When I decided to join the nursing profession, it was inevitable I would encounter patients in life-threatening situations. In my own mind, I have thought as to how I would handle such a situation.
Many nursing students, including myself, seek excitement during their clinical rotations. Each time a code is paged on the hospital overhead, we all turn to our instructor and say "Can I go watch?" The answer is always "no," and for good reason I'm sure. Today, I had the opportunity to be the witness as a code took place.
While caring for my own patient, "Code Blue" was paged overhead. In the SICU at Sharp Memorial Hospital, San Diego, clinicians on the floor manage the code. I stayed with my patient, as he was not in a condition to be left unattended. My preceptor ran down the hall to see whether assistance was required. After a few short minutes, he said I was welcome to watch the Code Blue.
Knowing it would be a wonderful way to learn how codes run, I walked quickly down the hall and stuck like glue to the wall, attempting to make myself invisible so I would not be in the way of the Code team.
Team in Action
Outside the door, I watched chest compressions being delivered at a rate so fast, I could not keep count. After several minutes of watching CPR and a great deal of medications being used, I began to realize the attempt to resuscitate the patient was becoming desperate.
I am well aware all last resorts are used in an effort to bring the patient back to life. It was a seamless effort, calm, collected and well orchestrated. Each member played an instrumental role: the doctors, the nurses, pharmacy and respiratory therapy all came together to achieve one common goal - to preserve the patient's life.
After several minutes, a physician stepped out. He gazed at the orchestrated room full of people playing their instruments in an effort to create one perfect harmony for the patient. I looked at the doctor and said "It's not looking good is it?" He replied "No, it's sad. She was a wonderful woman."
As I looked at the patient, it occurred to me the outcome was going to be quite poor. Her face was white, lips blue and her body flailed as the chest compressions continued. At that point a nurse had told another nurse the family wanted to come see their loved one. The nurse replied, "I don't think the doctor wants the family there." At that point, I knew what was important. It was no longer about accommodating the doctors, the nurses, nor their efforts to revive the patient. It was simply a priority to the patient and her family.
I recalled a study that assessed the presence of family during resuscitation. According to a study (Halm 2005), 94 percent to 100 percent of family members who were present during the attempted resuscitation said they would like to remain present in any future situations. Many family members present during the attempted resuscitation allowed them to feel confident everything possible had been done and allowed for an easier grieving process (Halm, 2005).
At that point I felt compelled to yell at the top of my lungs "let the family come, they want to be here!" For the first time in my life, I could not find my voice to speak. The nurse manager approached one of the physicians and said, "There are studies that show it helps the family when they are present during this process."
She then explained to the doctor she would escort in the family and explain to them everything taking place during the resuscitation attempts. Moments later, the family was allowed in the room for the final minutes of the code. A flood of emotions filled my heart. I knew then, the patient could not be saved. I also knew the nurse manager had fulfilled what may have been the most important role during those final moments - she was the patient advocate. She spoke for the patient, whose heart was no longer beating, and for the family members, whose hearts would break. Neither of the two could advocate for themselves.
In this situation, it is my belief the patient is not only the person who lies in the bed, but the family and friends who surround the room to offer comfort, concern and support. A few minutes had passed; I heard a cry from the patient's husband, and then the words "time of death." The curtains were closed and one by one, members of the Code Blue team stepped out quietly. Tears were shed, hugs given freely and encouraging words filled the hallway. I walked down the hallway quietly, in efforts to wipe my face of my own tears that rolled down my cheeks.
After taking the time to digest the evening, it occurred to me the patient and her family were much more than adequately cared for. The entire healthcare community had arrived in attempts to save a patient's life. The nurse (the advocate) had arrived to save the family from any unknown, any doubts, and any questions about the loss of the loved one. It is through this experience where I truly understand the importance of advocating for the patient and family as a whole.
Gratitude for All
I'm thankful I was able to be part of this SICU as part of my preceptorship in my fourth and final semester, and even more thankful to everyone who responded to this Code in attempts to reestablish life as it was slowly taken away, to the nurse manager, who stood her ground and was a true advocate to the patient and her family.
Thanks also to all the nurses who work so hard to advocate for their patient's wishes, their rights and their well-being. It is inspiring and humbling to become part of such a noble and wonderful profession.
Roshni Jamadar is a recent graduate of the University of Oklahoma, San Diego.