Posted by: medicblog999 | January 28, 2010

Saving a Life and the questions that brings

ii_defibrillator

Maybe Mrs 999 is right! Maybe all of this recent ‘deep and meaningful’ stuff I have been writing about has been me suddenly becoming aware of a need to delve into thoughts and feelings that I have neglected for a while.

It seems that I am finding myself in various situations that are lending themselves to me questioning so much. But then maybe that is just me anyway?

It’s fairly obvious from this blog that I have a very reflective and thoughtful mind. I always think about things far more than I guess is necessary or sometimes even healthy!

But yet another thing has me questioning just why things happen…..

What makes a 43 year old woman wake up in the middle of the night and decide to call an ambulance when all she has is a very slight niggle in her chest. If she knows anything from recent media pushes regarding chest pain, she will know that her pain is not typical of a ‘scary’ heart attack pain.

Julie lives alone and has never called on the ambulance service before now.

As I get there, she is all full of apologies that she called the ambulance out:

“I would never dream about calling you out, but you just can’t be too careful. I wouldn’t normally do this! If I wasn’t on my own I would have just waiting until the morning and called my doctor”

After reassuring her, I continue my assessment which turns up nothing too concerning. Her 12 lead ECG is grossly normal with some very slight depression (and I mean slight, you have to really look to see it) in her anterior leads. Certainly nothing to hint toward a significant  Acute Coronary Syndrome.

All of her other observations are within normal limits, but this niggle remains. 2 sprays of GTN later and she is now pain free.

Since this is her first episode of pain and since the GTN relieved it, a trip to the A&E was advised which was eventually accepted.

We had a lovely chat in the back of the ambulance, she remained feeling well, good colour, no diaphoresis, and no further pain……….Then BANG…….VF arrest!

  • A quick pre-cordial thump…….

No Response………

  • Out with the Tough Cuts……
  • A shout through to my mate driving

“TOM! STOP AND JUMP IN THE BACK, SHE`S ARRESSTED!”

“You  WHAT???”

  • Cut through the blouse and bra…..
  • Saftey checks:  No Jewelery, No Transdermal Patches, No internal defibs or pacemakers – Pads On.
  • Charging to 200J…….
  • “STAND CLEAR!”

One Shock……………Wait…………….

  • Asystole………………….

“Come on Julie” (Yes, I am ashamed that I did actually say it!)

  • Profound Bradycardia………………

“Come on, a little faster!”

  • Idioventricular Rhythm kicks in, PVC`s every where……………..
  • SVT……………………..

“Oh, dont be doing that!”

Then……………

  • Sinus Rhythm!!!

A gentle shake of the shoulders…..”Julie?”

“Oh, sorry….Did I fall asleep? I feel really tired”

All in the space of less than 2 minutes!!

She isnt out of the woods yet. Her colour drains and the sweat starts to come, quickly followed by the nausea and the vomiting. The monitor keeps showing me the reassuring sight of a regular and normal heart rhythm, although that doesnt reassure me that it isnt going to happen again. There was no way in hell that I would have thought that she was going to arrest, yet she did!

“Right Tom, Champion! Good Job, lets go….Quick and smooth”

As we pull away, I am about to put a pre alert into the hospital when I realise that Julie is about to hear everything that has just happened…

“Julie, Im going to tell you what has just happened, because you are going to hear it all soon anyway, and I want you to know before you hear me telling the doctors okay?”

“Yes, of course”

“You didnt fall asleep….. Your heart stopped and you needed an electric shock to your chest to get it working again. You seem to be doing fine at the minute though ok? Im going to keep a very close eye on you for the trip up to hospital and there will be some doctors and nurses waiting for you when you get there”

” Really? My heart stopped? Did I die?”

“No, you didnt die, but if you hadnt called for us when you did, you would have been in a lot of trouble and you may well have died. You did good tonight Julie”

“Well……..Thank you!”

“Its no problem Julie, Im just glad you are okay”

We arrived at A&E 8 minutes later, to find the team ready and waiting. I gave a quick handover then went to fill out my patient report form in the doctors area. I got plenty of ‘great job’, and ‘Well done’ comments, but really, it was more to do with right place at the right time. But that didnt stop me feeling like I had just won the lottery.

I was buzzing.

I was ecstatic.

If you arent in EMS, you wont realise just how rare this is. This is only the fifth time that this has happened in the last 10 years for me, but I know the feeling will last for quite some time. Its one of the reasons that we do what we do, and its one of the reasons why I love what I do.

It may not be ‘cool’ to say it, but I do truly love what I do. I was in a privaledged position that night. It was my turn to make a difference, and I will cherish those times whenever they come around.

Julie is still alive, still neurologically intact, still has a normal heart function and left ventricle because I was there at the right place and the right time………

Tom and I clean up the ambulance and restock. We are RTB`d (returned to base), and it is now that the questions start to come.

What made her call us for her initial symptoms? They were not especially worrying at the time, and she wouldnt normally think of ringing an ambulance?

What if it had been a busier night and we had not been on station and the nearest crew didnt get there in time?

What if she hadnt woke up in the middle of the night?

What was it that alligned the stars, or intervened to make this lady not die that night?

Or was it just coincidence again??

I have so many questions my head hurts!

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Responses

  1. Wow. Just… wow.Wish I had answers for some of those deep questions. All I can think is good for Julie for not second-guessing herself in the night, and good on you for using your brain and your training to do the right thing at the right time.My hubby is a medic, and happened to be in the right section of Walmart the other day. (Off-duty, shopping.) He thinks the guy will make it, too, but once again, right time right place. (BOO to Wallyworld for no AED, though!) He was flying high afterward, too! He called me afterward, and I said “That's amazing! You saved his life!!” Him, deadpan, “It's what we do.” 🙂 But I know he was flying.

  2. Good on ya mate! Mark, I don't have any insights to add to your questions either, but I can say that I have asked them of myself also and all it does is make my head hurt. I have resolved that it really doesn't matter much in the grand scheme (except to that patient). What matters is that I was there and did my best. I do get the mile high feeling for a few hours, but it is tempered by the recollection of those I have worked on with a poor outcome. We need to 'win one' once in a while and when we have a long tough streak it only serves to bring us down. SO good on ya and ride the wave for a while! Another medic might have blown the old gal off as overly concerned about spicy food and told her to see a Doctor the following day. THAT is the difference between a Medic and a GOOD Medic.Capt. Tom

  3. A W E S O M E.Seen it once myself, much thrashing ensued, and a youngish man lived to tell the tale…and the weird queer buzz lasted a while as we digested what happened. And DON'T use the word hero around me please. Right place, right time, really; not counting [or imagining] all the times it doesn't work out like for your patient.

  4. A medic friend of mine once told me a similar story about a middle aged man who went into VF arrest while he was talking with him about the new roof he had installed on his house. On go the pads, he gets shocked once and wakes up like he hadn't missed a beat and continues his story about shingles without the slightest clue what had just happened.

  5. Well done, that man! Sorry to make your head hurt more, Mark, but can I throw in another few Big Questions? What if God wanted Julie to be saved and wanted you to make that save and if God didn't want you to save the ones you didn't save? What difference would that make – would you feel better or worse? How would it affect the rest of your life?Keep thinking – that's why you're EMS Blog of the Year!

  6. Good job. In 23 years in the emergency services, I've had one person survive me giving him CPR. And that happened when I was 18, before I started. It was a witnessed arrest, and I jumped right on him.The hard part is that you're going to look over that call, and everything related to it, and mull it over, looking for clues, for years.Lt James RosseSouth Schodack Fire

  7. Good job. In 23 years in the emergency services, I've had one person survive me giving him CPR. And that happened when I was 18, before I started. It was a witnessed arrest, and I jumped right on him.The hard part is that you're going to look over that call, and everything related to it, and mull it over, looking for clues, for years.Lt James RosseSouth Schodack Fire

  8. :O

  9. :O

  10. Situations like this sure do give one a lift, don't they?I'm not immune to the lift myself. I've had a similar situation happen to me once and one time only in the last ten years. I had a patient with no real complaint go in to pulseless V-Tach two feet away from me. He was fine and without complaint one minute, so I went to sit in the captain's chair to give my radio report to the hospital, and when I returned to the bench the patient was purple, seizing, and in v-tach. 100joules later he was fully awake and continued the conversation like nothing had happened. I, on the other hand, had “become concerned”. Luckily I had started an IV and had him on the EKG based on a high index of suspicion… if I'd tried to skate on it and deferred treatment because of his vague complaints, I wouldn't have been right there and ready to get him back as soon as I had. Who knows if it would have made a difference, but the story has become very useful to tell to students who try to get lazy.Good job, mate. See you soon in San Fran

  11. Hi Mark:Great story, the very thing *I* live for as a medic … especially since it is so rare.Cannot answer your big picture questions. I have attended incidents when there seems to be Divine Guidance or an unseen hand present. I know when a person says “I think I am going to die” to take it completely seriously, regardless of the clinical presentation. I remain haunted by an off-duty rescue of motorcyclist who was run over by a car. Still under the car when I ran up. Bystanders lifted the car using a gas station floor jack. I slid the patient out.Not breathing, distended neck veins, priapism and other signs of traumatic asphyxia. Deep burn of thigh from automobile exhaust pipe. I hear no fire/rescue sirens. A police officer walks up and whispers to me, “Don't know if it makes a difference, but this is Sergeant xxxxxx.”I have the police officer hold the neck while I remove the full faceshield helmet. One of the best helmets available, the outer shell has been cracked open.Should I do naked mouth-to-mouth? As the helmet clears the face, the patient takes a deep sigh and starts to breath.I sigh as well. I finally hear a rising cacophony of a screaming Federal 2QB, stuttering air-horns and a yelping Powercall siren. EMS on scene time was under five minutes. That was one of the most severely injured patients I have treated. I thought for sure that he would not last 24 hours. Twelve weeks later I am telling him about what happened on scene. He is able to continue to work in an administrative position. Some loss of function. I *KNOW* that I had help that day. I am glad a random turn put me on the scene first.

  12. […] of one of the scarier pieces of EMS equipment. (Spoiler: It’s a bedpan) And Medic999’s story about saving a life and the questions it brings. Let’s not forget about Gomerville and the first anniversary edition of The Handover Blog […]

  13. I try to never question this, anymore, and I never “follow up”… It will make you nuts! I had a 23 year old heroin addict ask me “why the hell would you want to save me…I'm a heroin addict with aids..?” I actually was apologetic, explaining it was my job…she died of an overdose two weeks later. The big questioning problem I had was with a 24 year old…we worked so hard … we saved her…she was now a quadriplegic. I often would think 'would I want to live that way'… 'would I want to be saved?' I never followed up after that…

  14. I try to never question this, anymore, and I never “follow up”… It will make you nuts! I had a 23 year old heroin addict ask me “why the hell would you want to save me…I'm a heroin addict with aids..?” I actually was apologetic, explaining it was my job…she died of an overdose two weeks later. The big questioning problem I had was with a 24 year old…we worked so hard … we saved her…she was now a quadriplegic. I often would think 'would I want to live that way'… 'would I want to be saved?' I never followed up after that…


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