Code Whores

Fresh in at 0730, and joyous day, I am handed the code pager. This beeps a loud obnoxious beep and a voice directs me to a location when somewhere in the hospital a code is called. Some poor patient has become pulseless and/or stopped breathing. 2 ICU nurses respond to the call along with countless doctors, a pharmacist, and respiratory therapists run to the rescue.

Another nurse looks at me and we give each other a knowing smile, saunter over to one other and give a low high-five. We are whores. Code whores. I love a good code. I must be going to hell, because sometimes I get so bored with my patients, or on night shift, I just wanted to stay awake. I am wishing the code pager would go off.

The initial call sends a thrill through me. I drop everything and rush out of my patients room. I yell for someone to take over, grab my red box of emergency supplies and run where I am directed. The pounding of all our feet on the stairs, recognizing and appraising the responders. Cracking a joke, or giving a quick summation of recent life events, we rush to the scene. People point us to the room, and we run in, grabbing gloves as we go. Someone is already doing compressions, another is bagging. I slap on the pacer pads to get a rhythm, as a doctor takes the lead in the code and begins to give orders. I am the ICU nurse, there to make sure we have IV access, push drugs, take over compressions if needed, and my greatest role personally, is as the code nazi. Delegating to the floor nurses and med students, I become a goal-oriented force of nature. Typically we are able to get a pulse and intubate the patient, and then transfer them to the ICU. My energy transforms into the nurturer as I see family members looking on with tears in their eyes and horrified faces. I encourage them to come with us, hold their loved ones hand, as we rush together to the unit.

Now, if I was in pediatrics, or an OB nurse, a code would be my worst nightmare. I am not so ravenous for adrenaline that I would hope for that. If it makes you (or I) feel better, I will say that people typically have cardiac arrests for a reason. They are usually very sick or have sick hearts. The chances outside the hospital of resuscitation are 25%, inside the hospital are not much better. We can usually get a pulse back, but actually leaving the hospital, chances are actually like 5%. Really poor. We are typically giving families a chance to say goodbye. The patients have chronic illness, are on a ventilator, have enough heart or brain lost to be permanently damaged, and I help families let their loved one go.

I go from code whore, to a supportive, intuitive nurse who is protective of my patient and family. I help families to understand the events and many times we will go down the path of making the patient DNAR, and then eventually to transitioning to comfort care. The lights get turned down low. Machines are taken away and morphine drips are hung. Comfy chairs and warm blankets are brought in, and the endotracheal tube is taken out. Families gather around the patient and stories are told. The heartbeat slows and we gather closer. Families are lead in prayer and I hold hands with them all. I cry tears with them and hug them when I leave.

I go home, and as I walk to my car, I have the same elated feeling in my heart from the successful code, as I do with the loving family. My day was productive, I helped people in the best way that I could. Whether that was as a code whore or as a family advocate, I did my job, and I did it as best I could. And I can only be satisfied with that.