George

Some aspiring paramedics have to ride for well over a hundred hours to get a code in which they tube or shock a patient. Mine came yesterday at around 45 hours. His name was George and he weighed well over three hundred pounds, kitty cornered into a little room that was simmering at 90 some odd degrees.
When I got out of the bus, grabbed the monitor and started running toward the house with a police car infront of it, I didn't realize I was running to the wrong house. A woman in the door way started pointing across the street so I shot a quick look to find several other police cars and a pretty 20 something girl in an ankle length denim skirt and skin tight shirt with tears streaming down her face. A little sheepishly I turn and bolt up to her front steps, sloping my feet through dog shit on the way up to her house, the monitor banging against the door fram and taking a chunk out of the cheapo wood while I ask.
"Where are we, dear?" She points and makes some uncontrollable wailing noise while a stoner looking kid in a rasta cap with the dreads attached says. "Our dad's in the back. I don't know what happened, help him!"
I push through the house, hearing a dog going apeshit somewhere in one of the backrooms. We find George on the floor, his head purple while two sweat soaked cops bang out some impressive CPR. In Swansea, the Medic Rescue service is paid, so are the cops but the fire department is volunteer, so the police are all EMTs and respond as though they were firefighters, basically doing whatever we tell them to. They have their AED, a defibrilator that does all the thinking for you on the patient and the sergeant, still doggedly doing compressions despite the intense heat calls out.
"AED gave us a shock advisory so we zapped him but nothing happened." For the first time I smell the vommit that is bubbling out of the guy's mouth.
"Aw, fuck." I mutter and call out to another cop. "Go get the porto-suction, officer's side third compartment." The guy takes off like a shot while I turn the patient's head to the side, my gloved fingers trying to clear chunky puke from his blue lips, spearing deeper to try and evacuate the goo from his trachea. My partner takes over and i strip of the dirty pair of gloves, a new fresh pair already on underneath and I put our monitor on.
"Stop compressions!" I call out and the cop holds off for a few seconds. A lazy blip bounces along of its own accord on the monitor so I feel the neck and crotch for a pulse. Nothing, PEA or pulseless electrical acitvity. "All right, keep going we got a PEA. " I dig through the bag for some Epi and drop a big ass sixteen gauge IV into George's left AC, the huge pipe of a vein in the crook of the elbow. Thick, almost black blood spews out of the vein as I punch in the IV line and I realize my knee is in a pool of vommit. The cop shows up with the suction and Shawn, a medic with over twenty years of experience is pulling the guy's airway open with a laryngoscope and syphoning out refuse with the battery operated unit.
Joe, the third medic on the truck is setting up the Auto Pulse, a band that fits over the patient's chest and performs compressions so we don't have to. Its nice because it frees up another set of hands.
I push the epi.
"Oh, Jesus.....dad" I look up to see the girl who was out front standing in the door way and I manage to calm myself enough to say. "Look, hon, go in the other room, you can't help your dad there. Please go in the other room." An awful gargling noise emits from the man's mouth and Shawn calls out.
"Ok, looks like hes breathing, find me a pulse." I find and just as quickly loose the pulse in the man's neck as we switch off the autopulse long enough to find another slow PEA.
I push Atropine and we key up the machine again.
"What the fuck is that?" The rasta hat kid is in the doorway.
"Go take care of your sister!" I yell. "She needs you right now, you go be with her," I manage to say a bit calmer. I don't want their last memories of their father to be a vommit soaked ghoul show with us slamming all sorts of needles and tubes into his body.
It takes four of us to lift him, once we get him in the hallway we realize that its going to be a bitch to get him out into the kitchen. Rather than carry him we put the back board on the floor and slip and slide through his ever fountaing vommit to the kitchen door and try to slip him through the door way so we can load him onto the stretcher and get the hell out of there.
The police sergeant takes the lead and tries to cram the massive dead guy through the door while I bag him and push with my knees. "Come on you, please" the cop mutters to the lifeless body as we struggle.
Shawn gets pissed off and kicks through one of those little baby fences people put up to keep dogs out of certain areas and disappears around the corner. "We got a bay window, I'm gonna pop it." He wants to break out the bay window and drag the guy out through it so we can get to the hospital.
"Don't bother," I call back as we finally finagle our guy through.
When we load him up, I hear the unearthly sobbing of his daughter, I see her wrapped in her brother's arms as we plop her dead father unceromoniously onto the strecther, strap him down and screw from the house.
A police escort gets us to Charlon Hospital in a little under 8 minutes, an incredible feat for the time of day and the area in Swansea in which we were. On the way I max out on Atropine, pushing two more and I push another seven miligrams of Epi, bringing the grand total of drugs on board to 10 epi and three atropine.
"Nick, what now?" Shawn, ever the competent teacher wants to know what I would like to push.
"Bi...bicarb" I manage to spit out as I'm starting a third IV, one of ours got torn out in the hall way.
"Thats right, what dose?"
"An AMP." Already I have the pre filled syringe assembled when Joe tells me to put it aside, we're at the hospital.
A Fall River paramedic has the doors open on the back of our truck, our CMED report lightening up the ED and spurring everyone to get ready to help us. He helps pull the stretcher our and calls.
"V-Fib on the monitor." Joe tells me to get down there and shock him, giving me the requirements I need to full fill all of the points for my ride time.
"Clear the patient, charging." My voice is suprisingly calm as I realize that I am soaked as though from standing under a shower. Right there in the ambulance bay a crew of four paramedics, three nurses and a doctor put their hands up showing me they are clear and I call again. "All clear, shocking." The body does a hideous little jolt as 200 joules do litterally nothing to the rhthym.
The ED team works the patient for about twenty minutes before calling him and noting the time of death.
While I'm cleaning up the horrendous mess we made of the truck and all of our equipment, I see the family being brought in. The girl from the door had changed into a pair of jeans, the kid didn't have his rasta hat and they had somehow managed to bring the dog, a little shitzu into the ED. For the briefest of seconds, her eyes met mine and I knew what that look was. In one second she had nothing but hatred for me, the man who helped lose her father. She was confused, she wondered if I felt her loss the same way she did, if I was going to go home and it was going to effect me as bad as it did her. In one second she hated me yet loved me for trying and working as hard as I did.
I broke off eye contact as quickly as I could, going back to scrubbing a bit of vommit from the screen of my monitor, a device that most likely cost more than my first car and second car combined. From my time at the hospital I know that they are going to go in and see their father covered with a sheet up to his neck, the tube will still be in his mouth but he will be as cleaned as possible. At the worst it will look like he's smoking a clear plastic cigar.
Codes are nothing new to me, I worked them on the fire department, worked them on the ambulance, worked them in the ED. But this is the first time I did so as a paramedic in the field. Before it was "Hey firefighter, do compressions." Now its "Ok, Nick, what do you want to do?"
While I hose out the back of the bus, a job fit for the low man on the totem pole (and they rightly don't get much lower than the medic intern) I try to figgure out how I feel. I'm glad I got my points so early, overjoyed really. I have heard horror stories of people riding for well over four hundred hours before catching their codes. At the same time I feel horrible for the family. They lost a loved one, but they lost a love one in a brutal display of medicine at its most primal. We did everything we could and we did it correctly but EMS is not pretty and I feel terrible that they caught even glimpses of the barbaric things we needed to do to their father. I also feel exhausted, seven bottles of Poland Spring do very little to replinish all of the energy expended in trying to save George.
With the back of our truck finally cleaned and restocked we head back to quarters in order to clock out and go home. Once I get home I take a long, hot shower with a bottle of Sam Adams Black Lager and then join my father at the fire pit for more beers and a cigar. We're not celebrating my code, its just what we do, we burn things and drink outback when the weather is nice. He asks me to tell him about the code, what I did, how it felt and if I was scared. My father always wanted to do what I do, he took all the tests but because of the politics of Rhode Island fire departments he was never hired. So he has me tell him everything about what I do. He loves to hear the stories and know that I am doing what he wanted to do.
Eventually I stop talking, I've told the story and in the process analyzed everything I did to make sure I did it right. After it gets dark we bring a small TV out to the fire pit and watch Brady lead the Pats on a 24 point rampage over Carolina. We cheer and annoy our neighbors with shouts of joy and explitives at the lack of Corey Dillon to temper the talented but green Maroney. And for a little while I mange to forget that I couldn't save one today.