Friday, October 9, 2009

Code #1

We were doing our routine rounds this morning when we entered the room of a patient admitted during the night for possible Leptospirosis. He was febrile and complained of abdominal pain but was endorsed to us as one of the stable Lepto patients admitted the night before. As we entered the room, we saw the patient lying on his right side, breathing fast, and was complaining of abdominal pain. This is part of the constellation of symptoms of the infection we suspected he had. We checked out the rest of his vitals and my resident said we might give medication for the abdominal pain and he ordered one for him. We went about seeing other patients and I later found out the medication helped with the pain.

After grabbing a bit of lunch at 2pm, while we were waiting for endorsements at the office, a Code* was sounded. It was our patient. We rushed up to his room and found full resuscitative efforts under way. CPR was administered, along with injections of medications and infusion of fluids. I stood there, helpless, and for the first time that I can ever remember, I was affected by the resuscitation scene unfolding before me. I had never met the patient before this morning and had only briefly spoken with him and his wife. But for some reason, this code was different from all the others. Maybe it was because of the wife crying quietly beside me outside the room. Maybe it was the fact that as soon as I noticed the patient's fast breathing, I knew something was wrong. Whatever it was, I was affected by that picture before me, a middle-aged man, at the prime of his life, previously healthy, just lying there literally breathless, pulseless, lifeless.

As doctors, we are trained to distance ourselves emotionally from scenes like these. It is the only way we are able to think clearly, to do the right thing and give the proper treatment at the exact time it is needed. We need to be objective and critical, and emotions will always affect our judgment. We can feel sad and sorry for our patients, but not when our clear judgments are needed the most. I've seen many codes before, and in fact lost my first laptop when I rushed to one in med school. There will be many more codes in the future. But for some reason, I feel this code will always stick out in my memory, a reminder that doctors need to be human and emotional too, albeit at the proper time.

As my resident was writing post-mortem orders in the patient's chart, a nurse passing behind me at the station said, "just another day at work." For the medical team, perhaps it is. For the family of this patient, not by a million miles.

*For my non-medical friends, a "Code" is sounded in the hospital's paging system whenever a patient "crashes," i.e., loses a pulse, stops breathing, or generally becomes unresponsive. You might be familiar with CPR scenes like these in shows like Grey's Anatomy or E.R, but it is rarely as dramatic.

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