Batting .500

And again. July is the month of black cloud. Once is an anomaly; twice is a pattern. Another code.

This one didn't go as well.

The dispatch was for unresponsive male at a frequently visited nursing home. I left the dinner table for it, figuring it was a really tired guy or something. I got to the fire house in time to see one of the department's volunteer paramedics pulling up. He took his time putting on his department apparel, because it's usually not a huge emergency. In fact, the previous call I had been on, we had to wait while the patient, an elderly woman with a recurring heart valve problem, picked up the phone and had a polite conversation with a wrong number. While it's sad that there are so many people who don't have family close by to drive them to the hospital, it's usually not an emergency.

By the time we pulled out of the ambulance bay, the dispatcher had announced that CPR was in progress on scene. Oh boy. We were on scene in 5 minutes, and it was my job to grab the ALS (advanced life support, or paramedic-related stuff) bag. Of course, I had forgotten that as of a couple of months ago, the bag was locked up because the department decided that a huge department with only a handful of paramedics should have a supply of narcotics. Hey, morphine is pretty cool. I learn quickly that the key is hanging in the ambulance, right above where the bag is stored. Ah, nominal security at its best.

We head to the patient's room to find a bunch of nurses scrambling or staring uselessly, and the RHFD (the other FD in our town) EMS captain doing (a nice job of) one-man CPR. the nurses stand in the way for a few seconds before the paramedic, other tech, and I kindly nudge them aside to prepare the patient for transport. While we ready the stretcher, the paramedic turns on the EKG. Asystole. Flatline.

How long has he been down? He was checked on last an hour ago.

A patient's chances of survival decrease exponentially every minute that goes by without effective CPR. This is why it's important for everyone to understand how to give chest compressions, even if nothing else. One hand on top of the other, right between the nipples. Compress the chest 1 1/2 - 2". Push hard and fast, but allow for full chest recoil. That's it. That's all it takes to keep someone alive. After as few as 10 minutes without CPR, a patient's chance of survival is down to only a few percent.

I took over compressions as we wheeled the patient out of the nursing home and into the ambulance. The tech doing ventilations was not getting very good chest rise, which is the obvious indicator that the lungs are getting the air we were forcing into it. The paramedic intubated the patient pretty quickly, and we realized we weren't getting chest rise because the patient's lungs were not very healthy. According to his medical history, he had COPD, as well as a history of colon cancer. He also had esophagitis, which could explain the blood leaking out of the ET (endotracheal) tube when I took over ventilations. The paramedic also managed to start an IV on this man with old veins and no blood pressure, and then we were off to the hospital.

At the hospital, we went right into the trauma room, followed by every ER resident on staff (including a third-year, who is a good friend of mine). They continued to work up the code as I continued ventilating the patient. I don't know if they didn't notice I was still there, or I was doing such a good job (or they didn't have much hope for the patient), but I stood there the entire time. I got to see the entire workup.

July is a time of transitions for medical facilities. All of the graduating medical students start their residencies. Residents become attendings for the first time. In other words, a bunch of n00bs are running around. July is not a good time to need medical care.

It's not that I doubt any of the doctors' training, it's that they were new. Doctors who had never been in charge suddenly were. I was in a room full of doctors that had studied this scenario a million times, but had never been through it in this trauma room. There was fumbling for objects. There was excitement over doing compressions. There was searching for drugs. There was nervous joking and laughter. There was a room full of doctors wanting to try things and do things.

It appeared to me as if the code was run longer than normal, to give more residents opportunities to do procedures. A cardiac ultrasound was done a couple of times, to look for any remnants of cardiac movement. (Uncoordinated movement is bad.  No movement is much, much worse.) A few rounds of code drugs were administered. An IO line was started. The doctors continued to work. And the patient was lying there, arms splayed off the table, blood dripping out of the ET tube.

And then they called it. The patient was declared dead at a certain moment, and after that moment, all medical interventions ceased. In reality, he had been dead nearly 90 minutes at this point, but it wasn't official yet.

I didn't feel guilty, or upset. I didn't mess up; I did my job, and gave a full effort towards reviving a deceased man. He was gone long before we arrived. I tried my hardest, going through the protocols and maintaining this man's dignity the best I could. There was nothing we could have done better or differently.

I went home and took a long shower.