A variation of this was published in a peer reviewed medical journal. Another walk down memory lane. My first emergency medicine journal publication, and my last publication of the end of medical school.
The paramedic’s bullet was short and to the point. “40 something year old woman. Found down, possibly after a fall. Unresponsive in the field. Bradycardic to the 40s. Protecting her airway initially, but now desating to the 80s. Barely got an IV.”
As a fourth year med student who had seen a bunch of codes, I still felt a frisson of excitement when codes came through the door. After all codes for me represented Emergency Medicine- no information, a deathly sick patient, lots of adrenalin and a healthy dose of fear.
I stood by my resident’s side as she induced and intubated the patient. As the pearly whites of her vocal cords came into view and I saw the tube go through it, we all released the breath we had subconsciously been holding. A dose of Atropine raised her heart rate and she seemed to stabilize. I walked to the door of her room pulling off my gloves as I went- I had patients to see after all.
As I pulled off the gloves, alarms began to sound. Her heart rate was beginning to drop again. My resident met my eyes, and said just one word- “Compressions.” Within seconds of her having given the order, I was at it. I had done compressions on dozens of people- and each time I did, I recalled my BLS instructor teaching us to compress to the beat of Stayin’ Alive, since the song had a beat of 100 a minute. He said it also worked with Another One Bites the Dust- a connection that was too morbid for me at the time.
So as Stayin’ Alive played in my brain, I pushed down on her breastbone, hard and fast, and I felt something pop beneath my crossed hands. I was breaking her ribs as I compressed her chest in a violent, last ditch attempt to beat her heart for her. Each time I broke ribs I found myself pausing for a moment- pausing to apologize and acknowledge the violence I was inflicting. Then, I remembered that if I didn’t do it my patient would never hear any apologies again. So I fell into my terrible cadence, in my own little world with Stayin’ Alive for a soundtrack curiously disconnected from my humanity and the sadness of the situation.
Around me there was a blur of motion. The nurses were drawing up and giving med after med. My resident was splashing betadine on the woman’s chest right next to my hands and blindly trying for a subclavian line. I momentarily felt a stab of fear as she stabbed the patient in her chest millimeters from my crossed hands, but I made sure my compresisons never faltered. The patient’s one tenuous IV blew, and suddenly there were people all around me with needles stabbing away. And through it all I was humming “Staying Alive” under my breath. Each time I lifted and dropped my shoulders, about 100 times a minute, I saw her chest lift off and drop back onto the bed, her breasts, exposed to the world, flop up and down, her head jerk up and down, and her arms lift and fall just a little. For a second her movements gave her the illusion of life- an illusion I was creating. I knew the statistics, knew that more than likely she wouldn’t survive- but as I compressed I hoped. Sweat was running down my arms as I worked, landing on her chest and mixing with her blood as I kept to my terrible cadence.
Around me the needles were ineffective. Nothing was working. The nurses, who almost never miss, were cursing in frustration as they got a line only to have it blow a second later. My resident and two attending physicians were trying to get central lines, and from their lips too came soft curses.
As my arms began to tire, one of the nurses switched with me. Her light svelte frame was perched precariously on her toes as she began the same cadence trying to beat this woman’s heart for her. It seemed like seconds later that I was switching back with the nurse. As she did her final compressions and switched with me I heard the strains of “Stayin’ Alive” fading away softly under her breath.
We worked for what seemed an eternity. My arms pushed of their own accord. Thirty minutes after we began, my attending called it. “Time of death, 1040”. I walked out of the room yet again pulling off gloves- this time slick with blood. Having gotten sufficiently desensitized after dozens of unsuccessful codes, I walked out with a sigh and a stab of sadness at the life lost. In a few months I would be an intern, and a year or two after that I’d be expected to run a code. But for the here and now I was just a medical student, and my only job was to learn. So I learned from my patient, the woman who had died. I learned yet again that I couldn’t always save my patients.
There was a chart on the rack to be seen, and I walked to the room. As I walked into the room, trying to leave my previous patient and the violence I had inflicted upon her behind me, I smiled at the next patient with Stayin’ Alive still playing in my mind. All I could hope was that perhaps this patient would.