Le 25 avril 2015, 07:19 dans Humeurs • 0
Tug of War
Not a sport, really, nor a game. Just something I did as a Mobile Intensive Care Unit Paramedic. Often, it would appear that all the forces of the Universe were conspiring to take a specific life, and I, who happened to be at the right place at the right time, and with the right tools and experience, would do everything in my power to stop that from happening: Push and pull until someThing, or someOne, gave.
I was just out of Paramedic school, working in Daytona Beach, Florida and was getting ready to transport my latest patient to a local funeral home. At that time (1974) my role as medic often involved transporting the dead body of the patient I had just "lost" to their final switching station before burial.
It was bad enough to fail, let alone have to face the embarrassment of having to say to the funeral director, "Yup, here's some more business for you. Did this one myself!"
This had been a particularly wrenching call that led me, on a beautiful sunset of a Floridian evening, to pace back and forth in a hospital parking lot, fist raised to the heavens, yelling at the top of my lungs and ranting and raging at the God who put me in the position of killing one of my patients.
Just a scant hour before, I was approaching the fifth-story hotel room of a German couple who had come to tour Florida and had happened to end up in my "call area." My rookie EMT partner and I had been dispatched to a "woman down" call. I cautioned him at the door to just stand still and be silent for a moment before knocking on it. "Listen. First listen. Let's you know if there's a fight or a dog or something not very fun to contend with."
When we did enter, we were greeted by a man in his mid-fifties sitting in his underwear on a couch in a small sitting room, nursing a drink. He casually pointed to the bathroom. "She's been in there a while," he said.
"How long?" I asked as I quickly moved towards it. "Oh, maybe a half hour."
I was moving with a tempered urgency. My gut said there wasn't anything serious going on, but my logic said, given the circumstances so far, anything could still be up. In the bathroom, I found a middle-aged woman hugging the toilet bowl.
There was quite a bit of frothy, non-bloodied matter in the bowl. I wondered about alcohol, so I put my head almost into the bowl to smell. I have a very poor sense of smell from a childhood accident (my older brother smashed me on the nose with the edge of a tennis racket!). I often found myself over-extending myself to compensate which caused witnesses on the scene to wonder in the process.
Alcohol. I was sure. The woman was covered in clammy sweat, weak, but she could talk. I asked her if she had been drinking. She said "Just a little with dinner," with a slur and her husband called out shakily in a thick German accent, "Yah, she don't drink much."
"Right," I said to myself. I asked about pain and she said her jaw was aching and I thought to myself if I puked that much, mine'd be too.
Her pulse was weak and thready, and she had a fairly snug blouse on that seemed to account for an almost indecipherable blood pressure. Had it been a very busy night, I might very well have advised the couple to do what I had found myself doing after a long night with too much rum and an intimate encounter with the Porcelain God, "Just let her sleep it off...she'll be fine."
Still, there was something not too comfortable to me about the whole mess, and I didn't feel terribly secure about leaving her in her husband's care. I had my partner help me get her onto the gurney.
On the way to the hospital, the woman looking fairly asleep, I decided to hook her up to my cardiac monitor. I hadn't used it at the hotel room because the space immediately around the patient in the bathroom was quite compact and I didn't see the sense of going through the gyrations necessary to hook her up after I figured out what was going on. Still I thought to myself, it wouldn't hurt to check.
Sure enough, the image that greeted me on the monitor was an extremely slow rhythm with a number of wide, dangerous, extra beats interposed between the weak normal pulses--a highly critical configuration that placed the woman on death's doorstep.
Suddenly springing to action, I yelled out to my partner, who was driving, "Step up to Code Three! I've got an arrest cooking here!" I ripped off her blouse and took another blood pressure...of course it was indecipherable in the moving ambulance, yet I knew in my heart that functionally, there was none. I juggled oxygen, managed to start an intravenous line and administer intravenous adrenaline to boost the heart rate and called in to the hospital to "set up for impending cardiac arrest!"
By the time we arrived at the hospital, I was in full gear and torturing myself over missing the call. I had diagnosed the woman as a simple drunk rather than recognizing all of the earmarks of a myocardial infarction. I was uncharacteristically jittery and shaking, yet feeling better because her heartbeat had speeded up since I administered the adrenaline and I was SURE I heard a bit of a blood pressure. The woman was conscious--barely but noticeably.
There was hope, at any rate, and then, to my surprise, we were met at the door by a gaggle of men and a woman in doctor's garb. They all surrounded the gurney as we wheeled the woman in, and I breathed a sigh of relief. In the "Cardiac Room" of the Emergency ward, the woman was transferred onto the hospital stretcher and I stood off in the corner as I saw the "team" take over at about the same time as my patient lost consciousness.
It took me perhaps two whole minutes to figure out what was going on. What I had initially interpreted as concerted action by professionals was, in fact, a bunch of interns being "led" by a physician who hadn't spent more than maybe two shifts in an emergency room, all working off of panicked textbook knowledge to save this "what a great case to get practice on." Boy! were they screwing everything up.
Logistically, I had given up my place right by the patient, so now, I had to find a way to maneuver myself closer and assert myself more fully. In the brief period of time that I realized everything was amiss until the moment I got into a position to do something, the "gang" administered two wrong drugs that threw the woman into cardiac arrest, neglected to intubate her to protect her airway before she vomited and stopped breathing, and defibrillated her twice in rapid succession, both times with the paddles placed in the wrong position on her chest so that the electrical current moved in the opposite direction necessary to revive her heart.
My head reverberated with, "OhMiGod, they're giving her atropine instead of Epinephrine and her heart's slowing even more, her B.P.'s dropping fast, the paddles are being charged to 200 Joules and she needs 400 and they're, Oh, Shit, they're blowing apart her heart and it's my fault!!"
And then it was all over and there was nothing I could have done except change the past, and that wasn't an option. The woman was dead.
Oh, how I worked to absolve myself of guilt! After all, hadn't I caught my mistake and got that line in, and didn't she actually have a blood pressure by the time we got her in?
But then again, I missed it and cost her the most crucial seconds of her life, and then, I stood aside and basically relinquished my responsibility to a bunch of dolts. I was on an emotional roller-coaster ride.
And in that time, I had to comfort myself with knowing the woman's time was up. I was just an impersonal part of a string of impersonal f*ck-ups that followed through to the woman's demise. Nothing personal. In this time of the Universe, it was her time to leave. Period. I happened to be an impersonal agent of that death, just like each of us is inextricably linked with the death of everything that ever was or ever will be. It wasn't personal at all.
Yet, at the same time, I was being used (Goddammit!) as a tool that was clearly an instrument that would cause serious ripples to course through the life of every person that the poor woman's life had touched.
Some Higher Power Somewhere knew damn well of my specific weaknesses and arrogance and bad nose and used it all to full advantage to bring one more soul back home. How very Perfect!
It had to have been all about me because any other team of Medics in the City that night would have saved her. It was personal.
Regardless, an unnecessary loss was heaped on others and I was the key factor. I had to live with this for a long time. These moments affected every call I had since. From that day forward--for the remaining nine years of my career as a paramedic--I never made another mistake like it again.
I would not make any move with my patients until I was sure I was as thorough as the situation would allow. My two-hour relationship with that woman who was alive when I met her and dead when I left her was instrumental in assuring that dozens of people lived. Dozens? Maybe hundreds, I never counted. That couldn't have been by design. Could it?
Today, I have no doubt in my heart that my game of war fire age with God is impersonal, yet, I go out of my way to pay attention to what I am personally being told.
Russ Reina shares his experience in the healing arts (beginning 1968) through http://www.firetender.org. It is a potent resource to help you deepen your abilities in connection. Its sacred space includes high-quality art, articles, books (Moments in the Death of a Flesh Mechanic... a healer's rebirth), counseling, workshops and music.