9 | Breath

(Details and room numbers changed to protect privacy.)

Alarm clock crashes through layers of dreams: jolt awake. Stumble through the muted pre-dawn light of my apartment. Rituals of pulling on scrubs, packing lunch, making coffee. My commute takes me through rainy headlights and a winding parking garage. I dodge puddles and follow a line of scrubbed figures into the sleepy hospital.

Another day begins.

***

As I walk out of the locker room, my eye goes straight to the flashing red light. "Code Blue- 2nd floor- North Tower." The overhead speaker suddenly confirms what I'm seeing. My coworkers are jogging down the hallway, collecting in the doorway. Either some unfortunate soul bumped the Code Blue button while turning off a call light... 

Or someone is fighting for their life in room 319.

I drop my clipboard and run to find out which it is.

***

There is a small space between Life and Death, and as nurses, we can find ourselves thrown into that space without warning. That space is as small as a breath-- the breath you steal between chest compressions. The breath leaving the patient's lungs as you crash his sternum down onto his heart-- again, again, again. The breath artificially forced through the ET tube as the respiratory therapist calmly bags the patient's airway. Your own breath as it catches when the patient unconsciously vomits bile onto the side of the bed, narrowly missing the front of your scrubs. The breath everyone holds when we step back for a pulse check.

"Nothing," calls the code leader. "Resume compressions."

...27, 28, 29, 30.

Breath. 

***

Medicine is the story of imperfect people using imperfect tools to relieve the brokenness that crashed into our world at the Fall. We train, read, learn, practice, discuss, innovate. The stakes are high and real lives hang in the balance. We do the best we can, to the utmost of our abilities, with every tool we've got and every brain in the room working at 110% capacity. There are success stories: I have seen much suffering relieved and many gravely injured people go home to their families that I never expected would see the outside of the hospital again. Our efforts produce measurable, generally predictable results. But sometimes, that's just not enough. Sometimes we do everything right but the body continues to fail. Sometimes we are not enough.

***

I wonder if our patient looked out his window that morning, before the Code. Rain ran down the glass in rivulets. No way he could know these were his final moments on earth. And no way I could know I'd be present for that man's final moments on earth: I was just some nurse walking into work at 06:49 on a Tuesday. I clocked in as I ran into the Code room. My hands were among the last on his body before he passed. The heel of my hand pressed against his sternum as ribs cracked, one eventually slipping into a lung and puncturing it. 

We fought hard for him but it wasn't enough this time. God knew this rainy Tuesday was his final scene, but we did not. 

***

With enough epinephrine, we got a pulse back. A weak blood pressure appeared just long enough for the code team to capture it with a dopamine drip. They rushed the patient down to the O.R. and we stepped back, his fate out of our hands. [was it ever truly in them?] We washed up, closed the door to the room, and went back to start our shift. 07:51 on a Tuesday.

Later, the surgeon came up and dropped into a swivel chair near me, looking exhausted. I asked how it went. After a pause, he said that the patient coded again on the O.R. table, and this time, he never came back. After calling the time of death the surgeon scrubbed out, walked upstairs, and started rounds on his other surgical patients. Good morning; how are you? Did you sleep okay?

Life goes on.

[right until it stops.]

***

Our breaths are not promised. Our fates do not lie in our hands. We wake every morning with a task to do and the responsibility to do it well-- as well as we possibly can. But the outcomes are left up to our Creator.

I don't have every answer. But I do have life. I have breath. I have an alarm that goes off at 05:15 tomorrow morning, and I have work to do.

But most importantly, I have a Creator who promises to accomplish his perfect plan despite my imperfect abilities. 

And so we wake up and go back to work and fight for our patients with every breath we've got. 

***

"Whatever your hand finds to do... do it with your might." [ecclesiastes 9:10]