"Get the doctor!". "Bring the code cart!". The commotion was coming from Room 7. I rushed to the site. The patient was lying livid, lifeless. I glanced at the monitor. Flat line! In the fraction of the split second that followed, I had to decide whether she will live or die. I decided she would live... I would try... I had 20 minutes to do it. Beyond 20 minutes, she would be irremediably brain dead.

Norma was 37 years old. About a year earlier, while undergoing a work-up for a recurrent sinusitis, she had an MRI which revealed what looked like a tumor of the blood vessels in her brain, an hemangioma. Usually a benign tumor. But, she was advised to remove it anyway. The risks of the intervention were minimal.

She discussed the matter with Chantelle. Chantelle's love and affection were Norma's sole worthy possessions. Chantelle, her 17 years old daughter, was her roommate, her playmate, her confident, her life companion... They, together, decided that Norma would go for surgery.

The operation went uneventful, smooth. When she was wheeled a few hours later in my unit, she was off the respirator, alert, in good spirit. She was young, healthy. There should have been no complications... So, what happened? Why was she lying in front of me with no respiration and no heart beat?

I jumped in the bed and started CPR (cardio-pulmonary resuscitation). A nurse pushed the alert button to call the code team. In no time, the room was full. Norma received one shot of epinephrine and one shot of atropine. No response. I was pumping like crazy.

An intern panicked and started shouting orders. I barked at him. He shut up. I pulled him in CPR position. He had the right muscles for pumping. I grabbed a laryngoscope. In three minutes, the patient was intubated. We were able to make her breathe artificially.

At 5 minutes, the cardiac monitor still showed a flat line. Asystole. Three shots of epinephrine. I did not want to take any chance. I opted for the escalating doses.

At 10 minutes. Last dose of atropine. Still no response.

At 12 minutes, she went into fibrillation. I grabbed the defibrillator. Three shocks. I brought her back to a normal rhythm. But, she still did not have a pulse.

At 15 minutes. She had a pulse. A weak one. But, her blood pressure was still zero.

At 17 minutes, she had a blood pressure of 70 over 40. Too low. Bolus
some fluid. Start an infusion.

The blood pressure came up... Send blood for chemistry and other studies. And, a chest X-ray. And, an EKG. No one will ever learn what caused her heart to stop. We had 20 minutes to save her life. We did it in 17. We made a difference. That was medicine! In all its glamour and glory. I smiled and walked away...

These events happened last December. Six months later, I met Chantelle on the wards. She was visiting a young friend. Another case of teen-age pregnancy gone a haywire. I did not recognize Chantelle. She turned 18, graduated from high school and was accepted at John Hopkins.

"Thank you, Doctor.... Now, my mom will see me graduate from
college" says she. I smiled and walked away....

(Odler Robert Jeanlouie, on Thursday, June 3, 1999.)