1-15-04 0700mst:Been asleep for about 3 hours, good sleep too. Then that god awful sound of the radio "Please respond to female unresponsive and not breathing, PD doing CPR" Two minutes later I'm pulling the gurney outa the back of the unit My half asleep body trying to keep up with my wide awake mind. It is still amazing to me that I can go from deep drooling sleep to fully dressed and rolling down the road in less then 2 minutes.
I'm thinkin bout everything I need to do: Verify pulseless and apnic, establish an open airway and provide ventilation while my partner hooks up the AED.....but wait.... we have to get to her first we drag the gurney across the parking lot up a step and into a clean but sparsly furnished living room turn left and go down a long narrow hall to the very last room on the right.
Inside on the floor is a elderly female laying on her back with her bathrobe unsnapped making her naked from the waist up. One officer knelt by her head pressing a mask to her face and rhythmically squeezed then bag tha forced air into her lungs while the other officer knelt by her side both hands on her chest as he rhythmically compressed her sternum to circulate her blood.
One glance told me two things 1: The gurney was not gonna fit thru the door. 2: She was obviously dead.
Her hair was spread out on the floor around her head, her eyes were wide open glazed and they stared at me with that stare that only dead eyes have her mouth was open with a glob of partially dried bloody phlegm caked to her teeth and tongue Her skin color was the grayish-yellowish-whiteish color that only dead people have.
We rapidly extricate her from the room to the gurney down the hall out the front door and less then a minute later in the ambulance.....time to work. Place OPA hook O² to the mask and ventilate two times then compress chest 15 times. My partner hooks up the Defib......Flat line.....Asystole in all 3 leads....pupils fixed and dialated...beyond help..Gone . Call Medical Control get order to stop all efforts. It's 0718.
We put all our toys away and cover her with a blanket. I climb out into the fridgid 20° morning air, light up a cigarette as that dreaded but familiar feeling washes over me...As gray and cold as the cold January clouds that I stand under; A tornado of emotions that make me physically sick to my stomach, hopeless, sad, depressed, mad, discouraged, empty and alone, so alone. I miss my wife bad, real bad.
1-17-2004:
I saw another dead people today.
I was off duty too just yakking with my sister at the building when they get paged out for a male not breathing at mp 306, So stupid me says "I Will Go and Help You!"
We jump in the unit and we are headed east on the interstate from mp 286 at a high rate of fuel consumption. Twelve minutes later we pull up on the scene. I climb outa the back of the unit and remove the gurney; wheel it over to the shoulder and lower it to the ground and unbuckle the straps. Meanwhile my partner's were at the patient and had verified him pulseless and apnic so we voted, unanimously, to grab him and beat cheeks to the rig where all supplies are a hand reach away.
Ok, ABC's. Open airway, insert OPA. Still not breathing..Ok, ventilate twice. Check pulse, still no pulse without compressions..compressions resumed. AED hooked up...compressions stopped...V-FIB...charging 200 joules....."everybody clear?"...yep!...Ok!....THWUNK.....asystole....compressions resumed. Ok, medics ready to tube him, remove mask and OPA then set up two IV's normal saline on 10drop tubing and hooked one up to a 16ga angiocath in right arm runnin' wide open....alright!...line 1 in...ET tube in ...verified placement and secured....next!...1mg Epi rapid IV push followed by 50cc bolus.
Stop CPR, still asystole...still no pulse..CPR resumed. Now for the second line... another 16ga, in the left EJ also runnin' wide open. Alrighty then; ABC's done....."you guys ready?"...."yup"...."you wanna drive?"...."dont matter its your day off"...."OK I would rather not be back here" I climb out the back door of the unit shut it walk to the driver seat and climb in put it in drive and drive across the freeway thru the median and on to the west bound side and we are off on the 53 mile trip to the hospital 16 minutes after we got on scene.
Forever and a day later we arrive at the ER and I open the back doors to remove the gurney and there it was... that haunting and familiar scene. Pale, flacid and dead. A people. A dead people connected to our various machines by a multitude of different colored wires and tubes and bent over him two sweating people doing their, ultimatly futile, best to keep him alive. We unload him and wheel him into the ER transfer him to the ER bed then I remove the sheets and wheel the empty gurney outside. And under the cold January sky I light up a smoke and wait....
1-28-2004 - 1-30-2004
Not much happened this shift. Had four cancels and four calls that were transports to the hospital and none of those were critical patients.
3/5/04 - 3/7/04
Completed another 72 hours in Ft. Defiance. Had two cancelled calls and one transport to the airport.
2230hrs: Ft. Defaince E.R. calls us and says that they have a male patient with a broken leg who is being transfered out and him and the flight crew needs a ride to the airport and the flight crew would be there in 15 minutes. 15 minutes later we pull into the ER remove the gurney from the unit and wheel it inside; No sign of the flight crew so we park the gurney out of the way in the hall and start on the paperwork. A few minutes later the flight crew walks in with all their equiptment and set it down by my gurney and start their paperwork.
I have completed my paperwork all required boxes are filled out and all required autographs are autographed. So I prepare the gurney for the patient, unfold the flight stretcher and lock it flat put it on top of the gurney place a clean sheet on it, get their portable monitoring device and hang it on the rail. OK, all set. Time to load the patient now, I wheel it into the room, drop it down to a comfortable height, disconnect all of the ER's monitoring equiptment and with some help from him, my partner and I scoot him over to our gurney secure him in place and start applying the flight crews monitoring equiptment; EKG, PulseOx and Blood Pressure cuff.
Just as I am finishing up the flight nurse pokes his head in and says that we were needed upstairs on the pediatric unit for a kid that was more critical then the broken leg and to unload the patient and meet him upstairs. After we get the patient off our gurney we head upstairs to wait while the flight crew and hospital staff try to stabilize a kid with respiratory failure secondary to RSV infection. We wait and wait and wait while they try to get his Ph up from 6.68 to above 7.00. Before we can leave the hospital the receiving doctor wants his ph above 7.00. At 0220 we finally leave the hospital for the airport and still the ph is 6.80. We load the patient into the aircraft wait for them to lift off and we head for home.
4-9-04 1700
V and D came by and we all went to eat. Had a real pleasent dinner V's friends from work were there also and the restaurant was real busy so we waited for over an' hour for our food. I had a real good time in spite of the fact that it reminded me of old times and what I was missing with such poignance that it took my breath away and caused sudden onset substernal crushing chest pain that radiated everywhere.
After dinner we all went bowling for around an' hour or two. Was one of the best times I have had in years even tho my score sucked; threw quite a few gutter balls not to mention that none of us quite knew how to keep score!!! so we did the best we could which was good enough because it was all for fun anyway. But alas, all good things come to an end and there came that awkward goodbye around 2200 standing in the parking lot of the bowling alley a light rain falling, almost as if the sky was crying over us. The smell of rain in the air and the gentle breeze was intoxicating and for a moment time just stood still...................just us three, together ..........frozen in time for one sweet,beautiful,breathtaking moment.
Then reality breaks the ice and in less time then it takes to say "huh?" we all are going our seperate ways into the night.
5-22-04
"Click" That subtle, almost inaudible but unmistakeable sound of the radio breaking squelch just a fraction of a second before the sound of the tones can be heard sent an electric shock up my spine causing me to spring to my feet as the hair raising "Dooooooo.....Dahhhhhhhh...beadle..beadle..beadle" sound of the tones followed by a tense pause then.."An ambulance is needed at Jays for a 56 y/o female who has had a heart attack and is unconscious", The Dispatcher says, "Repeat: An ambulance is needed at Jays for a 56 y/o female who has had a heart attack and is unconscious. Time out 1927"
"I knew it! its been too quiet for too long..this is gonna be a bad one" My partner states as we hop in the ambulance."It's been too long since we had a bad one". "Yeah", I reply as we pull out of the bay,"It's sounds like its gonna be a bad one" I flip on all the lights, pick up the Mic "Dispatch. Medic 4 is 10-76"..."Copy. Medic 4 at 1928" We accelerate down the the road to the stop sign flip on the siren.. check to make sure traffic has created a safe hole for us to enter "Clear Left!" I say. "Clear Right!" My partner replies. I make the right turn and mash the pedal to the floor and the Powerstroke Diesel responds instantly and launches forward and 2 blocks later we are have already doubled the posted limit of 35mph(Powerstrokes Rule! BTW) ...Traffic light comeing up...we have green light...im scanning back n forth lookin left to right then right to left, lookin for that one car... always lookin for that one car...the one with your name on it never knowin what it looks like or where it will come from...but always expecting it...
But all traffic is apparently stopped, Even so I jump into the left turn lane go thru the intersection and end up behind a police officer responding to the same call so I drop into formation 'bout 500 feet in back him for the rest of the two minute 70+mph ride I put on a set of rubber gloves and I contemplate the horror I expect to find when we arrive there which, by-the-way, is right now.
"Dispatch. Medic 4 is 10-97" I say on the radio as we pull off the road onto the dirt parking lot and position the unit as close to the door as I can. "Medic 4, Dispatch replies. "Copy at 1930" My partner E is out the door with the AED before we are completely stopped and vanishes inside the restaurant. I quickly jot the time down in its proper spot on the time log, exit the vehicle walk to the rear, and open the doors and remove the gurney and place a backboard on it just in case CPR is needed. As I start dragging it across the parking lot I spot one of the cops going thru the door "Hey! Can you give me a hand getting this thru the door?" I ask. "Sure thing" He replies.
In thru two sets of doors, a quick right then a hard left and there it was unfolding right in front of us and the fifty other people eating dinner. Laying on the floor is a thin fairly healthy lookin elderly lady and she dont look very well right now at all, in fact she looks like shit. She was already decorticate posturing with her rigid arms crossed on her chest and mouth gaping open making this horrifing gasping sound everytime she took a breath and that told me all I needed to know; she had a head bleed and it was a bad one, she was dying from it and we needed to get her the fuck to Flag where the neurologist's and surgeons were who could maybe drill a hole in her skull in order to relieve the pressure that was building up inside her skull to give her the best chance of survival.
E looks up at me and I nod and say, "Lets get her outa here!" "Ok," He agrees. She is placed on the gurney and strapped in place and we are headed out the door across the parking lot to the back of the ambulance load the gurney lock it into place and climb in the back. Time to get to work. I turn on the Propaq and wrap the blood pressure cuff snugly around her right arm and push the start button and the Propaq hums to life and starts trying to get a blood pressure then I place the pulse-ox probe on her finger. I look up at E and he has set up an IV and is currently establishing access in the left arm and another paramedic is there also, applying some high concentration oxygen. E catches my eyes and says, "She's got a head bleed dont ya think?" "She sure does!" I reply. "You ready to go?" "Yeah lets go" E says. I climb out of the unit shut the doors to the patient compartment and remove my gloves as I walk up and open the driver door toss the ball of inside out gloves on the floor by the pedals and climb in the drivers seat pick up the clipboard with one hand and the radio mic with the other "Dispatch. Medic 4" I say as I get a pen ready to jot down the time. "Medic 4. Go ahead" Dispatch replies. "Medic 4 is 10-76 to the ER" I advise. "Copy Medic 4 at 1935" Dispatch acknowledges. I write the time down on the clipboard and toss it onto the passenger seat, slip the tranny into drive, turn on all the emergency lights ease onto the street and head south towards the interstate as swiftly and smoothly as possible.
Once at the intersection I get on the west bound on ramp and gas on it; feeling the powerstroke diesel unleash its ever ready turbocharged ponys and I had topped it out at the ludicrously slow speed of 98mph long before the ramp ended and we still had 34 miles to get to the closest hospital but this patient was way too critical for the small town hospital to handle, perhaps to critical for any hospital, judging from her presentation and the time element from onset and her rapid deterioration this one was in Gods hands and He wanted her now. Our job however, requires us to fight with Him to keep her here, so we need to get her to FMC which is 9o miles away and the quickest way to do that is by air so I call in the cavalry, "Dispatch. Medic 4",I say. "Medic 4 go ahead",Dispatch replies. "Could you launch a chopper to meet us at the airport" I say, "We will be there in about 25 minutes" "Copy Medic 4 at 1940" Dispatch aknowledges. For now, all I can do is drive as fast as the stupid speed limiter would allow and as smooth as I can to give the crew in back as stable of a work platform as can be possible in a moving vehicle because they are walking around as they work and using needles and other hazardous equiptment so gradual slowing and gentle cornering is essential in reducing risk and a more efficiant use of time. So for the next 25 or 30 minutes I had to drive, it was all I could do to help out
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