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Making The Call

A patient codes.  Almost simultaneously, a multitude of actions are set in motion.  When the nurses and therapists at the bedside know each other well, it’s almost like a dance, everyone moving fairly gracefully around each other and the equipment flooding into the room.

Someone watches the monitor, someone makes sure there’s a line and starts one if necessary.  Others give meds, record events, defibrillate, bag the patient, do CPR.  Someone is sent out to call the doctor.

Once the dance is well established, once we are in the middle of doing everything, someone always throws out the suggestion, almost as though it were an afterthought – “someone needs to go call the family.”

During one code, I was the runner.  I didn’t have a specific job; I was just running to get supplies as needed.  After I’d run to get suction tubing, more paper to record on, this, that and the other thing, I was just watching and waiting to see if anyone needed anything else.  Although what was happening was very sad, I was admiring the dance.  Everyone there that day knew each other very well and it was especially graceful.  Which is why when the suggestion was uttered, I was the one available to do it.

Would you believe it?  After over a decade of being an ICU nurse, I had never before been the one to make The Call to the family.  Do I call and be vague?  “Hi, this is the hospital and your mom has taken a turn for the worse.  You need to come in right now.”

“Oh no!  What’s happening?  What’s going on there?  Is she okay?”

“Just come in.”

I don’t really like that approach.  The unknown, in my opinion, is often more stressful than the known, even if it’s bad news.  I think the prevailing explanation was that giving someone such awful news would result in them driving to the hospital at break-neck speed, possibly creating a higher chance of getting into an accident due to being so distracted.

I think that chance exists whether the family knows the details or not.

So I told them that their mom had taken a turn for the worse, that she stopped breathing, the nurses and doctors were trying to help her, and they needed to come in right now.

The patient was sick, but as far as I know wasn’t expected to die anytime soon.  Still, the family member I spoke with took it better than I had expected.  I’m not sure what I was expecting – for them to exclaim “Oh my God,” drop the phone and leave immediately?  Hysterical questioning?

In fact, the person I spoke with was so calm that I wasn’t sure I was conveying the gravity of the situation.

“I don’t know if she’s going to survive this.  Please come as soon as you can.”

“Okay, we’re coming.”

And thus ended the call.

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As a heart transplant recipient, that as a pre transplant patient survived over a hundred codes, I can never thank the nurses enough for saving my life all those times. (I will forever have a secret love for all nurses)

It is a dance, it’s controlled chaos to a degree. Each with a job to do and doing it well. Believe me, it’s a surreal experience to “wake up” in a room filled with WIDE EYED nurses, asking if you are “OK”!

This past spring, as I was volunteering on the heart transplant floor at my transplant clinic, I witnessed a code first hand. I was a mere 25 feet away, throughout the event & they finally regained the patient’s rhythm. It was the first time I saw a code from that vantage point. It wasn’t television, it was truly scary! I cried like a school girl for an hour afterwards.

Thank you for saving lives. You DO make a difference!

DAP @ My2ndHeartBeat

Yeah, that’s one thing nobody ever taught US in school and that no one has covered with me at work in a nursing home, during my orientation (which is still ongoing). I had a patient who was obtunded and responded only to touch – vaguely. His daughter was freaking out, Oh my God, I’ve never seen him so out of it, what’s wrong with it, is he gonna make it? Man… How do you prepare for such an exchange? I just remained vague and evasive and I hated it.

Don’t be discouraged Ernie. As your experience grows, you will learn what works and what doesn’t. Those are the lessons you never forget. When a patient’s condition starts to decline, the nurse always finds herself in a delicate situation. Keeping the family honestly informed, always is the best policy.

Thank you for writing this article. I have been, AM the family and you are absolutelely right, the worst is not knowing. My mum has cancer of the meninges (the fluid sac around the brain and spinal chord) and the drugs she was taking caused her to suffer severe sodium deficiency which was REALLY scary since she was out of it for about 4 days. Doctors only gave us vague resopnses about what was happening, and only much later did we find out that they hadn’t thought she would make it through the weekend.

As someone all too familiar with hospitals and nurses, but not actually a nurse myself, I really enjoy your blog posts, since it gives me a peek into the other side.

Thank you for the good writeup. It in truth used to be a entertainment account it. Glance complex to far introduced agreeable from you! However, how can we be in contact?

As an ICU nurse, I have had to make this call also. It isn’t easy. The best practice I have developed is to tell the family the patient isn’t doing well and needs to come immediately. If they ask questions be honest. Honest is the best policy. Think of it like this, if that was your loved one wouldn’t you want the truth.

Wow. Great blog! I work in ICU now, but started out on a med-surg floor. My first pt to “take a turn for the worst” was a DNR. I called the family when I noticed he was not responding to me as he did the day before. I said, “There has been a change in his condition. It doesn’t look good.” The family said, “OK.” He passed away several hours later with no one at his bedside except me, holding his hand. I called to let them know he passed away and the only response I got was, “we will just see him at the funeral.” It still breaks my heart to think about that…

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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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