Defeat

It is 1–0 for Canada and CPR has just started.

The room is cramped and oppressively hot. Machines whirl to life. Alarms shout. Bodies swarm. Some stand in the doorway, watching the spectacle unfold; others huddle nearby. The TV hanging in the corner babbles loudly. It flashes an image of a man pacing up and down a green pitch, head in his hands, irate at the situation.

This is my first time leading a code. I am at the base of the bed. I am unsure if I am breathing.

Chest pads are placed. The still life is sandwiched between the rigid board and busy hands. The airway is secured. I announce that we are in the pulseless electrical activity algorithm, and nurses nod their approval. The rhythm then marches on again, more forceful this time, just as the TV shows a red- and blue-painted fan, banging a big drum, trying to rally his team. He appears to mouth, “ Let’s go.”

“Have we managed to secure the IO?” I ask.

“About to try the right tibia, Kacper.”

I cross my hands; I feel this is good form. Sweat soaks my scrubs. The broadcast switches back to the man I presume to be the English team’s coach. He is standing with his hands crossed as well. I uncross mine.

Epinephrine is given. Two minutes pass. Still pulseless electrical activity. It is the same story, but more desperate. I plead for labs. I plead for a full physical. I plead for an ultrasound. I plead for the full history.

“This is a 49-year-old male coming in for a COPD exacerbation who was found to have multiple likely lung malignancies, staging pending.”

“Anything more?”

“No.”

How can there be nothing more? Tamponade? Tension pneumothorax? Are there no other T’s? Hands continue to crush. The IO oozes. The strip still shows no electrical function.

I hear a gasp behind me from another patient in the shared room. The other team has scored.

I mumble to continue CPR. I do my best impression of authority. The room gets hotter, even though the body in front of me is cold. My voice disappears in the heat. I am asked to repeat myself. I sputter, “Quality CPR, please.”

The chest continues to be pummelled. I ask the room if they have any other thoughts. A wide differential is shared. I agree and agree and agree. One of the players misses a penalty kick. The audience shake their heads in maddened disillusion.

The cycle continues with little change. Some bicarbonate is given. Another shot on goal. Epinephrine is pushed. Another shot by the star player. Medication, CPR, penalty, medication, CPR, penalty, medication. At last, I am shown an ultrasound image. In different circumstances, the still heart on the small screen might be considered a beautiful example of anatomy.

What am I missing? What am I missing? What am I missing? Oh god, what terrible thing have I done wrong?

The staff physician taps me on the shoulder. She says we should call the code.

I want to murmur dissent. I want to stamp my feet. I want to say, of course we can come back. Of course, there’s still a chance. I just need a few minutes. We all just need a few minutes. Just give me a few minutes to put back the unapologetic outpouring of blood and a few minutes to address the serious acidosis and a few minutes to jolt the heart to happy wholeness and a few minutes for injury time and a few minutes to hydrate and a few minutes to turn on the air conditioning, for heaven’s sake. This cannot be how my first code blue concludes — in the heat death of an infinite loss.

Minutes pass like lifetimes. I do nothing. I cross my arms again. I nod to my staff. My voice has evaporated.

The game has ended.

The staff physician thanks everyone for the code as the clean-up begins. The mop weeps a leaky red on the floor. I hear cheers in the distance. The TV has been shut off in this room.

Afterward, my attending commends me on my calmness and says I managed a difficult situation with poised execution.

Later, I sit at home in the dark, trying to watch match highlights on a cracked cellphone screen. The Wi-Fi reception is poor in my building. There was an outage reported in my block. It is unclear if, or when, the service will be fixed.