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Saturday, March 13, 2010

A job well done is a job well done

Recently a code blue rang out over head, and the destination was OB. I swear I ran all the way from the RT Cave to OB in less than 15 seconds. And, yes, the adrenaline was flowing through my veins and I was even a bit shaky. I'm sorry, but even after 12 years on the job, this was the first time my neonatal resuscitation skills were needed.

I took over ventilations as soon as I got there while someone else did CPR. The doctor from ER showed up and immediately intubated the baby. He already had an umbilical art line in, so we we drew a gas and sent it to lab. Epi was given again and again and again. The heart came back, and then it faded, and then it came back and then it faded.

And while we held up strongly during the event, as soon as it was called several hours later the doctor slumped over the patient and said a long prayer. The rest of us stood by in utter disbelief that we had to whiteness this; in utter disbelief of what we had to do here at our small town hospital.

We prepare for this throughout the year hoping to never use these skills. We have to do special training to remind ourselves how to use these skills because we aren't a large hospital and we don't do this stuff on a regular basis. As I wrote above, this was my first in 12 years. And, except for the doctor and one nurse, it was the first neonatal code blue for all the rest of us.

Later I sat down to talk to the ER doctor who came up to help us. He said something along these lines, "When I arrived there you were bagging, another nurse was doing CPR, and every body else was just standing around. I think that you guys ought to be trained to do things better."

My jaw dropped. How could he say such a thing. Then my jaw dropped even lower when he said, "I hate having to go up to the floor at this hospital. Here I'm an ER doctor, and I have to go up and have my name put on a chart of a patient upstairs, so if there's a lawsuit my name is going to be in it."

How can you be so selfish? Is all I could think to say. Still riding on the rush, I couldn't let this slide. I had to defend my coworkers: "I think things went excellent up there. Considering that most of the people at that code never did that before, I thought things went awesome."

"Really, you thought that?"

"I have never left a code where I said to myself, 'Gee, Rick, I think everything went perfect.' I don't because there is always room for improvement. But considering the limited staff and the limited experience we have here, I think we did awesome."

Yet he continued to explain to me how there could be a lawsuit. I said, "Still, it's in your job description to help us. If there is a code blue you have to come, unless you're tied up with another more important situation. But I can't think of anything more pressing than a neonate that's not breathing. Can you?"

"Well, no," he said. Yet he spun off again on another rant about lawsuits. He's an awesome doctor, and I respect him deeply. I really do. And I understand where he's coming from. Yet sometimes it's best to do what's right now, do good charting, and worry about a lawsuit some other day.

Besides, all he did was put in the ETT and tried to save the baby's life. In fact, that's what we all did. Are we supposed to stand idly by and let a baby die because we might get sued. I don't think so.

In fact, I think we ought to make this RT Cave Rule #42:
RT Cave Rule #42: It's best to do what's right now, do good charting, and worry about a lawsuit some other day.


Steve said...

Sorry you had to experience that, and sorry that politics had to play a part in it. Codes never get any easier, but loosing a child is really tough.

Anonymous said...


That is really tough. I'm a chaplain resident right now, so I get called to a lot of situations like this. Well not a lot, but been there when more than one baby has died. I think you're right. We all do what we can do, but we all are mortal too. And you're right in that the best we can do is chart what we did in the patient's best interest, and really it makes me sick that this doctor was thinking about being sued in a moment like this. This is when I really think there is something wrong with out medical system, because I don't think anyone does their best out of fear, even doctors.