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 clichés 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

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