Codes are what we live for in the emergency room. There’s never any lack of help, people to draw up meds, run for supplies, page a cardiologist, anesthesiologist or a pediatrician. An air of urgency and an electric charge quickens everyone’s reflexes. Teamwork takes place on unprecidented levels, even amongst nurses who moments before were at each other’s throats for some real or imagined trespass.

As long as this electrified passion ignites each person in the room there is hope. Hope comes from the untried medication, the first shock, the successful intubation, the needled thorax and the CPR just begun. Sometimes, satisfyingly, the patient responds as if they’ve pre-read the textbook case. Their skin pinks up, their heart regains sinus rhythm, their blood pressure rises and oxygen saturations climb from the 60s to the 80s to nearly 100%.

But like any supercharged atmosphere, like a capacitor at maximum charge…the collected energy has to somehow begin to dissapate. The patient hasn’t read the book. The heart remains stubborn, the skin remains ashen, the pupils never react. The patient isn’t playing by the right rule book and all the players feel cheated.

Sometimes, the staff is relieved, as is the family which they secretly wouldn’t admit until given permission by the doctor. “He has lived a long life and now his body doesn’t need to suffer anymore,” might be the words of solace from the physician.

Other times we all feel angry at a God that would take a young man in the prime of his life, with a wife and young child…that he would simply vanish in the space of less than a hour. “His heart failed him so suddenly that there was really no time for him to experience any pain. He never realized that he was sick and I don’t think he suffered,” would be words of comfort for a shocked widow and grandparents of his infant son.

And then there are the times where there are simply no words. We are all speechless. In shock. Each of us shedding a tear, and some not so silently. I have to imagine that this is for from comforting for the “survivors”. For the parents of a child, for the newlyweds with an infant who hours before was a vibrant, healthy image of the future.

Those initial moments that the electric spark begins to fade, when the epi doesn’t work, when the CPR doesn’t brighten his skin, when the lividity that you tried to ignore before begins to make it’s morbid reality known. Those moments when the bustle becomes a slow-motion nightmare as if we are all trapped underwater…muddled words and clouded thoughts and disbelief that this little life might really be lost. The father’s wailing intensifies as he implores the staff to perform a miracle. “You can do it, right? Can’t you? Can’t YOU? Can’t you start his heart again?”

Mother and grandmother are too weak to stand and we open the adjoining trauma room to bring the entire family together…grandmother, parents and the little pale infant who stopped breathing an hour ago.

How do you tell them that you’re done? How do you tell them that nothing you have done is working and that there is nothing left to try? You can’t. You simply let them be with their son and hold a little pale lifeless hand that will never grasp again.