Code Blue, a heartless situation

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JasonBerry

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I've been working at my local hospital as an attendant (or perhaps also called orderly) for about two and a half years now. I basically roam around the hospital and do miscellaneous things, but two of our main responsiblities are picking up the dead bodies off the floor to the morgue and performing chest compressions during the codes. I mention the former, because at no point has dead people given me nightmares or freaked me out in any form or fashion.

Moving on to my point...

When I go to codes, the way people act is just terrible. People almost ALWAYS crack jokes, make funny faces when something "gross" is present on the person's body, watch television, poke at the in inappropriate ways, make absurdly rude comments at the obese, etc etc. It's also not uncommon for people to mention they're getting bored/hungry and wish the process would speed itself up.

I consider myself an extremely serious minded person with little to no sense of humor, so maybe that's why this all doesn't sit well with me. I just keep thinking that this is a human being, despite the situation and we should be treating them with some sort of professional respect. I'd just like some insight to how this sounds to someone who's never seen such a thing and especially from those who have seen it way too many times.

When I've had conversations in the past with members of the hospital typically these are the things I hear:

-This is people's way to cope with the mental stress of another human being dying.
-Seeing too many "slow code" situations and/or instances where you want the person to die (physician was unable to convince the family/patient to elect DNR status) makes a person increasingly desensitized.
-If you have fun with it, you'll do a better job. (bull****)

---

My apologies if this has been discussed earlier. I've been reading this forum for quite some time and have yet to see anything like this brought up. Not a troll post I swear =).
 
I think that some of that stuff is a bit inappropriate, but you have to remember that to a lot of people (including some physicians I would imagine), their just doing a job. It would be no different if they were working at McDonald's and cracking jokes. Obviously you would hope that there would be some sort of reverence since they're dealing with people, but this isn't always the case.

You also have to remember that for the people on staff, this is more than likely their 100th or 200th or 300th patient they've seen today. To them, this isn't new. It's just a normal occurrence and it's just another patient. There's nothing special about this person on the table and the person that died 30 minutes ago. Their just strangers.

I think it's wrong, but it's also understandable.
 
I too am having trouble coping witht he way some patients are treated by health cre personal. I have tried to empathize with these healthcare professionals and understand their dark humor, but honestly I really can't. Once I do become a physician I can't see myself making such comments int he face of sucha grave situation.

Also I have coem to learn that the personalities of the healt care personell are definitly variable depending on which hospital you are in.
 
JasonBerry said:
-If you have fun with it, you'll do a better job. (bull****)
Click to expand...

Codes are fun. And you actually do a much better job at them if you are relaxed, pleasant, and use a little humor to lighten the mood a little. The humor also depends on the seriousness of the situation: 79-year-old found blue and glassy-eyed wedged between the wall and the toilet (where the elderly often go to die)? Inherently humorous as you try to reanimate a corpse.

"How long are we going to code her, Doctor Melanoleuca?"

"Until rigor sets in our her grandchildren graduate college."

Six-year-old respiratory arrest? Not so much.
 
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Depakote said:
Dark humor is sometimes the only way to handle the absolutely horrible that you see in a hospital on a daily basis. It's a good coping mechanism.

Why so serious?
Click to expand...


This is completely right, humor is a coping mechanisms. I suggest you go take humor classes so you can go find a sense of humor, very nice!
 
Did you know that the optimal rate for chest compressions is to the beat of "Stayin Alive"? No joke.

But seriously... while some jokes I've heard may border on the in appropriate, I'd rather have a doctor that's able to keep his head during situations like that than have one that's burnt out because he treats every patient like his first born.
 
I began volunteering in EMS at 15 and have been doing it ever since. You can imagine I have seen my share of codes and death. I can certainly understand how it seems for an outsider looking in when they witness that behavior. Honestly, I am probably guilty of it sometimes as well, however, I like to think I do a better job of being more discreet and much more professional when I am around people who aren't my crew.

As for the reason why we do this, I would have to say its a way to decompress, stay relaxed, and remain human. It is unfortunate that this is often the way, but it is the reality of medicine. This is the way some health care providers cope with job stress.

I don't think your reaction is wrong at all. I believe you are quite justified. However, you probably have never been wrongly accused for "killing" someone who died because there was really nothing more that can be done. You probably have only witnessed a handful of traumatic situations from the outside, but may have never been a PART of them. This can be very stressful and your body/mind tends to react in an unpredictable way to cope.

My advice: strive to cope better, but try not to be too surprised when you find yourself talking about "a great case" in 10 years that may have resulted in someones death.
 
I hate to say it this way, but wait until (or if) you become a physician that has to do this on a regular basis (I say the if because some physicians don't deal with codes very often if ever). EMS is full of what most people would call inappropriate jokes. When you first start out you probably will be disgusted with it, but most likely if you're around it long enough you'll join in. It's not that you want to disrespect them or anything, it's just a coping mechanism. Humor, in my observation, is one of the most common coping mechanisms. You may even find that these people act one way at work and another at home. I've seen partners who crack all kinds of bad jokes on scene (when family/friends are not there of course), but when we get back to the station and it's just the two of us it's completely different and they're much more serious.
 
Humor is not a coping mechanism. Some things are just funny.
 
melanoleuca, yeah I guess I can understand what you're saying. Personally, I just try always to do the best job I can and use that as my motivation. Other people might try and have fun with it. If they produce the same result there's really no difference.

BigD311, I've easily coded 200 or more people while working here, and chest compressions are quite the workout if you've ever done them. If you don't know the person personally it isn't necessarily that stressful. Conversely, when you're walking down the hall and 3 people are screaming and praying to god for a good outcome you're often reminded that this is someone's brother, father, or son. Taking death seriously doesn't necessarily entail going home and drinking about it. I just sorta hoped that people could show more reverence for the situation by not openly ridiculing the person dying. All I know is if I was sitting outside waiting to know if my father was going to die or not, the last thing I'd want to hear is laughing coming from that room.
 
I don't doubt your experience. However, what works for some may not work for others. That is something you need to learn.

To say CPR on someone you don't know isn't stressful may hold true for you, however, I personally find that there is a significant amount of stress associated with it.

In your position at the hospital, you probably do not go to the family and provide updates. Based on your job description which you provided, this seems to be the case. When on scene, I am typically the crew chief and my job is to run the call and provide the family with an update. This goes well outside pumping on a chest for an hour. Speaking to a distraught family member is not easy and neither is trying to calm down a team of about 4 other first responders. Combined, this is a type of stress for me. I cope with it in my own way, mostly through exercise.

Everybody is different and not everyone thinks the way you do. You need to learn to brush some things off. While the actions of the doctors and nurses you describe seem to be inappropriate, they are THEIR actions. Yes, they do reflect on you, but you can't control what they do. The best thing you can do is act professionally and handle these situations in a way that is appropriate for you. If you don't agree with what goes on, then quit or remove yourself from the situation.

You can't change the medical profession. These people exist, as you can see. Perhaps you should keep that in mind when you are in charge some day. Make your team know what you find acceptable in the moment. I agree with you 100% that this is somewhat disconcerting, but like I said, it is reality. Learn from it.
 
Does anyone else feel like it's good for patient moral when everyone's joking around during an emergency? I've had sick family, so I've had the experience of the ER from the other side. Even when things were bad, it seemed very reassuring that it didn't seem to be serious for anyone there, just another day in the office. You sort of figuredthat however awful the situation seemed, it couldn't be that bad because if it were then everyone would shut up and concentrate. Then I remember the one time we went in and everyone actually did get dead quiet, and stayed that way. That wasn't so reassuring.
 
at the hospital I shadow at, the TCV team always jokes with the pt. before he/she goes under. Puts their mind at ease I suppose. Loosens the tension of the room too.

Besides, I wouldn't want to work at a job everyday where everyone is friggin uptight all the time. That's just not how a normal human is. Plus, if you ARE that kind of person, chances are people don't like working with you. I never liked doctors who don't smile/have a sense of humor...whether I am the patient or I am working with them.

Obviously, when it comes time to put your game face on, thats when it is time to kick it into high gear and put all joking aside.

As an aside: The best doctor that I have ever met (a cornell MD grad) was a comedian before she became a doctor...
 
Yeah, OP, I had the same experience with my first "code blue". I was...surprised to say the least.

I'm not going to question what other people do if it works for them, but I think my instinct is to shut up and work a little harder if I notice someone dying. We'll see what happens in the future. 😳
 
Perrotfish said:
Does anyone else feel like it's good for patient moral when everyone's joking around during an emergency? I've had sick family, so I've had the experience of the ER from the other side. Even when things were bad, it seemed very reassuring that it didn't seem to be serious for anyone there, just another day in the office. You sort of figuredthat however awful the situation seemed, it couldn't be that bad because if it were then everyone would shut up and concentrate. Then I remember the one time we went in and everyone actually did get dead quiet, and stayed that way. That wasn't so reassuring.
Click to expand...
Excellent point.

I observed a few conscious sedation surgeries and the surgeon and his fellows would always be talking about their colleagues or patients or he'd be yelling at them throughout the procedure. Needless to say, it made some patients very nervous but the surgeon assured them that as long as he's chit chatting, then everything is going well. I didn't really believe it until one day something more serious occurred and the surgical team moved like some well organized team of ninjas and resolved the situation without saying a word.

I guess it's true that it's when a doctor goes quiet that you should be concerned.
 
BigD311 said:
I began volunteering in EMS at 15 and have been doing it ever since. You can imagine I have seen my share of codes and death. I can certainly understand how it seems for an outsider looking in when they witness that behavior. Honestly, I am probably guilty of it sometimes as well, however, I like to think I do a better job of being more discreet and much more professional when I am around people who aren't my crew.

As for the reason why we do this, I would have to say its a way to decompress, stay relaxed, and remain human. It is unfortunate that this is often the way, but it is the reality of medicine. This is the way some health care providers cope with job stress.

I don't think your reaction is wrong at all. I believe you are quite justified. However, you probably have never been wrongly accused for "killing" someone who died because there was really nothing more that can be done. You probably have only witnessed a handful of traumatic situations from the outside, but may have never been a PART of them. This can be very stressful and your body/mind tends to react in an unpredictable way to cope.

My advice: strive to cope better, but try not to be too surprised when you find yourself talking about "a great case" in 10 years that may have resulted in someones death.
Click to expand...

Coming from someone with a background in EMS as well. I have heard some pretty distgusting and tasteless comments about patients in ambulances and at first my response was similar to the OP's. I guess I have just gotten use to it. It does make me angry whenever a medic decides because a person is a drug user and has overdosed that WE should punish him by inserting the largest NPA we have in the bag. I guess it just comes with the territory though.
 
As a fellow EMS provider, EMS is full of inappropriate jokes. Virtually every veteran medic I know typically oozes some sort of dark humor when under pressure. I already did that anyways, so I had already adapted. The medics I work with are very professional around everybody else.

It also depends on the type of code. If you have ever seen a pediatric code, that is an entirely different story than attempting to resuscitate a 90 y/o woman where you just broke every rib she had doing CPR. Everybody works really hard to get a ped. back., and those tough calls are the ones that stick with providers for a long time. No lightheartedness there.

I believe it also important to realize what happens to the patients who are resuscitated. Most of the time all that happens is you get a pulse but nothing much else, you have saved someone who is just turned into a vegetable and will suck up $$$ and space in the ICU until their family pulls the plug. Many MD's are frustrated by the lack of ability to accept that its time to die, and it comes out in their humor.

Speaking of bad EMS jokes, how about this one?
Whats the difference between a rectal and oral thermometer?


-The taste
 
OP: for your consideration...

the humor in gross anatomy lab is likely to be several times worse than anything you've experienced on the job. How will you react to those situations? Some of the humor will come from your partners with whom you are dissecting, other comments may come from people in your class who are working with other cadavers.
 
As much as I know this isn't the greatest of references, buuut...

Remember the Scrubs episode when Dr. Cox said this...

"You see Dr. Wen in there? He's explaining to that family that something went wrong, and that patient died. He's gonna tell them what happened, he's gonna say he's sorry - and then he's going back to work. Do you think anybody else in that room's going back to work today? That is why we distance ourselves; that's why we make jokes. We don't do it because it's fun. We do it so we can get by. And... sometimes because it's fun. But mostly it's the getting by thing."

Makes a lot of sense. In fact a lot of the things said on the show make a lot of sense.
 
Idk maybe some people do it b/c it helps them cope with all the horrible crap you can see in the medical field on a daily basis.
 
mic2377 said:
As a fellow EMS provider, EMS is full of inappropriate jokes. Virtually every veteran medic I know typically oozes some sort of dark humor when under pressure. I already did that anyways, so I had already adapted. The medics I work with are very professional around everybody else.

It also depends on the type of code. If you have ever seen a pediatric code, that is an entirely different story than attempting to resuscitate a 90 y/o woman where you just broke every rib she had doing CPR. Everybody works really hard to get a ped. back., and those tough calls are the ones that stick with providers for a long time. No lightheartedness there.

I believe it also important to realize what happens to the patients who are resuscitated. Most of the time all that happens is you get a pulse but nothing much else, you have saved someone who is just turned into a vegetable and will suck up $$$ and space in the ICU until their family pulls the plug. Many MD's are frustrated by the lack of ability to accept that its time to die, and it comes out in their humor.

Speaking of bad EMS jokes, how about this one?
Whats the difference between a rectal and oral thermometer?


-The taste
Click to expand...

Agreed.

Whether it is right or wrong I guess is for the bioethics people to discuss. I know that my partner and I hate to get called to a pediatric problem. I don't know about your experiences but ours usually for some reason appear to have been dead for a while. We work the code so the parents can see we tried, but the MD in the ER tells us there is nothing anyone could have done. 🙁
 
Man, when I bite the dust one of these days someone better be making jokes...in my opinion, that would be the only good coming from that situation.
 
I agree...I wanna go out making a good impression on people!

Though I do want my dignity...thats all I really ask.
 
Siverhideo1985 said:
Man, when I bite the dust one of these days someone better be making jokes...in my opinion, that would be the only good coming from that situation.
Click to expand...

But if it is your granny or your momma or your wife??? Would you want to be coming round the corner and hear someone make a joke about her breasts? It is possible to crack a joke without ridiculing the patient.
 
LizzyM said:
But if it is your granny or your momma or your wife??? Would you want to be coming round the corner and hear someone make a joke about her breasts? It is possible to crack a joke without ridiculing the patient.
Click to expand...

good point👍
 
LizzyM said:
But if it is your granny or your momma or your wife??? Would you want to be coming round the corner and hear someone make a joke about her breasts? It is possible to crack a joke without ridiculing the patient.
Click to expand...

I was speaking strictly for my own personal death...if someone cares to crack a joke about my abnormally large & saggy man breasts right after I kick the bucket...be my guest, I would even welcome a good laugh at the end of my life rather than people crying over my body.

I am not advocating insensitivity on the part of the professional, I was merely stating my personal preference.
 
BigD311 said:
at the hospital I shadow at, the TCV team always jokes with the pt. before he/she goes under. Puts their mind at ease I suppose. Loosens the tension of the room too.

Besides, I wouldn't want to work at a job everyday where everyone is friggin uptight all the time. That's just not how a normal human is. Plus, if you ARE that kind of person, chances are people don't like working with you. I never liked doctors who don't smile/have a sense of humor...whether I am the patient or I am working with them.

Obviously, when it comes time to put your game face on, thats when it is time to kick it into high gear and put all joking aside.

As an aside: The best doctor that I have ever met (a cornell MD grad) was a comedian before she became a doctor...
Click to expand...

There's a nurse at the ED I volunteer at that we call "The Machine". She doesn't smile, doesn't joke around, doesn't gossip. Just works. Like a machine.
 
JasonBerry said:
I consider myself an extremely serious minded person with little to no sense of humor, so maybe that's why this all doesn't sit well with me.
Click to expand...

Some things that are said are definitely out of line.

However, I don't know how anyone can go into medicine without a sense of humor...I feel like they won't last very long.
 
I've become a lot more relaxed lately and I am doing a hell of a lot better in school.

Take things in stride, don't let them cut into you. Be who YOU want to be. Learn from those around you. People will rub you the wrong way all the time but let them. It's their problem at the end of the day.
 
Question : if hospitals have 'designated chest pumpers', do medical students/residents/attendings end up doing much of it? Just wondering if I should be working out at the gym to get ready...
 
GeraldMonroe said:
Question : if hospitals have 'designated chest pumpers', do medical students/residents/attendings end up doing much of it? Just wondering if I should be working out at the gym to get ready...
Click to expand...

I am finishing my Emergency Medicine residency in 80 days and I have done chest compression exactly five times.

Happiest person at a code? The tech or medical student doing chest compressions because they are in the thick of the action, have a useful job, and don't have to do or know anything else.
 
Depakote said:
Dark humor is sometimes the only way to handle the absolutely horrible that you see in a hospital on a daily basis. It's a good coping mechanism.

Why so serious?
Click to expand...

This. Sometimes you get to go through stuff that's so much fun you want to scream. And keep screaming. 🙂
 
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