outline of how it followed what I studied in the book, and I could almost tell what the resident was going to ask for next. There was a lot of adrenaline at first, after running through the hospital, and arriving in a room crowded with other equally excited people; but by the time we were well into the proceedings, I stopped being scared and could think about what was happening. I can imagine being the one running the code; it’s no longer out of the realm of possibility for me.

Also: I would rather be a surgeon than an internist. The surgery resident, although he’s one of the weakest in this program, knew what needed to be done, and was ready to give directions firmly enough to make some order out of the inefficiency that always prevails at the beginning of a code. He didn’t, though, because in this hospital it’s the medicine resident’s job to run codes (except on surgery patients), so he had to hold back and let my resident do things. She was obviously more flustered than he was, not quite sure what to do next, not able to take control of the roomful of willing assistants. She did the right things, got the patient intubated appropriately, and did succeed in getting a strong pulse back in the end; but she wasn’t comfortable, and the nurses knew that she wasn’t really in control. The surgeon definitely stepped on her toes, and she didn’t appreciate his forceful assistance; but it is always hard to let someone else make a bad job of something you can do well.

If I’m going to be a doctor at all (which seems to be pretty well settled by now), I want to be one who can handle serious emergencies. In my imagination, a real doctor is someone who can start any line, do intubations easily, handle procedures without getting nervous, and take control of an ICU code or a trauma resuscitation, and then some. I didn’t realize, when I first imagined it, that that really only describes surgeons (ok, and ER doctors); but whatever the price turns out to be, it will be worth it to be that competent. If you can handle codes and surgical emergencies, then it should be easy to wing through a hypertensive emergency, or DKA, or whatever else. I don’t think that I’m actually any less shy than the medicine resident; but I want to learn how be in charge so that things can run better for the patient, when being in charge is needed.

The patient coded again early this morning, and by this time her family were willing to agree to DNR, so that was that. But that was the first semi-successful code I’ve seen (as in, we didn’t have to stop the code that first time).

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