Every DAY, in the course of medical training, we are exposed to situations that influence the way we turn out as doctors. One profound interaction with a patient, family or doctor can be life-changing. This is the story of one such experience that made me a better doctor. It begins with a cardiac arrest:
As senior medicine resident on call for the night, I was responsible for two interns, new admissions and all cardiac arrests. The interns and I each carried a little red pager that went off with a sound of screeching tires when a "code" was called. There was no mistaking that sound.
It was 11 o'clock when the beeper went off. I had been examining a man on 4-South whose kidneys had shut down. It had been a busy night, and many patients were still waiting to be seen by the interns.
I looked at the extension on the pager: 6-North. Surgery floor. Some medical screw-up by the surgeons, I thought at first. I ran down the long corridor to the north stairwell and up two flights.
A cardinal rule when running to a "code" is: Slow down and walk the final 50 yards, catch your breath, clear your head. As I passed the nurses' station, the unit secretary pointed to the patient's room. I asked about the patient's code status -- whether she had "do not resuscitate" instructions in the event of a cardiac arrest. None was listed.
I entered the room to see a very old and frail-looking woman sprawled unconscious on the bed, a nurse squeezing an air bag over her mouth, and one of the two interns performing external cardiac massage.
The head nurse from 6-North pushed a rattling "crash cart" into the room and started attaching EKG leads.
The other intern had joined us and was reviewing the chart:
Mrs. Cheever (not her real name), 89, leg cellulitis (a skin infection), admitted two days ago, on IV antibiotics, laboratory tests from admission OK, except hemoglobin a bit low.
Underlying illnesses: None stated.
The surgery admit note was basically two lines: cellulitis; IV cefazolin (the antibiotic).
A young nurse spoke up. She had been giving the patient a sleeping pill when the patient said she felt dizzy and fell back on the bed, unresponsive. The nurse initially thought she had fainted but then couldn't find a pulse. Fortunate timing for the patient, I thought, before reconsidering how unfortunate it might turn out to be.
Without a "code status," we would be going the whole way -- a "full code." I leaned over the EKG machine.
