A choice. The one thing worse than having no choice
We pulled up a perfectly judged fraction short of a tyre screech out front of the call out address. It was dark and I had to shine the scan light on the front of the house looking for the street number. This was the place. The call was urgent so we grabbed our equipment from the ambulance locker and headed straight in.
The front door was open and there, right in the doorway, was the patient. This was handy. The lady, elderly, was leaning against the wall clearly struggling for breath. She looked up at us and waved over her shoulder into the house. Quickly I looked past and could only see the length of the hallway and a small part of the room beyond. This was a fairly desperate invitation into her house but I could see that everything about her was desperate right now. We entered as far as she was standing. She couldn’t walk any distance and we weren’t going to make her.
I turned back to her to help. Her struggle to breathe was too obvious. She clearly couldn’t speak so engrossed was she with her gasping. Her home we were in but this was my home turf as we went to work. I stared into her eyes and reassured her it was going to be alright. I pulled out the stethoscope to listen to her lungs but she pushed me away. She pointed over her shoulder again.
It seems obvious now that she was trying to tell me something. But I wasn’t listening. I mean I was listening, but to the stethoscope. I was in medical mode. I could hear lung sounds. I didn’t need to listen to all the other signs around me. And there important signs. But I digress.
The lady was repeatedly pointing over her shoulder down the hallway. She pointed again with earnestness and deliberateness. My partner was pulling a Ventolin mask over her face to help with her wheezing but I was distracted now. What was down the hallway? All looked calm. Surely she didn’t want me to turn the oven off or let the cat out? It can be amazing sometimes that before a patient can allow themselves to be overcome by the life threatening illness, they have to put the cover over the budgie cage or turn off the kitchen light. Normality and overwhelming crisis both fighting for equal time and attention.
My partner couldn’t get past me as the lady and I blocked the narrow hallway. I said to him that I would take a quick look past to see if I could find out what she was pointing at. A few steps was all it took to find out. A foot. Attached to a leg. Attached to the rest of an elderly man lying on the floor. Deeply cyanosed from holding his breath too long. His breathing stopped when his heart did. I swore, remembered the lady, winced, then called even more urgently for my partner.
This was the real patient. Her husband. He had collapsed and was now in cardiac arrest. No pulse, no breathing, not anything. I looked at my partner and he swore too. Then he too cringed apologetically. He looked back down the hall and the lady had now also slumped to the floor, still alive but with only about a feeble grasp on that now.
We attached the cardiac monitor and could see there was nothing but a flat line. His heart had stopped, something we already knew. I started chest compressions and could hear my partner calling for back up on the radio. “Roger, we’ll see what we can do but there is nobody nearby,” wasn’t the message we wanted to hear back. We knew though that every ambulance in the city would have heard our call and would be climbing over each other to make themselves available. Still that could take time. Even minutes we didn’t have.
My partner returned to the lady and dragged her down the hall nearer so that we could see her. I was performing single person CPR now, a very bad situation indeed. The lady’s chin had slumped onto her chest in that a sure sign that she was very close to joining him. My partner stepped past and took over trying to ventilate the man’s lungs leaving me now closer to the lady. Calling her name, she opened her eyes briefly but without recognition.
I looked at my partner and we both knew. We had to stop working on the husband. Some would say let him go but the harsh reality was that he was already gone. If we kept working on him she would almost certainly join him. Maybe that would be better? That thought is immediately blown out of my head. We don’t pick and choose like that, we do our best for everybody.
Confirming that any help will still be several minutes, we make the agonising decision to stop working on the man. The lady doesn’t have several minutes. Fully focussed again on her now we return to what is in itself a dire resuscitation. Police arrive in response to our call as we are going to have to leave an unlocked house with a deceased man on the floor. And the job of breaking some bad news to some family members.
The good news is that the lady improved a little on the trip into hospital. The asthma, almost overwhelming, was abating enough now for her to open her eyes again. She still struggled to breathe but she lived. She even spoke again. She only asked me one thing on the way there. When you are desperate to breathe you tend to use only one or two words to talk. That is a good guide to how bad things are. She was down, or should I say up since she was getting better, to one word. Better than no words.
Better except what that word was. “Jack?” Jack with a question mark. Jack her husband. It is bad enough to have to break the bad news, but how do you tell someone that you were the one who stopped working on Jack, that you let him go, to save her. No wife of fifty years wants to hear this.
Jeff Kenneally www.prehemt.com