WARNING: This post contains graphic descriptions and scenarios that some people may find very extremely distressing.
So there I was after an awful day at work, sitting in a local pub, nursing a couple of drinks. It's a good way to unwind after a bad day, offloading to people that really know you. No bravado, no showmanship, just good company with people who care about you. Perfect! Unfortunately, even the nicest pubs attract idiots. And drunk idiots at that! The one tonight was harmless, but latched onto us as his new best friends. It didn't take long for him to find out I was a paramedic, and then that was it. Suddenly I was immersed in tales of the '24 hours in A & E', 'An hour to save your life', and '999:What's Your Emergency?'. Apparently he watched them all and therefor was an expert. He was under the impression that everyone we met, we saved and obviously had no comprehension about death and what death involves. It isn't anything like they show it on Holby City and they can't show the reality of it, even in the fly-on-the-wall documentaries. I didn't want to sit there and set him straight but for those not in the know, this is what I associate with cardiac arrests and death.....
"36 year old female, cardiac arrest, CPR in progress."
My heart sinks, just 36 years old. I really hoped it wasn't as given, but the more information I got, the more I knew I was about to walk into pre-hospital hell. I pulled up with a screech and grabbed everything I could carry. I was first on scene and had no idea how long I'd be on my own. I rushed up the garden path to see a kid, no older than my son, standing at the doorway.
"Please help my mummy, she's not breathing."
I literally can't deal with that stuff, so I ignore it. Children add a huge amount of emotion to any situation and cardiac arrests, are not a place for emotion. I need to stay calm, get in my zone and focus. It sounds very 'self help' but I do get in a zone and we all do what we have to do to keep our head in the right place. I bounded up the stairs to find our patient lying on the floor, her husband desperately doing CPR under the instruction of a call handler counting out the compressions over the speaker phone. I asked him to carry on whilst I got set up.
There was vomit all over her face and her hair was matted in it. When my hands touched her face, I could feel the vomit on my fingers. I begun ventilating her. With every ventilation, blood squirted out of her nose. I begun to suction the airway. I could tell the husband was beginning to really struggle with what he was seeing, and I didn't want this to be how he remembers his wife. I also can't deal with his emotion either so I sent him off to find someone to take the 3 children who were in the house. Again, the fact they were in the house and the fact that he was crying was something I chose to ignore initially. It's my way of focusing and my way of staying calm.
I took over CPR as he was leaving the room. A number of ribs cracked, the sound of which made the husband visibly cringe. I could feel my knees in the vomit and blood but it didn't matter. Neither did the blood spray up my forearms. Luckily for me, the second car arrived. I secured the airway with an i-gel and continued to suction the blood and vomit that just kept coming. The other FRU started trying to get IV access. The was no joy on the hands or arms, her veins were so shut down, it was futile. I then tried on the external jugular vein (EJV) on her neck but again, no joy. The only way we could now get access was to drill into her bone.
I continued to manage the airway whilst the drill was set up. Just as she was about to drill into her leg, a child appeared in the doorway. You can try as hard as you want to ignore certain situations but some you simply can't. The little girl was no older than 5. Her mummy was lying on the floor covered in vomit and blood, a tube coming out of her mouth, blood trickling down her arms from failed cannulas and a paramedic kneeling on the floor holding a drill. We both paused for moment not knowing what to do.
"Excuse me!" I called out. The husband appeared in the doorway. "Your daughter really won't want to see this."
She was quickly whisked away. The needle was drilled into the bone so at least we could now start giving drugs. Unfortunately, as one problem was solved, another appeared. Despite the constant suctioning, the airway was becoming increasingly unmanageable and full of blood. We decided to remove the airway that was in place and intubate. This was not without risk but on balance seemed the best thing to do. I took over chest commissions whilst my colleague get everything set up. Luckily the ambulance arrived, so with their student we now 5 people to work with. The student took over CPR, I started running drugs through, the other medic assisted with the intubation and the other went about do temperature, blood sugar etc and rotating the CPR duties.
The longer the CPR went on the worse the chest was looking. After about half an hour the top layer of skin on the breast bone had been pulled away due to the friction of constant compressions. Her chest was covered in blood and stomach contents was seeping out of her peg feed site. She had also become doubly incontinent, which is common in cardiac arrests.
We did everything we could and did so for over an hour, but to no avail. We called a time of death and all just sat around looking at each other, not really knowing what to say. We all had blood on our hands, arms and clothes. We all had blood, vomit, urine or a combination of the 3 on our trousers. Me and the other FRU had blood on our faces due to the original CPR and ventilations. I cleaned myself up the best I could so I could go and speak to the husband.
I stood at the top of the stairs and was reluctant to go down. Breaking bad news is not something we are trained to do, even more so in people so young. I had to tell a young man that his wife, the mother of his three children, had died. I had to tell him that everything we had tried, had failed. I didn't know, standing at the top of the stairs if the children were down there. I didn't know if I was going to the person they associate with hearing their mummy is dead. I didn't want to be the person to do any of that, but it had to be done. I started making my way down, and the husband appeared at the bottom of the stairs.
"Is she dead?"
"I'm so sorry sir, we tried everything we could but I'm afraid she has passed away, I'm so sorry."
With that, he dropped to his knees and wept. I just stood there, choking up myself. I didn't want to turn around and go back upstairs, but also didn't feel comfortable watching him. I put my arm on his shoulder and apologised again. A neighbour appeared in the doorway. It turned out that all the children were in her house. She knew what had happened and took over front me. I couldn't get up the stairs quick enough, it was just awful.
There is often very little dignity in death. This young mother laid dead on the floor between us. She was lying in her own urine, faeces, she was topless, she had friction burns on her chest, she had a needle drilled into her leg, a tube coming out of her month and clamped to her head, she was covered in her own vomit and blood and her grieving husband and children were a floor below her crying and not having a clue how to cope and deal with her sudden death. This is why these things are not on Holby City, this is why fly-on-the-wall documentaries stay outside of jobs like this and only tell you what has happened. It's because no one ever needs to see this stuff. We see it, and are part of it because we have to be. Any other eyes have no place being there, in person or through a TV. Death is not a soap or entertaining and that is why it is sugar coated for everyone. It may be considered reality TV and but it is as far from reality as can be.
Perhaps if I hadn't just done this job three hours earlier, the man in the pubs enthusiasm for pre-hospital entertainment might not have irked me so much.