I've seen lots of death. I'm not proud of that fact, and sometimes I
wish I hadn't. But it is part of me, part of my past. You may not
want to read this if you are bothered by descriptions of death.
I've never talked about or written about any of this before, except
to my wife, who I've been married to for 18 years and who was also a
paramedic. And then not in any great detail, more like stories of
the form "One time, we had this guy who...". You learn to keep it
light, to cope. We had some shared experiences, but we don't talk
about them much and I try not to think about any of this, although I
still do, 20 plus years later. Apparently I am thinking about it
now.
When I was at university in the 80s I had a friend who joined the
local fire department as a volunteer. Part of his job was working
shifts on the town ambulance, which was run by the fire
department. His stories sounded cool at the time and prompted me to
take an EMT course and get a summer job with a private ambulance
service near my parent's home. That was 1987. I still remember the
first time I did CPR, an elderly woman who died on the toilet. What
I remember most about that was the initial cracking of her rib
cartilage under my hands as I did chest compressions. Something no
one told me would happen when we learned CPR.
That was my summer job until I graduated in 1990, after which I went
straight into paramedic school. In 1992 I became a paramedic, and
worked on a city 911 truck until 1999. Seven years was enough, I
suppose. Burnout is real for those who work in EMS.
My wife and I met, ironically enough, at the scene of a fatal car
crash. I was a paramedic and she was an EMT and
paramedic-in-training. We were in different ambulances, she came to
assist after my unit pulled up on scene and saw the condition of a
Jeep that had hit another car head-on. The other driver was already
on his way to the hospital, but the Jeep driver was trapped in his
vehicle. After the firefighters extracted him with the jaws of life,
we pulled the young man onto a stretcher and backboard. He was
already in cardiac arrest. My (future) wife and I worked to save
him, but, as is often the case with trauma codes, by the time they
get to that point it is far too late. They needed surgery, like half
an hour ago.
I remember the man who hanged himself in his garage. His face was
puffy and purple, his tongue protruding, swollen. From the smell, he
had soiled himself. That was another thing no one told you - when
people die, their sphincters relax and anything in their body will
come out, subject to the law of gravity.
I remember being summoned to the scene of a gang shooting by the
police, they had the scene under control and cordoned off
already. We were to assess the victim. An officer lead us down a set
of basement stairs, and pointed. I saw a pool of blood with small,
grayish chunks in it beneath the head of the victim, a young man who
was probably not more than 16 years old. He was face up. We were
always told to be mindful of active crime scenes, even as police
gave us lots of leeway. In cases like this, the police called us to
the scene just to avoid the potential liability of not attempting to
resuscitate someone. So I put on my gloves, gingerly stepped over
the shell casings on the concrete floor and tried to avoid stepping
in blood as I felt for a carotid pulse. The young man was clearly
dead, shot in the head, probably more than once. Most of his head
wasn't intact. I'm not sure why I bothered to check a pulse, except
to make a show of checking _something_, even as I told the officer
we would not be transporting him to the hospital. Transporting
obviously dead patients in an ambulance was against state
law. "Injuries incompatible with life" was the guideline.
There are always exceptions, however. Eric C. was his name. He was
six months old. His mother found him dead, in his crib, early one
morning. When we arrived the mother was hysterical, and her
children, seeing her in that state, followed suit (she was a single
mother and so had no adult support). The police were trying to calm
her down. Despite the fact that rigor mortis had already set in
(that usually occurs 2-4 hours after death), my partner snatched up
the baby and we quickly got him out of the house. That was the one
and only time I ever transported a clinically dead patient and did
not attempt resuscitation. We just had to get the baby out of there,
to defuse the situation. It seemed cruel to do otherwise. The ER
staff understood, and we were never called out on the decision - I
don't think the police on scene or the ER staff ever told anyone.
I remember a five-year old girl whose mother had pulled her from a
pool, unresponsive and not breathing. She had looked away for a
minute, and the girl had climbed the pool ladder and fallen in. I
worked to save her with another paramedic, but to no avail. That was
another thing no one told you - most people in cardiac arrest die,
but especially children. Kids' circulatory systems compensate for
injury really well, so by the time they crash, it's usually too
late. I still remember the looks on the faces of the family members
who had gathered outside the ER doors as I exited. Part terror and
part hope. I knew the girl had just been pronounced dead by the
attending physician, but I said nothing. Cowardly, perhaps, but they
would hear the terrible news in a few minutes. I wanted no part of
that. It was all too raw.
I remember the woman who died in front of me. We were called to a
private home for a woman with chest pain, in the middle of an ice
storm. When we arrived, we found an older woman who was obviously in
great distress. She was pale, diaphoretic, and had difficulty
breathing. She told us in between gasps that she had severe chest
pain, 10/10. Her pulse was irregular. Sometimes you just know - we
slapped an oxygen mask on her and cranked it up, then got her on the
stretcher and attached the ECG leads. As we were wheeling her to the
ambulance, she stiffened, then relaxed. Her eyes rolled back and
when I looked down, the ECG showed v-fib. My partner dropped the
head of the stretcher and I shocked her right there, three times. We
hurried to the ambulance, now doing CPR, and asked a police officer
to drive so we could both attend to the woman. In the storm the trip
to the hospital was very slow, I remember using several rounds of
cardiac meds and continuing CPR as her heart rhythm changed several
times, finally to a sinus rhythm with a faint pulse. We wheeled her
into the ER with a pulse, but still not breathing on her
own. Unfortunately she died the next day in intensive care. Several
weeks later we found out that the family was considering suing us
and the ambulance company. My partner of that night and I attended a
meeting with the family, their lawyer, and the chief of emergency
medicine at the hospital we brought her to (technically paramedics
work under the direction of ER physicians, usually on standing
orders but also on orders given in real-time, via radio). It worked
out in the end because the doctor went to bat for us - he just came
right out and said we did everything we could and that he would have
done the same given the circumstances. The family quietly dropped
the idea of a lawsuit.
There were others, of course. My memory of the many (thousands?)
calls over that seven years fades with time. We did occasionally
save someones life, or deliver a baby, or find ourselves amused by a
drunk at 3am. But sadly, these deaths are the calls I remember the
most.
