The Story That Took a Month to Write: My First Code

I know that I’ve not written in weeks. There is no excuse for me to share but rather the fear of writing. If you’ve not noticed I always have something to say. This time though, I am afraid to say. I want to tell you a story that comes from the opposite end of the spectrum in comparison to my quirky tales of mishaps and hilarity. As we all know, there is another side to reality, of which I would like to share. With life comes death. This is a story that touches on this harsh truth. But truth nonetheless. May this tale honor an exceptional being that has changed my life forever.

I was so proud to be sitting in a classroom and sweating it out as I hashed out EKG readings and acting out a mega code. For those of you who don’t understand my lingo, this is the case of ACLS certification. This coveted certification is for Advanced Cardiovascular Life Support. The phrase makes nursing students shudder in their shoes and full grown adults immediately grow anxious (maybe a palpitation here or there). I had spent my week studying my brains out. It felt like nursing school all over again. In the back of my mind I knew that with this certification I would have the skills I needed to participate in a code situation in the hospital. My certification for Basic Life Support for the Healthcare Provider was already housed in my wallet. I guess you can say that the biggest difference between these two certifications are that you can administer medication to start or reset a heart again with ACLS. BLS is more basic. My friend and I sat in the classes giggling to one another at the scenarios on the screen being played out to perfection. The handsome doctor in the white coat giving orders and the also good-looking nurse pushing “Epi” as per order. Calm. Cool. Collected.

We had our hands on experiences with the manikins as well as mock situations in smaller classes. After a written test, if you passed of course, you walked away with a card stating you were absolutely, no questions asked, certified. I walked out of that building with my head held high, beyond thrilled to have my card in hand. Look at what I did playing over and over in my head.

The next morning began like any other. I woke up at 0530 to get ready for work. After a swift body cleanse in the shower, some food in my stomach and coffee to go, I ran out the door ready to tell all my coworkers of my good news. When I hustled onto the floor and rounded the corner, the main nurse desk was bustling with activity with many concerned faces. Too many even. I shoved my news into the back of my mind as I was approached by a coworker, “Thank God you’re here, I need to give you report on a situation now.” My stomach dropped, my throat became dry and my heart sped up to break-neck speed.

My coworker began her story with a young patient’s admission in the night. The gist was that the patient had presented with respiratory distress due to end stage cancer that had riddled their body with tumors. The presence of these toxic growths were altering the patient’s ability to breathe, their heart rate, and many other things crucial to life. To survival.

I had cared for patients in respiratory distress in the past but the thing that stung me to my core was the patient’s age and their circumstances. Cancer is a terrible thing that I have seen as a nurse on a daily basis. This case was no different. Yet it was. It is a difficult battle to fight but having your childhood taken from you by a force that attacks your entire body, well, this idea alone was enough to bring me to my knees. You better believe that it did. I began to pray. With all of me I was praying.

I walked into the patient’s room and was somewhat stunned to see the entire family there. My patient was leaning forward, holding their body up with their arm (what we in the medical field call the tripod position). I spoke to the patient and their family and learned in that moment that there had been a do not resuscitate order revoked just that morning. I looked at the clock. It was 0800.

As a good nurse does, I got report on the rest of my patient assignments for that day. I said my good-mornings to them and tried to settle their needs and orders to the best of my ability as I hurried in and out of my young patient’s room. I knew something was coming. I didn’t know what. But I felt it. With every part of my body. Every inch of my brain and will power. I knew.

I don’t remember my other patients from this day, their faces, or their cases. This does not surprise me, as many of us sort of “dump” this information from our brains as we leave the hospital grounds. This natural occurrence, I feel, is a mechanism of protection for our hearts, minds and souls. We are able, once we are home, to regenerate and partake in some semblance of a normal life outside of our workplace. This is a protective mechanism I am grateful for. This does not mean my patients aren’t important to me, or any health care worker for that matter, but rather it helps us be OUR BEST on a daily basis when we come back in for a shift. We can start new. We can leave our cases within the hospital walls. Unfortunately, this does not always happen. Many cases do come home. They can keep one up at night. They can prevent normal daily activities. Of this, I am also thankful. This reminds me of my heart, that I am a feeling human being. But oftentimes, this form of compassion can drain you to the bone and leave you a crumpled heap on the floor. This happens. More frequently than many of us speak of.

I don’t remember the time, nor do I wish to pretend to disclose every detail of this day, that is not the point of this tale. What stands out the most is what transpired next.

I walked into my patient’s room and found them sitting in that same tripod position, with a sibling at their shoulder, holding on tight. My chest tugged at the look in their eyes. It was the question, the burning question, how much longer do we have? I never get used to this look. In a sense, I hope I never do.

I blinked a few times and turned to my patient who was leaning forward, eyes pursed shut, heaving gulps of air. “What can I do for you, right now in this moment?” I asked. “Are you in pain?” At this, my patient opened their eyes as if seeing me for the first time. ‘Yes, I am.’ I nodded agreeing, having known this detail for some time. I just needed to hear it. It is only then I can medicate.

We discussed this issue quite plainly, I was thanked, and then I paused. Something felt troubled. Adrift. I am unsure of the right word or phrase. Even now, it still eludes me.

I looked across the room and saw mom, sitting in her chair, very quietly, unobtrusively even. She was cold, in shock, and silent. At this I asked the family if there was anything I could get for them to bring back into the room upon my return. Mom looked at me and said in a very low voice, “help my son, and do absolutely everything you can.” I nodded. This I could understand on a level, yes, I would do everything within my power. But from a mother to someone who has never birthed a child, at the same time, I could not understand the depths of this request. I believe I never will. Not until I bring my own flesh and blood into this World.

As I turned to leave the room, my patient gasped an odd sound. A word. Maybe it was my name. I was unsure. I turned as they grabbed my hand. ‘Please,” my patient begged, ‘please let me go.’ I know, for lack of better control, my jaw dropped. ‘Please,’ they said. Over. And over. It was almost a soft, melodic chant. My eyes darted across the room to this patient’s mother. She leaned forward, exasperated. “She will do everything she can honey. To help you.” Her eyes bore holes into my person yet held waves of sincerity and concern when looking at her child. I knew that this was not a request. I leaned into my patient’s ear, grabbed their chin and looked them straight in the eye. “I am here for you. I will be here to fight for you in any way that you need. Right now, and until you leave my care, I will be your nurse. I am your advocate.” I turned to my attention to the patient’s mother, “With no DNR status, I will do everything in my power if there is an emergency. As for everything else, my patient’s needs are my ultimate concern. I will do as they ask because I am their advocate.” She nodded. My patient smiled. A very small turn in the corner of their mouth. ‘Thank you Jacquie.’

I turned to leave the room and retrieve the pain medication.

My patient needed to be comfortable. They needed to feel in control. They knew what was happening, as did I.

As you and I both know, I didn’t even make it down the hallway, not even half of the hallway. A male voice rang out into the air and everything stopped for a brief moment. It was as if the World had stopped on its axis. “THEY STOPPED BREATHING! THEY’RE NOT BREATHING! PLEASE! PLEASE!!” It was my patient’s father. And it was that word again.

Please.

Please.

It was as if I had wings. I don’t remember my feet touching the floor. I don’t remember hearing any sounds except for screaming. A heart-wrenching wail pierced the air as my patient’s mother was dragged into the hallway by her husband. I flew in through the door past family as they ran out covering their eyes and moaning. There in the bed was my patient, for the first time, lying very still. I looked up into the eyes of my coworker as she pulled the pillows from underneath my patient’s head as I pressed the Code Blue button, “I’ll start compressions” she offered as we rolled my patient onto the back-board.

In my head things were moving slowly, but my ears were deceiving as all sounds sped up with real time.

Feet pounding down the hall, screaming from a horrified mother, and the sounds of a room in a very fine frenzy—trying to bring back a heart that was trying to be still. The patient’s doctor, the ICU doctor, nurses and nurse techs filed in to perform their duties. My coworker was working on the patient’s chest, pushing hard and pushing fast. I had bagged the patient’s airway and was counting to keep up. The code cart flew in and I hurriedly set up the monitor as my Respiratory Therapist friend tapped my shoulder to silently take on his assigned task. It was a dance of the strangest kind. The odd thing was that this dance worked. We had our roles. We had our knowledge of what was expected. And we did it. We did it one by one and all together. Somehow, some way. It just worked.                                                

It was 0945

We were all talking to one another in the room. In unison. As more specialties showed up the room grew more crowded. My boss arrived to tell me that the rest of my patients were being covered by my coworkers, and most importantly, friends who I’d trust with my life. I nodded. “Okay.” My boss took one more look at me, and was gone. I turned to a friend, one of the best nurse technologists I’ve ever met, “Please go close the doors of the other patient’s rooms on the hall.” The screaming and wailing continued in the hallway, ripping into my chest with each rush of sound. I knew the whole floor could hear. It was as if we were stuck in a scene from a movie. But this was real. More real than I wanted it to be.

Two rounds of epinephrine later, we had a pulse, we had a heart-beat. So we stopped.

The monitor was registering an irregular heart rate and my patient was breathing. It was not real breathing. It was a pattern known as agonal breathing.

It is a gasp. An entire body reaction-- gulping air. There is no certainty in this movement. There is no support for the body with this motion. It is a last and final effort.

As licensed personnel filed out of the room, save myself, the family rushed in. Mom immediately grabbed her child’s hand at the bedside apologizing over and over, begging with that word.

That word. Please.

Dad walked in. Calm. Quiet. Radiating. Pulsing energy. It was a still energy. Knowing and gentle. He touched my shoulder and looked me straight in the face. “We will not be doing that again.” With that, he walked further into the room, grabbed his child’s other hand, bowed his head, and began to pray. As did I.

Or rather.

As I became aware of my prayer that had started two hours earlier.

The family prayed. Sang. Said their good-byes. One by one everyone came in to say their peace.

I remained. I stood there and encouraged everyone in the room to speak to the patient, their friend, their family, their brother, their son. To touch. To hold.

I reassured everyone that the patient would hear it. They would feel it. They would know that everyone was still there. Patients can sense these things. No matter how close to life or death they are. It’s an incredible sight and experience. 

Then I stepped out into the hall to wait.

Some time had passed. I don’t know how long.

Everything fell very still. Very quiet.

Dad appeared in the doorway with a look.

That look.

“I think..” He paused. Then he turned and walked back in.

When I walked into the room, I already knew. I took out my stethoscope.

Silence.

I looked around the room. It took a second to find my voice, but when I did, it sounded foreign, hushed even. “They’re gone.”

Mom crumbled into her child and wailed. Dad nodded.

As I stepped out into the hallway, my own tears fell. I held my breath so as not to lose myself completely outside the room of a family in mourning. The doctor on the case looked at me and asked, “Are you okay?” I could only shake my head.

No.

When I showed up to assist the family out, my patient’s father stopped in front of me in the hallway. 

“Jacquie,” he said in that calm way, stunning me again. “Thank you for helping my child. I know that you did everything you could. It was their time to go.” With that he hugged me, grabbed ahold of his family, and walked away.

I turned to look at the room.

There was no darkness surrounding it.

No heaviness.

My friends, my coworkers, asked me if I wanted help with post-mortem care. I could only shake my head.

“No, it’s okay. I want to do this on my own.” And so I did. Handling every detail with a slowness that I can only liken to poetry. Slow. Steady. Whispering to myself with each touch. Whispering prayers over a battle fought, long and hard. It’s time to rest. The pain is gone.

I walked my patient down to the morgue--Not because I didn’t trust anyone with their care. But rather. I needed to do it. I needed the closure.

I needed the opportunity to pay this individual, mature beyond their years, the amount of respect and care that they ultimately deserved. I knew in this moment that yes, what was left was only a shell, a body. No matter to me. Shell or no. You are my patient. You are in my hands. You are in my care. I will carry you when you need strength. I will see to it that your life here on Earth is honored by all that I do. And when you choose to leave this World, I will help carry you to that final resting place. We will do it together.

I do this with respect.

I do this, because it is an honor for me to have these last moments with you. Providing a means to give you rest. To give you peace.

For my patient. 

The one who didn’t give up fighting until their body was through. Your strength. Your immense power. The ones who were left behind. I know now of what adoration looks like. You, by far, have left the most incredible imprint on life that I’ve ever seen.

What has transpired will be. 

I am forever changed. 

Thank you for changing my life.