3 | ER

Throwback to the student days, to one of the first times I participated in a code. 

* * * 

The ambulance theme song catches my attention from across the nurse’s station. I close my charting and jog over just as Kate, my preceptor, picks up the receiver. “This is Northwest Base, go ahead.”

“Northwest, this is Palatine 25. how do you copy?”

“Loud and clear, Palatine. Go ahead.”

“Alright, we have a 73-year-old man found non-responsive at home after a suspected heart attack. He was PEA on the monitor when we got to him, but since then we’ve been able to feel a carotid a few times. Pulse is gone now. We started compressions, put in a King airway, & got a line in him. Bringing him in now, ETA 6 minutes…”

Someone scrambles to call a Cardiac Alert for room Bravo-2. We pour into the room with a crash cart, clearing the floor, piling equipment and priming bags of fluid. We are ready when the paramedics burst in with the wheeled stretcher, delivering chest compressions as they approach.

A paramedic gives report amidst the flurried activity. “We’ve given him 5 doses of epinephrine but haven’t gotten a pulse back. He’s gone into V-fib a few times, but mostly he’s flat-lining.”

I catch sight of a tech about to draw blood; in a burst of courage, I stop him.

“Hey, I’ll start an IV and draw blood from that instead.” He nods and pushes the tubes and tourniquet in my direction. I jump in without letting myself think twice.

The patient’s arm feels like cold wax beneath my fingers; dead weight. There is no twitch when I slide the needle into his vein, no exclamation of pain. His arm jerks rhythmically as someone delivers chest compressions. I calm my breathing and search for the blood flash. Bang; got it. The IV is in. I hang a bag of fluid wide open and step back.

“I need a med nurse!” Someone calls. I don’t even hesitate this time. The adrenaline has hit.

“Got it! What do you want?”

The doctor considers. “Epi. Let’s try it again.”

I have never set up an epinephrine cartridge before. Once, after a simulation, my instructor passed a cartridge around and explained how it works. “You pull off the yellow tab, twist the two parts together, and you’re set.” Now, staring at the pieces as I dump them out of the box, it seems more complicated. I jam the cartridge into the injector and double-check with a nurse standing next to me.

“Hey, did I do that right?”

He nods. “You’re good to go.”

“Kate!” I call as I scrub an IV port. “First dose of epi is going in... now.” She nods and records the time.

Thump, thump, thump. The room is still except for the tech delivering chest compressions. We’re holding our breath, willing the epi to take effect.

Flat line.

10 minutes of compressions and 2 doses of epi later, the doctor uses an ultrasound to check for heart activity.

“I got nothing. Anyone object if I declare it?”

No one speaks. We know there’s nothing else to be done; 7 doses of epi should kick-start a stone.

“Alright,” says the doctor. “I’m calling it at 4:33. You can stop compressions.” The tech steps down from his stool and drags a shaking arm across his forehead. Compressions are a workout by anyone’s standard.

“I’ll send the family to the viewing room. Go ahead and get the body ready.”

Suddenly, the room is quiet. It’s just me, Kate, and a tech. Kate is filling out her time-keeping page, so I turn towards the bed.

The white body lies bare, glaringly pale in the fluorescent light. His chest is extended as though with a deep breath; our artificial ventilations left air in his lungs. I stare for a moment, half-expecting an exhale to relieve the tension. But he lies rigid.

“Hey, would you mind…?” The tech points towards the man’s eyes, and I realize I’m the only person still wearing my gloves. I step over and gently press the man’s eyes closed, but not before I see the vast emptiness staring up at the ceiling.

“The family is here; I’ll take him over,” announces someone in the doorway. With that, we are alone in the room, left to clean up papers, plastic packaging, and EKG stickers off the floor. To prepare the room for the next patient.

Life is a thread. Take a moment today to look around you at the people you love. Notice each one. Because pages turn, & you will never return to this one.