Code Blue Debriefed

She’s the nurse in Sweet Revenge who calls the code blue incredibly slowly.

The whole thing was more difficult than I ever expected. And I’ve never been good at self-examination-I go with the flow, keep it real. No rehashing what’s in the past, you know. That’s my motto, so getting this down in black and white isn’t what I am used to.

20/20 hindsight, I guess it’s called, when you think about what happened and see what coulda gone differently? I’d only worked at Bay City General for one month; he was my first code. Ever, and I’ve been a nurse for five years.

I was a great nurse at my old place of employment, Bay City Senior Facility. I liked the pace-slow and easy. Mostly pushed wheelchairs, gave insulin injections, and passed out Milk of Magnesia. Those old ladies adored me when I spoon fed them chocolate pudding.

But the rent for my studio apartment went up and the pay at the old folks’ home didn’t cover squat.

My sister is the recruiter at BCGen. Easy as pie to get a leg in, and there were lots of openings for experienced nurses. Thing was, intensive care was new to me. They’re all really sick there: on ventilators, with cardiac monitors, and lots of IV drips. Half of them are gorks and gomers. To be brutally honest, not my cup of tea. Plus, the charge nurse, Emma, had it in for me from day one. Kept giving me the difficult patients with no hope.

I got three weeks of training on unit procedures from a nurse who didn’t like me either. Kept calling me a lightweight, but I held my own and showed her! I’ve got skills. I’ve started IVs and hung fluids. I’ll admit-now-the patients took some getting used to in the ICU.

He was a good looking guy, can’t deny that, even in a coma. Dark curly hair and a strong jaw. Really blue eyes when I pried open his lids to check his pupil response. A cop shot in the line of duty. Pretty low, if you ask me, to shoot a cop.

Seemed like an easy enough gig, though. Monitor the cop, record his vitals every hour, because of how unstable he was. At least I didn’t have to do the damned every fifteen minutes vitals; the recovery room nurses had done that after surgery. And they dosed him up good with a morphine drip. But this was a whole day later, and was in a coma with one foot in the grave, as far as I was concerned. How hard could it be? Wasn’t like he was going to do anything.

I‘d have rather had old Mrs. Kinney in bed five with her decubiti and amputated foot due to diabetes. I know her. She was in the home when I last worked there. We could chat for hours and watch soap operas.

The cop’s heart rate was real unstable, the tracing bouncing up and down like a ball, and way too fast. Thing was-now I learn-he was in what’s called hypovolemic shock. Even though he got lactated ringers and who knows what all in the OR, the bleeding and trauma from the shooting, plus the surgery had decreased the fluid volume in his veins. How the hell was I supposed to know that? Those old people, when they get dehydrated, they shrivel up like raisins in the sun and quietly pass away when nobody’s watching.

I was minding my own business, reading Season of Passion, Danielle Steel’s latest, when there was the most obnoxious alarm coming from the monitor. The cop was in ventricular fibrillation-which means his heart was flopping around like a fish out of water. Pretty definitive definition of death, if you ask me.

The most important thing I’d learned in that first rough month of training in the ICU: how to call a code blue. First, establish that it was the real thing. Sometimes a lead wire comes loose, or the patient is moving around too much.

Like the cop was moving-that wasn’t happening.

I was cautious. I checked him careful-examined the monitor first, and then listened for breathing. You know, the ABCs of life support. Airway, breathing and circulation.

When I determined that he wasn’t breathing, I called a code. Like you’re supposed to do. And got criticized for every move I made afterwards.

“He was on a vent, Lorna. Of course his lungs were filling, but his heart wasn’t pumping effectively-you should have called the code and grabbed the Ambu bag to oxygenate him faster.”

Know-it-all Emma with her head full of policies and procedures. Ticked off my faults on her manicured fingers-which really ticked me off, I’ll have you know. I should have alerted the code team faster. Should have known my limitations. Asked for help.

He was my first code, I was trying to be thorough. And I saved his life! So sue me, Emma. Cause he wouldn’t be alive if it wasn’t for me.

Dr. Walker and about five other nurses and doctors came running like they didn’t have another patient in the unit, dragging the defibrillator behind them. Never saw such a commotion. I’d started bagging the cop, pumping oxygen into him to keep his heart and brain going, but it seemed like a losing battle.

“Doctor, there’s no vital signs. We lost him,” I reported.

Emma pushes me aside so she can be up there next to Walker. I’ve seen the way those two make eyes with each other and suddenly disappear at the same time for a break. They’re boffing in a supply closet, mark my words. I got shunted down to draw up meds with Sherri, who’s only three months out of nursing school.

Sodium bicarb and epinephrine, stat! All that math to calculate the doses makes my head hurt.

Walker swung into authority mode, delegating the CPR compressions to the head resident, Jerry, so he could turn on the defibrillator. It’s not like on TV where somebody yells “flat line” and then shocks the patient, jerking his whole body off the bed. First off, there’s no such thing as a flat line. I mean, come on. If you don’t have a heart rate, you’re dead. The defibrillator has to have some kind of electrical charge from the heart to shock it into normal sinus rhythm. A lowly nursing student knows that much. Ventricular fibrillation is a heart beat over 200 beats a minute.

The cop was circling the drain fast, no matter what we did. I could see his friends peering at us through the window. Made me all kinds of nervous, I’ll tell you. Like they expected me to make some kind of mistake. The cop was dying. It was obvious to everyone, including Walker, when he held those paddles to the cop’s chest.

I figured he was gonna go, then and there. Hadn’t seen a patient flat out die before. In the home, those oldies check out late at night, drifting off in their sleep for the night nurse to find at the end of her shift. When I’d clock in after seven am, I used to call the funeral parlor, the next of kin, that sort of thing.

“One more time,” Walker said, positioning the paddles on the cop’s chest for a third time.

I could smell the scent of burnt chest hair from the electric surge. The sutured incisions on his torso from his recent surgery peeked through the bandages Sherri had cut to give access for the defibrillator. Really pretty gross.

Then the damnedest thing I ever saw, just as Walker discharged the final shock. All of the cop’s friends suddenly turned away from the window at the exact second the cop’s heart beat slammed back into a normal rhythm. Like some kind of miracle the pastor at my church is always going on about.

I’d saved a man’s life, with my own two hands! Should gotten a commendation from management instead of a dressing down by Queen Emma. She said I wasn’t suited for the fast pace of intensive care. That I should work in another department.

She said that in front of Walker, Sherri, all of them. Really classy. Then Walker lets in the cop’s partner, the hunky blond I’d seen hanging around in the halls the last couple days. All long legs and blue eyes like some Viking warrior. He’d been haunting the cop’s room since the patient was admitted, mourning like he’d lost his lover. Made me wonder about the two of them, it really did.

Especially the way he grabbed the cop’s hand, really tight. Holding on like he didn’t want to ever let go.

The cop’s vitals had actually stabilized when his partner burst into the ICU-we were all busy so we didn’t get the significance of the whole thing until later on.

One minute, he’s in V-fib, even after three jolts from the defibrillator, then BAM. He’s in sinus rhythm. I’ve never seen the like.

Emma wants me out yesterday but I’m digging in my heels. After all, now I’ve got a whole month and a code blue under my belt. Saved a guy’s life! That feels really powerful, I must say.

It really is a peaceful unit, when there aren’t any emergencies, and nobody’s bleeding out. The myocardial infarctions do pretty well considering, and so do the diabetics. As long as I don’t have to draw up code meds, I am happy.

I preferred the old folks’ home, but getting paid to read a book while the patient sleeps in a sedated haze is my kind of gig.

Lorna Doran, RN.