Bathroom Codes

I was the "day float" on this past Sunday, which is basically me covering the patients of all the interns who have that day off.  It's a grueling day because there is a shit load of patients, and often a lot of stuff happening at once.  So there is this one guy who was quite sick.  Just came out of the MICU, he was 50, and had metastatic pancreatic cancer, far beyond any sort of chemotherapy.  There were metastases in his liver, lung, bowel, everywhere.  He was basically on the road to death, and probably had not even a week left.  I saw him in the morning, and he didn't look too hot.  Quite lethargic, breathing heavy, and just looked sick.  His pain was adequately controlled at least.  I looked at his blood tests, and things did not look good.  I discussed with him the issue of DNR, which was addressed several times over the past few weeks.  He insisted that his decision was to be resuscitated in case the worst were to occur, despite understanding the chances of him being revived were slim to none.  His family wanted him to be DNR, but he was quite with it despite being so ill, and it was his decision.  I spoke with the oncologist, and we both agreed that he probably wouldn't last the next 48 hours.  I ordered a few more tests, and went on my way to see some other patients...

Ten minutes later, I hear a code called on the overhead speaker, on that same floor.  I knew it would be him.  I made a run for the stairs, intercepting the other residents heading in the same direction.  When we got there, he was found unresponsive in the bathroom, and the nurses could only pull him halfway out the bathroom door.  He was a big guy, maybe 6'3", 230 lbs, and dead weight on the floor. Forget about getting him up into the bed, we were goin to code him right there.  From the waist down he was still in the bathroom, partly sitting in urine and feces, and his upper half stuck out the door, with the wall only a couple of feet from his head.  The whole team was there by then, and there was no pulse.  I got on my knees and started chest compressions as we got the cardiac monitor on him.  The rhythm showed asystole. Flatline. No shockable rhythm. Resume CPR and get him the meds! To make it worse, he had no IV access, so my co-resident jumped over him into the bathroom to try and put in a femoral central line.  Respiratory team arrives, as he is being bagged for breathing.  How the hell would they intubate this guy while he's lying on the floor, 2 feet from the wall?  I don't know how they did it, but somehow they tubed him.  Still no access, so we gave him the epinephrine and atropine through the endotracheal tube.  Now 8 minutes into CPR, my herniated disc was about to pop, so I gave the job to an intern as I leaped into the bathroom side to try and help my colleague with the femoral line.  I had to kneel inside the shower, with barely any room to work with!  Bad day to wear my jeans and nice sneakers I thought briefly as I felt the sweat sticking to my clothes.  After a few sticks I got the access, but the line kinked on the way in. Fuck!  We managed to get one round of meds in, but then lost the line. Luckily the critical care fellow was able to get one in on the opposite groin. More meds given, and by then it was 17 minutes into it.  Even if we were successful at this point, he'd be brain dead.  We called the time of death 23 minutes into the code.  I was not surprised, but somewhat shocked how fast it happened, especially after having discussed the issue not 15 minutes ago....

Comments

[T]

Shit man, your blog is looking better than mine. Complete with videos and everything. Anyhow, the bathroom codes are always the best. I bet you've never been involved in a bathroom code in the main floor, with visitors all around you. Yes, that's the beauty of dealing with the country's vets and doing drugs in the bathroom. Nothing like finding a needle in an arm and a PEA rhythm and coding someone in their own feces and urine. Ah yes, good times. Thank god for gloves and disposable scrubs...

[Suga]

Life indeed is very short..Who knows when ur time is up...dont matter where u r...on the floor of a bathroom or sittin comfy on ur sofa...when u gotta go..u gotta go..

:(