This is one of a series of posts on the strangest cases I ever saw.
“Code Blue, rear entrance to the emergency room.” I was an internal medicine resident on call one night as the medical admitting resident in 1986 when I heard the overhead announcement. The medical admitting resident was the senior resident who decided which ER patients needed hospital admission and what service to admit them to. The medical admitting resident was also the designated leader of the cardiopulmonary resuscitation team when a code blue was called to alert staff that a patient was in cardiac arrest. Along with the medical admitting resident, the other doctors who were required to go to all code blues were the senior surgical resident on call (to put in central venous lines) and the senior anesthesia resident on call (to establish an airway).
At the time, the rear entrance to the emergency room led to the hospital loading dock area. Patients never entered or exited there – it was only used by staff and for delivery of hospital supplies. So, I thought it was a pretty unusual place for a code blue to be called but I ran down the stairs to the rear entrance anyway.
I was the first code team member to arrive and when I opened the door, there was no one there. The senior surgical resident arrived a few seconds later. We both walked out into the loading dock area trying to determine what was going on. We didn’t see anyone so we figured that it must have been a false alarm or was called to the wrong location. So we turned around to go back inside the hospital and it was then that we saw a hand dangling over the roof overhang above the ER rear entrance door.
That roof was about 9 feet above the ground and there was no way to climb up onto it. The senior surgical resident flagged down a guy driving a pickup truck on 12th Ave., by the entrance to the loading dock. He parked his truck under the roof overhang. The surgery resident and I climbed on top of the hood and then on top of the cab of the truck and pulled ourselves up onto the roof.
There, we found a guy who looked to be in his 20’s who was unresponsive and looking pretty banged up with physical signs of severe blunt force trauma. Together, we performed CPR for about 5 or 10 minutes but it was pretty clear that the two of us were not going to be able to do an optimal resuscitation effort on the roof. So, we put a neck brace on him and passed him over the edge of the roof to other hospital staff members who put him on a gurney and continued CPR while rolling him into the emergency department. In the ER, it was pretty clear that no amount of CPR was going to bring him back, so they pronounced him dead. Just before pronouncing him, the ER physician had a portable chest and head x-ray taken. I saw the head x-ray and it looked like an egg shell that had cracked apart after being dropped on the floor.
Later that night, it was determined that he was an inpatient in Upham Hall, the psychiatric hospital that was part of our medical center and located on the other side of the loading dock area. He had been admitted after attempting suicide and was in a locked nursing unit of the psychiatric hospital. The windows of that unit looked out over the rear entrance to the emergency department. Earlier in the evening, he had told another one of the psychiatry inpatients to watch a particular window on the 11th floor of the hospital. Somehow (we never did figure out exactly how), he escaped the locked nursing unit, went in a back entrance of the main hospital, and took the elevator to the 11th floor. Next to the elevator, there was a small window about 4 feet above the floor. He had forced it open, climbed through, and jumped. The other psychiatric inpatient watched him jump and then alerted the psychiatry nurse who then got on the phone to the hospital operator to call the code blue.
After nearly 4 decades of being a resident, a fellow, and a critical care attending, I’ve participated in CPR efforts on hundreds of patients. I’ve taken the Advanced Cardiac Life Support certification or recertification course 19 times. I’ve seen a lot of patients in cardiac arrest. But only once did I have to climb onto a pickup truck to do CPR on a roof.
July 16, 2025
