First published in HOSPITAL PHYSICIAN as a Code Blue Story in January 2003.
As a newly minted intern, I was just beginning a month on 2700, the telemetry floor, which was populated mainly by cardiac patients. Although my first nervous week thankfully passed without major incident, my second week was not to end so calmly. Late in the afternoon on Friday, as I was trying to finish my notes and get out before something happened to extend my stay (I had finally managed to get a weekend off), I suddenly heard a series of piercing screams coming at regular intervals. The sound of multiple nurses yelling for me quickly followed.
I rushed down the hall, reciting the ABC's of advanced cardiac life support. I had participated peripherally in a few codes since starting my internship, but this was the first time things were firmly in my court. When I entered the room from which the screams came, I saw a 40-year-old woman sitting in a chair; she was intermittently convulsing, screaming, and then sitting quietly with a perplexed look on her face.
Although she was in a room assigned to me, I had not seen her before. It turned out that some of these rooms, when empty, were used for staging interventional cardiologist cases. Before I could begin my preliminary examination, she started convulsing again. The thought crossed my mind that if I were to grab her, I would start convulsing along with her, as if she were connected to some electric device.
She obviously had an airway and was breathing; her screams proved that. As for her circulation, her face was red enough to show that blood was perfusing all her tissues. Not knowing exactly what to do, I called a code. I ordered an electrocardiogram, oxygen, and a chest radiograph and then shouted for the medical resident. My yell must have been fairly loud, because the resident suddenly appeared without being paged. A general practitioner who had spent approximately 15 years working in an emergency department, he had decided to do an internal medicine residency to become board certified in the managed-care world. He was a blessing to a new intern.
Nothing seemed to faze this resident. Walking quickly over to the patient, he carefully but firmly took hold of her shoulders. He managed to calm her and to stop her convulsions, reassuring her (and me) that everything was all right. At that point, we heard a chuckle behind us and turned to see the cardiologist. We learned that he had been on the telephone all afternoon with the patient's health maintenance organization (HMO), trying to get approval to replace her defective defibrillator. The HMO denied care at our institution, so she had been waiting for transfer at the time her emergency occurred. Because of the episode, she was subsequently taken to our catheterization laboratory for a quick remedy to her predicament. Later that night, the patient explained to me that this was the second time she had had a malfunctioning defibrillator.
Thinking back to my internship and the whole of my medical training, I feel an incredible depth of gratitude to all the teachers, fourth-year medical students, interns, residents, attending physicians, and patients that make up the life of a physician-in-training. But most of all, I am grateful to that one resident. I have tried to emulate the calmness and certainty of purpose he showed that late Friday afternoon whenever I find myself in a crisis situation.
