(FYI: this post is graphic.)
I rushed down the stairs from the 4th floor as soon as I heard the code called overhead.
Nurses, doctors, and respiratory therapists were all running toward one room. I knew who was inside.
It was my patient who had been mostly unresponsive since I met him. Whose grandchildren–and possibly great-grandchildren–had colored pictures and made cards that were displayed in the windowsill and on the bulletin board. Who didn’t even flinch when I drew his ABG yesterday morning.
My patient whose son has an alcohol problem and had yet to come to the hospital to sign the DNR/DNI we kept talking about.
The senior resident had already started compressions when I walked in. My patient had no pulse and he wasn’t breathing. He had been pale all along, but now he was exceptionally white. Nurses were giving epinephrine and eventually vasopressin through his IV. Anesthesia was working to secure an airway.
It was my turn to take over compressions. Hard, fast, deep. You’re the only thing keeping his blood circulating right now, Erin. Focus. Just like you’ve been taught; just like you’ve practiced hundreds of times.
I was sweating. My stethoscope, draped around my neck, thumped rhythmically against me with each push. The nurse across the room grimaced as my patient’s ribs cracked and grinded with each compression of his chest. “I’ll never get used to that sound,” she admitted.
Hard, fast, deep, Erin. Make each one count. His head and neck bobbed limply as I continued to beat on his chest, forcing his heart to squeeze. His ghost-like skin was turning purple. Harder. Faster.
The patient was intubated. Nurses called both phone numbers his son had given them: one was disconnected, and he didn’t answer the other. They kept trying to call, praying he would make it to say goodbye, hoping he didn’t come in drunk. Respiratory therapists pumped oxygen into his lungs. A few of us rotated through compressions.
The monitor indicated slow, weak electrical activity of his heart. Dopplers confirmed what our fingertips had told us all along: his heart wasn’t beating. Pulseless electrical activity.
We stopped moving. Twenty minutes had passed.
The senior resident called time of death.
Nothing prepares you for that moment when you first start compressions. I’ve been certified in CPR since I took the American Red Cross babysitting course as an 11-year-old. I was recertified a few times as a lifeguard, then got BLS and ACLS certified during PA school. I’ve practiced on dummies and memorized algorithms. I’ve taken countless exams. I watched patients die and performed post-mortem care when I worked as a nurse assistant during college. But nothing–nothing–prepares you to crush another’s chest in an attempt to keep him alive.
I looked back into the room as I closed the door behind me. The handmade cards were still neatly lined up along the windowsill, untouched by the earlier chaos: Get Well Soon, Papa!
My patient’s son never came. No one said goodbye.