Highs and Lows: The Low

“Comms 15, priority one. 9 year old male, cardiac arrest.”. Tabitha and I glance at one another, knowing that the only available ambulance is an intermediate truck and we’re going to get this call any

way. “16 Comms, we’re clear of the hospital, we’ll be en route to that call.”, I hear play again in my head and I wish that I hadn’t. My prayers have been said, and all that can be done now is to get to the scene and see what happens. Dispatch has thoughtfully continued the intermediate truck to the call as well and they’re en route well ahead of us, from where I’m not certain.

Traffic moves at a snails pace and, as per the usual, nobody wants to get out of the way. “Come on, assholes, move.”, I say to myself, knowing that it won’t change what’s about to happen. Before I know it, we arrive on scene— with no intermediate truck yet. Fire and PD, however are on scene. Tabitha and I get our equipment and head for the door, just in time to be met by PD who is pushing furiously on a child’s chest. not fifteen seconds from our arrival on scene, PD unceremoniously plops a limp body onto my stretcher. He looks considerably smaller than a typical nine-year-old and I realize that he looks that small because he is that small. I can’t help but notice that he is the most beautiful baby boy I have ever seen. He was pale and blue, and yet appeared to be sleeping peacefully.

Tabitha takes over compressions and I ask the question, “So, what’s the story”, applying the cardiac monitor as PD gives me the details. “Mom’s in the house. She was getting ready to head to the bus stop to pick the rest of the kids up; says she checked all the doors as usual. When she got ready to leave, the kid was nowhere to be found.”, the officer rapidly blurts out. We head for the ambulance, him helping me push the cot while Tab stays on the chest. He continues, “She found him in the pool and he wasn’t breathing. She doesn’t know CPR and that’s when she called. He’s been down about 10 minutes.” I nod in thanks and though I don’t say it, he knows I’m grateful for him and the fire department. The cot is moved into the ambulance and seated in its position with a resounding thud, I hop in as the intermediate truck arrives on scene.

My thoughts run wild, sorting through the plan and what’s needed, Monitor’s on. Need access. Epi. Tube. Move Quick. “Where do you need me”, my thoughts are interrupted by Phil, the EMT Intermediate, snapping me back to reality. I toss him the intraosseous drill, hoping he’ll get access into the bone so we can divide and conquer. “If you don’t mind, I’d rather you do it.,” he says, “I’ve never done it.”. Fuck, man, I haven’t either. I haven’t been a Paramedic for more than 5 minutes. Nevertheless, I understand where he’s coming from. I grab the drill, and put a little pink needle into his tibia, flushing to make sure it’s good. “Give him an epi”, I say as I pass a tube, put on an end-tidal and glance at the monitor. Asystole. Nothing. The epi goes in as fire continues compressions. I look at Tabitha, “Let’s move. I’m ready to go”. She understands the urgency and lets herself out, hopping up front. “16 Comms, en route with one to Regional, Code blue”, I hear on the radio. Code Blue. Cardiac arrest. He hasn’t even had a chance to live, what the fuck is going on in the world?!, my thoughts briefly take over as a I feel the rig lurch forward, siren blaring, and we’re off.

Fire is furiously pumping on his chest. Despair taking over as I look on the monitor and see exactly what I thought I would. Asystole. Again. Another amp of Epinephrine goes in through the osseous catheter, and I spike a fluid bag with a pressor. His best chances of survival are happening, everything is being done, but the Reaper is ever-breathing down our necks, and time is not on our side. As if time not being on our side wasn’t enough, a sudden blast of a horn brings me back to reality as we stop. “You’ve got to be SHITTING ME!!!” I scream to the heavens as I look out the window just in time to see a bright orange train engine chugging toward right where we’re at. A train. A fucking TRAIN?! WE DON’T HAVE TIME FOR THIS!, my head screams as I give another round of Epi into the bone. I look at the monitor and its still asystole.

I wipe the sweat off my brow and get my next round of meds ready again. The train has finally passed and we’re off to the hospital again. I call my report, “Regional ER this is EMS 16, inbound patient report, code blue status.”, I push another found of Epi as I hear them say, “Go for ER.”. “16 inbound to your facility emergency status, 14 month, that’s one-four month old male, cardiac arrest, probable drowning. Full ACLS in progress. CPR was started within 5 minutes of him being found and is ongoing, patient is in asystole, 4 rounds of Epinephrine given with no change. We’ll be with you in 5”. They acknowledged quickly and after what seems to be an eternity, we pull into the ER bay. The waiting room is full as we breeze through the doors, a firefighter riding the stretcher to not delay compressions. Not much has changed and time is running out. We all know it, but we’re unwilling to give up. We get into the trauma room and move our patient to the ER stretcher, Give the rest of the report; we’re now up to 6 rounds of epi, no change. The ER team swarms the patient, and we back out.

I turn to walk away and there is the face I hadn’t seen yet. The patient’s mother and I make eye contact, tears fill her eyes as she searches my face for something, any inkling of hope. I give a sad grin, wishing that I could give her that something she was looking for, but I simply can’t. All I can do is hang my head and walk away. I busy myself working on the chart, trying to keep my mind off of what’s going on. My thoughts drift to his mother. How awful she must feel, believing that she checked everything (of that I have no doubt). One lock missed, one door that could be gotten through, and now her life will never be the same, barring a miracle which I don’t believe will come. Furiously typing on the keyboard, I see the chaplain out of the corner of my eye. He makes his way over to me, puts his arm around me and asks a question that destroys me…”Are you okay?”. All I can say is No, before shutting the laptop and hurrying out the door and to the ambulance, which is still parked at the ER entrance. I have to get out of here.

I can’t get to the truck fast enough. I feel the sting of tears filling my eyes and about to drip down my face. I can’t allow anybody to see, because this isn’t me. The automatic doors open and the fall breeze hits me; its a chill as cold as ice, oddly fitting in this moment when death’s clutches have sank in. I make it to the back of the rig, stealing a glance inside, seeing the destruction. The wrappers in the back, empty Epi containers, syringes, defibrillator pad packaging cover the floor and before I can stop it, the floodgates open in the form of tears. I sit on the tailboard of the ambulance, head in my hands, and sob uncontrollably. I reach into my right leg pocket and remove my pack of cigarettes, I need something. I light and take a long, deep pull from the Marlboro Red now in my lips, the sweet sensation of nicotine tickling my receptors as I wipe my tears away. I stand up and breathe. My partner brings the cot and the laptop, and gives me the news. “They called it. It’s over.”. There it is. Finality. Death has won in spite of our best efforts.

We spend the next several hours putting the truck back together, asking the questions, “could we have done anything differently? Did the train make any difference?” No, I don’t think so. I truly believe we did everything that we possibly could, the odds just weren’t in our favor. The days go by, I see his obituary. He was the youngest of 6, loved playing with his brothers and sisters. He enjoyed playing “where is that baby” and “peek-a-boo” and I smile as I imagine the family in happier times, his beautiful little face lighting up the room. His mother invites us to the funeral, my partner goes, but I can’t. I don’t like funerals anyway, but this one cuts too deep. Too raw. Too real. My heart hurts for his family.

As it does, time marches on. The days turn to weeks, the weeks to months, the months to years; it’s been 10 years this year. I wonder where the siblings are, how they’re doing, if they’ve found some sort of peace through it all. For me, time marches on, too. I’ve run many calls, had many more bad outcomes, but this one will always stick with me. I will forever carry his memory, and every October, when the leaves change and the summer fades to fall, I remember the most beautiful baby boy I’ve ever seen. I imagine him in heaven, playing with the other kids that went before him.

This job is full of highs and lows. On this October day, I experienced the highest of highs and lowest of lows. What a ride.