SICU Journal: Code Blue

Amy Lichtfuss

NSG 506P

SICU Code Blue

My first day in the SICU was a long day of firsts. While I was excited to be working on a critical care unit for the first time with my eyes wide open staring at a world of new learning opportunities, I did not expect to face an event that shook the whole unit. I was in a patient's room assisting with a transfer when the east side of the unit suddenly roared with ringing phones, nurses running, and the dreaded overhead announcement, "Code Blue". Without even hearing the room number I knew who it was - the patient at the end of the hall; the one everyone was worried about that morning. The patient I was currently helping mid-transfer said, "Yikes, that's not a good sign," and it instantly hit me that events like these must be terrifying for other patients on the unit who are fighting their own illnesses and trying to get better; especially when the code is only three doors away. 

With my thoughts racing and an inner turmoil of needing to help the patient I was with but wanting to see CPR in action for the first time, I just… froze. Then within seconds my nurse came back, hurriedly but calmly grabbed all the patient’s tubes and cords from my hands and sent me down the hall to witness the incident. While bobbing my head around the crowd, up, down, left, right, trying to get a view of the patient, a physician encouraged me to gown up and push my way into the room. For a fleeting moment the student in me felt lucky to be there for the experience, but amidst all the commotion and chaos I was quickly overcome by feelings I cannot yet put into words. I was fully aware of everything going on, almost hyperaware, with an underlying fear and anxiety reminding me that this was not a drill. The patient on that bed was a real person. The response team was there yelling out directions. The nurses were really compressing his chest and as hard as they could.  The AED was really shocking him. The patient really had no pulse. “Compressions! Now!” “Stop, check pulse!” “Push epi!” “V-Tach!” “Clear!” “When did we start?” “More epi!” “How many shocks have we given?” “Asystole...” “Time of death 9:27.” And then, seemingly as quickly as it began, it was over. I wasn’t ready for it to be over. The team shed their PPE, left the room, and carried on with their day (albeit with heavier hearts). 

The room felt different after that. The atmosphere felt colder and heavier and it felt wrong to leave the room with a breathless patient in bed. I requested to assist with postmortem care as a way to gain experience but also hoping time with the patient would help me process what had just happened. Eleven minutes ago he was awake and breathing and now he is still here but lifeless. Having been such a sudden change it was harder for me to grasp than when death is expected. I needed a moment to mentally transition away from life-saving mode and put aside everything I had learned over the last 18 months in nursing school. I discovered this was an instinct I could not switch off as quickly as I could switch on.  

I found postmortem care to be a unique and very important phase in transitioning this patient from life to death. I felt more pressure to provide the utmost respect and dignity during postmortem care as a way to redeem the burden that was placed on him during CPR. I literally felt the weight of needing to maintain the patient’s dignity and respect during this phase. 

            I will never forget the event as a whole and I will never forget the patient. I am thankful to the nurses and physicians for encouraging me to participate as much as I was able and I am thankful to the patient for teaching me more about myself professionally and personally. I pray that he is resting peacefully.