Friday, September 26, 2008

the first time

Rae drives with supernatural incisiveness, powering through the heavy morning traffic, anticipating with cool clairvoyancy the smallest deviation or hesitancy, flashing through gaps with a paint sweat of clearance, braking down before that driver even thought to indicate left and pull over to the right. We are heading out to a fifty year old female in cardiac arrest, and we want to get there quickly.

Swinging round into the close we can see the house we want: the one with the door open and a naked man pacing about on the grass verge outside. He holds a phone to his ear with one hand, the other the ends of a bath towel he has bunched around his waist. He flips the phone shut as we pull up.

‘Please, please be quick. She’s upstairs on the bed and she’s not breathing or nothing. Please, please, please, oh god. oh god.’

As I stride across the grass with the resus bag I ask him questions. He says his wife has a history of angina. She complained of chest pain when she went to get up this morning, but keeled over before she’d had time to grab her spray.

Inside the house and it’s horribly cluttered with junk. I wonder how we’ll fit the chair down these stairs, but immediately focus on the scene in front of me as I pick my way across the landing into the bedroom - an elderly man, pushing up and down on the chest of a naked woman sprawled on a double bed. Her body bounces lifelessly as he tries to compress her chest. He stops as soon as he sees me.

‘Help’ he says.

It feels like I’m climbing through some kind of waste facility. There are heaps of old clothes, boxes of video tapes and newspapers, chairs with dusty television sets and VCRs, lino squares and carpet off-cuts.

‘We need to get her on the floor,’ I tell the man. ‘Help me clear a space.’

In a few seconds we pick up and throw across onto the other side of the bed an occasional table with an overflowing ashtray and spilled packets of sweets and just enough boxes to make room for the patient. Rae is in the room now and she cheats the bed over to one side by another critical inch, just enough to get the patient down on the floor. I start chest compressions whilst Rae gets out the defib. The elderly man – the woman’s father – scrambles out of the way over the bed, and goes to stand with the husband on the landing. A technician working on the response car turns up to help. He fetches some extra pieces of kit we need, then takes the two of them to one side to get the paperwork going.

The readout is good for a shock. Rae hits the button. The patient gives a convulsive jerk and her head whumps back on the dirty carpet. I compress her chest for a further minute then we check the readout again. She has a pulse on the screen. And, crucially, at the neck. Her abdomen positively quivers with it. It’s fantastic to see. She starts to gasp beneath the mask with crude, primal intakes. I support these with the BVM.

After twenty minutes we have her wrapped in a blanket and on the chair ready to go. In those twenty minutes the father and the husband have cleared a path for us down the stairs. Fear lends them strength. Adnan, the technician, bussing our kit from the scene and making the ambulance ready, tells us that the father picked up an entire bookcase by himself.

We run the patient out to the vehicle and transfer her on to our trolley. Although she’s still unconscious, her vital signs are encouraging, with a respectable blood pressure and saturations. Rae passes the ashice and we set off for hospital. Adnan follows on with the husband and father.

***

I can see them now, standing side by side in the dirty frame of the bedroom door, the husband holding on to his towel, the father intensely still, watching us as we work. It seems to me that they were standing together at the edge of some new and extreme margin, the outermost point of their lives together so far, where the solid earth they had built their home upon had inexplicably given way to a great gulf of black water. They had watched us struggle to drag their wife and daughter back from this terrible place.

And this time – the first time, for me – we managed it.

20 comments:

Rob Knell said...

Well done mate.

Even if it only works once, it's still worth doing.

uphilldowndale said...

Oh wow! :o

Spence Kennedy said...

Thx RK & UHDD!

I can't tell you how made up I was about it! The only other remotely viable ROSC I managed was with a sixty something female who made it to ITU but died there a day or so later. I don't know the outcome of this one yet, but by all accounts the prognosis is good.

So much is to do with timing, of course. We got there at a point where we could still do something. Excellent.

It's given me quite a lift!

;0)

S

K4zwales said...

I've not commented on your blog before Spence but I have been an avid reader for many months. Just wanted to say your writing is superb and more than once you have brought a tear to my eye. Please keep doing what you do both work wise and blog wise, those of us with "normal jobs" need to know how hard you all work!
Kaz

Spence Kennedy said...

Thx v much, K4z!

I think ambulance crews do work hard and it is stressful sometimes, but it also seems to me that working hard and being horribly stressed seems to be symptomatic of the working life of just about any British person these days. Just the other day we picked up a guy with chest pain - he told me about the pressure his dept was under to 'meet targets' and cope with various 'management initiatives' and 'IT implementations' etc etc. Very familiar stuff.

Marine Operator sounds like a cool job. I love boats (but I've only been on a dinghy and a ferry). One of these days I'll book a passage to South America on some rusty old bucket....

Sx

MarkUK said...

As a First Responder, I'm still waiting for my first successful outcome from a cardiac arrest. I get the calls to a CP of 75 years (and won't make 76 whatever we do, a 90yo frequent flier with more ailments than you can shake a stick at or a 79yo bloke who gave up the chost 14 hours ago.

My mates, on the other hand, get people like the 15yo girl who got a good sinus rhythm after one shock or the very fit 40yo who collapsed by the side of an off-duty cardiac Registrar!

Spence Kennedy said...

Hi Muk!
It's so true. Often the circumstances are stacked against you - age, time, bystander intervention or the lack of it, x y & z. There are often fantastic success stories you hear about back on base (seemingly hopeless resus cases in the street etc), but mostly it's elderly at home, mostly the same outcome. You do your best each time, though.
:)
S

southron said...

Many years ago I used to be a first aider...been there and done that three times...Miraculously one came back to fight another day...

Feels so good doesn't it?

Bloody well done you two...and brilliantly written as ever...

lightsandsirens said...

They say that you can't do effective CPR on a bed... The father clearly managed it as I'm sure otherwise her outcome wouldn't be looking so positive! Absolutely brilliant! My housemate was involved in a sucessful resus when she was doing her placement at the end of her nursing training. The patients wife drove him to the a&e and fetched staff, when they got to the car he had arrested. They bought him back and he was almost immediately concious and talking!

Anonymous said...

Another excellent piece of writing Spence.
Isn't Protocol c great! Its moments like that we joined the job for.
I've had my fair share of "bloody hell they've got a pulse" moments and its the best feeling in the world.
Keep up the good work and the brilliant blog.

Crazy Nurse said...

Good skills mate, and beautifully written. I've had the good fortune thus far in life to only witness in-hospital arrests, often with good outcomes

Mary said...

Hooray!

Spence Kennedy said...

Thanks for all your comments & encouragement!

Louise said...

Well done Spence, I'm still waiting for one of these.................

Wish it could have been Thursday morning's job (http://ambulancenut-learningtheropes.blogspot.com) but sometimes the odds are stacked against you.

Wendy said...

It's something special when it works isn't it :-) Makes all the other shit totally worth it!

Keep writing, I love your style.

Anonymous said...

Im the anonymous who posted at 3.10am, and would you believe it just over 12 hours later we successfully resusitated a lady in the street. She is currently sitting in CCU slightly bemused and wondering how she got into hospital and stating that her chest is bit sore, "yep 10minutes of chest compressions and 5 shocks will do that love" :-)

Spence Kennedy said...

Wow! Well done, anon! That's fantastic news!

;) S

Caroline said...

And they will always have a snapshot picture in their minds of you and Rae saving their loved one - how cool is that??

loveinvienna said...

*cheers from Vienna*
Great news! Really pleased for you, may it be the first of many more :) You can't always bring them back but the times you do must really make the job worth it.

Liv xxx

Spence Kennedy said...

Hey Caroline!
It is nice to think about that! Too often in those cases our faces must become associated with trauma and loss...

Liv - how are you?
It really makes the job! I had been feeling a little down about the ambulance - not the patient side of things, which I think I'll always like - but the admin / management / backstage stuff which gets a bit wearing sometimes... same as any job, I suppose. I don't talk about any of that in the blog because I'm scared I'll end up dragged down into The Vortex of Gripe. Euch. So I paddle away from it as best I can, and concentrate on the reason why the job is worth doing in the first place. (Nothing to do with stats/times/initiative xyz)
;)
S