The Door

When I am in the rapid response paramedic fly car, I usually always arrive on scene, before the fire department, before the police, before the ambulance. (Unless, I am requested to stage for a violent psych or an assault if the assailant is still believed to be on scene).

I carry with me my paramedic house bag, my heart monitor, oxygen tank, and PPE bag.  I try to be mindful and always get my PPE on.

The call is for unresponsive with precautions.  “With precautions” is code for patient either has COVID or screens in as a possible COVID.

I stand now outside apartment 7J.  The door is closed and I can hear no sound from within. In the pre-COVID days, I would knock, and then if it is unlocked, open the door and say “Ambulance.”  Now before knocking, I set all my gear down in the hallway.  I open my PPE bag.  I take out a yellow infection gown.  I pretie the neck loops, drape it over my head, and then twisting to the side and trying to make myself thin, I tie the waist strings (some brands have plenty of string, but these the strings are too short to easily tie behind my back by myself.)  I take out an N95 mask, put that on.  Put my surgical mask over it.  Grab a face shield and apply that.  This may only take a minute, but it seems like an eternity.  I put on my gloves, pick up all my gear, knock on the door, open it and say “Ambulance.”

The hard part comes when the door is wide open when you arrive.  Even harder is when you pull in to the curb, and as you get out of the vehicle and go around to the back and lift the hatchback to get your gear and a young woman is standing there crying, shouting, “Please hurry! Please hurry!”  You throw the house bag over your shoulder, grab the monitor in one hand and the O2 tank and infection control bag in the other and follow her in through the front door, down the hall, up three flights of stairs,  and because she is only twenty and you are sixty two and are carrying heavy gear, she turns and waits for you begging you  “Please hurry!”  Down the hall and the door is open and her grandmother is lying motionless on the floor, and you are supposed to stop and take a minute and put all your PPE on  before getting near the patient, and the granddaughter does not understand why you are not moving quicker.  Please!

These are the choices that we have to make sometimes.  A doctor friend of mine said in a pandemic, you have to always put your PPE on – no exceptions.  In cases like this, I find that harder to do.  We are taught in cardiac arrest, every second counts.  It’s been at least four minutes since the 911 call was made.  If she has been without oxygen that long, she is already falling off the precipice of the living world, heading down into the void.

Apply the pads or put on your PPE?

It is an easy choice when the door is closed and you don’t know what is behind it, but when a person is dying in front of you, it is not so simple.