Faces of Life and Death

Earlier this week I did a cardiac arrest at a nursing home. I arrived to find an elderly patient apniec and pulseless. The patient was quite large and had a lifeless face with a small amount of facial hair that made it difficult to ascertain gender. The nursing home staff had last seen her (she was a woman, they confirmed) alive an hour before. I put her on the monitor and she was asystole. We resumed CPR. I intubated her, while my partner put in an IV. We gave her four epis and two atropines. Still asystole, we presumed her dead after 20 minutes of ACLS per our protocol. We detached her from our monitor, removed the ET tube and IV line, covered her with a sheet and cleaned up the assorted medical wrappers that were laying about. On the way back to the ambulance, the nurse handed me a W10, which I could use to write up my paperwork back at the base.

After we’d restocked and cleaned our gear, I called dispatch for times and then sat down to write my form. I pulled the W-10 out of my pocket and looked at the patient’s name.

I was shocked. She was someone I knew. I had in fact transported her to the hospital on many occasions and often saw her sitting in the hallway in her wheelchair. We always said hello to each other as I wheeled my stretcher past. She had a big, mischievous smile and often cracked jokes. I was startled that I hadn’t recognized her.

Cardiac arrests I find are relatively easy to work from an emotional standpoint because the patient is simply dead. More than dead — they are lifeless without a personality. It is much harder when your patient codes in front of you(you have after all just been talking to them), and it is certainly much harder if you have known the patient a long time.

During the arrest, I wasn’t working on “Hilda.” I was working on the corpse of a stranger. Not that I didn’t do my best. It just wasn’t very emotionally involving. After 20 minutes, I announced my intention to presume the patient unless there were objections. Hearing none, I called the time. Not at all like the TV codes or even real-life codes where the medical staff is working on a loved patient and while the tearful doctor or nurse won’t stop CPR, another doctor puts his hand on their shoulder and says, “She’s gone. She’s gone. You have to let her go.”

I thought about all of this this morning as I came across the following on the internet. It is an art exhibit of black and white portraits of hospice patients, before and after their deaths.

Life Before Death

6 Comments

  • Extranjero says:

    Great post. As an ER tech I often have to package the bodies and take them to the morgue. It’s especially hard if the patient came in alert and within an hour I am staring at their blank face. This is pretty rare though.

  • uphilldowndale says:

    Haunting photographs aren’t they I saw them in the paper and I felt drawn to go back and look again on the ‘net. I’d say a lot more on this poignant post, but not ‘out here’

  • brendan says:

    Interesting that you pull the tube and IV. Here, we don’t terminate arrests in the field. But if we begin to work an arrest and sometime after are presented with a valid, we can stop but we have to leave anything we did- pads, tube, IV, everything.

  • Witness says:

    I, too, find it interesting that you pull the tube and the IV. Around here, you have to leave them in so they can be confirmed during the autopsy- otherwise, you can’t prove you didn’t intubate into the esophagus. Instead, we disconnect the drip set from the well, and cut off the tube down to the mouth line.

  • PC says:

    Thanks for the comments.Our discontinuation protocol reads “Tubes and Iv lines may be removed if patient is being transported to or by a funeral home. If the patient is deemed a medical examiner’s case. leave tubes and lines in place.”Most patients that will end up being medical examiner’s cases usually fall in the transport category. We rarely, if ever, work and discontinue a trauma.Our tubes are documented for the record by capnography print outs, both wave form and trend summary.

  • FireResQGuru says:

    Very moving post. I was a bit surprised as well to see that you pull the tubes, but your explination of your local protocols make a great deal of sense. Too bad not all medical directors are that way.

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