Check Pulse...

Last weekend Cat and I saw each other for the first time all week Saturday in a PALS refresher class.  Welcome to my life.  I had been on travel most of the week for work, and Cat was working a 24 the day I got back.  The dogs didn’t bite me coming in the door, so that was a good sign.  We had duty on Sunday, and I was sure that going to PALS the day before was bad ju-ju.  The day started with a couple of kid-calls, but nothing too too bad.  Anyway, a part of the class goes over dealing with pediatric deaths, and how to tell the family etc.  There is a session that breaks out to talk about things that you may have done or seen that could have been taken wrong by a family member, and how to do it better.  That reminded me of a call I ran as an EMT years ago, but I’d rather share it here.

Now we all have our coping mechanisms, and the most common one that I have found among EMS providers is a morbid sense of humor.  Now, while very good at defusing a situation, we all know that you have to pick your timing carefully.  Family members really don’t like to hear a loved one referred to as “DRT” (Dead Right There).  That said, the right levity at the right time can help give a crew perspective and calm them down enough to get the job at hand done, and done right.

I was a fairly new lead EMT-Basic running with a very enthusiastic gentleman named Eddie who drove for me.  We got punched for a stoppage of breathing at that hole we call the fossil farm.  The engine from our station, and a medic were sent with us to round-out the complement.  Now, as I’ve said before, this place doesn’t seem to know much, but they know dead when they see it.  I’m sure we are going to have a code waiting for us when we get there, and Eddie gets us there pretty quick.  I am a newer EMT and I am pretty butt-puckered as we go.  My mind is swimming with what to do, and in what order when we get there.  I try to calm myself going in by mentally reminding myself that if this IS a code, he is already dead, and I can’t make that any worse.  We load up the gear on the cot and work our way past the collection of folks in the hall to the elevator and up to the room where the call is.  

It seems that while the staff knows dead when they see it, it must take a while to figure out to call it in...The patient has clearly been down for a little while, maybe an hour as I recall, but the staff is doing half-assed CPR and saying things like, “We saw him go down”, “we were right here when…”  as they run out of the room.  Basically putting us in a position where we were going to have to work this no matter what.  This is a typical reaction here, and one that happens to this day.  As soon as I’m at the patient’s side I recognize that he is WAY past saving and I start to calm down considerably.  There is no life to save today.  The engine guys were in right behind us and there is more help than patient at first.  We bring the guy to the floor and start our routine.  While I know that are not going to make a save today, we are still looking to do things right.  Compressions are started, and the patient is bagged with Oxygen.  The patches from the AED are attached and we are in business.  We hit the “analyze” button and stand back, with baited breath, to see what it tells us.  Now, unless we are going to shock him with a lightning bolt, there is nothing that this little machine is going to do for him.  “No shock advised….Check Pulse” the lady in the box tells us.  Now, Eddie is standing by the door, and there are some fire guys in the hall.  Someone else is actually checking the pulse, and as usual the entire staff of this place has left the room.  The only people in the room came with us, or are dead on the floor.  Sensing the opportunity, I look back and make eye contact with Eddie and place two fingers on my own Carotid artery.  (Clearly we didn’t need to check this guy’s pulse, he’s asystolic and achieving room temperature, so she must have meant mine.)  I put on a concerned look for just a beat, and then beam Eddie my biggest smile and give him a thumb’s up and a nod.  “Got one” I say softly.  

The intended goal here was a little bit of a smile and the perspective that we weren’t going to save him, and no need to keep our butts in a pucker.  Instead, Eddie lost it.  I mean, he busts out into a full-on eye-watering guffaw.  I guess breaking the stress hit him big time.  Well, out of sight in the hall is the rest of the engine crew.  They didn’t see what happened and all they know is that Eddie is laughing at the dead guy.  A life member of the department, and all around good-guy named Russ grabs Eddie and damn near throws him out of the room.  He gives Eddie a ration of Shit for the laughing, and pulls him into the hall.  I had turned back to the patient and was assisting the Medic with the code while that goes on.  I realize the misunderstanding, and damn near start up laughing myself.  It took a bit of will power to get that back under control and focus on the matter at hand.

The call proceeds normally from there, and as I recall, the medic got orders to cancel it from the ER Doc as soon as we hit the unit.  We take the patient to the hospital, drop him off and get the unit cleaned up again.  When we get back to the house, Russ wants to know what the hell happened on that scene.  At first I play dumb and deny everything.  Ultimately we had to explain what happened and let poor Eddie off the hook.  

All in all, everything ended like it was going to no matter what, and I would love to tell you that I have since learned to never enjoy a private joke on the scene.  But too many people who know me read this and we’d have nothing but a steady stream of comments calling me a liar.