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Outside the Room: A Code Blue

I was called to a code the other day.

Now, I should probably clarify: As a medical student, I don’t actually do anything (unless they really need people for chest compressions). In fact, I wasn’t even in the room.

But, outside, I got to witness the family as they stood in agony.

I couldn’t quite figure out who they were at first, but I immediately knew they were with this patient. One of the women had two small blood stains on her white sleeve. She didn’t seem to notice — she was too busy frantically trying to tell the nurse running for a tracheal tube that the patient already had a tube in his neck. The other woman shushed her. This woman was disheveled and smelled strongly of smoke, dressed in a pink sweatshirt and black pants. Her eyes glared as she paced. A nurse tried to guide them toward the family room, far from everyone running in the hallway. They refused. They couldn’t leave this man’s side.

Yet they had no idea what was happening inside the room.

The woman in pink questioned why there were people in the hallway and asked why we weren’t with the patient.

“They must be interns,” whispered the woman in white.

A chaplain arrived and she also encouraged them to walk to another room. Again, they refused. The woman in pink identified herself as the man’s wife. The woman in white remained unidentified.

I watched from the door as anesthesia came and pushed through the herd of people to intubate the man. I saw the commotion as they all tried to don a gown, gloves and a mask. He was on contact precautions, though I didn’t know why.

The wife continued to pace. She eventually made her way in front of the door and peaked inside. She heard a nurse shout, “Pushing 1 of epi in 30 seconds!”

She whipped around to the chaplain, who stood nervously with the other woman.

“They’re giving him epi, that means he’s coding. Is he coding?” She nearly shouted in the chaplain’s face.

The chaplain softly explained that, yes, he is coding.

“So he’s dead!” Her eyes were full of rage. “Why didn’t I know he was coding? Why didn’t anyone tell me? Why didn’t anyone do anything sooner?” she seemed to scream internally.

Initially, a rapid response had been called. The family knew he was in trouble but not the extent. It wasn’t until a few moments later that a “Number One Emergency,” had been called and the family had been ushered out of his room. At my hospital, a “Number One Emergency” is equivalent to a Code Blue. But nobody knows “Number One Emergency.” Everyone knows Code Blue.

The chaplain drifted away from the family, seemingly to find more information. She probably just didn’t know what to say to them. I certainly didn’t.

I continued to watch both the code and the family. A nurse tried for a third time to guide them elsewhere. The woman in white choked, “I can’t. I can’t leave him.”

A phone rang from the inside of a white coat hung over a hand sanitizer dispenser on the wall. The wife was leaning against the wall with her head in her hands. “Why is there a phone ringing!?”

The woman in white quieted her. A nurse quickly took the phone when it rang a second time.

I wondered if I should talk to them, but I knew as much as they did. In fact, they probably knew more: I knew the medicine behind the code, but they knew the man. I didn’t know him at all, not even why he was in the hospital. I didn’t think there was anything I could do.

The wife finally began to cry. Her hands clasped together, she looked up at the sky and prayed, “Oh god, don’t do this.” My heart hurt for her, but I was at a loss.

Eventually, I walked away. I found my intern, who had looked up the man. She told me that he was in the hospital for tonsillar cancer and he probably aspirated blood, resulting in the code. I learned the next day that he made it to surgery, but nothing else.

As doctors, we are called to codes frequently. We’re in charge of everything that happens inside that room, but our vision is finite. We don’t see anything outside the room. We’re laser-focused on saving the patient and it’s too hard to have family inside: It’s far too unsettling for them and far too distracting for us.

Despite the fact that we have their best interest at heart, the family is in agony. They only know bits and pieces of what goes on as the person they love crashes before their eyes. And as all the doctors and nurses work tirelessly to save the person in front of them, the family outside can only stand aside and wait.

I was called to that code in case I was needed for compressions. But, instead of being in on the action or even witnessing the medicine itself, I witnessed this family at their lowest moment.

I know I will be called to many more codes throughout my career, working my way into the room and eventually to the top. But when I make my way there, I’ll never forget the anguish outside the room.

Emily Ribeiro Emily Ribeiro (3 Posts)

Contributing Writer

University of Illinois at Chicago College of Medicine

Emily was born and raised in the suburbs of Chicago, received her bachelors in Human Physiology from the University of Iowa in 2014, and her MD at the University of Illinois at Chicago in 2019. She most recently completed her pediatrics residency at Nemours Children's Hospital in 2022. In her free time, she enjoys reading, swimming and doing puzzles.