Oh My God she coded

It had been a busy day in the ICU, unstable patients, speaking with families and the regular grind that we go through in the ICU. Thirty minutes left and the night team will be here were my thoughts as I had a moment to look at my watch. I told the nurse practitioner to start preparing for sign out when the admissions phone went off again. It was a sound too familiar to me. On the other end was the rapid response team member who started to tell me about K, who was breathing rapidly and needed ICU intervention right away. I told him to place her on positive pressure (bipap machine) and transfer her to the ICU. I spoke to the nurse and respiratory therapist in the ICU and told him to get the necessary medications and equipment to intubate the patient and walked up to see the patient. K was 29 years old when we met, she was breathing over thirty-five times per minute as I walked into the room with a bipap machine on her face. She looked at me struggling to breathe as I held her hand, squeezing it tightly as she felt her life slipping away.

K was admitted to the ICU. We quickly intubated her and upon review of her medical history she was an IV drug abuser and had developed endocarditis (infection on the heart valve on the right side of the heart). The infection had spread into the lungs with multiple septic emboli leading to sepsis and eventually septic shock. As we stabilized her in the ICU, her mother and aunt walked in, and I spoke to them about her condition. The distress was apparent as her mother worked in healthcare and explained to me how her daughter had gotten in with the wrong crowd and promised if she made it alive, would help her daughter change her life. I told her the best chance she had was to have the valve operated upon to stop the infection from injuring the lung even more. She agreed to that recommendation, and I spoke to the surgeon who told me over the phone “I will give her this one chance” and agreed to take her. She was subsequently transferred to the Cardiovascular ICU (CVICU) at our main facility.

I was on call the next night and heard a code overhead. It was in the CVICU. I responded to the code with the nurse practitioner next to me. We entered the room and CPR was under progress, it was K, who had just come out from surgery. Anesthesia was in the room, the surgeon arrived, we continued to resuscitate, thinking of a mucus plug, an emergent bronchoscopy was performed at bedside, echocardiogram was unremarkable and suddenly as if something magical happened she regained a pulse, and we were able to oxygenate her again. All her vitals improved albeit she was still on life support and medications. I stayed in the room as the surgeon stepped out to speak with the family. As I knew the family on my way out, I too stopped and spoke with them. They were scared and concerned. I narrated what had happened and explained the critical nature of the next few hours to days. I left the room and had a sense in my heart of what I had just witnessed that she will do well. Her recovery was slow, but she improved steadily.

Two months later, during rounds at a chronic ventilator facility, the respiratory therapist mentioned a new admission had just arrived last night and her mother was there and wanted to speak with me. I walked into the room, and it was K and her mother. She had a tracheostomy but was breathing on her own, wide awake and coherent. Her mother seeing me enter the room stood up and a smile came over her face. This was the first time I had seen her smile and she asked me if I remembered who she was. I said how can I forget. She spoke to her daughter about the first time we had met in the ICU and then after the time she had coded. Her daughter once again squeezed my hand and this time it was a different squeeze, one of being grateful, one filled with life and energy and said thank you. We decannulated (removed) the tracheostomy and a couple of days later discharged her. She is working now and has a new life. I still run into K’s mother at the hospital. On one such meeting, she told me she could never forget the night after K coded, and the moments after when I had come and spoken with her. In her own words, she described the event.

“I can never thank you enough or let you know what comfort you gave me when I saw that look on your face that night, which was not one of devastation, but a look of hope and that it wasn’t over yet”

Hope is what we in the ICU hold on to. Hope helps us deliver the care and it is hope that never dies.