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One Night, Two "Marathons"

PegLeg

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It occurred to me as I was driving an ambulance, my hands trembling from the rapid descent after a spike in adrenaline: I enjoy my job because it’s a lot like running and racing.

Just a bit prior, I was on my knees in a crowded, semi-lit living room, surrounded by 3 firefighters, 2 paramedics, and 1 other EMT with the same title as myself… hovering over the exposed chest of a male in his 60s who was sprawled supine on the floor. My palms were face down over his sternum just above the xiphoid process, where beneath lay that precious pump of the human body: the heart. A heart that had stopped working.

Cardiac arrest.

It is controlled chaos. The area around the patient looks like a tornado went through a medicine cabinet… used needle catheters, wrappers, packaging, medical bags with contents spilled everywhere, oxygen tanks. I am doing chest compressions, taking over for the firefighter who had been doing CPR upon our arrival. He is now ventilating the patient via bag-valve mask, a breath every 5-6 seconds. The medic in charge of the scene is reading the cardiac monitor and calling out instructions. One medic is inserting an IV, pushing meds. The other EMT is holding the IV bag and handing over supplies. Another firefighter is speaking with family, getting information and medical history. There is sobbing, wailing, from one or two adult daughters, or perhaps a wife? I am too distracted to really take note, but I see glimpses of them in the shadows as they helplessly watch, as they call his name over and over, entreating, willing him back.

Push-push-push-push-push-push…  I have never done CPR on a human before, but the EMT training in class comes back. Beads of sweat are forming on my forehead and I hate that I didn’t take off my uniform parka; it is very warm in this crowded room. There is a hot spot forming at one place in my palm from it rubbing against one of the defibrillator pads with each compression. I feel calm.  Acutely aware of every sound, sight, smell in the room, in ice-cold clarity, but at the same time, it seems as if I am in a dream. A trance. I am compressing, hard and fast, using my shoulders to drive the clenched palms downward. 20 thrusts, 50 thrusts, 100. You lose count. You just keep going. Someone asks me if I want to switch out yet. I shake my head and say another minute. Push-push-push-push. The monitor is showing the pumping of the heart; right now, we are contracting this man’s heart for him. Nowhere nearly as well as the healthy, functioning heart will do on its own, but enough to keep oxygenated blood circulating in vital organs.  And most importantly, oxygen to the brain.

The medic calls for a pause to check. CPR stops. The AED is analyzing, seeing if there is a shockable rhythm to deliver a charge to. For a second, everything halts, and I swear every person there held a breath at the same time. If nothing has changed, we have to go back to CPR, maybe another shock/charge, back to begging the body to respond.

And then. The zig-zag blip across the screen. The medic reaches down and checks the carotid pulse. “We have one!” he says, and instantly radios headquarters to let them know we have a converted arrest.  All 7 first responders gathered around let out a collective sigh, sharing quick nods of relief. It is a team effort.  

I feel tears pricking the back of my eyelids. Except there’s no time to waste now as the patient is packaged and carried out to the ambulance. Just because he has a pulse again does not mean he’s out of the woods. The family realizes that we stopped CPR, but that he is alive, and they are expectant and hopeful. We transfer the patient into the primary unit’s ambulance, and two medics hop inside with the second EMT driving. They head out with lights flashing, while ventilating and monitoring the still-critical patient. (FYI, Paramedics are amazing. They are the doctors of pre-hospital medicine, they are the kings of the emergency scene). I follow in my unit’s ambulance. I look down at my hands and realize that I am shaking. The entire time on-scene, I felt dead calm. Now I’m climbing back down the adrenaline ladder and it hits me like a tidal wave.

There was the déjà vu, the familiarity. This is like running a marathon. The fear going in, the trepidation and nerves. While racing: the cold, calculating focus of doing what needs to be done, the almost trance-like state. The final suspense, the push to the finish, the physical demand. Then the relief, the accomplishment, the completion. Followed by the emotion, trembling, the wide-eyed coming out of the fog.

A converted arrest feels like a marathon PR. Maybe even a better feeling, since you helped give life back to a person whose name you don’t even know.

And then because the EMS gods are like the running gods in that they are unpredictable and ruthless, our unit got called to a second cardiac arrest on the same night. I go nearly 3 months without witnessing one… then I help work 2 of them in a 12 hour period. When it rains...

As the assisting unit, we show up after CPR had already been initiated by the first-in unit. We assist with extrication and transport, this one being about 25 minutes from the hospital. At the hospital, I am on the side of the stretcher, feet on the lower rails a couple inches off the ground as two medics are wheeling myself and the patient into the ER. My one hand is holding onto a top rail to keep my balance, the heel of my other hand is used for one-handed CPR.  As once again, I hover over a heart not my own…pushing, willing, hoping.

It is strange how we humans are so connected. My own heart is exerting, doubling down, pumping harder… in order to help save the heart of another.   

An entire team awaits, swarming around us. A nurse takes over the chest compressions. I stand back, walk out, joined by the remainder of the teams. Our work is done. Once again, the shaking, the coming down from adrenaline. It is morning, nearly 12 hours in, at the end of my shift. I am suddenly exhausted. More so than I have ever been at the end of a shift. Today, the heel of my hand is tender and bruised, my shoulders and upper arms sore.

Before we leave the hospital, we are informed. We couldn't save this one. Too far gone before anyone arrived, but there’s a duty to act and to always try.

This is more of a race DNF feeling, the one where the outcome isn’t what you wanted. It hurts. You feel sad. Just like marathons gone awry though, you have to remind yourself you did what you could, you gave it your best. It is the unfortunate nature of cardiac arrests, much like races: perfect outcomes are more the exception than the rule. The variables are many and the margin of success is small.

There are boring shifts of medical transports and helping Grandma up after she fell off the toilet. There was that time driving to Pittsburgh in a snowstorm with a two year old in the back of the ambulance, going to Children’s. There are end-of-shift calls that force you to clock out two hours late from a 12 hour shift. There’s vehicle maintenance and rig checks and supply restocking. Holding puke bags for vomiting patients. Cleaning blood off the stretcher. And charting, oh the endless charting. There’s a lot of mundane stuff as well as challenges taking you out of your comfort zone. In just a couple of months, I've been on a maternity call where a baby was born, a shooting with multiple gunshot wounds, a pedestrian struck by a car, several overdoses, and now two cardiac arrests. I've never missed the office job.

And yes, I still run sometimes, too. Planning on gearing up for a spring race, and maybe some trail running and an ultra this summer. My focus has definitely shifted now that I work more and am focused on furthering training/experience in that field. But you cannot ask more from your life’s work than to have it give you purpose. And in the same way running helped shape me, fill me, and give me purpose, well, this is no different. A time on a clock or a heartbeat on a screen. You are fortunate indeed if you are able to do the things that make you glad to be alive.

 

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I don't even know what to say. This is powerful. Thank you for sharing this glimpse into the path you've chosen.

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Wow, that’s intense. +1 what SIbbetson said. 

I love the way you write. Thanks for sharing. I’m sure it is very much like a marathon. 

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