Monday, March 26, 2007

strong work

My mind recalls with great clarity, one distinctly horrific, beautiful night. A picture has been painted in hues of solemnity and gravity that will not soon be erased. I remember the call came in as a level one full arrest, mid-forties male, intubated, CPR in progress. The trauma bay was ready, crash cart ready, step stool at beside. Within minutes the automatic ambulance bay doors opened (sometimes I wish they'd open faster) and a medic rushed through pushing the yellow stretcher, another medic mounted on the side furiously pumping this apneic man's chest. We moved him over to the hospital bed, drugs ready, doctor at bedside. A fortunate EMT student took over the task of compressions, hand over hand, pushing for life. (The step stool comes in handy so the one doing compressions can employ gravity in the hardwork.) CPR is quite the cardiovascular activity, both for the person giving and the one recieving. This young student was faithfully and forcefully doing compressions; beads of sweat doing a dance-off down his face.

I quickly, yet futily tried to draw blood-it refused to come - it wasn't being circulated to the extremities. The doctor had one hand firmly pressing the femoral artery, the other hand, finger tapping lip, eyes intently on the monitor watching the little waves and huge spikes (that action was mostly compressions and drugs). I kept my free hand on the carotid, hoping my hand would move from the pulse underneath it, and only did it move slightly, in time with the compressions. Already our patient had been given sucs, atropine, epi, bi-carb, and pretty much ever other drug that would be of use. The doctor said, "Hold compressions." Worn out from his workout, the student stepped off the stool and we all affixed our eyes on the monitor and I kept feeling for a pulse. Nothing. The little waves stopped. Another forty minutes we worked, and I alternated the compressions with the student to give him a break. Family was right outside the door. The doctor, hand still on the femoral, glanced up at the red digital numbers and said "2340."

Almost as quickly as we gathered around him, most of us left the room. I stayed to make him presentable - I wiped the froth from his face that had dripped from the ET tube in his throat, I covered him with a white sheet, made sure his eyes were closed. Now the family could come see him, and they did. They wept over their newly deceased brother, husband, son. The father seemed to take it the hardest. This was his oldest son who would never open his mouth to form the words "I love you dad" ever again. After several minutes, the family left; I reached to the item in the bin labeled "body bag" and with the help of the student and a coworker, I packaged the patient in his new plastic apparel and zipped his face from the world. We took him on a ride through the halls and down the elevator to the lower level. Here we opened the cold metal doors on a structure that resembles an industrial refrigerator and pulling out the rack, we moved his stiff, heavy body onto the tray and sent it back into the cooler. The doors of this chilled temporary coffin closed as did his life. Every time I push the empty stretcher back to the ER after relocating a patient to the morgue, a feeling of sadness comes, subtle regret. Regret that this person's life is over; certainly not what he had planned for that day. Neccisity pushes those thoughts out of mind, and leaves them in the hallway behind me.

Almost exactly two hours later, another call came in "priority, mid-sixties male, full arrest, intubated, CPR in progress." Here we go again. Within five minutes, the bay doors slid open again and in came a medic pushing the yellow stretcher, the other medic mounted on the side doing compressions. Several of us recognized the crew; they brought in the first full arrest. Ironic? Not really. Here's the irony: this man on the stretcher we had seen before too, however, not as a patient but as a loving father, weeping over his son who left life at 2340. Yes, this was the father of the patient we worked two hours ago.

The routine of drugs and compressions began, and the minutes ticked. The thing different about this time was that all the family was at the bedside, and in particular, his wife. She was holding his limp hand and loudly demanding him over and over, "Get up! Get up! Levantate! I'm not losing both of you today. Wake up! You're not dying tonight. Come on, wake up! Levantate!" She kept up this routine and we kept up ours. "Hold compressions." We all looked at the monitor - the waves didn't stop - they kept right on going, and my hand on the carotid, doctor's hand on the femoral...we had a pulse! Job successful! His wife was right, he didn't die that night. She stayed right beside him, refusing to let him die, demanding him back to life.

In this line of work, you win some, you lose some. It's always sad when you lose, and always great when you win. I wish I could find that student and say, "Strong work, son, Strong work!"