Ghosts: A Tale of a Career Paramedic.

The Bright Side

By this point in the book I'm sure you are thinking that I'm some jaded old paramedic that hates his job, quite the contrary. I love my job. I love coming to work everyday. I love helping people in need. I'm not particularly found of the Private sector of EMS, but I wouldn't change anything. When I decided to write this book I had a concept in mind, truth. I wanted this to be a real as it can get. I have never lied to a patient, and I wanted this book to be the same. I wasn't going to overly dramaticise the calls I've had or the experiences I've encountered. I just wanted to share my thoughts and have it come across as genuine. So when it sounds like I am jaded, please be aware that I am just speaking the truth about the job and the price of helping people in need comes with. But there is a bright side to all of this. Along with the horrific events I have had the displeasure of being apart of, there have been more amazing and happy moments. I have witnessed the birth of a child at the delight of new parents. I have seen patients make remarkable recoveries from injuries or illnesses I would have never thought possible. I have comforted people in times of need and I have made friends with a few patients along the way. I think one of my favorite parts of the job is meeting new people almost everyday. I have had the poorest of poor and literal billionaires in the back of my ambulance, and all have a story to tell. On the non emergent infacility transfers, I.E., Hospital to Nursing Home, I have had some of the best conversations with complete strangers. I ask them all about their life they've led. I listen inyently as they tell me about the job they had, the children they have raised and becoming great grandparents. Given the chance, I ask about the pictures on the wall and who they are, most often family. I have had thank you cards delivered to me, sugary delights brought to the station for a job well done, and EMS discounts at stores are always appreciated. I have made solid friendships with comrades and connections that have helped me further my career. In my 13 years as a Paramedic there are 2 calls I am most proud of. The first being the only confirmed CPR I have ever had. It was a late summer night and I was working with my then girlfriend soon to be my ex 2nd wife (more on tha later). We got the call from our station over the fire radio of a woman who fell and is now unconscious. Upon reaching our ambulance, dispatched informed us that it was now a CPR in progress. My adrenaline immediately kicked in and I shouted to my parter/girlfriend/ex 2nd wife that it was a CPR. Moments later we and fire arrived simultaneously. We ran into the house with our gear to find PD doing CPR. It was a lovely house, big spacious rooms and a kitchen my wife now would die for. Natural wood floors, granite countertops, and the biggest fridge I had seen to date. It's funny the details you recall when there is a dead body in the room. The husband had i formed us that he was in the bedroom and he heard a loud thud and came out to find his wife unconscious on the floor and not breathing. I worki g around PD, started the IV, 18ga left AC (Paramedic standered in my opinion). My partner intubated and secured her airway with a breathing tube (not the right terminology, but I'll make it easy for the non medical people). We put on the defib pads and saw Ventricular Fibrillation, a lethal cardiac rythm. Only one option, shock the shit out of it. Cranked up the monitor to 100 joules, yelled clear and fired away. In TV medical shows, whenever they shock someone it's always proceeded with a loud noise, like a bang. They almost always jump half off the table or ground with the jolt of electricity flowing through their body. Let me assure you, it is far less glamours in reality. The only sound you hear is the small electrical discharge from the device, tiny really. And the patient only jumps a tiny amount, usually thers arms my shake and rise a smidgen. A bit underwhelming if you ask me. Like in most cases the first shock didn't do the trick, she required another shock. As per our protocol at the time, delivered 3 stacked shocks if necessary. Mrani g if the rhythm persisted, we lit the chest up 3 times in a row like a christmas tree. Nowadays, we delievery one shock and immediately start back on CPR regardless of the rhythm shown. The second shock worked, hoo ray! She was now in a normal rhythm. We staryed to package her up and head for the hospital. At the hospital after turning over care to ER staff I pulled the husband aside. It was my first field save and I wanted to know the outcome, regardless of what it was. I left him my phone number and asked if he would call and let me know, and he said he would. I left him with a handshake and best wishes. A week later I was in Chicago on the way home from my brothers wedding in WI. I was near the window of my hotel room looking out at the city skyline when my phone rang. I answered and it was the husband. He explained to me that when she fell to the floor after her cardiac arrest event, she struck her head which caused a brain bleed. She had been transfered over to a other hospital that had a Neuro ICU. He also said she was being discharged today and she was walking out under her own power with no neuro deficits. She was essentially back to her old self. I was elated to her that she had made a low odd defying recovery. Such tales are very rare even under the best circumstances. He told me that we had all done amazing work and that they were forever indebted to us. I find myself thinking about her occasionally. Wondering if she is still alive, that the second chance we gave her has lasted some 9 years down the road. My second proudest moment is of a sad situation, but the moment I don't think was bad. I'll let you be the judge. It was your typical snowy winter day. The roads were shit, cars at random had slid off into the ditch, and snow covered everything. I was working with a newbie paramedic, I can't remember his name, but I knew he webt onto teach English in Mexico with his wife who was originally from there. Good kid. We had been dispatched to yet again, another CPR. The fire radio had informed us along the way that we had been out to this address last night. We arrive and go into the house, my newbie partner, very enthusiastic runs into the house, damn near bites it on the slippery wood floors. I admit, even amongst a sad call such as a dead person, I would have laughed had he did, truth be told, I laughed to myself as he almost fell. Now, let me set the scene for you. Our patient wgo was in cardiac arrest was an end stage cancer patient that was on Hospice. All of her family was around, all... I noted the abnormal amount of people all gathered around, watching us like some horrified audience and thought it a bit odd. That was until I put all of the pieces together. I asked one of the first responder fire fighters why had we been called here in last night. It was the start of my shift and I had no such knowledge. He said, "For the same thing." (CPR). I said, "Well obviously not." Either she would be dead or be at the hospital had it been for the same call. We don't just bring people back to life an leave them, "Alright, good luck. Call us back if you need us." And they certainly won't be discharged in less than 8 hrs. So as we started CPR and took a look at the monitor and saw no electrical signal (Flatline, aka Aystole) we continued on. For whatever reason I turned around and saw the family all stairing at my patient horrified. Not the same look of concern of a really sick family member who is now in cardiac arrest. It was a different look, almost of disgust and disbelief. I snapped back around and saw the husband who looked lost, simply lost. I asked him what had happened, if he had knew what caused this event. It was then he informed me she had stage 4 metastasized brain cancer, and that she (herself) was put on hospice. Confused, I asked him if he wanted us to continue CPR, the full work up? He said yes, do everything that we could. I again looked at the family, the same look. I then looked at my lifeless patient. She was pale, very skinny, likr she had lost a lot of weight, as most cancer patients do. Her head was wrapped in bandages, presumably from the radiation therapy that was now discontinued. Had she been alive at that moment, I would be almost certain, she would have been miserable. She looked miserable. Taking all of that in I made a decision, some in my field have called in controversial, others have agreed or out right disagreed, but I stand by it. My patient had put herself on Hospice. And just a side note for those of you who don't know. Hospice is a program dedicated to those in end life stages, and it is for comfort only, no life preserving measures. A DNR (Do Not Recesutate) essentially. She had put herself on Hospice, she had known that her fight was over and had requested to come home, to die amongst her family, the ones in attendance. She wanted to die, her husband did not. Often times family will have a hard time letting go. Recently over the summer, I saw a 99 year old man be brought in for a cardiac arrest event. ER staff was doing compressions and the son was bedside yelling at his father, "Come on Dad, you fought in WWII, you're a fighter!" I thought it odd and sad all at the same time. I was like, "Dude, he's 99, let him go. He's got nothing left to prove, just let him go." It may sound callous, but if you have seen the amount of people who are brain dead being kept alive by ventilators, you would form the same opinion. It happens, I get it to an extent. It's hard to let loved ones go, there's a part of us that just wants to hang on. I told my partner that Id be back in a second, and I pulled the husband off to the side away from it all. I said, "Your wife is in Aystole, which means there is no electrical signal coming from the heart at all. Even on the remote chance I can get it back, ahe most likely will never wake up again. And even if she did for a bit, I can't cure the cancer, neither could the Dr's. She wanted to come home and die with her family, let her." He looked at me very intently. He wasn't angry or sad, he looked a lot less lost. He was looking so intently because he was making a difficult choice. He looked away from me to his wife, surrounded by strangers compressing her chest, and looked back at me. He took a deep breath and let it out in a heavy sigh and said, "You're right. You can stop." I nodded and turned around and made a notion to the responders to cease. The family i tially looked shocked but almost immediately looked relived. The responders were all confused, typically we don't stop until we have worked it for at least 30 mins, it had only been 5 at most. The Husband looked at peace, probably for the first time since the news broke about her cancer. Now the people that disagree with my decision have said that it wasn't mine to make, we are just there to do a job and not have opinions. I disagree. I was told from the very beginning that not only was I a medical professional, but that I was an advocate for my patient. I was their voice when they had none, I was to decide what was best for them when they couldn't. When I had pieced the puzzle togther and learned she wanted to die, I felt obligated to speak. I was her advocate, I was her voice since she hadn't one. I had to decide what was best for her since ahe couldn't. She wanted to die, so... That's what I did for her, I let her die. It's my proudest moment truly. I am more than happy for the lady that was given a second chance at life, truly a wonderous memory. But I am more proud for being an advocate for my patient, even if it meant letting them die.