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Medical Humanities

The Death Note and the Soft Code

Emily Pinto Taylor

May 8, 2015

 

My first night on call, we were getting sign out
when the pager went off for the rapid response at 7:02pm.
Immediately, we were running
and the senior put out his arm to hold us back
"go slowly, it's a soft code."
(Soft code, I learned later, means a patient is terminal,
that he should be DNR and isn't
and that there won't be much we can do.)
We stabilized him, and he came back enough
to bat us all away with his arms
and I spent the next few hours in a blur
admitting patients, writing notes, answering pages,
walking down empty hallways where each room I passed
offered a sliver of midnight blue sky.

Somehow, I ended up alone in the unit, finishing a note
when I heard the nurses say, "call the code, he's not breathing"
and my heart stopped.
I ran after them, the first one to arrive (and the one with the least authority)
and stood entirely in the way as the nurses frantically
suctioned, cleaned, compressed, elevated, and pricked
trying to get access, trying to get a response, trying to get a pulse,
trying.
The air felt hot and heavy and electric until the senior walked in,
"remember, soft code."
(Later he told me I didn't need to push so hard, didn't need to break a rib,
but my technique was good.)
I watched another resident drill into his shin
and the nurses try so hard to get a line in,
pushing fluid that, after all the unsuccessful needle-sticks,
squirted out through his skin like holes in a garden hose.
I stood at the end of the bed and stroked his feet, because I wanted him to feel something soft and tender,
a final gentle touch as he left this world
when they called it, time of death 12:53am.

I sat back at that computer later, lost
when my senior texted me "Don't forget to write the death note."
There's an unspoken understanding that
you can't unsee what you saw
that no one will understand later when you try to explain to 
your partner or your mother
and that it is for our healing, as much as for theirs, that we write it down
so we (and he) can go home.


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