I think this guy just died on me.
I was in the middle of putting the EKG leads on him and he just went out. He didn’t look good before. Now he looks pretty much exactly like a dude who just died.
He walked up to the ambulance while we were sitting in a parking lot, said his name was Carl and his chest had been hurting all day. That pretty much brings you up to speed.
“Carl!” I shout as I put on the last lead. With one hand I fire up the monitor and my other goes to his wrist, fingers searching for a pulse.
I can’t find a pulse.
The monitor cues up, the EKG takes a few seconds to read, and the survey says… V-Fib.
Fuck a duck.
I check the carotid pulse in his neck for few seconds just to be sure I’m not missing something.
Nope, that’s our old buddy ventricular fibrillation. This man’s heart is now pumping jack and shit.
I rip open a side compartment on the monitor and pull out the defib pads. I should probably use some trauma shears to cut off his t-shirt but I display a slight breach of etiquette by just yanking it up to expose his chest.
Tommy had been standing outside the ambulance with the back doors open, “Man, are you serious?” he asks but doesn’t wait for a response. He hurries back up to the driver’s side door. As I’m connecting the pads I hear him on the radio.
“Dispatch, medic 22. Can you please start fire to our location? We are in the parking lot of the Dollar Hut at the intersection of Howell and Carrington. Emergency response please, we have CPR in progress.”
A few seconds delay, then the crackling reply, “Um… we don’t currently have you on a call 22.”
“Copy that dispatch, we had a patient walk up to our ambulance. He is now pulseless and apneic. CPR in progress,” Tommy says calmly.
“Um… ok. Copy that, dispatching fire to your location.”
I hear the radio thunk down. That sound is followed immediately by the sound of the monitor charging for a shock. If you’ve never heard that sound before it’s kind of hard to explain. If you have heard it, it’s not something you’re likely to forget.
Tommy rounds the back of the rig.
“You wanna jump in the airway seat?” he asks.
“I’ll stay here ‘til fire shows up,” I answer. The monitor beep boops, signaling it’s charged and ready. I say clear just like they do on TV but I don’t yell it or anything. There’s no point to that shit, I’m the only one in the ambulance. Tommy is moving around to the side door.
But you still say it. You have to. It would feel weird not to say it.
I hit the little red button with the lighting bolt symbol and Carl gets 200 joules of electricity fired into his big ‘ol chest cavity, right through his ticker.
I’m not supposed to wait and see what happens, I’m supposed to start chest compressions immediately, so I do that. I have to drop the head of the gurney first to get Carl lying flat. I start pumping on his chest like a madman while Tommy pulls out this thing called a bag valve mask and hooks it up to an oxygen spigot on the wall. Tommy starts blowing oxygen into Carl’s lungs every time I stop pumping on his chest.
We do this song and dance for a little while, then I ask Tommy to charge the monitor again while I keep doing compressions. This time we charge to 300 joules. When it’s ready I stop compressions and check the screen to see what Carl’s corazon is doing.
And the answer is, not much, still v-fib but less v-fib than before. That probably sounds like a good thing but it isn’t.
“You clear?” I ask Tommy.
He responds by frowning at me like I’m an idiot, “nigga please.”
I should probably mention here that Tommy is a proud African American man and not a racist cracker asshole.
“I’ll take that as a yes,” I zap Carl again. He flops on the gurney a little bit and I go right back to squashing his chest.
A minute or so later the fire department shows up and everything gets really exciting. The Captain makes it crystal clear to me that it’s my goddamn fault some goddamn citizen walked up to our goddamn ambulance and had a heart attack without having the common goddamn decency to call 911 first.
“This kind of shit only happens when you’re around Bo,” the Captain yells.
“You gonna give me some help or what Cap?” I ask, stopping compressions so Tommy can bag some more air into Carl’s lungs.
“Well how many do you think you need Bo? You think two of my guys will be enough or do you want me to ride in too? Maybe give you a handjob on the way?”
I jump out the back door and let one of the firefighters take my place. I’ll call him McPushy because he starts CPR with enough gusto to compress Carl right through the floor of the fucking ambulance.
“I don’t like your handjobs Cap. Your wifes are better,” I smile at him.
“Fuck you, Bo.”
“Fuck you, Cap.”
I jump back in the ambulance and Cap slams the doors behind me. Tommy has been replaced in the airway seat by another firefighter. I’ll call him Airway King because I don’t know his name. The two fire jockeys are working together beautifully, like a well-oiled meat machine designed for the singular purpose of making Carl’s air go in and out, his blood go round and round.
“Tommy, let’s roll,” I shout and immediately hear Tommy on the radio again. I don’t catch what he says but it doesn’t matter. I know what he’s saying anyway. I start getting my IV shit set up. The clock in my head says it’s been over two minutes since I last shocked Carl.
“Hold up guys,” I tell the firefighters. They stop compressions and I check the EKG monitor, now having to look around a firefighter to do it.
“That looks organized,” McPushy says, excited.
“Indeed it does sir, check a pulse up there for me,” I say. Then because I never trust anybody else’s pulse check, I send a few fingers fishing under the waistband of Carl’s sweatpants looking for his femoral artery. Should be there somewhere, just to the left of his big, sweaty junk.
God, this is a glamorous job.
“You’re still bagging right?” I ask.
“Copy that,” Airway King replies.
The ambulance bounces over some speed bumps, then rocks into the street. Tommy lights up the siren. I’m pretty sure I feel a pulse.
“You guys feel anything?” I ask.
“Yeah, I think so,” McPushy answers, fingers on Carl’s throat.
“Try to get me a BP,” I tell him then go back to my IV.
While I tear strips of tape I take a few seconds to look at the monitor. It’s some kind of organized rhythm. It’s ugly as hell but if it’s pumping blood, I’ll take it.
IV goes in, no worries. Carl has an antecubital vein the size of a sharpie and it takes an 18 gauge intravenous catheter like a champ. I flush it and tape it down.
“62 over 36,” McPushy tells me.
“Beautiful,” I reply, “you mind switching spots with me and hanging a bag?”
“Sure thing El.”
In my head I’ve been giving McPushy shit, but he’s a good dude. It’s not his fault his Captain is a douchebag. We switch spots, always awkward in the cramped back of our ambulance, which is basically a utility van. I give McPushy what amounts to a lap dance as I step over him to reclaim my spot on the bench seat.
And so we ride. Tommy hauls ass through the city. Airway King sticks a curved piece of plastic into Carl’s mouth to ensure his tongue doesn’t block his airway, after that he keeps bagging oxygenated air into Carl’s lungs every few seconds. A minute or two later he has to stick a rigid plastic tube down Carl’s throat and suction out vomit. I’m more than happy to let him handle that task. I hate vomit.
McPushy hangs a bag of saline which I hook up to Carl’s IV. The extra fluid running into Carl’s veins will help bring his blood pressure up and that’s a good thing. Pumping low volume is hard on the heart and Carl’s heart is having a hard enough day already.
A few minutes into the ride I switch seats with Airway King and intubate Carl. This involves sticking a hollow plastic tube down his windpipe and it’s about as much fun for me as it is for Carl. While I do that Airway King and McPushy put more stickers on Carl’s chest and run a 12-lead EKG for me. Carl’s heart ain’t working well but it’s working.
Airway King takes over bagging again so I can do some other cool medical shit but it’s not important. What’s important is that when I radio the hospital to give them report, Abby answers.
It’s not Abby’s normal night to work. This is a surprising and delightful development. I tell her I’ll be arriving shortly, emergency traffic, with a cardiac arrest. When I finish report she doesn’t say any of the official stuff she’s supposed to say, she simply yells “copy medic 22” and slams down the mic. I like to imagine this is her version of flirting.
In her defense, it is like 42 minutes before her shift change. Oops.
“Five minutes out,” Tommy calls from the driver’s seat.
Five minutes. Plenty of time.
I hit the 12-lead button on the monitor and after a few seconds it spits out a piece of paper about a foot long. I rip it off, flip it over without looking at it and start writing.
“How’s it look?” McPushy asks.
“Not great,” I say.
“Anything we can do?” he asks.
“I don’t know. How are you with poetry?” I ask.
“Not great,” he admits.
But no matter! I’ve already got it. I scribble on the paper:
Roses are red,
Daisies are yellow,
Come out for a drink with me after work or I’ll be heartbroken,
Like this poor fellow.
I slap the finished product down on the bench and start doing my last bit of work on Carl. Last 12-lead, check. Last vitals, check. End tidal carbon dioxide, goodish. Lung sounds, check, my tube is still good. IV still running. I could probably give Carl some antidysrhythmic meds but it’s been a pretty short transport and I’m not convinced any of that shit works anyway.
I decide to make that a six figure decision, as in, a decision left to somebody who’s income is six figures.
While Airway King and McPushy get the IV bag ready to move and switch the oxygen to the gurney tank, I raid Carl’s pockets and find his wallet. There it is, I.D. and insurance cards both present and accounted for. Check and mate.
Considering this guy walked up to our ambulance while I was trying to eat a burrito, this whole thing went wonderfully, for us at least, not so much for Carl.
Minor chaos ensues as we pull into the ambulance bay, open doors, pull out the gurney and roll into the ER. As we approach the charge desk I spot Abby. She gives me the stink eye and says, “cardiac two.”
I flash her my serious medical professional look and slap the 12-lead with poem down on the desk. “You need to look at that. It’s the worst one I’ve ever seen,” I say, all business and continue down the hallway.
As we turn into the room, I see her pick it up but then my view is cut off and I’m back in medical mode. Four nurses, one tech, an EMT student and one very tired ER Doc descend on me and ask questions. I tell them things. They ask more questions, I tell them more things. I don’t have a lot of information to give them. Which is just as well because they’re amazingly unimpressed by anything I have to say.
If I do this three times a week they do it twenty. And again, as at least two of them remind me, it’s almost shift change. They have precious few fucks left to give so they’re saving them all for Carl.
Tommy has already bounced out with the gurney, McPushy and Airway King are loitering about hoping to score some snacks or maybe a nurse’s phone number. Honestly, they seem just as content with either. At some point their Captain shows up and commences his standard operating procedure of acting like an asshole.
After completing my necessary paperwork duties I mosey over to the charge desk where Abby is attacking a computer keyboard with appalling ferocity. She does not look up.
“You’re right,” she says, “that was the worst one I’ve ever seen,” she produces my poem from somewhere and holds it up as evidence. “What’s wrong with you?”
“What’s wrong with me?” I ask, “What’s wrong with you? Don’t you like poetry?”
“Did you write this on your way in?”
“I feel like we’re getting off track.”
“It’s time stamped like fifteen minutes ago, you idiot,” she shakes the slip of paper at me.
“I am trying to woo you, dear lady.”
“You need help Bo.”
“You need a drink Abigail.”
“Don’t call me that.”
“Don’t deny my heart’s desire.”
She finally looks up at me, the barest hint of a grin. “Where?”
“Fine. I might be late charting now that you brought me that poor guy,” she jerks a thumb in the direction of Carl.
“I’ll wait as long as I must.”
I turn to walk away but before I make the door she says, “bring Tommy.”
“And why would I do that?” I ask, turning to face her but continuing to walk backwards out the doors.
“Because he’s a lot more charming than you are,” she replies.
“And better looking too, which is why I’m not bringing him,” I answer, almost out the doors.
“I’m not drinking alone with you, I’m bringing the girls. You’ll need reinforcements.”
She gives me a quick, genuine smile and the automatic doors close between us.