Jessica Nutik Zitter - Extreme measures: finding a better path to the end of life

July 12, 1992

The second week of my medical internship.

2:45 A.M.

A nurse wakes me up. A patients Foley, or bladder catheter has fallen out, and the nurse needs me to put it back in. It is my second week as a medical intern, and her attitude is more like that of a hazing fraternity brother than of a patient advocate. Ive been able to lie down for fifteen minutes in the darkened call room on one of the four cots that already smell of another intern's sleep.

10:30 A.M.

Ive survived my first night on call but can barely function. Ive slept fifteen minutes. The morning hours bear no relief as my pager beeps relentlessly. I make a mental note to answer only every other page and ignore the intervening ones, assuming theyll call back later.

11:45 A.M.

I take the rear stairwell two steps at a time, heading toward my next task on the ninth floor. Mr. A needs to be discharged. That will bring my post-call census down from twenty-one to twenty. I imagine the pen slash I will make as I cross him off my list.

The door slams open above me. Looking up, I see another post-call intern rushing down to attend to something on his list. We grunt at each other. The only thing we need now is a code, he chortles.

We had all witnessed codes as medical students, standing at the back of the room, small and silent so as not to be ejected by a nurse or, worse, pulled into the fray. Uncapped needles strewn over the bed as a surgical resident tried repeatedly to thread a catheter into a large vein. Chest compressions, violent and exhausting, a relay race of residents and nurses taking turns pumping clotted blood through the patient.

Missing a code was frowned on; every doctor within earshot of the hospital PA system was expected to drop work and show up. Ninety percent of us would quickly be dismissed, but most would remain in the hall chatting, glancing periodically into the room to see whether life or death was winning. It was exhilarating. We believed that by merely following the protocols wed studied in medical school, we would be able to bring people back from the dead. Wed resuscitate their lifeless bodies with jolts of electricity and chemical cocktails designed to shock the heart out of its complacency. We could reinflate flaccid lungs by thrusting stiff tubes into airways and sending mechanical puffs of air into them, playing them like musical instruments. Wed practiced the various scenarios dozens of times on dummy mannequins, furnished with software showing us the various heart rhythms changing with every treatment we administered. The result was usually the same. The patients heart rhythm was restored by our efforts. We imagined him waking up from his ordeal, another miracle of modern medicine.