Code

When you work for an EMS provider, its only a matter of time before someone you are treating clinically dies in your care. In EMT jargon, this is known as a code, short for Code Blue, in other words, your patient will be turning blue because he's not breathing.
My first code, well the first code I worked as a primary care giver, occured last Wednessday. I was working a medical detail at Disney On Ice, a sort of icecapades meets every Disney movie ever made. From our little medical room in the basement of the Providence Civic Center, or the Dunkin' Donuts Center, whatever they call it now, we can hear an assortment of music that makes your fillings rattle and your eyes water.
I was working with two other basics, one a North Providence firefighter, the other an out of work actor who had appeared as "Irish Dockworker Number 2" in several episodes of The Sopranos and an EMT Cardiac. Cardiacs are a Rhode Island creation that spend only 140 more hours in class than Basics but can perform more procedures and adminster more drugs than paramedics in some states.
While some announcer told the kids in the audience that they were going to watch a hundred years of Disney play out before them, a doctor in the audience was pointing out the spotlights in the rafters to his kids. By some strange twist of fate, the man pointed to a light run by an 85 year old man with an internal defribulator in his chest. At the precise moment the doctor looked up, the man collapsed, clutching his chest like something out of an old episode of Rescue 911, you could almost hear William Shatner's voice giving a cheesy dialogue.
The doctor flagged down security who for some reason did not radio us in the EMS room. Instead, several rigging workers came sprinting down to our little bunker and told us. "One of our guys went down, we need help." I grabbed a jump bag, a small medical bag with bandages, vital signs equipment and an airway kit. Bill, the Cardiac grabbed his own jump bag and we tore off after the riggers for an elevator.
"So," I ask while we're waiting for the car. "This guy got a history"
"Oh, yeah, a big one," is my only response.
"You wanna elaborate on that?" I ask and the guys tell me he's 85 years old, has an internal defribilator and will tell us "Oh I'm fine."
When the elevator doors open, I'm looking at a spiral staircase that seems to climb to the heavens. My partner and I take off running, two, three steps at a time as Disney music blares from the stage several stories underneath us. Its then I realize that our patient might already be dead and all we have with us is two bags of bandaids and blood pressure cuffs.
The man is hunched over on yet another set of stairs, several coworkers are around him, trying to calm him since he is still concious. His skin is the color of old newspapers, and covered in a film of greasy sweat.
"Sir," my partner asks him as I get my vitals kit out and ready. "Can you tell me what happened?"
"I'm fine," the guy mutters. Suddenly he stiffens and his eyes roll back in his head, his internal defribilator picking up an irregular heart rhythm and shocking him. His head rockets back toward the steps."
"Shit," Bill curses realizing he's working his first code too. "Shit."
I drop my bag and we pull him to the floor, getting him on a hard service and ready for the seemingly inevitable CPR. Bill's cutting away his shirt as I go for a pulse on his wrist.
"No pulse, I can't get a radial, " I go for his jugular. His blood pressure might be too low for a distal pulse but his heart might still be beating. No pulse in his neck. "Fuck, nothing there either."
I get on my radio to call for our defribilator/monitor. "EMT-7 to Detail Command. We got a guy going to code, bring the monitor and stretcher." An affirmative reply crackles back and I realize that we're going to have to rush this guy all the way to the other end of the building. "EMT-7 to EMT-8," the Irish dockworker. "Bring 21 around to Eborne street so we can load and go for a dirrect shot to the Rog." We were going to transport him to the same hospital I took my EMT class at several months prior.
Bill's getting the guy's teeth out and I'm pulling an oral airway so we can start CPR when he stiffens again. The whole body bounces and miraclously the man's eyes pop open. Bill starts trying to talk to him when another rigging guy starts tries to push past us.
"I need to get to his spotlight." The rigger was taking the show must go on a bit too far, kicking our bags out of his way. "Move guys, I need to get to that spotlight."
Just then the patient starts convulsing again and the rigger complains further. I rage as I prep the guy for a blood pressure, as he sputters back to life.
"Fuck off, we're busy," I tell the over ansy rigger as he climbs over the railings to get around us.
"Shit," Bill curses again as we loose our guy.
Arthur, the North Providence firefighter arrives with our monitor and we hook the guy up, trying to figgure out how much juice his own defribilator has left. No blips, just a flat line. Arthur and Bill get the guy between them and the three of us rush down the stairs. While they get him on the stretcher, his defib goes off and he comes to. "I'm fine, I just don't feel well." He tells us.
I'm hooking up his oxygen mask and spinning the dial to full when he codes again.
"We gotta go." Arthur announces calmly as I throw the monitor between the guy's legs and we hustle him out a door to the crowded front entrance of the Civic Center. A trio of security gaurds, one with dread locks like the Predator, flank us and we push out to the ambulance. Bill's getting ready to start with ches compressions and I've got the bag for ventalation when the guy's eyes pop open.
"I don't feel well. Where are we?"
"Sir, we're taking you to the hospital. You ran into a bit of heart trouble. We're going to Roger Williams."
"Oh, I like them, my doctors...." He codes again and his defib shcoks back. "...are there." He died, shocked back and remembered where he was in midsentance.
Arthur tosses me the keyes to the medical room and tells me to get back down there with the other basic, he'll dirve and we need two people at the Civic Center to man the other ambulance. Bill muscles the stretcher through the front entrance and I calmly collect all of spent medical rubbish we left strewn all over the main lobby.
A guy in a button down shirt with a little girl looks down at me on my knees in the middle of a circle of people. "Is that guy gonna be okay?" His voice has an almost childlike innocence and on my knees in a sea of used electrode patches and spittle soaked 4x4s I see that no less than fifty parents and children are staring at me. They want me to tell them they didn't just see someone die on their big day out with the kids. They want me to tell them its all okay.
"He's going to a good hospital and those two guys are gonna take real good care of him on the way there."
I hope thats true as I stuff whats left of the ordeal into a bright red biohazard bag.
Two hours later a security guard and the head of the rigger's union come down to our little medical bunker. One has tears in his eyes and can barelly choke out what he tells us.
"You saved our guy....he just called from the hospital, told us to get back to work. You guys...." his voice trails off and I can only nod in response. The joy and the relieve come later, right then I could only sit and quiver as the adrenaline faded and the sweat on my forehead crystalized.