First Code

Dr. Danielle WallaceBlog, Joy in MedicineLeave a Comment

“Mr. Jones, what I’m trying to say is that your kidneys are shutting down and I’m worried I can’t….”

***Ding Ding Ding *** Adult Code Team to Unit 616-00! Adult Code Team to Unit 616-00!

Perfect. Why wouldn’t there be a code during a hospice talk? My SubI took off at a sprint, dashing my usual plans of slowly jogging/getting lost so as not to be the first person at the code. Guess we were going for this one.

We ran into the room to 5 nurses waving their hands and shouting at me, “ HE’S DNR!!!! HE’S DNR!!!!” Wonderful! My favorite type of code: where we let 88-year-old men with more medical problems than you can count pass peacefully.

But wait? There was a respiratory therapist bagging the patient. Apparently, his very outdated MOLST said “no resuscitation, specifically no compressions OR intubation,” but the EMR and the attending progress note indicated he was DNR only. Other upper level residents helpfully offered to leave and go call the family, the attending, and maybe a stat ethics consult to help clear up the confusion. I was left at the head of the bed.

First things first, get the story. I asked for someone to tell me what happened, and promptly everyone in the room began yelling medical information at me. I immediately entered a zone of panic and didn’t absorb one word they said. He could have had open-heart surgery or a toenail removed that day, I wouldn’t have been able to tell you.

Relax, remember the ABCs. A-airway! I helpfully yelled to the respiratory therapist, “Keep bagging him!” No kidding, Hippocrates.

B- breathing! Anesthesia entered the room and asked who was running the code. I squeaked out “me” while attempting to hide behind a nurse. He then asked if I wanted an airway. I wanted to sarcastically ask if anyone had ever said no to that question, but I just nodded. He shouted questions at me about last potassium levels that sounded vaguely like something I should know about.

C-circulation! “Umm, guys. Do we have a pulse?” Nurses froze. Hands darted to every available limb. If he had a pulse, we definitely cut off the circulation to his extremities and brain while trying to find it. After a solid minute, we determined that his heart was, in fact, not beating. Demonstrating simply mind-blowing clinical reasoning skills, I murmured, “Uh, if he’s definitely a DNR, then I think he’s dead.” By this time, the other residents had reached the family and confirmed that he should be allowed to pass with no resuscitative efforts.

Everyone stopped and looked at me. Oh right, this is my part too. I listened to his empty chest for longer than was necessary and then stared at the clock, completely incapable of telling analog time. I half-guessed at the time of death, and when no one corrected me, backed away from the code that wasn’t.

About the Author
Dr. Danielle Wallace

Dr. Danielle Wallace

Dr. Wallace is a second year resident in the Internal Medicine residency program at the University of Rochester Medical Center in Rochester, NY. She is a graduate of St. Bonaventure University and SUNY Upstate Medical University. During medical school, she was elected to the Alpha Omega Alpha and Gold Humanism honor societies. Danielle has also had several poems published in JAMA and The Pharos and enjoys using creative writing as an outlet to better understand and experience medical training. She will be contributing blog posts and forums to the Advisory Center for Health Professionals as a Resident Advisor.

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