Letter #27: To The Man Whose Life I Couldn’t Save

To the Man Whose Life I Couldn’t Save,

You were my first cardiac call. I was new, fresh out of 4 months of EMT training, and you were my first cardiac call. Until you, it was a few broken bones, some colds, and a lot of elderly patients. But you were young or at least young looking…maybe in your 40’s. I don’t remember your name, or the color of your hair, and your eyes were closed when we reached your house. You had grey sweat pants on, and a tank top, but I don’t remember if you had shoes on. I don’t think you did. 

I was lying in bed half-asleep when the call came over my radio. I was already half-dressed in my uniform, having already been out on call earlier in the night when your 911 page came through. I was already yanking on my boots as the dispatcher announced the information and I remember pausing when she announced the severity and the cause. My hands started to shake as my heart pounded. A cardiac call…male…police on scene… The next few seconds were a blur as I sprinted through my house, my mom yelling at me to be careful. I remember bypassing the stairs, just jumping into my driveway and throwing myself into my car. I brag now, about how fast I got up the mountain. It takes maybe 10 minutes with the speed limit…I got there in 7. I beat my captain to the rig and he lives down the street, but there was no bragging that night, just the pounding of my heart and screeching of my wheels that fought to maintain grip on the road.

As I drove through the bends of the mountain, I kept repeating the information drilled into my brain during class. We have the golden hour, from the time the 911 call is received to the EMT squad getting the patient to the hospital; we have 1 hour. But that hour can be cut short in certain instances…especially when babies/children are involved…and cardiac calls. 2 minutes…if someone drops in front of you, the first 2 minutes are the most important minutes. They decide whether or not someone has the chance to be revived. Many people do get past those 2 minutes, even if they go down without anyone around, but those 2 minutes are the most important. I got to the rig in 7 minutes from receiving the call, and we left the building 9 minutes after, the doors still open from us running into the rig as it was pulling out. All that kept going through my head were those 2 minutes.

There were 4 of us in the rig. My captain, my training officer, myself, and another probationary EMT, and although it might be comforting to many people who call 911 to have that many EMTs show up, it just made me more nervous. My training officer was watching me closely as I kept taking steadying breaths. It was my first major emergency, and I knew that everyone would be watching me closely, but I was feeling confident, even though my hands were shaking. I went through my routine: Jump bag…check…Oxygen tank…check…gloves…check…stethoscope…check…pen and paper…check…deep breath…check. It felt like an hour before we pulled up to the house we were called too…when in reality it was 13 minutes after receiving the 911 call. 13 minutes before I was lying in bed. There was snow on the ground and awkward footing and too many voices going at once. I remember hauling the jump bag and the AED from the rig as the others grabbed the stretcher and a backboard. Down a hill covered in snow and ice, towards the terrified woman standing in the doorway illuminated by the emergency lights of the cop cars and the ambulance. The lights danced across her as she told us where to go, her voice shaking and tears running down her face. I squeezed past her into a small foyer, and a slightly larger living room. Well, maybe it was bigger, but you were on the floor, surrounded by two cops that were already trying to shock your heart back into a rhythm. The room felt too small.

I froze as my team pushed past me, the cops barking out the steps they already took. April, the other probationary officer, immediately started chest compressions while my captain was at your head. We needed to open your airway, so CPR would be more efficient…an OPA was needed. At some point the jump bag had made it from my shoulder to the ground. I think I put it there. April was yelling for an OPA. It’s a curved plastic thing that prevents your tongue from blocking your airway. OPA…”Faith I need that OPA”. It felt like hours, but the demand for it lasted 15 seconds, and before I knew it purple covered gloves were ripping through my bag, and a quick shout gave the correct size for the OPA. It took me a second to realize the purple gloved hands were mine. I tore my gloves on the zipper, cold-reddened skin peaking through the wasted gloves. I tore them off as someone shouted for the backboard, and the reddish-orange board flew passed my head and my eyes met my captains’. He was saying something to me, pulling my training out of me. Grab the legs, turn on his count, am I ready?

I wrapped my hands around your legs in-sync with my captain…I knew this; I could do this…until I felt your skin. My head shot back up and I felt the panic seep straight through the confidence my captain had tried to draw back out of me. You were cold. Not in the, I’ve been outside shoveling snow, kind of cold. This kind of cold I can barely describe. There was nothing beneath my bare hands…no hum of blood moving through veins, or rippling of muscles. You were cold, and I felt my own heart clench as it skipped a beat. 1, 2, 3, roll. Our backboard didn’t have a place to set the head-blocks, so we had to tape them around you as we hoisted you onto the stretcher that hadn’t been opened up yet, so it sat around my calf. It was low…it wouldn’t budge…we didn’t have time to fight it. You were about 150lbs…the stretcher a few hundred as well, and all I kept thinking was don’t tip you. I couldn’t tip you; I had to get you to the rig. Get you inside…get you warm. The paramedics were en-route; we needed someone to administer medication to help your body to survive. We aren’t allowed to do those things, we were just the basic responders, the ones that make sure you stay alive, but you were cold and I was scared.

My foot kept slipping as we worked our way up the hill and into the rig, and I kept thinking that I needed to get better boots. Boots with a decent tread…it would cost some money, but it would be worth it. Maybe 2 weeks of saving would give me enough; it would be worth the investment. It took 6 of us to hoist you into the rig, damn stretcher, and the paramedic ran out of his still moving transport and hopped into the rig. April and Joanne, my training officer, were calling out the CPR rhythms as the paramedic inserted a tube down your throat as I kept your head stable. I cursed the blocks as they kept slipping from place, but we got the tube in and attached the bag to the tube. 1 and 2 and 3 and 4 and 5 squeeze, 1 and 2 and 3 and 4 and 5 squeeze. We were supposed to rotate the CPR, so no one person got tired. But those damn blocks kept moving, so as we tore down the bumpy roads of a New York mountain chain, I clamped my knees around your head, holding your airway open with my knees as my hands worked the bag pumping oxygen into your lungs. I couldn’t move, I couldn’t…I had to keep your airway open. The cold of your skin seeped through the rough material of my uniform, but I had to keep rhythm…I had to keep rhythm…1 and 2 and 3 and 4 and 5 squeeze…1 and 2 and 3…

You were cold.

We were told, in class that we don’t stop until we are told to by the doctor or someone of authority. We don’t stop, not for experience, but so we can tell the family we did everything that we could do to save the person. We don’t tell the family anything, we let the docs handle that, but we don’t stop. Your family had beaten us to the hospital, but they were able to take the back roads that were too unsafe for the rig to get down. I saw the woman, who was standing in your doorway when we first arrived, through the glass of the rig as she clutched at her chest; her eyes meeting mine through the window. The paramedic was talking to us, preparing us for what to do when those doors opened. We all knew it was over, but my hands still pumped air into your lungs automatically. 1 and 2 and 3 and 4 and 5 squeeze…The woman was scared. So was I, but I wasn’t allowed to be, wasn’t allowed to show it, despite the desire to throw up and cry in frustration. My hand was cramping from squeezing the bag for so long. It was 45 minutes after the call came in; we were still in the golden hour. I looked down to your face, your head still clamped between my knees. You were pale, your eyes were closed, and I can’t remember what your hair color was…brown maybe? I don’t remember your features all that well, just that you were pale. I couldn’t even remember your name in that moment. I just watched your chest rise with each squeeze, and felt your skin grow even colder.

The doors at the back of the rig flew open and we were moving again, a blue gloved hand replacing mine on the bag as the doctors and nurses took over. I stepped into the familiar territory of the Emergency Room. I had been to the ER of this hospital many times, both as a patient and an EMT. Familiar faces of nurses and other staff rushed around us as all eyes were trained on you as doctors yelled out some orders and hooked you to monitors. More CPR, more eyes to the screens…and the floor was silent. Tears streamed down faces as everyone waited. I felt Joanne and April next to me as we stood in the middle of the floor, and waited.

I grew up watching shows like ER. Actually, it was one of my favorite shows, and I remember the scenes were the doctors are over the patient, paddles in hand, looking at the monitor as the patient slips into asystole. It’s that flat line on the monitors…no cardiac activity. The monitor gives off a long beeping noise, and the doctors always sigh heavily, the weight of another death on their shoulders as they call the time of death. In the movies, it’s always a flurry of activity and then straight to silence as everyone walks away and someone goes to tell the family, eyes always finding their way to the patient one last time. Reality is a cold, harsh reminder of the fantasies of movies and TV.

I couldn’t look away from the monitor as the line spiked with each chest compression, only to go flat again. You were surrounded by medics and doctors, but they were all still. No one called for a crash cart, and no one was yelling for another dose of epi, or to charge to 300. The doctors stopped compressions, looking at the flat line, and pulled off their gloves, and called out your time of death. Everyone moved away from the room you were in, a woman saying she would notify the family, and then it was over. I stood there, looking at you. No one pulled a sheet over your head, or offered comforting words to one another; they just moved away from you. Joanne squeezed my shoulder as I looked at you, and started to lead me away when we heard her, the woman in the doorway.

They don’t prepare you, you know…for what grief sounds like. I’ve buried enough people in my life to hear the sobbing of loss, but not like this. I don’t think I will ever forget that sound, that moment, it silenced everyone; it hung heavily in the air. I felt like I had been shot when the sound reached my ears, and Joanne’s grip on my shoulder grew tighter, urging me to move. We still had work to do, paperwork to fill out, and the stretcher to breakdown. We might get another call; we had to prepare.

Everyone kept asking me if I was okay. I was green, new; it was my first cardiac case. I brushed them off because death wasn’t new to me, even if I couldn’t get the woman’s pleading “no” out of my head. Joanne started to joke around with me, pulling on my sardonic nature and love of irony. I knew what she was doing, trying to pull me back out of the call, the situation. Make it funny, inject humor into it…we have to. We have to find the funny amongst the death or we’d go insane. She knew this, so jokes were cracked. “Hey it’s kind of dead in here, let’s go” and “Don’t be dead to the world” were slung about, followed by tight chuckles over paperwork. The nurses gave us death glares, no pun, for our insensitivity, but it did little to chastise us. We couldn’t let it, couldn’t let them drag us back down to the issue…the situation…you.

I had to walk away from you; the last hour of your life was held in my hands; I had to walk away. I had held you steady, pumped oxygen into your body, fought for your life in the back of a speeding ambulance, and I suddenly had to walk away. So I joked…I desensitized, and rolled my eyes at the nurses that touched you for 2 minutes. When we finally left the ER it was 2 hours after your call came in. Someone had finally put a sheet over your body, and I turned away from your room, and walked back out of the hospital and into the back of my rig. We were quiet on the ride back, save for a few questions on what we needed to do after we got back to the squad house, and if I was okay to drive. It was 5:30 in the morning; I guess I forgot to mention that. It was really early, and I was suddenly exhausted beyond measure. April was up front, while Joanne and I stretched out in the back of the rig. I was playing with my phone, debating if I wanted to call my ex or not. I was told to go home, get some rest…but I couldn’t. I didn’t want to face the questioning faces of my family, so I called my ex-fiancé. Her roommate answered, someone I couldn’t stand, but after a few beats I heard her voice over the phone and it was all I could do to not cry.

I told her I had a bad call and I needed to crash with her for a few hours so I didn’t kill myself driving home. In reality, I just needed her to hold me, and tell me that I didn’t kill you. That I did everything I could do to help and that freezing up didn’t make me a bad EMT. As I bid my goodbyes to my team, and nodded to my captain’s “good job kiddo,” I replayed the entire night in my head. I was in bed, the tones, driving, the woman in the doorway, counting out your breaths, the scream.

My ex lives down the street from my squad house you know? I sometimes crash there if I get the feeling it will be a busy night. Before I knew it she was holding me in her doorway, asking me if I was okay in her husky half-asleep voice that always made waking up to her worth everything in the world. She was warm, and soft, and I remember trembling in her arms a bit as she just held me. Ignoring her roommate she pulled me into her room and into her bed, my gear in a pile next to her bed as I stripped out of my uniform. I whispered to her what happened, leaving out specific details that I can’t remember now. Like your name…I wish I could remember your name, and she held me…allowing my ear to press into her chest. I fell asleep listening to her heart beat, and feeling the warmth of her skin.

You were loved you know? The woman in the doorway cried for you, mourned you. When I woke up a few hours later I let my eyes fall to the woman next to me. Did you know that I love her? We may not be together anymore; hell we haven’t been together for years…it seems trivial now, but I love her. I watched her sleep, and I wondered who would cry for me, if I died suddenly; my friends, my family…but would someone scream like that…would she? I’ve been in love with her since I was 16…But you were loved; I just wanted you to know that.

I lost a few more people after you; mostly elderly patients or cancer patients. I laughed, I made jokes, and I appreciated warmth and heartbeats a little bit more; however, I never forgot about you, or that night. I studied more, pushed myself a little harder, and took risks, but I still freeze whenever that night echoes through my mind. I still cringe at the sound of anguished screams, even though the movies will never be able to get it right. I became an EMT to help people, to save people, and you were the first person I couldn’t save. It’s mind-numbing, death I mean, because no matter how far we advance in medicine, or science, no matter how much we practice, eventually we lose. I don’t know who you were in your life. I just know that you were loved, and I’m sorry I couldn’t save you. I’m sorry. I hope you know that I tried. I’m sorry.

-Faith

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