Just coded a terminal cancer patient.
It was their third time coding today. Each time they were brought back weaker than before and a little more brain damaged. The family was watching the action through the ICU room window and refused to let us stop.
Y’all, let this be a public service announcement. Breaking your loved one’s ribs, pumping them full of medical grade speed, and shoving tubes down their throat is not necessarily the most loving thing you can do for them. Most of the codes I go to are prolonging suffering rather than prolonging meaningful life.
I’ve said it once and I’ll say it a thousand times: if I’m already in terrible shape or am terminally ill, don’t code me bro. No PEG tube, no ventilator, no compressions, no shocks. Don’t do it. Let me go.
The other night we had a patient who was flown into our ER from a much smaller and rural hospital after going into cardiac arrest. The other hospital didn’t have the facilities to care for him after he was resuscitated. He was already intubated and sedated. He wasn’t my patient so I didn’t know much about him and he went up to the ICU fairly quickly.
Several hours later after the physician who saw him had already gone home, they called a code upstairs in the ICU. As we began our rush to the ICU, the hospitalist practically sprinted past us, telling us that we didn’t need to go because he wasn’t busy.
About 30 minutes later one of the nurses decided to pull up the telemetry monitor of that patient to see if he was was doing alright. He wasn’t. His vitals were absolute crap. He was hypotensive, hypoxic, and bradycardic. We called the doc over to look at it, and we just watched. Watched as his HR slowly become more and more brady: 50s to 40s….40s to 30s. We watched as his BP fell from 90s/50s to 80s/50s to 60/40. Watched as he somehow became more and more hypoxic. We watched as his 12 lead slowly evolved from sinus bradycardia to what looked like an evolving idioventricular rhythm. We watched and waited. Slowly he dropped into the 20s. Eventually he jumped into this fantastically extravagant polymorphic wide complex tachycardia. Finally a code was called and once again we ran to the ICU.
It’s hard to realize that on the other end of that telemetry monitor, past all those lines and numbers, lies a person.