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Teaching and Learning Moments

The Burdens We Bear

Ng, Damond B. MD, MPH

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doi: 10.1097/ACM.0000000000003196
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“Code blue, OR 4. Code blue, OR 4.” A billowing voice repeats this call to action with calm composure and cadence as if announcing grand rounds. Amidst the fray, I find myself 10 feet from the emergency. After a few moments of primal fear, I don a surgical mask and enter the operating room. Four robotic arms draped in plastic hover over a pale, hairy man. I don’t know his name or his malady, but I know he has no heartbeat. The charge nurse rushes past me with an AED. Scanning the faces in the room, I see shock, melancholy, and quiet confidence.

After others perform a few rounds of CPR, I approach the on-deck circle and say with a slight quiver, “Let me know when you’re ready to switch out.” In the meantime, I frantically recall the basic life support training I received. The appropriateness of following the rhythm of “Stayin’ Alive” by the Bee Gees while performing chest compressions is not lost on me.

“Checking rhythm … shock advised … please stand clear,” the cold, robotic voice from the AED announces. The man’s body jolts as if awakening from a free-falling nightmare. Four of us continue compressions, alternating in 2-minute shifts. Dressed in sterile attire, we remove our facemasks to breathe easier and avoid passing out.

Thirty minutes elapse. Beads of sweat drip down my already glistening forehead. My unconditioned abs call out in pain from the exertion, but I summon what strength I have left and focus on the disco bassline. Recuperating during my break, I overhear chatter of whether the patient is an ECMO candidate or not.

The patient has now been without a pulse for 45 minutes. The charge nurse shouts, “You have to compress deeper!” I feel less resistance and rebound from his now cracked costal cartilages. A phone call from the ICU team deems the patient an unfit candidate, and I am told to stop compressions. In a daze, as if struck by a flashbang, I continue on.

“It’s ok … It’s ok, kid,” the code leader says as he pats my shoulder. I notice his bloodshot eyes as he turns toward the wall and laments, “Time of death, 17:36.” We all give rather reluctant pats on the back while filing out of the operating room. It feels as if this is a routine to everyone except me. It isn’t sweat but tears now dripping down my cheek. Taking a few moments at the foot of the operating table, just as I did before giving my grandmother’s eulogy, I realize a life escaped from beneath my palms for the first time. I didn’t even know his name.

Responding to a code is a defining experience once entrusted with a white coat—albeit a short one. Every clinician can remember his or her first real code as a singular event, but often unspoken is how these experiences chip away at the body, mind, and soul of even the most steadfast of people. Piece by piece, the mosaic of a fledgling medical student builds, cracks, and rebuilds with the ever-present risk of shattering altogether in the crucible.

One month later, my partner woke me up in the middle of the night after noticing my rhythmic upper extremity jerks. In a nightmare, I was psychosomatically re-experiencing that fateful day in an infinite loop, struggling to change the ending. I try to spare her the grim details of my training, but my body can’t lie. I’ve slowly and soberly learned there are innumerable, veiled scars that each medical provider bears—the groundwork of quiet confidence. Nothing can prepare you for the weight of a human life beneath interwoven hands. I know this will neither be my last code nor my last patient mortality; I will be code leader one day. In rapid responses and emergent cases in the interim, I’ve challenged myself to slow down and dignify the situation at hand. To always remember the patient from that day in OR 4. Medical training is a beautiful struggle of keeping harm at bay and staving off death. And I’m humbled to bear this burden.

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