A Midwinter's Night Dream

So it has been almost forever since I’ve posted, I’m blaming the holidays, and a bout with the flu for that.  But I’ve recovered from the flu, and running all over Virginia seeing family and sharing laughs, so it is time get back here.  I’m still kicking myself for missing the call that DTXMATT wrote up, but there will be more, there always are.  But, just like sharing stories around the bay table, hearing one story reminds you of another, and hearing the scene security issues reminded me of a call that sticks with me even today.

The call came shortly after nightfall during a snowy mid-winter’s night.  The snow had accumulated a few heavy, wet inches on the roads and was still falling hard.  Those of you in the Virginia area know the type of snow I mean, the heavy stuff that crunches under your feet, and you have to shovel off of your car.  Great for Snowmen and snowballs, but packs rapidly into muddy ice on the roads, and only gets more and more slick when the salt doesn’t totally melt it free.  This becomes important, because it means that ‘response’ indicates that we are on the way, but full speed is more like 20-25 mph and the rumble of the on-spots can be felt once we turn off the main roads.  On-spots are an automated chain system that can be activated by the driver when the unit comes onto icy roads.  When activated, a disk with lengths of chain rotates down in front of the tires and lets the tires drive over the chain.  This allows us the benefits of chained tires, but removes the need to have the chains on all the time.  The restriction is that you are limited to only a few miles per hour when they are used, or you risk damaging the system.  All of this is important because these conditions result in it taking much longer to get to our calls, and equally affect each of the subsequent units as well.  

The initial dispatch was for a difficulty breathing in our second due, a bread-and-butter call.  We get sent with the basic unit from that due to assist.  We start the trek up to the call, and Wayne and I exchange comments on the light traffic, and poor examples of parking that are demonstrated every so often by a vehicle that slid to the side of the road.  We make good time for the conditions, and see the ambulance coming from the opposite direction as we approach.  Not far from the address, dispatch passes information that perks our ears, and puckers our backsides.  “Units responding to the difficulty breathing…we have lost contact with the caller.  The line is open, but the caller is not responding.”  Well, that’s bad.  Okay, sure, maybe she went potty, and left 911 hanging, but it’s not likely.  The tone in the dispatcher’s voice tells me that she doesn’t think so either.  

The address is an apartment, and following the unwritten rules of EMS, the patient is on the top floor.  We arrive with the basic unit, and boogie ourselves up the stairs hauling everything we think we may need, to include the drug box, up to the third floor.  (I know, waaah, 3rd floor is the top one).  Getting to the door, I test the knob.  Of course, it is locked.  POUND, POUND, POUND on the door – “Rescue!” I yell, fully hoping for an “In here” or some such.  Instead I’m met with a loud series of barks and growls and scratching at the door in front of me.  Now, I’m a dog lover, and have two myself, but I know that I’m not hearing the “Hey, someone’s here to pet me” bark, and the scratching is going on about head level on the door.  Great, a big, pissed off dog, and no response from inside.  Okay, I’m a big guy, 6 feet tall, and 250 lbs at the time with a size 12 ½ duty boot, and the door is not really an obstacle here, or not for long.  And Difficulty Breathing-turned-Open Line means someone checking out and NOW.  I need to be in there, and quick.  “Start an engine company and PD to this location, I need to force entry, and I have a large dog on the other side of the door” I say into the radio.  Damn!

Two thoughts battle for supremacy in my head: “The odds of resuscitation diminish ten percent every minute post cardiac arrest” and “If I bust through that door, and that dog hammers me, this call is over for that patient.”  I know the first responsibility of any Medic is the safety of self and crew, and I know the rest of the team there feels that too.  One of us goes down with that dog, and they become the only patient, until that situation is resolved.  

What we have here is a first class dilemma.  I promise you that it is much easier to talk smack in either direction before you get there, than it is to make that call standing by that door, hearing the dog, and KNOWING that there is someone slipping away on the other side just a sure as you know that they called YOU for help.  In the time since, I’ve come understand that I made the right call, and I even use it to teach new people, but it still stinks.  

As I stood there waiting, and banging on the door, the complex manager comes up to see what is going on.  I explain the situation, and he offers to run for the master key.  I encourage him to do that, and we start talking about how to handle our situation.  The bottom line is, once the fire crew, or the master key got there, we could get in, but that did not mean that a quiet entrance would deal with the dog.  The lead from the basic was then relatively new as a lead, and with a former military background, I could tell she was straining at the leash to get in there too.  We agreed that it sounded good, but would get one of us attacked and leave nobody for the patient…so we waited and planned.  The only protection we had was our bunker gear, so Wayne ran down to get a jacket.  (We run with full Structural Firefighting gear on our units).  

A few long, long minutes later, I see red and blue lights dancing through the hallway window.  The engine and Police units were here.  The fire crew comes up the stairs with the ‘rabbit tool’ in hand, and in full gear.  The police are with them as they arrive.  We explain the issue and get a look from all of them that said, “And what exactly are WE going to do about the dog?”  To the fire crew’s credit, they started work on the door right away.  The door popped open briefly and we caught a glimpse of the Chow on the other side.  Big hairy bear of a dog and one I’ve heard has powerful jaw strength….wonderful.  The Officer on the engine grabbed the extra jacket and started back for the door.  

After a short three count he pushed back into the apartment, leading with the jacket like a matador’s cape.  A second firefighter followed him in similar fashion.  I went in on the second man’s hip, with MedicCat right behind me, and the Basic crew following her.  Our own EMS SWAT stack making entry.  The dog barked once or twice, then retreated in the face of the swinging jackets.  Unfortunately, he moved back right to the patient’s lap, turn and growled, guarding Momma.  Of course.  

The patient was a female, apparently chronically ill by her physique, sitting in a chair facing the front door.  She was head up, pale, and still holding the phone to her ear.  She was also apparently not breathing, and her eyes and mouth were open.  Shit.  Not a surprise, but damn, didn’t want that to be the case.  The two firemen-cum-Matador shooed the dog off of her with flourishes of jackets, and the dog hopped down and circled through the kitchenette area, around an island and back behind us, between us and the door.  Convinced those two had a system now, Cat and I rushed to the patient.  We each checked for a carotid pulse, and felt none, but as her head moved back from our touch we heard this agonal gasping sound escape her throat.  My head whipped towards Cat’s and I caught her doing the same to me.  She heard it.  “You hear that?” she asked.  “WE GOT SOMETHING” I announced to the group, “let’s GO!”  Now we are NOT working this code while fighting a dog, so we each grab an end of the patient and start for the door.  The dog/bull fight is still raging, and we advance and retreat a couple times towards the door under the cover of bunker jackets as the dog and the fireman do battle.  Finally, the firemen get the dog to retreat to a back room and slam shut the door.

What followed next was an ugly, full rush to the waiting unit.  The basic crew and fire guys grabbed gear and chased us and the patient down the three quick flights of stairs, out the door and the couple of yards to the unit.  Someone had run ahead and pulled out the cot, and wham, on she goes, and up into place.  Okay. Code.  No dogs, my house, the medic unit.  

Hoping that we heard some sort of breathing or breathing attempt we quickly get a look on the ECG….Asystole. Damn.  I was really hoping it was something better, but that is just not my luck.  The police are in the apartment and are checking for identification etc. and we pass word to look for medications if possible.  

We start transport quickly, knowing we have a longer transport time ahead due to the weather, and run our ACLS protocols by the numbers.  Everything proceeds smoothly, and sometime after MedicCat gets the IV on our dead patient, a secondary exam finds a subclavian subdermal med-port in her chest.  We note it to pass on to the hospital.  We aren’t going to be able to offer much else in terms of helpful history and hope the police get an ID to get some records.  The intubation goes well, and there is not too much resistance to ventilations.   We work the code into the ER, and they continue for a while before stopping efforts.  At some point the police arrive with a patient name, and the hospital could pull her records.  I don’t know exactly when her heart stopped, but even if it occurred at the moment we heard of it, I was only a few hundred yards away when it happened.  That though has visited me more than once since.

While writing my report, I noted that the call taker at dispatch stayed on the line the whole time.  They noted in the log the time they heard my first pounding on the door, they said that there were dogs in the background and that one sounded Big and angry.  (There HAD been a smaller dog in a pen on the other side of the room).  They also noted the time when they heard us making entry.  I don’t specifically recall, but I think the delay was like 9-11 minutes or so.  Seemed like forever…and at 10 percent a minute…  Anyway, I thought of something else later, that call taker must have still been on the line when Cat and I got to the patient, and heard the gurgle that I now think was just gasses escaping when we moved her head, and the hopeful “we got something, let’s GO”.  I’ve wondered since what this call was like for her, though I’ve never been able to ask.  

I think I heard at some point that she’d been a cancer patient, but don’t hold me to that.  It did occur to me that she died, eyes open and still on the phone, so it must have come fast.  That’s good for the patient, and probably means we would not have had a chance either way, but I’ll never know.  A family member, either son or husband arrived as we were leaving the hospital, and I remember learning that he came home to find a coffee table pushed aside, the dog in the bed room, and his family member gone.  He figured we’d been there, and asked the property manager or the police what happened.  I never did get to talk to him but I hope he knows we tried, but we just could not risk our crew with that dog.  Like I said, I’ve come to grips with this one intellectually, and would run it the same way again, but I’d rather not.