It was around 3:00 in the morning when Mrs. S’s condition has deteriorated.
We have just finished tranfusing another set of 6 units of platelet concentrate. She reported that she is having difficulty breathing and the pulmonary fellow on duty ordered for an IV push of Furosemide, a diuretic that was supposed to ease her pulmonary congestion.
She did not recover, the fellow ordered for an NIV or the Non-invasive ventilation but as the respiratory therapist was starting to set it up, it did not work immediately. While the RT was trying to jump start the machine, the fellow prompted us to prepare for an intubation. I wheeled in the crash cart in the patient’s room. Everything happened so fast. She crashed and so we called code blue.
Resuscitative measures brought her back and as we prepared for her to be brought down to the medical ICU, she crashed again. At that time, relatives have told the code team to stop. They want a DNR.
We let her go. I shook my head in disbelief.
She has just been diagnosed to have Idiopathic pulmonary fibrosis

On my way home, I had this thinking about loosing our patient who has been confined for more than two years. She has been in and out of the intensive care unit since then. She has just turned 95 on March 10th.
This morning I woke so early and punched in at 6:10 am. I came in early to get the bedside-to-bedside endorsement done before the grand endorsement. While on my way, the caregiver of our resident patient texted me to bring her some cheese, to which I replied that there was none left. It was 5:30 am.
As I reached the ward, I was informed that the said patient was hooked to mechanical ventilator late last night de to difficulty breathing and for some reason it suddenly stopped working so the charge nurse was doing the ambubagging. I hurriedly entered her room and she’s becoming cyanotic (bluish discoloration) showing signs of respiratory distress. The pulse oximeter does not register pulse rate nor oxygen level in her body. No blood pressure can be acquired even on palpatory way. I and the bedside nurse tried but to no avail.
The charge nurse asked me to page the cardio and pulmonary fellows. The bedside nurse did it. But as we waited for the fellows to arrive, her condition got worse, the charge nurse asked me to call the code. I dialled 7 and in a heartbeat the PA summoned the code blue team to our ward. I wheeled in the crash cart into the room. The team was there in less than a minute.
They hooked her to cardiac monitor and four doctors tried to start peripheral line. One has started cardiac compression and was shouting to push to epinephrines. It started at 6:31 am and ended at 6:37 am. After the fourth epi has been pushed, she showed sign of revival.
We felt relief. She’s prepped to be wheeled in to the medical ICU again.
out of silence, the tension was pulsating. We love our abolita (as I fondly call her).
At past 2:00 pm I texted the caregiver asking for the patient’s condition and they said that she is stable. A few minutes after that, the PA summoned code blue team to medical ICU. We became worried. I called the medical ICU and as if a large rock was removed from my chest, it was not our beloved patient.
I learned from the medical ICU nd the caregiver that she will be wheeled in to her favorite room in our ward once she has tolerated the weaning process from the mechanical ventilator.

I am trying to ward off the idea that I am jinx because in the past two weeks, My partner, Mark and I have joined the code team in resusciating two patients. This evening, we again have had a patient who coded. He was just tranferred from the ICU. This time though, we were not able to be in the code team as those who brought him from the ICU were the ones who performed the CPR.
Actually, I did not knot that there was a code that was called since we’ve got a handful of patients that evening.
It was three in a row. I hope it will not be a sweep this week.

It was our last day in Medical ICU (MICU) and in our shift, we were only 2 trainees. I was assigned to manage two patients — both were suspected to have PTB but the other one has episodes of hemoptysis (coughing out of blood).
He was actually extubated or the endotracheal tube that assisted him to breathe has been removed. He was being prepared to be transferred to the ward because he can already breathe on his own. He though has nasogastric tubing or NGT for feeding.
I started monitoring the patient hourly until 7:00 p.m. I fed him and gave him his antihemorrhagic drug via NGT with strict aspiration precaution. I was asked to have my dinner since he was stable. The patient was talking with his wife when I left. I was starting to eat my dinner when my groupmate came to the pantry and told me to rush to my patient’s room as he was having another bout of hemoptysis. I ran to his room and the resident was already trying to intubate him. The patient continuously coughs out enormous amount of blood with fragments. The attendings have been paged. Emergency drugs have been pushed — Atropine, Epinephrine, fast drip IV fluids but the patient coded. His vitals deteriorated despite efforts to revive him. The attending and the nurses took turns giving cardiac massage but the patient remained on flat line.
I wanted to tell the code team to try reviving the patient.
Time of death was called.
We have given him post mortem care in order for his relatives to see him in resting state.
It was a sad night. The patient was okay when I left. His wife was joyful talking to him. The joy was replaced with moans and outburst of emotions as she was allowed to see him.
I tried to hold back my tears and went out of the room.