It was Christmas season, only a few days before. Actually, it was in the middle of Hanukkah, which is pertinent, given the Star of David around his neck.
It was late evening, when most normal people are winding down, in bed, perhaps with a snack, or watching some late news. The address was for a fairly nice neighborhood, full of upper-middle class homes, and successful people. For a man "not feeling well."
Cupcake and I arrived only a few minutes behind the first-in Engine and Rescue units. We took our stretcher and first-in bag with us into the well-appointed home, and were directed through a
kitchen, full of pictures of children and what appeared to be a new grandchild.
As I rounded the corner, Elrod and I made eye contact, and I saw the distinct look of fear in his eyes. The look that says "this guy is sick something bad." Elrod is a career paramedic, with 20 years under his belt. He has seen some sick people before. His eyes tell me enough. Elrod is starting a line while Tim is hooking up the monitor and Kevin puts a nonrebreather on him. I look at the wife. "What's going on?"
"He hasn't felt good for a few days. He just took the trash out, and came in and said he couldn't breathe."
"No, he doesn't take any medications."
I get a glimpse of the patient in the dim light, with the glow of Fox News in the background. He looks terrible. Like, as my father would say, "death eatin' a cracker." His skin is grey. An amalgamation of pale, cyanotic, diaphoretic and dusky.
"Forget the line, Elrod. Let's get him on the stretcher."
Cupcake and I are out of the house with the patient within 4 minutes of walking in. She asks if I want a rider to the hospital, which is 10 minutes away. 6 minutes with her heavy foot.
"I want to leave. If there is a rider in the back with me when you get up front, so be it. Otherwise, lets get the hell out of here."
No rider.
O2 saturation is 88% with 15 liters going. I get a blood pressure that is terrible. 82/50. His carotid is incredibly fast and weak. The monitor is counting out 140. A minute later I have two 16 gauge lines going. I don't know how I found those veins, but I did. His skin still looks terrible.
I'm throwing the 12-lead on as fast as I possibly can.
"I can't breathe."
"I know, buddy. I can breathe for you if you would like, so you can try and relax."
"Okay."
I drop an NPA in and start bagging him. "Data quality prohibits interpretation" says the monitor. Shit. I don't need a crappy algorithm to tell me this guy had a massive MI over the past few days. B/P cycles again: 73/49.
Cupcake tells me we are 2 minutes away from the hospital. That's two minutes too long. He should have been there 2 days ago.
We unload him from the truck. "I'm about to die."
Cupcake says "no you aren't, there are really good doctors in here, and they are going to take great care of you."
We walk with incredible alacrity into the ER, and the receiving doc sees my NPA, and shows us to a room close by. "Let's get RSI."
"I'm going to put you to sleep and put a tube in your throat so we can breathe for you."
"Okay."
The drugs are in, and the tube follows quickly. As does the noises from the monitor. V-tach. "He have a pulse?" "No." "Start CPR."
Normally, I am out of the room at this point, so the more educated people can do their jobs. Usually, I am just in the way. Not this time. I'm right there. I haven't had time to leave yet, and the crash cart is blocking my exit. I start compressions, pushing hard and fast on this man that was talking to me just moments ago.
Epi is in. Charge. Shock. Asystole.
More compressions. Something catches my eye at the door to the room. It's Cupcake, and she has turned her head. I hear a vaguely familiar, polite voice: "Is he doing better?..." as I see his wife come around the curtain.
We make eye contact and she sees me doing chest compressions on her husband of 30 years.
What followed was the most terrible, shrill, eardrum piercing sound I have ever heard. The sound that all of my fellow EMSers have heard, and dread hearing again. It's the sound that still, to this day, awakens me occasionally from a still sleep.
The next few minutes were a blur. More drugs are pushed, more joules are administered, all with no effect. The wife has since come into the room, and is sitting on a chair next to her husband, talking to him, as I continue to compress his heart, and respiratory continues to inflate his lungs.
"You can't go now, you need to come back. You can't leave me."
"It's okay if you need to go, honey. I understand. You are a wonderful husband."
I can't believe I am seeing these stages of grief happen in front of me. She looks at the doctor.
"I think he's gone. He's not coming back."
Doctor and I make eye contact, and he gives me an almost imperceptible nod. I stop, and walk out the room, then I hear the wife again.
"Wait."
I turn around, and she looks through my eyes, hers full of tears, and mine full of failure.
"You did a great job. I know you took good care of Danny, and you did everything you could. Make sure you go home and hug your wife real good, and kiss that sweet boy of yours."
How on earth did she know I was married, with a young child? Oh, damn, his 3 month picture is on my nametag.
She hugged me hard. For what seemed like an eternity, and I returned to my ambulance with her tears soaking my shirt, and a few of mine on my cheeks.
3 days later I read his obituary. He was a lawyer. His office was only blocks from mine. He was an avid tennis player, and a father of 3, with a baby granddaughter.
I wish he would have called earlier.
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