Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

You hear code blues overhead in a hospital all the time, but one on a psychiatry unit is different. A young patient died after a cardiac event, and what followed looked nothing like a code blue on a medical floor. Devina Maya Wadhwa, a psychiatrist, discusses her article “When a code blue happens on a psychiatry unit,” published on KevinMD. She describes the locked oxygen tanks and missing electrical outlets that slowed the response, the coroner’s investigation that opened automatically, and the police interview that felt like an interrogation. You will hear why standard debriefs fall short when staff are trained for emotional safety rather than cardiac arrest, how self-doubt follows a physician long after the incident report closes, and what genuine check-ins could look like weeks later. Wadhwa also names the hypervigilance that settles over the unit afterward and why she believes sharing these stories is empowering and deeply healing. Listen to hear what psychiatric teams carry when a patient dies on their floor.

Partner with me on the KevinMD platform. With over three million monthly readers and half a million social media followers, I give you direct access to the doctors and patients who matter most. Whether you need a sponsored article, email campaign, video interview, or a spot right here on the podcast, I offer the trusted space your brand deserves to be heard. Let’s work together to tell your story.

PARTNER WITH KEVINMD → https://kevinmd.com/influencer

SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Devina Maya Wadhwa. She’s a psychiatrist. And today’s KevinMD article is “When a Code Blue Happens on the Psychiatry Unit.” Devina, welcome back to the show.

Devina Maya Wadhwa: Thank you. Thank you very much for having me.

Kevin Pho: All right, so what’s your latest article about and why did you decide to share it on KevinMD?

Devina Maya Wadhwa: So the title of the latest article was “When a Code Blue Happens on a Psychiatry Unit.” And this relates to an experience that happened as I was the most responsible physician for a patient that suffered a significant cardiac event and unfortunately died on our psychiatry floor.

It prompted me to write this article because of the sequelae of the emotion and trauma, for lack of a better word, that the entire unit faced not only as the physician but the nursing team and, interestingly for me, the patients that really struggled with this event that happened in a pretty young patient. That is quite a tragic event. And I think the reflection was, we hear code blues overhead in hospital settings all the time. However, when that happens on a psychiatry unit, the sensation and the implications are quite different.

And for me, I had never experienced an event where the entire event after the code led to a coroner’s investigation being opened, which is something that has to happen when a death happens on a psychiatry unit, especially a death like this one in a young person that was not anticipated. And also police arrive and interview you as the physician, the primary nurse gets interviewed. A case is opened. So a very different scenario than when you have a code blue and a patient death happening on a medical floor in an intensive care unit setting.

And I think that’s what sort of inspired this article because there was a lot of reflection that happened after it. There was a debrief that happened, but it didn’t feel like this debrief did justice to the environment and the emotional sensation that got created. And in medicine, we expect this to happen all the time, but just not the way it was felt on this specific unit.

Kevin Pho: So you mentioned that because this code blue happened on the psychiatry floor, it was different of course than in a medical floor. Talk more about some of the differences in the contrast of this code blue on the psychiatry unit.

Devina Maya Wadhwa: Absolutely. So on a psychiatry unit, as your audience may or may not be familiar, the rooms are quite sterile in the sense that there is no tubing, the oxygen tanks are locked away, you need a specific key. The arrival of the crash cart can take a little bit more nuanced because of the way the corridors are structured. So for example, just the setting, the bed, the way it moves, you need an electrical cord to plug in that’s not readily available because of safety that is required on a psychiatry unit.

And also the code team responding is phenomenal. Yet they don’t often anticipate code blues in this manner with a patient losing their life to happen on psychiatry units. Nursing staff are also not primed in the way that nursing staff on medical floors would be primed. We’re primed in a way. The environment is a milieu of emotional safety. We’re very comfortable talking about suicidal thoughts, but not a patient losing their life on a unit like this. And I think that’s the fundamental difference where you’re always in a way emotionally keeping people alive and safe. You never expect someone to lose their life on a psychiatry unit.

Kevin Pho: So tell us about how this event affected the nursing staff and the physicians. How did it affect you? The whole staff.

Devina Maya Wadhwa: A lot of emotional shock in terms of, we are used to debriefing safety incidents. We’re used to debriefing patients that try and hurt themselves because they’re so profoundly depressed and suicidal. And so it affected us in the sense that we lost a patient in quite a tragic way, a young patient. And the debriefing was, we were not really skilled to talk about this kind of a loss.

And I think the code team is fabulous in helping, yet they’re so, I don’t like the word used to, but it’s a way for them where they’re responding to code blues multiple times a day. They see loss in this sense multiple times a day. Not the same for the psychiatric staff. There was tears, there was a lot of questioning, did I do something wrong? What did I miss? And I went through that as the most responsible physician who took over care for that patient earlier in that morning.

And that self-doubt, that cringes in those experiences, I think they’re universal to medicine when we lose patients or we have outcomes that are difficult and negative. And I think yet, we’re used to staying in our lanes. And we have a scope, and this was a lane that wasn’t mine. And so it created a lot of self-doubt and questioning as to, am I, I’ll be transparent, am I in trouble?

When I was interviewed by the constable, it felt like, it wasn’t supposed to feel like it, but it felt like an interrogation in terms of, did I do something wrong? So I think that’s the heartbeat, that’s the difference. You often don’t have police showing up when there’s a patient death on a medical floor. Sometimes yes, absolutely. But not often. And I think on psychiatric units, it’s routine.

Kevin Pho: So you said that there was a debrief for you and the staff afterwards. What was that like?

Devina Maya Wadhwa: I think there’s, for debriefs, there’s all this evidence around post-incident debriefing. Is it good, is it not? I think our team was just really rattled by the entire incident, so I don’t think the debrief was productive, to be transparent, because it was more like, check in, are you OK? And I don’t think the, are you OK, really gets processed until probably days after, or when you’re starting to look at the coroner’s report.

So yes, in hindsight, the process was done, we went through the motions, but the emotional impact, I’m not certain that it had high yield in that moment. I think the emotional impact came from weeks later where I reflect and I write. That’s one of the ways I process things, and certain things feel meaningful to share. And that’s why I decided I wanted to share this article on your platform. So I think the processing has happened and is continuing to happen today as I’m speaking about this with you. And I’m hoping it will be helpful for other psychiatrists or other physicians that are not in the lanes where they see code blues and loss firsthand.

Kevin Pho: There’s a certain amount of irony. Of course, you have a psychiatric staff where very emotional needs weren’t met after this code blue. What would you have liked to see happen under ideal circumstances?

Devina Maya Wadhwa: I think, yes, an immediate touch point. That day, potentially the people that were impacted, could have been, if you’re not doing OK, please go home. And I know I had a whole patient load to take care of, and I moved through the day in a numbing fashion. I can’t remember the day. And I’m not making this sound like it’s a big T traumatic event. I think in medicine we all go through this all the time. Incidents happen, they affect us, but we’ve got this training mindset where we kind of cushion it, we put it in a ball, we hide it somewhere, and we get through, and then hopefully we process it down the road. A lot of times we don’t have the time to process it down the road.

So ideally, yes, a good check-in. It’s difficult to send people home because there’s already a shortage in health care. So who’s going to look after those patients? And then I think down the road, another touch point would have been really, really helpful. Not just for myself, but for the staff.

One great thing did come out of it. We looked at our crash cart. We’ve looked at where did things go inefficiently, how can we improve? So that’s a productive thing that came out of this really tragic event, but I think emotionally, I don’t think a lot of productive things came out of it.

Kevin Pho: So emotionally, how did this event change the nursing staff? Just from your observations, have you noticed any difference emotionally after the event in terms of how they interact with patients or your interactions with them?

Devina Maya Wadhwa: I think we’ve all, this often happens when you lose a patient to suicide, but in this case it’s much more hypervigilant, and this was really a tragic sudden death that unfortunately would have happened. But being mindful about vital signs, are the investigations done? Just because this patient is admitted to psychiatry doesn’t mean that medically they’re well and stable. Right? So there’s this added touch point that a patient being admitted to psychiatry, are they medically OK? It’s not that they’re suffering from psychosis or they’ve used stimulants and that’s the reason. Are they medically OK? And I think as a team, we’ve become a lot more hypervigilant in terms of making sure that that piece is hyper met.

Kevin Pho: So I guess in terms of messages and lessons that other staff has gone through, what could they learn from this event? Because I think that you yourself, of course, you mentioned what you’ve learned and the support that you needed to process through it, and other staff who’ve gone through similar things like watching a code blue. And this happens so many times that we think that it’s routine, but it really isn’t. Right? Each individual event has an emotional toll that it has on the staff. What kind of advice do you have for the staff to help process this event, like you said?

Devina Maya Wadhwa: I think taking away the shame and the stigma and talking about it. Again, I was, nervous is an overstatement, but I was a little bit hesitant today in terms of, there’s an emotional vulnerability to say, this affected me. I was thinking about it. I was more hypervigilant, I was scared that I did something wrong. And I think just vocalizing that and sharing our emotional burdens that we experience in medicine, I think is deeply healing. And it ties into my hat as a wellness advocate for physicians and my interest in physician wellness and burnout. And I think that’s the messaging, which is why I am here today in terms of, I think sharing our stories can be quite empowering and deeply healing.

Kevin Pho: Thank you again for sharing this story. In terms of immediate support, like you said, you’re a psychiatrist, so you’re leading a team, but you yourself, was there any formal, immediate, emotional support for you as you were processing this event?

Devina Maya Wadhwa: I would say sort of yes, informally. The yes informally hallway check-in. Are you OK? How are you doing? OK. So yes. And if you ask me what could more formal support have looked like, are you OK, but not just the one, are you OK. Down the road, that continual, are you still doing OK, where are you at? I think could have been really helpful.

And a big safety incident report came out of this, and each touch point I was like, have I made a mistake? Is there, am I to blame for this incident? And I think sometimes that gets lost in terms of the physician just swallowing all of these self-doubt feelings. And I think we all face them as physicians when our patients have bad outcomes or terrible, tragic things happen to our patients. And I think that’s the question in my mind, how can we do better in terms of the, are we OK, being a little bit more consistent?

Kevin Pho: We’re talking to Devina Maya Wadhwa. She’s a psychiatrist. And today’s KevinMD article is “When a Code Blue Happens on the Psychiatry Unit.” Devina, let’s end with some of your take-home messages they want to leave with the KevinMD audience.

Devina Maya Wadhwa: Being vulnerable about our struggles in medicine is extremely important. I think it empowers us as physicians and also helps the next generation learn how to not take these deep outcomes that happen to our patients home with us, and knowing that yes, bad outcomes happen. It’s not normal though to lose patients. It’s not normal to have a code blue happen. These are exceptional circumstances that we are exposed to every single day, and I think talking about it can be really empowering and healing.

Kevin Pho: Devina, thank you so much for sharing your story, time, and insight. Thanks again for coming back on the show.

Devina Maya Wadhwa: Thank you very much.