The smell of death is sour.

I remember the first person I saw die.

I'm unsure of whether or not he was already dead before I got there. His pulses weren't palpable by that point and the only thing perfusing his organs was dr's and nurses pumping at his chest while yelling out orders for epinephrine, atropine and the rest of the ACLS protocol trying to restart his heart. All I remember is hearing the code, rushing to the room amidst all the other medical staff, seeing his roommate being wheeled out of the room, him laying on the ground in a pool of blood and the smell.

Death smells sour. It smells sour, putrid and vile. It's a smell that you'll never forget once you've been acquainted with it (kinda like C. diff... peeeuu!).

A code (and a trama) is like nothing you've ever seen. There are a gajillion nurses, techs, dr's and students running around trying to get all the things necessary to save someone's life. People are shouting, drugs are being passed around, IV lines are being secured, airways are being evaluated, etc etc. Every person has a role, and whoever doesn't crowds around the doorway ready to step in the second their needed.

Yesterday there was another code in the SICU. The first of our patients in 3 months to full on code, during transport no less. He stopped being responsive in the elevator from the telemetry unit en route to the SICU and the rush began. I heard the code while trying to get blood for some routine labs and booked it down there.

I saw the crowd as I ran up to the room and saw one of our interns pumping at the patient's chest while others we setting up a femoral line and doing the other necessary things to bring the patient back. The second I entered the room... I smelled it. It was like the first time only this time i knew what it was. I took over compressions putting my entire body weight on the man's chest. I felt one of his ribs break, I noticed my bangs getting into my eyes, and watched as his oversized obese belly flowed with every thrust I put into him.

I barely heard as the nurses shouted what drug was being administered next and watched as one of the residents attempted to insert a chest tube only to be greeted with a large stream of blood the second he entered the thoracic cavity. I can still see his eyes get wide as he stuck his entire finger into the hole to plug the faucet like rush of blood while he muttered "something's not right." I remember staring at the patients face... and remembering how blue he looked, "just like the first one" I thought, as someone started pulling me away from the body "switch out and take a break! You're panting." And someone else took over, as I wiped my forehead and realized I was covered in blood.

We kept doing compressions for the next 45 minutes, I administered epi, atropine, bicarb and etc during the breaks from compressions in an attempt to get his heart back on track. I watched as the attending removed clots of blood by the handful as he tried to clear the cavity for his lungs. He died at 11:37AM, due to a pulmonary artery rupture. He had no chance. The blood we gave him to bring him back was going in and being pushed right into his chest, they could feel the cold blood being put in come right back out... and all I could remember was the smell.

I smelled it on me all day. I washed my hands at least 30 times, afterwards before eating, during eating, etc etc. I could barely finish my lunch because I smelled it on me... it was... there. Ugh it was awful.

I hate it.

Medicine is only fun when you save lives...