I was asking a hospitalized patient about bowel movements and nausea when the alarm went off in the hall. The spritely nurse in the room immediately dropped what she was doing and ran out.

The befuddled old man and I looked at each other.

“What’s that?” the patient asked me.

“I uh … don’t know,” I answered, “Maybe I should check.”

A handful of nurses and techs had swarmed into another room down the hall. Fan-mucking-tastic, I thought, a CPR. I hadn’t recognized the new CPR alarm in this new hospital tower. I hurried to the room, making two wishes along the way:

1) I hope it’s a false alarm (sometimes patients choke on the meatloaf), and
2) I really hope I’m not the only doctor there.

It was not my lucky day (not to mention the patient CODING). An intern’s worst nightmare is to be the first one at a CPR. I’m eleven years past my internship but even now, it’s still a scary experience, especially since I haven’t been part of a CPR team since residency. I haven’t run a CODE in years. Sure, we get certified every other year or so, but two days of testing isn’t quite the same thing.

I didn’t have to go. There’s a designated CPR team of residents that would be along any minute. But I would feel guilty if I didn’t at least take a look, especially if it’s practically in the next room. Motivation by duty? Nobility? Nope. Guilt? Yes.

Fortunately, the nurses already had the basics down and were hooking up the rhythm monitor and lifting the patient back into the bed. It gave me the two seconds I needed to mentally construct some order out of the chaos.

“She was walking out of the bathroom … her eyes rolled … she dropped to the floor,” the tech on the scene stated.

I remembered the ABCs: airway – check, breathing – they’re bagging her, circulation –

“What’s the pulse and pressure?” I asked loudly, aware of mine going up enough for the down patient and myself.

The monitor finally showed the thready line that still bound this woman to life as we know it. Tethers. Need more tethers.

“Do we have I.V. access?”

“A peripheral.”

“One milligram of Epi now,” I commanded, secretly thankful it was one of the “easy” rhythms on the monitor.

I heard the words “cancer… radiation today….” Cancer can make you clot more.

“Let’s get a STAT echo,” I ordered. If there were a massive lung clot, the echo would show the right side of the heart straining against it.

“Is the epi in yet?” I asked as a nurse pounded on the frail chest.

“The peripheral I.V. isn’t working,” another answered.

Motherfuc–

“Need a line?” the surgical resident said with a rubber gloved snap. “Kit, please.”

Two other residents arrived as if gawking at a car accident. They were probably part of the official CPR team, in name if not in spirit. The senior started looking at the chart. I understood their doe-eyed hesitation.

“Line’s in. Later,” the surgical resident surgically excised himself from the situation.

“It’s been three minutes, anything else?” a nurse asked. I looked over to the senior resident whose attention was one-eighty in the wrong direction.

“Still P. E. A. Atropine one milligram,” I replied glancing at the resident who was looking at the chart. Come on man, the show is over here. You’re The Captain of the CPR Team. I’m just the samaritan here.

“Continue compressions. Send a gas and lytes. Anyone call the family?” Sigh. I’m not even supposed to be in here today.

As if on cue, the granddaughter stepped into the room, already swollen-eyed with her hand over her mouth. “Grandma? Grandma!!”

I recognized the next doc who showed up. He was a hospitalist like myself, nearly the same age, and his name was on the patient’s chart.

“Hey,” he said after a pause surveying the situation,

“How’d you get here?”

“Just passing through,” I answered.

Nod.

The granddaughter started whimpering in high-pitched tones, asking questions that would have to wait. Personally, I don’t really mind a family member present during a CPR but usually someone will ask family to wait outside. It’s hard enough thinking or hearing without having an audience screaming and crying at bedside going through Kubler Ross’ five stages of grief in twenty minutes or less. She was kind of cute too – at least I wasn’t going to be the one to break her heart staring at her bleary and bloodshot eyes.

“Ma’am,” the coding patient’s doctor asked, “Could you wait outside?”

“But can’t I stay? I’m family. What’s happening to her? Is she alright?!”

“I need you to leave. Now.”

I thought it was a little harsh, but then again, it wasn’t my patient who was actively dying if not already dead lying before me. Death is a diagnosis made after at least twenty minutes of the gauntlet of chemical, electrical, and physical pummelling during a CPR, in the hospital at least. Unless you’re a DNR (Do Not Resuscitate).

After the granddaughter was escorted by a nurse, the patient’s doc turned to the resident CPR Captain, and inquired,

“Who’s in charge here?”

I wasn’t sure if he was talking to me or not. The CPR Captain eeked out a, “Well, he (pointing to me) was here first.”

Oh man, wrong answer. The patient’s doc repeated directly to the CPR Captain,

“WHO IS IN CHARGE HERE?!”

“I’m … I’m the CPR Captain,” the resident finally accepted his mantle.

“Then run this CPR,” the attending urged in nicer tones.

I stepped back for a minute, saw things running smoothly, as the two of them took over together, and left. Relieved. The granddaughter was being comforted by the social worker outside. As I walked down the hall, I heard, “CHARGING … CLEAR!” Must have flipped into V-fib. Not a good sign. But neither is an elderly person with cancer in cardiac arrest.

I returned to the old man I was originally seeing before the CPR started.

“So … where was I?”

A final bead of sweat rolled from my armpit down my ribs.