What happens during a "Code Blue" in a hospital? (photo from Riverside Methodist Hospital) Most laypeople know the drill because they’ve seen it all on television. But a provocative essay by Dr. Katharine Treadway in the New England Journal of Medicine (September 27, 2007) gives us a deeper insight into something critical that has been missing. The essay was brought to my attention by one of America’s great, caring nurses. Sarah Kaminski, R.N.,B.S.N., L.N.C, of Greenville, South Carolina, campaigns tirelessly for Radical Loving Care in health care. If you, as a caregiver, are seeking to understand more about the real meaning of medicine, read this essay by Dr. Treadway. (http://content.nejm.org/cgi/content/full/357/13/1273)
   In it, this physician tells the story of attending one of her first "codes" as an intern. The senior resident took charge, she tells us, and he was a model of cool competence. But the patient died anyway and one doctor knew something else was wrong….

   "We all stopped what we were doing," Dr. Treadway reports, "and then, as though the whole
episode had been some minor distraction in our otherwise packed day,
we filed out of the room. We were no longer involved."
   Something was clearly missing, she thought. But what was it? In several subsequent codes, the same ritual was repeated. If the patient died, all of the caregivers, as if they had suddenly been fired from their jobs, wandered off to do other things. This abrupt detachment troubled Dr. Treadway (photo at left.) For several moments, a team of caregivers had been working frantically together to save a life. Upon "failing" the  team disbanded as if they’d been working on a broken car instead of working to save a human life. This disconnection left Dr. Treadway deeply disturbed. How could those who so dedicated to saving a life be so uncaring when the code was "called."
   To her enduring credit, Dr. Treadway persisted where so many thousands gave up. She determined to add something simple but powerful to the code experience. But what could it be? "How different might those codes have felt" Dr. Treadwell writes, "if, at the end, having
declared, ‘The code is called,’ the resident then said, ‘Let’s have a
moment of silence to honor this life.’"
   How humane. How revolutionary.
   When we wonder about the causes of caregiver burnout, we may need to look no further than this example. When caregiving is treated as a transaction, burnout will occur because transactions really don’t matter the most. It’s relationships that count. And Dr. Treadwell’s suggested ritual is a call to each caregiver to remember that caregiving is about human beings, not about technology and procedures. Systems are there to enable helping human life, not to crank out a transaction that will generate a bill.
   Dr. Treadway uses another line of her own when she is present at a patient’s passing. It is a line she recalls from her childhood: "May choirs of angels greet thee at they coming."
   It is people like Dr. Treadway who teach us the essence of sacred encounters. They show that there is no path to love. Love is the path.

   Can you help bring about this change in the code ritual at your hospital, nursing home or hospice? Let us know.

-Erie Chapman