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We get called for a medic alarm. “Eighty-year-old man having a problem with his aneurysm.”

Odd.

Just before we get there we hear the first responder call for backup saying “There is a lot of blood here.”

I make certain to grab a pair of gloves before I enter the house. The door is ajar. I step in and call out hello. I see an elderly woman standing in the living room. “What’s going on?” I ask.

“He’s in here,” she says nonchalantly. “We were at the doctor yesterday.”

I’m looking about for blood but I don’t see any. When I get to the kitchen, I see the first responder standing holding a man up in a chair. The man’s head is leaning forward. He is quite pale.

“What’s going on?” I say again.

“He’s out.”

“He passed out?”

“No, no, he’s out.” I notice the responder has a finger on the man’s neck. “He doesn’t have a pulse.”

“Well, let’s get him on the ground.” I grab the legs and the first responder holds under the shoulders and we lay the man down. It’s then I see the blood. It is coming out of his nose and the corners of his mouth.

“We were at the doctor just yesterday,” the woman says. “He has an aneurysm. The doctor had a hard time getting a pressure yesterday at the office.”

“We’re having a hard time too,” I say. “He isn’t breathing and his heart doesn’t seem to be working.” We already have his shirt off and are starting CPR. I put the monitor on and there is a PEA at 60.

“He uses an inhaler,” the woman says. “Do you want me to look for it?”

“If you could write his name and date of birth on a piece of paper for us, that would be better.”

When I open his mouth to intubate, it is like opening the lid on a bottle of dark fruit punch. Filled to the brim. With each compression, it splashes over. Mixed in with the juice are some thicker chunks.

I don’t know if it is an outer body experience or not, but on calls sometimes its like I’m watching myself and I’m saying “Well, here I am on this call and it has surprise turned out to be a code, and not just a code, but a bloody, nasty one, and this sort of sucks. This may not go well.” I guess it is a mechanism that lets you stay calm outwardly, while your nervous self is removed to a safer seat in the commentator booth.

“I found the inhaler,” the woman says.

“Good. How are you coming on that piece of paper?”

“Right,” she says.

By this time another responder has arrived and I’m telling him to get the stretcher and a board into the house.

I manage to see the epiglottis, but when I lift up with the laryngoscope, I don’t see the chords underneath — just a lot of blood. I hand the tube to my partner and using my right hand, try to apply crick pressure. With one finger I push down like I am playing the flute and the chords come into view. I have my partner put her finger right there and then give me the tube back. I pass it. “Feel it?” I say.

“Yes, I do,” she says.

I look over at the capnography and there is a wave form.

That went well enough.

Blood comes flying back up the tube, but the bagging is easy. I have lung sounds on each side and nothing over the belly. The CO2 filter clogs. I put another on and I still have the wave form and the gook coming up out of the tube is less.

I get an IV and push some epi and we keep doing CPR, but we get no pulses. He is still PEA on the monitor.

“He went out right in my arms,” the woman says. She is back standing in the doorway. “He lost a lot of blood. He has some allergies.”

“The prognosis is very grim right now,” I said. “We are breathing for him and pumping his heart for him.”

“So you are,” she says.

This lady is freaking me out. I have had this happen before — a relative has no idea their family member is basically dead.

We get him onto the board and up onto our stretcher.

“You’ll be taking him to city hospital?” she says.

“No, we’re going to the closest hospital.”

I often stop and have the family members gather around the patient so they can say goodbye before we leave the house.

“You want to say good bye. It might be your last chance.”

“No, I’m coming down to the hospital. I’ll see him there.”

I nod to my crew to head on toward the door, and we go out doing CPR the entire way. More epi, more fluid on the trip in, but no change. At the hospital, they work him for about fifteen minutes and then call it.

When I am turning in my paperwork, I see the woman coming down the hall looking at a hand mirror as she applies powder to her cheeks.

Later the crew fills me in on a few details I missed. The kitchen sink evidently was filled with blood and thick clots. The woman who I thought was the patient’s wife was actually his next door neighbor/friend.

“She was incredibly calm,” my partner says.

“She certainly was.” I’m thinking more that she was just plain clueless. But now, on afterthought, maybe her reaction was her defense mechanism, too. Maybe she did know her friend was dying, and just couldn’t let herself show it. She had to step outside herself. I guess I’ll never know. Just another EMS mystery.

I wonder what she will do tonight? Will she play bridge with friends? Will she rent an old comedy and watch it while eating popcorn? Before bed, when she looks into the mirror at the deep lines in her face, will she wonder how much time she has left? Will she cry into her pillow? Will her sleep be dreamless?

8 Comments

  • Lucian says:

    I know that feeling about having a call turn out to be a code. Where I used to work we didn’t have medical dispatch, so literally you said you needed an ambulance and what for and that was it. We once got dispatched for a ground level fall (thus sending a BLS ambulance) and it turned out to be a code.Yeah, they fell alright, they fell secondary to their heart stopping.Stay safe!LAM

  • Anonymous says:

    I had a code the other day and wondered this. It’s one of the reasons I try to pick up everything and leave as little trash and detritus on scene as possible.We transported the man to the hospital though there was little hope of any meaningful outcome. I told the firefighter doing CPR-the reality is that he’s dead now, and he’s going to be dead in 20 minutes from now. She seemed a little alarmed by this declaration, but understood we still have a duty to perform.As I was writing my report, I pictured what it would be like walking into that house.What would that family see? The spot where their dad had died on the floor, where he vomited during the intubation, where the blood from the IV had dripped, would they see his body there in their mind? Would he be dead? Or does he look alive? He’s never coming home again. That was the last time they’ll ever see their dad at home. Would it be like a crime scene or a memorial? What does it feel like to pick up the little yellow caps that fell onto the floor from the prefilled syringes? Does the family even know what they’re from? Are they angry that I forgot to pick them up? Are they mad because it seemed like I was careless and dirty? Are they understanding that I didn’t mean to be messy? That, in the haste of moving a patient, monitor, cot, oxygen, BVM, and coordinating the actions of 6 people, that things get missed?What’s the like to sleep that house on the first night? Dad’s staying in the hospital until the funeral homes picks him up. But the living, they have clothes to change, showers to take, and beds to lie in. When they walk though that door, can you ever go home again? How many times do you need to pass the threshold of the door before you forget? I know that from time to time, when I clear from the hospital after a cardiac arrest with a clean truck, clean boots, and drive to the next call, I catch myself thinking, “This patient, the guy with foot pain for the past 2 days, he has no idea that someone dead was sitting on that cot 20 minutes before.”The family of course isn’t thinking about that. But on a quiet night, with a sleepy patient, I’ll sit in that captian’s chair and look out the back windows and wonder what kind of unspeakable horrors have played out in this ambulance? But for me, I don’t have think that when I go home.

  • brendan says:

    “We were at the doctor just yesterday,” the woman says. “He has an aneurysm. The doctor had a hard time getting a pressure yesterday at the office.”Further proof that doctors kill more people than guns ever could. Nice job on the tube.

  • Anonymous says:

    We got dispatched BLS cold(which within a short time was upgraded in priority due to a decreased LOC) for bleeding below the knee. Long story short,the pt bled out from a vericose vein in his leg- he was still alive/talking(but quickly fading) in the house but by the time he was in the rig we were doing CPR- His wife was sitting up front in the ambulance calm as could be and asked if she should call his doctor. I told her she could probably hold off on that for now. It was rough, because all the CPR and ALS interventions weren’t going to do a damn thing for him. They worked and then called him after we arrived at the ER…so much for BLS cold..Excellent writing Peter, keep up the great work

  • kvegas911 says:

    Serious denial. I hope the poor woman has a good support system. Went to a routine headache call once. Once was all it took for me to always always always carry all the crap in with me ….. when he arrested on our arrival. Talk about a heart attack. And a HUGE rookie lesson learned in my first year.

  • Stretcher Jockey says:

    I had a strange case of denial like that many years back. An elderly mother and her oldest son living together. The son had a multitude of health problems. She had called 911 because she couldn’t wake him up. He was in full arrest. While we were on the floor of the cramped little bedroom working him, I could see her out of the corner of my eye in the adjoining kitchen washing dishes like nothing was wrong and then she proceeded to make a pot of coffee. When the backup crew arrived and we were packaging her son for transport, she came in holding a tray filled with cups, saucers, spoons, sugar and cream and asked if we wanted any coffee, just as natural as can be – as if we were guests over for an afternoon visit. All I could do was look up at her, speechless. What can you say in a situation like that?

  • Anonymous says:

    Peter,Just curious, but why transport? Why give hope that taking this dead person to the hospital will somehow save them? Eric

  • PC says:

    Thanks for all the comments. I particuarly liked the long comment of anonymous.Eric – the reason we worked her was she has just passed out, was in a narrow complex PEA, and no other significant medical problems. To call her I would have had to contact medical control and wasn’t certain, given the circumstances, that I would have gotten permission to presume. Also, I felt it would be fairly traumatic to leave her there, given the neighbor’s state of mind.The problem with these calls is while they are still freshly dead when you would call to try to presume, by the time you transport and arrive at the hospital twenty minutes later, they are good and dead.

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