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24 Hours On Call
MON 3:47PM Senior resident Dr. Lisa
Pastel, Ryder, second-year resident Dr.
Martin Palmeri, D'Souza, and Laquer
race to a code-blue emergency—an
unconscious person somewhere in the
DHMC complex. Because Ryder is on
call, she carries the code-blue pager and
must respond, with her team, whenever
such an emergency is declared. Pastel
and Palmeri are also on the adult CPR
team, with respiratory-care providers
and others. It turns out that an elderly
outpatient had gone into cardiac arrest
during a routine diagnostic procedure.
MON 3:54PM Ryder directs the determined efforts to
revive the patient. The code team administers CPR and
medications, as well as
shocks from a defibrillator.
MON 4:16PM The patient hasn't responded, so a nurse has
gotten the woman's next-of-kin on the phone; then Ryder gets
on the line. "I'm the on-call physician," she tells the patient's
son. "I'm calling about your mother." Ryder explains what
has happened and says, gently, "The chances of her coming
back after almost half an hour are very unlikely." Ryder
then hands the phone back to the nurse and returns to the
patient. "Stop compressions. Charge. Are we clear? Let's
shock." Soon the woman's heart goes into ventricular fibrillation,
a series of rapid, irregular contractions, and eventually it
stops beating completely. "Does anyone feel uncomfortable
stopping resuscitation?" Ryder asks the team. "Stop compressions,"
she says when there's no dissent. The room falls
silent. Ryder then returns to the phone and breaks the news
to the son that his mother has died. "I'm so sorry to be talking
to you like this. I wish we weren't in this circumstance."
MON 4:35PM Pastel and Ryder are
completing paperwork as Palmeri looks
on. Pastel "was the charter" during the
code, Ryder explains. "She charted when
medications were given [and] all the
other procedures when they were
done"—such as when compressions
started and stopped, when the ECHO
machine was run, when shocks were
administered, and so on. "At the end,
all the residents have to sign off," she
adds. But handling a code entails more
than directing the medical team and processing
the paperwork. Ryder, Pastel,
and a few other members of the code
blue team also stood quietly beside the
patient during a brief memorial service
conducted by a DHMC chaplain.
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