Saturday, November 27, 2010

They Are All Code Blue Now

"Code Blue ICU....Code Blue ICU"

I was greeted by the PA system as I walked into the hospital this morning. A shiver ran down my spine as I quickened my pace . The days of running to codes are long gone. But since I have a patient In the ICU I was curious and just a little bit worried.

As I walked through the sliding doors I passed the room full of doctors and nurses frantically working. It was not my patient. The ICU doctor stood on the side calmly directing the measured chaos.

And my mind wandered back to my training. As a second year resident I was on call at at VA hospital every fourth night. left alone with a few unseasoned interns and hundreds of ill patients I was the head of the show.

And our patients crashed and burned on a regular basis. One...Two...sometimes four codes in one night. Although it was the beginning of my medical career I was used to it...each of us residents a veteran of hundreds of codes already.

I would stand at the head of the bed. Directing the CPR, medications, Line insertions, and intubations. Some of our patients lived. Some of them died.

We felt like doctors. real doctors. Like the ones on TV....swooping in at the last minute to save the day as family members knelt at our feet in gracious thanks (well not exactly).

But eventually I graduated residency. I became an attending and practiced in the real world...unshielded by academic hierarchy. I was rarely in the hospital when my patients coded. The ICU, nurses, and rapid response teams took over. And the decision process changed.

I still make decisions that alter people's lives. They may not be as dramatic. I no longer pull out the paddles and shock their chest when the monitor starts to buzz. My decisions are much more mundane. To change the medicines. To order the cat scan. To offer hospice.

Much less glamorous. But still fraught with consequences. I may sleep more then I did during residency.

But probably a lot less soundly.

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