We all joke in ways our families, friends and patients don’t understand. See around the 3:20 mark of this video:
Godspeed, friends!
Archives for heart-strings
For the past 11 weeks I’ve been back on nights. I’ve spent 50% of the last 3 months away from my family, missing them more than I can describe. The hardest part has been saying “goodnight” to my son over the phone. When we started, it was particularly hard. He didn’t really get it, and mostly just ignored the voice on the phone. Now he gets it… and maybe it is even harder… His sad little voice is just too much sometimes.
But in a week, I get to go back to days. There are a lot of changes with that switch to days, all of which make me anxious… But I get to go back to days! I get to tuck my boy in, sleep in a bed next to my wife, and see them both in the morning.
The stress working nights has put on my family is hard to explain… but god damn it will be nice to be home like a normal dad. Three years ago when I started this career I couldn’t imagine how it could put strains on my life….
Be safe out there, friends…
Godspeed,
m3
“Mr Thompson…. Today when we arrived your wife was not breathing, her heart was not beating. We began CPR and hooked her up to our cardiac monitor. The monitor showed that your wife’s heart had stopped. It had no electrical activity.
At that time we continued CPR while administering heart-starting medications and inserting a breathing tube. After nearly 20 minutes, nothing has changed. Her heart is still not beating. She is still not breathing.
I give you my most sincere condolences, but she is deceased and there is nothing more we can do. I’m very sorry sorry for your loss. ”
This is how it plays out in my head. Well put, accurate, somewhat concise…
But it never comes out as well and they never let you get that far. It is even harder in untimely deaths.
What do YOU tell people when their loved ones have died?
Probably one of the most tragic, yet somehow sweet deaths I’ve ever heard of:
Elderly couple dies while trapped in home elevator
While I imagine dying trapped in a closet size elevator for likely days prior to dying would be terrifying, I think that if I had to go this way being with the love of my life would offer some solace, no?
“Police discovered the Wadsworths’ bodies lying in a fetal position, facing each other…”
I can picture this pretty well… and won’t deny having lost a tear or two over it.
“We always said we hoped they would go together because if one went, the other wouldn’t survive long,” the couple’s son, Wesley Wadsworth of Blue Bell, Penn., said Thursday. “They were so dependent on each other.”
Godspeed.
While perusing the blog front I was reminded of a few calls… While one I am writing now, the other I will just let Kelly Grayson tell for me….
Often times during those calls, while showing my stern and focused face behind swollen eyes ready to burst with tears, all I really want to do is say a nice health “Fuck You” and flip the bird…
Instead I put my nose down, do my job, and treat those we can. The shit days are when the dirt bag is your patient.
Like a page from a book, dispatch sends us code 3 for a finger amputation. Grumbling as I roll out of bed while dispatch updates us–a 27 year old female at one of the local state-run group homes who intentionally put her hand in a garbage disposal. The grumbling increases. The staff at these facilities leave something to be desired and the patients usually are fine. This has to be an overreaction, doesn’t it?
As we round the corner inside the door, the scene is as expected–practically empty. One staff member sits with our wheelchair bound patient, everyone else seems to be missing, despite it being meal time. A quick once over leads me to believe there is no amputation, the annoyance sets in.
So I ask my patient “whats going on tonight? How come you did this?” I am completely unprepared for the answers that follow. My patient–a 27 year old paraplegic female who suffers from Bipolar disorder, severe depression, and a gamut of other psychological issues–literally just came from our Behavioral Hospital. The very behavioral hospital she has requested to be transported to several times over the last few weeks due to depression and serious thoughts of suicide.
The story goes like this… as a child she was sexually abused by her father, her brothers, and her uncles. Her father pushed her down a set of stairs leading to a mild Traumatic Brain Injury and complete paralysis from the belly button down.
The state put her back in this home where these ingrates continued to sexually assault, mentally abuse, and psychologically destroy her for the next 9 years. Finally the father is arrested for assaulting a neighbor’s daughter–when the story comes out again and the state takes her into their custody–only to be bounced from group home to group home, from one mental facility to another and back to the group homes. She has literally begged to be given inpatient treatment and the physicians say she just needs long term counseling. She is unable to do anything for herself–she cannot function without someone pushing her along. Not because she is physically weak, but because she is mentally broken.
She hurts because she has to actually hurt herself to get anyone to listen. I tell her we’ll get her help but she knows what that means. I will take her to yet another hospital where yet another doctor will push her back into the care of undereducated and overworked group home staff. All she wants is to feel safe. She wants to know that she can’t get out and THEY can’t get in–but no one will give this to her.
By the time we arrive at the hospital I know her story. I know enough to know that she needs this help. She knows what she needs, but doesn’t have the resources to do it herself. As I transfer care I take the doc aside and give him the story. I tell him how I think she is a genuine threat to herself and that her mental anguish is real–not like so many of the calls we go on–the ones that made me grumble as I rolled out of bed. This is the real deal.
– — –
Two months later the tones startle me awake. Code 4, Any unit in position, Cardiac Arrest to an address I am all too familiar with. Dispatch updates with a 28 year old female, unconscious, not breathing, her throat is cut.
My foot reaches the floor. My knuckles are white on the wheel. My partner looks at me and asks me if I’m O.K. I just drive faster. I walk in, the same deserted scene. The same deafening silence. I look down and know we’re too late. I let out a sigh, turn around and make the call.
I hurt because we failed.
Asher had another VCUG and Lasix renogram today for his hydronephrosis. Won’t have results for a day or two, but it looked like it always did… delayed draining of the left kidney. Hoping they find something diagnostic soon.
Until then, here is a pic of the little monster(who does not like anesthesia… fought it really hard).
After a dose of chloral hydrate and 2 doses of versed… the walk BACK to PEDS is what put him to sleep… Stinker.
Often times on a call, it is what ISN’T said that is most important. As paramedics we are trained to ask a set of questions necessary for assessing our patients, but more often than not, we know the important answers. We know when our patients are sick. We know when they hurt. We know when they can’t breathe. Those things are usually obvious.
The hardest thing we often know without a word spoken… we know when our patients are ready to die. The look–or lack there of–in their eyes, their posture, their sound–they all tell the tale all too well.
The trouble is that we are trained to prolong life. Little about our training prepares us for letting allowing watching someone die. We are trained to do everything possible to prolong life–whether that is what the patient wants or what is best for them. We are trained to give drugs, artificially ventilate, pace, defibrillate, and otherwise interfere in the dying process. We are not trained to let people die.
So what do we do when the ultimate time comes? Outside of a DNR most systems won’t allow you to cease rescussitation. My system takes the word of a family member very seriously–outside of suspicious circumstances, we honor the wishes of an immediate family member. We also take the time to educate them on what will happen either way. I find it important to make sure someone knows that even if we get them to the hospital alive, they very well might never wake up.
My job isn’t as cut and dry as most think. I rarely save lives. Most of what I do has little to do with medicine or emergencies. Most of my night is spent dodging drunks or other frequent fliers. In the last 6 weeks my partner and I had 4 or 5 really “exciting” calls. Maybe I’m sick/twisted/strange/gross, but the exciting calls are the ones that make you go “aw shit…”. Most of the time we are running call after call of No Ambulance Needed or PD to Transport. But every so often we actually run a “real” call. Every so often we come across a sick patient.
Every so often that patient has already made up their mind that they
can’t fight anymore. Who are we to decide otherwise? Does what we do make a difference other than to prolong a life of pain and discomfort? Are we doing harm in interjecting in what is the obvious end of the dying process? Are we causing pain? Obviously we are bound by our protocols/guidelines. Obviously we are bound as medical professionals to follow the medical standard. But at what point are we doing MORE harm?
In the time since the American Heart Association has begun advocating Compression Only Layperson CPR, I haven’t really heard and stories of confirmed success. While we all know that layperson CPR tends to be inadequate and layperson CPR breathing tends to end up in the stomach, there has been little to indicate that the outcome was any different than before.
Well, JEMS has a story that might just give us some hope that the AHA did the right thing. CNN has the full story. There are some interesting facts to consider in this story. First, the patient was a 33 year old female–not a likely case for sudden cardiac arrest, under most circumstances. Second, she was otherwise healthy, with no known cardiac history. Third of importance to me is that her husband is a Sheriff’s deputy–While he says that it was “different” that being at work, there is little doubt in my mind that his training and experience helped in some way. Fourth, but maybe the most important thing here–a skilled dispatcher walked him through CPR–Compression Only CPR. All of these factors are important. Lets examine what we can–33 year old women rarely experience sudden cardiac arrest. When they do it is usually caused by other (known or unknown) serious medical conditions–cancer, immune disorders, cardiovascular disease, etc. Initially it was uknown what caused Kathie Harden to die for 18 minutes that night. Kathie being just 33, her husband actually waking up just prior to her losing pulses, outstanding Dispatch direction, quick EMS response, and skilled hospital care can all be thanked. After her initially recovery it is found that she contracted a flu-like virus that attached itself to the left side of her heart, deteriorating heart muscle and function until the Right side of her heart could no longer function. She now lives with an internal cardiac pacer/defirilator.
After arriving at the hospital, Post-Arrest Cardiac Hypothermia was used to cool Kathie’s body to abnormally low temperatures. This is useful in protecting heart and brain function. It allows the body time to repair and recover before trying to fully “restart”. Initially neuro exams did not look good, but after just a few hours Kathie had started to show signs of improvement. After 18 hours Kathie was back from the grips of death. Theraputic Hypothermia was discontinued. She was soon on her path to recovery and “life went on”.
So here’s the thing: what saved Kathie? Was it Compression only CPR? Was it her skilled husband? How about fast EMS response? Her age? All signs indicate that all of these factors were essential to her survival. Most Certianly the Flagstaff EMS Calltaker that helped Scott pound on his wife’s chest that night deserves more than just a little credit. Arizona has worked hard to increase Cardiac Arrest Survivability and this is proof they are winning the battle. Keeping callers calm while giving them the tools to prolong life until destination care can be provided is no easy task and the fine people in EMS call centers everywhere need to be given credit.
Does this mean Compression Only CPR is the end all of Cardiac Arrest Care? Obviously not. Kathie recieved several rounds of CPR and several shocks from the AED brought by EMS. In the end cardiac drugs(epi) and defibrilation saved Kathie. But without early Compression only CPR it is certain that the tools EMS brought with would have had little chance to obtain ROSC.
I’d like to congratulate Flagstaff EMS Dispatch, Scott Harden, and the men and women of Flagstaff Medical Center EMS for providing outstanding care to Kathie that night. Every one of them did their part in saving a life–something that sadly most of us rarely get the opportunity to do, despite our profession.
It is 0300 and the fog of a dark sleep is interrupted by the shrill of my nemesis, the Motorola Minitor V. I love doing my job, but at 0300 no one likes doing anything (outside of stumbling home from the bar to burn eggs and bacon). The tones sound and a gruff but friendly dispatcher give me my assignment: “truck 1, medic three, medic 2… high speed MVC, head on, 2 unrestrained passengers. Reporting party states 6 year old son is not alert, barely breathing, has pulse.” The dispatcher gives directions to a rather infamous intersection on the edge of my little county.
** ** ***************** ** **
I have blood on my arm. My fear of other people’s bodily fluids is strong. I’d rather cut my own finger off than get someone else’s blood on my… or IN me…
This time I’m not bothered though. The blood is that of a 6 year old boy. A non-breathing, bloodied and mangled 6 year old boy.
** ** ***************** ** **
I pull myself from my daydream. I look down at my patient and know my tasks. Secure the airway, maintain breathing, collar, board, load and go. I roll through the tasks like I’ve done this thousands of times. I’m confident. Proud.
I’m scared shitless.
** ** ***************** ** **
As I pull into the little town ER where I will meet my hellicopter crew, I give report to the little town RN and the little town DOC. I’ve done by myself what I didn’t know I could do with 5 assistants. As I roll the little boy to bed 1 he is starting to buck the tube… Bad, but good. He hadn’t shown any signs of responsiveness since I arrived by his side. We slide him off my bed and the Doc asks if I’m ok. I’m grey. My face is blank, emotionless. Neither fear nor grief shows through.
** ** ***************** ** **
I sit at home on the couch. My wife by my side. Tears running down my face. All I can think of is what if’s. Not knowing that at this very moment that little boy is sitting up in his hospital bed, half smiling at his mother. I cry a little, mostly out of fear. I’ve got a little one on the way. But I cry.
** ** ***************** ** **
Several days later
The phone rings. A voice I recognize, but not sure where from, says to me… “do you remember me?”
I respond… “I’m sorry, I’m not sure”
She says… “My name is Amanda. You saved Daniel’s life. We took him home today. Just wanted to say thanks.”
My throat tightens. My eyes water. I can’t find any words.
Amanda says… “do you want to talk to Daniel?”
Really, I hadn’t. AD’s post was better than I could do… But I have to say something.
First, head over to Remember the Fallen. After I read AD’s post I did a little work on google and found that site. I browsed around and then I found the gallery.
It is full of heart wrenching photos.
This one got me.
With a son of my own, the fear of getting hurt–or worse–at work is ever present. The number of kids out there who have lost their mother, father, brother, sister, grandpa or grandma to war is growing. It hurts. I’m a grown man and I was blubbering like a baby.
It hurts.
May God have mercy on your souls.
God have Mercy.
Some Memorial Day Reads:
Just how hard being away from my baby would be. Tonight is my first shift away from home–away from my little boy.
I hate it. It leaves me with the worst feeling in the world. I can’t describe it at all.
I had no idea something so small and new could have such a strong pull on my emotions.
I love you Asher.
Mrs. M3–I’m sorry I didn’t get you anything for V-day. I promise I will make up for it on your Birthday–next friday(see! I do remember). Thanks for the cards… they were so very sweet.
Take care of our little boy. His daddy misses him…..
Little Ambulance, Code 4, Cardiac Arrest, 200 W House you’ve been 3 times in 40 days.
One of the hardest things about small town EMS is that inevitably you run on someone you know, or like today, you run on a “frequent flyer” for the last time.
She wasn’t the bad kind of frequent flyer though. She was the best patient I’ve ever had. Today was my third and last time giving her a ride.
Her husband will probably follow soon. Stage 4 Lung cancer, prostrate cancer, CHF. Like his wife, it will be too late before we even get there. They have no family close, so when he goes hopefully he isn’t all alone.
I checked him out and tried to make sure he knew we were there for him before I left. I don’t think he heard a word we said.
May God Have Mercy On Your Soul. god have mercy.
With Ninja Medic. Then Epi followed suit.
Really about once a month one of my fellow EMS bloggers(and I’ve done this too) eludes to one of the many stories of terror that haunt our Nightmare Bank.
There will always be a few memories of calls past that will NOT go away.
The irony for me is that tomorrow I am teaching a SIDS portion of our refresher as well as a Neonatal Care refresher.
More than a few things are ironic about this:
- My haunting pt is just a wee 18mo baby. Helpless.
- We talk about CISM(Critical Incident Stress Management) in both classes–how often do we actually use those tool? How many systems HAVE them?
- I’m about to have a baby. A helpess baby. I know far more than I wish I did.
Be safe out there, all. Godspeed.
And people still die. Rogue Medic’s post about ON the Clock’s post(yeah, I know) got me thinking TOO.
Sometimes we get there too late. Sometimes we can’t get that “vital” IV. Sometimes things just don’t work out. But then, sometimes you do everything you can, all in record speed–only to “fail”.
As EMS providers we see a lot of dead people. We see a lot less people actually die. Sometimes when we get there, the circumstances haven’t lined up to allow for survival. Sometimes people die.
One of the first lectures we got in Medic class said just that. You can do everything right–everything–and sometimes PEOPLE DIE. It is sad. It can be hard. But it is true.
One of the most important things we can do is to be strong. Sam at On the Clock is getting there–so am I. Some patients hit me harder than others. Sometimes people die.
It is important to remember that for us to do our jobs, we need to be able to live, learn, and move on. Some might find this harsh–but you can only take a little piece from each death you have in this job–if you take it all home, you’ll end up at the bottom of a bottle or signing your name at the end of the saddest letter ever.
Take a step back, and remember–not everyone can be “saved”. We don’t get to pick them. But more people out there need our help and you have to be ALIVE to do your job.
Good Luck and be safe out there.
Today is a solemn day of remembrance. Today, September 11th, 2008 is the 7 year “anniversary” of one of the most infamous days in American history.
For my family and I today is more. Sept. 11th, 2001 was also the day we burried my grandfather.
I remember everything about this day. I remember waking up to the phone in our hotel ringing–my grandmother telling us to turn the TV on. I remember watching the second tower fall–and I remember praying for all involved–especially those who ran IN despite the impending danger.
I also remember the tears in the eyes of the VFD members who came to mourn my grandfather–undoubtedly more to those tears than our day of mourning…
I remember the vintage fire engine that lead our way–not knowing who would be left to maintain it now that grandpa was gone.
I remember everything. I think about these things every day.
You are not forgotten Grandpa… None of you are.
May God have Mercy on your Souls.
You might have seen it before. I don’t really give a damn. Watch it. Those that know me know that I’m not a big fan of this war. I’m not anti-war. There are lots of wars worth fighting for.
This one just isn’t it. Regardless, My support for those who stand up do what I can’t imagine doing is strong, steady, and true. Our Soldiers need our thoughts, prayers, and support–both home and abroad.
Watch it.
Back home now I know you’re probably sleeping
Over here it’s the middle of the day
I finally found some time to write a letter
Sitting here a half a world away
I heard about all them folks protesting
As if I really want this war
But that don’t stop me from believing
There’s just some things worth fighting for
And if I die before you wake
I pray the world would take
A good look at what God’s given us
If we could only understand
Everything is in His hands
All we need is a little faith and trust
I want you to know
It ain’t too high a price to pay
If I die before you wake
Tell everybody that I miss them
And I can’t wait to get back home
Until then I’ll serve my country
And be proud to wear this uniform
And if I die before you wake
I pray the world would take
A good look at what God’s given us
If we could only understand
Everything is in His hands
All we need is a little faith and trust
I want you to know
It ain’t too high a price to pay
If I die before you wake
No, it ain’t too high a price to pay
If I die before you wake
Here is a powerpoint slideshow you can download.
