Last shift

9 Nov

Was somewhat of a doozy.  And at the same time, it sucked.  

0830 – got a call for a Cardiac Arrest – a ‘Code Red’.  67 yo male who was found by his family.  CPR was in progress by a neighbor when we got there.   We were the first of the ERS to arrive.  The cops with their AED’s arrived seconds after we did.  The neighbor had actually done really good CPR as there was obvious cavitation where she’d done compressions.  So we take over – get an OPA in and start bagging.   My trainee is doing the bagging while I’m doing compressions and my partner is running the show. My partner actually shows the officer that carried in her AED how to apply the pads.  AED analyzes the rhythm and tells us to continue CPR.

 First ALS on-scene is a paramedic engine and they start their protocols of establishing an IV, trying to get a tube in (guy had clamped down pretty good, and starting to push drugs.

All the while I’m doing compressions – alternating with one of the firefighters. 

The wife of the man we are working is screaming in the background that she’d been playing computer games last night and if she’d only checked on him sooner and that it’s all her fault.

The guy ends  up taking 4 rounds of medications, compressions had been going for 30 minutes when one of the paramedics called the hospital looking for orders to terminate CPR. 

The doctor declines our request – patient had been asystole on the monitor for the entire time – and orders us to continue CPR and that he’d see us on arrival.

So we transport.  Once we get to the hospital, the doctor says that he agreed with the paramedic’s request to terminate resucitation efforts but that he ordered us to transport ‘for the family’s sake’. 

What he didn’t understand is that the family knew that their family member was gone.  As my crew and I were walking in, one of the sons was holding the door and he told us he thought his dad was gone.   

The doctor calls time of death. 

 

A little later on in the day – about 1600 – we get a call to a house ‘to transport a woman in pain’.  I admit to thinking that this was a crap call.  That this was a BS call for a woman who just couldn’t suck it up and drive herself.  How wrong I was.

This woman is a 43yo who is currently coping with end stage breast cancer that metastasized to her bones.  She’s got tumors in her hips that she’s undergoing radiation therapy so her hip joint is very brittle.  She’s currently on 180mg daily of oxytocin and 80mg daily of morphine.  And she’s still in pain. 

She screams a primal scream when we go to move her in her wheelchair.  She bursts into tears when we ask her what’s the best way to get her from the wheelchair and onto the stretcher.  And she begs us to drive slowly down the main road to get to the hospital. Each bump she says shoots a shockwave through her body. 

My closest ALS for pain management is 20 minutes away.  I’d be at the hospital before then and she’s on so much pain meds, I wasn’t sure that the dosage that could be given would do anything. 

It takes us an hour to get the patient out of the house.  And 45 minutes to make a 20 minute transport.  My partner is driving and he’s fantastic.  He takes the streets that have been recently paved to avoid any unnecessary bumps. Once we arrive at the hospital, it takes 6 of us – 3 from the truck , 2 nurses and a tech to lift her from the stretcher and get her onto the bed.  I had to ask my patient’s family to leave the room while we moved her from the stretcher to the bed because they were too distraught and not helping my patient remain calm.  And the more hysterical my patient got, the worse it was for us (the nurses, EMTs and tech) to organize a plan as to best move her. 

It was  a 2hr call but I can still hear her screams in my head when people ask ‘so how was your shift on the ambulance’.  

It’s this type of calls like this last call that are the hardest.  I would prefer a trauma case where I can DO something – afterall, it’s the ‘doing’ that I signed up for.  The ‘not doing’ is very hard deal with especially when you know that there is nothing that you can do.  I can’t take away her breast cancer, I can’t take away the tumors in her hips and I don’t have any pain medications that would cut through the pain for her. 

She’s 43.

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