Lung sounds right. Lung sounds left. Over the belly. Nothing. “Yes.” I’m in. I look at the monitor. All she has is the wavy rhythm of CPR.
“Stop CPR,” I say.
The line goes flat.
“Start CPR.”
I grab a sixteen-gauge needle from my pocket and jab it into the jugular vein in her neck. Blood flashes back into the chamber. A direct hit. I hook up the line. It runs flush. I need a dressing. The EMT hands me one and I tape it down. We switch positions. Arthur takes over bagging. The EMT goes to do CPR. “Watch out for the line!” I see it before it happens. Her boot gets caught in the line and the line pulls out of the IV. Blood flows from the woman’s neck onto the floor. I grab the line spurting fluid, and reattach it to the catheter which fortunately is still in her neck. I open up the Biotech and grab the pouch of epinephrine, and popping the yellow caps off, one after the other, start firing the ten cc vials through the line. Epi after epi. With a couple atropines thrown in. “Let’s get out of here.”
We’re finally on our way. The tube’s good. CPR is in progress. I’ve got the line, and I’m slamming the drugs. “Come on back,” I say. “Come on back!”
I glance up at the monitor, and I see something funky. It’s like CPR, but with little notches. I slam more epi. The rhythm changes. “Stop CPR.”
I’ve got a rhythm back. “Feel for pulses.”
Arthur feels her neck. “Nothing,” he says.
“Keep going,” I say. “CPR.”
I put more epi in. Her color is starting to pink up. The monitor is changing again.
The driver hands me back the mike and says the hospital’s on.
I give a quick report. “Approximately thirty-year-old female asthma code. Was in respiratory arrest, now in cardiac arrest. We’ve got her intubated, a line in, and starting to get some movement on the monitor. Be there in five minutes.” I toss the mike back to the front, not even waiting for a reply.
“Stop CPR. Check pulses.”
Art feels her neck again. “I’ve got something. I’ve got a pulse.”
“We saved her?” the EMT says.
“We’ve got a pulse,” Art says.
Her heart is beating wildly at 160 on the monitor in a rapid A-fib. She’s back, but I’m not celebrating. I fear we are too late.
We wheel her into the hospital, and right into the cardiac room. I give my report. “Any trouble with the intubation?” the doctor asks.
“It was very hard,” I said. “I got it on my third attempt.”
“Did she get ventilated? How was the resistance? Was she breathing when you got there?”
“She was out when I got there. The cords were closed.”
“Laryngospasm,” he says.
Arthur congratulates me on our save as I walk out of the room, but I shake my head.
She goes to intensive care. A few days later I go up to see if I can find a nurse to talk to. She tells me our patient, Nicki Joyner, is hemodynamically stable, but had an anoxic event—anoxic meaning a period where insufficient oxygen caused tissue death. Her heart is beating and she is breathing on her own, but she is unconscious.
I tell myself I didn’t give her asthma. I didn’t delay calling 911 when she started having trouble breathing. I came as quick as I could. I didn’t cause her cords to close or cause her to stop breathing. She wasn’t breathing when I got there. But I think, Christ, if I had only gotten the tube on that first attempt. If I could only have gone in, lifted up, seen the cords, passed the tube, heard the lung sounds on the left, heard them on the right, no sounds over the stomach. Got her ventilated. Forced the O2 in. Maybe. Maybe she’d be back at work today or home laughing with her family around the dinner table. I lost her. Then I rallied, seized control, and brought her back, but to what end? I know other medics have told me about codes they’ve done, where they’ve brought the person back, gotten the save, and now instead of the person being six feet under the ground, they’re in some nursing home, hooked up to machines.
I talk to people about the call. The veteran medics and doctors cringe when they hear asthma code. These are people who shouldn’t die. Asthma is a preventable disease. But people abuse their medications, they don’t call when the attack starts, so when the medic gets to them, or when they are brought into the ER by their screaming family, they are on the edge—savable, but the window is short. I feel like a wide receiver who gets his number called late in the big game. I get open, the pass hits me square in the chest, but I drop it. It can mean nothing or it can cost the game. I catch the next pass, dive and grab another, but it’s too late. I’m a yard shy of the goal line. I didn’t get the tube right away and that was it. Season over.
Two weeks later, we’re sitting outside Saint Francis when the call comes in for a person unresponsive on a back porch on Barber Street, not far from Kensington.
“It’s a drunk,” Art says. “Whaddya bet?”
“Or a code.”
“Yeah, that’s right, the last one we had unresponsive in the hallway was the big guy, facedown with his shorts around his knees. Stiff. Remember that guy?”
“It’s a code,” I said, “I’ve got a feeling. It’s a code.”
“Four-seven-one,” the HPD dispatcher calls.
“Four-seven-one.”
“Four-seven-one upgrade to priority one. It’s a pediatric respiratory arrest.”
“Four-seven-one, copy,” I say, then, to Arthur, “Fuck.”
All the way there I am concentrating on what I am going to do. I’m going to get the tube. I’m going to get air into that child. I am going to bring that child back to life. I will not, I cannot, I must not fail.
We pull up and there is a woman standing on the corner flagging us down, crying. “Around back, around back,” she shouts.
Arthur pulls the stretcher and I grab the blue bag and monitor. We run down the drive to the back door. A man stands behind the glass. I try to open the door, but something is blocking it. “You can’t open it,” he says, crying. “She’s blocking it.”
I look down through the glass and see a body facedown.
I turn and run along the side of the house. Wendy Albino and Matt Lincoln in car 463 pull up on scene to back us up. I scale a low fence and go in through the front door. The house is dark. “What happened?” I ask a woman, who is wailing and following after me as I run.
“It’s my baby. She got asthma. She’s not breathing.”
“When did she stop?”
“I just found her. She been gone two hours.”
I get to the back and find her in the stairwell of the back breezeway. It is cold there. She lies facedown wearing a heavy snow jacket.
“She’s not breathing,” the man says, through his tears. “We thought she’d gone to school.”
I touch her face. It is cold. I try to move her jaw. It is stiff. She isn’t breathing. Fuck, she’s already dead. Rigor has set in, I think. But she’s a kid. I’m going to work her anyway. I reach down and put my arms around her, and lift her up forcibly. I fall against the door, and, as it suddenly gives, we tumble out onto the back driveway where the stretcher is set up. My equipment isn’t there, nor is Arthur. He and the other crew come charging out of the house behind me. I lift her up onto the stretcher. “Let’s just get her in the truck. We’ll work her there. Get the ambu-bag out,” I shout.
“Is she breathing?” Wendy asks.
Matt undoes her jacket. We wheel her toward the ambulance.
“Wait, she’s squeezing my hand,” Wendy says.
Matt feels her throat. “She’s got a carotid pulse.”
None of this is sinking in. It makes no sense to me. We lift her in the back. I go for my airway kit. I see the woman from two weeks ago lying there on the stretcher. Not breathing. I remember the struggle to get the tube, to get air in her. I’ve got to get the tube. I’ve got to get the tube.
“She’s breathing,” Wendy says.
I grab her jaw, and her eyes open suddenly.
“I don�
�t think you’re going to need to tube her,” Matt says.
The girl smiles at me and says, “Can you get my mommy?”
I let my laryngoscope drop to the floor.
We all sit there.
“I’ll get her mom,” Wendy says.
Arthur puts his hand on my shoulder.
I am all at once too tired to even move. On another day I might want to pick this girl up and spank her. I might want to put a large needle in her arm to teach her a lesson for her cruel, attention grabbing charade, but now I am beat through and through. Spent. I let out my breath. I sit there.
It is a week before I feel like doing anything for anybody.
Gory Stories
One of the most common questions any EMT gets from a layperson is “What is the goriest thing you’ve ever seen on the job?” Very few of our calls are what you’d call gory, but that’s what everybody seems to think about what we do—gore, beheadings, guts hanging out.
A mechanic at the garage where I’m getting my car inspected sees my uniform jacket in the backseat and says, “I bet you must see some pretty gross stuff, huh?”
“Yeah, I guess, a little bit,” I say.
“Like what, tell me. What’s the most gruesome thing you’ve ever seen?”
I think for a moment, uncertain whether I want to get sucked in or not, but he looks so expecting, I tell him, “I guess it’d have to be this body I saw spread-eagled on the road at an MVA scene. Completely ripped open. I could see the intestines, the heart. It stunk something fierce.”
“Yeah, aw, gross,” he says.
I don’t tell him the body was that of a skunk, run over by a station wagon that swerved to avoid the animal and ended up crashed into a telephone pole, leaving the driver with a facial laceration and some back pain.
“What else?” he says.
I think for a moment, then come up with a real call. I tell him about the guy shotgunned to the groin. “He was lying there holding the bloody mess, and there was nothing there but a bloody crater.”
“Did they fix it?” he asked.
“That’s what he was asking, all the way to the hospital, ‘Is it going to work? Is it going to work?’ I gave him an IV and told him it was going to hurt a little, and he said, ‘Anything so long as it’ll work.’ ”
“Well, did they fix it?”
“Yes, they did. He can even pee through it, though it’s a couple inches shorter than it was before.”
I can see the pain on his face. He squeezes his legs together. “What else, tell me one more. You get any other good dead bodies?”
I tell him about the guy in Bellevue Square where we’re called for a possible 78—a dead body. We arrive outside the complex, and I have to say the air smells a little odd. The cops have been waiting for us to arrive. They say no one has seen the gentleman who lives in the first-floor apartment for two weeks, and there is a funky smell coming from his apartment. The apartment is dirty. I can hear a TV coming from the kitchen. I walk in slowly. Roaches run before my feet. I pass the kitchen. The small black-and-white TV is playing, the local weatherman is giving the forecast—hot. I pass the bathroom. Empty. The back bedroom lies ahead, the door is open. I hum to keep from inhaling the odor that is wafting out to meet me, hovering at my nostrils, begging me to breathe in. I walk slowly, like a soldier through a mine field, ready at any moment to take cover or run. I step through the door, look to the left, and there he is, a four-hundred-pound naked man, bloated up like a pig, lying on his back, a chair broken to the side. There is shit or dried blood, some dark brown-black material all over the floor. My eyes are fixed on his scrotum—it is the size of a football. The smell is in my nose now, and I fight back the heaves. He has a thick black beard. Bugs run out of his mouth.
“Bugs?” the guy goes. “He had bugs running out of his mouth?”
“Bugs,” I say.
I turn and walk past Art. I go into the kitchen, and fight back the heaves. The cop looks at me from the door. “He’s dead,” I say.
I am supposed to put a monitor on all my dead bodies and run a flatline strip for documentation, but I just head out the door. The only place he’s going to come alive is in my dreams. I go to Saint Francis and scrub my mustache. For days every now and then I get a whiff, and I cringe.
The mechanic is impressed. “You must get a lot of chicks, huh, being a paramedic?”
“I get my share,” I say.
“Cool,” he says.
“Yeah,” I say.
I start to collect gory stories from other medics to impress the guy with when I go back—tales of transected bodies, beheadings, kittens eating dead bodies’ eyes, the intestines hanging out of a guy I treat who was stabbed while buying drugs, intestines that looked like deflated sausages. But before I get back the mechanic goes over to his friend’s house one night, has a couple beers, and they start passing a gun around. It goes off unintentionally and shoots him through the neck. A bloody scene. He’s DOA at the hospital.
Too Much Confusion
Carbon monoxide is a colorless, odorless gas present in the fumes of gasoline engines. The deadly gas binds with the oxygen-carrying molecules on red blood cells and prevents them from transporting oxygen to the tissues. Symptoms can include nausea, headache, faintness, and confusion. Continued inhalation can lead to death.
The call comes in for a car running in a garage. The address is a town-house complex. A woman stands outside a one-car garage, under an apartment, frantically hailing us. As we get out I can hear a car engine running inside. A man runs toward us and goes to the door, hands shaking, to key it open. As he lifts the door up, I can see a tube running from the tailpipe into the back window of the car. The small garage is filled with smoke and fumes. I can see a body slumped behind the wheel. A man runs past me and opens the car door. He tries to pull the person out, but the person is stuck.
“Give me a hand. I can’t get him out of here. He’s stuck!” the man shouts at me.
I hear fire engines approaching. I know the garage is filled with carbon monoxide, but they are only fifteen feet from me; the man is shouting, pleading for my help. “Get the stretcher,” I shout to Arthur, then I run in. I grab the man, who is unconscious, under the arms and pull. He comes loose. The other man grabs his legs and we have him out. We carry him toward the ambulance as Arthur lowers the stretcher.
The man is shirtless and looks to be in his twenties, a muscular Puerto Rican kid. His skin has a yellow hue, his face is cherry red. He is not breathing. We set him on the stretcher and lift it quickly into the back.
“Get him on the monitor,” I say to Arthur, as I reach for the airway kit.
I grab the laryngoscope and a number-eight tube. I go in, lifting up on the tongue. The cords drop down into sight. They are huge—they look like the entrance to a cave. The light at the end of the laryngoscope blade illuminates the cords as if they are onstage, like they are talking to me. Here I am, baby. Tube me, tube me.
I pass the tube easily. I tape it down, check for lung sounds. In solid.
“He’s flatline,” Art says, starting CPR.
I have the drug box out. I take out a bristojet and a vial of epinephrine. Holding one in each hand, I pop off the yellow caps with my thumbs. The caps float up in the air, spinning.
“Where’s the fire department?” Arthur asks.
“Why don’t you stick your head out and get somebody?”
I screw the epi into the bristojet, separate the ambu-bag from the tube, squirt the drug down the tube, reattach the bag, give two hard squeezes on the bag, then reach over and do some compressions, as Arthur gets out and shouts for someone to help us. A cop gets in the driver’s seat as Arthur gets back in with me.
“Where are we going?” the cop says.
“Hartford Hospital,” I say.
“How do these lights work?”
I lean toward the front and flick them all on. “Go nuts,” I say.
He grins like a little boy, shifts into drive, and we’re off.<
br />
I need to get an IV line now. The kid has a huge external jugular (EJ) vein running down the left side of his neck. It is so big, I think I could lay it across a mountain stream and walk across it like Karl Wallenda. I take out a fourteen-gauge needle and stab it with an audible “Ya-haa!” I get a flashback. In. I hold pressure on the neck, withdraw the needle, and attach a line of saline Arthur has spiked to the catheter.
“Gangbusters,” Arthur says as we open the line up.
We are flying through the streets now. On one bump, both of us end up sprawled across the patient. Arthur shouts at the driver. “A little easy on the gas,” I say.
The cop smiles, like the dog Mutley who used to drive Dick Dastardly’s racing machines.
I fire epis one after the other into the line. Arthur’s doing CPR. I bag. We whirl around another corner and go flying again. I find my eye looking at that other external jugular vein on the right side of his neck. It’s calling to me. Stick me. Stick me. I take out another fourteen and go for it. “Ya-haaa.” I get the flash.
“Bilateral EJs,” Art says. Impressed.
We have two bags of fluid running wide open. I am still firing epis in. Still flatline on the monitor. We hit a bump and go airborne. We crash over the patient. I feel like I’m in a rodeo. “Bag for me while I call the hospital,” I say to Arthur.
I lean into the front. As I reach for the C-Med mike, I say to the cop, “Good driving.”
I call C-Med and am connected to the hospital. “Approximately twenty-year-old male in cardiac arrest, found in a car in a garage, engine running. Tubed, two lines running, asystole on monitor. See you in a couple minutes.”
I go back to firing epis through the line. As we pull into the hospital, I fire my last one.
We wheel him right into the cardiac room. I see one of the nurses looking at me a little strangely as I give my report. “Four atropines, twelve epis, no change. Got an eight tube.” I point to the EJs. “Two fourteens.” They check the tube placement—solid—hook him up to their monitor, asystole. The nurse is still looking at me as I strut in place.
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