Rookie's First Code

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I am leaving the firehouse after we got canceled en route to a motor-vehicle accident. It is 05:00 hours, and I am driving home lazily. It is late. I am tired. I have been a member of the Fire Department for only a few weeks, and I know I have a lot to learn. Even so, I am thinking about how much I enjoy being part of the Rescue Squad, and how I don't mind waking up to get to calls when my pager crackles to life. "Echo Cardiac Arrest."

Fuck.

I screech to a stop and make a u-turn as fast as I can. My car protests as I hit the gas and accelerate without warning, but I make it to the firehouse in time. The EMT and the Driver from the last call also return to the firehouse in a frenzied, frantic blur. The EMT looks worried. "Is anyone else on their way?" he asks the Driver up front. "I don't think so." The Driver replies. The First Responder cars dart past. The Chiefs are already en route. "I guess that's it." The EMT says, with a mixture of apprehension and disappointment. "Let's go."

The sirens scream as we make our way to the scene. I grab gloves. The EMT tells me that we will need a backboard, and that I should bring it in with me. I grab the PCR book and a backboard from the ambulance and run into the house. The patient is in full arrest when we get there. She has no pulse and she is not breathing. She is an elderly woman who has a history of cardiac-related problems. She originally called the ambulance because she was having trouble breathing, but things took a turn for the worse.

I prop the backboard up on a nearby wall. The EMT in charge tells me to take our patient's son out of the room and get information from him. This is my first time interviewing a patient's family member, and I am nervous. I try to be professional, though. "Excuse me, Sir, what is the patient's name?" "Mary." He says, distracted. I scribble the name in the appropriate box. "Ok, and how old is she?" "uh..." He looks into the adjacent room, where his mother lies on the floor. "76." He turns away and begins to cry. I feel relentless and cold. "You don't happen to know her social security number, do you?" He looks at me, confused. "No" he replies, distantly. He doesn't want to talk to me. He doesn't want to talk to anyone, really. And I want to offer compassion, but I am new and scared and unsure of how these things are supposed to play out, so I continue asking questions. "What is the telephone number here?" "123-4567." He says, now completely hollow.

When I finish obtaining the necessary information I place a hand on his shoulder and smile, weakly. It's all I can do. It's all I know how to do. He turns around and enters the other room. I remain where I am, shaking from anxiety and adrenaline. I replace the pen into the clipboard and wait. The crew brings the stretcher outside the front door. I hear the EMT in the other room say "Come on, let's go." They had shocked her with the AED and had successfully recovered a pulse. None of us were ALS, so we don't start an IV or intubate. 5 different men work to place our patient onto the backboard and then onto the stretcher. I wait outside with the stretcher.

The patient is placed onto the stretcher. I quickly realize that no one is going to tell me what to do. I see that the EMT bagging the patient is struggling, so I reach up to make a better seal for him. I struggle to hold the mask on the patients face because of the height of the stretcher, but I manage to keep it still. I get into the ambulance and help load the stretcher on. I hear police sirens and the EMT in charge saying that we are getting a police escort to the hospital. I am positioned directly over the patients head, now. I am kneeling and I am looking directly into her eyes. They are glazed over and glassy. Her mouth is open and she is agonally breathing. I wonder what it's like to be her. I wonder about her family and her son. I wonder about who she was, what her legacy was, what she was passionate about. I hold the seal on the mask. I grip the mask so tightly my hands begin to hurt and I wonder if I am hurting her, too. I realize how ridiculous that question sounds. I still feel like I am hurting her. I still feel like her fragile skin will rip because of the extreme force I am exerting on her jawline to hold the mask in place. I feel as if someone is doing the same thing to my jaw.

She watches me.

We get to the hospital. We lost the pulse on the way to the hospital. We get the stretcher out of the ambulance. The EMT who is bagging the patient also happens to be a retired officer, and he orders the EMT who unloaded the stretcher to lower it to my height so I can maintain a proper seal. I am eternally grateful to him.

We get into the ER and are directed into a trauma room, where a code team is already assembled and waiting. We transfer the patient to the hospital gurney. I hold the seal until an Intern takes over. It is now 06:oo hours.

The code team is pitiful. They are new and young and inexperienced. They take turns reading the EKG and doing CPR rotations. They shock the patient. They push drugs. They are trying, I suppose.

We wait for the head EMT to fill out the PCR and then we leave. Our work is done. Our patient would eventually be revived, and live for quite a long time, with permanent brain damage. Sometimes I can't help but wonder if we had ALS on scene, or if she had a more experienced code team, what the chances of her recovering entirely would be.

It was a Monday. Cardiac arrests happen on Monday.