The first code I ran, it was a nightmare. The patient was hypotensive because he was losing vast volumes of blood into his GI tract. I had three lines of a triple lumen running in wide open saline. I emptied the crash cart of atropine and epinephrine. 6 amps of bicarb. All in the first 10 minutes.
I turned to the unit supervisor, who looked back at me and told me, "Five more minutes, Dr IFinding." So I tried for 5 more minutes. And got nowhere. And that was that. And he was officially dead when I said he was dead. And I wrote in his chart "dead."
It's very surreal, calling a code. I say he's dead, and poof! He's dead. As if the words from my mouth have some sort of magic power. I go to talk with the family, and that's that. One time, I sat with the patient, watching each agonal breath, thinking to myself that I know that I called the code after 20 minutes. I know I gave a gallon of epi and vasopressin. I know that I couldn't get a pulse out of the patient using every trick and technique I had. But watching those agonal breaths...
It's a good reminder to me of the desperate primal urge to live. I remember a line in Crime and Punishment: "...if he had to live on some high rock, on such a narrow ledge that he'd only room to stand, and the ocean, everlasting darkness, everlasting solitude, everlasting tempest around him, if he had to remain standing on a square yard of space all his life, a thousand years, eternity, it were better to live so than to die at once! Only to live, to live and live! Life, whatever it may be!"
Sometimes, all we do is try to live. But sometimes all of nature and all our best intentions are not enough.