Code Gray: Death, Life, and Uncertainty in the ER

by Farzon A. Nahvi

Despite whatever I was experiencing inside the hospital, outside, life continued on normally.

Before entering medicine, I had always assumed that our systems were more sophisticated than I found them to be.

Despite confronting the extraordinary, it is always the everyday things that hold our attention.

“See you for round two later today!” Danny yelled with a chuckle. He was technically right. I would be seeing them all later that same day. When you work the overnight shift, work schedules become unsynchronized with the calendar. We were walking out of the hospital on a Wednesday morning, and would be seeing each other again on Wednesday evening. Even when we sleep after an overnight shift, because we wake up in the same day we went to sleep in, we don’t have that sense of a reset upon waking back up. It is difficult to put yesterday’s shift behind you when yesterday’s shift is still today.

What now? This experience was clearly important, but what do I do with it? What lesson could I possibly draw from it and how does it fit into my understanding of the world?

“How might these experiences make sense given my understanding of the world?” eventually turned into, “What is my understanding of the world given the truth of these experiences?”

We might find that what may look ordinary from one perspective may be extraordinary from another. Our everyday lives are meaningful and profound. It is worth slowing down to take a closer look.

Glucose, or blood sugar, is always checked immediately upon encountering a dead patient. Glucose levels that are either too high or too low are two of the few correctable, reversible causes of death.

As a resuscitation progresses, a major part of the care team’s job is to look for any potential reversible causes of death, known as the five H’s (Hypovolemia, Hypoxia, Hydrogen ions, Hyper- or Hypokalemia, and Hypothermia) and five T’s (these are: cardiac Tamponade, Toxins, pulmonary Thrombosis, coronary Thrombosis, and Tension pneumothorax).