Different code colours are used to call overhead in a hospital setting, and one of them is code blue. Code blue is called when someone is in respiratory distress or experiencing a cardiac arrest (in simple terms, the heart stops). It's the most common code that gets paged overhead in hospitals. Code blue is called for any adults over the age of 18. For those under the age of 18 (or pediatrics), they would call a Code pink. Whenever I hear a Code pink get called in a delivery room, it's always sad and nerve wrecking.
Although code blues are called quite frequently, I personally believe what doesn't get discussed is the mental and physical toll it takes on the medical staff to run the code. It's almost like it's a basic requirement of anyone going into the medical field to expect a code blue to happen at anytime, to put on your big pants and just deal with it. Once it's over, you go back to what you were doing before and just carry on with your day.
What does a Code blue entail?
When the code is called overhead, there's a team of dedicated doctors/intensivists, nurses, respirologists/RTs, and security (to name a few) that will come running to the area of the emergency. As an example, someone stops breathing in the operation room so a code is called. The surgeon and OR nurses are the primary care team, where they will initiate CPR and clear the path for the code team. It is crucial that the primary team record everything that is done during this time, along with a team that rotates between giving CPR to the patient as this will be important to pass on information to the code team when they arrive.
For those who have never done CPR on a real person, it is exhausting. No matter how many plastic dummies you have to practice on during a course, the CPR on a real person takes a huge toll. If you think pressing down on a plastic dummy is tough, you will be surprised how tough it is on a real person, especially when they are of all sizes. To give good CPR, you will need to crack a few ribs. If you don't crack ribs, that means you aren't giving good enough CPR. Now, imagine doing CPR for 30-45 minutes non stop. You don't even need to go to the gym for the rest of the year.
When a code blue happens, none of us know how long it will take to bring a person back to life. It could take a few seconds. It could take 45 minutes. Sometimes an hour if not more. Every chest compression is crucial for blood circulation. The only time we stop is to check for a pulse. If no pulse, we continue with CPR. The Code team specializes in IV insertion, intubation, pushing all the necessary medications into the patient to bring them back. CPR is just the basic, yet the most crucial.
You cannot have one person doing CPR during this time. It takes an entire team to do it. You take turns every 2 minutes to rotate otherwise if the same person keeps doing chest compressions, not only will they exhaust themselves but the quality and depth of the compressions will not be good and this would decrease the chance of the patient getting enough circulation throughout the body, resulting in decrease chance of survival.
The chest compressions, the running around to grab supplies or document...these are all the physical toll it takes on the body. The mental toll? That's a whole different ball park.
Some say that doctors and nurses aren't too compassionate when it comes to codes. Because after a code, we all walk away and continue doing our jobs. I wouldn't consider myself a true veteran (I mean, it's getting towards 2 decades of hospital work), but I remember almost every code I've attended and the result of each code. I remember the patients who I've worked on, and the sadness and anger when the patients don't survive a code.
I remember coding patients who were not only older than me, but also much younger than me. I remember coding adults who had young kids, kids that would never get to see their parents again after a clinic visit. I remember the sadness from families who had to witness a code happening on their loved ones. This is also why we ask families to step aside into the waiting room, because a code isn't just a code. It's chaos. It's not something we want them to see because CPR is aggressive. Some doctors allow the families to witness the code, because sometimes the families are so adamant that they want everything done for their loved ones, even if it means CPR, intubation, and ICU care but without knowing what it all entails. When they realize how aggressive CPR is, and how much it takes the code team to revive someone, they take a step back.
You might wonder what this mental toll is all about. To put it simply, us doctors and nurses and RTs, we can spend an hour to revive someone. When the patient doesn't survive, the code team leaves, leaving the primary team to deal with the aftermath. This would include calling the family to inform them, and cleaning up the patient before family members arrive to view the body. We give our last respects before walking out of that room, and we go straight into another room, where a patient had been asking for a cup of water for the past 30 minutes, or someone who had soiled themselves in the past hour and is now crying because they're uncomfortable. We put on a half smile, apologize for the delay, and help them.
We carry on the rest of our shift, do our documentations, and probably forget to take a break. Then we go home.
There is never any time to discuss what happened, or how we felt after the code. It's almost expected that we deal with it ourselves.
Recently I returned to work, and of course I had to catch up on a lot of things that have happened in the past 2+ months. At the end of my shift one day, a patient coded. I could have left and never looked back, but a team is a team. I stayed even though I am physically not able to do chest compressions. But I did whatever I could otherwise to help the team and the patient. I may not have dealt with the physical toll this time, but the mental toll didn't hit me until I went home. During the code, you always need someone to delegate roles. I don't remember all details, but I just remember reporting the case to the EMT, the firefighters, the charge nurse in hospital, the educator, and lastly the family. In that moment, I could not say I was off for 2 months and had no idea what was going on, but I had to take control of the situation and gather information as the code happened. Convey the history and the situation to all involved. At the end of the code, I was able to finally go home. The moment I came home, that's when the adrenaline stopped and I could feel every muscle in my body ache, my head was pounding, and I was damn hungry.
The entire medical team...we are all humans. Patients and families have high expectations that we deliver the best care possible, and obviously we strive to give the best care possible. But we are also human. We have feelings. We deal with the pain, the sadness that each unsuccessful code entails. The only difference is we don't talk about it. And I believe this is what needs to change in our current system.
If you don't want staff to keep burning out, the hospital management and corporations should make it mandatory for staff involved in code blue situations to have follow ups with a psychologist, or at least have a post code discussion with the team to review what went well, and what could've been improved. I know it might be difficult to get a psychologist in, but the group discussion should at least be the bare minimum. Not only will this initiate discussion, but it can also improve the way care is provided for patients.
This is also why I am here to discuss code blues, because this is also my avenue of freedom typing (but of course not going in depth with every case). For decades, I believe we are all forced to suppress our feelings and just deal with it. But I think it's just as important to talk about it with someone, whether it be a colleague involved with the case or speaking to a psychologist for severe cases. I also think it's important to give feedback and encouragement to those directly involved in the code, because sometimes all we need to hear is a "hey, you did great today. Those were some damn good compressions" or something like "that was a great call with the AED and how fast you got it here."
To the Code Blue team, you guys are amazing and we are thankful to have you here. To the primary care team, you guys are kickass because you deal with the brunt of it all. Please don't be afraid to speak up, especially if it's affecting your mental health.
