Hey all,
I recently had an article published in Hospital Physician. It’s a true story about a code that I participated in during my intern year. It’s a pretty interesting story, and you guys are always so supportive of my - and other people’s - writing, so here it is 
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www.turner-white.com Hospital Physician September 2003
"Code Blue…Younker 8. Code Blue…Younker 8.”
A new surgical intern, I nervously slung my
stethoscope around my neck and trotted down
the hallway in that comical flat-footed gait necessary to
keep medical paraphernalia from flying out of the
bulging pockets of my lab coat as I ran.
Arriving on the
telemetry floor, I entered a room already bustling with
first responders and curious ancillary personnel. A
plaid suitcase lay on its side in one corner.
“She was supposed to go home today,” a young
nurse murmured almost apologetically.
I nodded, pushing my way to the head of the bed.
Grateful to find the patient edentulous, I slipped in an
endotracheal tube and the respiratory therapist initiated
bag ventilations. After confirmation of no pulse,
someone started chest compressions.
I asked the nurse about the patient’s history. Quickly,
she recited the facts: 68-year-old woman, 6 days post
urgent coronary artery bypass grafting, unremarkable
convalescence, found down and pulseless in her room
shortly before final discharge to home.
The attending cardiothoracic surgeon strode into
the room. I turned my attention to placing a central
venous catheter in the groin, while he ran through the
advanced cardiac life support protocol of her various
rhythms. Sinus tachycardia degenerated to ventricular
fibrillation that, after defibrillation, settled into a seemingly
resistant ventricular tachycardia, and finally—
after a series of shocks—asystole.
“Still no pulse,” a paramedic trainee duly noted before
resuming chest compressions.
“We should crack her chest,” I heard myself say,
almost more a question than a statement.
The attending frowned. “It’s probably ventricular
wall rupture. She’s been down a long time. I think we
should call it.”
“She’s right; it is protocol,” a voice rose from the
back. The chief resident stood leaning against the doorway,
an amused smile on his face. “Besides,” he said,
with a subtle gesture and nod in my direction, “she’s got
to learn sometime.”
The attending shrugged his consent and someone
produced a chest tray. My hands shook as I assembled
the pieces to the sternal retractor. The freshly operated
on skin separated easily. Underneath, blood began
pressing through the closure as the sternal wires were
cut and pulled free. The retractor was placed and the
mediastinum was a pool of dark blood, obscuring the
heart. I reached in gingerly and fumblingly began
open heart massage.
“Careful of the grafts,” the attending said irritably.
After a few compressions, the heart quivered and
spasms of contractility settled into a pattern of regular
motion. The blood was suctioned from the cavity and a
hole on the anterior surface of the aorta with active
bleeding became visible. The attending placed his finger
over it and the bleeding stopped. The heart filled
as fluids and then blood were pumped in by hand
squeezed intravenous bags.
“We’ve got a heartbeat, but I doubt we’ve got much
else. Someone better call the family,” the thoughtfullooking
paramedic muttered.
I stared down at the woman’s ashen face. She still
wore remnants of the lipstick she had applied in anticipation
of leaving the hospital. What degree of complexity
had my educational pursuit now burdened the lives
of this woman’s family? Had my desire to learn a novel
procedure converted an unexpected—but simple—
death into long hours or days of painful end-of-life
decisions? The scenario took on the uncomfortable
aura of a science experiment gone horribly awry.
Suddenly, the woman’s eyes opened, her back arched,
and she cast her eyes about the room, seemingly searching.
People screamed and pushed back from the bedside,
then sheepishly exchanged glances and embarrassed
smiles.
“Call the OR!” the attending barked. “Let’s roll!”
The patient was whisked out of the room, a finger
still pressed against the hole in her aorta, past the
shocked onlookers crowding the hallway.
Weeks later, my sleep-deprived consciousness recalled
the event long enough to ask the cardiothoracic
surgeon about the outcome. He looked at me blankly.
“Who? Oh, yes. We repaired her aorta. She was in
the hospital another 2 weeks and was discharged to
rehab. She’s home now and doing well.”
He paused and looked at me wryly. “So, doctor, do
you think you know how to do a postoperative resuscitative
thoracotomy now?”
We shared a smile. “Yes, sir. Thank you, sir, I do.”
Meredith McBride, MD
Lewiston, ID
Meredity,
Great story! And what a feeling that must have been to find out that the patient had not only survived, but was home and doing well!
Thanks for sharing it with us!
Meredith,
Thanks for the story! My heart was beating faster as I read it. I could feel every emotion. What a great experience! I am glad that you are hanging out with us and taking some time out from your attending duties to post. I love your writing style!
Natalie ( I should be “buns up” in the call room but I am reading OPM)
Thanks for posting!!!
Great work, Meredith! (that is, both the doctoring, and the essay.)
cheers
joe
Meredith,
WOW, I’m not usually into the “adrenaline rush” side of medicine but that story was great.
Kathy
Great post about your experiences. Thanks.
I sit here reading this thread on call at the “VA Spa” knowing, like Nat mentioned, I should be ‘buns up’ asleep & not perusing/reading OPM. Hell, I am the airway man while on call here…have had to drop a couple of emergent tubes already in the last week. Talk about an amazing charge! However, my first emergent intubation of the week did not fare as well - taken off life support today.
Oh well…it is way past time that I hit the sack.