The cellphone clock face displays 5:45am. I lie in bed, lingering, procrastinating, waiting for the alarm to buzz. Sleep is fitful when I am edgy. It is my first day, returning to the ICU, after a ten- week hiatus enforced by knee surgery. My recovery has not followed the predicted course. Consequently, I am apprehensive about my ability to fulfil the physical demands of an intensive care unit shift.
I secure the bulky leg brace. My quads have atrophied, and the neural-motor pathways are fractured, seemingly beyond repair. I lack confidence in my innate ability to stand and ambulate without assist. I rely wholly on my cane. I am wary about the perception of my disability at work.
I behold the sunrise in the rearview mirror. Pacific Northwest sunrises are magnificent. The snow-covered mountains, edged with pink, orange, sepia hues of the ascending sun, enthrall my senses. It is a stark reminder of the insignificance of my being.
I park in the covered lot that is reserved for hospital employees. My knee is stiff as I transfer my weight from cane to leg. I need to prop against the car door, not only for balance but to brace against the pain. I flex and extend my leg a few times, willing the joint into fluid mobility.
The walk to the hospital appears unattainable. Normally, I would appreciate the serenity of the rose garden, in blatant contrast to the angst and suffering of the intensive care unit. Today, however, my eyes are intent on the ground, vigilant, so as not to stumble over a random pebble on the concrete walkway. One step at a time, aware of muscles, joints, nerves, my unconscious mind orchestrating multiple pathways that govern movement, the cane supporting my body weight.
I struggle to scan my badge at the entrance, whilst grasping the cane, looping my lunch bag over my shoulder. I am cognizant of other employees waiting behind me, I do not want to delay their entry.
I make my way through the check-in counter, the badge allowing unrestricted entry. I am still intent on the ground as I ponderously limp my way to the elevator. I am relieved to be the sole occupant. The door to my office is locked. I let myself in and arrange the cane and bag onto the side table. Next, I start the ritual sanitizing of the workspace with disinfecting wipes. My colleague arrives and inquires after my recovery. I hide my apprehension, I feel uncertain, unconfident, insecure.
After we finish sign out, I take a deep breath. I plan on ten minutes of physical therapy exercises to prepare for rounds. Halfway through my routine, the overhead speaker announces, ‘CODE BLUE ROOM 701’! My face flushes. Instinct kicks in, as I scramble for the cane. My knee buckles and it takes a few seconds to steady. My limp is exaggerated as I hurry out of the office, to traverse an immense corridor leading to the elevator. The exercises have helped, I feel somewhat stable. I make my way to Room 701. I conceal the cane at the nurses’ desk, before entering the room.
The primary hospitalist has arrived. She gives me a detailed run down of the patient’s history. He has been in the hospital for two weeks, battling a perforated viscus which has been repaired, complicated with multiple intra-abdominal abscesses’ that have needed additional external drain placement. He has acutely decompensated and is in respiratory distress. He is confused, grunting, struggling to breath. He abruptly slumps forward, and I discover he has no pulse. He has an organized heart rhythm on the vitals monitor. I give instructions to the staff, as I simultaneously place a breathing tube in his airway to relieve his distress. I direct the rhythm of CPR and medications like epinephrine to be administered intravenously. We work on the patient for about twenty minutes. His wife has been called by staff and is on her way.
By the time she arrives, we have return of spontaneous circulation. I decide to obtain a CT scan to rule out a pulmonary embolism and re-evaluate the intraabdominal infection. It has been approximately forty minutes and I have forgotten about my knee in the organized chaos of the code. As the adrenaline surge subsides, I feel the familiar sharp throbbing in my knee, reminding me to slow down.
I accompany the patient and his nurses to the CT scanner. This involves another long trek down to the first floor. After the scan, we clamber to the second-floor intensive care unit where the patient will receive further care. I place urgent orders for labs, pressors, fluids and antibiotics into the electronic medical record.
I remember my cane. It has been forgotten on the seventh floor. It will need to be retrieved. I need to rest for a few minutes before I am able do that. I utilize this time to review the patient’s chart, reading about his hospital stay. I review the CT images that have popped up on the electronic medical record. There are no pulmonary emboli, but the abdomen looks grotesque, it is hard to spot normal anatomy. I suspect his acute decompensation is due to sepsis resulting from worsening intra-abdominal infection. The radiologist calls to confirm my interpretation.
I stumble back to the intensive care unit and inform the patients wife of the CT findings. She grapples with the grim prognosis. She has been on a roller coaster ride for weeks. She is acutely aware that this ride is nearing its tragic conclusion. She affirms a ‘do not resuscitate’ order, with tears clouding her vision. She requests time to gather family.
I walk up to the seventh floor to retrieve the cane. I have many patients that I have not yet rounded on. I make my way back to the second floor. My steps are measured and balanced. My pager beeps. The CODE BLUE patient’s family have arrived. They are ready to transition him to comfort care measures.
published in Doximiy-Op-Med-April 2021