Tuesday, April 15, 2008

Tax Day

Fortunately, I did my taxes months ago. My wife and I used our refund money to replace our bed. I think I may have talked about the new bed in a previous posting, but I'm not sure. We bought it from one of the national chains, and we had originally looked into buying a Tempur-Pedic or a Sleep Number bed. But we found a bed we liked by Kingswood out of South Carolina. The mattress has a coil count of over 2000, and the makeup of the mattress includes latex and memory foam in the construction. Without a doubt one of the most comfortable beds I've ever slept on. Including a frame, the total cost was just over $2700.00. I would say it was a good investment.

Yesterday was one of the toughest days I've ever had on the job. We got a call at right around 1430 for a cardiac arrest. Immediately after Fire Alarm dispatched the call, the dispatcher asked us to call them. I did, and I was told that the patient had hanged himself. Once we got that news, we were expecting the worst, and we got it. A 47 year-old male, found hanging on the frame of a platform bed by his wife. In the bedroom of one of his children.

When we arrived, an engine company was already on scene and they had started CPR. The room was maybe 8 X 8, at the most, and there were a total of 6 of us there with the engine company. They had a "no shock advised" warning on their AED, so when we moved the connection from their pads onto our LP-12 we were seeing Asystole on our monitor. No room to work, so they wanted to move him onto a board and get him out. When we went to get him on the board, I got a look at him: cold extremities, purplish face, and the beginnings of lividity on his back. My immediate thought at that point was whether or not to stop the proceedings and call medical control to get an order to terminate efforts, but the crew on the pump was like a stampede of bulls. They wanted to load him and go. I suspect it was because his wife was hysterical that they wanted to make the effort, so we got him out and kept going. We loaded him on the truck and we brought three firefighters with us, two for CPR and one to drive. My partner and I did everything we could and nothing worked: we couldn't intubate him because his neck was broken and his cervical vertebrae kept getting in the way of his airway. He'd been down long enough that we couldn't get IV access, and the working IO I got wouldn't flush or flow after a minute of so - no extravasation, no drainage, nothing that would cause a problem. Just no flow. Therefore, we couldn't push medications.

We got him to the hospital and two of the docs we know were working in the ED. We filled them in on what was happening and we brought him into the Trauma bay. It was there that we were able to get IV access in an EJ and his left AC, he was intubated, and we got some medications on board. All said, I think they maybe worked him for 15 minutes tops as it had been about a half-hour from the time we got called to the time we got him to the hospital.

Now, for the things that bothered me so much. First, the fact that this person basically said "Fuck You" to his family by killing himself in a bedroom that one of his children sleeps in really sent me over the edge. I mean, how could anyone be so callous and selfish? This disturbed me so much that I have no words to describe how I feel. And I suspect it will take me a while to work this out.

Second, I understand that the members of the engine company did what they thought they had to do. However, when does it become unnecessary to look at the patient in a situation like this and determine whether or not he is workable? Really - all of these men are at least trained at the EMT-Basic level. Some are Intermediates or Paramedics. Any one of them should have been able to look at this person and say, "hmmm.... I wonder how long he's been down for?" As it was, there was no definitive time of death, at least at that time, but the signs were all there: the temperature and the color should have been giveaways in this case. Not to mention that he indeed had a clean break to his neck, and that became apparent when we attempted to intubate him. All of those factors should have been clues pointing to a phone call to medical control about termination of efforts.

On the other side of this, the patient's wife was out of her mind. Understandably so; she had found her husband hanging dead in her kid's bedroom, she cut him down, and then she called 911. I have to believe that she didn't want to see him dead, and the firefighters perhaps wanted to deliver some hope to her. But is that going too far and delivering what turned out to be false hope? Personally, I believe that was the case. If I'd been able to get ahead of the pump crew, I would likely have made a concerted effort to spare this man's dignity as much as I could and stop the process. However, under the circumstances there was no way to stop this once it started. Most people I've spoken to have said to me, "but you are the Paramedic, and you had the authority to call it on scene." While that is indeed true, I would have been up against 4 firefighters that were bound and determined to try to resurrect this man from the dead. I likely would have fought a losing battle. And, as I said earlier in this post, trying to stop working this patient would have been like trying to stop a stampede.

After we got him into the ED and efforts were terminated, my partner and I both were interviewed by a police officer whose job it was to investigate whether or not this was indeed a suicide. As we didn't see a note or anything like that (truthfully, I didn't look as I was occupied with other things) it is difficult to know whether or not this was a done deal. But I suspect it was.

I'm still working on trying to process this whole mess. Between my sadness for the man's family and my anger at the engine company, I don't quite know where I truly stand on all of this. I'm sure I'll talk about it more over time, though. Plus I have an appointment with one of the mental health folks I see this coming Thursday, and I'm planning to air this out further then.


Ellie said...

Wow, thats a rough call. You were kind of between a rock and a hardplace given that the FD had already initiated care. You certainly didn't want an argument on your hands.
Psychologically that is a really tough call. I'm glad you've found a place to talk about it. I had similar feelings about that murder/suicide call that we were on together last year.

Anonymous said...

What a horrible situation to have to deal with. I am saddened just thinking about it. I'm glad you are going to speak to a counselor. I think worthy of pondering is the fact that the crew that arrived first although professionals and skilled at dealing with crisis, are humans first. You said there were 4 of them, and emotionally there is a dynamic going on there..almost like a mob phenomenon, reacting to the wife and off each other. You were right not to jump in and let your ego try to correct everyone. Sometimes you have to know when to understand the humanity of the situation, not just the wife but the other rescue folks, and assuming no harm is likely to the patient ot the other rescue members by making the effort, it seems like letting it be might have been the right thing to do. Being right and taking control is an important part of the job. Seems you knew the guy was dead already, and no harm came by the way it went. The wife likely triggered a lot of emotion in the guys, they wanted to do something..I doubt false hope for her was the motivation, they really wanted to make it better for her. At some level they knew they couldn't, maybe the false hope was for themselves...that they could bring him back. Nothing easy in that situation for sure. I'm glad there are people like you willing to walk into those situations..not all of us are capable of such heroics. The cost is great emotionally. I'm glad you work hard to maintain the ability to continue on.

manchmedic said...

Your point about humanity being a factor in the pump crew working this particular patient is a really good one. I had thought of that after I wrote the post, and I had to take a step back from my anger. I'm doing a little better with all of this today, but I'm still working it out.

Thank you for your kind words, by the way. I am no hero - I just do my job the best way I can, a day at a time.

Ellie, I remember that double stabbing really well and how bad a situation that was. I think everyone involved had a hard time dealing with that one from any of the agencies that were there. I hope you got some reinforcement of your own afterward.