basric | LJIDOL CHALLENGE 4 ELEPHANT IN THE ROOM

One thing the hospital drills into its new nurses is there are specific steps to follow during a CODE:
(1)PUSH THE CODE BUTTON BY THE BED
(2)Escort ALL family members from the room and into the waiting room. The Code Team will be in the room by the time you are back
(3)RUN the CODE

Experienced nurses teach them that there is nothing to fear during a CODE, for nothing you can do is worse than what the patient already is ...DEAD.

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The Medical Center's ninth floor Oncology Unit had been steady all night with the charge nurse monitoring three new nurses with less than six months experience, along with pushing chemo on two Leukemia patients and admitting three patients.

When making out the assignment for the night she was careful to give these new nurses patients that were basically late stage cancers that just need assessment, monitoring and medications.

At one in the morning one of these new nurses strolled into a patient's room searching for the charge nurse. Finding the charge nurse changing a P.C.A. machine's medication she waited until the charge nurse snapped the door shut and locked the machine. "Um...I think my patient has died."

The charge nurse straightened and at the calm and relaxed pose of the nurse and asked what she assumed was a rhetorical question, "They are a DNR (Do not resuscitate)."

When the new nurse responded "No, but he is late stage lung cancer."

By the time the words left her lips the charge nurse yelled for help and ran toward the patient's room. She entered the room concentrating on the patient obviously not breathing and although she'd heard the overhead speaker voice call THE CODE she pushed the button beside the bed and then popped her pen and wrote the time. The tech pushed the crash cart into the room followed by another nurse. She headed to her desk for her CODE clipboard as the patient was rolled and a board placed beneath him. C.P.R. was started.

She noted as the IV Tech ran into the room followed closely by the Respiratory Tech. Four rumpled residents, most likely awoken from a nap in the room down the hall sprinted into room 922. She grabbed the patient's chart and ran to the room and found it filled with people. The new nurses and techs crowded the room as they all wanted to watch a 'real' CODE.

The charge nurse flashed the lights and raised her voice, "Anyone not actively involved in this code, GET OUT NOW." They grumbled and whispered breaths of "BITCH" but the room cleared in seconds. Although they only needed one resident, not four, she had no authority over the doctors and reluctantly accepted their presence.

She lifted her clipboard and took position as recorder. This record would be what the committee would examine when this CODE was dissected in a few days.

She noted Respiratory had the Ambu Bag hooked up to physically force oxygen into the patient's lungs. The tech continued CPR. The IV Therapist was flushing the central line in the patient's right subclavian vein. One resident began the usual barrage of questions about the patient. The charge nurse noticed the new nurse not present. So she asked the nurse present to run the code. She dug through the chart, found and answered each question precisely. She made notes on her arm to transfer later as the resident decided to intubate the patient.

"What size?" she asked the nurse as the nurse handed the doctor the intubation kit and hung another bag of fluids then pushed the drug called for by the doctor. She cut her eyes behind the charge nurse then quickly looked down and answered. Leads had been attached to the patient and the EKG paper ran continuously. The resident looked behind the charge nurse then quickly down as she ordered another drug push and a shock.

The charge nurse was surprised, the code had been going on for 45 minutes. It should have been called, but no one seemed surprised as she continued. At the next order one of the other residents touched her shoulder, glanced over the head of the charge nurse then back at her, "He is in asystole. He's gone."

With a sigh she glanced up at the clock, "T.O.D. 2:20 a.m."

The charge nurse continued her charting as the room emptied each person glanced behind her as they slid out of the room until only she and the other nurse remained. The nurse sighed and looked behind the charge nurse, "Would you like me to stay?"

She was rolling up the EKG strip as a bolt of awareness shot through her. She shut her eyes, sighed deeply inside, as she felt the weight of her job as it pressed hard on her heart and spirit. She steeled herself and opened her eyes, "No." She mouthed "Call the son."

Then she turned to face the elephant in the room.

This one stood five feet nothing, about seventy years old, dressed in a floor length white nightgown with pink rosebuds and her toes peeking out from the ruffle on the bottom. A blue robe was clutched to her chest, eyes wide and overflowing with tears. The wife...married fifty years. Who'd watched her life mate CODED. To think she'd been waiting for the miracle.

As the charge nurse held and tried to comfort the sobbing woman, silently she cursed the new arrogant nurse.