Blog | Friday, August 10, 2012

My first code

A real code deviates from what they depict in medical dramas like Grey's Anatomy. Television chest compressions are usually too slow and superficial, they are nowhere near forceful enough to sustain blood flow throughout the body. There is no foreboding soundtrack to hint at what's coming, only the numbers that appear on the monitor that suddenly dip in the wrong direction.

Although I understood the magnitude of the situation as it unraveled before me, the monitor deceived me into believing that our fluid and pharmacologic interventions were enough. I watched the numbers bounce around, then steady at a reasonable value. They sat there for a short stint, before starting a slow descent.

I felt the air in the room change.

Everything moved faster, except time. The seconds dragged on as I watched more people filter into the room. More supplies were requested. More fluids and drugs were administered. Everyone's motions were hurried and purposeful as I stood at the end of the table with my hands together.

I remember watching everything but not really hearing it all. There were orders being called and more groups assembled to assist, but I processed it like a silent movie. Everything was surreal up until I saw that chest compressions had begun. The stoic, lighthearted facial expressions that the room started with had all faded into concerned, determined ones.

I notice the time, only minutes have passed.

Shocks were administered between bouts of compressions. Indeed, they do call out "All clear" prior to defibrillation [Grey's got that right]. Abruptly, all the hands abandon the patient for a split second as the body receives a jolt. Everyone resumes their work immediately.

I study the compressions, they are exactly as we were taught: at least 100/minute with 2 inches of depth. There are three people switching off, but they look tired. To my left, someone asks, "Have you done compressions before?" I slowly nod my head and am nudged to assist.

The individual doing CPR looks relieved as I step forward. During the administration of a shock, we quickly switch positions. My heart raced and adrenaline coursed through my vessels as I stepped up toward the patient. At that moment, it was as if someone else took over my body, I felt myself approaching the patient, but then I saw myself rhythmically pumping the chest. Everyone continued to work around me, but all I really registered was the patient and my motions.

It seemed like I had been giving compressions for at least five minutes before someone else took over; in reality, it was only a minute or two. The motion really wipes you out, I stepped back breathing like I had just run my fastest mile. My second round of compressions was tough, but I pushed on.

The code continues to run. After what seems like hours, it comes to a close.


In medicine, we fight time and nature with tests, drugs and surgeries. Over the years, we have been successful in extending life, however, we haven't discovered a magic formula to live forever. The reality is that sometimes we delay nature's course, but there is no stopping the inevitable.
Every single day of life should be lived to the fullest, even if external forces put up road blocks, we need to realize that they are temporary and sometimes out of our control.

I have wasted a lot of time and generated a hefty amount of cortisol worrying about things that I cannot predict or change the course of. But this, and the events of the last week, have shown me the importance of letting go. Not to say that I'm going to forget this patient or the experience, they will undoubtedly stay with me forever, but there is a stark contrast between healthy reflection and incessant "what ifs." I wasn't responsible for this code, but someday I will run one and if I continue down the path that I'm on, I will never be able to move on from nit-picking at details for years on end or forgiving myself for things that I could not alter, nor foresee.

I need to change.

I don't expect a sudden personality shift, but I'm working slowly toward peace, as corny as this sounds, I think it'll do me [mind & body] a lot of good.

Wish me luck moving forward.

Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich. She has a Bachelor of Science in Engineering [Biomedical Engineering] and Master of Science in Engineering [Biomedical Engineering, again] from the University of Michigan. This post originally appeared at her blog, "And Thus, It Begins," which chronicles her journey through medical training from day 1 of medical school.