For those who have never been exposed to death, it can be a scary thing. Death can stir up feelings inside of individuals that they did not even know they possessed. An individual’s first encounter with death can make them feel angry, devastated, depressed, and simply confused; at least that is how I felt when I had my first encounter with death. I had been working as an Emergency Medical Technician in Inglewood for about a month and a half when I had my first encounter with a patient dying. My partner and I got a call at approximately five-thirty in the morning for a full arrest. The patient was an eighty-two year old female, full code, who was residing at a convalescent home, and who received a complete code workup. I took over chest compressions when my partner and I arrived on scene, and continued with chest compressions all the way to the hospital until the Physician called time of death. After the Physician pronounced my patient, I was devastated. I felt that because I was the one doing chest compressions the majority of time during the call, that my patient’s outcome was a result of my performance. As well, I was angry because my partner and the other Paramedics on the call were completely fine after time of death was called- joking around with each other, laughing, and carrying on as if nothing had happened. I could not understand how these men could just have a patient die on them and not think anything of it, and that made me angry, upset, and confused. I cried my entire drive home.
Well, my first encounter with a patient dying was nearly a year ago, and I can say for a fact that I do not feel the same way about death that I did then. Now, I have lost track of the amount of times that I have encountered patient’s dying, and honestly, death does not really affect me anymore, I cannot allow death to effect me. Death is something that I encounter on a regular basis, and over the past year I have become immune to it, and I have taught myself to simply laugh about it. Because honestly, if you cannot learn to laugh about death when you encounter it so frequently, you will want to do nothing else but cry. You have to learn to put up a wall and to separate yourself from work, otherwise work will eat away at you. Over the past year I have had to learn to separate myself from my work, and thus, I have had to learn to separate myself from death. I now view death and patient’s dying as something that simply happens. Death can happen to anyone, any time, in any circumstance, and it can happen to those that do not deserve it in any sense. The only time that I have ever started crying at work was when I had a 2-month old full arrest that did not survive. Honestly, I think pediatric calls and pediatric deaths are really the only types of calls that still affect me. There is something about children, maybe it their innocence, which still manages to get to me. When I had the 2-month old die, the call stayed with me for at least a month. I could not stop seeing the little blue baby’s face in my mind, could not stop hearing the mother’s cries in my head, and could not forget the terror that I felt the entire time I was bagging the infant. So I suppose that I was not completely accurate earlier when I said that death does not affect me anymore. Adult death does not phase me, at least I have yet to encounter a call in an extremely long time where I have been affected by an adult dying, but there is still a part of me that aches when I encounter a child that dies.
One of the ways that I have found that helps with encountering death on a frequent basis is writing about the experiences. The piece below is about my fourth experience with death approximately eight months ago. It was when I wrote this piece that I was realizing how I had changed as a person, and that patients dying no longer upset me like it had in the past, which was scary because I realized that me separating myself from my work was causing me to lose emotion in other areas of my life, which I have found may be a sacrifice that I have to live with to survive in the medical field.
Full Arrest.
Full arrests. You have a love/hate relationship with full arrests. You love them because they are legit, and you finally feel like you are able to use the skills that you have been taught, that you have spent hours practicing, that you were so eager to use in the classroom, and that actually make you feel like you are making a difference. You work up a sweat [you are usually dripping when you are done], and you have so much adrenaline rushing through your veins you feel that you could take on the world. You have never felt stronger in your life. You have never felt more accomplished. But even after all of that- you still hate them. You hate them because you have never seen a person survive. You hate them because the poor bodies you work up get destroyed. You hate them because they are messy- not just kind of messy, but messy in a sense that you have to make a conscious effort to not vomit on the patient while you are doing chest compressions. Vomit. Sweat. More vomit. More sweat. Urine. Crap. Full arrests are messy.
It had been a pretty [dare I say it] quiet day in the city of Inglewood, a nice change since last shift you didn't see the inside of the station for 14 hours. You had been enjoying your afternoon nap when the phone rang, and just like a robot, jumped out of bed, quickly threw your boots on, pulled up your pants, and sprinted out the door. This routine had become so second nature that you could very easily do it in your sleep, and on most nights, you usually do.
The call information came streaming over the radio with the address numerics, the fire station that you would be running with, and the call type- full arrest. Crap. While your partner maps you to the call, you sit there wishing that you had eaten before your nap so that you would have more energy right now, and because full arrests always make you so hungry afterwards.
You arrive at the call 3 minutes later. You unload the gurney while your partner grabs a backboard. Pd is already on scene. As you roll the gurney up to the door the first thing that catches your eye are three kids [the oldest could not have been older than 11] standing by the front door. The kids look up to you as you walk in the door, their eyes full of tears. The look they give you pierces your heart. No one has ever looked at you with so much hope and faith before- and it kills you because you have yet to see a full arrest survive. You walk in the door just as one fireman is beginning compressions, and after you put the backboard down and help cut off the man's clothes, you jump on compressions. You forgot how exhausting these things are [boy you wish you had eaten]. As you are doing chest compressions you look at your patient- gosh this guy is young, turns out he is only 49. He had been eating spaghetti [which is now spurting from his mouth] with his 7-year-old son when he collapsed and went into full arrest. Please God, you pray, please let him make it. You glance at the front door while still trying to continue the rhythm of your compressions to see if the kids are watching. Pd is talking to the kids- good; no one should ever have to witness a full arrest work up. No one.
You are on scene for 15 minutes, and you never get the patient to v-fib [the rhythm that the heart needs to be in to shock]. The medics push a round of epinephrine.... then a round of atropine...another round of epinephrine.... nothing. Absolutely nothing. You are reminded why you hate full arrests [you begin to feel like you are just prolonging death, not actually saving a life]. You load up the patient, wheel him out to the ambulance [the entire neighborhood is standing in their doorways now, this is probably the most excitement they have had on their street this month], load him up, and speed off to the hospital.
You roll into the parking lot of the hospital about 4 minutes later, throw the ambulance into park, put on a pair of gloves, and run around to the back to open the double doors and let out your partner and the 2 medics that are in the back with the patient. You pull out the gurney, your partner jumps on the bar connecting the wheels [this is called "surfing the gurney"] and continues to do chest compressions while you push the gurney up the ramp and into the Emergency Room.
This ER is like your second home, and on some days you spend more time here than at the station. You know the nurses, they know you, and for the most part, you have a great relationship. "WHERE ARE WE GOING?" you yell as you roll into the ER...."room 1" the nurse replies. You go into room 1, move the patient from the gurney to the hospital bed, and stay in the room in case they need help, which they usually do. As you are standing against the wall the other bed in the room catches your eye.... it contains a body bag, and the room you are standing in quickly begins to feel like a morgue.
Your partner is still doing chest compressions and you can see the sweat dripping from his face [you have never seen his face that red]. The nurse responsible for the drugs wishes she has five more hands and begins asking you to prep the iv bags and prep the drugs...eppy...atropine...bicard...dextrose 50. Your pulse is racing, you have never been this involved with a full arrest patient once you have arrived at the er...hopefully you get to work on him until the very end. You jump on chest compressions now, your partner is exhausted. The doctor compliments your chest compressions, you feel accomplished.
Another round of drugs is given. He is shocked [you are amazed because this is the first time you have actually seen a patient get shocked with a bolt of electricity]. Then another round of drugs is given. He is shocked again. Then one more round of drugs. It has been 20 minutes. The doctor asks you to feel the femoral artery for a pulse. Nothing. Absolutely nothing. The doctor asks you and the nurses if anyone has any ideas or objections, no one does. She calls it. Time of death, 20:36. That is 4 for 4.... every full arrest patient you have ever had has died. Dang this gets depressing. You look over at the other dead body in the neighboring bed...you could really feel the death in the room now.
You leave the room and go out to the hallway to begin to clean the gurney. There is a knock at the ER entrance door coming from the waiting room, you glance over, it is a woman, with 3 kids standing by her side, saying that her husband was just brought in by ambulance, the security guard [whom you have come to be great friends with] looks over at you and asks if you brought him in. you nod, keeping a blank look on your face, hoping she gets what you are trying to say. She does. She tells the wife that she will be called back soon. The security guard scurries over and asks if you brought in the full arrest. You respond by saying that they just called it. "Damn. There are 3 kids out there" she responds. "I know. The kids were the ones that called 911" you reply back. "Damn" the security guard mutters back.
You finish cleaning the gurney. Remake it with a crisp white sheet, and roll it back out to the ambulance. As you are walking the gurney back out you think to yourself how 4 months ago you would be heart broken that your patient just died. But now, it doesn't even seem to phase you. Just another "day at the office" you think. You are becoming so immune to death. You can feel yourself losing your emotion. You can feel yourself becoming less human.
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