Jungle Cat

It has been a ridiculously busy evening, and we're already stacked 2-deep in the hallway of the hospital, waiting interminably for a bed, any bed. A crew has patched that they are coming in with a violent patient and is requesting the security meet them in the garage with restraints, they are accompanied by PD. As with any call that sounds interesting, bored medics start emerging from the woodwork to "help" the incoming crew. My patient is right near the door so as my partner joins the crowd in the garage, I have a great view to watch.

They arrive lights and sirens, and uniforms pour out of the back like a clown car, each one more sweaty and disheveled than the last. They've all definitely been in a fight, and we crane our necks to see what big, burly dude they're bringing in. When they pull out the stretcher we look at them in disbelief. A 19 year old, maybe 90-lb little blond girl lies sleeping on the bed, handcuffed, rip-hobbled and seatbelted in tight. Really? This seems like a bit of overkill. "Just wait" the one medic says wearily as he pulls the stretcher into the hallway. 

As if on cue, she starts to writhe and the medics, their student, several fire fighters and police officers assume their positions, it's obvious they've done this before and have a routine down. Security steps forward with restraints as the charge nurse comes around the corner to investigate the commotion. 

The tiny body on the bed starts to thrash, and each of her limbs, her head and her torso are held a little more firmly. Despite the manpower, I swear she begins to LEVITATE off the bed, her torso bending at an unnatural angle as she opens her eyes and begins to growl. She has become a wild animal, there is nothing human about her actions or the sound she is producing. An unearthly, wild snarl comes from her lips as she writhes and thrashes, nearly escaping the desperate clutches that hold her down. The hairs on the back of my neck stand up as the sound intensifies, everybody within earshot gets the urge to start throwing holy water or grab a wooden stake. And then just as suddenly, she relaxes. The rabid jungle cat is gone, and the sweet teenager has returned. As quickly as possible, the restraints are secured and she is moved into one a room, the door closing as the sound begins again.  We never found out what drugs she had taken, just as we all never forgot that bone chilling sound. 

True Save

Our 6 am shift is off to a good start, it's a beautiful, clear summer morning and we successfully managed to get coffee before heading to our downtown base. I have not worked with my partner before, but he seems like a pleasant enough older guy, obviously counting down the days until retirement. Dispatch calls our truck number; "Code 4 at the gym, unconscious male." The address is right around the block from us, so we swing around and arrive within seconds. "Update: CPR in progress." We see a lone police cruiser parked haphazardly on the sidewalk and load up the stretcher with all of our bags before heading in. An idiot of a security guard leads us straight to the escalator, and I look at him, then at our fully loaded stretcher, "Do you have an elevator?" "Oh, yah, I guess we do. But he's right up there, can't you just balance it on the steps?" Fire arrives to hear this and we collectively shake our heads. My partner and I grab our bags and head up the escalator while a couple  of fire fighters volunteer to bring the stretcher up the elusive elevator.

We are ushered into a small workout room where a spin class was taking place, and see a relatively fit-looking man in his 60s lying on the floor with a police officer doing impeccable CPR, an untouched AED is sitting at his feet. "Keep going, officer, you're doing a great job!" I set down the equipment I'm carrying, avoiding the pool of blood under his head, and we get to work - although it is quickly obvious that my partner should be thinking about retiring sooner rather than later, he is incredibly slow and flustered with everything he is doing - and he's an Advanced Care Paramedic. I cut his shirt off, slap the pads on, set up the ventilation gear and take over CPR while my partner fumbles with the monitor, finally succeeding. The man is in textbook v-fib, a rhythm where the heart muscle quivers like a handful of worms, a lot of action but not coordinated enough to pump any blood. The first shock is delivered and a firefighter continues compressions while I gather patient information.

The spin class instructor tells me that he is in class 3-4 times a week and has never shown any difficulty, that he has always seemed quite fit for his age. Today, he simply stopped peddling and fell sideways off the bike, striking his head hard on the one next to him. That explains the blood, at least. I turn back to the patient just in time to see his hands come up, "Stop CPR!". As I reach for his pulse, I glance at the monitor and see that he is now in a relatively normal looking rhythm. Awesome! Now our priority changes, we no longer want to stay on scene and work him, we want to get him to the hospital quickly, and hopefully still alive. I ask dispatch to give the nearest hospital, which luckily happens to be the cardiac hospital, a heads up, since we are only 3-4 minutes down the road and they tend to want a bit of notice when getting critical patients.

We get him packaged quickly, needing to restrain his arms as he starts to flail around widely. He is still alive and fighting a few minutes later when we unload him at the hospital, his vital signs amazing for somebody who was just dead. We find out later that he walked out of the hospital, neurologically intact, several weeks later. The spin instructor who began CPR started the Chain of Survival, the police officer who took over continued it, although using, not just grabbing, the AED would have been a great idea. He was extremely lucky that we were pretty much driving by the gym when he collapsed, and that the cardiac hospital was super close. All in all, a true save.

False Hope

It was 5 am, still dark but with the sky just the beginning to lighten in the east. We're headed to a base for the first time all night, exhausted and spent after call after call, hoping to get a half hour to nap before we head home. Those weak hopes are dashed just before the base comes into view, "Code 4 to a VSA". I'm not sure if my groan is audible or not, but I swing the truck around and hit the lights. Somebody has woken up to find a family member dead, and it's our job to see if they are really dead or just nearly dead.

Fire is already on scene when we arrive, I have a good friend who works out of that station but its not his rotation. I like seeing him on calls because I know him, I trust him and he knows his stuff. We walk into the stereotypical Grandma and Grandpa's apartment, wall-to-wall thick beige carpet, pastel walls, ceramic plates and shiny silver spoons in a display cabinet. It could be my Grandparent's.

She is sitting in a well-used recliner, reading glasses on, paperback novel splayed out on the carpet beside her feet. She would look like she was napping if she was any colour other than bluish-gray. The Captain is with her husband and son in the kitchen, already explaining that she has passed away and there is nothing left to do. We approach her with our bags and my heart sinks as I begin my assessment. There is no question that the woman is dead, but she has not been dead long enough to allow for a field pronouncement. No rigor mortis, no mottling from where the blood has collected due to gravity. She is in fact, still warm. My partner and I exchange glances, we know she is dead and is most likely not coming back, but there is no other option, our protocol dictates that we must work her, we must attempt resuscitation simply because she is not quite dead enough. Damn. The family is already grieving.

We slide her out of her recliner and I begin CPR as my partner starts to assemble airway equipment and dictate tasks to the surprised fire department. I hear the captain in the kitchen rapidly change his tune as he hears what we are doing. He tries to explain the sudden flurry of movement without giving them false hope, but it is next to impossible.  We run through the steps of our resuscitation smoothly and quickly. There is no adrenaline rush, no sense of urgency, and it feels almost like a practice code from school. Check off the steps, but the outcome is already known, confirmed once we reach the point where we can call the physician and finally let the poor woman rest.

My partner goes to talk to the family as I clean up the living room. She is exposed from the waist up, so I tidy up her torn pajamas, smooth down her rumpled hair and cover her up with an afghan from the couch. She still looks like she is sleeping, lying on the carpet with a blanket she probably made herself, just now with a tube sticking out of her mouth and an IV in her arm. In my exhaustion, I am struck by the emotion of the situation. The family's despair, the hopeful 911 call, the firefighters storming in to save the day only to let them down, then our arrival and a burst of false hope, followed by the realization that she was indeed gone. As I hear the heartbroken sobs of her devoted husband of decades, I busy myself with gathering the assorted pieces of equipment scattered around, not trusting myself to make eye contact with anybody until I have composed myself.