Friday, 1 February 2013

Death Becomes Her


“51 year old female, collapsed in street, ? unconscious O/S”

Remember me banging on about presumption?! Well, this is the kind of job where the jilted cynic in me says that it will be a load of tosh. It’s where I decide or suspect before we arrive on scene that alcohol will be involved. The fact that the call was made by a passer-by immediately makes me suspect they haven’t checked the patient and instead call 999 and walked off. This job would be a simple walk-on, walk-off kind off job. Let’s be honest, i’m usually right! Maybe repeated success can lead to complacency, I don’t know. As bad a habit as it is, doing the job we do and seeing the stuff we do I think it’s impossible not to pre-judge based on information given. People’s behavior and thought processes are based on experiences. That’s what makes us who we are. All I can say in my defense, is despite any pre-assumptions that I have made I approach every job in the same way. I still take all the bags with me and until my suspicions are confirmed I remain open to any outcome. This is why!

Having raced through the busy streets, jumping red rights, driving on the wrong side of the road and under taking down a bus lane we pulled up on scene 7 minutes and 52 seconds after the call begun. The clock is stopped, everyone take a bow, this job is a resounding success. Lying on the pavement about 6 feet from us was our patient. She was conscious and surrounded by 5 or 6 people; the same 5-6 people who had frantically waved en masse as we pulled into the road! I’ve mentioned before that people who are really ill, look ill and people who think they are really ill but are not, don’t! Well, despite my previous presumptions I was wrong. She was sober, well dressed and looked like crap. The world of medical diagnosis is all about best guess. Based on how she looked, by best guess was that this was a cardiac problem. I took some basic obs off her and to my surprise everything was normal; her pulse, blood sugar, blood pressure and oxygen saturation we fine. Despite that we got her up, on a chair and inside the truck, out of the glare from the crowd and the rubber-neckers.

The weird thing about this job, was that she wasn’t complaining of anything specific. She kept saying she didn’t feel right but that was about it. No pain, occasional light headedness but nothing that led us to suspect anything we could treat. We did an ECG, that was completely normal. We did a neurological exam, an abdominal and respiratory assessment yet still couldn’t find anything wrong. The only thing that was obvious was she appeared to be getting worse. She was sweating more, appearing more drowsy, talking was becoming more of a problem and she was panicking slightly. We decided to just go, we put in a blue call for a ’51 year old female, collapse ? cause’ and off we went. It was only a 4 minute drive to hospital. In the end it took a while longer. 

After a minute of driving she started going blue. Extremely blue. I watched over a 10-15 second period as her oxygen saturation dropped at alarming speed from 98% to <50%. I put her on full flow oxygen but it didn’t change for the better. I silenced the oxygen alarm on the monitor, only for the respiration alarm to start going off. Her resp rate had dropped from 24 a minute down to 14, then 8, then 4 and the 0. F**K!! 

“Pull over, she’s gone into respiratory arrest.”

“F**K!”

At no point before that did I think that the Angel of Death had been circling above. I grabbed the Bag Valve Mask (BVM) and started bagging her whilst my crewmate got the defib pads attached to her. Within about 20 seconds of the ambulance stopping her heart had also stopped. My crewmate started CPR. An ominous flatline appeared on the screen as we checked for a rhythm. What the hell had we missed?! We had done everything?! I called control and told them to update the hospital that the patient was now in cardiac arrest and we would be there in 3 minutes. We decided that as there was just 2 of us and we were so close, we would just go and give basic life support on route rather than waste time at the roadside delaying definitive treatment. Some crews would act differnetly but these decisions are made in a split moment based on what is in front of you. We felt her best chance would be a crash team at the hospital. 

Off we went for the second time, this time with me doing CPR with one hand whilst hanging onto the ceiling bar. As we pulled into hospital the crash team were waiting outside. The back door swung open and to my relief a nurse jumped on to help out. Because she had just gone on us without warning we were not ready for it. When transporting a patient in cardiac arrest, you do so in a way that transferring at the hospital is easier. This patient however, was attached to the main oxygen, the blood pressure cuff, the ECG leads, the CO2 lead, the pulse ox, everything. After basically ripping everything off we got her inside and onto the hospital bed while I gave a pretty vague handover. 

“This is a 51 year old lady who collapsed in the street. No memory of the event. Denied any pain, complaint of slight light headedness. On arrival she was sweating and pale but all her observations were normal. She was FAST negative, her ECG showed a normal sinus rhythm and there was nothing untoward on a neuro exam. Same with resp and abdo. No recent travel or surgeries, no allergies, normally fit and well, doesn’t take any regualr medication. On route she became heavily cyanosed and rapidly desaturated. Within 30 seconds she was in respiratory arrest and about 30 seconds after that went into cardiac arrest. She has been in asystole (flatline) throughout. She has been down now for 5 minutes give or take.”

We left the department scratching our heads as to what had just happened. I suppose that’s healthcare right there. Whether you are a paramedic, a nurse, a health care assistant, a doctor or porter, at some point in your career someone will die whilst in your care. It isn’t nice and isn’t something that sits well with me but it’s true. I have gone over this job from start to finish over and over and over and over again. As has my crewmate. She should not have just died like that. How can someone who is fit and well, and relatively young just die without any obvious cause. I think that is what troubles me still. What did we miss?! It is hard feeling to describe watching someone die. I watched the life drain from her as death took over and I was absolutely powerless to stop it. It’s one thing to die at home alone but when inside an ambulance surrounded by medical professionals? I hate to think what was going through her mind. She must have known. I remember her eyes fixing on me, gripped with fear. I can only imagine what my face looked like. 

Normally i’m very blasé about death. I'm very much a ‘when it’s your time, it your time’ kind of person but it’s a very different dynamic when you arrive on scene to someone who has already died or is dying. Be it old age, a stoke, a heart attack, a fall from height or an RTC you can distance yourself from it and follow your cardiac arrest rule book. When it happens unexpectedly in front of you there are no coping mechanisms in place to rationalise it. Problem is, I couldn’t dwell on it, I had to get to a 27 year old with a 4 day history of lower back pain to rush off to....


25 comments:

  1. Sad story, reminds me of one of my jobs except mine was in her 40's and c/o chest pains. Everything was normal until she said she felt 'a bit odd' and went straight to asystole. Some jobs stay with you.

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  2. ugh hate this when it happens, also that sometimes you never get to find out either to help with the battle in your head, did I miss something? Could I of done anything.
    I always think considering our very basic medical diagnostic equipment we do very well with what we are sometimes presented with.

    Will you let us know what happened to the poor lady.

    And may she RIP x

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    1. Afraid this was a long while ago and we never get to find out :(

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    2. Oh thats always a shame :((

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  3. Saw something very similar with a AAA that went pop. Being the last person to have a conversation with someone is a strange privilege.

    RIP.

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    1. Thats what i was thinking. That or PE

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  4. Had the same type of thing happen to a guy we picked up. Nothing we could do he just went on us on the journey to A&E. The suspicion was that it was a PE but, as with all to many of our jobs, we never did find out. Not right to have the ceiling of an ambulance as the last thing you see but...!

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  5. Despite everything we do, and doing everything 'right', sometimes people just die. It happens...and nothing you could've done was going to change it.

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    1. I know, cant help but second guess in these situations though.

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  6. That kind of sounds like a P.E. but there's no way to scan for that in the field that I know of.

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    1. Thats what I was thinking but no symptoms really.

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  7. I can sort of relate (at least to the feeling of being helpless and not knowing what happened / the outcome was). I have all kinds of stories from my days as a 911 dispatcher, but there was one call that really stuck with me.

    I was on the "overflow" position that day, so I could have gotten a call from EMS / Fire / or any of the 4 police zones. It was quite the busy day! Toward the end of the shift it had slowed down a lot, and I hadn't gotten a single call for the past 40 minutes or so. So I was sitting there doing some sudoku puzzles, and I'm not sure exactly what it was that caught my attention, but I overheard a call from EMS that sounded confusing. (The details around the call are fuzzy, but the call is not). Shortly after I was asked to log into the call to update the officers that were responding too. I'd never heard / been around anyone that was dying before. Me and some friends had found a dead body once when I was still a teen, and I'd taken calls where bodies were found, but no one actually dying.

    Apparently this woman had shot herself in the abdomen and wanted to "go home to be with her father" (who had also apparently died earlier that year). I remember hearing her talk about how cold she was, how thirsty she was in the background (her fiance was on the phone). There was something in her voice that just chilled right to the bone. That was the last call I took place in that night, and to this day I have no idea whether she made it or not.

    Not the same I know, but I kind of understand. While I understand it must be frustrating wondering if you missed something, there are just some things where no matter what you do, there is nothing that can be done at that time. The most important thing in my opinion, is that you ARE wondering if there was something you missed, because that means you care.

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    1. Blimey, sounds horrible, you guys do a fantastic job x

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  8. Oh wow! That must really shock you especially if there was no obvious cause for you to be able to understand wht had happened and why you couldn't save her. I hope that someone has been able to tell you to help you come to terms with it. Frankly though I must say that I'm disgusted that Ambulance control don't have the vehicles and staff (and thus funding) to allow you and your crewmate some time to 'decompress' after having a patient die on you.

    However, keep up the brilliant work!

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  9. Actually my father went like that but wasn't even in the ambulance. He was 39. My brother made it to the hospital and was rushed to surgery for an aortic dissection. He was 27 and died 36 hours later because they couldn't fully repair it. Then my youngest child at his 9 month checkup had a murmur.(Believe me with our history i was freaking out.) We were sent to the cardiologist and informed that he had a bicuspid aortic valve. He has to be checked every year for the rest of his life. Also, my granfather did the same thing as my father at the local small town hospital 6 months after my father. The doctors believe we have 2 different genetic conditions affecting the main aorta that runs on the male side. I have been through too much in such a short time & basically any male on my fathers side could drop and be gone in a second, including both my sons. I too believe when it's your time to go then you go. So take comfort in knowing you did what you could nd it was apparently her time.

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  10. Hi Ella, I don't mean this in a good way but that millisecond someone goes infront of you and I'm on about that instant life stops, it's fascinating because the eyes change to lifeless 'glass' eyes. I don't know what leaves them - not being religious I don't want to say their soul but that is the closest I can get to. Something goes and you know that pt has died

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  11. I've had several go on me as you describe. I remember doing a gp admission for a ? Dissecting aaa. The guy was poorly but stable. No sooner had he got in the back, he went off on us. The bad thing was, unknown to me, my crewmate had said to his wife she could come with us. She went inside to get her bag, I climbed in to the cab before he died, saw her looking out the frontroom window, waved (thinking she was making het own way to hospital) and drove off. She never saw her husband alive again.

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  12. This is a truly tragic case. Like you say when you have been talking to the patient and built up a relationship, no matter how tenuous, and then they die its hard to take, especially for no discernible reason. I know it probably wont happen for all the reasons we understand but if you could find out the result of the PM perhaps we could all learn from it. Hope you and your crew mate are ok.

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  13. I cannot begin to understand what you went through fully - I am not a professional just joe public who does not panic and faint at the site of blood and can do a bit of first aid.

    I would ask from this story though if there is any way of asking for cases like this to be flagged for information to be given back to the ambulance crew both to help with the crews mind worries and to cover any "could ofs" for the future. I know lots of others here are saying about aneurysms which of course you can do nothing about but I am sure you would feel better just knowing - having A&E or possibly the pathologist/coroner - give you the report. Not for every case just for ones like this where even after a long time it still weighs on you.

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  14. I had a very similar job a few years ago and I will never, ever forget it. This young woman went from gcs 15 to 3 within two minutes, tragically in the back of the ambulance in front of her mum. This may sound harsh to people outside the job but I have been to many patients in cardiac arrest over the years; and although I have tried my best at the time and felt sad for the family, because I didn't meet the patient when they were alive, its easier to be distanced from it all. But when this girl went from speaking to me to hypoxic to resp arrest to cardiac arrest, I had a proper cry at the hospital. And seeing her poor mum with her was utterly heart breaking. The young lady died of a p.e, she was in the paper a few months later after the Coroner wanted the side effects of taking the Pill to be published.

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  15. My ex-wife suffered a pulmonary embolism a few years ago, and went from "I feel a little off" to flatlining in under 45 minutes; five minutes after the ambulance arrived, she passed away while the EMTs were doing their best to save her.

    My heart goes out to you and your crew -- indeed, to all medical personnel and emergency responders -- when you have to deal with situations like this. I know you were doing your best, but I can understand how phrases like that are often cold comforts.

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