Wednesday, January 27, 2010

Pedi call

The call came in as “Man Down”. It was the first one of the day, we had barely finished logging in from the parking lot and it was only 6:08 in the morning. It was chilly and grey as a thick blanket of fog sat over Oakland and it’s immediate suburbs. “Man Down” is a very common call and can mean anything from a bum taking a nap to a drug overdose to a murder victim to anything else you can come up with that would make you lay down outside. Quite often we arrive and the “man” is not only no longer down, but no longer anywhere to be found.

The labor is divided up on a dual medic unit such as the one that I was on that day. If you are driving, you are responsible for of course safely driving, any radio traffic, verbal reports, and filling out the daily activities log (or DAL). On scene you assist the paramedic that is the “patient medic” with various duties such as gurney manipulations, gathering vital signs, negotiating egress from the house, etc… If you are in the “hot seat” you are the patient person in charge of all patient care. You make all the decisions on patient care, destinations, and priority of transport. Before you get there, you are primarily the navigator and a second set of eyes as where the patient is located is not always as easy as it would seem. Today I was in “the hot seat.”

“Copy man down, show us enroute to the call” my partner Jeff replied into the CB microphone. We were both a little irritated that we didn’t get our first cup of coffee right after login, but this would probably be a quick cancellation and then we could get our caffeine levels up and possibly a tasty muffin to boot. Little did we know but the coffee would have to wait.

As we turned the corner to the street of dispatch, I noted the types of things I try and notice. The street was a dead end and probably not paved or repaired in the last 20 yrs. The lawns (if there) were not well kept and more used for storage for broken down cars. The housing was run down, single family and multi-plex units in need of paint. Probably lower to no income families. More often then not representative of a lower education level and high occupancy. All part of the picture.

The fire department had arrived before us, as usual, but they were all huddled in the street behind the engine. The sun was just starting to come up so it was difficult to see what they were doing. Probably putting their gear back together, I thought. I think my partner joked they were “working” the street meaning that they were performing CPR on the pavement. Typical medic humor, taking a cheap shot at the firefighters.

The first thing I saw was the soft, pastel yellow color. Just a flash of it through and elbow or knee of the hunkered down guys. Not a color I am used to seeing, especially in the street. It caught my attention. The captain looked up as we approached and his stare said everything to me; something was very, very wrong.

I was squinting to see as we rolled up, I could feel the muscles in my forehead tensing, but I still could not figure out what I was looking at. Suddenly for whatever reason it all became clear.

“Dude, it’s a baby.” I said.

“Shut up”

“No I’m serious, it’s a friggin’ baby. Son of a bitch” I said. Instantly I felt a cold sweat. I didn’t care about the coffee anymore.

“Bro, I have never run a pedi code” my partner said tentatively referring to our common contraction for pediatric, meaning child or baby.

“Me neither” I relied. “Let’s get at it” My door was open before we even stopped.

I was struggling to not allow the tunnel to close in on my vision. I knew in this neighborhood it was important to keep your eyes open and mouth shut or things could go south very quickly.

Pediatric CPR is very weird to see. We practice it all the time so it shouldn’t look so odd, but it does. It seems almost barbaric, but at the same time absurdly silly. Grown, muscle-bound men using two fingers to compress the chest of an infant they outweigh by over two-hundred pounds. The captain looked at me with a very concerned look, clipboard in hand. He had been collecting information from the gathering family who were standing in the gutter by the curb. Their sobs were audible. Palpable.

“Downtime?” was all I could come up with to say. As sad as this was, I could only serve this child and his family by getting these answers. After all, I had to pass the info on to the ER doctor.

“Unknown. The baby was warm, but pulseless, apneic, and cyanotic when we arrived. Last seen normal at bedtime last night”

The captain asked me what I wanted to do. The firefighter quietly suggested “calling it” on the down low so none of the family would hear. “Calling it” would mean that it was a lost cause and we would stop life-saving efforts.

That was not going to happen.

I looked up and saw a couple large SUVs pulling up filled with family members. These people were streaming out of their clown cars without shutting them off or closing doors. The extra light from their headlights was welcome, their menacing approach was not. Dressed in the uniform of the hood, long oversized white T-shirts, pants falling down, and tattoos. They were also very large people, even the women, Maybe Samoans or Tongans. I had a baby in the street, traffic backed up, and a crowd that was growing more and more agitated. The women went straight to the other women on the curb. The men were bee-lining for us with authority. Their disbelief and anguish converting to anger, the only emotion they are comfortable displaying in public. It was time to go.

“Let’s get the hell out of here.”

I scooped the kid up and we were driving in seconds. I took the firefighter with me to serve as an extra pair of hands and emotional support.

Enroute we were quickly doing everything that needed to be done. It was like clockwork. We both knew it was a lost cause, SIDS kids generally don’t come back, but still, we had to try. I suddenly realized I knew very little about this child. Our retreat had been so hasty, I did not even know the sex of the child.

The rest of the call was a blur and the patient was out of my hands and swarmed with emergency room personnel before I knew it.

The family arrived and the wails were too much, I had to leave the hospital. I went over to the fire engine that had followed us in. I locked gaze with the firefighter. There was nothing to say really. So we joked about something else. Perhaps the absurdity of the scene or the guys coming at us. We wrapped it up pretty quickly. Everyone was sizing each other up, but too much man to ask if we were all OK. The jokes were more a barometer and emotional release than humor.

I am having my second child this spring as I write this. I try to never put myself in the shoes of the people I serve. It is far too dangerous and I fear I may not make it back to me. I just hope I never have to know a day like that day.

Copyright 2010 Jon Kuppinger

Wednesday, January 13, 2010

The Bad Call

“We’re losing her, Jon! Get that tube now!” shouted my partner Dawn from the open doors at the back of the ambulance. She was right. As I looked into the pale watery eyes of my patient and saw her struggle to squeak in a breath and buy her a few more seconds on this earth, I made a realization. This was really happening… to the both of us.

As a paramedic rolling through the rough streets of Oakland, I have had my share of what we would call bad calls that I carry around in my head and heart. For each paramedic, the definition of a bad call is unique. There are, of course, the calls that nobody likes such as the pediatric calls. You would have to search far and wide to find someone who wants to work around sick or dying children in an emergency setting. Still, most medics have specific kind of call that really bothers them. For me, it is not so much the type of call or any specific pathology that gets me; rather, it is my own disappointment in my ability to help someone that earns that call the status of “bad”.

As far back as I can remember, I have always been a giver and have valued the concept of being “the helper”. I have tutored, taught, and mentored throughout my life. But the one frustration I have always struggled with is to not be able to help, regardless of my level of effort. And that was exactly what I was dealing with here as I cradled the head of a woman I had only just met moments ago. I suffered with her.

“ I’m trying but there’s just too much fluid, I need suction now!” I responded, realizing I was yelling even as the words came out. I wondered if I sounded too harsh. After all, we were all concerned and trying. Dawn was only a mere three feet away. I could touch her. She did not seem fazed as she was completely engrossed in trying to get IV access. The firefighter assisting me got the suction without a word.

“I got it!” I shouted, as if I had just scored the winning touchdown. A rush of pride mixed with completion washed over me, but only for a second. “Don’t get cocky” I thought. I was on a roll, but there was a lot more to do.

“Hold this and DON’T move it” I told the silent firefighter who was assisting me. He nodded in agreement, controlling his emotions, but his eyes told me a different story.

I turned my back to grab a few additional pieces of equipment when I heard some gurgles and the firefighter broke his silence with a yelp. Apparently he had been splashed by the overabundance of fluid from the patient’s now full respiratory system and he was not too pleased about it. When I turned back I noted that the firefighter had indeed inadvertently moved the tube, and it was now in her esophagus not her trachea. I didn’t blame him, he was scared and clearly feeling like he did not sign up for this, which was manifested in his frozen frown and voiceless nods. I immediately pulled it out and noted the color of my patient change to a raspberry ashen color, much like rain laden clouds with a setting sun trying to break through.

It was then that she died.

Those watery eyes that were our only form of communication, our connection, dilated for the last time. Her fight was over and there wasn’t a damn thing I could do about it. I didn’t have long to lament, I still had a lot of work to do, but this part was easy. We are heavily trained in what to do with people whose hearts cease to function. I fell into my training and went through the familiar motions of CPR.

It was almost silent as we breached the doors of the emergency room. It was like walking into a hopping nightclub club from a quiet street. There were people everywhere, bright lights, lots of bustling around and shouting. I joined in and shouted the words I needed to shout and the doctor shouted questions back and shouted orders to the nurses who shouted to other people, and on and on. Once they had what they needed from me, I slowly slipped out of focus and everyone was on the patient like yellow jackets around a picnic lunch. It was an odd feeling. It was as if I could feel the white-hot spotlight slowly panning off of me until I realized I no longer had a part in this play. My character had no more lines. I needed to leave the now darkened stage.

I walked outside alone and a bit dazed. My heart was still racing. I realized I could hear my breathing and I was soaked in sweat. I felt like I had just been involved in a car accident. There is not much to do, but I felt as if I needed to do something very extreme. Anything to dissipate this now waning adrenalin surge. Instead, I called my wife and told her I loved her. I needed to touch base with reality. Slowly over the next hour I calmed down with the mundane tasks of the job. Cleaning. Organizing. Putting things away. Paperwork, always paperwork. Need to get ready for the next call.

In the end my patient was revived and transferred into the ICU. She passed away a few days later of severe pneumonia, which was not a surprise, but still the same left me with that melancholy feeling paramedics know all to well. I had tried so hard to bring her back. I comforted myself with well worn clich├ęs designed to ease the confliction of emotions at these trying times. “It was her time.” “We did the best we could.” “There is only so much we can do.” “It’s in God’s hands now.”

I knew it was not my fault, but still, as I reviewed the call over and over in my head, my heart searched for reason in all the chaos that surrounds a bad call.

Copyright 2010 Jon Kuppinger