Five Dies: One night, 5 cardiac Arrests

2016. First night shift of four. Med Reg. 12-hour H@N cover. AMIA, Cardio, Gen Med, Thoracics, Vascular. Roughly a quarter of the hospital was mine.

Pager buzzed at 11:27pm. First arrest.

Arrest 1 – False Calm

11:30pm. A post-PCI patient. Cardiology SHO was already in the room. I got there, just in time to catch the end of the first cycle. Chest compressions. Tight rhythm. ROSC after one cycle.

There was a weird calm to it — almost clinical. Cardio took over. Fluids in, adrenaline given. Patient stabilised, bundled to CCU.

The SHO cracked a joke about the “good omen” of a straightforward save. I laughed, but my gut disagreed.

We forget how a "clean" arrest can lure you in. It’s rare. It gave me false confidence. The kind that makes you second-guess your own cynicism.

This was the warm-up. Not the story.

Arrest 2 – The Spiral

1:33am. Vascular ward. Male in his 60s, recent femoral endarterectomy. Suddenly collapsed, pulseless, blood pissing everywhere from new wounds made newer.

Go through the motions; ECG pads on — VF. The nurse looked me in the eye: "how the fuck is this shockable?"

I led the arrest. One, two, three cycles. Shocks delivered. ROSC after 12 minutes.

But something was wrong. SpO₂ never recovered. GCS never returned. Lac 12. Arterial blood like Coke syrup.

ROSC yes - but this one wasn't a rescue; this was an extension of the inevitable. A courtesy run to the next of kin. Someone had to say we tried.

We phoned the family. They’d already gone home. Consultant contacted - all covered for but thrombolysis and that was a given no.

I stood in the corridor while the nurse quietly cleaned around the body. He went while they turned him - classic.

I made a note. “Post-arrest, deteriorated. No further escalation appropriate.” We call this clinical detachment. I mumble something about making ACPs in the daytime and beg the domestic for a coffee in a plastic cup.

Arrest 3 – The Ghost

2:28am. Gen Med. A young woman, mid-30s, long psych history, catatonia noted earlier in the day. Didn’t know that going in, naturally. She was just a patient for now.

HCA had found her "not breathing" and "unresponsive."

CPR had already started when I arrived. The SHO was pale. O₂ monitor off the finger.

As I moved in, she flinched.

She flinched during compressions.

She’s fucking speaking.

I asked the SHO to stop. She was tracking us. Eyes open. No chest rise, but conscious. Apnoeic, but aware.

It was a pseudoseizure. The second-worst kind of arrest: the one that isn’t.

The shame creeps in quickly. The nurse who started CPR is mortified. But she did what she was trained to do. We all did.

No one wants to get it wrong. But the fear of not doing enough often trumps the fear of doing the wrong thing. That, right there, is one of medicine’s worst tugs-of-war.

Arrest 4 – The Quiet Collapse

4:41am. Ward 7. General Medical patient, IV potassium. Chronic liver disease, low albumin, multiple comorbidities. Nurses said he’d become “more confused” since 1am.

When I arrived, he was unresponsive - another one I thought in a very sociopathic way.

VT. I don’t remember much of what I said, but I remember what we did: adrenaline, CPR, ABG.

The gas told the story. K+ 1.4.

This man had been sweating out death for hours and only getting dribbles of fluid to feed off in return.

We got ROSC after two shocks. We LMA’d him. Sent him to ITU. Consultant wasn’t thrilled about the outcome — but didn’t argue at the time - his politics to sort.

I spent ten minutes post-arrest writing notes that felt meaningless. It’s a strange paradox: doing everything “right” and still feeling like you’ve done something wrong when you’re pointing out what someone else may or may not have done right.

I stopped in the corridor. My head was pounding. I hadn’t eaten since 5pm yesterday. I wanted to lie down in the sluice room and not come out.

Still got half of acute medicine to review. I grab a Junior with excellent handwriting and decent shoes and we go for a speedrun.

Arrest 5 – The One that Should NOT have been so cool

7:18am. Final insult. This one I laughed when it went off - now you really are taking the piss

Post-CABG patient, 60s, found collapsed in the toilet.

No obs. Clearly dead. CPR started. By the time we got there, a nurse had dragged her out and was yelling for help. No airway. PEA.

We do the needful, start the cycles, hog lift her poor, limp frame onto a bed like she’s already a corpse.

Thoracics was called. Daytime team in so handily handed over.

Consultant arrives — furious. There’s shouting. Decision-making. Eventually, the decision is made: open massage.

Surgeon pushed me out of the way, whisked surgical trolley in in, as sterile as possible, gloves.

Staples out in a matter of seconds.

Click

Click

Click

Crack

I’ve never heard a chest make a noise like that. Like wet sticks underfoot in mud.

I'm sort of ashamed to admit that it was, without a doubt, really cool. I held an unchallenged fluid challenge with Gelofusin and watched - rapt with dark fascination as this poor woman expired in front of me displayed like an H.R. Giger exhibit.

We all knew it wasn’t going to work. You could feel it in the silence between "compressions" of a quivering, rapidly blueing heart. Drama increased as things went on - Nurses refusing to leave, grand statements of claiming "she's mine - I need to see this through!".

It was madness.

We stopped. No ROSC. Time of death called. The consultant walked out without a word. The nurse sat down on the floor in the corner. I went to the Morning debrief with a wild story to tell that would make me look like an absolute monster.

Processing that - I felt unclean at my own glee.

Reflection: Surviving the Night

I learned a lot that night. Not all of it useful.

You learn that systems don’t care if you’re tired. Arrests don’t time themselves around your cognitive bandwidth. The same pager that gives you a stroke call will give you a sepsis six alert 90 seconds later.

You learn that not every win feels good. ROSC isn’t always recovery. CPR isn’t always care. And no-one is safe from error.

You learn your team is everything. It was the ANPs, the nurses, the SHOs, the random HCA with a calm voice and a glucose gel in her pocket — they made that night survivable.

You learn to hate the term “resilience.” What we do isn’t a resilience issue. It’s a systems issue. But if you survive, you will be labelled as resilient. Which really just means you didn’t quit.

You learn it's ok to be part of something gruesome - it's all learning and experience but it's worth being comfortable with that discomfort. Doctors/Nurses/Medical types are who they are for a reason - we are interested in this stuff.

Conclusion: You Don’t Need to Be a Hero

You need to be human. And maybe get to breakfast.

Five arrests in one night is an outlier. But nights like this aren’t becoming less rare. The system is strained, and the pressure points are people. I’ve said it before — burnout isn’t about strength.

It’s about attrition. If the system keeps eroding your time, your confidence, your sleep, your hope

— you will crack.

And when that happens, I hope someone looks after you as well as you looked after your patients.

In the end, it actually became funny. When people fired at me for not being somewhere else it was self-evident and unchallangable, and it allowed me to do some independant decisions and re-prioritising that worked well.

Stay human. Stay hydrated. And if your pager goes off again — take a breath.

Then run.

DW