It's been snowing all day -- a blizzard. Eight or nine inches on the ground already. Now it's night and I'm hungry, so we drive out through the snow to get a hot pizza.
At the pizza shop, I notice a grey faced woman say hello to me as I go in the door, then when I come out she is lingering in the heavy snowfall.
"You took care of my mother," she says. "I wanted to thank you."
"You're welcome. Thank you for saying that," I say. "How is she doing?"
"She's dead."
"Oh, I'm sorry."
"They had her on life support for six days."
"I'm very sorry."
"You partner was upset with her beacuse she wanted to take her jewlery off. You knew she was having a heart attack, but you didn't tell me."
I'm not really certain what to say.The woman is standing there in the driving snow, looking at me hard. She looks very unhappy. I'm not certain if she is grateful or upset. She takes a deep drag on her cigarette, and stares at me.
I just stand there. I have no words for her. I don't even remember the call or ever seeing her before in my life.
"God bless you," she says.
"Well, thank you," I say again, "You have a good night. Try to stay warm." I start toward the ambulance.
She stays there standing in the snow watching me as I get in the front seat. As my partner starts to drive away, she gives a short salute like wave and I wave back.
I have this sense that she will always be there in my memory, standing in the driving snow on a cold night, smoking her cigarette down till the butt is gone, extinguished against her cool skin. She stares at me.
I have no idea what she sees.
Wednesday, January 26, 2005
Sunday, January 02, 2005
Compressions
Last night one of our long-time members came in at ten to relieve the on duty crew. He has been an EMT for over twenty years and helps teach the EMT class here in the suburbs. He heard about the code we did yesterday and talked to the new kid about it.
"I wanted to make sure he was okay," he told me. "You never know how young kids take their first code."
That was when it dawned on me. It was the kid's first code. I knew it was his first code, but I never really thought what that meant. I felt really bad about it. There I getting on the kid to do better CPR and he was probably thinking "oh my god, I'm doing CPR on a real person and I'm killing them."
To me, it was just another call, another code, another dead body. I was more concerned about my capnography reading than the kid's physce.
"Put some muscle into it!" I said to him.
He was giving these little pushes as he muttered "one, two, three, four, five."
"Stop counting. You don't need to count. Just pound away."
"It's my first time doing CPR on a real person," he whimpered.
"I know, so do it like I'm telling you. Look at the monitor. Make some waves. The line shouldn't be flat, it needs to look like this..." And I leaned over and pounded hard so that on the monitor, you could see big rythmic waves. "You have to get the blood flowing in there."
And so he pressed harder.
"That's better. And stop counting!"
When he left that night, I did call after him. "Good job today."
I don't think he heard me. He walked out, his head looking down at his shoes.
***
8:00 A.M. on the dime this morning, he presents himself, wearing his shirt with his silver badge on it. I ask him how he is doing. He says okay. I ask if he has any questions about the code.
"She was asystole, right," he says, "That's pretty much dead, right?"
"You got it. She was dead and she wasn't coming back."
"That's what I thought."
"We didn't kill her and at least you learned how to do CPR on a real patient."
"I know -- that was my first time."
"I'm sorry I yelled at you," I say.
"That's all right," he says, and looks back down at his shoes again.
"We'll try again today. I'm glad you're here."
He nods.
"Now, go check out the truck."
He grabs a checkoff sheet and heads to the garage with determination.
It's a slow day. We only do two calls. A nursing home fall and a rollover, where the fire department had to come and take the front windshield off the car, which was on its side, so we could get the 74 year old lady out. She was fine, unhurt and refused transport.
My preceptee is on today so we did a fake code using manaquins. The preceptee and the crew wheel the stretcher and gear into the back room, where I am pretending to have chest pain. As they treat me, I keel over and then they have to turn their attention to the manequins -- a mannequin head that can be intubated and a CPR manequin. The preceptee intubates the mannequin, while the kid does compressions on the other manequin. The medic puts an EJ in the mannequin's neck where I have taped a sponge in a plastic bag to serve as the vein. He pushes drugs and reads the monitor, and eventually they load the patient, and cart him out to the ambulance. This is a pretty straight forward code -- a simple asystole. In the past, I have done full v-fib arrests, complete with angry relatives, drug dealer pals, and crying spouses trying to distract the preceptee. He's getting his routine down pretty well now.
Once the patient is loaded, another crew member then drives around the block a few times, while they continue care. The kid is working up a sweat doing CPR. "How's the back?" I ask.
"Good," he says, "Holding up."
He is concentrating on his CPR. No counting, just pounding away, strong compressions.
"Good work," I say.
The driver backs the ambulance back into the bay, and they unload and wheel the mock patient into our fake ER, where I, the realist doctor, recieve their report, check tube placement, then look at my watch and say, "2:30. Rest in Peace."
I look at the kid. "You killed another one. Two for two."
He hangs his head.
"Hey, they usually always die. Nice job on the CPR. We'll get him next time."
And he smiles.
"You did well," the preceptee says to the kid.
He's positively grinning now.
When the day is over, the kid says goodbye and then says, "Thank you."
"You're welcome," I say. "We'll see you next week."
I still feel bad about yelling at him.
"I wanted to make sure he was okay," he told me. "You never know how young kids take their first code."
That was when it dawned on me. It was the kid's first code. I knew it was his first code, but I never really thought what that meant. I felt really bad about it. There I getting on the kid to do better CPR and he was probably thinking "oh my god, I'm doing CPR on a real person and I'm killing them."
To me, it was just another call, another code, another dead body. I was more concerned about my capnography reading than the kid's physce.
"Put some muscle into it!" I said to him.
He was giving these little pushes as he muttered "one, two, three, four, five."
"Stop counting. You don't need to count. Just pound away."
"It's my first time doing CPR on a real person," he whimpered.
"I know, so do it like I'm telling you. Look at the monitor. Make some waves. The line shouldn't be flat, it needs to look like this..." And I leaned over and pounded hard so that on the monitor, you could see big rythmic waves. "You have to get the blood flowing in there."
And so he pressed harder.
"That's better. And stop counting!"
When he left that night, I did call after him. "Good job today."
I don't think he heard me. He walked out, his head looking down at his shoes.
***
8:00 A.M. on the dime this morning, he presents himself, wearing his shirt with his silver badge on it. I ask him how he is doing. He says okay. I ask if he has any questions about the code.
"She was asystole, right," he says, "That's pretty much dead, right?"
"You got it. She was dead and she wasn't coming back."
"That's what I thought."
"We didn't kill her and at least you learned how to do CPR on a real patient."
"I know -- that was my first time."
"I'm sorry I yelled at you," I say.
"That's all right," he says, and looks back down at his shoes again.
"We'll try again today. I'm glad you're here."
He nods.
"Now, go check out the truck."
He grabs a checkoff sheet and heads to the garage with determination.
It's a slow day. We only do two calls. A nursing home fall and a rollover, where the fire department had to come and take the front windshield off the car, which was on its side, so we could get the 74 year old lady out. She was fine, unhurt and refused transport.
My preceptee is on today so we did a fake code using manaquins. The preceptee and the crew wheel the stretcher and gear into the back room, where I am pretending to have chest pain. As they treat me, I keel over and then they have to turn their attention to the manequins -- a mannequin head that can be intubated and a CPR manequin. The preceptee intubates the mannequin, while the kid does compressions on the other manequin. The medic puts an EJ in the mannequin's neck where I have taped a sponge in a plastic bag to serve as the vein. He pushes drugs and reads the monitor, and eventually they load the patient, and cart him out to the ambulance. This is a pretty straight forward code -- a simple asystole. In the past, I have done full v-fib arrests, complete with angry relatives, drug dealer pals, and crying spouses trying to distract the preceptee. He's getting his routine down pretty well now.
Once the patient is loaded, another crew member then drives around the block a few times, while they continue care. The kid is working up a sweat doing CPR. "How's the back?" I ask.
"Good," he says, "Holding up."
He is concentrating on his CPR. No counting, just pounding away, strong compressions.
"Good work," I say.
The driver backs the ambulance back into the bay, and they unload and wheel the mock patient into our fake ER, where I, the realist doctor, recieve their report, check tube placement, then look at my watch and say, "2:30. Rest in Peace."
I look at the kid. "You killed another one. Two for two."
He hangs his head.
"Hey, they usually always die. Nice job on the CPR. We'll get him next time."
And he smiles.
"You did well," the preceptee says to the kid.
He's positively grinning now.
When the day is over, the kid says goodbye and then says, "Thank you."
"You're welcome," I say. "We'll see you next week."
I still feel bad about yelling at him.
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