A Pediatric Code Blue

It was the second week of my pediatric rotation. Monday mornings can yield conflicting zeal. Like my frozen car that morning, I needed time to warm up to full productivity. The day started with some good news; my septic kid from last week was going home today! It was fulfilling knowing that I contributed significantly towards his care. As I finished skimming through the charts, a nurse asked me about a newer patient. My fraud feeling was fleeting as I learned that it was a 3-day-old boy with jaundice. I had just taken care of two other jaundice babies with a similar plan the prior week. I agreed with the nurse’s plan and reiterated that I would update Dr. M. The rest of the morning went along unperturbed until…

I was rounding with Dr. M when from a distance, I heard the code blue alarm. She started with a brisk walk that graduated to a jog, then a full-on sprint down the hallway. I presumed she realized the gravity of the situation as I mirrored her mannerism along the hallway.

“Baby stopped breathing in room two.”

That room number rings a bell. Upon approaching the patient’s room, the blinding blue light illuminated the hallway. My heart was racing, my thoughts; static. I could hear a high-pitched grief-stricken cry. I assumed it was his mother. I situated myself in a corner of the room, with an unobstructed view of the organized chaos.

A couple minutes into the code, I garnered enough courage to alert the nurse that I was in line for chest compressions. I had never done compressions on a real baby before. I watched his thumb placement on the baby and tried to imitate his actions. He counted down, “3, 2, 1 switch!” It was now my turn. Baby was grey and felt clammy. I had to readjust my sliding thumbs. Mom and dad who had been crying in the hallway were accompanied into the room to be with their baby. Mom was in a state of shock; her eyes peeled back in anticipation. Dad was more expressive, his face flushed with teary eyes and a snotty nose. Both, visibly in agony. She touched her baby’s arm and cried out his name “… please don’t leave me, you cannot die ….” She looked at me and said, “please help my son.”

I held back my tears, suffocating my emotions, this was not a time to be emotional. I had to be focused with my chest compressions to her baby. “A little faster,” the respiratory therapist said. A nurse on my left-hand side murmuring, “you’re doing great keep going.” Dr. M directed, “push x units of epi.” Another nurse replied, “pushing x units of epi now.” I tried to zone out mom as I focused on counting each compression. Even though codes can be oddly calm, there were occasional silent moments in the room. I sensed most people were thinking the inevitable. My heart ached for the parents. It was unimaginable how they were feeling.

It became more evident that our efforts would prove futile. Dr. M started the dreaded conversation, her face flushed, yet, still professional and empathetic. She was a seasoned doctor, but this was still very hard for her. As she spoke to the parents, dad cried even louder, falling to his knees. Mom ceased her spiritual chants and screamed out her baby’s name. Her voice clearly echoing pain I could not even imagine. Why did this seem so cruel? Part of me wanted to carry some of her burden. As I stepped outside the room, I could not hold back the tears anymore. I was visibly crying in front of people I had only worked with for a week. The atmosphere was somber, some red eyes in between and a few quiet whispers along the hallway.

The next morning, I snoozed my alarm a few times. Sleep was not the culprit, as I felt heavy-laden with thoughts from the previous day. The shower was longer than usual, as I contemplated the thought of calling in sick. The frigid walk to the car further potentiated this feeling. Why am I doing this? I asked myself.  At work, it was clear I was not alone with this feeling. Whispers of yesterday’s event permeated the break room and nursing station. “Veteran or rookie, these situations are hard for everyone,” a nurse said. I was reassured that I was not alone with this feeling. Regardless, there were newborn babies to be examined. I had to hold a smile to mask my current mood. As I listened to the steady heartbeat of one of my patients it was like a sunray piercing through an overcast sky. Days like yesterday give greater appreciation to uneventful days like today.