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Pediatrics is unique in that, unlike internal medicine, codes are not a daily occurrence. What is a “code,” exactly? It’s when the patient’s heart stops beating, AKA cardiopulmonary arrest. When my first real code happened in the PICU this past week, I felt the imposter syndrome hit an all time high. The patient had already coded in the field for an unknown reason. I spent the day with that fact in the back of my minds. At 3 AM, deep in a late night hustle to finish some notes, a simple alarm when off for the patient’s monitor: ventricular tachycardia. It was a quick run that self-resolved in two seconds. Then it happened again, this time resolving as we stood up to go to the patient. The third time it didn’t stop, I looked at my senior and we ran.

From that point on everything happened in slow motion.

I remember cursing under my breath as my pager fell off my scrubs. The monitor showed the very obvious arrhythmia. We felt for pulses and there were none. I completely blanked at this point. The fatigue mixed with inexperience had rendered me useless.

I watched as the charge nurse came in and hit the “Code White” button at the head of the bed at the same time our attending appeared. He took one look at the monitor, confirmed no pulse, and delivered the shock. Even the way the patient jolted seemed to be in slow motion.

From there on out I played more of a secretarial role, pulling tubes for blood, entering orders for non-code medications, and occasionally taking a peak at the patient. Part of me was relieved that I didn’t have to make the decisions, but part of me also knew that I couldn’t, and that was so upsetting.

I’ve now taken four ACLS courses and have participated in countless “mock codes,” but real life is SO DIFFERENT. My attending that night tried to reassure me and reminded me that he had been running codes like this for 15+ years, but it was still a hard thing to admit to myself.

Like most failures and bad days in medicine, the positive that came from all of this is that it motivated me to go home after 30 hours of being awake and review those darn ACLS algorithms, again. Out of anger, out of fear, and out of necessity for the next time I’m in that situation.*

*This story is being published months after the incident to avoid the risk of any HIPPA violation.


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