My first code

[MissTrishEMTB08]

Hi. My name is Trish, Ill be 20 years old on the 30th. I got my EMT license a couple months ago and havent been able to get a job. My apostrophe or quotation key doesnt work right now so Im not clueless as to what they are. Im currently in Medic school, about halfway through.

I am the cursed student. I never get anything good, a station could have a code every day for two weeks prior and the day that I get there they wont have a single call. At the hospital we always have a slow day with no patients.

Yesterday we were doing 16 hours at the hospital. Our clinical instructor dropped the ball so we have to pull doubles to get all our clinical time done on time. Yesterday everything changed.

I had my first ever code.

THe woman wasnt my critical patient. My critical patient was an 84 year old man with CHF struggiling to take every breathe. I was sure that I was going to see a code, because I was sure HE was going to code. My classmate had her. She was a 51 year old woman with a sudden on set of difficulty breathing while moving furniture. I watched her stabilize and then went to check on my patient and check in some rescues that came in. Suddenly, not five minutes later my insturctor was calling me back in.

I came in to see CPR and intubation in progress on that 51 year old. I had never done CPR before so I was excited when they told me to jump up as soon as my classmate took a break. My hands shook putting my gloves on. Suddenly it was my turn and Im pumping away on her chest. My hand placement is wrong so they slide my hand over an inch. It feels squishy and I can feel her bones breaking. My arms are tired. I look up at my classmate Switch? So we switch, I grab the bag and he takes compressions. Im bagging now. 1...2...3...4...5 bag. 1..2...3..4..5 bag. Meanwhile I hear the nurses joking with the doctor and I cant help but think This woman is dying! How can you joke? Her eyes are half open and fixed on the ceiling. I knew in the back of my mind. They push epi, atropine, more epi, more atropine. A student nurse jumps in to take over compressions and gives my classmate a rest. Im still bagging...1..2..3..4..5. bag. The doctor asks Does anyone else know of anything we can try? Another nurse yells out shock her just to see! But the doctor sighs and calls the time of death. \47 pm Tuesday August 5th, 2008. I dont know if Im supposed to stop suddenly so I bag once more and the nurses yell out Stop it! Its over!

My face goes red and Im fighting back tears. I was talking to this lady not too long beforehand. I turn around to throw out my gloves and lose it. My instructor tells me to go wash my face and well talk. I have just witnessed my first code, and lost my first patient. In the bathroom I grip the counter. I cry. I tell myself its ok. We did all we could. Im ok. Some people just die. But I dont believe it. I have a gnawing ache in the pit of my stomach that knots up as I hear anguished cries of the family.

Once I get out, Im ambushed by a group of the nurses telling me its ok, the first is the hardest, there was nothing left to do. They all tell me about their first, but I dont feel it was ok. A woman was dead. And 30 minutes later we were going to go have dinner like there wasnt a problem in the world.

We got out of the hospital at midnight. I came home, I tried to talk to my mom about it, she doesnt understand what it felt like, to have this womans life dangling in your hands, while youre listening to jokes from the nurses and RT. To have been talking to this lady one minute and come in to see CPR in progress the next. She shrugs. You did your best and went to bed.

I couldnt get this womans face out of my head while I was trying to sleep. I couldnt help but think.. maybe if I hadnt of had to slide my hands over. Maybe if I had bagged faster... And her poor family. She was only 51. My mom is older than that.

How do you deal with it? Your first code? How do you get them out of your head and accept the fact their dead and you did all you could.

 

[Jon]

The first can be tough... and sometimes we have other bad ones, too.

One thing you saw was the physician running the code ask if anyone had any other ideas... this is VERY common in a teaching hospital.

How can we joke? To quote Steve Berry... "How can we not?"
Humor, espicially dark humor, is a coping mechanism. It helps us ignore that we were talking with the patient 10 minutes ago.


As for eating: The patient died. You did what you could, so did everyone else. You need to take care of yourself... there isn't anything you can do for the patient.

 

[legion1202]

I know it is very hard. I am not a emt or medic yet but I did Loose a older lady while helping out with a roll over including kids. It was in NC while i was moving back to FL. My dad and I started cpr on a lady and the medics did not know what they were doing.. They didnt have the right equiment according to my dad. He is a retired cop/paramedic. I was doing compression why he was bagging for about 15mins. I was doing compression for what seem like 3 hrs. We did get a heart rate when we boarded on the Resue but she died on the way to the hospital.

I had to drive home still and i was alittle confused and out of it. I asked my dad if i was doing cpr right and if there was anything else we could have done. My dad looked at me and said "son you can do 1 thing to one pt and they will live. But another pt might die doing the same thing with the same injuries". In this profession I think you need faith. If it is there time it's there time. I think you did all the right things. And trust me she wasnt going to live or die because you started doing cpr in the wrong spot of her chest.

You didnt make her code, Nor did you put her in the hospital. Think of it this way.. You were there trying to help her in the last few secs of her life. Thats somthing to be proud of. You didnt freak out or Freeze while it was happening.. You did it. You did good.. But god had a diffrent plan and I know it sucks.

I still remember the ladies face and her kids who said thanks to my dad and I.
I`m sure the next one will bother you. Its normal if you didnt care you arent human. People just deal with it diffrently then others. My dad and his old partner use to listen to music after a code or a bad scene. I hope I helped alittle..

Greg

 

[Ridryder911]

Not to sound callous but it's called.... Life. People live, people die and have since God created them. The only difference is NOW you are noticing it. Medicine is a business, when you work in it, it's just a job... nothing more, that's it .. Really, no heroic music, dimmed lights, and break to a commercial.

Now, one should be the best and remembering it is just a job, one should deliver the best care and part of that care is empathy.. not sympathy ( yes, there is a BIG difference).

One has to develop a sense of separation. For several reasons. One is maintain your own sanity, to be able to continue in this profession and to improve upon your care. Second, for the next patient. By remembering and thinking about the last patient, you are not giving 100% of your attention to that patient and they deserve and need it.

Part of the problem in EMS is we teach way too much .."dream world visions". That the care we provide actually changes things, people get better when we treat them, and most people care about our profession. People die in high numbers, CPR is pretty much worthless (but it is the only thing so far we can do) and people become accustomed to their job.

Like others describe, all have felt similar feelings and continue too, we better ever so often or we become jaded. Yes, if you continue onward you will find yourself doing the same.. you have to. Take time, look at the whole picture and attempt to get more exposure. Many can get through the transition and some don't ... nice to find out earlier.

 

[Hastings]

I came in to see CPR and intubation in progress on that 51 year old. I had never done CPR before so I was excited when they told me to jump up as soon as my classmate took a break. My hands shook putting my gloves on. Suddenly it was my turn and Im pumping away on her chest. My hand placement is wrong so they slide my hand over an inch. It feels squishy and I can feel her bones breaking. My arms are tired. I look up at my classmate Switch? So we switch, I grab the bag and he takes compressions.

Sounds exactly like my first arrest situation in the hospital. Actually makes me smile looking back. Well, all things considered, a good experience for you.

Edit: Oh, and as for never getting anything good...that'll change quickly. Especially if you have an internship. In fact, it's often the students that got nothing good during the program that get the wildest internships. Every time I was doing a ride-along at the fire department, they'd go from 12 calls in 12 hours the day before to 0 calls in 12 hours. At the private services, it'd be transfers and alcoholics. But as soon as I hit my internship, I had a critical patient every other day.

 

[BossyCow]

This was your first code. So it carries a lot more emotional weight than it will when you have seen dozens of them.

Be very careful of the tendency to beat yourself up over what you could have, should have, might have done that would have changed this outcome. Especially since this was in the ER. If there was something else that could have made a difference, it would have been done.

CPR doesn't cure anything. Doing picture-perfect CPR is not going to change the fact that this woman's body was not able to overcome the cascade of ill effects of whatever caused her demise. This was her emergency, not yours.

Very often new EMTs will see themselves as heros, fighting death against the odds, snatching the helpless pt back from the jaws of death. This is a very dangerous image because its impossible to maintain in the face of doing this job for any length of time.

Those who last are those who are humbled in the face of the fragility of human life. Our job is to assist those who are going to make it, and to ease the passing of those who aren't. The decision is not ours, the outcome is not up to us and the results are what they are.

It does get easier. This is not a bad thing. It doesn't mean you have lost your humanity or your ability to feel. It means that you have increased your sphere of experience to include a familiarity with death. Hang in there, talk about it with those close to you. If you find that you can't get over it, find a therapist or other mental health professional to help you develop coping skills. Growth is generally painful at first.

 

[el Murpharino]

It's pretty normal to feel the way you did about this patient after your code. I think after my first code I was pretty bummed for a few days afterwards. I accepted what happened, and moved on. You can't let it consme you. Learn from the experience, and accept that death happens. It's part of the job. It's not being cold hearted...it's the nature of the beast. Before you know it, you'll be running a code while talking about the baseball game or arguing about what song to play on the radio.

 

[mikeylikesit]

It happens all the time and sometimes you get used to it while sometimes you don't. i feel personally that is always bad to act off emotions or carry them with you because your more likely to make further mistakes.

 

[Jeremy89]

I can understand being emotional about it. Being a guy, I was more shocked than saddened by my first code (also during ED clinicals, 52 y/o Male, started with resp arrest like yours). I got to see the whole thing including intubation. Once we called him (~40 minutes later) I got a pat on the back from the doc while he said "good job".

It doesn't seem like your ED team was very dedicated to saving the pt. Hell, we pushed 4-5 rounds of Epi, plus Atropine, even went down to Sodium something or other. They hooked up the defib and alternated pacing him with compressions.

After all that, we bagged him up for the coroner's office. Then went and had a bite to eat. Not like nothing happened, i mean we talked about it and everything, but you can only do so much. I understand how you feel, but like Rid said, life happens. Obviously she was meant to be elsewhere and you or the doc or anyone couldn't stop it.

I guess different people react differently in situations. I channeled my feelings into a positive "what can I do better next time" attitude, where you chose to dwell on those sad feelings.

The first one is always tough. My thoughts and prayers are with you, and hopefully you will do better next time! Good luck!

 

[Onceamedic]

My first code patient was 3 1/2 months old. We could do nothing for the baby and after he was declared, the family became my patients. I know I was a great comfort to the mother and I find a lot of satisfaction in that. I can honestly say that it did not bother me. Everything that could be done for that child was done and done well. If something had been undone or done badly, then I would have been quite upset. I got angrier in a case of a broken leg where I felt the patient was on the backboard for much too long. I am not a cold person but as Rid points out, death is a part of life. If it tears you up repeatedly, then you may need to reconsider your career choice. Good luck to you.

 

[mikie]

I've only had one 'code' so far and I probably won't stop dwelling on what I did wrong and what I could have done right. Odds are the patient was already dead on scene, but it still makes me think, "what if I did better compressions" or "I should have done this before that" etc!

Do these thoughts go away?

 

[rhan101277]

I wanted to note, that during my ambulance drivers course. Our instructor who was a paramedic, remembered his pt that died. It was a 7 year old boy who was hit by a car while on his bicycle, he still remembers the face from 1988. He said he could draw the way he was lying on the floor.

 

[KEVD18]

It doesn't seem like your ED team was very dedicated to saving the pt. Hell, we pushed 4-5 rounds of Epi, plus Atropine, even went down to Sodium something or other. They hooked up the defib and alternated pacing him with compressions

i dont see where you get this at all. they did cpr, tubed, pushed meds; short of open cardiac massage, theres not much left to do.

4-5 rounds of meds? well, im sure R/r will be along to tell you that 3/5 of those were wasted. think about progressive ems systems. cpr/defib/2 rounds of drugs and if no improvement call it a day. since the overall results for cardiac arrest are pretty dismal regardless of setting, you'll see more of this type of code being run. the numbers just dont support the effort.

oh, and the sodium something or other was sodium bicarbonate.

 

[emtjen15]

First Code

My first coed was a lady who was about 6 months pregnant and had a PE. I did not work her but the other crew did for the family's sake. If was a difficult call. She had died before she fell to the floor.

 

[Ridryder911]

It doesn't seem like your ED team was very dedicated to saving the pt.

Why did you say that?

From what I read, they did far more than the usual. Most physicians will call off a code after the second round of medications. The old work-em days are over. If there is a question we will document in two leads and maybe check with u/s to verify no mechanical function (PEA) but that is very seldom.

What I have seen is the usual code now lasts about maybe 10-30 minutes in duration if that long. If they arrived per EMS & demonstrated no response (with ALS) they are stopped immediately.

R/r 911

 

[MAC4NH]

You always remember the first one. However, as many have posted so far, you have to learn to compartmentalize. Unlike student clinical time, when you're out in the big, bad world, you won't have the luxury of spending time talking it over with your instructor, etc. You'll have to clean up the bus, call back in service and go on to the next one like nothing happened. As Ridryder pointed out, you owe the next patient 100% of your attention or you're not doing your job. BTW, that next patient might become your first (or next) save.

 

[Jeremy89]

Why did you say that?

From what I read, they did far more than the usual. Most physicians will call off a code after the second round of medications. The old work-em days are over. If there is a question we will document in two leads and maybe check with u/s to verify no mechanical function (PEA) but that is very seldom.

What I have seen is the usual code now lasts about maybe 10-30 minutes in duration if that long. If they arrived per EMS & demonstrated no response (with ALS) they are stopped immediately.

R/r 911

Just the way she stated some things, it seemed like they didn't really care. Though I did miss the part about Epi, Atropine, Epi, Atropine

...Meanwhile I hear the nurses joking with the doctor and I cant help but think This woman is dying! How can you joke?

The doctor asks Does anyone else know of anything we can try? Another nurse yells out shock her just to see! But the doctor sighs and calls the time of death. \47 pm Tuesday August 5th, 2008. I dont know if Im supposed to stop suddenly so I bag once more and the nurses yell out Stop it! Its over!

Correct me if I'm wrong, Trish?

 

[KEVD18]

well, while it might seem crass, joking during serious events happens. code are mentally easy to work. these drugs for this rhythm, these drugs for that one, pump, blow etc. ive discussed dinner plans, sports, while working a code.

"does anybody have any ideas" thats also pretty easy. they had done everything in the book. the doc was asking for a left field i read about it an a journal idea. at that point, death was the only option other than something crazy. nobody had any decent ideas so he called it. thats sort of how codes end.

i think your wrong on this one sir. everything that could be done was. and the op is, by her own admission a rookie who therefore hasnt "been there and done that" therefore her take on it isnt entirely reliable.

 

[firetender]

...and, now begins your relationship with death.

Not a whole lot of people get to do this.

It's not particularly pleasant.

And sometimes you WILL feel like you're playing Tug of War with God,
but you won't talk much about that because it's just too nuts

At some point you'll have to look death in the face and see yourself.

(Not a whole lot of people get to do this.)

But there are things there to learn, and you'll have to experience your humanity to do it.

Of course, you could always pile layer upon layer of insulation between you and your experience of it.

But then, insulation isn't porous, so nothing else gets in either.

It boils down to a series of new choices you'll learn to make.

They'll either allow you to move forward with new tools to use that are life-affirming for others in need

(in this way, death becomes one of your greatest teachers)

...or withdraw into your own world where death has the upper hand.

And, yes, you can experience the pain without it getting to you.

(It only gets to you when you hold on to it.)

Life is nothing more than moments passing through you, and now, because of the work you do, some of these include death.

You're the one who decides how they are used.

 

[Ridryder911]

I have to admit out of the sight of the family, I joke, whistle and become very relaxed during codes. This occurs after I have seen that the patient is not responding to therapy. It usually relaxes the members of the team and myself. Their boring, methodically and usually a waste of time. Only on television does one see the dramatics and seriousness occur or when an emotional contact if the family is present.

In a non-viable patients (as in 99.6%) of all cardiac arrests, the emphasis is to attempt to see if the patient will respond or not. It NOT inappropriate for the physician to ask.. "Does anyone have any suggestions or ideas"....Actually, AHA ACLS megacode highly suggests and promotes such ideas as being a team effort and usually is the last ditch. I honor the physician as doing so, they were actually following current standards.

It's easy to come to the forums and judge, especially when one has not even performed the real job yet. Personally, I feel you cannot consider yourself experienced in codes until you have past the four digit numbers. When that occurs you will see and develop a different understanding of codes.

R/r 911