Code Blue

Code Blue. It is a term I never enjoy hearing over the loud speaker at my hospital. I have only heard it twice before, but this time, it was on my unit. As I was passing my morning medications, I heard “Code Blue, 3^rd floor, Room 18.” I am still thanking God that it wasn’t my patient and I didn’t have to call it. Code Blue, you see, is a cardiac arrest. A patient isn’t breathing, his heart may not be pumping, something is definitely very wrong. It’s the worst of all announcements that can be heard, and Friday the 13th, Code Blue became very real to me.

I’ve heard the code called before, but it was always a different floor, a different unit. I’ve told myself that if I could, I would go to the codes, to experience it so that if…no wait…when it happens to my patient, I will be as prepared as I can be (if you can even prepare for that). As I heard the 2^nd announcement, I forced myself to stop what I was doing and head to room 18. 10 people were already in the room, doing chest compressions and forcing air into his lungs. The crash cart was opened, pads were on his chest, and no pulse could be found. I weaved through the crowd of people and found my charge nurse, who was recording (all the medications, shocks, pretty much anything done to the patient). I helped her keep track of time, what we’d given, how long it had been since the last dose of epinephrine or atropine. The ER doc arrived and attempted to intubate the patient, respiratory therapy was giving him air, an ICU nurse was drawing up medications, the CNA was doing compressions, the House Supervisor was keeping an eye on the heart rhythm.

After 22 minutes, 5 rounds of Epinephrine, 3 of Atropine, 5 shocks, 200 mg of Amiodorone, the patient didn’t make it. No one was sure at the time, but he was admitted for sepsis and everyone was thinking he threw a blood clot in his lung. I stood there, not really sure what to think. I gave the patient’s nurse a hug, and asked him if I could do anything for him. The strangest part of the whole experience was that the staff didn’t seem all that affected by the event, like they were just doing their jobs and now would go back to what they were doing before. Now, that could be a defense mechanism or they may see this all the time, but I hope that I never get that way; that each Code Blue upsets me, and I don’t leave that room the same. I can imagine it gets easier to deal with death, but all I could think about was where is that man now? Is he pain free, hanging with Jesus or not? All I could do was pray for him and his family.

I know the day will come that I am put in that situation. I will be the nurse that has to call for help because her patient is crashing. When that day comes, I will be more prepared for having this experience but I can imagine it will be like it’s the first time again.

Confidence

One of my all time favorite movies is The Sound of Music. I know…many people laugh when they hear that but it’s totally true. I watch it at least once a year. I love that the lowly nun-in-training ends up with the powerful Captain. I love that she has no idea what she’s doing when she’s called to serve these children that are NOT ideal. In the movie, Maria is skipping down the road to the Captain’s home, guitar in hand, belting out one of her favorite tunes. As she approaches the house, she says, “I have confidence, in confidence alone…oh help” and then continues into the house. At that moment, she sees what she’s gotten herself into, and for a moment, doubts herself.

I headed to work a couple weeks ago, positive attitude, and ready to conquer the world. After report, I was already defeated. I immediately went down the road of “this day is going to be horrible” but told myself to take it one step at a time. I was J.F.’s nurse the day before. She’d had a stroke, affecting the right side of her body. She could follow commands but wasn’t able to move the right side, nor was she able to speak. But J.F. was there; she was very responsive. I could see it in her eyes, and I could feel it when I’d hold her hand.

0700--So, that morning, in report, I was told that NO consent was signed for the placement of her feeding tube (which is usually a night shift responsibility) and the pre-op checklist wasn’t even started (yet again, another night shift duty).

0740--After getting report on my other 3 patients, I sat for a moment, composed myself, took some deep breaths and decided to start with J.F. I called the GI lab, and they told me that if everything wasn’t ready at 0845, the doctor wouldn’t place the G-tube. Ahhhh. Okay, everything just got a little more intense. All I could think was, “how am I going to get consent signed (her husband wouldn’t call us back) and get her ready—oh, and assess all my other patients?” She’s needs this procedure!

0745--Back to concentrating on J.F. I finally get a hold of her husband, and he’s on his way. My other patients are okay. I check her chart, make sure the labs are printed, EKG is filed, and chest x-ray is included. Check her labs. Shoot. Her WBCs are 28K. Dang it.

0805—Another patient is in pain. Assess his pain, check his chart, draw up his medication, take his vital signs, and give the medication. I let him know I will come to check on his pain shortly.

0815--I head to J.F.’s room only to find that she’s pulled out her IV. Seems as though the restraint wasn’t tied. Sweet. Lesson learned: check the restraints during bedside report because sometimes they aren’t tied (even though the nurse tells you they are). I have NO confidence when it comes to starting an IV. Could this day get any worse (yeah, it could probably get way worse actually!)? Clean up the bloody linens and head to the medication room to get my supplies.

0830--I head in to start her IV, knowing that there was no way I would get it. Apply tourniquet, explain procedure to the patient, shop for veins, and find a fat one. Lo and behold, I nailed it! Okay. One thing down.

0840--Get the checklist done and the consent signed, assess my patient, and get her prepped for surgery.

0845—Called transport and got the patient downstairs for her procedure.

Too many times, I enter the hospital thinking there is no way I am going to make it through the day. I have all the confidence in the world when it comes to being with patients and families, but when it comes to the so called “skills” of nursing, I doubt myself every time. I defeat myself before I even try. I tell myself there is no way you can get everything done in time, your medications are going to be late, you don’t know what you’re doing, what have you gotten yourself into? I have Joshua 1:9 written on a note card in my car and read it every morning before work. “Have I not commanded you? Be strong and courageous. Do not be afraid, do not be discouraged, for the Lord your God will be with you wherever you go.” I should probably tattoo it on my forearm!

God has called me to His service and that happens to be in the hospital. As I doubt myself, I in turn doubt God too. If He’s called me to this discipline called nursing, then by His strength, I will succeed (maybe not by the world’s standards). As a new nurse, confidence is always a struggle. Do I know what I’m doing, am I worthy to be called nurse, do I know enough to care for these patients? As I channel my “inner Maria,” I sing,

“Oh, I must stop these doubts, all these worries

If I don't I just know I'll turn back

I must dream of the things I am seeking

I am seeking the courage I lack

The courage to serve them with reliance

Face my mistakes without defiance

Show them I'm worthy

And while I show them

I'll show me.”