Its 5:45 am. I am already awake, waiting for the alarm to go off. I tend to wake up every few hours to check the time, when I am nervous. It’s my first day back to the ICU after a 10-week hiatus, following knee surgery. I am not as far along in my recovery, as I had expected, and I am worried about my ability to meet the physical demands of an ICU shift.
I make sure to wear my leg brace. My quads are still weak and I did not trust them to hold me upright. I am still walking with a cane. I am conscious about how that will be perceived at work.
I drive to work as usual, enjoying the sunrise in the rearview mirror. PNW sunrises are truly spectacular, and the ice-covered mountains framed in the pink, orange and yellow hues, never fail to take my breath away. It reminds me of the vastness outside my life.
I park in the covered lot that is reserved for clinic docs. I had asked for permission to park there since it was closer to the hospital. My knee is stiff as I scoot out of the drivers’ seat. I need to hold onto the car door for balance. I gingerly walk to the passenger side to retrieve my cane and lunch bag.
It’s a long walk to the hospital. Usually I enjoy the serenity of the rose garden and fountain, but not today. My eyes are intent on the ground, since I don’t want to trip and fall over a pebble or crack in the concrete walkway. One step at a time, aware of my muscles, the cane supporting my body weight; my knee has decided it’s not in the mood to support me this early in the morning.
It’s a juggling act as I scramble to find my badge to scan at the entrance whilst holding the cane in one hand and my lunch bag in the other. I am hyper-aware of the other employees behind me, I don’t want to delay them.
I make my way through the check in counter, without stopping, my badge allowing me to walk right in. I am still intent on the ground as I slowly limp my way to the elevators’. I am the only one in the elevator and I am relieved. I make my way down a long corridor to the office where I will get sign out from my colleague.
The office is locked since I am early. I let myself in and arrange my cane and bag onto the side table and start cleaning all the surfaces with disinfecting wipes. My colleague arrives and she asks about my recovery. I don’t let her see how apprehensive I feel today.
As we finish sign out, she leaves, I settle into the chair and take a deep breath. I plan on 10 minutes of physical therapy exercises to get ready for rounds. I am 5 minutes into my routine when I hear —-CODE BLUE ROOM 701 —- my heart rate shoots up 10 points, I feel my face flush —- I can’t believe it! I scramble to reach for my cane and stand up as quickly as I can. My knee wobbles and I take a few seconds to steady myself. I limp my way out of the office and make the long walk to the elevator as quickly as I am able. The 5 minutes of PT has helped and my leg feels more stable. I make my way to Room 701. I place my cane at the nurses desk outside the room.
The primary hospitalist is already there. She gives me a detailed run down of the patients’ history. He has been in the hospital for 2 weeks battling a perforated viscus which has since been repaired, complicated with intraabdominal abscesses and multiple drains. He had acutely decompensated early this morning and is in respiratory distress. He is on BIPAP and clearly encephalopathic. He is able to follow a few simple commands, but suddenly slumps forward and has no pulse on palpation. He still has an organized heart rhythm on the monitor. The ED doc arrives, and I ask him to intubate the patient. I run the code. I direct a PTCA to start CPR. We work on the patient for about 20 minutes. His wife is called and is on her way. She is a senior RN who works on a different floor, so I didn’t know her personally.
When she arrives we have return of spontaneous circulation. I take stock of the situation and decide to get a CT scan to rule out a pulmonary embolism and re-evaluate the intra-abdominal abscesses. It has been around 40 minutes and I have forgotten about my knee. As the adrenaline surge subsides, I feel the dull throbbing reminding me to slow down….it is only 8 am.
I accompany the patient and his nurses to the CT scanner. This is another long walk down to the 1st floor. Then from there to the 2nd floor ICU where the patient will receive his post code care. I place some urgent orders for labs, pressors and fluids into the electronic medical record at bedside.
I then walk back to the office. I remember my cane. I have left it on the 7th floor. I will have to go back to retrieve it. I need to sit down for a few minutes to rest my leg before I can do that. I take that time to do chart review, learning as much as I can about the CODE BLUE patient. I review the CT images. There is no PE, but the abdomen looks awful. I suspect more intraabdominal abscesses hence the sepsis with acute decompensation. The radiologist calls me to confirm my reading.
I walk back to the ICU and inform the patients wife of the CT findings. She understands how grim things are. She has been on a roller coaster ride for the last month and is all but too aware that the ride ends here. She make her husband a DNR, with tears in her eyes. She asks for time to gather family.
I walk up to the 7th floor to retrieve my cane. I have patients that I have not seen yet in the 5th floor ICU. I make my way there. I am slow, I am steady. I am an ICU doc. My pager beeps. The CODE BLUE patients’ family have arrived. They are ready to make him comfort care. It is 10 am.