I had experienced codes before. Prior to entering medical school, I had worked as an emergency room scribe, charting patient encounters as they unfolded. I considered myself familiar with a code’s whirlwind of action, always one step away from the true pandemonium. After all, I had stood on its borders, plucking shouted orders and silent actions from the maelstrom, weaving them into a coherent, documented clinical picture. Naïve, and all too eager to count at least one thing as somewhat familiar, I did not consider myself a novice. Of course, that assumption was proven wrong.
I had already been on my surgery rotation for four weeks, having just switched from general surgery to the trauma service. The day of the code, the pagers went off in the middle of grand rounds. Room nine of the emergency department was a confused impression of scrubs, blue gloves, bleeping machines and blood. My fellow medical student and I were shuffled like hot potatoes from one corner of the room to another, before finally being banished to hold the elevator so that we could quickly transport the patient to the surgical floor. It was not until I was scrubbing in that I realized that my hands were shaking. They had never shaken before. The barely contained chaos seemed to have followed us from the ED to the operating room. I remember a constant revolving door of people going in and out of the room, and what seemed like half of the trauma surgery attendings showing up at one point or another. They barely had time to open and begin shoving in packing before the patient’s pulse cut out.
I had expected to be relegated to the typical medical student roles of hand and hold, but suddenly the attending turned to me and said, “be ready to step up when she gets tired,” indicating one of the surgical nurses standing on a step-stool at the head of the bed, doing chest compressions. Everything took on a surreal quality after that, both blurred and sharp-edged at the same time. I tried desperately to recall everything from my basic life support training I had barely a month ago. And then, it was too late; the time for recall had past. The nurse was stepping down, and I was stepping up. Chest compressions are not all that difficult to do on a mannequin lying on the hard ground, but unfortunately, I had found that it was infinitely more difficult to do standing on the tips of my toes on top of a rickety step-stool. At one point, I could feel the stool beginning to slide out from under me. Luckily, someone’s foot shot out to hold it steady, and I sank back into the mindless, repetitive movements of chest compressions: push hard, push fast!
The whole thing only took thirty minutes from start to finish, from the door of the ED, to the operating table, but it felt like an eternity nonetheless. Once the time of death had been called, it was as though someone had pulled a plug: the room instantly became silent and empty. However, the ache in my wrists stayed with me for days afterwards, and ultimately, it reminded me of the lesson that medical school has taught me over and over: seeing is very different from doing.