EMT: Grab the suction!

Trigger warning:

Someone dies in the end

Actually, we all die in the end.

That’s life

That’s death.

And death is not dignified.

It’s not kind.

And since it robs one of all their control in the matter, it’s downright cruel.

At the beginning of my shift, I say my mantra, arrive alive. That’s the job. To get someone from point A to point B while they are still living and breathing. I have shared my mantra with some more anxious patients and I like to believe they rode with us a little bit more assured.

At the end of my shift, I judge the whole night on the mantra. A good night being that no one died.

Starting a new career in the world of EMS, I was not naive to think that I wouldn’t ever see a human in the act of leaving this plane of existence. In fact, I saw it a few times years ago.

And I saw it again last night.

It wasn’t even our call.

Not even our patient.

Just the right place at the right time.

We started our shift, and because I am a not the best (a wuss really) when it comes to cold, my guess on the type of call we are about to be hit with was hypothermia. its a game we play, guessing what medical situation we're going to have to run into and we go over a game plan, symptoms to look out for and what possible treatments are in our protocols. My partner's guess was a pediatric call. His was a safer bet since we have been making drops at Rady Children’s Hospital quite often. RSV is still surging. Also to note that in this field, most people I work with have what can best be describe as a morbid curiosity and even a dark sense of humor about it. Part coping mechanism and part deep desire to put the skills and training to the test. To see, if disaster does strike in front of them, will they act with professionalism or will they crack under the pressure.

It was my turn to run the call while my partner drove. Our phone goes off. Our first call, Hospital to Skilled Nursing Facility. And right there, next to Dx: (stands for diagnosis ) HYPOTHERMIA.

My partner was so flabbergasted with my prediction and asked how did i possibly know what was to come. I too was surprised although at this point in my life, my guesses being correct have become quite common. So my partner says he owes me a beer for that one and we ride off.

We meet the nurse at nurse's station. She gives us the report and the transfer documents. Pretty straight forward call. Patient is an unhoused individual and it’s been barely above freezing these past few nights. Came in via ambulance through the ER and was admitted. They ran their tests and scans and x-rays. Gave them fluids and fed and kept them warm. Got them a bed at a skilled nursing facility to get them back to 100% and to keep them out of the elements for a bit longer, while they work with a social worker to see if maybe they can’t find a better solution than spending these winter nights out on the streets.

We help them onto our gurney, gather their belongings. I ask if this is everything. And he says he hasn’t seen his down coat. And the first thing that crosses my mind is that if even in a trauma situation, take the time to unzip the jacket and not just cut it open with trauma sheers cause if you do, then the scene will be a bloody feather mess.

We swing by the nurse's station on the way out and ask about the coat. They haven’t seen it but the nurses offers our patient a warm blanket straight from their blanket oven. They accept.

During the ride, I check some vitals and hear some stories. The stories people tell me about their lives really are the top perk of this gig.

We arrive to the SNF. A long ride but a smooth one. This was turning out to be a very straight forward call. There was absolute no foreshadowing that in less that half an hour, the scene we would find ourselves in would include vomit, blood, sheriff deputies and a dead human being on a cold linoleum floor.

Almost as soon as we ring the door bell for the front door of the SNF. I found it a bit odd that they locked up the front door and did not have anyone at reception even though it was barely past eight p.m. Being chilly outside and having a patient recovering from hypothermia, it felt longer than an eternity waiting for someone to come to the front door. I pulled out my phone and look up the number to call to say, hey, we're outside it is cold. I hear the familiar panting of someone in full sprint. I turn and see an individual in green scrubs, venti cold Starbucks drink in one hand and phone to his hear in the other. I only make out the words, ‘I'm almost there, just open the front door’. We move our gurney with patient to the side just as the front door is opened and the green scrubs rushes in, sets their cold drink on the reception counter and darts off down the hall. The first thought that crossed my mind is that they are late to clock in.

We move our patient inside towards the nurses station. There’s a single nurse behind the station, switching looks between us and the computer screen in front of her. They tell us a room number then looks back at the screen and says a different room number and points down the hall. I realize the person running was not late to clock in (or maybe they were but that was not what all the commotion was about).

I recognize a code when I see one. But I can’t abandon my patient and it looks like the staff is handling it but I cannot see what is going on inside the room.

I tell my partner that he should go see if they need help. He says that he can’t leave our patient and that they have the staff but I tell him, our patient is fine and I can get them to their bed on my own and that they may need fresh hands to perform chest compressions. (Per San Diego protocol, they want people to switch out after two minutes of performing compressions since once a person is tired, this pumps to the chest are not as effective).

My partner rushes over to the room and in like three seconds flats, I see him rush out of the room and back outside. I wait for him to come back and notice he has our AED (Automated External Defibrillator). I messaged our dispatch. Tell there there’s a code here at the SNF, that my partner grabbed our AED but that our patient is okay. They ask if the facility has one of their own AED and I tell them I don’t know. They tell me it’s fine that we grabbed ours but they should be using their own. The reasoning from my guess is that since we use our own, afterwards, we’re going to have to return to station to get new pads which means we’ll be out of service until we are back to being a fully stocked rig. And we were about 35 minutes away from station at this point.

I take my patient to their bed, offload them. Ask if they need anything. They tell me they are fine. I wish them all the best, find their nurse, give them my report and transfer care over to them once they sign the e-document.

I head to the room to find that fire and the sheriffs have arrived.

My partner is with the fire medic holding up the IV bag. Three others from fire are at the patient's side who is now on the floor and has the Lucas, an automated chest compressions machine. The Lucas looks like a cross between a Tonka truck toy and a medical torture device. It is this construction machine yellow with black handles and just pumps away at about 100 beats per minute, much like a jackhammer fitted with a hockey puck mid-sternum. And the sound it makes, nothing quite like it. Closest I can think of is a lowrider hopping at a ridiculous pace but instead of landing on pavement, it is landing on a road made up of frozen butterball turkeys. There’s just this sound of a hydraulic machine versus meat and bones.

I size up the scene and aside from staying out of the way, I figure out what I can do to be at the ready in case fire needs something.

One of fire is at the patient’s head with BVM (bag value mask) so if they need a break or to do something else, that’s an easy task I can jump in on. And it wouldn’t be the first time I bagged someone.

Next thing I think of is extraction. Patient is on the floor and will need to be put on a gurney. Even with six of us, picking up a body from the floor to gurney is no easy task. Luckily, we carry a MegaMover (transfer sheet) on our gurney. Just as I am about to leave the room, blood pours out from the patient’s arm. The fire who was working on putting an I/O on the patients knee moves to stop the bleeding, but direct pressure isn’t working. Especially when it’s a machine doing the patient’s pumping. The blood starts to pool on the floor. Fire asks for a towel and having done some time as a CNA, working at SNFs, I know where to look. I find the linen cart in the hallway, but it’s just about bare. No towels, just sheets. I grab a few sheets, go back in the room, hand it to fire who uses the sheets to mop up the blood. I head to the nurse's station, asks for towels, and they go to a closet and hand me more than enough. I stop by our gurney, grab the MegaMover and am back in the room, on stand by. This took about 45 seconds.

The room has this vintage institutional like vibe to it. As if it were once a public school in then late 50s. Cold, lacking a healing touch and giving off more of an abandonment feeling. If it weren’t for a few of the patient’s personal family photos taped to the wall, the room would be without a soul.

They stop the Lucas for a moment to check pulse and no ROSC. (Return of Spontaneous Circulation).

One of fire steps outside with the radio, hailing the physician at base hospital. This is not a good sign. In the world of EMS, a physician is the person that has to declare a person dead.

Fire lets them know the whole situation. When they were dispatched, what they found when they arrived and all the treatments they performed and the vitals, or lack of vitals they were getting on their checks.

As fire explains it all to the physician over the radio, I look at this patient, naked except for baby blue briefs (as a CNA, we are trained to refer to them as briefs, to let the patient keep a bit of dignity) in the world of EMS, just about everyone calls them as they see them. Diapers.

Death does not care about the patient's dignity. There is nothing dignified about dying in a baby blue diaper, on a now blood stained floor, vomit all over themselves. Of course I don’t know the full story of the patient. I did learn that they were placed here to recover from COVID-19 complications after spending some time in the hospital. To die from something that half of the population didn’t take seriously just adds to the cruelty. I’ve dropped off many patients to SNFs and more than once, the patient absolutely did not want to be placed there. They felt that after a lifetime of looking after their family, that they are being abandoned all the same. Despite, how fancy and warm a room is in the higher end SNFs, all the rooms boil down to the same characteristics.

Rooms that once you’ve been pronounced dead, are left alone. You lay there while fire packs up and leaves. You lay there, while someone one like me bags up the bloody towels and leaves. You lay there, while the sheriff takes notes on the scene and integrates the nurses and CNAs. The world moves on in a flash and you lay there, alone, waiting until; your next ride, most likely the coroner arrives.

When death does not allow any control let alone dignity, there is only the time above ground in which we can act dignified. To be grateful for the time above ground. To recognize that it is finite and precious and most importantly to realize that of which is most valuable, the time we give to others. That gift is priceless. I am grateful that I am constantly reminded of it every time I gear up for work. I do my very best to make the most of the moments I share with others. And that is where I believe, I can find of the dignity of it all. If death is going to be cruel, the only treatment I can do, is to be kind.