Thursday, March 4, 2010

Healthy, Sick, Dead [work story]

Last night we had a call that I can't get out of my head. I'll tell you the whole story, not just the part where I came in. [Identifying information has been changed].

So a man drives his 48 year old wife to the hospital because she is having chest pain. The hospital takes chest pain quite seriously, and runs tests looking for signs indicating it is all the worst things chest pain could be. It turns out, she is having a heart attack, and a middle of the night run to another hospital for specialized care in a cath lab is necessary. This is where I enter the story, as the driver of the ambulance to take her to the cath lab, code 3, in the middle of the night. See, the cath lab is closed at night and only opens for very dire emergencies. Like this one. So we arrive and the patient is alert, pink, warm, dry [heart attacks often present and pale, cold, and clammy], talking and joking around. Awesome! This bodes well for her probable outcome. Yesterday, this woman felt well and fit and healthy, and today she is sick.

We drive fast to the other hospital, with a nurse on board just in case the patient needs medications to control her pain, and because some of the meds in her IV are above our scope of practice. At three o'clock in the morning, the cath lab is staffed and waiting for us, they do the surgery, and finish and hand her back to us in under an hour. We load her back up. She is pink, warm, dry, talking, happy it's over, and healthy again. I hop in the front seat and take my time on the drive back. Almost an hour later my partner sticks her head through the window between the front and back of the ambulance and says, "Um, can you go a bit faster? Our patient's blood pressure is 80/35 and she looks pretty grey." Woah! What happened there?! So I step it up, and when we arrive at the original hospital and I go to help unload her, she looks like SHIT! In and out of consciousness, pale as a sheet, sick, sick, sick. WAYYYYY worse off than when we picked her up. Holy crap! And her blood pressure just hit a freefall. Normal blood pressure is around 120/80ish--the top number is more significant than the bottom number for paramedics, though it is still significant with regards to health. Above 150 and there is added stress on your heart, lungs, blood vessels, and kidneys in particular. Below 100 and you feel dizzy a lot, have blackout spells, or difficulty moving quickly from a lying or seated position to standing. Below 80 and you lose your radial pulses and have difficulty staying conscious when sitting up or moving a lot. Below 60 and you lose your carotid pulse and seriously compromise oxygenation of your brain.
This woman's blood pressure is now 47/15. The nurse escort is doing not much. I mean, he dumped fluids in her IV and stuff but he didn't seem to be experiencing any of the "Sphynctor factor" my partner and I were experiencing. You know, where you get anxious and your butt sphincter winds up somewhere near your esophagus? We rushed the woman up to ICU and I kid you not, TEN MINUTES later she died. And they pounded and pumped and blew and shocked, and she came back to life again. The last I heard she was still alive but not expected to live beyond another 24 hours. The surgery in the cath lab is performed by sticking a long, flexible, very narrow, hollow tube in her femoral vein and threading it up to her heart to open the blood vessels in her heart and stop the heart attack. When they pulled the catheter (tube) out, it left a hole in that vessel. It would have been closed, but I'm not sure what technique was used, but it was either not closed enough, or the blood thinners she was on to treat the heart attack prevented her body from making a clot to heal that hole, and all five liters of her blood poured out of the vessel, into her abdomen, under the skin so it was impossible to tell from the outside until her pressure dropped and she went pale, cold, clammy, and whoozy. [Yes, whoozy is an official medical term. Or is it vertigo? Ha ha. And yes, I did just make a joke in the middle of recounting tragic mayhem] She was given multiple blood transfusions and many drugs and liters and liters of fluid, and it looked like a war zone in the ICU afterwards. Crazy.

The part I can't get out of my head was the medical intervention part. Without the surgery, she would likely have died. But it was a complication of the surgery that killed her. And so fast. At such a young age. Crazy. Life is just crazy sometimes. You know, it is funny because I had this niggling intuition that we should watch her closely, you know? Like death was hanging around and somehow I smelled him.

Travelling mercies, Mrs. X, whether you survive the ICU or not.


lori lls said...


Breanne said...

I just want to say thanks for doing your job. You have the type of job where I am so thankful that people are willing to do it, because I know I NEVER could. I couldn't handle meeting a nice lady, joking around with her, only to find out a few hours later that she is dead. I'd be an emotional mess. Kudos to you and your co-workers!

Asheya said...

Wow, that is so crazy. It's interesting that you had a feeling that you should watch her. I find the topic of gut feelings very fascinating, and I think that many gut feelings come from information that only our subconscious brain picks up on, so that we have data that we cannot logically identify but we just have a 'feeling' about something, which often proves to be right. If she was bleeding internally there may have been a certain energy in her body that you picked up on, that equated to a feeling on your part.

I like hearing your work stories, although of course I am sorry that this woman is dying.

tamie said...

Traveling mercies.

tamie said...

P.S. For the few weeks before my Grandma died, I had the feeling that death was impending somewhere in my life. I didn't know she was at the end of her life, and I had no idea where the death would come from (so obviously I was a nervous wreck!), but after she died, the feeling went away.

melissa said...

I agree with Asheya regarding intuition. I think it's based on something, or several somethings, that we observe without knowing we observe them.

And who knows? Those of us who are particularly sensitive can probably pick up on the presence of an angel of death drawing closer.

Tamie; crazy story! Wild, especially knowing the unexpected and traumatic nature of your grandmother's death. I'd say on a sensitivity scale, you're probably in the thousands, while the rest of us are in the hundreds.

I also think it is protective, this intuition regarding imminent death. The death doesn't knock us off our feet with surprise, because we were already hovering JUST above sitting down in preparation, because we kind of felt it was coming!

It is wild, this life.

Tamie said...

Welllllll......I was actually talking about the other Grandma, the one who just died this past summer. The Grandma who died in a fire--that did indeed completely blindside me.

Which isn't to say I'm not super-sensitive, much to my detriment sometimes! The issue for me is figuring out what's genuine sensitivity to real stuff, and what's like, paranoid sensitivity. Know what I mean?


lori lls said...

I too believe there is much to be said about listening to your gut, even when it doesn't quite make logical sense.

What's weird is that I have the feeling of impending death all the time. I think you and I have talked about that some, Tamie, the 24 hour death channel inside our heads. And Melissa, some of the anxieties you've mentioned center around death / injury to people you care about, right? It's so hard to sort it all out.

In regard to the death of loved ones, I really wonder if the fear of it, the negative anticipation, is worse for our psyches than the actual event. We lost a close family friend a couple weeks ago, but for her husband specifically, there was so much relief. Granted, it was after a 6 month illness. But still, the wondering, the waiting, was more traumatizing than the death itself. This may not relate to accidental deaths...but it may.

By the way, what was the outcome for this lady?

Tonya said...

I actually read this one! :-) Not a good story though. You are amazing at your job. Question though - blood pressure under 100 (top number) isn't good? Mine's many times 90/60. :-) Am I dead? :-)