The code blue alarm set off a chain reaction. Within seconds, a doctor was giving chest compressions. A cart of supplies rolled in. Oxygen mask on. A charge nurse read off vital signs and times. Nurses, looking anxious, waited for instructions.
After several minutes, nothing had worked. The nurses took turns giving chest compressions, told time and time again they had to press harder, increase the frequency. Finally, they straddled the patient, using locked elbows and their weight to bear down on the rib cage to the unresponsive heart.
Shot after shot of epinephrine had to be opened, pushed through stubbornly thick protective packaging and administered. Still nothing.
A flash of hope as someone felt a pulse, but the mannequin patient’s vital signs showed no heartbeat. It was just the adrenalin-fueled heartbeat of the taker giving a false reading.
After 37 minutes of chest compressions, five shocks from a defibrillator, nine shots of epinephrine and a team discussion, the doctor declared the patient dead.
The last man giving chest compressions wiped away sweat. The student team took a collective breath and left the emergency care unit. The patient lay still, ready to come back to life – and death – at his next curtain call.
In the Modesto Junior College simulation lab, on the second floor of the west campus Allied Health building, tech Josh Brown saved recordings of the vital signs and video-recorded care for a critical debriefing later Friday.
That look back at what happened would be the most instructive part of the exercise, nursing instructor Leta Love explained.
“The purpose of the simulation lab in nursing is it allows them to bring what they know and use those critical-thinking skills, put it into practice in a safe environment,” she said. Love led the exercise as the charge nurse. Nursing instructor Sally Chaffee filled out the team, providing hands-on expertise.
All MJC nursing students go through a code blue exercise before they graduate. “That’s so they’re ready. It’s not something they’ve only read about,” said Love, a nurse for more than 20 years.
How much strength it takes to give CPR. How hard it is to open the injectors. Keeping straight the order and placement of suction tubes under stress. The intensity of having a patient’s life in your hands.
“I was so focused on helping him survive, no matter what,” said nursing student Kamaljeet Singh during the debriefing that followed. It was his second experience with a code blue. The first had been a real patient he had been able to save during a clinical training shift at a hospital.
For student Adam Shane, it was a first. “It was good we were able to do this. I’ve only seen it from the edge, from the periphery, before,” he said. The three student nurses on the team, Shane, Singh and Daniel Torres, will graduate in April.
The team doctor, Sabrina Arora, said it was the first code she had to lead on her own. “I had so much anxiety. It’s nice to practice in a safe and supportive environment,” she said.
Arora is a second-year medical resident at Doctors Medical Center, with another year on her medical residency and an orthopedic residency to complete before exiting as a doctor of osteopathic medicine. Her participation is part of an MJC collaboration with Valley Family Medicine Residency at Doctors Medical Center.
The mix of doctors and nurses in training, working in an emergency scenario, brings each group a better understanding of the others, Love said. “It improves communication and that improves patient care,” she said.
For Torres, the exercise showed the interdependence of every person in the room. “That need to act fast and working like a team. It’s like an orchestra. The doctor’s the conductor and we’re like the band,” he said.
Another key point, he noted, is staying focused under pressure. “Even though you’re screaming inside, you have to maintain that calm,” Torres said.
The pseudo-death hit him hard, he said.
That comes with the territory, Love said. “We all walk away knowing we’re humans, and you have to do your own grieving,” she said.