Tell me what happened.
I was sitting in the workroom when the nurse rushed in.
What were you doing?
I can’t remember. Putting in orders or signing a note? I was sitting at the computer furthest from the door.
Tell me more.
She came in, breathing heavily. I can still picture the look of panic in her eyes. One of my patients was so hypotensive that the monitor wasn’t registering his pressure anymore. I chased her to his room. His nose was purple. He had taken off his breathing mask, I think. His nose was so purple, man. That was the first thing that caught my eye.
What did you do next? Walk me through your steps.
I tried to gather myself. I was only a few months in. I knew the day would come but I was dreading it, and it had to happen now, in the middle of the night. I tried to look calm and collected since there’s no point in giving others a reason to panic some more, but my face felt like it was on fire. I scanned his chest, not sure what I was looking for, and asked the nurse what tipped her off. I couldn’t hear what she said.
My heart was beating so loudly that I couldn’t really hear anything over it. I know how ridiculous that sounds.
Right. Then what?
I racked my brain for that heart attack management mnemonic, MONA BASH. I couldn’t think of the second word, though. MONA something. The nurse went ahead and tacked on the EKG leads and asked me to give a verbal order. I did. My mind was racing. We put him back on oxygen.
An EKG is a good start. What did you see?
It was bad. It was the first time I ever saw the automated read in capital letters. ACUTE MYOCARDIAL INFARCTION! ACUTE MYOCARDIAL INFARCTION! It was so distracting. My eyes kept jumping to those words.
Did you call a code?
I was told he was DNAR. My hands were tied. It didn’t sit right but I wasn’t sure what to do. I had checked his pulses, which were virtually absent, and briefly paused to check my own. The room was filled with nurses now. Someone kept asking me over and over again if I should call a code. I kept deflecting — the answer was no, but maybe they knew something I didn’t? They’ve been doing this for years. I was barely out of medical school and my senior resident was still on his way.
But did you call it?
I did. I obviously wasn’t supposed to, so we canceled it within seconds. I heard a few loud sighs and I’m sure I looked pathetic as I kept searching for a pulse and listening to his chest. I was too immersed in my thoughts, running mental checklists to make sure I didn’t miss anything, making sure he was getting his supportive medications. The EKG sheet was at his feet. As much as I tried to read the individual leads, I couldn’t take my eyes off of the capitalized readout.
So you called it, then canceled it. Who else, besides nursing, was with you?
Rapid Response was there, but they left when we canceled the code. My chief walked through the door and asked for repeat vitals. Still absent. No pulse, no pressure, EKG spotty. I gave him the story. His first question: did you check for signs of life?
Yes. I couldn’t hear any air movement in his chest or appreciate a pulse when I first assessed him, and nothing had improved since. But I hadn’t yet checked his eyes. His pupils were non-responsive. The EKG was flat. The room was silent without the beeping. We declared him.
What time was this?
Some time around 2 o’clock in the morning.
I walked back to the workroom. I looked at the ground the whole way. I was embarrassed and ashamed. How selfish, right? A guy dies and I’m embarrassed.
Perhaps you thought you had more to give.
Did I? He died on my watch. Do I?