By Terrance Ito, RN, BSN, CEN
Founder, Nurses-Forum |
Every nurse has been scarred one way or another. I too have been subjected to numerous situations that left a mark. Being a new, young, and naive nurse full of energy and I was ready to save the world. It took a trauma patient and learning a new term to set me straight.
It was 3:30 am, just another day at a community hospital trauma center. As usual the phone rang and it was fire department bringing in a 34 year old trauma victim secondary to a motor vehicle collision. The adrenaline coursed through me as I hung up the phone. The trauma team was activated and standing by at the bed side. Report revealed that she suffered massive head, neck, chest, and abdomen trauma. Paramedics placed 2 large bore IV lines. An endotracheal tube was inserted due to agonal respirations. What was most memorable wash how cold and pale she was. Her body limp, no type of movement was noticeable even with noxious stimuli. Yet, the first set of vital signs were surprisingly normal. In the following minutes x-rays and CT scan were done, labs sent, and all other necessary test and procedures completed. While hanging the O negative blood, (her hemoglobin was about 6.2) I noticed the trauma surgeon and the trauma doctor agreeing with each other. I remember looking at the trauma surgeon, his arms crossed grasping on to a few copies of x-rays with a strange look on his face. He shook his head and told me to slow code her. Huh? I didn’t learn this in school. Searching my memory banks I came up with nothing. In a state of confusion I looked at him and said, “What the hell is a slow code”? My co-worker pulled me away and was about to let me in on a dirty little secret not known to outsiders.
Slow coding a patient means that we go through the motions normally done if a full arrest situation but with an artificial effort. Hopes of revival is slim to none. Doctors will call a slow code when the patient’s outcome and the quality of life is poor. Now don’t go looking in your dictionary or medical book for this. It does not exist. Information put out on the slow code is scarce. It’s a taboo terminology. This subject matter does not leave the walls of the hospital. Slow coding a patient is rarely talked about even between co-workers. Just remember this; slow code is reserved for patients with the poorest chance of survival or quality of life. The decision of life or death is at the hands of the hospital staff.
This new term left me frustrated and angry. My only thought was how dare they play God with her life. I walked up to them and said “I‘m going to do everything possible to keep her alive.” They just smirked and nodded while retreating back to their quarters. The rest of the trauma team slowly trickled out, and my co-worker went to break. Alone in that trauma room I was convinced she can be saved. She will not die, not on my shift. For the next several hours I used every capability to keep her alive. I ran ACLS protocols till the cart was empty. I pleaded to her to keep fighting, but it was a futile effort. By the time the whole ordeal ended it was 7:10 am. All that was left was an exhausted nurse apologetically staring at a lifeless body. My co-worker looked at me as she sat back in her chair and said, “Welcome to trauma, you are now an official trauma nurse now”. I just shook my head in disgust. It was the longest night ever. Looking back with older and wiser eyes, now who was really playing God…him or me?
Original source at http://www.nurses-forum.com/article2.html
