A perspective on the golden moment after ending a code.
“Next pulse check in 30 seconds,” the nurse announces from the corner of the resuscitation bay.
As you consider all that you’ve done for this patient in cardiac arrest, you share with your team your next plan: if there is no pulse, no shockable rhythm and no cardiac movement on bedside ultrasound, you’ll end the code.
Just as you ask if anyone has any other thoughts or suggestions, you’re quickly interrupted with a commanding, “Pulse Check!”
And so, like many prior resuscitations that ended like this, you announce the time of death.
After thanking your staff for helping, and everyone exits the room, you realize as if programmed, everyone simply starts to pick up whatever tasks were interrupted prior to this code. This is an unfortunate, yet common scenario in the Emergency Department. More so with the pandemic, there are no family members at the bedside to share this news. We have been breaking these challenging conversations via phone. Patient after patient “die alone.”
In reflecting on these events, the medical team also suffers from the vicarious trauma of seeing death upon death. Is there a way to humanize our interactions, and acknowledge our common humanity as we care for the dying? Can we align our efforts to also provide healing for ourselves, just as we hope to impart to the patient’s family?
A former resident at Stanford, Dr. David Wang, who now practices in Palliative Medicine, shares this “golden moment” immediately after calling the patient’s time of death to shift the focus towards the rest of the care team who just witnessed and contributed to the resuscitation. He reads this script:
“Thank you, everyone. Before we leave this room, could we just take a moment to stop as a group and honor this person’s life? Before they arrived today, they were a person. They had a story. They were a son/daughter, perhaps a brother/sister, a father/mother, or a spouse. (Patient Name) was loved by somebody, and (Patient Name) loved others. (Patient Name) lived a life worth remembering. We need to take this time to recognize that, and we also need to honor one another for the tremendous efforts we have put in to try and save (Patient Name).”
Some of us have incorporated this in our practice since, and in our experience, this moment does not take a lot of time — a few minutes at most. However, it gives us a chance to recognize how this resuscitation affected us and how each of us is connected. You may save this script on your phone so you can easily retrieve it and read it, as, without fail, this experience evokes several emotions at once.
First, it normalizes being vulnerable in front of our team. It also acknowledges the reality of how busy we are in the Emergency Department, and at the same time, allows us the space to attend to our emotions and our needs. This brief moment is a reminder for everyone that we must also take the time to take care of ourselves.
While simple, this “golden moment” allows those who participated in the patient’s care to remember them for who they were: a person.
And we remember that each of us, including our team, is also human—with feelings and who are impacted by the loss. And that death is hard. And that even though we may not have a cure for everything, we can offer a chance to heal.
Spencer SA, Nolan JP, Osborn M, Georgiou A. The presence of psychological trauma symptoms in resuscitation providers and an exploration of debriefing practices. Resuscitation. 2019 Sep;142:175-181. doi: 10.1016/j.resuscitation.2019.06.280. Epub 2019 Jun 25. PMID: 31251894.