Silent Siren, page 5
Ben and I clear the scene. For the rest of the day and part of the next, though we showered and washed our clothes, we couldn’t get the stench out of our nostrils. It seemed to cling to our mustaches and the roots of our hair like an oily residue. Even the smell of food nauseated me if it bore even the slightest, tangential resemblance to the sickly-sweet stench of decay. In Dad’s fruit dehydrator reposed dried plums, blackened, puffy, and amorphous. They sickened me. The most mundane of olfactory and visual stimuli seemed suffused with the presence of death.
The Coroner’s deputy arrived later that evening. Concerned that Mr. Thompson would fall to pieces if he tried to drag him out the van’s front, he called the fire department for assistance in cutting off the back of the van to slide him out. “Body gas,” he had said. “It’ll eat your arm off if you get that in a cut.”
Captain Lundin and two firefighters took the rescue truck out to Pleasant Beach to assist, carrying with them an air chisel to remove the back of the van and a new tarp to slide him out on. Only one firefighter had the wisdom to don a self-contained breathing apparatus during the removal as the other two gagged through ineffective paper masks.
Once Mr. Thompson was removed from the van and slid onto the tarp, the powerful spotlights of Rescue 21 revealed how discolored his skin was with the results of decomposition.
“I thought Mr. Thompson was a white guy,” says one of the firefighters.
“He was,” says Captain Lundin.
Sleeping Beauty
We are called to the Winslow Arms Apartments, primarily a low-income retirement community, for an elderly man in respiratory distress. We enter the overheated apartment to find a rather grizzled old man sitting on a couch, dressed in boxer shorts and a “wife beater” T-shirt. I notice a half-dried amber stain on the front of his shorts, which at first I think is urine, but then I realize it’s whiskey. A tumbler of the malted beverage sloshes between the old man’s mottled thighs as he puffs for air.
“I can’t breathe!” he gasps. His color is dusky. His lips are deeply purple under his white mustache. I pull up his shirt to assess lung sounds. Neither the wheezes of asthma, nor the coarse gurgling of pneumonia, nor the fine crackling of pulmonary edema, are obvious to my ears. His lungs are perfectly clear.
“Can I lie down?” he says.
I nod. Whatever makes him most comfortable. I place his finger in the pulse oximeter and get a reading in the low 80s. A consistent reading of less than 95% in someone without a history of lung disease usually means trouble. His blood pressure is low and his heart rate is high.
“I need to sit up. Can I sit up?” The man is restless and agitated, a sign his brain is not receiving enough oxygen.
I notice an old woman, likely his wife, seated in the corner. She seems only mildly concerned, but I tell myself people have many different ways of dealing with crisis. Some scream and shout. Others are silent and numb.
Firefighter Dana Tenen pastes monitor electrodes to the man’s sweaty chest and I prepare to start an IV. From experience, I suspect the man is having a pulmonary embolism—a blood clot that has traveled, most likely from his legs, to the microcirculation of his lungs and destroyed his ability to oxygenate his cells.
It’s a condition known as ventilation/perfusion mismatch. He can take deep breaths and no fluid is in the lungs, but the oxygen isn’t getting where it needs to go.
A couple of other firefighters bring in the gurney and I turn around to ready it for our patient.
Dana shouts, “Matt!”
I whirl to once again face the patient. His struggle for air has ceased. His chest no longer heaves. Glazed eyes stare straight ahead at nothing and the purple hue deepens around his ears and mouth. His heart stutters to a stop.
We yank the newly dead man off his whiskey-stained couch and onto a backboard. Dana starts CPR.
The initial heart rhythm on the monitor is PEA—pulseless electrical activity. His heart is still producing electrical impulses, but it is not coupled to pumping. It lends evidence to my original suspicion that the man was having a pulmonary embolism; PEA is the most common rhythm post-arrest from a PE.
The very tall paramedic ducks to get through the doorway as he arrives on scene, unaware until he walks in that the man had gone into cardiac arrest. He pauses for a second to take in the scene.
“What happened?” he asks, eyebrows raised.
We go through three rounds of drugs and 180 milliequivalents of sodium bicarbonate for acidosis—the standard dose. He doesn’t respond to any of it and, within ten minutes, his rhythm degenerates into a flat-line. We declare him dead and pull a clean white sheet over his head.
I’m stunned that the man who had just been talking to me ten minutes ago is now dead. It’s one thing to arrive after someone goes into cardiac arrest, yet another thing to watch death occur before my eyes.
In contrast, the new widow seems to take this recent development all in stride. She putters in the kitchen, staying clear of the shrouded body.
The paramedic speaks. “I’m sorry. We tried everything but he died.”
“Yes, I figured that. He was a good man in his time,” she says, already speaking of him in the past tense. She washes her hands and dries them on her apron, as though washing her hands of the marriage. She casts her gaze downward. “He drank a lot and yelled at me. I used to have to sleep in my car for some peace and quiet.”
The woman pauses for a beat and then brightens. “Would you like some coffee?” she asks. Such hospitality at such an odd occasion! We decline and wait for the police department to come by and take over the scene.
A police officer arrives through the sliding glass door at the rear of the apartment. “So, where is he?” he asks.
The woman indicates the blanket-shrouded body lying on the couch. “Sleeping Beauty is over there.”
A few days later, I come back to the residence to pick up the backboard on which he had been lying. I ring the doorbell and hear a cheery, “Come in!”
The woman sits on the couch, in the exact spot where her husband breathed his last, reading a newspaper. She tells me the backboard is at the funeral home. They used it to lift him over to the gurney.
I’ve had people pound their fists on me when I have informed them their loved one has died. I’ve had others just walk away in disbelief. This was the most unusual reaction to death I had ever seen.
Guts in the Street
The call for “victim of a gunshot wound” jangles me to consciousness in the early hours of a foggy Bainbridge Island morning, an hour or so before I am to get off nightly resident firefighter duty at Station 21. As we are to later learn, the patient is an elderly man with advancing dementia. His wife had awoken alone, her predictable and faithful husband of sixty years no longer sharing her bed. Unable to find him anywhere in the house and concerned for his welfare, she had called 911. Before Bainbridge Police could even arrive on scene to contact the patient’s wife, they found the old man face-down at the end of his driveway in a puddle of blood.
Paramedic Jerry Ehrler, Captain Butch Lundin, and I speed northward through the mist, the medic unit’s strobes reflecting off the atmospheric moisture. I shiver despite my heavy lined duty jacket. The rig screeches to a halt just short of a long gravel driveway. Lying prone before us is an elderly man, still clad in striped pajamas, his feet bare and dirty, blood oozing from beneath him to form a trail of blood that snakes slowly across the road, forming rivulets as it conforms to the contours of the asphalt.
The man gasps as Jerry turns him onto his back, though his ashen face and vacant stare convey how deeply he has already plummeted into shock. His bloody pajama top has been slashed in several places, as though with a knife. Pink loops of intestine protrude from a gaping wound in his belly and spill onto the dirty street. Steam rises from the bowels into the cold morning air. Rapidly, we scoop the filthy innards onto the man’s belly, place him onto a backboard and load him into the back of the medic unit.
I don splash-resistant glasses, grab the bag-valve mask from a shelf, and begin squeezing life into the man’s aged lungs. His skin is putty-gray and cold beneath my fingers. His mouth puckers in an “O” where, years ago, a full set of teeth resided. Butch wraps a blood pressure cuff on a flaccid arm, and its gauge falls to zero—profound shock. As I extend the man’s head to open his airway, I discover a horizontal incision on his neck, gaping like a second mouth, dribbling maroon blood.
Jerry jams a large bore intravenous line into the crooks of each arm in an effort to maintain some circulation to his vital organs. The intubation is easy and accomplished without the use of paralytics, since all the man’s muscles are already flaccid.
Medic 21 takes off, screaming towards Station 21’s helipad to meet the helicopter that will transport our patient to Harborview’s Trauma Center in Seattle. En route, Jerry places a sterile sheet on the man’s eviscerated intestines and douses it with IV fluid to keep them moist. The man has almost no chance of survival but we have to make the effort.
Two hours after the man arrives at the hospital, Jerry calls to inquire on his condition, expecting to hear that he had expired shortly after arrival.
“No shit?” he says into the receiver. He hangs up. “They sewed him up in the O.R. and said he just had a small slit in his bowel!”
Later we get the complete story from the police department. Our eighty-nine-year-old patient, Harold, had recently become more confused with the effects of Alzheimer’s, as well as increasingly depressed. In the early morning hours, he had arisen and walked to the kitchen, where he found a large kitchen knife, later found bloodied. He had attempted Hara-kiri and slashed his throat for good measure, then staggered out into the cold, misty morning air, where he soon collapsed at the end of the driveway.
I read Harold’s obituary in the Bainbridge Review one year later. He had passed away in a Seattle nursing home, where he had spent the last twelve months of his life, dying peacefully, but not the way he had intended.
Up a Creek without a BVM
Slumped in the passenger’s seat of Bainbridge Ambulance 21, I sip lukewarm coffee from a dingy coffee cup as my brother, Ben, scans the streetlight-illuminated suburban roads in a rather relaxed manner. No hurry, after all. We are responding routine, no lights and sirens, to a private residence for a ninety-two-year-old woman with pneumonia. Her daughter had called and wanted her transported to a Seattle hospital, about an hour away.
I balance a laminated map book on my lap. “Turn right here.”
Ben swings the rig into a small housing development where all the residences seem to have been built without imagination, each with its own nominal chemical-infused unnaturally green lawn and miniature driveway.
Ben slows the rig to a crawl and frowns. “Now which one of these damn houses is it?”
“I can’t see any address numbers but that one there has all its lights on.” I point out a small rambler in the middle of a cul-de-sac and Ben backs the rig into the driveway.
We saunter up to the door, towing our stretcher. Tiny address numbers on the front door confirm we are at the right residence. No need for an aid kit or oxygen on a routine transfer, or so I conjecture.
A heavyset woman of about seventy greets us at the door.
If this is the patient’s daughter, the patient must be as old as Methuselah!
“I think she’s already gone,” the woman says, a mixture of sadness and bewilderment on her finely lined face.
I quicken my pace. Well, this was certainly not in my plans. I expect my routine transfer patients to be alive when I arrive.
The old woman lies in a hospital bed in the middle of a starkly appointed, dimly lit living room, tethered to several yards of oxygen tubing that lead to a hissing tank. The air hangs heavy with the smell of menthol—some kind of balm the woman had used on her aches and pains. A baby monitor sits on her bedside table along with mouth swabs, an emesis basin, wads of Kleenex, and other accoutrements of the recently and chronically afflicted. She reposes, I think, quite peacefully, her eyes closed, her skin the color of old newsprint.
I reach out a gloved hand and check the woman’s carotid pulse. None.
The woman’s daughter stands at the corner of the room. “I think you’re right,” I say. “She is gone.”
Briefly, very briefly, I consider what to do next. It seemed cruel, even ridiculous, to start CPR on a woman who had obviously died peacefully before I even arrived, in the comfort of her own home, yet by protocols, I had no choice but to do just that.
“Does she have a DNR?” I ask, hoping that the younger woman has had the presence of mind to keep handy a Do Not Resuscitate document, signed by the patient and physician, that will allow her mother to die naturally, without heroics being performed.
“She doesn’t want to be…” She searches for the words, “brought back.”
“But do you have documentation of this?” I press. I need to do something, or nothing, quickly.
“Our lawyer has some paperwork,” the woman offers. Paperwork off the premises wouldn’t cut it. With no documentation, I need to start CPR.
“Ben, go out to the rig and grab the bag mask!” I yell. “Then get on the phone to 911 and get me a medic unit!”
Our ambulance is only used for transport and is thus only basic life support-equipped; it doesn’t carry cardiac drugs, endotracheal tubes, or even a defibrillator. The fire department will need to respond on this one.
Ben tears out the front door and I grab the woman by her limp shoulders and flop her out of bed and onto the carpeted floor. Her head hits with a soft thud. No style points for Matt the Super-EMT.
I compress the woman’s frail chest with my gloved hands, feeling a little sick every time I hear the crunch of cartilage separating.
The daughter remains at the corner of the room, dismayed, hands on her hips, slowly shaking her head. “She wouldn’t have wanted this!” she wails.
Watching the distraught woman, I feel ridiculous. I have transformed what had been a peaceful passing of an old lady in her own home into a screaming, 5-alarm, chaotic fight for life—a mere mockery of emergency medical services as it should be. This feels so wrong, but by protocol, what else can I do?
I’m about a minute into my chest compressions but it seems like an eternity. Where is Ben with the bag mask? If this woman had any chance at all, she would need artificial respirations. I don’t relish the thought of performing mouth-to-mouth on a ninety-two-year-old lady.
Ben rushes back in. “I can’t find the bag mask!” he exclaims. That’s understandable, I guess. How often do we need to resuscitate somebody on a BLS ambulance? The BLS ambulance carries no jump kit containing basic lifesaving supplies, so the bag mask is probably secreted away in a really inconvenient location.
“Check under the bench seat,” I say, and Ben goes tearing back to the rig.
This may take a while.
I need to ventilate this lady. With no other options, I bend down, pinch off her nostrils and seal my mouth with hers, exhaling my 16% oxygen into the old woman’s fragile (and diseased) lungs. It would have seemed much more unpleasant a task if I hadn’t had adrenaline coursing through my system.
Years later, the American Heart Association would complete a study which concluded that, during the first four minutes of a cardiac arrest, compressions alone are sufficient to maintain oxygenation and artificial respiration is not crucial. I wish I’d known that as I’m getting up close and personal with a woman whose mustache rivals my own.
Ben has finally arrived with the BVM. He hands it to me and I gladly accept it, grateful that my moments of great intimacy with the nonagenarian are over. I continue with one-person CPR as Ben calls 911 from a phone in the corner of the room.
From the sounds of Ben’s conversation with CenCom, the dispatcher appears not to grasp the gravity of the situation. “I told you once already what the address is!” Ben shouts into the phone. “I need to get off so I can do CPR!” He hangs up and joins me, red-faced, in my futile attempt at resuscitation.
The daughter looks on with despair.
Whooping sirens herald the arrival of Medic 21 at our scene and two paramedics clamber in with their gear.
As the lead medic slaps EKG patches on the woman’s chest, I explain the circumstances and that I have been doing mouth-to-mouth.
He looks at me, incredulously. “Mouth to mouth? You’re my hero!”
The monitor reads asystole—not a single blip to interrupt the straight line being traced across the screen by the stillness of the woman’s heart. She is not only dead, she is dead-dead, having passed to the great beyond possibly twenty minutes or so before Ben and I arrived.
“We’re not going to work this,” the lead medic announces. “We’re done.”
His partner appears disappointed. “Don’t you at least want to give her an airway?” He hovers over the dead woman’s gaping mouth, laryngoscope in one hand and 7.0 mm endotracheal tube in the other.
“Suit yourself,” the lead says, shrugging.
The other medic inserts the laryngoscope and slides the tube past the woman’s toothless gums. At least he’ll get credit for an endotracheal intubation. He needs twelve of those a year to stay qualified, and sometimes they are few and far between.
The lead medic, rather unnecessarily, informs the daughter that her mother has died. She looks relieved that our little charade is over and her mother can be left in peace. We heft the body back into bed and pull the covers up to her chin. She looks somewhat less peaceful than she did about twenty minutes ago, especially with a plastic tube protruding like a periscope from her gaping mouth.
Medic 21 packs up and leaves just as Bainbridge Police arrives. It is policy for police to respond to all home deaths in which the decedent was not on hospice care.
Ben and I trundle our empty stretcher back to the ambulance. The police officer waits on the arrival of Hess Funeral Home.
Months later, as I’m finishing a duty shift at Station 22, the early call comes in for a cardiac arrest in our area. Rena Clough, a veteran EMT/firefighter, and I take off in Aid 22 and make our way up the narrow gravel driveway to the residence. Medic 21 is responding from Station 21, about seven minutes away still.
The Coroner’s deputy arrived later that evening. Concerned that Mr. Thompson would fall to pieces if he tried to drag him out the van’s front, he called the fire department for assistance in cutting off the back of the van to slide him out. “Body gas,” he had said. “It’ll eat your arm off if you get that in a cut.”
Captain Lundin and two firefighters took the rescue truck out to Pleasant Beach to assist, carrying with them an air chisel to remove the back of the van and a new tarp to slide him out on. Only one firefighter had the wisdom to don a self-contained breathing apparatus during the removal as the other two gagged through ineffective paper masks.
Once Mr. Thompson was removed from the van and slid onto the tarp, the powerful spotlights of Rescue 21 revealed how discolored his skin was with the results of decomposition.
“I thought Mr. Thompson was a white guy,” says one of the firefighters.
“He was,” says Captain Lundin.
Sleeping Beauty
We are called to the Winslow Arms Apartments, primarily a low-income retirement community, for an elderly man in respiratory distress. We enter the overheated apartment to find a rather grizzled old man sitting on a couch, dressed in boxer shorts and a “wife beater” T-shirt. I notice a half-dried amber stain on the front of his shorts, which at first I think is urine, but then I realize it’s whiskey. A tumbler of the malted beverage sloshes between the old man’s mottled thighs as he puffs for air.
“I can’t breathe!” he gasps. His color is dusky. His lips are deeply purple under his white mustache. I pull up his shirt to assess lung sounds. Neither the wheezes of asthma, nor the coarse gurgling of pneumonia, nor the fine crackling of pulmonary edema, are obvious to my ears. His lungs are perfectly clear.
“Can I lie down?” he says.
I nod. Whatever makes him most comfortable. I place his finger in the pulse oximeter and get a reading in the low 80s. A consistent reading of less than 95% in someone without a history of lung disease usually means trouble. His blood pressure is low and his heart rate is high.
“I need to sit up. Can I sit up?” The man is restless and agitated, a sign his brain is not receiving enough oxygen.
I notice an old woman, likely his wife, seated in the corner. She seems only mildly concerned, but I tell myself people have many different ways of dealing with crisis. Some scream and shout. Others are silent and numb.
Firefighter Dana Tenen pastes monitor electrodes to the man’s sweaty chest and I prepare to start an IV. From experience, I suspect the man is having a pulmonary embolism—a blood clot that has traveled, most likely from his legs, to the microcirculation of his lungs and destroyed his ability to oxygenate his cells.
It’s a condition known as ventilation/perfusion mismatch. He can take deep breaths and no fluid is in the lungs, but the oxygen isn’t getting where it needs to go.
A couple of other firefighters bring in the gurney and I turn around to ready it for our patient.
Dana shouts, “Matt!”
I whirl to once again face the patient. His struggle for air has ceased. His chest no longer heaves. Glazed eyes stare straight ahead at nothing and the purple hue deepens around his ears and mouth. His heart stutters to a stop.
We yank the newly dead man off his whiskey-stained couch and onto a backboard. Dana starts CPR.
The initial heart rhythm on the monitor is PEA—pulseless electrical activity. His heart is still producing electrical impulses, but it is not coupled to pumping. It lends evidence to my original suspicion that the man was having a pulmonary embolism; PEA is the most common rhythm post-arrest from a PE.
The very tall paramedic ducks to get through the doorway as he arrives on scene, unaware until he walks in that the man had gone into cardiac arrest. He pauses for a second to take in the scene.
“What happened?” he asks, eyebrows raised.
We go through three rounds of drugs and 180 milliequivalents of sodium bicarbonate for acidosis—the standard dose. He doesn’t respond to any of it and, within ten minutes, his rhythm degenerates into a flat-line. We declare him dead and pull a clean white sheet over his head.
I’m stunned that the man who had just been talking to me ten minutes ago is now dead. It’s one thing to arrive after someone goes into cardiac arrest, yet another thing to watch death occur before my eyes.
In contrast, the new widow seems to take this recent development all in stride. She putters in the kitchen, staying clear of the shrouded body.
The paramedic speaks. “I’m sorry. We tried everything but he died.”
“Yes, I figured that. He was a good man in his time,” she says, already speaking of him in the past tense. She washes her hands and dries them on her apron, as though washing her hands of the marriage. She casts her gaze downward. “He drank a lot and yelled at me. I used to have to sleep in my car for some peace and quiet.”
The woman pauses for a beat and then brightens. “Would you like some coffee?” she asks. Such hospitality at such an odd occasion! We decline and wait for the police department to come by and take over the scene.
A police officer arrives through the sliding glass door at the rear of the apartment. “So, where is he?” he asks.
The woman indicates the blanket-shrouded body lying on the couch. “Sleeping Beauty is over there.”
A few days later, I come back to the residence to pick up the backboard on which he had been lying. I ring the doorbell and hear a cheery, “Come in!”
The woman sits on the couch, in the exact spot where her husband breathed his last, reading a newspaper. She tells me the backboard is at the funeral home. They used it to lift him over to the gurney.
I’ve had people pound their fists on me when I have informed them their loved one has died. I’ve had others just walk away in disbelief. This was the most unusual reaction to death I had ever seen.
Guts in the Street
The call for “victim of a gunshot wound” jangles me to consciousness in the early hours of a foggy Bainbridge Island morning, an hour or so before I am to get off nightly resident firefighter duty at Station 21. As we are to later learn, the patient is an elderly man with advancing dementia. His wife had awoken alone, her predictable and faithful husband of sixty years no longer sharing her bed. Unable to find him anywhere in the house and concerned for his welfare, she had called 911. Before Bainbridge Police could even arrive on scene to contact the patient’s wife, they found the old man face-down at the end of his driveway in a puddle of blood.
Paramedic Jerry Ehrler, Captain Butch Lundin, and I speed northward through the mist, the medic unit’s strobes reflecting off the atmospheric moisture. I shiver despite my heavy lined duty jacket. The rig screeches to a halt just short of a long gravel driveway. Lying prone before us is an elderly man, still clad in striped pajamas, his feet bare and dirty, blood oozing from beneath him to form a trail of blood that snakes slowly across the road, forming rivulets as it conforms to the contours of the asphalt.
The man gasps as Jerry turns him onto his back, though his ashen face and vacant stare convey how deeply he has already plummeted into shock. His bloody pajama top has been slashed in several places, as though with a knife. Pink loops of intestine protrude from a gaping wound in his belly and spill onto the dirty street. Steam rises from the bowels into the cold morning air. Rapidly, we scoop the filthy innards onto the man’s belly, place him onto a backboard and load him into the back of the medic unit.
I don splash-resistant glasses, grab the bag-valve mask from a shelf, and begin squeezing life into the man’s aged lungs. His skin is putty-gray and cold beneath my fingers. His mouth puckers in an “O” where, years ago, a full set of teeth resided. Butch wraps a blood pressure cuff on a flaccid arm, and its gauge falls to zero—profound shock. As I extend the man’s head to open his airway, I discover a horizontal incision on his neck, gaping like a second mouth, dribbling maroon blood.
Jerry jams a large bore intravenous line into the crooks of each arm in an effort to maintain some circulation to his vital organs. The intubation is easy and accomplished without the use of paralytics, since all the man’s muscles are already flaccid.
Medic 21 takes off, screaming towards Station 21’s helipad to meet the helicopter that will transport our patient to Harborview’s Trauma Center in Seattle. En route, Jerry places a sterile sheet on the man’s eviscerated intestines and douses it with IV fluid to keep them moist. The man has almost no chance of survival but we have to make the effort.
Two hours after the man arrives at the hospital, Jerry calls to inquire on his condition, expecting to hear that he had expired shortly after arrival.
“No shit?” he says into the receiver. He hangs up. “They sewed him up in the O.R. and said he just had a small slit in his bowel!”
Later we get the complete story from the police department. Our eighty-nine-year-old patient, Harold, had recently become more confused with the effects of Alzheimer’s, as well as increasingly depressed. In the early morning hours, he had arisen and walked to the kitchen, where he found a large kitchen knife, later found bloodied. He had attempted Hara-kiri and slashed his throat for good measure, then staggered out into the cold, misty morning air, where he soon collapsed at the end of the driveway.
I read Harold’s obituary in the Bainbridge Review one year later. He had passed away in a Seattle nursing home, where he had spent the last twelve months of his life, dying peacefully, but not the way he had intended.
Up a Creek without a BVM
Slumped in the passenger’s seat of Bainbridge Ambulance 21, I sip lukewarm coffee from a dingy coffee cup as my brother, Ben, scans the streetlight-illuminated suburban roads in a rather relaxed manner. No hurry, after all. We are responding routine, no lights and sirens, to a private residence for a ninety-two-year-old woman with pneumonia. Her daughter had called and wanted her transported to a Seattle hospital, about an hour away.
I balance a laminated map book on my lap. “Turn right here.”
Ben swings the rig into a small housing development where all the residences seem to have been built without imagination, each with its own nominal chemical-infused unnaturally green lawn and miniature driveway.
Ben slows the rig to a crawl and frowns. “Now which one of these damn houses is it?”
“I can’t see any address numbers but that one there has all its lights on.” I point out a small rambler in the middle of a cul-de-sac and Ben backs the rig into the driveway.
We saunter up to the door, towing our stretcher. Tiny address numbers on the front door confirm we are at the right residence. No need for an aid kit or oxygen on a routine transfer, or so I conjecture.
A heavyset woman of about seventy greets us at the door.
If this is the patient’s daughter, the patient must be as old as Methuselah!
“I think she’s already gone,” the woman says, a mixture of sadness and bewilderment on her finely lined face.
I quicken my pace. Well, this was certainly not in my plans. I expect my routine transfer patients to be alive when I arrive.
The old woman lies in a hospital bed in the middle of a starkly appointed, dimly lit living room, tethered to several yards of oxygen tubing that lead to a hissing tank. The air hangs heavy with the smell of menthol—some kind of balm the woman had used on her aches and pains. A baby monitor sits on her bedside table along with mouth swabs, an emesis basin, wads of Kleenex, and other accoutrements of the recently and chronically afflicted. She reposes, I think, quite peacefully, her eyes closed, her skin the color of old newsprint.
I reach out a gloved hand and check the woman’s carotid pulse. None.
The woman’s daughter stands at the corner of the room. “I think you’re right,” I say. “She is gone.”
Briefly, very briefly, I consider what to do next. It seemed cruel, even ridiculous, to start CPR on a woman who had obviously died peacefully before I even arrived, in the comfort of her own home, yet by protocols, I had no choice but to do just that.
“Does she have a DNR?” I ask, hoping that the younger woman has had the presence of mind to keep handy a Do Not Resuscitate document, signed by the patient and physician, that will allow her mother to die naturally, without heroics being performed.
“She doesn’t want to be…” She searches for the words, “brought back.”
“But do you have documentation of this?” I press. I need to do something, or nothing, quickly.
“Our lawyer has some paperwork,” the woman offers. Paperwork off the premises wouldn’t cut it. With no documentation, I need to start CPR.
“Ben, go out to the rig and grab the bag mask!” I yell. “Then get on the phone to 911 and get me a medic unit!”
Our ambulance is only used for transport and is thus only basic life support-equipped; it doesn’t carry cardiac drugs, endotracheal tubes, or even a defibrillator. The fire department will need to respond on this one.
Ben tears out the front door and I grab the woman by her limp shoulders and flop her out of bed and onto the carpeted floor. Her head hits with a soft thud. No style points for Matt the Super-EMT.
I compress the woman’s frail chest with my gloved hands, feeling a little sick every time I hear the crunch of cartilage separating.
The daughter remains at the corner of the room, dismayed, hands on her hips, slowly shaking her head. “She wouldn’t have wanted this!” she wails.
Watching the distraught woman, I feel ridiculous. I have transformed what had been a peaceful passing of an old lady in her own home into a screaming, 5-alarm, chaotic fight for life—a mere mockery of emergency medical services as it should be. This feels so wrong, but by protocol, what else can I do?
I’m about a minute into my chest compressions but it seems like an eternity. Where is Ben with the bag mask? If this woman had any chance at all, she would need artificial respirations. I don’t relish the thought of performing mouth-to-mouth on a ninety-two-year-old lady.
Ben rushes back in. “I can’t find the bag mask!” he exclaims. That’s understandable, I guess. How often do we need to resuscitate somebody on a BLS ambulance? The BLS ambulance carries no jump kit containing basic lifesaving supplies, so the bag mask is probably secreted away in a really inconvenient location.
“Check under the bench seat,” I say, and Ben goes tearing back to the rig.
This may take a while.
I need to ventilate this lady. With no other options, I bend down, pinch off her nostrils and seal my mouth with hers, exhaling my 16% oxygen into the old woman’s fragile (and diseased) lungs. It would have seemed much more unpleasant a task if I hadn’t had adrenaline coursing through my system.
Years later, the American Heart Association would complete a study which concluded that, during the first four minutes of a cardiac arrest, compressions alone are sufficient to maintain oxygenation and artificial respiration is not crucial. I wish I’d known that as I’m getting up close and personal with a woman whose mustache rivals my own.
Ben has finally arrived with the BVM. He hands it to me and I gladly accept it, grateful that my moments of great intimacy with the nonagenarian are over. I continue with one-person CPR as Ben calls 911 from a phone in the corner of the room.
From the sounds of Ben’s conversation with CenCom, the dispatcher appears not to grasp the gravity of the situation. “I told you once already what the address is!” Ben shouts into the phone. “I need to get off so I can do CPR!” He hangs up and joins me, red-faced, in my futile attempt at resuscitation.
The daughter looks on with despair.
Whooping sirens herald the arrival of Medic 21 at our scene and two paramedics clamber in with their gear.
As the lead medic slaps EKG patches on the woman’s chest, I explain the circumstances and that I have been doing mouth-to-mouth.
He looks at me, incredulously. “Mouth to mouth? You’re my hero!”
The monitor reads asystole—not a single blip to interrupt the straight line being traced across the screen by the stillness of the woman’s heart. She is not only dead, she is dead-dead, having passed to the great beyond possibly twenty minutes or so before Ben and I arrived.
“We’re not going to work this,” the lead medic announces. “We’re done.”
His partner appears disappointed. “Don’t you at least want to give her an airway?” He hovers over the dead woman’s gaping mouth, laryngoscope in one hand and 7.0 mm endotracheal tube in the other.
“Suit yourself,” the lead says, shrugging.
The other medic inserts the laryngoscope and slides the tube past the woman’s toothless gums. At least he’ll get credit for an endotracheal intubation. He needs twelve of those a year to stay qualified, and sometimes they are few and far between.
The lead medic, rather unnecessarily, informs the daughter that her mother has died. She looks relieved that our little charade is over and her mother can be left in peace. We heft the body back into bed and pull the covers up to her chin. She looks somewhat less peaceful than she did about twenty minutes ago, especially with a plastic tube protruding like a periscope from her gaping mouth.
Medic 21 packs up and leaves just as Bainbridge Police arrives. It is policy for police to respond to all home deaths in which the decedent was not on hospice care.
Ben and I trundle our empty stretcher back to the ambulance. The police officer waits on the arrival of Hess Funeral Home.
Months later, as I’m finishing a duty shift at Station 22, the early call comes in for a cardiac arrest in our area. Rena Clough, a veteran EMT/firefighter, and I take off in Aid 22 and make our way up the narrow gravel driveway to the residence. Medic 21 is responding from Station 21, about seven minutes away still.
