Monday, September 24, 2007

- Old Hands

Lifeless eyes stare through the ceiling as my partner does compressions. The bicarb we pushed in a little while might be helping out because even though we don't have pulses yet, our patient has reached an organized rhythm. My partner, the new one, is getting tired quickly. This is the first time she's ever performed CPR on a real person.

"Get your shoulders over the chest a little more. You want to be at a 90 degree angle" I coach her.

The other paramedic squeezes air into the man's lungs.

The patient in question is a 51 year old former employee of the company I currently work for. He had moved into our service area recently after starting his own safety business. We've called in the chopper and are on our way to the LZ across the bayou.

My partner is starting to tire out, so I tell her to take over bagging and I take compressions. The other medic, who I went to paramedic school with, pushes in another epi. I feel the burn start in my shoulders as we pull up to the LZ. The Flight Medic opens the back doors, looks inside. The man on the stretcher was his partner for 2 years, back when he was still on the truck.

"Fuck. What we got?"

I give a rundown of the patient - 51 year old male, told his wife he was having trouble breathing, dropped. CPR almost from the moment he hit the ground. All we've had on the monitor is PEA.
IO drilled, number 7.0 tube, almost done with his first bag of fluid, 6 epis in, maxed out on atropine, bicarb in, d50 in, narcan in. Hypertension, didn't take his meds, no allergies.

The Flight Medic loads up the patient. The other paramedic flies in with him.

The man doesn't make it. They lose the rhythm shortly after takeoff and don't ever get anything back. They later say it was due to a massive infarct.

I wipe the sweat from my forehead, walk back to the cab of my unit, pick up the phone. Could I've done anything different? I run through my algorithm in my head. I treated the hell out of him.

The funeral service is well attended.

I walk out of the funeral home, run into the Flight Medic. He and I aren't on the best of terms - I don't think he's a very nice person, and he has a lot of disdain for the paramedic factory that I was churned out of, which I don't blame him for. Some of my class mates were less then stellar, and some of those were less than competent.

He takes a drag from his smoke.

"I was really mad at you, MedicMarch. When they called him, all I could think of was that you did something wrong, or fucked up somewhere, and it was your fault he wasn't coming back. I was looking for someone to blame."

I stand there silently, wondering if I'm about to get hit.

"Then I thought about it a little more. Thought about the report you gave me." He points inside. "Thought a lot about him. He never listened to his doctors."

He takes another drag. "I just wanted to say I'm sorry about that. You did what you could for him, and I'm embarrassed for having been mad at you. It was very unprofessional of me. I'm sorry." He sticks his hand out and shakes mine.

I walk to my jeep and get in, rest my head on the steering wheel for a moment. At home that evening, I am sitting on my porch, and I pour a little of my beer into the garden. One for me, one for my homie.



Ambulance Driver said...

Damn, another brother lost. My condolences, MM.

I understand why you worked him so aggressively, but flew a code??


Medicmarch. said...

No real justification other than it was someone we knew, and we weren't ready to quit on him. By helicopter the nearest hospital was 6 minutes away, by ground it was twenty five or thirty. When we had realized no one had canceled the chopper he was in asystole, and I think the flight medic just wanted to get him to a hospital. I realized in hindsight maybe the air resources might've been better used on someone else or possibly not utilized, but the chopper was already on the ground at the LZ when we left the residence. We're supposed to not get too emotional on scene for stuff like this, but it's different when you know the guy. The flight medic was senior and he made the call. If it just would've been just me on scene I probably would've more inclined to work him in the house, but by the time we got on scene (we were the backup unit) they were already bringing him outside and I jumped on board the rig with the other medic.

We probably should have driven him in, but...well shit. Hindsight's 20/20.I know it's hard to work a code in a chopper.

I remember seeing an article in JEMS awhile back that stated that we in EMS as a whole just needed to stop transporting cardiac arrests that have a high probability of a bad outcome (someone in asystole) because it's not worth the dangers to the public and ambulance crew of going priority all the way to the hospital with a person who is basically dead. As you know not many come back from asystole. I think it was an emotional decision as opposed to a rational medical one more than anything.

I understand why transporting this patient might've been potentially a bad choice, but I still would've done it. For me it goes back or is similar to the rule we have about first responders getting hurt at the scene of an MCI - they immediately get all the resources they need. We were watching one of own go right before our eyes, and we treated him aggressively, including the fastest possible transport to a hospital.

Well, that was long and rambling, and I'm not sure I answered your question. Did that clear things up or muddy the water even more?


Ambulance Driver said...

Dude, you work a code on a colleague, you do what you gotta do - even if it seems wasted effort in retrospect. No judgments from me, MM.

Strings said...

I can only hope that, should I need EMS, I get the same level of aid that you (or AD, or any of a number of other bloggers) provide. If it helps MM, I'dd feel in capable hands with you trying to save my worthless carcass...

Loving Annie said...

It means a lot when someone begins to see you without prejudice...
You did a good job, and got recognized for it.
I am sorry he died, regardless. It is never easy when it is someone you know, be it in a work or a personal context...
Life is precious, and often gone waaay too soon.

NYC EMS said...

You handled it with style and grace.

Loving Annie said...

Came by on Thursday night to say hello, MM !

Loving Annie said...

Hello again, cupcake ! Hope that you are having a good Sunday.

Would you be willing to update your links to reflect my new blog address when you have time, MM ?

(and actually, now it IS erotica... snicker. How prescient you were... :)

Mhmmm Yes I Love That

Thank you !

Loving Annie

p.s. I still blame you for creating the monster with your powers of suggestion :)

Loving Annie said...

Good Monday morning to you, Sugar !
How are you doing ?

And exactly what sort of a prize did you have in mind, hmmm ? Please do explain to me in great detail... :)

And please, lurking readers, this isn't a potential Babs/A.D. thing - the two of us are just flirting for the fun of it, honest !!!

Loving Annie

Anonymous said...

we got to talk not here but at the place we talked about.