Code Blue: The young ones always die.

Strictly speaking, this is non-progressive. It's another of my stories about life in our modern healthcare system.

It was 5 AM in the ER at Our Lady of Immaculate Grace. I was just documenting an early-morning nebulizer on a young lad when the radio crackled to life.

“Backwoods EMS to Our Lady.” The charge nurse yawned and wheeled her chair back to the radio. At 5 AM, it’s usually either a nursing home shift-change dump or an all-night alcoholic. Charge nurse snapped the mike on.

“Our Lady. Go ahead backwoods.” There was a moment of silence, and the radio fizzed on again. “Our Lady, this is Backwoods 5. We’re en route with, uh–” There was a moment of silence. “–A 35-year-old male, found down by his wife this morning. Found him in a pool of blood, intubated him on-scene with assist from Backwoods Fire. Thready pulse…BP is sixty over palp. We’ve got fluids going into an 18 in his left AC. We’ll be at the door in five.”

Charge Nurse and I got up and began to ready the code room: bed, ventilator, pumps, fluids, code cart cracked and waiting. Tall Doctor came in, suppressing a yawn. The sound of sirens grew louder and louder, stopping with a yelp at the backdoor. The room was quiet. Tall Doctor went and stood in the hallway outside the door and watched the medics unload the patient, the early-morning sunrise painting his labcoat blood red for a moment. I double-checked my equipment: ambu-bag full of oxygen, suction cath sucking, blood gas syringe laid out at the ready on top of the linen tray beside me. Tall Doctor gestured the medics into the room, and stepped aside to let them in. Fat Paramedic was at the head of the bed, squeezing an ambu-bag with one hand and holding an array of fluidsup in his other. Flannel Volunteer was at the side of the stretcher, pumping the mans chest with one hand and steering with the other; the trio was fleshed out by Short Medic at the end, who pushed the stretcher in and flipped a big scary grin around at everyone. The medics repeated their story as we began working on him.

“This is a 35-year-old male. He woke up and told his wife he felt funny, she went to get him a drink and came back to find him like this.” I looked at the patient. His face was covered in blood and coffee-ground emesis. He had apparently vomited out an astonishing quantity of blood: his entire torso, pajama tops severed by trauma shears, was covered in that sticky bloody residue that only the dreaded coffee-grounds can leave. His eyes were open, staring through me and looking at the ceiling. I hate it when their eyes are open.

“Wife tried to rouse him but could not, then called us in. Backwoods Fire arrived first, began CPR. He had a rhythm until about a minute before we backed in; now he’s asystole. No pulses.” Charge nurse sneered at Fat Medic.

“Thanks for telling us.”

“We were busy.”

We slid the patient onto our bed and pounced. The monitor, fortunately not one of the hand-cranked models so commonly in use at Our Lady, was placed on the patient. I squeezed the bag and felt a lot of resistance; something was down his tube. While the nurses skittered around and monitored and compressed the patients chest, I placed a suction cath down the tube. What the hell was down there that was making this so hard? Had they punctured one of his lungs during CPR? The tube wasn’t in too far; it was unlikely to be a main-stem intubation. My 5:15 brain tried to think of what it could be, when the suction catheter jumped. Dark blood began to stream up the catheter. I pulled the cath out and saw a big clot on the end of it: the obstruction! I replaced the bag, squeezed once. The doctor ordered everyone to stop.

There was still no pulse. Tall Doctor brooded for a moment.

“Continue CPR for now. Does he have a family? Where is his family?”

“Backwoods Fire was going to bring them in their command truck. They should be here by now.” Fat Medic picked up his radio and began inquiring with Backwoods Dispatch.

I bagged again, and when the bag reinflated a mass of brown blood and emesis spilled up into the ET tube and blocked the valve of the ambu-bag. Damn. I grabbed the suction cath again and sucked out a bunch more of the emesis. One of the ER nurses squeezed in next to me and slid an NG tube into his stomach, immediately pulling back several hundred CCs of bloody stuff. Tall Doctor ordered us to continue CPR for now. Murse began compressions again, and I cleared the bag and resumed breathing for the patient.

A few more minutes passed. The family arrived, and tall doctor spoke to them in the waiting room. When he returned, he looked around the room at us all.

“Does anyone have any more suggestions?”

There was a long silence. We all stared at the patient. His dead eyes were looking at me, his bloody face slack, the ET tube protruding between his bloodstained teeth. His arms hung by his sides, palms up in anatomical position for some reason. Nobody said anything. I looked at the clock. It was 5:40 in the morning.

“We can call this, then. Let’s clean him up before the family comes in….I’ll go talk to them.” Tall Doctor left the room. I disconnected the ambu-bag and threw it away; my bloody handprints were all over it. I threw away the suction equipment, put away whatever clean respiratory equipment I could, and I left.

As I walked through the waiting room I saw Tall Doctor talking to the widow. She clutched a three-year-old boy as she cried silently in the sunrise, shaking her head in disbelief. Tall Doctor was being as gentle as he could, talking her down, sitting next to her, holding one of her hands like most of our ER doctors wouldn’t do.

I drove home after change of shift and thought about it. The mans death from some sort of bleeding ulcer or GI problem was probably totally unexpected. His wife and his son were alone now. He’d been fine an hour ago, and now he was dead.

I never even knew his name.