My shoulders are sore from doing compressions, and my hands ache from holding the seal around a face for ventilation, or squeezing a bag of saline to make it run faster. Three codes in two days – far too many.
The last one, I just went up to the floor to check on a patient I’d transferred out of the unit, and they called a code down the hall. I had to be one of the closest people, so I thought I’d go check. It was real. The patient got intubated, and we had a line in, and it felt as though things were under control. Airway, rhythm on the monitor. . . so why was the patient so blue? I found myself doing compressions, and trying to persuade everyone else in the room that I really had not felt a pulse, and the rhythm on the monitor was nothing more than PEA (pulseless electrical activity). . . It’s hard to talk while doing compressions properly, but it wasn’t hard to prove. . . Not much good in the end. (Note to self, ekg leads aren’t enough, you need pulse ox and blood pressure too; and just because the patient had a pulse two minutes ago doesn’t mean they still do.)
When I was younger (a whole year ago), I used to go to these things and be all quivery and excited because I thought we might save somebody’s life. Now, like the rest of the senior residents and attendings, I don’t worry too much, because I know it’s not going to work anyway. Even if by some chance we got a circulating rhythm back, the patient will, 95 times out of 100, die in the ICU anyway.
I woke up this morning and I couldn’t figure out why my shoulders ached so much. It took me a couple of hours to even remember the code the day before, and connect my frantic compressions to the current situation. It was several hours later that I remembered the code before that, which was why my hands hurt. Ok, I’ve got it all straight; I’m ready for the next one.
Cut On The Dotted Line 
August 8, 2008 at 10:40 am
3 Codes in 2 days? Thats sorta slow to tell you the truth. If Patients knew the primary value of codes was providing realistic training in Intubations/IV/Line Placement there’d be so many DNRs they’d wear out the D,N, and R keys on the Keyboard.
August 8, 2008 at 12:06 pm
Dr. Alice
I really like your blog. I am a new Christian, and I have been investiaged Christian blogs. I was wondering if you think that this blog: http://www.baylyblog.com/ is a good one or a bad one. I’m not sure that I agree with a lot of his teachings. Thanks for your guidance.
August 8, 2008 at 5:30 pm
Dr. Drackman – No, three that I went to. Being in the trauma ICU, I’m not primarily responsible for codes in other ICUs or on the floors.
Ashley – I like a lot of what the Bayly brothers have to say; we’re of a similar theological persuasion. But whatever you read, the most important thing is to compare it to what the Bible says. Don’t take any one person’s word for it.
August 8, 2008 at 8:50 pm
Ahh, that explains it. So tell me why God let the Ayatollah Khomeni live to be 90, Castro and Jimmy Carter are still alive, but little 4 year olds get Neuroblastomas? I’ve got my own ideas, just curious what yours are.
August 8, 2008 at 11:41 pm
Frank, a simple answer: He is God, while you are not; you can barely see things 5 years ahead, while He has a time-equivalent satellite vantage point. Rx for you, Doc: put your pediatric challenge-you aside and give the Gospel a try. Just a suggestion!
August 11, 2008 at 1:00 am
Dear Dr. Alice,
I’m a Christian internist in Bloomington, IN and just today discovered your blog. Codes always seemed to come in waves — when it rains it pours — for me during residency. I’ve done several in a day before, and I’ve thought often about the seeming pointlessness of it all. But, over time you meet a few that are helped/saved for a time, and life is precious so I pray that God will not let us grow hardened or calloused.
Ashley,
Praise God for your new faith! It encourages me to hear of God’s work in your life. I was also glad you asked about the
Bayly blog because, as a new Christian, you may find it hard to track with some of the points made on that blog. That said, however, I would commend the blog to you as “a good one” without hesitation. You’ll find the Bayly’s applying the Bible to our culture (and thereby to us) in many helpful ways that many other pastors won’t.
The thing to understand about the Bayly blog is that it’s a different kind of blog. I don’t particularly like blogs, but I do check the Bayly blog out regularly because of it’s unique qualities and content. Unlike many blogs which mostly contain personal stories or off-the-cuff posts meant to stimulate discussion, the Bayly blog posts are written with great care and forethought with specific goals in mind and comparatively little self-referencing. More importantly, they’re not written primarily for anyone who finds them interesting. They’re targeted toward Christians who have become leaders in their churches by demonstrating certain gifts and a certain level of maturity. That doesn’t mean new Christians can’t read the Bayly blog, but it does mean that many posts/teachings will be too difficult for young Christians to understand or apply to their lives. Keep in mind that even King David says in the Psalms that he will not concern himself with things too difficult for him. As long as you know that, seek the Holy Spirit’s guidance, and follow Dr. Alice’s excellent advice to constantly submit your mind and heart to God’s word as you think about what you read, you’ll find the Bayly blog consistently profitable and hopefully avoid incorrectly judging the Bayly’s work.
I don’t know if you’re in the medical field too, but one great thing about the Bayly’s is their rare depth of knowledge and insight into God’s law and the Gospel applied to medicine. This comes out in their blog quite often. I’ve known Tim Bayly for years, and he has been God’s primary instrument in teaching me to think about medicine with a Christian mind.
But remember, the reason that the Bayly’s are qualified to write difficult teachings on difficult matters is because they’ve devoted themselves to knowing the Word of God. As a Christian, you now have the privilege and obligation to do the same, relying on the Holy Spirit to bless your work and draw you nearer to the Father. Isn’t God good to provide a way for us to be restored to Him and to know Him?!
Yours truly,
Adam Spaetti, M.D.
August 11, 2008 at 1:12 am
Dear Dr. Alice,
As I said above, I’m not much on blogging, but I am happy to discover your site. As you can imagine, I stay pretty busy practicing medicine, but I’ll check in from time to time. The quest to be a “Christian” physician is life-long, and if I can offer any guidance or encouragement as you share your joys, struggles, and failures, I’ll try to do so.
Sincerely,
Adam Spaetti