CPR

What’s a skill you consider basic, that most people don’t actually know how to do?

Alarms scream. I feel my heart beat in my ears. My lungs are screaming. My back, my triceps, and my wrists ache.

I stand over the body of a dead man, surrounded by controlled chaos. Nurses are starting IV’s, my partner is putting the patient on the monitor, physicians are prepping the airway for intubation.

Complex tasks for the well educated members of my team.

I’m a grunt. The manual labor. The muscle. I’m on my own mission.

One. Two. Three. Four. Five. Six. Seven..

Counting compressions looks easy on TV. But in reality, it’s a full body workout to keep the chest pumping. His is slick with mucus, saliva, and vomit. Looks like eggs for breakfast.

Try not to get distracted. Try not to slip.

My eyes lock in on the Defib monitor. One of the nurses preps to place Defib pads on the man’s chest. I count down, lift my palms for a split second, and resume compressions with hardly a beat missed.

The pads are placed.

The monitor starts to give me feedback.

“Good compressions,” it tells me. I appreciate the visual feedback it gives me more than the auditory. I dial in my compression rate using the heart rate metrics. Preferred heart rate on an adult cardiac arrest patient is 100-120 bpm.

I’m usually at the higher end of that range.

I stabilize my rhythm at 115-120 bpm. It’s hard going. It’s important to get good depth and more importantly, good recoil. Recoil allows the chambers of the heart to refill with fresh blood. I pride myself on my technique. A strong downward press, a full rise, my palm lifting from the chest leaving my fingers only to index and ensure perfect aim on the next compression.

I sink into the calmness of the rhythm. My focus narrows down to only the important details.

Without this measure, nothing else matters. I am the beating heart of the patient. I circulate blood, oxygen, and medication to the patient.

Maybe I am hope. Maybe I’m just arrogant.

My attending orders a “compression hold” for a difficult intubation. The residents aren’t paying attention. My hands hover over the patients chest. I’m being told to resume compressions by three or four different voices, but there’s hierarchy at work here. I follow the orders of two people in this room: my attending, and the nurse running the code.

Sweat pours down my face, my neck, my arms. I feel my forearms tremble for a moment.

“Resume compressions.” The race is back on. Had I resumed compressions at the behest of the residents, I might have spoiled the whole procedure, and cost the patient a precious airway.

The next pause is for a pulse check. Ten seconds. I float over the patients chest as free hands feel wrist, neck, groin, and foot for a pulse. My attending checks the monitor. I pray for good news.

Anyone can do CPR. Doing it well, on the other hand, is entirely different. Knowing the technique, understanding the sensations, and then adjusting to the changing scenario around you are all part of the rhythm.

Most are unprepared for the grueling work. A CPR dummy just can’t prepare you for the tactile, physical, and emotional nature of a code.

It’s not criticism to say that most people can’t do CPR well. In fact, I don’t want people to reach a point where they are good at it. My skill level comes from experience, and unfortunately, this is a case where experience is measured in corpses.

Because the most prominent part of getting good at CPR, is losing. Once CPR starts, there’s an almost 90% chance the patient dies. My best work hasn’t done anything to nudge that statistic in a happier direction.

I look down at dull, voided eyes. Two light grey irises stare back. The body that lays before me is empty now.

I feel empty too.

Sometimes I see them staring back at me in my sleep. The ones we couldn’t save. The ones that never stood a chance. I hear the screams of family members in the halls.

Sometimes, the blood runs over the edge of the bed and spatters on the floor.

Always, the room looks like a tornado came through.

My work phone rings. No time to contemplate. No time to grieve the loss of a once living person.

It’s time to work.