Last Night on Call

To code or not to code, part 3

The sisters did not call a code on this patient. The right move to make.

When a code is called, a voice booms through the hospital on the intercom, and it goes something like, "code blue, ward 4. Repeat, code blue, ward 4."

In the universal language in this hospital, it means drop what you are doing and go help resuscitate this person. Run there.

I arrived t the ward, and the sister who had been so indignant before pointed me to the closed blue curtains.

I walked in and sighed. "Oh no, Mr. P." I took a moment to absorb this. He had been alive 15 minutes ago. Breathing. Not breathing well, sure, but breathing. He had nodded to me. 

I called my senior and confirmed that no measures were to be taken, he had passed and we would not be resuscitating him. Not for code. 

I did all the legal things with heavy shoulders. I think back to the way he had spoken to me earlier. Thing he said. Like, "I want to rest," not, "I want to sleep." I wonder if he knew. 

As I was leaving the ward, Mr. John was at it again. Up and about, restless. This time he told me he was too cold.

"Let's put these back on," I said, once again having to untangle him from his drip line.

He picked up the sheet and began to wrap it around his shoulders, becoming entangled again.

"Sir," I said, "you have a hospital gown here. Lets use this gown rather." 

I wrapped the gown around him and convinced him to lie back down and put the sheet on top. While I was there I checked his vitals again - he was still stable. Oxygen levels within normal limits still. Just seemed to be a bit strange.

I went back upstairs, grumpily, I'll admit. Would I ever get any sleep?

Apparently not. 

I was called 20 minutes later. 

"Doctor I'm calling from ward 4. There is a patient here who is acutely short of breath. His saturation is 80% and I've put him on oxygen."

"Coming."

Medical emergency yet again. 

The man was a lung cancer patient who had walked to the bathroom and come back unable to breathe. Back in the bed, sitting straight up, breathing heavily. I have often found that psychology is an invaluable tool when dealing with people in distress and so I verbally calmed him down, explained that he was doing well, things were looking better, he was recovering. He nodded as I spoke, panting into his oxygen mask.

His saturation was climbing, but slowly. I turned to the sister and asked for a different face mask that would deliver oxygen to him more efficiently. 

During this ordeal, I heard in the periphery of my awareness an announcement over the intercom. I paid no heed, as I was dealing with something emergent. His saturation was 85% when I applied the new mask, and told him to keep breathing in deeply.

I watched the monitor as the value climbed to 92%, my panic abating a little with each percentage.

I sighed in relief and told him I would be around and keeping an eye on him.

I went to the doctors room to book an ambulance for another doctor's patient, she had asked me to do it in the morning. As I was waiting on the line I overheard the sisters talking, and one of them said something about a code blue.

My stomach sank. "Sister," I asked, lowering the phone receiver, "was that tonight?"

"Yes doctor, it was just now, maybe 15 minutes ago. Didn't you hear it?"

Shit shit shit. "Where was it?"

"Overnight ward."

I almost dropped the phone. The clerk answered the phone then, so I booked the ambulance with a shaky voice.

I texted my senior then, "did you go to the code blue in overnight? was it one of ours?"

"Yes," he texted back, "it was Mr. John."

My heart sank. 

I made it down to the EC with five minutes to spare before the ward round, and found my senior at the table, writing notes. 

"What happened?"

"I'm not sure," he admitted, "I was in overnight ward, and he suddenly stopped breathing. We did CPR and got his heart going again. I had to intubate him, he's in resus now." He ran a hand through his hair. "I'm not sure I did the right thing."

I was surprised to hear this. "I'm sure you did."

The senior on the round didn't feel the need to fire shots at him. But I had forgotten to write his vitals in the file when I had gone to check on him. So, as she said it, not written down means not done. I hadn't done enough as the doctor on call. 

Note to self: make copious notes all the time for everything. To be safe. 

Despite all measures over the next few days, his blood pressure kept falling. His lungs seemed to be shot. He passed away a few days later. 

I learned a valuable lesson that night.

If a nurse thinks a patient is going to crash, even if his vitals are all stable and he just seems a bit distressed, believe them. If a nurse thinks any patient might deteriorate, trust them. Even the rude ones. They know.