If you died, do you want us to bring you back?

Yesterday was my first day on the trauma team at the ED. Around 8 am, we received a call that a 60-something year old man had had a witnessed cardiac arrest and the ambulance was already on its way.

We gathered in trauma bay 1 for the arrival and I started shivering. It was freezing and the adrenaline was pumping. This was my first real code. As we waited, our attending took us through different diagnoses, how the code would set up, who would do what, etc. My student partner and I looked at her with hopeful expressions. Yes! we were assigned to chest compressions.

The ambulance pulled into the bay and soon the EMT's quickly walked in and rolled the patient into the room. They weren't doing chest compressions. I blinked. I expected to see someone sitting on top of the patient, precariously balanced on the gurney, giving him frantic chest compressions and shouting, "Come on, damn it! Come back to us!!" Was the patient already gone?

We shoved the overweight white male onto the table. and it was momentary chaos. the patient wasn't all the way onto the table. no one knew how to detach the EMT's ambu bag to check his airway. the iv's were going in. chest pads were being placed. we still couldn't see the airway. then my resident yelled out,

Start chest compressions!

We formed an organized line and got to work. Someone joked that maybe tonight we would break the 96 minute record set in Minnesota where someone actually made it.

My turn was quickly up. I stepped up on the stool and put my right hand over my left with my elbows locked and started singing staying alive in my head. It was hard. Really hard. My arms and abs were burning and my calves were cramping. I had to tap out at a shameful 1 minute.

I couldn't believe I was so weak. The dummies were always so easy to resuscitate. Were my weak compressions killing the patient?

While waiting for my turn again, I hesitantly reached out and touched the patient's skin. He was warm. I was hopeful. Maybe we were breathing and pumping enough blood to keep him going.

My partner got him into VFib after the 4th cycle of CPR. We all cheered and shocked him a couple times. He went back into asystole. With each cycle, I was getting more and more confident of my chest compressive abilities. I was lasting the full 2 minutes. My compressions were fast enough and hard enough. But the patient kept getting cooler and cooler.

The patient stayed in asystole. My attending turned to all of us and asked, does anyone have any more ideas? we silently shook our heads. ..Does anyone have any objections? We shook our heads again. Time of death, 8:59 am.

The patient wasn't coming back. I snapped off my gloves. Poor guy, he probably never had a chance. He'd been popping nitrates all weekend. He had a history of congestive heart failure. He probably wouldn't have made it even if the ambulance was right there when he collapsed. But at least we did something. We didn't save him, but we tried. and I actually helped.

We left the room to get our coats and I saw a quiet older woman with a strained, pale face staring at us while we filed out. I froze. It was the coworker who had called 911. Did she know? How could she not know? She was sitting right outside.

I kept staring at her. Slow seconds passed. One of the attendings came out and bent down with a hand on her shoulder.

"I'm sorry"

She started crying. Large wailing cries of grief and denial. And I suddenly realized, this man is really dead. He's not coming back. We didn't accomplish anything. He was dead dead.

My attending took us students aside to help us sort our feelings. She was crying a little herself. We talked about the morbid excitement and feeling of accomplishment. Feeling the patient getting cooler and his face get more purple. The moment when you realize the patient wasn't coming back. The moment you realize that this patient was an actual person when you witness the grief from a friend/loved one/coworker. And then my attending took it farther and started talking about code status. She said you have to be honest.

It's not, if your heart stops, do you want us to do everything we can to help you? It's, if you die. if nature takes its course, and if you DIE. do you want us to bring you back? Don't fool yourself. The patient had been dead for 30 minutes before he arrived. He was not alive. He was not barely alive. He was dead. And we tried our best to resuscitate a dead man for another 30-40 minutes. He had been dead, and he stayed dead.

I'll never forget looking into an unresponsive face with eyes barely open that looked like he could wake up any moment. I'll never forget staring at the coworker in her chair, anxiously following our exits with denial in her eyes. I'll always remember this. Feeling like a hero. And a patient who was still dead.