Code Blue

Today, I performed my first real chest compressions. I have been doing pretend CPR for almost 14 years. Never before had I actually compressed a sternum 2 inches into the chest cavity. We had a woman rushed into the resuscitation bay, 3 minutes into our shift. Nobody knew what had happened to her, just that she was found unconscious in the bathroom. She hadn't even been checked in to triage yet. Nurses, techs, we all run in. The resident intubates her lickity split. Her eyes are half open, blankly staring at the ceiling. Nurses are dashing around everywhere getting epinephrine. Her hands, feet are sickly pale. Her face is still pink, but I try not to look. Her eyes are open. There is no pulse. One of the nurses starts chest compressions, but she is short and the bed is raised up high. Pump, pump, pump. The resident tries to put in a central line in the femoral artery. She is so huge that I have to hold her belly out of the way so he can access her groin. He can't find the artery. Pump, pump, pump. We pause to see if her heart is pumping on its own. No. The nurse is about to start compressions again, but I ask if she needs to switch out. She says sure. In I go, hands 2 fingerbreadths up from the xyphoid -- but not really, it would waste too much time. I just slap my hand down on the huge expanse of chest and start pushing. Pump, pump, pump. 1-2-3-4-5, 2-2-3-4-10, 3-2-3-4-15 I start counting, but I don't have to stop to give 2 breaths so I keep going: 20, 30, 40, 100 compressions. I don't think I have been pumping for even a minute. The bouncy resistance of ribs feels oddly familiar, and suddenly I remember why -- the plastic CPR mannekins feel just like this. Pump, pump, pump. Sweat starts beading on my forehead. The glassy eyes just keep staring at the ceiling. I am up to 80, 90, 100, 110 again. I get a quick break as the team tries to see if her heart has started up after a few doses of epi. No, it hasn't. Pump, pump, pump. Pause again. Lo and behold, her heart's beating! We bustle around trying to get the central line in. 5 minutes passes. She loses her pulse. We shock her with the defibrillator, it is strange to see her arms flop when we shock. One round doesn't start her up, it's back to CPR. Pump, pump, pump. I switch in again. This time I don't get a break so soon, and I start to tire. I can feel myself getting sweaty. Pump, pump, pump. As long as I don't drip sweat on her. Pump, pump. I switch out to let the M3 try chest compressions, but by the time I grab him some gloves and tell him how to push, they called time of death at 1637.

She didn't make it, but we sure as heck tried. Strangely, I wasn't bothered by her being dead. Maybe it's because I knew we did everything we could. Maybe it was because nobody knew her at all before she coded. Maybe it's because she was as good as dead when they rolled her in. Maybe it's because I've seen my fair share of dead people. I don't know. All I know is, today I performed my first real chest compressions, and they felt good.