Wow. Excellent recounting. Brought back memories of the first patient I had who died on my watch. I was an intern on my required six months of Internal Medicine ( I was a psych resident) back in the early 1980s. The patient was a middle aged gentleman in the ICU. I was on call ( back in the days we had every third night call, and worked the entire next day after having been up all night the night before— that was before they changed the rules about how many hours a resident could work), the patient coded, and I was the only MD in the ICU right then. Running my first code on equal parts terror and adrenalin. We used to call experiences like that a rite of passage. And next July my son will be a first year resident in Family Medicine.
This hit hard. A “first code” is one of those moments that rewires you; part adrenaline, part disbelief, and then the quiet weight afterward when you realize the patient is not an algorithm and you’re not a machine.
What I appreciate most is how you capture the two parallel jobs we do in those minutes: the visible choreography (compressions, meds, airway, time) and the invisible one (staying anchored enough to make good decisions while your nervous system is on fire). Those early experiences also shape how we lead later; calm voice, closed-loop communication, and making space for a debrief because that’s where meaning and learning settle in.
Thank you for putting words to a rite of passage many clinicians carry privately!
This reminds me of a combination of many of the codes I witnessed as an unlicensed unit assistant in ER and ICU. The one poor fella was ahead of me in line for morning coffee at McDonald's an hour or 2 before. I was in the room asking if he wanted me to contact his family when he arrested. I knew where that big red button was on the console. Until. That. Moment.
That would have been a “make it or break it” moment for me. Glad you stuck around. The ER needs physicians like you.
Wow. Excellent recounting. Brought back memories of the first patient I had who died on my watch. I was an intern on my required six months of Internal Medicine ( I was a psych resident) back in the early 1980s. The patient was a middle aged gentleman in the ICU. I was on call ( back in the days we had every third night call, and worked the entire next day after having been up all night the night before— that was before they changed the rules about how many hours a resident could work), the patient coded, and I was the only MD in the ICU right then. Running my first code on equal parts terror and adrenalin. We used to call experiences like that a rite of passage. And next July my son will be a first year resident in Family Medicine.
This hit hard. A “first code” is one of those moments that rewires you; part adrenaline, part disbelief, and then the quiet weight afterward when you realize the patient is not an algorithm and you’re not a machine.
What I appreciate most is how you capture the two parallel jobs we do in those minutes: the visible choreography (compressions, meds, airway, time) and the invisible one (staying anchored enough to make good decisions while your nervous system is on fire). Those early experiences also shape how we lead later; calm voice, closed-loop communication, and making space for a debrief because that’s where meaning and learning settle in.
Thank you for putting words to a rite of passage many clinicians carry privately!
This reminds me of a combination of many of the codes I witnessed as an unlicensed unit assistant in ER and ICU. The one poor fella was ahead of me in line for morning coffee at McDonald's an hour or 2 before. I was in the room asking if he wanted me to contact his family when he arrested. I knew where that big red button was on the console. Until. That. Moment.
Accepting that moment is so important.