Do Not Resuscitate

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I am in the middle of practicing the fine art of splinting with some of the newer Rescue members down at headquarters when, thankfully, the tones drop. Myself and two other EMTs rush out of the room before we even hear the dispatch information, glad to be free of the scrutiny our seniors were putting us through.

We are walking into the ambulance bay when the dispatch info. comes over. "Respiratory distress at a local nursing home." We groan, and get ready for the uneventful 4 minutes it will take to get the patient to the hospital.

I grab the oxygen bag and the PCR book, and walk into the nursing home. Immediately, I am greeted by a friendly security guard that denounces men and praises us for being so quick in our response. In her words, "it takes the guys that respond here at least 4 times longer then you ladies!" I play along, and then follow her as she leads me to our patient.

The patient is lying on the bed with a non-rebreather on. She has her eyes closed. Before I even walk fully into the room, the nurses shout out that she's DNR... I blink. Upon further questioning, it seems as if this patient hasn't had a pulse or, consequently, a blood pressure for approximately 40 minutes. She is agonally breathing. For all intensive purposes, this patient is dead.

I turn to the other EMTs, with a "what do I do?" look, but they are as perplexed as I am. It strikes me as ridiculous, to tie up an emergency vehicle and an emergency crew for this kind of thing. Isn't that what transport services are for?

One of the nurses says "uh... so are you gonna take her now?" I look at our patient. "I guess," I say, "but I need to see the DNR order." They go to photocopy it, and leave me and 2 other very small EMTs to move a rather large patient ourselves.

We manage. We get outside the nursing home, papers in one hand, stretcher in the other. We call our captain to make sure we're doing the right thing, and we head off. I begin filling out the PCR. Vitals.... pulse... zero? blood pressure.... zero/zero??? I pick up the radio to give the hospital report.

"Uh... be advised we are en route to your location with a 81 y/o female from stars nursing home. She is DNR. She has a doctors order to be sent to you. Was found unconscious for about 40 mins. Vitals are as follows.... pulse zero, blood pressure zero, respirations 6. she is on oxygen. we are pulling into your back door."

I hang up. I am dreading hearing the response from the ER nurses. I am half-expecting laughter at the other end. Instead, the radio crackles and spits, "You have clearance to the main room." It still seems insane to me to give this patient a bed in the ER for any extended amount of time, but hey, who am I to judge?

We roll into the ER and are greeted by 2 nurses. They direct us to a bed. We obey.

I am about to finish filling out the paperwork when the hysterical relative shows up. "Please tell me she's okay" she says as she approaches me. I sidestep her, saying that she's got to wait for the doctor to show up. In retroscpect, I probably should have been straight with her, kept her away from her now dead relative, not let her see her that way quite yet.... Anything to soften the blow. But I was confused by the entire call, and not prepared to deal with a hysterical relative in any form, so I left her alone.

She walks into the area where the bead was, and one of my co-workers does her best to calm our patients relative. I fill out the paperwork and listen as the relative screams, and cries, and hugs my partner desperately. I watch as my partner, equally as shameless, comforts this woman. I am struck by the complete abandon, the truth to this womans grief. the depth. the reality.

We all walk out of the ER a bit shell-shocked. We get into the ambulance and head back to quarters, now ready to welcome another lecture on the importance of proper splinting technique. I close my eyes for a second, to absorb what has happened in the past 20 minutes. The tones drop. "possible fracture, adult male." The sirens blast, and the lights turn on.

Here we go, again.

A Rookie Mistake

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It is the last day in Kaberamaido. I am busy triaging patients, performing basic wound care, and filling hastily written prescriptions. Dr. Bill is taking a break for a change, and enjoying the company of the children. Apparently, myself and the other EMTs have proven ourselves competent and capable healthcare providers, and he has entrusted with us the medical care today. Any serious cases, we are to refer to him, but all Basic Life Support and First Aid type cases we are allowed to take care of on our own.

I am thrilled, as are my fellow pre-medical colleagues. Finally, we get to play Doctor for real.

I am performing an exam on a child from the orphanage. She is a quiet and shy 11 year old, but she speaks English fluently, which is a pleasant and welcomed surprise. She presents with a headache, slight fever, and sore throat. Her vitals are stable, lungs are clear, and seems to be in otherwise relatively good health. I give her two chewable tylenol. I instruct her to stay hydrated, to take a tylenol to bring down the fever and take the other later on that day, to stay out of the sun, and to generally take it easy.

Easy enough, I think to myself.

We triage more patients. We hand out more medication. We write prescriptions. We fill prescriptions. We work until daylight ends, feeling like "real" Doctors.

"I got this," I think to myself.

We are packing up to leave when one of the Matrons motions to us. "Very sick child," she says as she pulls a little girl towards us. It is the patient I handed tylenol to earlier.

I am confused. I could have sworn this was just a headcold. I feel her forehead, and immediately am alarmed. "She is burning up," I think to myself. I grab another tylenol and hand it to her, with water. "Take this." I call over another EMT. "Get Doctor Bill," I said as calmly as I can manage.

Doctor Oscar, the local physician on the ground, arrives. He feels our young patients head. "Too hot!" He exclaims surprised. I agree. Doctor Oscar transports our patient on his motorcycle to his clinic, to watch her overnight. I walk with the other EMTs back to our house.

We later learn that our patient was having an acute malaria attack. She also was HIV/AIDs positive. I feel awful. We missed a huge, gigantic, enormous part of the patient's history, and almost put her in a life-threatening situation. If we had left the orphanage for the day and the patient was overlooked, our mistake could have cost her her life.

But a lesson learned is a lesson learned. No half-hearted medicine. Thorough, patient histories are just as important as filling prescriptions and "active" medicine. We visit our patient the next morning. She is smiling, and sitting up on her own. Her fever went down. She will be okay.

I feel relief. Relief, and guilt. I vow to never let a patient of mine down like that ever again.

Dead On Arrival

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It is 19:00 hours. I am driving to the weekly Rescue Drill when the pager sounds. Signal 24; Mutual Aid, Water Rescue. I hit the gas without switching on my blue light; I am only a few blocks away, and it's too early for my light to be effective, anyway.

The engines are already waiting outside the firehouse bay. Firefighters scramble to make the trucks. I wait near the ambulance for a Rescue Crew to assemble.

A group of firefighters, and one older EMT jumps onto the rig. I get on with them and we're off.

We get to the marina. The Chief is already on scene, and setting up a command post for centrallized radio communications. Firefighters and a few select rescue members hop onto the rescue boats. The Dive Team arrives, and gear is loaded onto the boats. After limited delays, the two boats are off.

I stay behind, with the ambulance and the Rescue Crew stationed with the ambulance. I stand next to the Chief and listen to the radios. Chief begins speaking with the local police department, and establishes connection with the U.S. Coast Guard. Together, they establish a search pattern in the water, centralized around a large bridge connecting the mainland to the beach. My first thought is carwreck. Ejection; Fast & Simple.

But, as I look towards the bridge I see that traffic is moving. MY theory is shot to pieces. What the hell happened? I wonder to myself.

Chief gets a message from the Police Department. "We just got a call from the mother..." The radio spits and crackles. The Truth emerges.

Our victim, a 19 year old female, was dropped off at the base of the bridge by friends of hers, and then left there per her request. She walked up to the center of the bridge, called her mother who lives about an hour and a half away, told her mother she was jumping, and then jumped.

I turn to look at the water.

Suicide.

It's windy outside. I become acutely aware of the sensation the cold, salty air leaves as it beats at my exposed skin. I watch the water.

45 minutes pass and no sign of our victim. We wait... An hour passes. Two, We don't know where our victim jumped in relation to the bridge, and the waters' currents are strong, making most of our work guesswork at best.

The U.S. Coast Guard releases the Firematic units after two hours of searching, deeming the operation a "recovery" rather then a "rescue." The U.S.C.G. requests help in a few hours to search for the body.

The rescue boats return to the marina and the firefighters unload their gear. I sit in the back of the ambulance and contemplate what my first Dead On Arrival feels like.

Later on that night I go for a run. I stand at the edge of the water and listen to the dark waves lap against the sides of the wooden dock I am now standing on. I star out into the vast, dark, empty water, and am struck by how tainted everything in my sight seems. I stare down into the dark, cold water, and try to imagine what it must have felt like to be on top of that bridge, staring your own death in the face, and then taking your own life.

The lighthouse blinks in the distance. I sit on the dock and watch the cars pass over the bridge.

I close my eyes.

I pray.