Post Code Management

  Why is it that after every code, the next day I feel like I have been hit by a Mac truck? I don't want to imply that I have been involved in a whole ton of codes but when you work the ICU and float to the ED on a regular basis, you see more than your average floor nurse.

  But seriously, my experience has been that the day after my whole body aches, I'm exhausted and want to do very little other than sleep. The problem is settling down, my mind goes over and over what happened, analyzing what happened and storing it away for later. What could I have done better? What was done right?  It's not like I'm beating myself up, I've come to accept the fact that when you deal with critically ill patients, it is inevitable that one will code on you. But codes are so infrequent that I have to replay the events over in my head to learn how to better execute the next one.

  That is the biggest problem with a code, if everyone is doing their job well you rarely see them, so you don't get a chance to practice for them. Back in nursing school I think we had one simulation code and it focused more on the CPR aspect, making sure we all knew how to rotate out and keep compression's at the right depth and speed. They never made us rip open a cart and look desperately for the Epinephrine while people are yelling orders at you faster than you can process. 

  How do you practice something like a code?  You can go through the motions in a simulation but honestly you can't ever replicate the feeling of helplessness that you can feel, during a real one when you watch the monitor and see that vicious rhythm that won't convert back to something life sustaining or as you have pushed what feels like your millionth Epi and you still see a heart rate of 10 bpm. How do you teach students to prepare for that? 

  How do you replicate the chaotic feeling, the rush of activity? How do you teach a student how to anticipate where the Doctor, RT and other bodies will be so that they can move deftly around the bodies constantly in motion around the patient. It's amazing sometimes to stop and think about how many people are moving so quickly and somehow no one runs into the other. How do you give a person a chance to develop this skill?

  The answer is, you can't. There is simply no way of exposing a person to the complexities of a code until they are part of one. Sure in nursing school I was able to stand in on a code once at a clinical rotation, but you are really an outsider looking in. I remember being in awe that day of the nurses, doctors and respiratory therapists. It seemed like some of coordinated chaos, where each person was part of some loosely choreographed dance, weaving around one another. Honestly I will say it was beautiful, while the tension in the air was thick enough to cut, there was a calm, assured manner about they room as each team member knew their role and carried it out. It was beautiful.

   In my short career I have been part of some ugly codes, where nothing seems to go right and I have been part of some beautiful ones where the team just clicks.  I have learned that not one code is like another, each is it's own unique entity that leaves you feeling different each time. Sometimes you feel on top of the world, other times you just want to lie down on the floor and close your eyes, sometimes there are nights when humor finds itself into the room and we laugh for some reason.  

  I am starting to learn the steps of the complicated dance, and how to move with my partners. Last night I found myself moving through the cart without a feeling of desperation, my hands falling on all the right things without having to think. I knew what was going to be needed, I anticipated what was going to happen and was prepared. Things flowed last night, people moved with purpose and when it was all over we were able to say things were good. The night went on and the team was closer that night then usual and when I left in the morning I was feeling exhaustion setting in.

  Today I ache, my body hurts all over. I'm still exhausted even after sleeping 12 hours. My mind keeps going over the events, rehearsing for the next time.