Plenty of people out there abuse ambulances, calling for colds, hangnails, and other similarly trivial stuff.  Then there’s ambulance anti-abuse, where people don’t think to or choose not to dial 911 even as they are actively dying.  Like the family of my patient who watched him clutch his chest and collapse to the ground.  More than a time to dial 911, really this is the time to dial 911.  But for whatever reason they didn’t, instead they loaded him up in the back seat of their car and drove him frantically to my ER.

It’s not very often that someone shows up unannounced in cardiopulmonary arrest.  Usually they come by ambulance and since they radio ahead to us it gives us a little time to prepare.  All of us I would imagine have our little rituals.  I like to check the equipment — make sure the suction works, make sure the lightbulb on the laryngoscope is good — while sort of visualizing in my head how the code will go.  I used to run down the ACLS protocols in my head, but really by now I have these down cold.  Instead I focus on the finer points of a resuscitation: making sure breaths aren’t given too fast, making sure the chest compressions are the appropriate rate and depth, etc.

Showing up unannounced makes the process more ragged, especially in the beginning.  Initially unaware of what was going on down the hall, I was with another patient when the nurse pulled back the curtain and said with strained calmness “we need you in room 1 now.”  I pretty much knew then what I’d find, getting interrupted means it’s serious and that tone meant it was really serious.

Room 1 contained what seemed like every nurse and tech in the department, all surrounding this newly dead person.  Pretty much everyone in the room knows the protocols and therefore how to run a code, but with so many different people involved and multiple tasks to be done there has to be someone in charge giving instructions and doling out responsibilities.  That job belongs to the ER doctor, and while I’ve never excelled at this since I don’t have anything resembling a take-charge kind of personality I still understand my role in the process.  So I walk in and take charge as best I can, telling this person to start compressions, this person to get the pads hooked up to the chest, that person to get the bag connected to the oxygen, and off we go.

After awhile the dramatics of his entrance wear off and now it’s just another code and we settle into a code rhythm, the techs switching out every so often as they fatigue from the compressions while some med or another is given every five minutes or so.  One of the nurses cracks a joke and it’s funny so some people laugh.  This happens partially to relieve built up tension, but mostly because for us there’s no sadness attached to what we’re doing.  If it was a kid that would be different, a kid’s death is always tragic but this is just the latest in a long line of middle to older-aged people whose time on this earth happened to run out while we were on shift.  Still, I softly remind the nurses that this patient’s family members are just a few feet away, separated from us only by a thin curtain.  Their faces fall and they immediately feel bad.  Even though it’s not sad for us we all understand it’s horrific for someone else and the importance of remaining professional out of respect for the unseen family is instantly remembered.  

The patient died but I felt good about the code.  We were taken by surprise but quickly got organized.  I got the tube right away, and the nurses immediatedly established the IV’s.  We gave him every chance we could to regain a pulse, and that’s all we have control over.  Whether or not his body starts working again is out of our hands.

As usual, I didn’t feel sad until it was done and I had to tell his family memebers that he had died.  Our chaplin came in from home fortunately and was much more comforting than I could ever be.  I don’t have that kind of time to spend with families anyway, this was exciting and somewhat draining but now it was over and as always the next patient was waiting to be seen.