There is an eerie feeling in the room before you receive a patient who is in cardiac arrest.  Sometimes, you don't know it's going to happen, and there's no time to prepare, no time for the eerie feeling.  But sometimes, especially in the Emergency Department, you get that call from EMS, the "CPR in progress" call, and you know it's coming. 

Everyone switches gears from normal ED business to preparing for this patient to arrive.  Jobs are assigned, gowns and masks and gloves are put on.  Someone prepares to manage the airway, someone get ready to put in lines, someone manages drugs, a couple people get in line to do chest compressions.  Every detail is planned and assigned so that as soon as the person hits the door, everything gets done.

And then, you wait.  Silently.  Everyone knows what's coming.  Well, you know a person is coming in dead.  Our job is to try to bring them back to life.  Maybe that's what everyone is thinking about while they stand there silently.  Maybe they are thinking about their job, working through each step in their head so they don't miss anything.  Maybe they are thinking about the person who is coming in, a 55 year old dad who had a heart attack, or a 33 year old mom with cancer, or a 95 year old great great grandfather.  Maybe they are thinking about the family they will have to talk to after it's over.  But everyone is thinking about something.  And the room is in asystole.  Still.  Silent.  Pulseless. 

And then the patient arrives, CPR in progress.  You move them from one gurney to another.  Someone takes over chest compressions, someone puts the pads on, someone starts more IV's, someone puts in a central line, someone takes over the airway.  The room comes to life in an effort to do the same to the patient.  And you either succeed, or give up.  At some point, you have to stop.  You have to decide that there's no hope.  You watch them go into asystole, flat line.  You call time of death.  You tell their family their loved one is dead.

Last night, it was an 11 year old boy.  How he died doesn't so much matter.  He went through the same process.  We did CPR.  We pumped on his chest, pushed drugs, intubated him.  At some point we had to give up.  We called time of death.  We told his family.  And then we went back to the rest of the patients. 

But you don't forget, the silence in the room before you get what you know is coming, or the stillness after it's over.  You don't forget the asystole.