"What?"
"You know, a slow code -- so when they call you because she's going into cardiac arrest or suddenly isn't breathing anymore, you walk over there slowly. Don't worry, you'll be fine. I mean, you really can't lose either way. You save her, fine. She dies, fine. You know, it's one of those. She's going to eventually herniate out or die from an arrhythmia, and there's nothing we can do."
I was getting signout on my very last day of night float for intern year, and my co-intern had just finished telling me about this new patient. She had been cooking, cleaning, and decorating her house for days, excited beyond words that all six of her children were coming home to celebrate her 63rd birthday. She accidentally fell over some laundry five days ago and hit her head, but she swore to her husband that the giant bruise didn't hurt. She tripped a bit the next couple of days, even mixing up the date every now and then, each time joking with her husband that see, she didn't need to celebrate birthdays to know that she was getting older. Her children started arriving the day after that - her middle daughter that first night with her three kids, and her youngest son walked in the door the next morning while she was busy making chocolate chip pancakes.
She went to the bathroom to wash off her hands, when she slipped on the rug, and hit her head on the sink. Her family came running when they heard the loud thud, but she waved them off. She was fine, she kept insisting. She had a terrible headache now - who wouldn't?! - but she was fine. Really, she was fine.
"Go eat your breakfast! I'm just going to go lie down for a bit, okay?"
Those were the last words she would ever say to them.
An hour and a half later, she was unresponsive. The family called 911, and an ambulance brought her immediately to our hospital, where a CT scan showed that she had had multiple large hemorrhages in her brain. She was bleeding into her ventricles, into her brainstem, into seemingly everything, and her outlook was bleak. There was nothing neurosurgery could do for her.
But the family wanted her to be full code, full care. The family wanted a miracle. Or at the very least, they wanted to pray for one. But mainly, they wanted the entire family there before any decisions were made.
So when my co-intern told me to "slow code" her, I was surprised. I mean, I understand. I get it. There's nothing we can do for her, and let's face it, most codes aren't successful, so why waste an ICU bed on a patient who is one gag reflex away from being officially brain dead? Instead, let's help the family through the grieving process. This is for the best.
But then again, I also get it from the family's perspective. Sure, maybe it just boils down to terminology in the end. Brain death, after all, is declared after a clinical exam, and there are no alarms that go off or monitors that show neurons flat-lining. But there's something to be said about being able to say your final goodbyes, something about being able to say that you were there to hold your mom's hand as she took her last breath, regardless of whether or not she's being mechanically ventilated. And it just doesn't feel the same if you're saying goodbye to someone who was legally declared dead two days ago.
My signout was that she was a slow code. But after my co-intern left, I went to her bedside, checked her telemetry, and started giving insulin and D50 and multiple amps of bicarb and kayexalate by the bucketful. Because, her family wanted her full code and full care. They wanted a couple more days with her, and I was going to try my darnest to keep her heart going until the morning.
And so I stayed by my computer, watching labs and her rhythm strip, repleting and giving meds throughout the night.
She made it.
She made it another two days. Made it through so that her husband and all of her children were standing around her hospital bed as she was extubated.
It was Valentine's Day, and it was also her birthday.
