Saturday, February 10, 2007

"Congratulations, Vitum, you started his heart again."

I couldn't believe it.

We had been having a thrilling morning (no, they wouldn't let me drive). After sitting the first two hours of the shift in the ambulance shooting the breeze and watching the Saturday morning news and discovering new ways to be annoyed by whomever was reading the headlines / sports / weather, we got our first call of the day - a motor vehicle accident. We left a guy having chest pain who refused to go to the hospital, took a guy having neck pain who tried to refuse having to lay on the spine board, and proceeded to wait at the hospital for two and a half hours once we took them there (it's all politics... post on that stuff will be on here soon).

And then it happened.

The dispatcher's calm voice came over the radio. Sixty-seven bravo, Code 3, cardiac arrest, 22416 Church Hill Road, file 3026702.

The attending paramedic (as opposed to the driving paramedic) wrote down the details on the little white pad attached to the dashboard, and the driver hit the four switches on the console to activate as many as possible of the flashing red and white lights stuck to the white box we were driving. He turned the knob under those switches from "OFF" to "WAIL." Off we went.

It's funny, albeit a bit sad, watching drivers with a screaming ambulance on their tail. Most have a general idea to let the ambulance through and pull over to the left or right. Some people stop dead in the middle of the road. Paramedics are required to stop briefly before going through any intersections where the light was red, and in doing so, one oncoming driver (this is not the place for gender generalizations or debate on who drives better so I'll omit her gender) thought that meant she/he could complete her left turn in front of the ambulance, almost plowing into us when we started moving again.

Despite the numerous other vehicles that were apparently working hard to oppose us, we made it to the call scene. The advanced care paramedics were just walking in, and the firefighters were already inside. We grabbed our stretcher and bags of supplies and went inside the group home.

In the fairly spacious common area / tv lounge right through the doorway, there was an sixty-something gentleman laying with his back on the floor. His lips were blue, like nothing I'd ever seen before. He was mostly bald but the hair he did have was neatly trimmed. The firefighters were pumping on his chest and stopped for just a second to let the advanced care paramedics cut off the patient's shirt. I was surprised at how deep into his chest they were going, and how the patient's huge bloated stomach ballooned up with every pulse.

I was amazed at the efficiency and controlled environment in the midst of the fact that a man was laying dying. It was like a well-choreographed dance. One firefighter was getting information from the home staff, another was timing out two-minute intervals for CPR - "switch, whether or not you feel tired." One of the advanced care paramedics had defibrillator leads on his chest within seconds and were seeing if his heart rhythm was shockable or not, and while another was putting a breathing tube down his throat, one of the regular paramedics was starting an IV in the patient's right arm. As soon as they had the IV line, the advanced paramedics started whipping out bottles of epinephrine and atropine, popping off the tops with their thumbs, and plunging the drugs into the man's arm.

I stood as far away from the situation as I could while still having a good view. Not only did I not want to get in the way, but it had been made pretty clear to me that except for the times when the paramedics called upon me 'to assist as a bystander,' I was forbidden to touch anything, and would be held liable for anything I did touch.

"Have you ever seen a cardiac arrest before?" was a question I got a few times as well. For that one, the answer was no - I'd seen one (though it was a Do Not Resuscitate) while volunteering five or six years ago.

As soon as the patient's heart started to do something that resembled beating, they worked together to scoop him up and in a few seconds we were outside, somebody bagging the patient (breathing for them), somebody pumping on his chest, a few people steering the stretcher. "One of you drive," said the advanced paramedics to the ones I was shadowing. "Okay - We have a medical student with us today," they replied. "Sure," said the advanced paramedics, looking at me. "Hop in."

We were on our way to the hospital a few seconds after that. Even though we were in a hurry, nothing seemed frantic, disorganized, or really even that rushed. It takes experience to keep a level head when you know that valuable seconds are ticking by. "So, Vitum, can you bag the patient for us?" they asked. "Press in the bag about one third of the way every three seconds or so." I was happy to help. I was doing something and felt significant for a change.

In the car his heart rhythm decided to go down the tubes again and the paramedics started CPR and pumping more drugs into him. From my view at the head of the patient I was watching two people that were keeping this man alive, and I was playing a role too!

SNAP went a rib or two while the paramedic kept pumping on the patient's chest. When the car swayed around a corner or screetched to a stop at an intersection, CPR form was sacrificed for balance and I watched a neat little ditty they must call 'one-handed CPR' while the paramedic's other hand held onto the bars on the walls or roof. They didn't teach me that one in CPR class.

Fortunately they taught me plenty in CPR class, though, and when the paramedics turned to me and said "want to do CPR?" I was able to jump right in there, not missing a beat, and soon I was pumping this man's heart for him. SNAP went another rib. I pumped away.

"Have you ever done CPR before?" the paramedics asked. "No, only on a dummy in class..." I replied. "Oh come on," replied the paramedic. "I know the patient is from a group home, but you don't have to call him a dummy..."

He was making a joke. I know and completely understand the stress of a job where you're surrounded by death and dying, and that black humour is a common coping mechanism (I have read The House of God, after all). I was a little caught up in the situation, though, and I didn't find it funny. But I was suddenly aware that my not laughing made the paramedic obviously uncomfortable and I felt bad for that. He leaned towards the unconscious patient's head and said, "Sorry, pal."

After about a minute or two of pumping, they asked me to stop so they could check the rhythm. "He's got a heart beat! Congratulations, Vitum, you started his heart again."

I had saved a life.

Maybe it was beginner's luck. Maybe it was the immediate actions and CPR of the care home nurses, the expertise of the firefighters, the cool organization of the first responders, the quick IV placement, the copious amounts of epinephrine and atropine administered, the rapid on-the-scene intubation by the advanced care paramedics, the continuous CPR given to the patient by somebody from every department listed above. Okay, so I played a small part. And I didn't necessarily save his life - he still had a long way to go. I just happened to be helping out right when the combined efforts of everybody who attended started paying off.

It still feels incredible, though. I know not every day as a doctor is like this, and that getting a heartbeat back after CPR isn't usually the way things go... but still, it was a good seeing what paramedics do before patients arrive at the hospital, and I have a huge new level of respect for paramedics now.

And I had a blast.

I think I might enjoy doing this medicine thing for a living.

- Postlogue -

The patient kept his heartbeat for the rest of the ride to the hospital, and there I learned a good lesson about one of the huge disadvantages of being a paramedic - as soon as we had relayed the information, and the doctors took over, the paramedics left the room. I lingered but soon I had to leave too.

I still don't know if he made it or not.


Chris said...

"so I'll omit her gender" - heheh

Anyway, congrats! Must of been an awesome felling. =) I can't wait till i get to do some actual 'stuff'. Still in my science years of my 6yr med degree.

(long time reader, first time commenter)

Pseudo_Doctor said...

Im a first year med student who just started reading your blog that must have been an awesome feeling...congradulations man

TaciturnGossamer said...

Makes the getting up at 3am moments completely worthwhile doesn't it?

Anonymous said...

I always knew you were I life saver, I think it may have been the SOS thing that first got that thought started. Congrats man, I'm jealous what can I say, I've only chopped up dead people

Anonymous said...

Hey good work, always a good feeling when you get an "arrested" patient to hospital with an output. Always expect ribs to crack, it's rare when they don't.

You can always pick up a few tricks of the trade, but be careful with that one-handed CPR. Its usually of very poor quality.

Anonymous said...

I think it should be mandatory for all medical students to ride with EMS. I have often heard doctors ask "Do you have oxygen in your ambulance?". The level of ignorance is appalling.

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Anonymous said...

Nothin like a lil elbow grease, edison medicine (defib), and go-go juice (epi and atropine) to start a heart! I love working codes thru the whole ACLS protocols. Great learning experience. Where I am from med students do ride with us, albeit only for couple shifts. I wish the favor was returned and we could also shadow them for some shifts as well! Good job!