Code Blue

I saw a man die today. It was my first night on call at the VA and I was seeing a patient who was hyperventilating and delirious. Then I heard over the speaker that there was a code blue in the ICU. My team all rushed down to the 4th floor. By the time we got there, an obese AAM had all his clothes off, wires hooked up all over his body, lying on the hospital bed, and the ICU attending was trying to intubate him. I didn't have my white coat on so they must have thought I was a resident on call that night. They asked me to do all these procedures I had no idea how to do. Even after I told them I was a student, they asked if I could help with these things anyway. So I put on gloves and made myself available. I began by counting the minutes for the shifts of compressions. Then I began doing them myself. I felt the ribs crack beneath my hands while I pressed against his chest. I saw his eyes open, rolled to the back of his head. I heard his labored breathing even though his heart had given up. I smelled his stale breath wisp past my face with every compression of his chest. I tried feeling for femoral pulses and carotid pulses. I thought I felt something, but I think it might have been my own heart beating from all the adrenaline. They threw every medicine in the book at him, hoping that something would stick. But nothing helped. They were defibrillating him throughout the hour with increasing voltages. They had me continue compressions while I heard the machine charge up. There was so much yelling and running around, the nurse was confused on when to shock. I felt both hopeful for this man lying in front of me and fearful for myself if I would be maintaining compressions while a confused nurse accidentally pressed the button too soon. I remember hearing people shouting clear, clear, clear, clear.. then his lifeless body jump from the shock as the room held their breath. His rhythms bounced around and the patterns on the EKG monitor were things I had never seen before nor was I able to recognize them. I saw attendings scramble over placing femoral lines, blood splattering on the sheets. Over an hour had passed in what seemed like seconds. As I was leaving, the ICU attending looked crushed. He was thanking everyone that had come down to assist. The patient lied there on the bed, with only socks on. He was leaving this world the same way he came in. Vulnerable and naked. The only thing I could think of was his wife in the waiting room. Nothing seems to matter much anymore when you see someone whose life has just passed him by. My brain feels fried. My nerves felt heightened, now dulled. It just happened a few hours ago but I can only remember flashes of what happened. I don't remember a sequence of events, just seconds of reenactment that replay through my mind. I see him coughing for air. I feel his pulse go in and out. I see everyone not knowing exactly what to do. I hear the frailty and humility in the voice of a man who has gone through years and years of medical training, to come to the point of pleading to the room full of interns, nurses, and students if anyone knew of anything more we could do before calling it. Surrender. I don't feel sad or upset. Just a little empty when I think of all the things that I usually fill my mind with. It's most important, I think, to be healthy and love every moment of every single day, regardless of how difficult it is. The struggle is the pursuit. The goal is happiness. The gain is character. I know as physicians, we need to separate ourselves from patients to make logical, intelligent, objective decisions.. but I hope I never get to the point where I forget what it's like to lose someone important... Hold fast, David.