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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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