6 Minute Read
Intern Year, Day 21:
“I don’t know WHO you are! I’m leaving!” “At least let us cover your bottom, sir!” “Please come back to your room, you’re going to fall!”
I had been sitting in one of the hospital’s computer rooms around 10PM on a Thursday evening with the other residents who were working that night when we heard the pitter-patter of bare feet against the linoleum hospital floor. We opened the door to a sight that was equal parts comical and disturbing: a 73 year old male patient running full speed down the hospital hallway, with two nurses in tow. His hospital robe flailed behind him, revealing his bare, wrinkly bottom as he ran. The nurses yelled “Mr. B, PLEASE come back to your room!” at the patient’s naked behind, winding through hospital carts and computer stands toward the third floor elevator.
Another nurse peeked his head into the computer room and breathlessly gave us the rundown: “Mr. B became delirious a few minutes ago and tried to fight off one of the nurses who was helping him use the bedside commode. As soon as she turned to get wipes for him, he took off running, saying that he’s trying to leave!” Stifling a laugh, I followed the group to assist in getting the patient back to his room. As funny as the scene was, I was well aware that it would be all fun and games until the patient had a fall on our watch.
We eventually had the patient cornered by the elevator, while he yelled at us indignantly, blocking the doors so as to prevent him from fleeing the hospital like this in the middle of the night. After 20 minutes of coercion, we finally convinced him to get into a wheelchair and be taken back to his room. Afterwards, we called a family member who was able to help us calm him down.
There’s no way to predict how the evening will go when you’re on night float (which is the medical way of describing working overnight in the hospital). Simply. No. Way. They all start out similarly. Your job is to provide “cross-coverage”, in other words baby-sit patients overnight until the day teams return the next morning.
Sometimes, during a light night, you just get a few calls from the nurses about small things, like “Mr. X is having a headache, can you prescribe him some Tylenol?” Sometimes the night is more challenging, studded with more serious calls like “Mr. Y is complaining of chest pain” or “Ms. Z is having shortness of breath.” Other times, things are just WEIRD, and you get the occasional “Mr. B is running down the hallway half-naked and trying to leave, help us get him!”
By 3 in the morning, calls about patients had dwindled down to a minimum, so we all went in search of call-rooms to get naps. Just as I had climbed into a bunk bed to sleep, my pager went off. NO. NO, NO NO NO NO! I begrudgingly climbed back off the bed, and walked slowly to the desk where my pager was. UGHHH who needs some constipation medications THIS time. Picking up the pager to see which number I needed to call back, I saw this flash across the screen: CODE BLUE, Room 270. Oh crap! Oh crap, Oh crap! My first code!
A Code Blue is an emergency notification in a hospital that is called when a patient is in cardiopulmonary arrest, or essentially when the patient is unconscious and would die without immediate resuscitative efforts. When this code is called, medical professionals from all over the hospital rush to the patient’s room to do everything they can to save his or her life.
In 20 seconds flat my shoes were back on and I found myself sprinting full speed down the hospital hallway, winding through hospital carts and dodging computer stands for the second time that evening. This time, however, the situation was without a hint of comedy. The next thirty minutes were a whirlwind. People shouting. Machines beeping. I remember taking off my jacket, and getting in a line of people ready to continue chest compressions when the person ahead of them got tired (usually in less than two minutes).
When it was my turn to perform chest compressions I almost panicked. Though I had done this many times before on mannequins, I’m sure you could imagine the reality of pushing down forcefully on a person’s real chest was very different. You just can’t simulate the fragility of a human’s chest, the feel of ribs cracking underneath your hands, the way the person’s entire body flops up and down with each compression. People’s voices were distorted in my ears, as though I was listening underwater. “Push a little slower!” “Push a little deeper!” “Hold compressions, can anyone feel a pulse?” “No pulse, continue compressions” “OK, you’re tired, switch!” “How many minutes since the last Epi?” No CPR class could properly prepare you for the pressure of quite literally having a life in your hands, trying to ignore the lifeless look of the person beneath you, praying to God that they will come back.
I think we all knew we had lost him. After 35 minutes of CPR, multiple rounds of epinephrine, and even defibrillation, we slowly realized he wasn’t coming back from the dead. Finally, the person running the code told us to hold compressions. “Time of death…”
I walked away from the patient’s room reeling from the emotional whiplash. I had started the evening laughing, running down the hall after a patient, and ended it feeling sad, helpless, and oddly guilty over the death of a patient who’s name I didn’t even know. Maybe his name was one of the things people were shouting when I got in the room, but I didn’t hear it. I looked it up after the experience was over, but couldn’t quite shake the feeling of guilt that I didn’t know his name before… as I, along with the rest of the team, fought to bring him back from the precipice of death. Maybe that was a silly thing to feel guilty about, but… that’s what I felt.
There’s no way to predict how the evening will go when you’re on night float. Simply. No. Way. They all start out similarly. They all end differently. You go home to sleep. And then… you do it all again the next day.