The Pain of a Patient’s Death
By: Diaries Of An Emt
Tags: Death And Dying, Paramedic, Ambulance, Patient Care, Emergency Medicine

Diaries of an Emergency Medical Technician

One early morning during an ambulance shift, I pull up to a house expecting “weakness and numbness in the legs,” as stated on the dispatch. I am grabbing the first-in equipment bag when a woman bursts out of the front door yelling:

“HURRY! HE’S NOT BREATHING!”

I run into the house and toward the bathroom where this woman is indicating. I find the patient on the toilet, slouched over with his head against the wall. His face appears limp, his mouth draped open so I can see his tongue. His son is gripping on to his shoulder and asks me what is happening. I try to get a quick history from the son as I check for breathing and a pulse. Both are absent.

“He was complaining 30 minutes ago of numbness and tingling in his legs. That’s why we called the ambulance,” the son says. “He went into the bathroom and was in there for a while, so I barged in and found him like this.”

“Alright,” I say. “Let’s move him to the floor.”

The man’s son and I both grab an arm and lift up the man in order to slide his limp body from the toilet seat to the ground. In the process of moving him, some feces stain the toilet seat, the man’s pants still at his ankles.

As my two ambulance partners (one driver and one trainee) rush in behind me after grabbing equipment from the ambulance, they ask for details. I try to summarize the situation as I start chest compressions. This is the first time I have ever had to do manual chest compressions on a real person. During an ambulance call, one partner usually sets up a machine called the “Lucas,” which delivers mechanical chest compressions to a cardiac arrest patient. Somehow, until now, I have always been the partner who sets up the machine.

However, today it is me feeling the disturbing crackles and pops as I push down on the chest, the sensation that is caused by cartilage connecting the rib to the sternum separating. I know the popping noises indicate that I am giving good compressions, but the sounds and feels of pushing down on real human’s chest instead of the mannikin I practiced on in training is shocking. My two partners set up the bag-valve mask, used to administer breaths to a patient who is not breathing on his own. When a backup rescuer arrives a few minutes later, he sets up the LUCAS, and I switch from doing manual chest compressions to delivering ventilation via bag-valve mask.

Thirty minutes later, a paramedic comes to provide advanced life support. He starts an IV and delivers medications. As he walks in, I look up for the first time since I had arrived. I notice about 4 first responders standing in the room who I hadn’t seen or heard enter the house. I also notice that my ankles hurt from kneeling on the wood floor, and I shift my balance to alleviate the pain.

We continue with the same routine — delivering CPR, stepping away for the AED to analyze the patient’s heartbeat, and resuming again. No pulse is detected for the entire ordeal, but we continue until the paramedic speaks:

“2 more minutes of CPR.”

We all know what the paramedic means by this statement. While CPR can be an effective lifesaving technique and should almost always be attempted, many first responders would tell you that at-home episodes of cardiac arrest often have bad outcomes. For every minute that a person’s heart stops, the chance of bringing them back decreases. Three minutes after the heart stops pumping blood to the brain, the lack of blood flow can lead to progressively worsening brain injury. By 10 minutes, odds of survival are low. Therefore, while ambulances respond to the scene of emergency as quickly as possible, the life-saving window is slim upon arrival.

With his words, the paramedic is recognizing that this man has been pulseless for nearly an hour. He is giving us permission to finally acknowledge reality. Up until this point, we were all acting under a sort of collective denial. Denial — of the rejection of truth — is sometimes considered a weakness in other aspects of life. However, it is a sort of skill in the EMS community. As first responders, we show up to a variety of dire situations and must put 110% of our energy into saving a patient’s life, even when we know that the chances of survival are sometimes slim to none. For me personally, denial is an essential driving force. If I stopped for a second to ruminate on the low chances of survival for a cardiac arrest patient, I would be entertaining feelings of negativity and grief before I even attempted lifesaving interventions. Pushing these emotions out helps me to focus and provide good care.

The paramedic pronounces the patient dead. The transition from the symphony of medical machine noises to silence is chilling. I hadn’t realized how loud the room had been a minute earlier, between the verbal instructions of the AED, the beeping of the heart rate monitor, and the pounding of the Lucas machine on the patient’s chest. However, the silence after we all step away from the patient’s body is deafening.

The chaos resumes just 30 seconds later when my partner’s body hits the wooden floor with a thump. In the wake of all the stress and the heat of the room, she has fainted. It is like her body has decided that it is finally time to relax before her mind can realize she feels exhausted. We check her vitals to assure that the fainting was stress-induced and not medical. It feels so bizarre to be treating my partner — the new patient — while a dead body lies on the floor just 3 feet away. The paramedic insists that my partner go to the hospital, and she does.

After my partner leaves in another ambulance, the police come to deal with the dead body. I leave the house and chat outside with the fire department employees, thanking them for their help. Someone even cracks an unrelated joke and I laugh. I feel a sort of guilt and confusion for my laughter, but I think it serves as a release of tension that could have otherwise only been satisfied by weeping.

I have seen people die before on the ambulance. I understand that it is an unfortunate, but inevitable, part of the job. For whatever reason, this death impacted me differently than any other I have seen. While I don’t know why, I do know that it is important for me to put my thoughts on paper, because someone may see them and relate.

After leaving the scene, I return to the ambulance headquarters to chart the incident, as we always do. Then, I drive home. At home, I make my first cup of coffee of the day. Just as I am about to sit down and take my first sip, my head explodes with thoughts. I start to go over my experience with the deceased patient from the minute I entered the house to the minute I left, analyzing and scrutinizing every detail and every choice I made, over and over again.

How fast did I run to the bathroom to find the patient?

Could I have run faster?

Did I take too long when I tripped over that piece of rug?

Should I have told my partners behind me to hurry up?

Did I take too long to get his pulse?

Did I take too long to move him onto the floor?

Did I take too long to start chest compressions?

Were my chest compressions good?

Why did my partner fiddle with the bad-valve mask before getting it on?

Did my partner take too long to get the airway adjunct in?

Should I have just put it in instead?

These questions go on and on in my head for HOURS. I meet my mom for a run to try and escape the rumination, but it continues. The more I think about the experience, the more the memories seem to slip away. I feel like I do immediately after waking up from a dream, as the harder I try to think about the content of the dream, the faster it fades from my memory. The memories disappear to a point where I am questioning everything about the experience. I even question the memories that remain. Can I even trust what I think I know?

Why can’t I seem to remember anything that happened?

How we could have been there for an hour when it all feels like a total blur?

What if his heart was actually beating when I got there, and I somehow missed it?

What if I didn’t even take his pulse?

What if he was breathing?

What if his death is my fault?

I now know that many of these questions are completely irrational, but in the hours following this incident, every doubt I had felt so real.

I have my mother to thank for advising me through this tough situation. She made the simple suggestion that I meet with my ambulance partner and discuss the incident. I was so overcome by emotional thoughts that I wanted to talk with him right away. We met an hour later and discussed each detail of the event, reliving the experience together in a way that was both painful and cathartic. We filled in holes in each other’s memory and ultimately realized that we had done all we could.

I will admit that the experience still hurts. Now two weeks later, I still sometimes catch a mysterious smell on my hands that somehow reminds me of the scent of the room where the man died. I have purposefully avoided the obituary section of the newspaper these past weeks because I would rather not come across his name or any details about family he left behind. However, I feel a lot better than I did in the hours following his death.

I don’t really know if this story has a moral. I guess I hope that it is something that others in the medical community can identify with. In my experience, grief and loss can sometimes hit home in a profound way for healthcare workers, and that is ok. Emotions are unpredictable, but they make us empathetic care providers. I hope that this experience does not make others see me as a “weak” EMT, and I hope it doesn’t mean that I can’t handle this job. I instead hope that my compassion makes me a more caring EMT, and a more relatable person.

From this experience, I have learned to appreciate the “team” approach in the healthcare environment. Communicating my feelings and doubts to an ambulance partner was the best thing I did to get over this trauma. I have learned to lean on my team members and trust their judgement in addition to my own. I was not alone on that ambulance call; I was surrounded by a support system.

Trust your team and trust yourself. There will be times when you will question your choices and even your memories. In these cases, rely on your knowledge and skills to get the job done. If you are struggling, lean on your colleagues. A job in emergency care is hard, and it is our duty to not only support patients, but to support each other.