So, it sounds funny to say, but codes rarely work out for anyone. I mean, obviously it isn't a great starting point, but I didn't know til I became a real grown up nurse how seldom CPR actually does anything at all- and that when it does actually "work", we bring people back to the life of a week long, million dollar ICU stay after which they either a)die anyway or b)spend the rest of their life in some kind of long term care center with a trach and a hypoxic brain injury. Maybe like, a couple times a year you will get someone who is a legit witnessed cardiac arrest where CPR is immediately initiated and the underlying problem is correctable and they get up and walk out a couple weeks later like nothing happened. And boy, is it weird when those people check back in to the ER.
Unfortunately, this was not one of those cases. Guy was older and had already been down around 30-40 minutes when we got ahold of him. But okay, he's not that old and we've got some gung-ho paramedic students here who wanna do some compressions. Let's give it a shot. So we do a couple of rounds of CPR- asystole, asystole, what do you know-V Tach-clear!, asystole, that way too long of a pause in compressions for central line insertion that ACLS guidelines don't want you to do anymore, PEA... asystole, okay, let's resume compressions, and okay, does anyone object to calling this now, because... yeah. We've already been doing this probably longer than we should have given the circumstances. Yeah, alright. Let's call it. Time of death is agreed upon, and we go to print the strips off the monitor, and WTF? The patient is in V tach again. Recording nurse is distressed and tells the doctor we can't print off a strip that looks like this. "That's a shockable rhythm. I mean, I know you called it, but I can't put this in the chart."
Doctor: "Okay, well, whatever, he's been pronounced, but I guess you can shock him into asystole if that makes you feel better." Walks out of the room.
Except, uhh.. now it looks like some kind of accelerated junctional funkiness on there. And, holy shit, the patient has a pulse now. And, could you hit that button please? A blood pressure! Um, can someone go stop the doctor and tell him before he delivers the bad news to the family please?
So yup, this guy is totally alive again. Well, technically. His pupils are non-reactive and he's down with no sedation. His blood pressure responds pretty well to pressors when the epi finally wears off, but, uh, yeah. Here we are now. The recorder was apologizing to everyone for the rest of the night, but I would have probably done the same thing.
It felt awful, to be honest. He had a huge, super sweet family who were eternally grateful that we had saved their patriarch's life, and now we've got to find a way to break the news to them that he's still not really there. They were on the fence about a DNR status. They said they wanted everything done but they didn't want him to suffer. I tried to gently explain that it's impossible to tell if he's suffering because there doesn't seem to be much there. The hospitalist pretty much laid it out how it was, but you could tell they were still grappling with all of it. I'm sure it probably seemed like he had died twice.
That's the thing that kind of sucks about what we do. Yeah, it's incredible when our interventions save and improve people's lives. But so often I just feel like we're making it worse.