We might be shopping for groceries, or dinner may already be on the table. We might be snug in our bunks, living beautiful invented lives, in our dreams. When the call goes out, and the tones go off, we scramble to our rigs, abandoning whatever we were doing. There are calls, and there are genuine emergencies. Chest pain is right up there, but a collapse with prior history is a red alert. We move faster, we drive faster, and when we arrive, we run up the stairs. We trot, panting, into the living room or through the kitchen, taking clues from family, finding our patient, assessing him even before we touch him with our gloved hands.
We arrive first, in the aid car, at the address in the mobile home park. A worried, but calm, woman meets us at the door and directs us in. This guy is in the bathroom, a common enough place to have the big one, so frequent, it's become cliche. He's a dark purple-blue and not breathing. I drag him, by his wrists, into the living room, where we will have room to work this patient, surrounded by panelled walls and knick-knacks. We cut off his t-shirt, and this guy is fat. His belly rises above his chest like pregnancy. I start compressions and my partner fumbles for a moment with the AED, the automatic external defibrillator that we carry in our EMS kit.Our new protocol dictates two minutes of CPR before delivering a shock, via the AED. This is a marked change from how we did things in the past. Our instincts and training have always told us to get a shock on board as fast as possible. Now, we are trained to slow down a bit, to perform good CPR, give the heart time to flush out metabolic toxins, in order to maximize the potential for life-saving conversion to normal sinus rhythm. It seems to work, too. My buddy, Mike, on engine 43 brags about a three for three save rate since the new protocol.
"How 'bout some oxygen?" I suggest this kindly, keeping count in a corner of my mind while I form the words. He hooks up the bag-valve mask to the Oh-two regulator.
The medics arrive with the engine company. CPR is hard work, and like any difficult task, we throw manpower at the problem. I'm only into a minute of compressions, and the extra hands ready the monitor, a fancier AED, placing sticky electrodes on shoulders and legs, the large patches on the chest. Tools, medications are readied. One of the medics tries to tube our patient, to put an endotracheal tube into the lungs, a patent airway, a guarantee that we can deliver ventilation. Hands off, I cease compressions to minimize movement. The other medic is trying to find a vein in the elbow, Chad, the pipeman on the engine, assembles the IV tubing and bag of saline.
"It's in!" I place my hand on the big round stomach and feel bubbling as the air is forced down the esophagus, as the BVM is squeezed.
"Feels like it's gastric," I state, wondering if that makes sense. A stethoscope on his chest confirms it, no air is moving in the lungs, the tube is in the wrong hole. It's pulled out and I resume CPR, but we are having difficulty getting air into the lungs without the tube.
"Clear the patient, analyzing," we move back, not touching the body, the monitor recording the absence of electrical activity in the heart. There's nothing to shock, no uncoordinated contractions, no sign that this heart is fighting to survive. "Resume CPR."
Chad takes over compressions, a medic calls the doc at the hospital, laying out the details of the code. He lists the patient's history, medications, interventions, waits a moment, listening, and hangs up. "Stop CPR. What time is it?"
Family is comforted, explanations offered. The body is covered. We pick up the garbage we generated, scattered on the floor. We shuffle our gear outside, leaving the Captain and medics to express our collective regrets.
I've been party to this drama repeatedly, and the tone is usually the same, a hushed reverence when someone ceases living. We habitually distance ourselves from our patients, relating to them as a problem to be solved. We do our best, and, in the end, if it's not enough, we usually shrug it off as that guy's time to go. But deep inside, we know that this man, this woman, had a life before they died, and they leave a hole, however small, after, in this universe. It's a privilege to be present for that pivotal crisis, when a person is facing certain death without our skills. We don't know the past, we can't know the future, but we are there, in that moment, to help.
I attended a memorial this week for my (ex) step-father. It's a complicated relationship to explain, but wasn't in life. He loved me and everyone in his extended, blended family. I went, reluctantly, knowing I'd be facing down a lot of ghosts. My kids were there with their mother and step-father, and my son sat with me. Former in-laws, lost friends, all present in the church where I had been married twenty-two years ago. Family animosities, arguments, and ambivalences were pushed down below the level of the solemnity of the ceremony. We laughed and cried and hugged. I had some cookies and caught up with people I will probably never see again.
Wayman died from a terminal cancer. He didn't pass in a chaotic, heroic minute, it dragged on for weeks, then months. I'm sure he received the best possible care from doctors and nurses during that time, but I wish I could have been there for more than a phone call to Florida. He had a long full and happy life, and we all miss him terribly now.
I'm tired of attending funerals, tired of shaking out my Class-A uniform. I know, as I age, this is only going to get worse.
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