I remember walking in to the room at health south at the same time fire engine 16 was arriving. No one had an advantage on the other crew of knowing or doing more with the patient. CPR was in progress, though I didn’t see it, and we saw a very small elderly black woman with withered arms and legs lying motionless on the bed.
I remember feeling calmer than normal on this cardiac arrest. It has always been a tenet of mine to remain calm and collected, not to have a sense of urgency caused by emotion. To try to use the brain instead of making emotional decisions is what these situations call for. But at the same time, a sense of urgency is needed, as long as we can also think clearly. I can fall on the quiet and meek side because of my over-correction. I took the listening role right off the bat, seeing what the people taking charge would need. I am still apparently not certain enough to take charge, and also the chain of command is at work. But the world will need me to speak up, and soon enough it will be my turn to lead a call like this.
I remember scoping out the fire guys, when my brain should have been thinking about what I could initiate. I remember the fire medic speaking with Ashley and establishing some teamwork, which was a good thing for everyone. But I also remember him making some calls right off the bat that she would not have necessarily made, like deciding to intubate from the get-go. We could have put in a BLS airway first to see how it would go. While I was helping get the BVM set up, I remember thinking: “Oh man, these cowboys make moves quick, too quick,” but was that just jealousy on my part for wanting to be doing their job?
I remember the medics trying to establish lines, and the one on the patient’s left arm bleeding out onto her bed sheets. Then I remember the student speaking up, wanting to do the IO, but Ashley did it, and all the thoughts of “it’s not about me, it’s about the patient” began to swirl. Were these fire guys more eager to get good training than they were to help the patient? But is that so wrong, we want experience and good training so we can help people effectively. I just wish my brain could let these things go and hyper focus on what needs to be done.
The first useful thing I did was suction the tube with a French catheter, although to the fire guy I wasn’t using it properly. I wanted to say it didn’t matter as much as the CPR, which is true it didn’t, because I was the only one getting instructions on the scene. Made me feel stupid, but then again, he said it nicely, and I am in his position sometimes to correct people. It didn’t seem to make a big difference because we were already getting ETCO2 readings in the 20s, which is good for CPR, and soon up to the 50s, which meant that some of her normal circulation was returning (measuring the CO2 output in the BVM on exhalation.
I soon noticed one of the fire guys was practicing one hand CPR, and not doing it hard or fast at all. “How to correct him politely?” Ugh. Why is polite what I am thinking about now. So I spoke up “You need to use two hands and go harder and faster.” I’m sure these statements raise tension, but it’s true he was not doing good compressions. When I jumped in, I intended to do the best compressions of anyone in the room. “Staying alive, staying alive.”
After 18 minutes, we all began to look at each other. We all knew what the situation was, and there was no indication for a shock. Ashley said she would call. She gets the medical control doctor on the phone and explains what we’ve been doing and what we’ve seen.
“Compressions for 18 minutes with good chest rise and fall from the et tube. Catinography shows decent waveforms, but we are still in asystole or PEA, no indications of a rhythm. We’ve established an IO line in left shoulder and given the following meds. No indication a pulse is returning, request permission to cease resuscitation.”
The doctor pauses on the phone to take it all in. Then tells us “give up to three more doses of epinephrine and one of sugar and try again.” I’m thinking… at 18 minutes really? After 15 we are allowed to cease if criteria is met. But the doc says, so okay we will keep going.
More compressions, more et tube suction, looks like our O2 tank is running out. Some of us are standing around now looking at the screen, not sure what the point is anymore. They give the doses of epi and the sugar. Still pumping, no change, no change,25 minutes now, and then suddenly, we can feel a pulse in the distal region of the arm and then we check the carotid artery. We feel pressure there too.
Did we just get a pulse back when we were about to give up? We all wanted to let her go just a minute ago… A new hope and energy enters the room. Now it’s a flurry of moving shit out of the way to get her on a backboard and get her into the ambulance. I move her O2 to a portable. I’m trying to get the spider straps untangled. Fuck it, it is a fool’s errand. What should I be doing, how can I be useful? I grab the backboard and help swing her over. I don’t want to just stand there, but there’s not much useful to do at the moment except clean up the room.
In the back of the truck we continue to connect her to our mobile monitor, better oxygen, use the penlight, I think I see sluggish movement in the left eye? Right? Watching the monitor, watching watching, we’re bumping down the road, making sure her levels are good and her pulse is still there. I desperately try to change our empty O2 tank and put on the nozzle the correct way. Backwards, fuck… and then when we check on the lady again, her pulse disappears just as we’re pulling into the hospital. This lady is running to the light, then back away from it, to the light, then away again.
Now there is motivation. “We just got her pulse back from all that hard work, now it’s gone again. We have to get it back again.” So we resume compressions and continue as we carry her stretcher out of the truck. Tunnel vision. I don’t have time to be polite or care about the people watching. It’s do or die.
In the ER, tons of people. I make a mistake of thinking the ETCO2 reader on the BVM is the French catheter for suction and a nurse corrects me. Again! I don’t have much credibility in the room, but that’s okay I don’t have much to say. Just to tell them about getting the pulse back and when exactly we lost it. But I hope my presence in the room can help motivate the staff. We still have the ability to save this woman’s life, whatever is left of it, and I want the staff to try. For the last 45 minutes I have been sweating on this woman, crushing her rib cage to try to get her pulse back. We get it back, and now it’s gone, and some of the ER staff looks skeptical that this is worth our time.
Yet they got it back again after 8 minutes, the male nurse doing compressions looks please with himself, and everyone breathes a sigh of relief. She’s not out of the woods, but she’s out of our hands. If she had any other chances to live, we gave them to her. Our job is done.