My First Code

I found something I'd written back when my first patient ever coded. It's from November 2008, written the night after this patient had coded and died. I went home from work exhausted, crashed into my bed, but was awakened by nightmares of the situation. I had this "fullness" feeling, like I was carrying something in me that shoved every other thing out-- rest, peace, or feeling connected to anyone else's reality. I decided to get it out the same way I get most of my other emotions out-- by writing about it. I usually journal or pray through my other emotions, but for this, I needed to share it with a nurse who wasn't there: someone who could hear my story and how I experienced it and why it was, now, haunting me. So I wrote to one of my nursing instructors. This is what I wrote to her:

I coded the first patient I ever admitted today, Ms. G. She came about a week after I started orientation on the unit. My preceptor and I cared for her steadily for about 3-4 weeks. After that, I needed to get new experiences, so I had to accept other patients, but I visited her almost daily. I spent a lot of time with her mother, also a nurse, and even when I wasn't Ms.G's nurse, her mother would come over and hug me and tell me how her daughter was doing and ask how I was doing.

My preceptor and I would go to Ms. G's room and have "spa days". We'd tell her family to bring in her favorite shampoo and conditioner, and we'd pull out the green bin and wash her hair FOR REAL (not just with one of those warmed shower caps). Then my preceptor would braid her hair while I got the room in order. Ms. G had very particular and orderly taste... she could be downright persnickety at times! The unit started referring to her as the CCU Princess because my preceptor and I gave her such special treatment. We'd lotion her with her favorite Ann Taylor lotion, and organize her bedside table exactly to her liking. When she started getting better, but also lazier, we created a daily schedule for her that incorporated specific times for her to get out of bed to the chair, times when she would be on pressure support rather than a breathing rate on the breathing machine, times for physical and occupational therapy to come, and even times for the massage therapist to come at the end of the day. (We'd jokingly made a deal that she had to earn her massage by doing her homework and sticking to the schedule). It was a great experience in interdisciplinary collaboration and individualized care that allowed us to plan to give her pain meds before physical therapy, time for a nap before her pressure support trials, etc.

I knew she was getting worse, but I didn't expect her to die today. I walked out of my patient's room and heard her nurse yell, "Get the code cart!" and I couldn't believe she was standing in front of Ms. G's room. My preceptor knew I needed experience in Code 12 situations, so she told me to get over there. Initially, I was the "med pusher", where I stood at the head of the bed and pushed meds through her central line while yelling out their dosages to the person charting the whole event. As we started doing CPR, one of the nurses asked the doctor to let me do the compressions for the experience. I did my first set of CPR ever today. It was surreal. I was doing what I'd always seen on TV and prepared for in school, but I wasn't scared or nervous... it felt very natural. I started feeling proud of myself for handling the whole event so well!

A doctor took over compressions when I got tired, and then we stopped for a moment to see her heart rhythm. Pulseless Electrical Activity... PEA. Nothing was there. The doctors pronounced her dead.

Somewhere between being pulled into the code and pronouncing her dead, I forgot who the patient was. I was totally task-oriented, completely immersed in what was happening rather than to whom it was happening. When they pronounced her dead, it all came stampeding back to me. I saw her mother approach her crying, kissing her forehead. I lost it. I had to get out of that room as quickly as possible, but the world moves in slow motion when a death takes place. I held my breath as I waited for doctors and nurses to file out of the room. I was suffocating. I ripped off my isolation gown and quickly walked to the bathroom where it all came out. I couldn't believe she had just really died. I couldn't believe I had just felt proud of myself! I felt guilty and overwhelmed and very isolated. I knew that none of my friends had just felt a woman die. They were all in offices or in graduate school, reading and going to meetings and complaining about their bosses. I just physically sustained a non-beating heart, and watched the decision to stop it all. I just watched a mother lose her daughter. I've worked it the hospital for 3 years now and today was the first day I've cried there.

I will interrupt at this point. This is how my morning felt that day. Even after the code and crying, I felt like I couldn't catch my breath-- like when you are trying to get your ears to *pop* and just want to take in a good deep breath. I couldn't breathe in deep enough. I felt heavy. I felt like you feel in an air plane when the cabin pressure isn't quite normal... I literally felt the atmosphere around me.

But that didn't last all day.

What happened next was amazing. My whole unit was very supportive of me, encouraging me on the "good job" I did in the code, asking me if I needed to take a break, etc. When things settled down, a few of us found ourselves in the lounge drinking coffee and mulling over the event. As the conversation progressed, we started telling our favorite "Ms. G stories", of her sassiness and strength, her family and her resoluteness. I said that I felt like she would stay with me for my entire career as the first patient I'd really grown attached to... and then, one by one, every nurse told me about their own "Ms. G". Many of them were patients from the CCU, so other nurses could join in on talking about those patients and their personalities. Everyone had their own version of my Ms. G.

I told her mother what an impact her daughter will make on my career as a nurse. Because she was a nurse, she knew what I meant by that, and she was very thankful for it.

I feel like I've really experienced the heavy privilege of being a nurse; daring to care for people and risking the potential for grief. And each of those more-experienced nurses had stories just like my Ms. G, but they told them with laughs and contented smiles and a gentle attitude of thankfulness for the experience; the privilege of caring.

I've shared my feelings about being a nurse on this blog before, and to many of my friends and family. I know that, for all of its lifestyle difficulties and absurd personalities, I'm incredibly blessed to be in a job I feel called to do... in a job I feel God created me to do (for now, at least). There's a movie, Chariots of Fire, about an Olympic runner who is a Christian, and at some point in the movie he describes why he loves running: "I believe God made me for a purpose, but he also made me fast. And when I run I feel His pleasure." I don't always feel God's pleasure when I'm at work, but I do feel it sometimes. And in that moment after Ms. G died, when I felt alien to the atmosphere around me, I think I vaguely felt what God was feeling then, too. Not pleasure, but grief, like when Jesus wept after Lazarus died. He knew he was on his way to bring him back from the dead, but he experienced the grief of human loss all the same.

And after the code, sitting among others who had lived through their own heavy days on the unit, I think I felt His pleasure. And now after 2 years of heavy days and joyful days, I see the arch of His emotions even better. His pleasure isn't always there, but it doesn't leave me for long.