Sunday, 16 March 2014

Reality vs Reality

WARNING: This post contains graphic descriptions and scenarios that some people may find very extremely distressing.

So there I was after an awful day at work, sitting in a local pub, nursing a couple of drinks. It's a good way to unwind after a bad day, offloading to people that really know you. No bravado, no showmanship, just good company with people who care about you. Perfect! Unfortunately, even the nicest pubs attract idiots. And drunk idiots at that! The one tonight was harmless, but latched onto us as his new best friends. It didn't take long for him to find out I was a paramedic, and then that was it. Suddenly I was immersed in tales of the '24 hours in A & E', 'An hour to save your life', and '999:What's Your Emergency?'. Apparently he watched them all and therefor was an expert. He was under the impression that everyone we met, we saved and obviously had no comprehension about death and what death involves. It isn't anything like they show it on Holby City and they can't show the reality of it, even in the fly-on-the-wall documentaries. I didn't want to sit there and set him straight but for those not in the know, this is what I associate with cardiac arrests and death.....

"36 year old female, cardiac arrest, CPR in progress."

My heart sinks, just 36 years old. I really hoped it wasn't as given, but the more information I got, the more I knew I was about to walk into pre-hospital hell. I pulled up with a screech and grabbed everything I could carry. I was first on scene and had no idea how long I'd be on my own. I rushed up the garden path to see a kid, no older than my son, standing at the doorway. 

"Please help my mummy, she's not breathing."

I literally can't deal with that stuff, so I ignore it. Children add a huge amount of emotion to any situation and cardiac arrests, are not a place for emotion. I need to stay calm, get in my zone and focus. It sounds very 'self help' but I do get in a zone and we all do what we have to do to keep our head in the right place. I bounded up the stairs to find our patient lying on the floor, her husband desperately doing CPR under the instruction of a call handler counting out the compressions over the speaker phone. I asked him to carry on whilst I got set up.

There was vomit all over her face and her hair was matted in it. When my hands touched her face, I could feel the vomit on my fingers. I begun ventilating her. With every ventilation, blood squirted out of her nose. I begun to suction the airway. I could tell the husband was beginning to really struggle with what he was seeing, and I didn't want this to be how he remembers his wife. I also can't deal with his emotion either so I sent him off to find someone to take the 3 children who were in the house. Again, the fact they were in the house and the fact that he was crying was something I chose to ignore initially. It's my way of focusing and my way of staying calm. 

I took over CPR as he was leaving the room. A number of ribs cracked, the sound of which made the husband visibly cringe. I could feel my knees in the vomit and blood but it didn't matter. Neither did the blood spray up my forearms. Luckily for me, the second car arrived. I secured the airway with an i-gel and continued to suction the blood and vomit that just kept coming. The other FRU started trying to get IV access. The was no joy on the hands or arms, her veins were so shut down, it was futile. I then tried on the external jugular vein (EJV) on her neck but again, no joy. The only way we could now get access was to drill into her bone.

I continued to manage the airway whilst the drill was set up. Just as she was about to drill into her leg, a child appeared in the doorway. You can try as hard as you want to ignore certain situations but some you simply can't. The little girl was no older than 5. Her mummy was lying on the floor covered in vomit and blood, a tube coming out of her mouth, blood trickling down her arms from failed cannulas  and a paramedic kneeling on the floor holding a drill. We both paused for moment not knowing what to do. 

"Excuse me!" I called out. The husband appeared in the doorway. "Your daughter really won't want to see this."

She was quickly whisked away. The needle was drilled into the bone so at least we could now start giving drugs. Unfortunately, as one problem was solved, another appeared. Despite the constant suctioning, the airway was becoming increasingly unmanageable and full of blood. We decided to remove the airway that was in place and intubate. This was not without risk but on balance seemed the best thing to do. I took over chest commissions whilst my colleague get everything set up. Luckily the ambulance arrived, so with their student we now 5 people to work with. The student took over CPR, I started running drugs through, the other medic assisted with the intubation and the other went about do temperature, blood sugar etc and rotating the CPR duties. 

The longer the CPR went on the worse the chest was looking. After about half an hour the top layer of skin on the breast bone had been pulled away due to the friction of constant compressions. Her chest was covered in blood and stomach contents was seeping out of her peg feed site. She had also become doubly incontinent, which is common in cardiac arrests. 

We did everything we could and did so for over an hour, but to no avail. We called a time of death and all just sat around looking at each other, not really knowing what to say. We all had blood on our hands, arms and clothes. We all had blood, vomit, urine or a combination of the 3 on our trousers. Me and the other FRU had blood on our faces due to the original CPR and ventilations. I cleaned myself up the best I could so I could go and speak to the husband. 

I stood at the top of the stairs and was reluctant to go down. Breaking bad news is not something we are trained to do, even more so in people so young. I had to tell a young man that his wife, the mother of his three children, had died. I had to tell him that everything we had tried, had failed. I didn't know, standing at the top of the stairs if the children were down there. I didn't know if I was going to the person they associate with hearing their mummy is dead. I didn't want to be the person to do any of that, but it had to be done. I started making my way down, and the husband appeared at the bottom of the stairs. 

"Is she dead?"

"I'm so sorry sir, we tried everything we could but I'm afraid she has passed away, I'm so sorry."

With that, he dropped to his knees and wept. I just stood there, choking up myself. I didn't want to turn around and go back upstairs, but also didn't feel comfortable watching him. I put my arm on his shoulder and apologised again. A neighbour appeared in the doorway. It turned out that all the children were in her house. She knew what had happened and took over front me. I couldn't get up the stairs quick enough, it was just awful.

There is often very little dignity in death. This young mother laid dead on the floor between us. She was lying in her own urine, faeces, she was topless, she had friction burns on her chest, she had a needle drilled into her leg, a tube coming out of her month and clamped to her head, she was covered in her own vomit and blood and her grieving husband and children were a floor below her crying and not having a clue how to cope and deal with her sudden death. This is why these things are not on Holby City, this is why fly-on-the-wall documentaries stay outside of jobs like this and only tell you what has happened. It's because no one ever needs to see this stuff. We see it, and are part of it because we have to be. Any other eyes have no place being there, in person or through a TV.  Death is not a soap or entertaining and that is why it is sugar coated for everyone. It may be considered reality TV and but it is as far from reality as can be.

Perhaps if I hadn't just done this job three hours earlier, the man in the pubs enthusiasm for pre-hospital entertainment might not have irked me so much. 

32 comments:

  1. This is the most honest and heartbreaking account of what you guys n girls see on a regular basis. It makes me appreciate my own paramedic colleagues in Belfast who, like yourselves, do their job with the utmost care, empathy and professionalism. Thankyou x

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  2. You're amazing. All of you are. And that's about all I can say after reading this.

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  3. Tough job! Sounds like you handled it as best you could though, given the situation. Probably not really a consolation, but at least you can take that away from it.
    There'll always be idiots (sorry, armchair experts), who know what we do better than us. It just sucks they always seem to catch you at the wrong times.

    Any idea the cause? Sounds like it could've been a ?AAA from what you've written.

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  4. It is a sad fact that Holby et al have dressed up emergency care to the extent that many of my volunteers cannot deal with the reality of arrest. Keep on blogging! A Newcastle Resuscitation provider.

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  5. Jobs like that will always have an effect on you, but I'm sure writing this was very theraputic.

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  6. Well lets start by saying - I started reading this while eating - it reminded me of my childhood in the 70's, mum was an A&E nurse and dad was an ambulance driver - and some of the dinner convos were hair raising, but interesting to hear about at a young age! People seldom understand the commitment involved in being part of the emergency services unless they are either part of it, or have family who are part of it.
    Even growing up with the information etc. it still comes as a shock to see first hand - and I dont think age of the person suffering matters. I arrived to find 5 people round an elderly gent trying to get him to respond to questions, but no one thought to dial 999... So I did, went through the details of location and scene etc. while the others were still trying to make him comfortable - as I got confirmation that the ambulance was on route, some staff ran out from a surgery (which I had no idea was there as it was in a courtyard) complete with defib kit, straight down on the floor shirt open pads connected and cpr started. the operator started to ask questions which I was not in a position to answer competently as I was going to have to relay them to the nurse providing the cpr etc., with lots of traffic passing by within a couple of ft - so for the sake of accuracy and expediancy I held the phone to the nurses ear so she could answer until the defib was ready and she could take the phone herself.
    Other than that I was pretty much a sundial in a coalmine - but my respect for health professionals was renewed (not that it needed it)

    I honestly believe that part of secondary education should include time spent with paramedics heading to scenes like the one you described, but more so to RTA's and the results of drinking/drug taking on the weekends - or at the very least uncut film footage from start to finish - with the simulations of the smell of blood/vomit etc.

    Because when you see it on tv, there's nothing scary or real shown, so you dont actually learn about the realities.... And then they should have to be provided with at least basic first aid as part of that education!

    But thats just my view

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  7. thank you for putting these blogs up. as another RRV paramedic I turned up to a very similar job to this this week and am glad to see I am not the only person to struggle with these situation. As part ot the ambulance service coping mechanisms we all ignore the hard bits and find the dark humour to cope. After this day I got home to find my housemates boyfriend who works a 'normal' job moaning about how bad his day at work was and I may have had a few harsh words to say about how he has no idea. So the more people who see this and hear the reality of our job the better. Thank you again

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  8. No comment needed, this says it all. I am a LIVES first responder.

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  9. No comment needed, this says it all. I am a LIVES first responder.

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  10. Thank you for a frank and honest account, this struck a chord not least because of a strikingly similar experience I had very recently. People want sensationalism not reality. I would recommend your blog to any student paramedics because I'm not sure many of them know what awaits them . As a fellow professional I will post anonymously hope you don't mind

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  11. I also watch these programs, but I realise that we are only shown a certain amount of the actual situation. I have nothing but admiration for what you and you colleagues around the country do to try and help, save and preserve life. Maybe it is time that a program was made about how you cope with the stress of your job, so that we the public can understand the stress and emotions you feel ever day. Thank you for you skill and dedication.

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  12. Your all fantastic! My daughter is a paramedic and although I hate to think what she also sees and deals with am so proud of her,as I'm sure your family is of you.I also think it's sickening that payrises probably won't happen. Thanks for all you do.

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  13. Thank you for doing what you do day in, day out with everything the job (and management) throws your way. As volunteers we CFRs, and I am sure this is true of all of us, will always stand by you, work with you and help in any way we can no matter what.

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  14. You're not alone. We all have ghosts, but many times they're not nearly so bad as the living who are bent on reminding us. Thank you for everything you do from a sister Medic in the US.

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  15. I read this the day after attending a paed arrest, I don't think the general public want to know what it feels like to compress a weeks old babies chest, to put an IO into it's bone and draw up minute quantities of drugs, all to no avail. They want the couple of rounds of half hearted CPR and then the person leaps off the bed and is restored to perfect health world. A world where babies don't die and paramedics/techs/ECA's don't fight the tears and move onto the next job.

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  16. I once wanted to become a Paramedic, but you need to be a special type of strong person to deal with the situations described here. Sadly I'm not that type, and I admire each and every Paramedic/A&E doctor and nurse, as they see people in their worst possible state and I simply don't know how they cope. A mate of mine is a Paramedic and he's a little mad, but he's also dedicated and he absolutely cares about his patients. He sometimes calls for a long chat about a bad day, and then I remember, no one cares for the carer.

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  17. You mentioned a peg feed. At a guess possibly terminal/secondary? Definitely non reversible. Well done for your efforts! They never said it would be easy. LAS Paramedic

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  18. As the wife of paramedic this situation is a normal job nowadays and dealing with relatives is not easy.people dont realise that every case affects you and quite often you take your work home with you(thoughts of jobs done).this is where i get to offer a shoulder to cry on.if people must watch casuality programmes remember you are watching either safe jobs or staged jobs.give a thought for people who do the real work.afterall that the staff on real life jobs are dedicated and love their work.

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  19. Echoes of one of my jobs, only she was a 12 year old handicapped girl surrounded by her family. Her brother was beside himself with grief while her parents watched and realised her struggle to survive was finally over.

    Not as messy as some of the others but a difficult day nonetheless.

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  20. Thank you for this insight into a traumatic emergency situation. I am currently pursing a career in the Ambulance service and was a very eye opening and thought provoking story.

    Danny

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  21. I want to add my thanks. The work you do is incredible and we are so grateful to you.

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  22. Very well done to you, incredibly hard situation dealt with extremely professionally regardless of the unfortunate outcome.
    Great post. I've added your blog to my reading list, look forward to the next one and hope for a success story.

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  23. Great blog post....
    I have been there, done that, and tried to deal with the aftermath.
    I started a 4 year career break from the ambulance service in January 2012. It came at just the right time (after having one too many jobs like this one). I was burned out and didnt know how much longer I could keep the smile on my face. I have two years left of my career break before I have to decide to return or not. Colleagues keep saying I will be back, but to be honest I doubt myself when I think of it.....
    Do I want to put myself in situations like that again...I don't think so...
    The memories I have will always be with me, both the good and the bad, but I don't think I want to add any more bad ones. I keep thinking about the rush of being back on the job and 'making a difference' but then I read an account like the one you posted, and I realise that I don't think I can go back to that now.
    No matter how many keen readers enjoy a look into the life of a paramedic, and blogs like yours allow them into our world, the only people that can truly appreciate what it is like is fellow paramedics.
    I hope this isn't one of the jobs that sticks with you and I hope that you last in the job for as long as you want/can.
    Thanks for sharing.

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  24. I am an ECA frontline, working along side paramedics and IHCD Technicians. How true this account is. You never forget your first one and although everyone is different they all have their own stories to tell.
    Very well and sympathetically written

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  25. I am an ecfr for nwas and have been on scene when things like this have happened. It is not the nicest thing to have to watch a paramedic call it and to then explain to a partner, parent, son daughter etc that we did everything we could. And watch them break down in tears. I have every respect for you guys who do this day in day out. As a volunteer can choose what jobs attend. Keep up the good work. I could tell quite a lot of stories about jobs I have attended but I know at the end of the day those stories are private for that patients family if they want to tell . I know you would just say you were just doing your job, but it's more than a job, it's a way of life. Keep up the good work.

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  26. having left the service after 22 years as a Paramedic I congratulate you on having the courage to tell it how it is. Why is it that people are either "experts" or want to know the "what's the worst job you've ever had to attend" If we really told them I'm sure they'd throw up in front of you. Keep up the good work and those of us that know are right behind you. We cope because we have to and we learn to cocoon ourselves at the time because we have to. Take care and stay strong, You have great colleagues who understand.

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  27. Thank you for sharing that experience. A real eye opener though I had tears in them as I read it.

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  28. I too have similar experiences and feelings. I ended up leaving the Service, as a paramedic and Station Officer in order to teach as it all became too much and I had no-one to share the load. The Service had "procedures" in place, sure, but anyone who tried to avail themselves of such things was "weak" and made to feel pathetic. Thankfully, things have changed since then and there are REAL procedures that don't result in such stupidity.The public, thankfully, have NO idea of what we do. That's the way it should remain....

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  29. Oh my, wow! I've worked in a hospital as a B3 HCA on a trauma ward so have seen some horrific sights, well so I thought but your description makes my experiences seem more like Holby City!! I would really like to thank you for opening my eyes to the reality of emergency care and hopefully when I start my nurse training I shall be able to go out with the ambulance crew.

    Thank you and all emergency responders for this amazing job you do.

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  30. Thank you for your honesty, commitment and your support to the general public. Been around healthcare/first aid for thirty years an it is the most accurate I have ever heard. I try to support my friends who are also paramedics and technicians and give them a safe place to offload

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  31. I cant even begin to imagine what that was like to be in, you did everyone you could possibly could, you and everyone else to save her. people like that shouldn't go, but they do. I really hope you are ok now, and thankyou for the honesty, so people do see what they want to see. like to think we all go in our sleep peacefully, but that's only in a perfect world.

    Catherine x

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