Code

“BEEP BEEP BEEP BEEP”. My beeper.

“Code Blue, Francis Tower, Dialysis”

A Code Blue! I grab my stethoscope, and rush down two flights of stairs to the dialysis unit. The doors open, and it is a frenzy of activity there. My senior is already there. I’m the cardiology resident. That makes me the second code team leader. I dread the days I arrive before my senior.

A code team consists of the cardiology senior who is the code team leader, the cardiology intern, the critical care fellow who is the airway and central line technician, the critical care senior, respiratory techs, nurses, phlebotomists and 2 pharmacists.

A nurse is performing chest compressions, while another bagging.

“57 year old man with diabetic endstage renal disease on intermittent hemodialysis, admitted for diabetic foot. Coded 20 minutes into dialysis”, his nurse tells me. In short, diabetes has killed his kidneys, his feet, and is slowly killing him.

The crash cart arrives. Within seconds electrodes are placed on his chest.

“Hold CPR. Check for pulses and rhythm!” the code team leader shouts.

PEA! Pulseless electrical activity. No shock indicated. As I try to recall the ACLS algorithm for PEA, my senior is shouting orders for epinephrine and stat blood tests.

“Resume CPR!”

I climb on the bed, straddling the patient and resume compressions. One and two and three and four and ….

“No pulses”.

Damn! Inadequate compressions. I press harder, someone responds with “Good fem pulses”. Under my hands, I feel his chest give to my pressure.

Crack. Crack, crack.

I feel his ribs break as I squeeze life sustaining blood out of his heart into the rest of his body for him. In a kidney failure patient with renal osteodystrophy, the bones are brittle. Fractures are almost expected during CPR. Nonetheless it is a sick, unforgettable feeling.

The critical care team successfully places a central line. A tube going into the right neck directly into the vein that feeds the superior vena cava.

Hold CPR. Suddenly, “Weak pulses!”. He’s back. How long I wonder. They package him up, and ship him 4 floors up to the medical ICU.

4 days later, I receive a call. He passed on.

Now, 18 months later, on a bad day I still get nightmares about that morning.
“Crack. Crack, crack.” I shall never forget.