My First Code

“Code Blue, room 3012. Code Blue, room 3012.” After only eight days of rotating as a medical student in the hospital, I had already developed a keen ear for that ominous call over the loudspeaker. I was with Dr. T as we had just entered another patient’s room when she calmly announced, “That’s our patient.”

I hesitated for just one moment to see if she would direct me to stay on the second floor, away from the chaos. When I saw her walking upstairs purposefully but composed, I realized that I was about to experience my first code.

The patient was a 63-year-old homeless man. Earlier in the day, we had been requested by a nurse to return to his room. A friend had brought him in, but no one knew of any family and the friend had not returned to visit.

 As we entered the room I saw a disheveled man with a long gray beard, his mouth wide open revealing a white coating in the back of his throat. He was gasping for air as tubes and wires danced all over his body. His eyes were opened unusually wide and, although he could not communicate in any way, he fixed his gaze on the person who spoke.

Dr. T discussed the case with an ICU doctor in the room while I quickly tried to remember the specific treatments for fungal pneumonia and which part of the brain stem houses the respiratory center. I couldn’t concentrate though; I kept on looking at the patient. As I watched his nurse kindly try to comfort him, I had a strong impression that I was witnessing a man in his final moments of life. All of the physiology and microbiology suddenly seemed less important as I realized this man was probably going to die soon.

The other doctors and nurses seemed concerned, but didn’t know what to do. Without knowing his wishes or those of family, it was impossible to know how aggressive they should be in treatment. Consequently, the medical decisions continued as normal. More imaging was ordered and a bed was to be prepared in the intensive care unit.

Now, as I approached room 3012 for the code blue, I discovered a completely different scene. I grabbed a precautionary surgical mask specially designed to protect from tuberculosis and entered a small hospital room filled with doctors and nurses. I tried to settle into a corner so that I could watch without getting in the way.

The patient was now lying flat on the bed with his body completely exposed and naked as a strong nurse’s aid pushed forcefully on his chest. His eyes, that had been so open and scared earlier in the day, were now rolled back and not moving.

I tried to count all of the people in the room, but couldn’t keep it straight in the chaos. I thought about 20. After what seemed to be hours of compressions and IV pushes of medications, I found myself somehow to have been pushed to the bedside. Someone asked if I would step in. Without thinking about it I was suddenly standing over a man who was dying, shoving my palm into his chest, while everyone in the room alternated their gaze between the patient and the monitor.

After a dozen different chest compressions I finally realized what I was doing, but it didn’t scare me. I don’t know why it didn’t. Maybe it was because pushing on his chest felt surprisingly similar to the dummies I had practiced on in a quiet, air-conditioned room at my school. Maybe it was because I sensed that it was probably too late for him. Maybe it was because, in my heart, I wanted him to die.

I knew his quality of life would be even worse if he survived. Furthermore, my strong conviction of a loving God and the eternal nature of man steered me closer to hope than fear. So in my heart and mind, I wanted him to die. Nevertheless, the lack of emotion kind of bothered me. Was I a cold hearted and jaded physician already?

After a few minutes someone relieved me and I stood back and observed the other people in the room. I could sense something as I looked at their faces; they wanted him to die too. Despite all of this, the compressions, the meds, and the shocks and any other means to keep him alive kept coming. He had some electrical activity at times, but no pulse and no movements. After rounds of repeated attempts Dr. T finally told another doctor she was going to call it. After nearly 30 minutes, she calmly said, “Okay. Let’s call it. Time, 15:22.”

Then, almost as quickly as people had arrived on scene, the room emptied out. I was left standing with Dr. T and the two nurses who had cared for him. One nurse closed the patient’s eyes. I washed my hands and stood quietly. Suddenly the other nurse began to cry. It surprised me. She was the tougher looking nurse. She was young, had multicolored hair, a nose ring, and looked more like a bartender than a nurse.

Dr. T gave her a hug and began to explain how his condition was only getting worse and it was okay for him to go. Then the nurse said something I will never forget. “I know,” she said through tears, “we just really liked him.”

The newly deceased man had never spoken to anyone in the hospital and no one knew anything about him besides the labs that showed up in the computer. Yet, this nurse said she really like him.

I don’t know if it was harder or easier to see my first death knowing that there was no family to whom we would have to break the bad news. But I did take comfort in that nurse’s words. I liked him too.

-Kyle Von

 A "surgical selfie" in December 2014, with a different patient who also a grim prognosis. It should be noted that I'm locked in a bathroom, ashamed that I was actually taking a selfie. My wife requested it.