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The Not So Easy Firsts in Medicine

There are a lot of “firsts” in medical training. Some are really positive things that we love to talk about

like your first real patient encounter, your first delivery during obstetrics, or your first time diagnosing

something right. But less physicians talk about the difficult “firsts” like failing your first test, losing your

first patient, or being involved in your first code. These can be really difficult and can make you feel

isolated and alone. Training sometimes does not prepare you for these scenarios, which is why we must

talk about them so we can gain better insight and realize we all go through the same emotions.

Code Blue. These two words bring fear into every physician’s heart no matter how seasoned or what

they may tell you. It gets announced over the PA system in the hospital and can cause a tad bit of chaos

with people from multiple specialties running to the room called. It means a patient is dying and

requires immediate resuscitation.

I remember my first code blue like it was yesterday. He was only a teenager. He was an athlete with a potential sports career ahead of him. He was healthy with no underlying illnesses. He had such a bright future…until he rolled into our pediatric ICU.

I was on my first PICU rotation in residency. We got a call for a transfer from a nearby emergency

department. “We have a teenager in respiratory failure with pulmonary hemorrhage. We have

intubated him and are requesting a transfer.” He had been diagnosed with the flu just a few days prior.

We accepted the transfer and he arrived in the middle of our rounds in the morning. He was already

intubated. His whole family arrived a few minutes later.

Thirty minutes after he arrived a code blue was called. His heart rate was dropping and he was not

responding to medications.

He was the first pediatric patient I ever coded.

The first time I did chest compressions on a real person, nevertheless a child.

The first time I could hear the family behind us praying to save their son.

We ran through the code algorithm with my PICU attending calling out instructions. We gave multiple

pressors, blood products, and other medications. We did this for about an hour. We did everything we

could to help him, but it wasn't enough. He died despite our best efforts. He was my first code and my

first real patient death. I was both physically and emotionally exhausted. He was a healthy teenager and

died from the flu, of all things.

After things settled down and the attending talked with the family, it was back to rounding almost as if

nothing happened. I could not focus during the rest of rounds.

What just happened?

Am I the only one who is upset?

Is this normal?

The rest of the day was a blur. There was talk of doing a debriefing session, but it never happened. The ER resident who was on with us that day joked about needing to go get Tamiflu now. I chuckled a little bit. Humor is one way for people to deal with stressful situations. But, what we really needed to do was talk about it and recognize what happened.

Unfortunately, sometimes we do not have the time in medicine to reflect. This is why burnout is a reality and physician mental health is a big concern. That is why I talk about the hardships during training. We should be more open about these experiences so others can see it is okay to be upset, angry, or numb.

Even just writing this article years later makes me feel better and it gives me the opportunity to reflect on my own growth from then to now. It never gets easier losing a patient, but you get stronger.

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