Monthly Archives: June 2016

First Code: Part 2

My resident says to call her after I finish my work. It’s early evening, and I’ve just returned from a teaching session, which was relatively uneventful except for a code blue announcement that made us pause our discussion on antibiotics. Two sets of closed doors had muted the words so I didn’t catch the exact location, but it hadn’t been in a place close enough for us to respond to.  We had finished talking about penicillins and moved on to fluoroquinolones.

I click the mouse to sign my note, adding it to the plethora of documentation in the electronic medical record.  As a medical student, my information bytes don’t count towards anything, but I go through the motions to help me prepare for when they will. I pick up my phone and I punch in the five-digit extension to my resident.

“Before you leave, stop by the computer room at the emergency department. I need to talk with you,” she says.

A brief flash of anxiety. Does that mean I messed up on something?

Take two flights of stairs down, make a quick turn, press my badge to the reader and wait for the beige emergency department doors to ponderously swing open.  Two turns down two more halls, right and right again. I slip into the computer room where we often type up our notes and slide onto a stool next to my resident, slightly breathless.

She swivels her chair to face me. “I have some bad news,” she says gently, her eyes meeting mine. “You know the code blue called this afternoon—”

Somehow, I know what she’s going to say, and everything instantly goes still inside me.

“It was for Ms. ——. She died.”

Silence inside me, the eye of a hurricane.

You died?

You were not supposed to die.

You were supposed to get better in the ICU and come back to our team and I was going to take care of you and you were going to get physical therapy and get stronger and go home and you






This wasn’t part of my plan.

You were alive yesterday.

“She might still be at her room… you could go see her if it would help you find closure,” my resident says.

I know I need that closure—I need to see you one more time. You were my patient for nine days. You were my responsibility. You still are my patient.

I’m biting my lip the whole way down the hall.

I’m not going to cry in the middle of the hospital.

I show up at the wrong ICU on the wrong floor and have to stop to look up your room number on the computer.  Backtracking down a floor, I try again.  This time I get it right.

As I approach your room, counting off the numbers on the walls, I see the curtain is drawn. The room looks deserted; no legs or shoes are visible beneath the fabric hem.

The early evening sunlight spills though the window and the curtain is a glowing sheet of sea-foam green. I peek around it before entering to see if you are still there. Your familiar gray hair spills onto the pillow as I catch sight of you.

I still clean my hands with the slippery foam sanitizer as I step into the quiet ICU room.  Habit, I suppose.

It is so still.

No beeping monitors, no waveform peaking and falling with the rhythm of your heart and the pace of your breaths. For the briefest moment, I entertain the thought that maybe you still are alive. Maybe they made a mistake, and you are just sleeping.

I’ve wakened you so many times over the past week, stirred you from sleep to check your heart and lungs and to see if you’re still having nausea. Maybe I can wake you again. You look so quiet, your eyes closed tight, lashes interlaced. You could be asleep.

But as I pause, I realize there is no breath in you.

That’s when I break down, standing alone beside your bed in the same white coat I’ve worn since I met you. I touch your forehead—your skin is smooth over your skull and not quite cold—and brush away your strands of hair.

I am still crying beside you when the nurses arrive to begin preparing your body, removing the stiff plastic tube protruding from between your lips, pulling off the array of cords and bandages we connected to you in our attempt to stave off the inevitability of death.

One of the nurses gives me a hug and hands me a couple of paper towels.

“She was my patient,” I say by way of explanation. “I’ve only been on wards for six weeks,” I add, trying to excuse myself.

I’m a novice still. I have not seen death like this before.


Perhaps with time, I will stop crying so much when this happens, when time runs out and red bleeds to blue.  Perhaps I will grow to accept that the air we inhale at birth is only on loan and must one day be returned to the sky.

But you were my first.


First Code

You were fine this morning.

No crackles in your lungs, no new murmurs in your heart, no grimace as I press into your abdomen, no redness around the catheter line protruding from beneath your clavicle. Nothing new to remark on as I pound away at the computer keys five minutes before I join my team for rounds. Alert and oriented times three, sleepy but able to be aroused.

I am in another room one floor down from yours, awkwardly swaddled in a contact precaution gown, when my resident’s phone beeps. She listens for a moment and then is tearing off her gown and heading for the door; she has to see you immediately. I rush after her, untangling myself from blue plastic sleeves and sweaty gloves.

I only realize I’m on the wrong floor when I see signs for the pediatric unit–not the one I’m looking for.  Turning, I scramble up the stairs.

The code blue is repeated overhead just as I round the corner, breaking into a half-run. People are already swarming around your room, spilling out of your open doorway and into the hall.  I squeeze past them, feeling like a minnow in the ocean.

You lie with your eyes closed, salt and pepper hair spilling over the pearlescent earrings you haven’t removed since you came here over a week ago. A doctor’s voice projects over the noise as he calls out his role as code leader. An anesthesiologist is already at the head of your bed, fitting you with a mask to feed you air.  The crash cart is already at bedside.

The names of medications are called out over the noise, approved, administered.

I squeeze your toes, pinching hard enough to feel your joints beneath my fingers, but you do not pull away like you should. Your skin is cool to my touch, and that chills me.

Move your legs. Move your legs, show me you can move. Squeeze my fingers. Can you hear me? Can you hear me?

Your heart rate is too slow.  We are pacing it, the muscles in your chest and abdomen jerking in rhythm as invisible tendrils of electricity seek out your heart, trying to capture its beat.

Open your eyes. Can you hear me?

Someone is asking for your pulse again, and I press my fingers into the crease where your leg joins your hip, seeking out the beat in your femoral artery.  No time to waste hunting for the smaller arteries I routinely check on pre-rounds.

Your heart is still pumping, tracing out peaks in fluorescent green on the monitor.  I can feel it and confirm it.

Another IV line. The needle slides beneath the skin over your wrist, the same wrist I took your pulse in this morning.  That all seems so long ago, that quiet time when I woke you up to ask you how you were feeling and to press my stethoscope to your skin.

I am in free-fall with no time to contemplate if I can fly.

The ICU will take over from here.  Everyone is unplugging monitors and switching cords and unlocking the bed’s brakes so they can roll you out of the doorway, oxygen tank and IV line in tow.  You are surrounded by a halo of monitors as the beeping bustling fades down the hall away from me.

My team and I regroup for rounds; we still have several patients to see.  The next one is mine, and I need to discuss the mass in his gastrointestinal tract.

I am fine, I tell myself.

I am fine.


I am not fine.