We’re called for a person not feeling well in an elderly housing hi-rise not far from the hospital. The man is an emaciated AIDS patient, who is laying naked on the couch in his dark apartment. he has a colostomy bag. His girlfriend says they were at the emergency department for seven hours today, then left.
“What did the doctors say was wrong?”
“Nothing. We were in the waiting room.”
The fire fighter first responder says he can’t feel a pulse, but the man is talking and alert. Its not unusual to have a difficulty feeling a pulse on some AIDS patients who are often baseline hypotensive. Since it is so dark in the apartment, I just say put him on the stretcher, give him some 02 and we’ll work him in the ambulance.
Downstairs in the ambulance, I try for a blood pressure and can’t hear anything. His nail beds are white. I put in an IV while my partner puts him on the monitor.
“Why are you grimacing?” my partner asks.
The man is suddenly writhing.
“My chest hurts,” he says.
I look at the monitor. He’s in V-tack.
I slam some lidocaine in the IV line and tell my partner to drive to the hospital. We are only a coupld blocks away.
I put the pads on the man’s chest. “This is going to hurt,” I say.
Before I hit the shock button, I pull out my intubation kit and have it ready.
I shock him.
He screams.
Still v-tack.
“Sorry, I have to do it again.”
I shock him. He’s out.
I grab and tube and using a device called a bougie, slide the bougie between the vocal chords, then slide the tube over it. I’m in in like twenty seconds. I do some compressions, venilate through the tube, grab some epi and slam it in the line, and just like that we are out at the hospital.
Another EMT comes around and helps us unload the patient. When we wheel him into the cardiac room, the doctor takes one look at his emaciated body and says, “He’s asystole, he’s dead.”
“But he just coded like two minutes ago,” I say.
“Look at him, he’s terminal.”
The doctor is right. He looks like a Biafrian.
“He was v-tack. I shocked him twice. He was here for seven hours today in the waiting room.”
The doctor ponders a moment, looks at the ECG, says, “11:34,” and leaves the room.
The nurse takes the rest of my report, then writes in the time, then goes over to prepare the body.
The man takes a breath, a deep gasp.
She jumps. “Oh, my god.”
He gasps again, and with each gasp, his breathing becomes more regular. She hooks him up to the monitor. He has a rythmn.
“I guess I better get the doctor.”
She comes back with the doctor just in time to see the man take his last gasp. The monitor goes back to straight line.
The doctor shakes his head. “He’s dead,” he says.
“You don’t want to give him some epi?”
“No.”
He turns to leave the room. The man takes another deep gasp.
The doctor turns and glares at him as if to command him to cut it out. He’s still breathing.
The doctor approaches, lays his hand on the man. He stops breathing.
“I’m giving him epi,” the nurse says.
“Fine,” the doctor says. He glares at me. “Thanks again,” he says.
I have been bringing him a number of codes lately. “My pleasure,” I say.
I leave to write my run form. When I come back fifteen minutes later there is a sheet over the man. The nurse stands across the room watching him.
“He’s really dead now?” I ask.
She gives me a sarcastic smile as she accepts my run form, then returns her gaze to the body on the ER table.