Koustubh Kondapalli submitted 2020-10-04

I was only in my third day of the first rotation as a third-year medical student when I was assigned to the “Code Team” for the day. The residents began giving us an overview of the different codes and telling us our responsibilities and duties as a medical student. Within minutes of their briefing, a code blue was called, and it was time to go. As we quickly grabbed our stethoscopes and started to run towards the emergency, I started to prepare myself for what was to come.

The first step in handling any given medical emergency, especially as a healthcare professional, is establishing a knowledge base. In preparation for the day, I reviewed my BLS training modules. As we approached the patient room, I tried to recall all the sessions in the simulation rooms where we practiced different roles in the setting of different emergencies. Before we even entered the room, I visualized the key elements of a Code Blue, the crash cart, the oxygen, and the AED. Medical training is never static. The patients we treat are always different and the training needed to treat them is also constantly evolving. With the advent of machines like LUCAS, chest compressions may no longer be our responsibility. Therefore, it is crucial to stay informed and always be updating your knowledge. While this was my first time helping with a code on a real patient, I knew I had years of preparation leading up to this moment which eased my anxiety.

By the time we entered the room, there was already a group of people getting the room ready. This is where step two comes into play: active listening. Running a code requires teamwork and coordination. It is the one area where a confluence of health care professionals come together, and it is no longer about a hierarchy of degrees or medical expertise. It is about taking charge of the situation if you are a leader or actively listening to the orders and following through if you are the rest of the team. Even if you do have all the medical knowledge necessary to run a code, if you cannot actively listen, you cannot successfully be a part of the team. Contrarily, if you simply act upon the instructions given, you can bridge any knowledge gap.

As I got in the rotation to perform chest compressions, I began listening to the nurse’s orders and taking in the situation. I read the vitals, the patient’s heart rate was elevated in the 150s and he was in Ventricular Fibrillation. It is essential to take stock of the situation, understand what every person is doing and where things are. For every order that was given, I echoed it back to acknowledge that I listened, and I understood. Everyone fit in and rotated through their positions like a complex choreography intended to save this person’s life. A life that has a rich story behind it, one that has family and friends relying on it.

Throughout that day, we had a total of nine codes. Not all of them were the same, not all of them required resuscitation, and unfortunately not all of them ended up saving the life. It was an exhausting day both physically and mentally. For me, step three is taking the time to recoup and recover. While we celebrated the successful codes, it is the unsuccessful ones that always stick with you. The soreness in my arms were a constant reminder of the chest that lay beneath them, the heart that could not be rescued and the breath that could not be reinstated. As a team, we discussed not only what went well and what did not, but we kept a space for the patients we lost that day. Discussing the loss and processing through the grief is what keeps one ready for the next emergency. It is what encouraged me to keep going and strive towards perfecting my skills and training so I can better help patients in the future.

The hardest part about a medical emergency is the inherent unpredictability of the situation. Medical emergencies are not always confined to the hospital, they can occur anytime and anywhere. You will not always have the resources to immediately help the person. But if you have the knowledge base and active listening skills you can call for help and rely on them. Since my day on the Code Team I have been in a few more emergencies. The fear of the patient’s future relying on our team is still present and it is still gripping. Instead of succumbing to that fear and letting it interfere with patient care, I use it as fuel to best prepare myself for these situations. Ultimately, that is the key to continuing to save lives.