Code Sepsis

Hospitals got secrets. Where we buy our kidneys, where we hide our bodies, what that drug that starts with an "x" and sounds like "manex" is. It's what all the locked doors and privacy's about. Not personal protection, but cover for a massive, secret effort by the health insurance industry and World Health Organization to put thimerosal in all the tap water and autism in all your children. We're up to something, and let me tell you: it's gonna be big.

One secret I can share without fear of a propofol coma, however, is the color code system which keeps hospital staff informed of impending disasters while simultaneously allowing all our naive and overly trusting patients to continue wandering about the hospital premises. Maybe they'll wander into a fire, maybe an armed assailant, maybe a chemical spill, or maybe all of the above. It's for us to know and everyone else to eventually find out. In this system each conceived of disaster is assigned a color which is then relayed over the hospital intercom. The most common code is the "code blue" for cardiac arrest -- or as it often is at our facility, old man down in the parking lot. Additionally, however, there are "code pinks" for child abduction, "code oranges" for chemical spills, "code greens" for aggressive, angry person, and, most recently added, "code whites" for aggressive, angry person who is now shooting a gun. Many of these codes are adopted across the country with some variation, but there is one that is relatively unique to San Antonio: code sepsis.

"Code sepsis" is the call for the medical intensive care unit (MICU) team to come and evaluate a septic (severe infection) patient for immediate admission to the MICU. Practically speaking, however, it's the call for everyone in the ER to don their crazy hats and go completely out of their minds. Twenty people surround what need only be a 3 or 4 man intervention while central lines and endotracheal tubes fly about in a mad effort to place the patient on minimal ventilator settings and a random dose of dopamine vasopressor. Sometimes the patient will get antibiotics during this time, sometimes a nurse ends up with a femoral catheter in groin. Once this is concluded, typically shortly after the MICU team has arrived, the crowds disperse in a flurry of triumph and indifference while the staff begin the hard work of incessantly pressuring the MICU team to admit the patient to the unit as quickly as possible lest the chupacabra get them. Eventually the orders get in and the insanity returns to normal levels, but not before there is one last self-congratulatory high five.

So it is with my career currently. Somewhere in mid-December the Air Force yelled, "code sepsis!" and all sorts of rip up your bed sheets, fling your poo craziness has ensued. In the course of completing my residency and determining my future station in life I've worked at three different hospitals, flown to two separate fellowship interviews after sending out dozens of separate emails and making dozens of different phone calls, underwent ATLS certification and a week of military field training, had some vacation, had my computer die, got a shot, got an HIV test, got some lunch, filled out an unholy amount of paperwork only to be rewarded with even more illogical sums of paperwork, created and given a lecture, attended a mid-year evaluation meeting, had my already completed research project randomly chosen for quality control review and then had that review canceled, planned for an upcoming medical readiness training exercise (MEDRETE) in the Dominican Republic, and been booted from a base reassignment process entirely without my knowledge. I have not at any given moment been entirely sure of where I am or what time of day it is, nor do I even really know where this all is heading, but I am confident that, in the end, the Air Force will totally be throwing the high fives all around. They'll have done their job of sticking me somewhere, and I will have been successfully stuck somewhere. Good job guys, the chupacabra didn't get me.