code blue

Bekah's next extubation attempt was to be handled with kid gloves.  She would be given steroids to minimize swelling of her air way days in advance.  She would be given more time off the fentanyl to allow her to be more alert.  She would also be placed on a high-flow machine.  This is a breathing machine with a nasal cannula that basically blows air up your nose.  The idea is stimulate breathing.  Think of what it's like when you hang your head out the window of a moving car.  The force of the air in your face stimulates the inhale.

Once the necessary precautions were taken, Bekah's breathing tube was removed and she was transitioned to the high flow  machine.  She didn't like it at all.  She was very agitated.   Dr. L came in and said she must be having withdrawals from the fentanyl.  "We are going to start her on methadone."  "METHADONE??!!  What is this the Betty Ford clinic?  We left Venice so we would never have to face this."  Jeffrey and I laughed.  We couldn't believe our 1-month-old infant needed a drug with such a stigma.

If you haven't noticed a theme in the previous posts, everything in the hospital takes hours.  Hours to set up the high-flow machine, hours to coordinated care for extubation, hours to do a blood gas.  What happened next took mere seconds.

The nurser administer the i.v. dose of methadone.  Bekah let out 2 little squeaky sounds.  Her eyes rolled back in her head and she turned grey.

"She doesn't look good."  I told the nurse and ran to turn on the light.  When I returned to the bedside, the nurse was giving my baby a little extra oxygen.  I grabbed the face mask, so Bekah could be bagged.  She was unconscious.  Alarms began to blare.

"Call PICU RT!"  the nurse told her intercom device.

"Calling PICU RT." the mechanical voice responded.

By this time, the nurse had the mask over Bekah's face and she was receiving artificial respiration and the respiratory therapist was on the way.

What happens next is a blur.  Someone called the code.  The room filled with nurses, drs, and respiratory therapists.  The head of the pediatric department was there looking very nervous.  Someone started chest compressions.  There was a security guard standing outside the door.

"Does she have a pulse?"

"She has a pulse."

"GET THE CODE SHEET!  GET THE EPI!"

I don't know who was talking at this point.  Every voice seemed disembodied except the voice of the alarms warning us that Bekah was near death.

"Epi's in."

"No response."

"Get the adrenaline!"

"Got a line in!"  someone had given her another I.V.

"I wish we didn't have to wait. The nurse is getting it from the med room."  Someone had spoken this to me.  It was no comfort.

The head of pediatrics approached me as I squeezed my husband's hand to near numbness.  "She has a pulse.  Her heart is beating very slowly.  We always start chest compressions when the heart rate drops below 40 beats per minute."

"Adrenaline is in."

My baby's arms were sprawled and jerked with every compression.

"No response."

"Get the narcan."

I knew this drug.  I remembered studying it in school.  It blocks opiates and opioids like heroine at the cellular level so that the drug cannot penetrate the cells.  It is an emergency room medication that is administered to overdose patients.

"We have to wait for it to come up from the pharmacy."

"I wish we didn't have to wait."

CPR continued.  Somewhere outside, a siren blared adding to the chorus of alarms and tense voices.

The narcan was administered.  The alarms stopped and there was a collective sigh.

"Cancel the code?"

"Yes cancel the code."

The head of pediatrics looked at me and expressed his relief.  "She's ok."

Dr. L. approached me and said something I don't remember.  Probably something about adverse reaction and narcan and withdrawals, heart, rates, pulses and "She's ok now."

one the room emptied of nurses, doctors,  and respiratory therapists until even the security guard was gone.  I was cold and shaking, trying to catch my breath after holding it for so long.  I looked at my baby.  She was beautifully pink and sleeping soundly.  It was the best she had looked since the day she was born.  I took a picture.

One The nurse offered me a cup of tea.  Usually, I don't care for tea, but at that moment, it was the best thing I had ever had.  A soothing cup of chamomile was perfect.