"…further measures of resuscitation would be futile … do you concur, doctor?"

A phrase I thought was reserved for geriatric specialists, palliative care physicians, internal medicine hospitalists, and critical care docs. It hit me like I imagine a phaser gun would out of a science fiction novel. The words seemed to ram a shockwave with rippling effects through my reality.


I was called to the ER that morning. It was an infant in cardiac arrest with the paramedics doing full CPR en route, could I come immediately? The only time I've run as fast was once before when they paged the team overhead immediately to the Operating Room (unlike TV drama, an overhead page to the OR/ER is a rare occasion, pagers are generally used). But this time was just as critical, to say infants rarely have cardiac arrest is a gross understatement.

I arrived into the middle of a full code, Dr. R was at the helm. I asked where were we were in the process, and looked over to see the scribbles of epinephrine given. I looked over to see the interosseous line, and the chest wall response, but what struck me was the color and appearance of the infant. My first *Blink* response was, "we're too late, it's been too long." She could have easily been a mannequin and this could have been a mock code. I reached over to verify my instinct, and the cap refill was so delayed, I'm not sure it ever returned to its original color. The skin felt like cool rubber, not the soft resilience we anticipate the perfect skin of a young baby to be. We were in the middle of a med push, and Dr. R was checking cardiac response at interval. The guardian arrived, so feeling the current progress sufficient, I spoke with the aunt. Verbal hysteria was directed by a few well placed questions, I needed to know what could help us direct the remaining treatment with intentionality. I had nothing to give her in comfort except that the team was doing their best help the little girl's heart. I returned to the bedside to see a new tube being placed. Cardiac monitors still erratic with artificial heart beat wave forms. All the meds had been tried, we were running out of options. We couldn't even attempt electrocardioversion, her heart was so unresponsive. I recounted the history of the morning with Dr. R, and we reviewed our options. I asked a few questions whose answers satisfied me that everything had been tried. I looked up at the clock, and it had just been over half an hour. Reviewing everything that had been attempted, at the best case scenario, this baby had been receiving CPR for over an hour and a half. Worst case scenario, her brain had not received oxygen for almost 3 hours. She should have grown up without any complications. Her history was clear except a slight premature birth. She should have learned to crawl in 7 months, learned to walk in about a year like they all do. Learned to say no, and take piano lessons, reduce fractions, parallel park, and make it to a prom. All before she leaves her doctor's practice.

So when Dr. R posed the question, I realized that I was the second doctor. I looked around the room, and I was the youngest man there, and the only other physician. Despite the seasoned experience of the respiratory therapist securing the airway, and the dignified gray haired gentleman who was a physician's assistant coming to run a case by Dr. R, it was incumbent on me to agree with Dr. R's decision that enough had been done. I thought, well, maybe I only hoped, this was for other people. Even the crash c-sections in the past had all resuscitated well, and with a little work and my very able staff, they came back to see me. But the question was posed, "… further measures … futile … concur?"

I knew the probability of survival was low, but this wasn't a geriatric patient with multiple MI's or a PE we were talking about. From the phone call until now, I had bent my mind with such determination to make the next step in attempt, reviewed where we had been, sparring almost, with Dr. R, to make sure we had taken the right course, then probing my repertoire of options to synthesize another endeavor. I remember stepping from the charting nurse's clipboard to assure myself of the attempts made, then spinning a slight left to face the monitor, seeing the flat line when the cardiac response was checked, and in my recollection a blur. Then the words. Futile? Concur? And realized that we had been trying, as a team, for more than ninety minutes.

Until then, we had been speaking with each other and our team members with the efficiency and clarity that comes with a focus of urgent duty, but when Dr. R turned to face me with the question, it sounded like someone else was speaking, like I was in myself but somehow different, almost an auditory blur. Everyone else seemed to fade out of consciousness, and it was just the two of us in the room, deciding if we were done. It took a little time to have it sink it.

My options had run out. My response was weak, not because I was unsure of my duty as a doctor, but because my mental movement had been clipped. I was being asked, essentially, to concur that we had run out of options, that each contingency plan had failed. It was this fact I found so exhausting about stopping a code. The futility was draining. My words, "I concur" were an acknowledgment.

After today's events, I couldn't just leave it at that. It occurred to me, as God had often used the analogy of healing with that of our redemption, then today's efforts are a marked comparison to these end times. Maybe two thousand years ago, we were cripple and blind. But today, we're crashing and about to flat line. The gentle touch that would heal a despairing soul, Christ now replaces with the urgent direction of an almost desperate Physician. Desire of Ages tell us that though some methods may seem harsh to us, there is no other way to arouse us to our condition. The extreme measures He takes with us we must see as an indication of the dire position we are in, to the extent that only God can see. Why must He afflict us with pain, why must we endure this loneliness, why must we face the harsh censure of the people he places in our path though they may claim to be Christian? He does these acts not out of a desperation of His own inadequacy, but out of a desperation bred from our own inability to see. If we could only see our failing heart and cooling limbs, we would let Him have His way with us in every aspect. Oh, our arrogance as a people, as a race, a denomination! Oh, if we could know that God is running the code for our resuscitation, for our redemption. And it may not be the gentle endeavor our crippled minds wish to perceive. If we could only see the costly effort Christ is putting into our salvation, not just at the cross, but even now in the heavenly sanctuary, we would trust Him a with reciprocating desperation.

So maybe it hurts now. Chest compressions hurt. And maybe it's painful. Intubation can be painful. And maybe we're crying tears no one else can see and we don't understand. Then now is the time to believe like no other, because we're coding now. But Christ is at the helm.

Romans 8:32 - He that spared not his own Son, but delivered him up for us all, how shall he not with him also freely give us all things?

I want to ask God for a faith that only He can give.