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A Prayer for These Hands By Anita Vasudevan, MD from the Writers' Workshop
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K
araagre Vasate Lakshmi, Karamadhye Saraswati
Karamoole Tu Govinda, Prabhaate Karadarshanam I learned this daily prayer from my grandmother, a mantra to start the day, chanted looking at your hands as soon as you open your eyes in the liminal space between conscious and subconscious. The prayer is a pilgrimage around the palm, naming the presence of three Hindu deities at each aspect: Goddess Lakshmi in the fingers, Goddess Saraswathi at the palm; and Lord Vishnu at the base of the hand. By drawing upon their energies with the focus on my hands, the organs of action, I set an intention to myself and the universe at large: May these hands do something good today.
A code in the hospital is short for code blue: a code for a heart that has stopped beating without warning. It is a call to action for the designated team of doctors, nurses, and pharmacists to resuscitate this heart, ideally before the owner of the heart truly turns blue. The overhead system at my hospital is primed with the grating screech of a microphone caught by surprise when it is about to announce such a code. The shrillness of that sustained alarm silences the whole hospital and steals my breath.
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There is a brief pause, a moment to exhale while my hands reflexively check for my stethoscope before the speaker blares, “ADULT MEDICAL EMERGENCY,” ...followed by exactly where in the building I’m supposed to appear. On my second day as a senior resident in the intensive care unit, that dreaded alarm rang, and I took off to the stairwell, running the code algorithm in my mind. Was it two rounds of chest compressions before the epinephrine? Or three? I arrived at the patient’s room, the curtains in front of the doorway already drawn back, the drapes of the windows pulled up. Light from every direction poured onto an elderly woman, the snaps of her patient gown hastily undone, exposing her bare body as she lay on the hospital bed, the sheets crumpled and stained with unabashed shades of brown bodily fluid. The putrid stench of fecal matter wove through the fine mesh of my respirator mask, slightly delayed like thunder after lightning. “What’s going on? Does the patient have a pulse?” This was the opening line at the mock code I had attended three months prior. “None,” her nurse reported. Another was
starting chest compressions. I got out my timer, ready to issue commands, when a voice from behind me called out, “She’s DNR! No code!” Do Not Resuscitate. A fist clenched my stomach. No code? Why were we resuscitating her? I could sense the arrival of others on the code team: more doctors, nurses, and the pharmacist filing in behind me. “Oh...so let’s stop compressions?” I had forgotten to announce myself as code leader, maybe in part because I felt like an imposter giving myself that title. I had only seen a handful of code situations, and never had I led one. But I was the first doctor in the room, and apparently was issuing enough authority that two others were looking to me for direction. Then from behind, outside the room, another voice: “No! They switched! She’s full code now! Continue CPR!” Codes are somewhat of an “act first, ask after” situation. You show up to the room with the intent of reviving a pulseless patient. You aren’t privy to their name, age, medical history, or what even drove them to a pulseless state, much less their hopes, dreams, or fears. I was once given the advice that anxiety about doing something wrong
