Chapter 5: "I Thought For Sure This One Was Going to Make It"

Those of us on the interdisciplinary team reached a breaking point on the last day of 2020.  I saw a patient die of COVID who was my age.  This impacted me so much that I used it for my Verbatim assignment, which is a part of our CPE curriculum.  I have included portions of the Verbatim below:

Context of Visit: I responded to a Code Blue during the daytime of my New Year’s Eve on-call.  The patient was in the corner room in [the COVID ICU], and was already receiving chest compressions upon my arrival.  It was obvious that end-of-life concerns were at play.

I stood at the back of a cluster (about 6) of medical staff who were talking outside the room.  One of the staff members was gowning up, but was told that they had enough help.  I was wearing my N95, and other staff members also had face shields and helmets on.  Inside the room, another cluster (about 8) of medical staff were attending to the patient.  I made eye contact with the social worker, with whom I had already connected twice earlier in the day, over two other code blues.  She was busy speaking with other staff so we just nodded at each other, but to me it felt like we already had a “shorthand” established, from my on-call experiences.  

I listened as medical staff exchanged information about how COVID was impacting other parts of the world, and how diet might factor into it.  There were comments about people surviving COVID in Northern India, and importance of Olive Oil in Italy, and also Filipino diet and culture.  

I thought to myself that medical staff have such a calm nonchalance during these emergencies sometimes, but also how each code blue is different from the next.  For example, during an earlier code on [another COVID unit], medical staff seemed more concerned and stressed. 

I could barely see the patient, but I saw on my census that he was my age (34).  Another medical person showed up and stood next to me, carrying drugs that were labeled for code blue use.  We nodded at each other.  The sound of the code blue alarm continued on the unit, drowning everything out.

At one point, the doctor left the small talk and went to the glass door, opening it a crack to tell the medical staff to stop the chest compressions, reading off numerical medical data.  He then stepped back out to join the cluster, who had all stopped talking.  The doctor said, “That’s what I hate about this disease.  It makes us feel so helpless.”  The doctor left the scene.  As the medical staff inside the room began to remove tubes from the patient and clean up inside the room, one of the staff members in the cluster outside the room immediately began to cry.  This was a staff who, during last week’s code down in CDU, had said to me, in passing, “We need spiritual care.”

I realized that I had never seen medical staff cry immediately after a code blue death.  I had seen hard situations where they were upset but also seemed numb, but this release of emotions was very new to me.  I think everyone else felt it.  Even though it was hard to tell with masks and other PPE, it did seem that others had tears in their eyes.  I felt helpless, and I also felt like an outsider bearing witness to a close-knit team.  

The social worker stepped over to hug her and rub her shoulders.  The staff person who had been gowning up earlier also went over to comfort her.  I started looking around for a box of tissue, but then noticed that staff member going over to wash her face in the sink.  

The charge nurse arrived and was shocked the patient passed.  She said, “I thought for sure this one was going to make it.  Now I have to decide who gets the bed next, who to send up here.”  Meanwhile, one of the medical staff who had come out of the room said, “I’ll call the family, since I’ve been following this one.”  I told her, “Let me know if you need chaplain to follow up with the family later.”  She continued walking over to the sink to wash.  “What’s your extension?”  “3433.”  “Okay, thank you!”

The charge nurse and the social worker continued to talk, and the rest of us continued to disperse from the code.  I noticed another medical staff starting to shed tears, the first woman who had cried right after the death went over to hug her, and together they walked into the break room.  I was touched by staff members’ ability to be there for one another because they had already been working as a team.  I couldn’t keep track of who was saying what, but I could hear a few comments all around me, “He was so young.”  “If he couldn’t make it, then what about us?”

It felt surreal, like I was watching a movie scene.  I felt helpless, because now did not seem like the time to process with staff, who were either very busy, or already comforting one another.  I walked to the other side of the unit and looked at the COVID patients who were still alive, thinking to myself honestly that I didn’t really have it in me to send a blessing to them.  Instead, I bore witness to them as they hung onto life.  I walked over to another part of the ICU, to follow up with the nurse for a patient who had survived a code blue earlier in the day.