We get called for a medic alarm. "Eighty-year-old man having a problem with his aneurysm."
Odd.
Just before we get there we hear the first responder call for backup saying "There is a lot of blood here."
I make certain to grab a pair of gloves before I enter the house. The door is ajar. I step in and call out hello. I see an elderly woman standing in the living room. "What's going on?" I ask.
"He's in here," she says nonchalantly. "We were at the doctor yesterday."
I'm looking about for blood but I don't see any. When I get to the kitchen, I see the first responder standing holding a man up in a chair. The man's head is leaning forward. He is quite pale.
"What's going on?" I say again.
"He's out."
"He passed out?"
"No, no, he's out." I notice the responder has a finger on the man's neck. "He doesn't have a pulse."
"Well, let's get him on the ground." I grab the legs and the first responder holds under the shoulders and we lay the man down. It's then I see the blood. It is coming out of his nose and the corners of his mouth.
"We were at the doctor just yesterday," the woman says. "He has an aneurysm. The doctor had a hard time getting a pressure yesterday at the office."
"We're having a hard time too," I say. "He isn't breathing and his heart doesn't seem to be working." We already have his shirt off and are starting CPR. I put the monitor on and there is a PEA at 60.
"He uses an inhaler," the woman says. "Do you want me to look for it?"
"If you could write his name and date of birth on a piece of paper for us, that would be better."
When I open his mouth to intubate, it is like opening the lid on a bottle of dark fruit punch. Filled to the brim. With each compression, it splashes over. Mixed in with the juice are some thicker chunks.
I don't know if it is an outer body experience or not, but on calls sometimes its like I'm watching myself and I'm saying "Well, here I am on this call and it has surprise turned out to be a code, and not just a code, but a bloody, nasty one, and this sort of sucks. This may not go well." I guess it is a mechanism that lets you stay calm outwardly, while your nervous self is removed to a safer seat in the commentator booth.
"I found the inhaler," the woman says.
"Good. How are you coming on that piece of paper?"
"Right," she says.
By this time another responder has arrived and I'm telling him to get the stretcher and a board into the house.
I manage to see the epiglottis, but when I lift up with the laryngoscope, I don't see the chords underneath -- just a lot of blood. I hand the tube to my partner and using my right hand, try to apply crick pressure. With one finger I push down like I am playing the flute and the chords come into view. I have my partner put her finger right there and then give me the tube back. I pass it. "Feel it?" I say.
"Yes, I do," she says.
I look over at the capnography and there is a wave form.
That went well enough.
Blood comes flying back up the tube, but the bagging is easy. I have lung sounds on each side and nothing over the belly. The CO2 filter clogs. I put another on and I still have the wave form and the gook coming up out of the tube is less.
I get an IV and push some epi and we keep doing CPR, but we get no pulses. He is still PEA on the monitor.
"He went out right in my arms," the woman says. She is back standing in the doorway. "He lost a lot of blood. He has some allergies."
"The prognosis is very grim right now," I said. "We are breathing for him and pumping his heart for him."
"So you are," she says.
This lady is freaking me out. I have had this happen before -- a relative has no idea their family member is basically dead.
We get him onto the board and up onto our stretcher.
"You'll be taking him to city hospital?" she says.
"No, we're going to the closest hospital."
I often stop and have the family members gather around the patient so they can say goodbye before we leave the house.
"You want to say good bye. It might be your last chance."
"No, I'm coming down to the hospital. I'll see him there."
I nod to my crew to head on toward the door, and we go out doing CPR the entire way. More epi, more fluid on the trip in, but no change. At the hospital, they work him for about fifteen minutes and then call it.
When I am turning in my paperwork, I see the woman coming down the hall looking at a hand mirror as she applies powder to her cheeks.
Later the crew fills me in on a few details I missed. The kitchen sink evidently was filled with blood and thick clots. The woman who I thought was the patient's wife was actually his next door neighbor/friend.
"She was incredibly calm," my partner says.
"She certainly was." I'm thinking more that she was just plain clueless. But now, on afterthought, maybe her reaction was her defense mechanism, too. Maybe she did know her friend was dying, and just couldn't let herself show it. She had to step outside herself. I guess I'll never know. Just another EMS mystery.
I wonder what she will do tonight? Will she play bridge with friends? Will she rent an old comedy and watch it while eating popcorn? Before bed, when she looks into the mirror at the deep lines in her face, will she wonder how much time she has left? Will she cry into her pillow? Will her sleep be dreamless?
