Monday, August 8, 2011
THIS WEEK IN DEAD PEOPLE
aaaand, this week is no different. It was a morbid ass week, i won't lie, but only in that tumultuous, joyful, challenging way that it so often is in my job.
Started with The Stench. Never a good job to get. I think PD gets it as the FOUL ODOR, for us it's a CARDIAC ARREST because if something smells SO bad you have to call 911, it's probably dead. Fire trying to get themselves canceled the second they get there- "Um, you really gonna need us? It says Possible DOA in the job descrip..." which is an absurd excuse to leave because "possible DOA" can mean anything from dude taking a nap to...well, to what we ended up finding. So i tell Fire no, y'all comin up there with us, possible DOA or not. As I've said before, the main thing you need on a Cardiac Arrest is enough hands to have CPR ongoing while we do the other stuff, and I wasn't about to be the jackass that cancels Fire only to have a just-died dude on his hands and no one to pump the chest.
When the elevator door opened on the third floor, the whole Fire crew literally took 1 step into the hallway, did an about face and went poof. And at that point, I couldn't blame 'em. The smell of human decay is singular, unmistakable, unshakable. Some EMT showed up out of nowhere acting all cocky and loudmouthed about something, I don't remember what, so we let him go in first. He opened the apartment door and then we all had to move out of the way while he ran retching in the other direction and then was never heard from again. Poked my head into the apartment, not breathing through my nose at all. Didn't see anybody, just a dingy old onebedroom, cluttered with old magazines and piles of clothes. I peeked alittle further in, but the door was one of those swings shut quick behind you joints so I kept one foot blocking it. The air was thick and nasty and ahhhhh yes, there on the couch was the gentleman, lying peacefully on his back in a state of total Indiana Jones style decay/damn-near mumification. I hadn't noticed him because he was so perfectly still, obviously, and so many different colors that a human being should never be.
It's possible that I said "Where's the dead guy? Oh." But I can't confirm that.
Anyway, we made a quick retreat, ganked PD's paperwork so we could write the guy's info down from the safety of our air conditioned ambulance and then went out to breakfast.
The next night we started out with a 55 year-old dementia patient who'd turned up dead on the floor of his nursing home room. He was on the young side, but otherwise, it was the same nursing home "we just saw him alive 5 minutes ago" routine, when clearly he'd been down much longer. It's maybe one of the saddest parts of my job that I've come to expect that kind of utter-incompetency and negligence from nursing homes, but that's what it is. He probably didn't have a chance but we did what we could. The family showed up halfway through, and we tried to have them stand outside but the son, a tall cat in his late 20s who was fasting for Ramadan and had been an EMT for a few years, just stood there shaking his head and saying he'd seen it all before. Family reactions are hardest when the death comes out of the blue, there's no time to brace for the impact and it just seems to sweep people up and knock them over like some angry wind. The son stood there solidly while the patient's wife bawled on his shoulder. I don't like prolonging the uncertainty. As long as we're working on him, all that maybe maybe shit gets drawn out, when really, it's not a maybe maybe situation. So i call, get a time of death and that's that. The son thanked us and then swooped around his mom like a big bird and the true mourning commenced.
Then some lady called us because her back had been hurting for like 18 years and she just couldn't take it anymore.
At six or so that morning, an asthmatic woke up barely able to breathe. He told his brother to call 911, put himself on a treatment and died. We got it as a DIFFBREATHER first, "...unable to speak in full sentences..." (never good) and then as we approached it became a CARDIAC ARREST. The brother had started CPR right away, and the EMTs were doing those real good ribcracking compressions, and the guy was only fifty-something, so everything was basically in place for him to pop back around, but still, he was flatlined, which is the deadest rhythm your heart can possibly be in, and he didn't change in the first 20 minutes of working on him. I did a round of compressions, felt the crunching of breaking ribs beneath my hands, then handed it off to fireman and stepped out the room to call Medical Control.
Passed the guy's ancestor shrine on the way down the hall. I was on hold with telemetry, so I just gave them a nod and mumbled 'go take care your homeboy,' and then the doctor picked up. Laid the presentation out to him, got a few more medications to give and came back in the room. The EMTs are still pumping on his chest. I push the meds, we do some more CPR and then stop to check a pulse.
"Pulse!" the EMT yells. "Strong one!"
Indeed it is - a good solid pounding up his carotid artery. His blood pressure's a healthy 148/72, his heart's a little fast, but that's to be expected considering everything. Okay. now we have to move. People that come back like that can look really really good until all the sudden they're not, and then there's a tiny window when you might be able to get 'em back stable but it's real touchy, and really, they need an ER at this point. So we scoop him up, gather our shit, carefully carefully lift him on the board, because if we dislodge the tube right now it's a wrap, and bustle him off to the ambulance. Downstairs we recheck everything: his heart rate is still good but his pressure's diving. The recently-undead can be so finicky and unpredictable with their blood pressures! It's not low enough to intervene yet, and given said finickiness I tend to be a little tentative about putting major gamechanging medications on board prophylactically, which is what the lieutenant on scene thinks we should do.
So i hold back on the dopamine, and sure enough when we get him in the ER and they take his pressure it's through the roof high, 180/100 or something, and any kind of intervention would've skyrocketed it into guaranteed stroke territory. We give the report, the doctors are always a little wideeyed that such things happen outside of hospitals, and they take over. Before the shift ended we check on him up in the CCU and he was in an induced coma, his body being inundated with cold fluids to preserve the tissue, but he was still alive.