Run the Code

I’ve been working with a couple of young leaders whose organization is going through a major crisis right now. Their teams are freaking out, and given what’s going on, you can’t really blame them. When all hell is breaking loose, how do we get our teams through to the other side? I think we can learn a few lessons from a situation we’ve all experienced, that arrives out of the blue, and that is literally a matter of life and death: the code.

Most of us have witnessed codes that are run well and those that aren’t. The difference, more often than not, is the leader of the team. Think about the kind of person you’d want in charge if your life, or the life of someone you love, was at stake. What characteristics would they have? How would they act? 

Whoever is running the code needs to exhibit an appropriate level of gravity. This is serious, urgent business, and we have to treat it that way. But despite the urgency, the leader has to stay calm and focused. There’s nothing worse than a code leader who seems scattered, frantic and unprepared. The first pulse you check should be their own. Move quickly, but methodically. Demonstrate, by your own demeanor, that the moment isn’t too big for your team. You can do this. 

In a well-run code, everyone has a clearly assigned role. Only one person is doing chest compressions at a time, and they need to be able to tap out when they’re tired. Someone else needs to be bagging. Someone needs to start lines, someone is charging paddles, and someone else needs to draw up meds. Everyone needs to know their role, and they need to work together without getting in each other’s way. The choreographer of all that is the team leader. 

You need a plan, and you need to focus on one step at a time. Airway, breathing, circulation. Get a rhythm. Shock. Reevaluate. The situation is changing quickly, so you can’t get too far ahead of yourself. Assess the situation, respond as a team, assess again.

When you can, take care of the caregivers. My first code as a medical student was a horrible cardiac arrest on a young trauma patient in the ER. He arrived flatlining, and he never came back. Afterwards, one of the senior residents came and sat next to me. We didn’t say much, but there was comfort in knowing I wasn’t alone in everything I was feeling. 

There’s no such thing as a “good” code. Even if you resuscitate the patient, they’ve been through hell, and they’re on their way to the ICU with no guarantees that they’ll make it through the night. But when faced with a sudden, traumatic situation, all you can hope is that your team rallies and meets the moment with the best they can offer. A lot of that is up to you.