Code of Honor

Today was one of those days. It was a day where anything could have gone wrong and it somehow ended up being incredibly efficient. K and I were the only nurses on the floor today and we turned over the ward twice. We had our first "same day surgery" patient. Not only did we conduct efficient and amazingly thorough patient care involving a lot of patient handouts and teaching, we worked on standardizing our paper charts and I'm currently writing a policy on it. We also completed chart audits, ordered clothes from our clothing ordering system, and cleaned up the ward. However, none of this is what this blog is about....



Today while our same-day patient was in surgery, K called the EMT because we heard a helicopter flyover, land, and stay there. We had heard a patient was being flown in with an Myocardial Infarction (heart attack). He had been found slumped at his desk, was coded and resuscitated twice at his station of origin for ventricular fibrillation, and had been flown to us in stable condition. Dr. S, our cardiologist, said he felt one coming just yesterday, that he sensed one. A few months ago, I wrote that I knew I would see my first code and my first death on this deployment. None of us knew that today was that day. K got off the phone with EMT and said "they're coding him right now, let's go". We were lucky the MCU was empty at the time, so we both ran to EMT and came in the back door not knowing what we were going to see or do to help.

People always tell you it's a zoo during a code. Everyone is standing around and there are a million people surrounding the bedside. Like I was taught in ACLS, it was easy to identify the code team. Dr. S was the leader, MAJ M was the medicine nurse, there was an IV starter, Anesthesia had him intubated and was bagging him at the head of the bed, multiple people were rotating out chest compressions, someone was at the crash cart, and there was a recorder at the foot of the bed. Lab and Pharmacy were running back and forth with additional runners being sent when needed. K and I stood to the side ready, if necessary, to take over chest compressions for someone if they were tired. Sometimes you just have to know when not to try to help and wait for instruction.

He was in a rhythm called pulseless electrical activity. The monitor was showing that he was in ventricular fibrillation but in reality, he had no pulse. Medications like epinephrine, amidoarone, atropine, and magnesium sulfate were being administered rapidly through a femoral line and there was no response. They began pushing anything they could think of in the cardiac arrest indexes to try to get any response. He was shocked multiple times and finally he went into complete asystole. Chest compressions where always resumed immediately to give any treatment time to take effect while maintaining the pumping motion in effort to deliver blood to the brain and the rest of the body. After 40 minutes of cardiac arrest, 10 of which were in the air, all intervention was stopped. They looked for rhythm from different leads measuring electrical activity on different planes of the heart and felt for pulses. Anesthesia was listening for sounds with a stethoscope. After 40 minutes of cardiac resuscitation effort, they called it. The soldier was dead. An Echo or ultrasound (i think) was performed at the bedside by Dr. S that confirmed there was no electrical activity in the heart. The curtain around the bedside was pulled and the mortuary affairs team began to tend to the soldier. There was a chaplain who flew with the patient here and was standing at the bedside the whole code. He said to me, "he's one of my guys." with tears in his eyes. You realize that even though a soldier might be away from their spouse, children, parents, and siblings, they have a family here in the combat zone that has been standing by their side, eating with them, showering with them, even peeing with them, and suddenly their gone. The grief affects that family and it can't be devalued as anything less than love.

K and I had a patient come out of the OR immediately, they knew we were in the code and were actually waiting on us for a few minutes, so there was no time to processes it. We jumped right back into our busy day. Our head nurse had heard that we went to the EMT to help from the head nurse of the EMT, so she came in to let us know that there was to be a ceremony right around shift change. Some of the other MCU staff memebers had come in to grab some stuff not knowing what had happened today and agreed to cover the floor while we attended the ceremony.

There were may people who came to send this soldier home. The sidewalk from the EMT to the helipad was lined with soldiers from our CSH and from this soldiers unit stationed on our base. For a brief moment I was standing At Ease across from another McCullough. How strange. We spread out and at the command came to the position of attention. The soldiers transport team walked up the aisle to greet the litter team and together they went from the EMT to the helipad. This soldier will be personally escorted all the way home. As the team came by with the soldier in a black bag on a rickshaw, everyone presented arms (salute) and held it until the soldier was on the chopper and the litter team had returned. Faintly, you could hear a trumpet playing from a room across the street. Whether it was intentional or not, it was only noticeable if you were listening...