[Asystole is when your heart's electrical system fails entirely, which causes your heart to stop pumping. It is also known as “flat-line” or “flat-lining” because of how your heart's electrical activity appears as a flat line on an electrocardiogram - Cleveland Clinic]
I recently accompanied my wife on her ER duty at a local hospital nearby. I wasn’t affiliated with that hospital, so I was just, let’s say “tagging along”. While she did her ER rounds and consults, I stayed in the doctor’s call room reading books or watching some videos during my study breaks.
The morning of her duty was relatively chill: nothing much happened. But come late afternoon and patients started coming in one after the other. I figured out she was already preoccupied in the ER as she never came back to the call room after the last referral to her. That was a couple of hours ago already.
While finishing up the chapter I was reading, I heard the intercom calling for “IWs (Institutional workers) on duty to be at the Emergency Department immediately.” The announcement was repeated at least thrice. Right then, I realized what was happening: Code Blue.
I wrapped up my reading, closed the book, and went to the ER as well. I might be able to lend a helping hand somehow. I was not that confident as my last ER duty was about two years ago, before I started residency training. (No, we don’t do Codes in Rad Onc).
When I arrived at the ER, true enough, they were already in the middle of resuscitating a patient. A middle-aged, (big) guy, lying limp in the stretcher bed, no shirt on but his khaki shorts. ECG leads attached to his broad chest.
A couple of nurses were already giving chest compressions and some were talking to the relatives. My wife was already at the bedside, giving directions as the team captain. I rushed in, put on some clean gloves, and prepared to do CPRs. I went to the other side of the bed and observed. I asked Daya (my wife) if we needed to intubate. The family was still undecided. She was already checking the pulses and the patient’s pupils were already fixed and dilated: a tell-tale sign that this patient was already way beyond saving. He is already brain-dead. But we can not NOT do something somehow. We still have to try, right?
In this situation, different roles are usually assigned to the trained health professional present. The doctor on duty (which is my wife) will be the team captain. She will direct the overall of the code. Someone would time and record the medications given, and the rest would help in doing chest compressions. Another one will do support tasks (provide needed equipment, do suction, etc). It takes a whole team to do a good resuscitation.
I came in late and the expected role I will go to would be the chest compression “team”. One of the nurses approached and took the IV line, and he then injected IV epinephrine into the venous access.
“3rd Epi given!” he shouted. “Thank you!” I instinctively replied. Epinephrine hydrochloride is a drug that is administered, in the easiest sense, to “reverse” cardiac arrest. The recommended dose is given at 3-5 minutes intervals. We are at our third dose already. 15 minutes max. Still no response. Continue chest compression!
Another rule of thumb in doing resuscitation: Our time limit is 20 minutes. By then, if there is still no ROSC (return of spontaneous circulation), the outcome would be the same. You see, our brain cells can only tolerate a little over 5 minutes without a blood supply. Beyond that, it could no longer survive without permanent damage. And 20 minutes of trying to revive a person and still no response, any other method would yield the same.
At this point, my wife approached the next of kin. I was not close enough to listen, but I already knew what she was about to tell them: We would continue to resuscitate until 20 minutes.
20 mins in, still no response. No pulses. Rythm check: Flatline. It was already time to call the time of death: 7:45 PM.
The room was suddenly filled with wails and cries of loved ones. Daughters crying, refusing to accept that their dad was already dead.
“Masuuk na ku mag-graduate ama’!” (I am almost graduating, Dad!), said one of the ladies sobbing, still wearing her white uniform. I presume she is a nursing student (or some healthcare-related course) in the same hospital.
Heartbreaking. Devastating.
As someone who has been working in the healthcare profession for years now, these kinds of occurrences are already considered a common thing for us. Too common that we tend to be desensitized at times.
We are in a unique position of experiencing a dichotomy of things: of life and death. Of hopes and despair. Of denial and acceptance.
And within those, exists a thin line separating them from one another. This time we are the ones trying to revive someone. The next time around, it could be our turn: to be that someone who will lose a loved one or worse, the one lying on that bed, unresponsive. With a flat-line.
A kind reminder that we are not above others. We are nothing but just instruments. We are not God. We can never play God here.
As the nurses did the “post-mortem care” for this patient, preparing the remains so that his loved ones could bring him home, I went back to my room and contemplated these things.
Inna lillahi wa innā ilayhi rājiuwn.
'Verily we belong to Allah, and verily to Him do we return.''