I had a shit day at work yesterday.  A woman in her mid seventies came in for a lung biopsy.  We do lung biopsies just about everyday of the week and our rads are amazing at getting samples.  This particular biopsy was for a clinical trial which means this woman had no more options with regards to treatment; the oncologist had tried everything and nothing had worked, or the treatment had stopped working.  They needed a tissue sample for the trial, prior to the clinical trial treatment starting, and yesterday was the day for this lovely lady.

I admitted her, asked her how to pronounce her last name (Vietnemese I'm guessing, I said).  The lady and her sister smiled and asked how I knew that.  Her last name started with Ng, something english speakers have a hard time pronouncing.  They tried to teach me how to pronounce the name, I was unsuccessful but we all laughed at my efforts.  I asked a million questions and we chatted.  She was just sweet, nervous and cold.  I got her a warm blanket.  After all my questions, I told her the doc would come and talk to her and explain everything that was going to happen, including the bad stuff that could happen but rarely does, that's what informed consent is I told her.  I also had her CT changed from today to yesterday; we would do it after her biopsy and save her a trip back to the clinic.  Her sister left.

I walked past the stretcher bay, where she was waiting, a number of times after I had finished her admission, and smiled each time.  I had my break and when I got back, I went to interview a line patient.  I got about halfway through the interview when I heard, Code Blue, CT Room 1.

I ran down the hallway and into CT Room 1; my lady was laying there, gray and lifeless, with blood coming out of her mouth.  One nurse was suctioning blood out of the lady's mouth while trying to get oxygen into her.  Another nurse said she was starting an IV, so I ran and prepped an IV bag for her and made sure she got everything she needed for the IV start.  By then the Code team had arrived and there were probably fifteen people in the room.  Someone else had started CPR compressions.  There was still blood coming out of my lady's mouth and the nurse was still trying to suction while respiratory put in an airway and started bagging the lady.  I realized we had no CPR board under the patient, so I got one off the Code cart and we turned the lady and put it under the mattress.  911 was called as we're not a hospital and have no emergency or ICU, so she needed to be transported.

My patient started bleeding after her lung biopsy when she was moved to the recovery stretcher.  I don't know how much blood ended up in her lungs but her heart stopped, as well as her breathing.  Lung cancer tumors can rupture and bleed, sometimes just from coughing, sometimes from prodecures such as biopsies and sometimes from a bronchial artery bleed within the tumor itself. 

The Code team did manage to get a heartbeat but my lady wasn't breathing on her own when EMS left with her; she was still being bagged.  One of the young nurses that I work with loves codes, (not the death involved); she likes the intensity,  likes the action, likes the skills required for a successful code.  I don't like codes.  They break my heart, someone is dying.  I think that death should be peaceful and dignified, not traumatic with lots of people in the room, trying to get your heart to start again.  I told that lovely lady that bad things rarely happen during lung biopsies, but something bad happened to her.  I felt like I had lied to her by minimizing the risks.  I just looked it up online, there is a 1% risk of hemorrhage in percutaneous biopsies so I didn't lie to her but I still feel like I let her down somehow.

I had to phone my patient's sister because I had promised I would call her if anything happened to her sister, or when her sister was ready to be picked up.  Something bad happened, and I had to tell my patient's sister that her sister had stopped breathed after the biopsy.  I didn't mention the CPR but I did say that we had gotten her heart beating again.  I don't know how much the sister took in but I did tell her which hospital emergency to go to.  

The code shook us all up yesterday morning.  We had to all go back to work and start more IVs, or in my case, go back to finish my interview and teaching on the line patient.  I cried a few times but mostly I felt kind of numb.  I had been talking and joking with my patient an hour before this happened.  It seems unbelievable that things can change so quickly, even though I know from experience that things can and do change that quickly.  Before I left work yesterday, I checked online and my lady had been admitted into ICU, so she was still alive.  I don't know if she's still alive now though.  

 I still feel numb and sad and teary.  I know we all have to die but still it's so sad.  Jack asked me not long ago why Lucy died and I told him that all living things die.  He asked me why and I told him, that's just the way it is.  Life is filled with grief and with joy, and hopefully the two can balance each other out somehow.