More codes last night. That makes the intern happy; she still thinks it’s a game. Which is all well and good, but I’m the one running the code, and I don’t think it’s quite so much fun any more.
In a way, yes. It’s the nice that the nurses say, “Oh Dr. Alice, it’s great that you’re here. This isn’t your patient, is it? What do you want us to do?” Um, you’re doing good compressions, and I see we’re ventilating nicely, and you paged anesthesia to intubate (that’s how it’s done at my hospital). (These nurses are good. I much prefer codes in the ICU.) How about finding the doctors whose patient it really is? Because I’m getting tired of running codes that I’m not even responsible for. The medical people are supposed to be responsible for codes at night, especially on their own patients. So why am I the only one there for twenty minutes?
So my interns work on lines (they’re good enough with lines on still patients; people bouncing around they’re not so good at yet; we’ll have more practice), and I work my way through every single drug in the ACLS protocol, first-line, second-line, and last-resort. We intubate nicely, and defibrillate more times than I can count. I ask the nurses in the hallway, for the third time, if they would please make sure we’ve paged the medicine folks. By the time they show up, much to my own surprise, we have a perfusing rhythm, a central line, and even an arterial line (which is nice in a prolonged code because it tells you for sure whether there’s a pulse or not, and how much good it’s doing).
I’m a little ambivalent about the value of what I did. After a 45-minute code, I’m skeptical that the patient will have much neurological function left, or that he will even survive till morning. But I couldn’t have decided to stop earlier, without knowing anything at all about his background, and without having managed to get in touch with the primary team. (Also the arterial blood was bright red the whole time, which made me think we were oxygenating and perfusing pretty well, so there was no urgent need to stop.)
On the other hand, I’m making myself a reputation for successfully running codes while also placing impossible lines. A reputation for invincibility doesn’t hurt, until it breaks. It is true, though: the key to being relaxed while someone else learns how to do a procedure is being confident that you can fix it. I knew I could get the lines any time I really wanted them, so it was ok to let the interns try for a while. Next time, maybe I won’t have to run the code, and I can coach them through it better.
(I guess that paragraph definitely qualifies me as a cocky surgery resident. I never thought I would be that person, so I’m going to enjoy it, until it breaks in a night or two.)
(Next time I’m going to see if I can think coherently enough not to have to ask the nurses every five minutes what the patient had been admitted for. They must have told me the same thing six times, and I just kept asking again, as though they had a secret that would tell me why the patient arrested.)