A Look Back

I was reading some old entries I made on another blog, and I found the post I made after my very first ALS call. It makes for interesting reading:

The baby was on the kitchen counter, and everyone was just looking at it. That’s what I saw when I ran into the apartment. We snatched up the baby and ran, with the mother wailing after us.

A few minutes earlier, the call had come in for a 3 month old, not breathing, and my stomach had turned over. I’m the paramedic, and I’m less than comfortable with pediatrics. Everyone has a weak area, and that’s mine. EMT-Basic, EMT-Intermediate, Paramedic… I’ve always felt weak in peds. I offer up a silent prayer.

In the back of the ambulance… No pulse. No BP. Mom is in the front passenger seat, and my driver is talking soothingly to her. The baby has been down for at least twenty minutes, and probably more. Shit. There’s still a little warmth there, even though the monitor shows asystole.

We’re going to work this kid.

Dave, spike a bag, and I’ll look for a vein in his scalp. Never mind a vein… the IO kit is right behind me. Prep the site with alcohol, betadine, betadine… Insert the needle, push and twist… *pop* and I’m in the marrow. Try to aspirate some marrow fluid… nothing, but that doesn’t mean anything. Try to flush it. It’s difficult, but it flows with no sign of infiltration. Good.

“Mom, what does he weigh?” “Fifteen pounds,” she says. “Is he breathing?” “We’re doing everything we can,” I evade. Mental math… Half 15 minus ten percent is around six and a half kilos. I push 0.6 of epi and flush with about a 50cc bolus. Continue CPR. I have a minute to breathe now. Consider intubation… No, we’re getting good compliance with mouth/mouth, and he’s pinked up a bit, I think. Nobody has bothered with PPE on this call. You make sacrifices. I check the monitor again. Nothing but CPR. I pray for a spark, a blip…

I’m getting ready for atropine, and we’re at the hospital. I grab the baby in one arm, the bag of saline in the other hand, and run. They’re ready for me. They take over, and I’m left holding the bag. Literally, I’m standing there holding up a bag of saline as they take over CPR, and I give my report.

“He’s been down a minimum of 35 minutes at this point. No pulse, no BP. We’ve had good compliance and chest rise with rescue breaths. He’s fifteen pounds, so I make it 6.5 kilos. IO seems slow, but it runs. I’ve got about 50cc’s in. 0.6mg of epi in, about 2 minutes ago.”

The doctor gives another round of epi, then atropine. After a while, he asks if anyone sees any reason to continue. No one does, but no one wants to stop, either. Finally, he calls it. I realize I’ve been clinging to my bag of saline like a life preserver, and I lay it down on the edge of the bed. I take my hat off, and we all cry.

I’ve gone over the call a hundred times in my head since then, trying to think of something I missed; some way I could have forced a spark back into that lifeless little body, but the fact is, I did everything I could. I was afraid of pediatrics, but my training didn’t fail me. He was just too far gone. I didn’t freeze up or freak out. I did my job.

It’s payment, really.

The bad calls are the price we pay for getting to pat each other on the back and congratulate one another when we make a save. One bad call can sour a whole string of saves , and one save can redeem a string of bad calls. It just depends.

I love my job. I love the excitement of the emergency calls, and I love the predictability of the routine transports to and from dialysis. I derive a little bit of joy every time I start an IV or run a 12-lead, and every time I ask a little old lady if she’s warm enough and she says she’s fine. I hurt when my patients hurt, and I’m happy when they get some relief.

Really, I’m a lucky, lucky man. Maybe later I’ll tell you all the reasons.

I’m going to plant a tree for the little boy who died before he got a chance to live.

It’s interesting to look back and see what my perspective was at the time, and see how it’s changed.