when it's someone you know

I heard that you had passed out somewhere. Someone said, "everyone is running to the locker room." We opened the doors to look out into the hallway. I don't even remember how I got in there. In my mind, one minute I was looking down the hallway, the next minute I was fumbling with the crash cart, trying to get the cords that connected the defibrillator pads, grabbing an oral airway, finding the recorder sheets.

I barely look at your face. Maybe this is on purpose. At some point, though, I find myself staring at your colorful socks and clog-clag feet. Feet attired for a day of work on the unit. Your pink scrubs, the skin of your abdomen jiggling in rhythm to 100 beat per minute chest compressions. I keet remembering you telling me you were coming down with something, two days ago, during our shift together. I can still see you sitting hunched over the table back there, on your break, trying to get through a few more hours.

The first time we shock you, blood spurts out of your mouth. I watch almost detached while they drill a second IO into your other shin. I have a specific job to do, I am the recorder, and I watch the second hand go around and around the clock, repeatedly shouting out "2 minutes!" so we can stop and check for a pulse and a rhythm.

No pulse. Fine V fib. No pulse. PEA. No pulse. Asystole.

"30 seconds!" I shout. "Two minutes since the last epi!" I call out. "One more minute!" I say, over and over. I lock eyes with another nurse. She says, eyes wide, "is this really happening?" I just shake my head. You are supposed to be fine now. You are supposed to come back now, occupy one of our empty beds, let us give you VIP care. We are not supposed to keep coding you. You are supposed to come back.

Total code time, they want to know. I look back at my sheet. 45 minutes? Impossible. We haven't been coding nearly long enough. Not nearly long enough. There must be something else we can do. Epi, calcium, dextrose, I scribble furiously in a row labeled with each minute of the code. Amiodarone, bicarb, lidocaine... Time of intubation. Time of blood gas. Calcium, atropine, potassium. Vfib. PEA. Vfib.

I pull out a second recorder sheet, and then, somehow, I need to pull out a third. It feels like we just started this code. We're nowhere near giving up. I'm shocked when the doctor running the code, a SICU guy with the code pager, says, "One more round of CPR, and then we call it. Does anyone object?" No one says anything. But we all object. We don't have to say a word to object; our silence is pregnant with objection. Our eyes are alarmed. Stop? The very idea seems so absurd. You aren't back yet.

Your heart, there on the ultrasound monitor, is not moving anymore, not even the quivery motion of V fib.

Ok, he says. We'll do another round. Our fellow keeps looking at us, we keep looking at her. She keeps suggesting things. Lido drip, TPA injection, ECMO. She sees the desperation in our eyes, but slowly her look of intense focus turns to a look of pity and quiet resignation.

One more round. Last one. I am the counter, I watch the clock. Tick, tick, tick. One minute. The room has grown very quiet. That's how you know. A group of 50 doctors, nurses, and other staff in a code saying nothing, and you just know. My own voice, "30 seconds" and the soundless up and down motion of the person compressing your chest.

"15 seconds," my voice is flat, and hangs heavy in the quiet air.

"2 minutes is up."

We check a pulse. "No pulse," says someone kneeling next to you. NO PULSE I circle on the recorder sheet. "Asystole," says the doctor running the code. AYSTOLE, I write on the recorder sheet. 1818 is the time written next to it. "OK, I'm calling it," says the doctor's voice.

I slump to the floor, knees to my chest, back to you. The three code sheets in my hand, the three gas results, they slide onto the floor. I still have a duty, to get all of the names and pager numbers of everyone running the code. But I can't. I give the paper away with those final instructions. Then I stand up, and I leave. I don't look at you, but I know what you look like. Your eyes have rolled back, your skin is grey, and there are ET tube tapes tied around your head like a forlorn crown. There is watery blood on your mouth and running down your neck. It covers the floor along with the wrappers and caps and other code debris.

I cry all the way into the unit, into a back room. I cry until I feel a hand on my back. I cry until 5 more co-workers are there with me crying, too. We form a circle and hug. I walk around in a daze after that, trying to figure out what to do for the patients for whom I'm still supposed to be responsible. But the world looks different now, everything is blurred, out of focus, and not at all balanced. I want to go home and that's what I end up getting to do.

I think about the last day I had that was blurry like this, but even more so. The day they handed me my dead baby, and I thought, "You are supposed to be alive now. You are supposed to be ok." I think of skin that was the wrong color, eyes that were unseeing and rolled back, blood and more blood everywhere. I think of sad, sad doctor eyes and nurses with nothing to say. I think of death, and His presence, standing in the room. I feel His closeness again.

We think we are so comfortable with death, us ICU nurses. We think we know it, we think we can manage it. That's what we think with an air of smugness, until it comes to touch us personally, and suddenly we realize we never knew it at all. We never understood death.

And we never will.