Code

It was 7pm, and Isabel was nearly done mopping the patient rooms 12 East. After that, she'd round the corner and tidy up the remaining three rooms of floor 12, then it was on to floor 13. Custodial night shift wasn't the most glorious of jobs, but the atmosphere was safe, the pay was okay, and the hospital never was lonely. One last room, in the corner. Then one more hallway, then floor 13. Isabel knocked on the door and called, "pardon!" before opening the door. The light was off. "Turning on lights!" she called again. With a flick of the switch, the empty but messy patient bed was illuminated by a fluorescent glow. Isabel always started with the bathroom. She opened up the second door, and screamed.

"Today was the worst birthday, EVER," though Lisa to herself as she left the MICU room on floor 10. Not only was she on call, but she had spent the whole day arguing with triage about placing a patient directly into the ICU rather than the floor. Triage had broken protocol, the ICU refused to take the extra patient, and in the ensuing confusion and gridlock, the elderly paraplegic patient's bicarbonate continued to plummet as she waited. By the time Lisa had finally convinced the ICU to take her, it was too late to save her life. She was now DNR with a focus on palliative care. Lisa had always been an optimist, and she couldn't help but believe that this patient might have lived if not for the systemic mistake, even if it was clear to everyone else that the woman had presented to the hospital when it was already too late. So was the life of a resident physician. Lisa was shaking her head to herself when the trauma pager on her hip went off. Code. Floor 12. Lisa sprinted to the stairwell, dashed up to 12, and ran to the corner room as fast as she could. She could see the room before she got there. She'd be the first physician to respond, so she'd be running the code. Instinctively, she started reviewing the steps she had memorized so many months ago. But when she finally arrived at the patient's bathroom, her through process came to a jolting halt as she came upon the gruesome scene.

The 50 year old patient had hanged himself with his belt, and now dangled suspended from the towel rack near the ceiling. Nurses from the floor started to file in, and without losing a beat Lisa barked commands and together they got the man's body down to the floor, laid him on his back, and stripped off his hospital gown. More residents came rushing in, as they too had received the page. Lisa was in charge; deliberately but forcefully, she ordered a nurse to retrieve a defibrillator, and had another resident check for a pulse. There was none. In came another resident with the medical student. "Chest compressions, now!" The student dove in, and right away began pumping at the chest, locking his elbows throwing his body weight into every violent thrust. Anesthesiology was here. Quickly and expertly, they shoved down a plastic tube down the body's throat, secured the air mask, and began squeezing the airbag to give the man artificial breaths. The student now was exhausted, and was dripping sweat over the patient's body. One of the residents tapped his shoulder and took his place, and the student sat back to catch his breath. This was not like on TV. CPR was a tiring, violent, last-ditch act to save a life. 90% of the time, it would fail. Defibrillator was here. The nurse placed on the electrodes between chest compressions then called to clear the body. Airway stepped back. The chest pumper stepped back. "I'm clear. You're clear. All clear!" The body lurched forward as the defibrillator issued a long beep and discharged. Still no pulse. It was now the student's turn to do compressions again. Once again, the anesthesiologists pumped. Once again, the defibrillator charged. All clear. Discharge. Still no pulse. The cycle repeated. Then again.

Finally, Lisa called a stop. Time of death, 19:17. By now there were about 20 people crammed in the patient room, all of whom had a separate role during the code. Some stayed behind to finish off the situation, while the rest left to return to their interrupted work. The medical student didn't know what to think as he returned to the team room. His knuckles were bloody; somehow he had scraped them during the code. He now felt cold as the hallway breeze hit his sweat-soaked scrubs. As he logged back into the computer to finish off his evening notes, he knew that he wouldn't have time to reflect until hours later when he returned home. Codes happened all the time. There was still work to be done in the hospital, and the hospital didn't wait.

Within the next hour, Isabel had returned to the patient room, now messy but empty, and had sanitized and reset the space for the next patient. Now the room was spotless, with a new bed on wheels with a new mattress and neatly folded sheets. The room had already been assigned to a patient waiting in the Emergency Department hallway downstairs. That patient would be here in a few minutes. The hospital didn't wait.