September 17, 2003
Code

This week I've been serving as the "Night Float" for the Cardiothoracic service, meaning the interns during the day hand their patients off to me at 1730, I tuck them in and take care of any issues that may crop up overnight, as well as attend to any work that couldn't be finished during the day.

Unfortunately I lost a patient the other night. We still are trying to piece together why. His family dealt with it with as much aplomb as you could imagine, but declined an autopsy, meaning that we'll never have a definitive explanation of what happened. I've made clear to the upper levels that I am completely open to any advice on things that I omitted to do, or should have done better; but overall, I think we ordered the appropriate tests, and made the appropriate moves. In retrospect, (and the attending physician called me directly the morning after to discuss this--a slightly nerve-wracking experience), it would have been better to have transferred the patient to the intensive care unit.

The patient likely would have coded there as well, but these are the places to be if something like this is going to happen.

The problem is that while he was foremost in my mind among the patients I was covering, I didn't see him as being so precipitously unstable. His family also notes that he seemed fine all the way up to the moment that he became unresponsive. Interestingly, the nurses tell me afterward that the family would have rather have let him go quietly rather than calling a code.

I get heartburn less than once a year, but had to guzzle a quarter of a bottle of Maalox to prevent my stomach from auto-digesting the rest of the evening. The nurses sympathetically minimized calls the rest of the night.

Posted by erich at September 17, 2003 02:05 PM
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