Saturday, January 7, 2012

Stayin' alive.

*Names, details, etc. changed to protect anonymity. . . y'all know what's up.

"But now it's alright. That's okay.
You can look the other way.
We can try to understand
The New York Times' effect on man

Whether you're a brother 
or whether you're a mother
you're stayin' alive. . ."

~ The Bee Gees' "Stayin' Alive"


It was chaotic. People running and pointing and reaching and grabbing. So many moving parts. And so all-of-a-sudden, too. This wasn't supposed to happen. I mean technically it could happen at any point. But it wasn't on my radar. Or anyone's radar.

And neither was she.

I'll never forget that day. This lovely phlebotomist was on the ward preparing to draw blood for that four hour time block before it happened. Smiling with her wide smile--unusually striking because of the large diastema between her two front teeth--but stunning and beautiful in its imperfection and in how she owned it. Every time I saw her, I always made time to chat and laugh, mostly because that smile of hers warmed my heart. Gap and all.

So this is how I remembered the timeline from that afternoon. That easy exchange with the phlebotomist standing in front of her rolling cart of Vacutainers punctuated the start of the time clock.

"Hey lady!" I greeted.

"Hey there, doc! You cut your hair some more?"

I rubbed by hand over what little hair I have and chuckled. "Probably since the last time you've seen me. You know? I'd buzz it right down like a little boy if I thought my husband wouldn't disown me!"

And just like that she unrolled that high beam grin on me while simultaneously unrolling a rubber tourniquet to use on the next patient. She caught me looking at her wispy hair--also a short style--but with long bangs swept behind her ears and held snugly with bobby pins. "Yeah, chile. This is about as far as my husband will let me go."

"I like it. It suits you." She blessed me with that perforated grin once more, letting me know that it was time for her to get back to business. Off she went into that room, easy and confident--perfect ingredients for someone charged with the task of finding tiny rolling veins under redundant skin folds.

I could hear similar pleasantries being exchanged between her and someone inside the room with a tone that sounded relaxed and familiar. She was more than likely talking to the daughter of Mrs. Gentry--the patient in bed two--who had been dutifully at the bedside throughout her mother's entire hospitalization.

I went back to what I was supposed to be doing which, at this moment, was typing a note into a portable "W.O.W."-- workstation-on-wheels. I waved at a group of rounding residents and students walking by and gave a fist bump to one of the environmental services workers. I yawned and returned yet again to my task.

I must have zoned out because what happened next caught me by surprise. One minute things were calm and mundane. The next, people were moving all around with a sense of urgency. When the phlebotomist had gotten to bed two, she found Mrs. Gentry to be unresponsive and with cool extremities. She yelled for a nurse to come help and Stan, the nearby nurse, leaped into action.

"Get a crash cart in here!" he bellowed to the other nurses while placing the heel of his hand into the center of Mrs. Gentry's sixty-something year-old chest. "And call a code. NOW!"

By the time I got into the doorway, the team of residents that had just passed by, along with a Cardiology fellow, had already swarmed the scene and a code was underway.

Chest compressions. Monitors being connected. Meds being drawn up. Lines being emergently inserted. And Mrs. Gentry lying there listless like some kind of lifeless ragdoll.

"What's the story? Does anyone know this patient?" The Cardiology fellow had taken over as the leader of the code and tried to grab some history while getting her heart in motion. Those words flew out over the room to whomever had the answers.

"She was. . .I mean I was. . . Oh my God! I thought she was just sleeping!" her daughter squeaked out in response just before someone else spoke over her with a booming voice. 

Of course she knew the patient. He wasn't talking to her. He was talking to everyone else.

"Sixty-seven year old female with a known history of coronary artery disease status post two stents placed last year and ischemic heart failure who'd been admitted for acute decompensated heart failure. I think her ejection fraction is around twenty percent and this is hospital day three."  That description offered by the intern was firm, loud and controlled. "Slightly elevated potassium this morning but otherwise everything lab-wise was okay."

I noticed the beads of sweat popping out on Stan's brow as his stiff arms rhythmically worked to revive Mrs. Gentry's heart.  Right on beat, almost like a pendulum was swinging to help him. That or he was hearing what they teach you in Basic Life Support to sing in your head to help you keep a steady compression pace--"Stayin' Alive" by The Bee Gees.

"Hold compressions!" announced the Cardiologist.  "Checking rhythm. . . . .pulseless electrical activity! Resume compressions!"

More voices. More chaos. More people in white coats swarming around the bed.

"Shit! I can't get this guidewire to pass!"  The twisted face of the gowned and gloved resident speaking these words showed his frustration. He'd been charged with putting in the central venous line necessary for giving lifesaving medications but wasn't succeeding. "Dammit!"

Members of the critical care team had come in from the intensive care unit and flooded into the room by this point. One of them stepped in to take over for the frustrated resident. Before you could say Rumplestiltskin, that guidewire was passed and the line was being flushed with saline.

More chest compressions. More voices. More people. More medications, now being pushed through a working line fast and furious. Controlled chaos all around.

"Hold compressions!" That Cardiology fellow had the kind of quiet confidence that was needed in these types of situations. All eyes on the monitor to check the electrical activity of the heart at this point.

"V. Fib! Prepare for cardioversion!" he announced--still sure and controlled as he gave his interpretation of the monitor: ventricular fibrillation.

"That's still PEA! I don't think that's shockable."  These were the words spoken (loudly) by a member of the critical care team to the code-leader. He had just arrived from the ICU where running codes is their thing. But he wasn't running this code. The Cardiology guy was.


"Look, what do you want me to do?" pressed the nurse holding the paddles over the patient's chest. Her eyes were on the Cardiologist who was standing there with folded arms and a now furrowed brow.

"Exactly what I just said. Prepare for cardioversion. All clear!"  All of those moving parts and moving people stepped back from the bed as those paddles pushed down firmly on Mrs. Gentry's chest.

I remember the first time I saw someone get defibrillated with an electrical current. I was a third year medical student and was right there front and center doing the chest compressions. My arms were exhausted and I was nearly out of breath; I couldn't tell if it was from the actual act of pumping a chest to "Stayin' Alive" or just the adrenaline pumping through my own veins. Those paddles went down and someone shouted "CLEAR!" and that patient got a big shock.

Well, sort of. His body made a tiny flinch that looked nothing like codes I'd seen on "E.R." No high arching torso flying upward and then landing back onto the bed like some kind of deep water fish recently reeled out of water. Disappointing.

So Mrs. Gentry's shock was equally disappointing but for different reasons. That shock didn't bring her heart back to where it should have been and what was worse was that there was now a question about the heart rhythm altogether.

Clear again. Shock again. Meds again. Nothing again. Intubated by Anesthesia. Shocked some more. More meds pushed but nothing improved. That roomful of chaos that initially looked like some rapidly swirling twister was dying down. . .swirling slower and slower. . .a spinning top that was losing its spin. The frantic bodies were moving with less deliberation; the voices now twinged with the sound of defeat.

"Do you want to call it?"  spoke the paddle-holding nurse to that Cardiology code-leader in a voice that was as tender as it was tired.

Call it. Stop the hope. End the twister.

"Ummm. . . .let's try some bicarb," the Cardiologist finally said with a quiet clearing of his throat. Anyone in that room senior enough to have run a code knew that this was the worst part. Calling off the fight.

Bicarb. Yes. Let's try it. The pharmacist began drawing it up and that tired twister spun a little more.

That's when I saw something from the corner of my eye. Backed against the wall wedged between an IV pole and the wall-suction shaking and weeping and looking horrified. Mrs. Gentry's daughter. Who had been standing in the room and present for the entire code.


It was like every person in that room began to move in slow motion and become blurry amorphous blobs. Her eyes were wide like saucers and she was clutching her mother's purse against her chest probably out of shock more than anything else. Those saucer eyes were darting around the room, bouncing from voice to voice and horror to horror. Aimlessly tossed about like some sort of ball in a pinball machine.


No one was holding her hand or rubbing her shoulder. No thoughtful soul had eased her out of the room or compassionately bearhugged her as she kicked and pleaded to stay. No, not one person at all. Not even that charming gap-toothed phlebotomist with her easy laugh and steady hands. Instead, we had all let Mrs. Gentry's daughter melt into the background and become a fly on the wall of what would likely represent the worst day of her life.

I heard it over and over like a nauseating chant. . .

"Life going nowhere. 
Somebody help me
Somebody help me, yeah. 

Life going nowhere. 

Somebody help me, yeah. . "

It was like she had been singing that refrain to "Stayin' Alive" the whole time and no one had been listening. Not even those who weren't doing anything but standing there watching.

Mrs. Gentry wasn't my patient but I'd chatted with her and her daughter in passing. I'd cracked a joke with them on that first hospital day about her stack of Word Find books and had even made small talk when I saw them both doing bible study together on the bedside tray table. No, she wasn't my patient but I felt like I had somehow failed them both.

Sometimes there are so many people inside of a code that if you arrive even one minute into it, you feel useless. You count up the cooks in the kitchen and make a decision--join in or not? Then, if you don't join in, you might decide to wait near the door in case someone needs you to make a fast break down the hall to grab some kind of supply. And if there's someone there to do that, sometimes. . . you just stand there watching. . . .which is what I did on this day. Humming to the internal beat of "Stayin' Alive."

How could I have neglected to look to see where her daughter was?
How could I have just stood by as a foot-tapping voyeur without catching that part? 

But it was chaotic. People running and pointing and reaching and grabbing. So many moving parts. And so all-of-a-sudden, too. This wasn't supposed to happen. I mean technically it could happen at any point. But it wasn't on my radar. Or anyone's radar.

And neither was she.

"Time of death: Four thirty-two P.M." said the Cardiology fellow. He called it. Finally. And just like that, the chaos ceased and like many twisters there was nothing but debris and destruction to show for it.

The only sound in the room was the whimper of Mrs. Gentry's daughter, now burying her face downward into that weathered pocket book. Holding on to this piece of her mother. . . smelling her smell and holding on to her energy. Those whimpers morphed into some guttural moans; sounds that I wish I could say sounded unusual. But at least an earnest medical student had thought to wrap her in a hug. Still young and non-jaded enough to follow some instinctive rules of empathy. And to still be intensely bothered by the sight of this kind of grief.

Thank God.

People filed out. A death packet was completed. Hushed words were spoken to the family. Everyone went back to work and doing whatever they had been doing; the phlebotomist went to draw some blood from the patient in the next room. And that was it. Just like that, a mother, a grandmother,  a bible-reader and a word-finder was gone.

Even though that happened a long time ago, something about that scene still haunts me. I hate knowing that this is how someone has to remember losing their mother. I hate that. Even more than that, I hate knowing that someone in that room could have done something to make that memory different for Mrs. Gentry's daughter. . .  through a simple touch . . a kind word of explanation. . .by gently guiding her out of that code-algorithm tornado . . . .or . . . .something. Anything. Something. But not just nothing. 

Most of all, I hate knowing that that someone could have been me.

The primary team of doctors was talking to Mrs. Gentry's daughter and son-in-law when I walked by.  I wanted so badly to interrupt and tell her how sorry I was and even lingered for a few moments hoping I could. But then I realized that those words would be for me and not her.

After all those years of hearing the beat to "Stayin' Alive" in my head during codes, I finally heard the words. And now. . .for Mrs. Gentry and her daughter. . .I always will.

Now playing on my mental iPod. . . .

*And to my friend who lived through a similar horror and reminded me of this story. . . .
I will remember to keep others on my radar and teach others to do the same.


  1. As a street paramedic for 12 years, I worked a lot of prehospital codes. With one or two exceptions, they were unsuccessful.

    As I became more senior in the service, I found that I was more useful in providing family care than I was in standing around watching everyone else. I would remain available in case the crew needed assistance with a procedure (intubation, IV placement, etc.) but would try to take the family member(s) aside and explain what was happening. Each time, the family members were grateful for the extra support. From the beginning of the code, the family (if present) needs our support and assistance. At a certain point in the code, the family becomes our primary patient. This will be a defining moment in their lives (one of my partners was find of reminding us that "today is this family's 9/11") and it's up to us to help manage that memory.

  2. With the holidays I have been so behind on the blogs I enjoy. Reading this I was heart, my head...because this could be my loved one or a dear friend.

    This was so powerful to read because I can only imagine the extreme task of trying to revive Mrs. Gentry and easy it would be for her daughter to melt into the background. Not on purpose but because every one in the room was trying so hard to get her back.

    A day in your life, not every day but one of many that stand out...Gesh...what a day for me to read your

  3. You learned a lot that day.
    This is all just too heartbreaking for words. I have to be honest with you- I want a DNR if I'm in that situation. I want it tattooed on my damn forehead.
    I want to be allowed to go.
    I don't want my children to have to go through that as their last memory of me.

  4. I love your reflections. And I pretty much love the Bee Gees.

    Don't let this moment haunt you. Pass it on to your interns. (I agree with PJ about managing memories.)

  5. The fact that you still ruminate on this experience speaks to your character as a physician and as a human being. I really get you , on this topic. Whether they are patients , or otherwise, those with whom we come in contact with are people first. It's easy form this point to become muddled -especially in the context of an emergent situation.

    As a resident, I took care of a patient with a ruptured triple a ( a torn abdominal aortic aneurysm - the main big a!& artery in the abdomen that supplies blood to the lower body for the non medical people) , who had done very poorly in the operating room , as expected, while the surgeon attempted repair.

    The collective decision was to bring this person, to the recovery room , where we would continue to " code"/ resuscitate in As a resident, I felt I had little to no say about the ethos of this- but I remember the faces of the patient's husband...her children.

    Despite my lack of perceived control in the situation secondary to being just " The Resident" , I was equally culpable for contributing to that family's pain.

    So- that is to say, all we can do is move onward, forward,upward. And try to do better when we know better.

    Sorry for blogging in the comments!!!!

    Maria- fellow Meharrian.

  6. You are an amazing storyteller. I'm in the middle of my internal med rotation at a county hospital and your stories have been resonating with me. Also, I just had to add a link to this CPR video featuring ken jeong and the Bee Gees song:


"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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