Code Blues

“ATTENTION!”

Every muscle in my body tensed and my brain immediately awoke from a light sleep. 

“ATTENTION, PLEASE - CODE BLUE ROOM 315. CODE BLUE ROOM 315.”

My mind began a sequence of thoughts but then remembered and important fact: I’m a visitor.  

It was just after one in the morning at a hospital in Knoxville last Friday.  My mother was asleep in the bed struggling with the first night of discomfort from a scheduled surgery.  I was asleep, no, dozing, in the recliner next to the bed taking the seat my dad would always be in when she was in the hospital.  

First recollection:  There is no rest for anyone in a hospital.  It’s a simple fact.  Too many vital signs, medication schedules, loud rolling equipment in the hallway, and blood collection interruptions which make a night in the hospital anything but restful. I knew that, but got to learn it again. 

Yet the called code early in the morning brought back a wave of memories from residency over twenty years ago.  There were usually one or two interns and a second year resident on duty.  We were the only physicians in the hospital overnight and responsible for running all codes on all patients.  

A “Code Blue” is called when a patient is unresponsive or in severe distress.  A team of nurses, respiratory techs, phlebotomists and physicians are assigned to drop everything and respond.  The protocols have been refined over the years and everyone knows their duty.  

Airway.  Breathing.  Circulation.  Someone adjusts bed.  EKG leads placed.  Oxygen is confirmed flowing.  The crash cart is wheeled in from its standard location loaded with drugs and equipment for the code.  

It was routine in residency.  A resident, in that day, may have been up since six AM the day prior but the adrenaline would jump from the first word.  I was taught the first rule of a code was to check your own pulse.  Recognize you need to be awake, alert, calm and thinking clearly.  

And we saw a lot of them.  It became an expected occurrence on the medical, surgical and oncology floors.  It was an outright terror to be called to labor and delivery or the pediatrics floor.  

As I awoke from my sleep last Friday morning many of the codes I was a part of in that phase of my training came to mind.  Once, I was casually asked to see a patient a new intern was seeing as I was simply passing in the hallway.  It was a patient I had known from an earlier rotation.  She had a look of terrified fear on her face and in her eyes. 

It’s a look I’ve never forgotten.  She was having mild shortness of breath but had smoked for over fifty years.  But it was the look.  She truly looked like a woman staring straight into hell.  

I called her name and she turned her head to me.  Stared at me for a moment then grabbed the collar of my white coat with both hands and pulled me into her bed as she fell back in cardiac arrest.  She literally had a death grip on my coat.  I wedged her fingers loose, told the nurse to call the code, and cracked her chest with a blow to the chest that is suggested if there is no other equipment yet available.  Chest compressions, bagged respirations, until the team arrived.  She didn’t make it.  I have never forgotten that look.  

I remembered the sweet older couple at the Memphis VA hospital in 1993.  He had been in reasonably good health, but had some blood in his cough for a day or two.  Chest x-ray showed something in the upper right lung.  Full work-up with the team would be done in the morning. She could not stay.  I remembered how tender they were to each other as she said goodbye.  

His bleeding into his lung became dramatically worse at 3 AM.  We battled suctioning blood out of his lungs while trying to put oxygen in.  It was a very ugly code.  That sweet couple who had shared years together had said goodbye to each other as if they knew.  Their tenderness in how they parted has stayed with me to this day.  

I stopped shopping at KMart while I lived in Rome.  The last time I was there an announcement came across:  “ATTENTION! Blue Light Special is now going on in jewelry…..” I nearly jumped out of my skin after the word “blue.”  I literally started to sprint to the jewelry section before I came to my senses.  No more. 

After airway, breathing, circulation, comes a host of questions.  What is the history? Who has the chart?  (Confirm it is the correct chart - learned that the hard way).  What meds were recently given?  What is the cardiac rhythm? What is the blood glucose?  Check the airway again.  Most code teams are so well trained that the questions are answered routinely as everyone is doing their job.  

“CANCEL Code Blue room 315.  CANCEL Code Blue room 315.”  

It had been about a minute.  Probably some poor soul was finally sleeping well, didn’t have his hearing aids in, and was tough to wake up for vital signs check.  The code was called and the patient woke up to a crowd of people about to unleash a lot of activity on him.  Good for him.  

But I was awake.  My long journey down a memory lane of a lot of codes had taken a minute or so sitting in the reasonably comfortable naugahyde recliner.  Mom was sound asleep.  Closed my eyes and drifted off for another hour or so of stolen slumber in the hospital.  

I am thankful for those who run the Code Blues at night in the hospital with great skill.  May God bless them for their dedication and training. Nevertheless, I don’t miss it. 

Eric J. Littleton, M.D. (@DrEricLittleton) is a musician and Family Physician in Sevierville, TN. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com