How Soon is Now?

I’m standing on the stage of MTV’s Video Music Awards, handing an award to Green Day for being the Most Boring Pop Band of All Time when my code blue pager goes off, waking me from my enjoyable dream to find myself in the ninth floor call room.

I throw on my shoes, grab my lab coat, and run up the three flights of stairs to the twelfth floor, where the code blue is occurring.

When I get into the room, there are a group of nurses and nursing assistants crowded around a young man wearing a nonrebreather mask gasping for breath.

The nurse tells me the man has AIDS—freshly diagnosed—and PCP, a vicious form of pneumonia. He had been complaining of worsening shortness of breath that evening, and she walked in and found him laying half-off the bed.

As she speaks, I survey the available information. The patient is still conscious, though in severe distress, with the skin behind his clavicles tenting inward when he inhales, neck veins bulging. His skin is wet. He has a peripheral I.V. in his right arm. Standing at the foot of his bed, I touch his foot—which is cold—and feel a strong pulse. The pulse Ox monitor is attached. It should read above 95% in someone healthy, 87% in a severely debilitated person. His is reading 72%. I see the respiratory therapist preparing the Ambu Bag.

I have been in the room approximately 20 seconds when the patient begins to seize.

The surgery intern walks into the room.

‘This is not a code,’ the surgery intern barks. ‘This man is just having a seizure.’

Everyone ignores him, instead the nurse prepares the five milligrams of diazepam I order.

‘This is not a code,’ the surgery intern tells the emergency department team as they enter the room.

‘Mike, glad to see you,’ I say to the Emergency senior, again ignoring the surgeon. ‘Can you secure his airway?’

‘Got it,’ Al says and moves to the head of the bed.

The nurse pushes the diazepam through the peripheral in his arm and the seizure starts to subside. The respiratory therapist is Ambu Bagging the patient and his pulse ox now reads 93%.

‘What are we doing?’ The surgery intern continues to bark, ‘This man is not coding.’

‘Can someone please give this surgeon a triple lumen kit?’ I ask.

The nurse already has the kit ready and hands it to him. Another nurse prepares the 20 of etomidate that I’ve requested for the intubation.

‘He has access in his arm,’ the surgery intern says.

‘Your role here,’ I tell him, ‘is to secure venous access. What size gloves do you wear?’

The surgeon asks the nurse for size 8 gloves and begins working on access.

Mike gets the airway. The surgeon gets vascular access. We have stabilized the patient.



Outside, I pull the surgery intern aside.

‘At this institution,’ I tell him, ‘we ask the nurses to call a code before the patient’s heart actually stops. Once a code is called, your role is to establish secure access so the nurse can give any medications I think are necessary. A 22 gauge in his forearm is not what most of us would call secure. If you are not willing to secure central access, give the code pager to a surgeon who is.’

I have said this quietly in the nurses’ station, but the ICU nurse is there with the Code Log, asking me to sign it and has overheard my comments.


A bit later, the nurse and I are moving the patient into the ICU.

‘Dr. Erik,’ She says, causing me to look sideways at her, because she doesn’t usually refer to me with the mixed formality of my title with my first name. ‘Don’t take this the wrong way, but you really need to get laid.’