The bell went off just before midnight. The text said DIFFICULTY BREATHING. While driving to the person’s home the radio crackled with an update from dispatch, “This is now a full arrest.” Full arrest is just what it sounds like, the guy’s heart and lungs have stopped.
As we neared the house, my partner said, “Oh, I’ve been here before. This guy has lung cancer. Poor lady.” I was patient-man, which meant I was carrying the drug box and the monitor. We were greeted at the door by a crying woman who pointed us to a room around a corner on the left. I rounded the corner and saw an older man lying perpendicular on his bed, as if he had been sitting up and then slumped back when his heart stopped. He had a knot of congealed blood coming out of the right side of his mouth and his face was ghostly.
We pulled the man to the floor to begin resuscitative efforts. A guy from my crew grabbed onto the man’s wrists and pulled up to get him to the floor. I supported the man’s head. I learned to do that after trying the arm movement and seeing a lifeless head jolt backwards when the body was pulled forwards. It looked awful. Heads are heavy and watching them fall back and then violently stop when the neck can’t extend any further is grotesque. I don’t want to see that again, so when we move dead people to the floor to try and help them, I hold their heads.
By ghostly, I mean his face looked pale, which can be a tip off for long-term-death, but his skin was warm (and he wasn’t laying in the sun), which usually means death has just occurred. I asked the woman when the last time she saw him was and through sobs she said that he was talking two minutes ago.
I had the team suction the blood out of his mouth and we began CPR. The first time ever I did chest compressions was in a convalescent home on an elderly lady. On my first compression I felt all of her ribs separate from her sternum. I would have thought that that would have given me the creeps, but it was my first time and I really wanted the compressions to work. That incident gives me the creeps now when I think about it. I patched the patient up to our monitor, both the four leads and the pads and his heart was in an agonal rhythm, which means it is un-shockable.
While we worked, the captain asked the crying woman if the patient had an advanced directive. He did. The directive stated that the man did not want any resuscitative efforts performed. He had lung cancer and when he died, he wanted to stay dead. But he expressed this wish with a DNR (Do Not Resuscitate), which can be overridden by family. Only a POLST (Physician Orders for Life-Sustaining Treatment) cannot be overridden. Even though the man did not want to be brought back to life, his wife wanted him back. So we tried.
There was almost no way that we or any doctor could bring this man back, though. Based on the blood pouring from his mouth and the rhythm he was in, he was gone. Another medic and I tried to get IV access in his arms, his neck and his feet. After missing 6 times, I was successful in his left ankle. We gave him three rounds of drugs, continued CPR and suctioning and things deteriorated. The agonal rhythm progressed to asystole, which is a flat line, which occurs when there is zero electrical activity left in the heart.
We called the hospital, told them about the patient and everything we’d done and the doctor gave us orders to cease resuscitative efforts. We stopped. We cleaned up as much blood as we could, picked up all the debris from IV catheters, gauze, O2 tubing and other gear and covered the man with a blanket. We walked out and gave our sympathies to the widow.
While we were cleaning and replenishing our equipment, a neighbor walked up to us and thanked us for our efforts. He was wearing a House Season 5 jacket. He was friendly and had been close to the dead man.
We drove back to the station and slept for an hour and then woke up for another call. Then another and another and a sister and a brother. He tried to rob a man who was a DT undercover.