Responding to a call is a lot like
diving off a cliff without looking first. I never have
any idea whether I'll be in over my head or not. But
even though I didn't run any codes as a first year resident,
I'm surprisingly calm carrying the code pager as a PGY2
on cardiology.
My mother, a retired nurse, was
amazed that I was running codes already. "Make sure
you tie your shoes!" she reminded. The question that
still plagues me is whether or not I should wear my
shoes to bed when I'm on-call.
ON
THE RUN
We were in the middle of rounding when my first code
was called. Luckily, the code was just next door on
the general cardiology ward and I got a lot of support
from the nurses and other staff. The CCU attending was
just steps behind me and took over by the time the crash
cart arrived.
Immediately after the first code,
a second one was called down in the bronchoscopy suite.
Since we were spread thin, the team consisted of me,
another resident and two code nurses. Dashing down several
flights of stairs, I found a lady who had a hypotensive
episode during bronchoscopy. She was immediately intubated,
and currently has a good pulse and blood pressure.
Although it wasn't technically
an ACLS code, it was still the first time people were
looking to me to call the shots. The pulmonary fellow
helped me out suggesting sedation medications and the
anesthesia staff was there to give me pointers: "Do
you want an ABG?" he suggested. "Make sure his ABCs
are OK," he reminded.
I haven't had the (mis)fortune
of running a code on my own at night yet, but I think
that's when there would be the least support and my
skills would be put to the ultimate test. Of course,
I would run the code by the book, but to make it all
the more confusing my senior cardiology colleagues often
run codes very differently.
We've had several codes on CCU
that I thought were surprisingly chaotic, consisting
of a mix of old and new ACLS guidelines, not as much
continuous CPR as I would have liked and too many pulse
checks. Vasopressin and atropine seemed to be given
randomly, but, as one person pointed out, what's the
harm when they've been doing CPR for 40 minutes already?
STAGE
LEFT
Perhaps the most difficult hurdle for me is getting
over stage fright, especially in an academic centre.
When a code is called, a circus of white coats and scrubs
shows up to the event. I'm quite happy running a code
when I'm the most senior physician present, but it's
not uncommon to have the cardiology staff watching in
the background, the ICU fellow dropping by, or cardiology
fellow pushing you aside and running the code himself.
I find it unnerving having better qualified people watching
me run a code.
As I type this in my call room,
I look at the code pager hoping that it will let me
sleep tonight, but also ambivalently hoping for some
experience.
|
