A DIFFERENT TYPE OF CODE BLUE

 

The eighth hour had crept up and I had just had my dinner break. An afternoon shift in Emergency is always full systems go from arrival and has to be approached at speed.
 I bounced from cubicle to computer, from trolley, to resus, from computer to triage all afternoon. The investment in my “walking” shoes and comfort wear scrubs is a small win when dealing with all the discomforts of human life at its most vulnerable time. As fatigue set in, I settled in the tea room with left overs and a cup of tea to refuel and wait for my second wind to hit.



 

Sitting briefly to catch up on notes, a couple and their baby were directed into the cubicle right in front of me. Mum was off loaded from the ambulance trolley. Baby Jane’s cry placed her as an infant to my maternal ear and I waited with curiosity for the triage to pop up on my screen as the nursing staff buzzed around Mum and took some obs. 



 

“Dad concerned for wife’s welfare……” Mastitis? Retained products? Post Natal Depression? 



 

I clicked on her name, placing my own next to hers onscreen formalising our relationship and gathered myself for entry into the lives of strangers. 
I did not take this privilege lightly. 



 

As a female doctor in scrubs and stethoscope hanging around my neck, the all too often comment at the end of my history and examination is “when is the doctor coming?” It always reminded me that my patients may not recall my title or name in the chaos of the emergency department, but my impression will be palpable… I hope.

 



“Hello Sarah, my name is Rebecca and I’ll be the doctor looking after you.” 


 

Nothing.

 


“Hi my name is Steve, I’m Sarah’s husband and I called the ambulance.” He nodded his head as he held baby Jane unable to reach for the usual handshake, looking decidedly awkward. 



 

I spent the next 20 minutes gathering a full history of a highly competent couple that craved the blessing of a child. Medical history of Sarah and delivery history was unremarkable. When granted the blessing, their world did not fall into place as it should have. Sarah did not bond in the same way Steve did, yet she conducted her duties with efficiency and accuracy. The last three days though atheist Sarah started to voice reasons why God was unhappy with them, and spoke of bringing Steve back to her. There was no mention of baby Jane and tonight on arrival home from work Sarah was no longer herself.

 



Sarah just stared blankly at us, disconnect as her eyes grazed over the parcel in Steve’s arms. Her fingers felt for something on her left hand and I noted the tell tale sign of whitened skin where wedding rings might have been. 



 

Our eyes locked “Missing something there are you Sarah?” 
“My rings” she answered. “I had to swallow them to bring Steve back to God, back to our marriage and away from evil.”



 

Post Natal Psychosis in florid form had taken his wife from him and broken his trust in his own mind. He was visibly broken, lost and shaken to be fronted with such a cruel, insidious disease. He held his baby daughter and we discussed how he was to feed her and I did my best to reassure him that formula will be ok. Sarah’s medication will not be compatible with breastfeeding. 



 

The confusion was recurrent as with each explanation I allowed time for his mind to adjust that Sarah was not going home with them tonight. That Sarah would not be caring for Jane tonight. That Sarah was not physically sick, but ever so desperately ill. 



 

There was no insertion of tubes, teams of staff or rush of adrenaline to accompany this life threatening presentation. It was in the quiet despair of a husband and the fearful stare of a mother that lay a different type of code blue.

 

Dr. Rebecca Wolf