Saturday, September 1, 2012
Sunday, August 26, 2012
There are three distinct incidents that I feel personnel assigned to the EMS unit need to arrive in PPE and ready to perform.
1) First Due Building Fire
When you are the first arriving medic unit to a building on fire you need to be fully dressed in your fireman suit and ready to work. Your primary responsibility is not to make the nozzle, ladder the roof, or run around and try to prove what a great fireman you are. You can do this when you are assigned to the engine, truck, or rescue. Your number one responsibility is to locate, triage, and treat any civilian injuries. In order to do this properly you need to be fully dressed so that you can safely approach and work in and around the scene. Large crowds are often found all around a fire scene. In these crowds you will find witnesses, homeowners, civilian rescuers, green linemen, and many of them may be walking wounded. It is your job to figure out what happened, how many are injured, and relay to command all of this information along with any additional resources you will need to begin to develop the EMS branch of the incident. Look for soot running out of nostrils or on clothing, torn or ripped clothing, citizens without shoes, cuts and scratches, or obvious burns. Adrenaline will be running high with victims and they will be ignoring any and all pain or discomfort. As you are doing this by no means should you neglect the kink in a hose line, but do not expect to be fighting fire. It is not a glorious job but a very important one. Everyone on the incident has a specific job to do and the EMS unit is no exception. If there are no civilian casualties your number two responsibility is to function as the initial RIT medic unit for any firefighter injuries or deaths that may suddenly occur. It has been said that the word "MAYDAY" is the most frightening thing that can be heard over a fire ground radio. It is your job to be prepared for and expect this event on every fire. Be familiar with the egress points and make a plan to evacuate any civilian or firefighter casualties from each exit point. Some tricks of the trade I have learned over the years are:
- Place your cot in the down position in an area easily accessed by all egress points
- Only bring essential EMS equipment away from the unit to perform the initial key functions in a cardiac arrest (airway, IV, defibrillation), everything else can be treated in the unit after the victim is evacuated from the scene.
- Use a reeves stretcher or a large soft stretcher such as a Shamu to evacuate victims. They work much better over hose lines and around common obstructions found on a fire scene than trying to roll the cot everywhere.
- Be diligent, be prepared, and expect the worst. Everything else will be no problem
2) Vehicle Fire
It is very important for the EMS crew to be dressed and ready to work on a vehicle fire. Not so they can smoke the engine with a dry chem, but to perform and/or assist in any victim rescue from the vehicle. It is a rare occasion, but the reason an EMS unit is dispatched on a vehicle fire is for just this reason. When you do roll up on an incident with a screaming victim hanging halfway out the drivers window with black smoke billowing all around them you better be ready. If you are not already dressed and able to easily and quickly don your SCBA you will be way behind the eight ball. Some tricks of the trade I have learned over the years are:
- Be ready to break glass and cut seat-belts.
- If you have an extra SCBA place it on the roof and give the victim air. We carry three on our units in case we have an intern.
- Bring a dry chem to the car (to help extinguish the interior fire around the trapped victim). They will appreciate this even more if you have a mask on them so they don't suffocate from the dry chem as well as the smoke
- Be mentally prepared for "whatever it takes!" If you have ever run an incident like this you know that it can be one of the most trying and stressful incidents you will ever run. There is nothing quite like being face to face with another human being while they claw and scream at you because they are burning alive. This image alone should be reminder enough for you to get dressed before you leave the house.
- You may need to enter the vehicle while it is on fire from the opposite side to remove the victim. This is an impossibility without full PPE and SCBA.
3) MVA with Extrication
On an extrication it is the rescue's job to either remove the victim from the vehicle or remove the vehicle from the victim. It is the job of the EMS crew to access and treat the victim during the rescue. This cannot be done unless the EMS crew is in full PPE. There should be no one in the action area around the vehicle without the proper PPE, but too many times you see a member of the EMS crew popping in and out wearing a station uniform and a traffic vest. This is unacceptable and should never happen. Some tricks of the trade I have learned over the years are:
- Be ready to break glass and cut seatbelts
- Absolutely do not try to enter a vehicle that has not been stabilized
- Coordinate with the rescue officer
- Wear a low profile rescue helmet rather than a suppression helmet. It allows you to move around the interior of the vehicle more easily.
- Carry a small amount of essential EMS supplies with you when you are the interior EMS. Be prepared to control an airway, start IVs, control bleeding, place tourniquets, etc.
Saturday, August 25, 2012
You must scrutinize any and all abdominal pain for the presence of an MI, regardless of what the patient is telling you, regardless of the quadrant, regardless of your gut instinct as to the origin of the pain or discomfort. Not long ago a woman walked into a hospital complaining of gallstones. She had a history of gallstones. She told the triage nurse the pain was more to the upper left quadrant and she was sure it was her gallstones. The patient stated she should of had her gall bladder removed years ago but did not and now she is paying for it. The nurse and the patient had a very thorough conversation regarding the patient's history, all signs and symptoms pointed to the gallbladder. After the patient was escorted to a room the doctor ordered a routine EKG and found the following:
This was no gall stone! The only reason we perform 12 lead EKGs in prehospital medicine is to quickly identify the presence of an acute MI. We cannot successfully do this unless we get in the habit of rapidly (within 5 minutes of patient contact) performing a 12 Lead EKG on all patients at risk of having an MI. That means all chest pain, chest discomfort, dizziness, syncope, shortness of breath, nausea, and yes abdominal pain to name a few. There are few medical patients that you can absolutely rule out the risk of an MI. If you are going to perform a 12 lead EKG on a patient it should be done quickly and efficiently. Train your partner and crew to make this part of their initial physical assessment and acquisition of vital signs. A well trained paramedic should never say, "do you want to get a 12 lead now or wait till we get to the unit?" My response to that question is, "exactly how long would you like to wait to determine the patient is having an MI? Would 10 more minutes suffice?"
Don't let an MI slip through your fingers just because the patient describes abdominal pain. You do not want to be THAT medic!
Saturday, July 7, 2012
Kidney stones can obviously occur on either the right or the left side as we have two kidneys, but we are going to discuss them here because we spent our time in the lower right quadrant focusing on appendicitis. Kidney stones are not life threatening but have been described as the most painful medical experience, including childbirth, one will ever encounter. One minute you are fine and the next minute it feels like you are being stabbed in the back or the groin. Most kidney stones pass on their own but the ones that don't may require some sort of urological intervention that can range from supplemental medications to surgery. Kidney stones do not cause symptoms until they try to pass through the urinary system. Symptoms are extreme pain in the back or side that will not go away, nausea and vomiting, blood in the urine, and fever/chills. The best prehosptital indicator that the pain your patient is experiencing is a kidney stone is a good history. A history that predisposes a patient to kidney stones are, male gender, previous stones, family history of stones, diet heavy in animal protein and eggs. There is no magic physical assessment tool here that will point towards a kidney stone in the field. The pain can be anywhere from the back to the groin, depending on where the stone has decided to get hung up, or radiating down to the groin. The best prehospital treatment for a kidney stone is good pain management. Pain medications are classically under dosed in the prehospital setting. Give an initial dose of medication and continue to give additional doses as long as their pain is greater than a 5/10. Your goal should be 0/10 pain management, but that is rarely possible with a kidney stone. Left untreated a kidney stone can lead to infection and sepsis.
The next emergency you should rule out is a big one and can definitely kill your patient faster then you can transport them to the nearest operating room. An abdominal aortic aneurysm is a permanent localized dilation of the abdominal aorta greater than 3 cm and is one condition every near syncope and every syncope patient needs to be scrutinized for. Symptoms can range from back pain to lower abdominal pain. it has been described as tearing, stabbing, or ripping pain. A pulsitile mass can be an ominous sign and if you feel one then you need to be very gentle with the patient and very carefully transport to the nearest hospital with an operating room staffed and ready to go.
Attached is a good YouTube video explaining the anatomy and the process of the surgical repair.
Thursday, April 12, 2012
The next test you can do is called obturator sign. The internal obturator muscle lies close to the appendix and flexation of this muscle in the presence of an acute appendicitis will cause an increase in pain in the lower right quadrant. A picture is worth a thousand words so this test is best explained by watching the following video:
This brings us to the topic of rebound tenderness. We have all learned that the presence of rebound tenderness in the LRQ could mean an appendicitis. Rebound tenderness is not an isolated test for an appendicitis. Anytime the peritoneum is inflamed you will find rebound tenderness. An inflamed and infected appendix will irritate the peritoneum thereby causing rebound tenderness in the area of the appendix. Rebound tenderness can also be an early sign of abdominal bleeding even before rigidity as blood in the abdomen will cause peritoneal irritation as well. So rebound tenderness in itself is not conclusive of an inflamed appendix. Using the assessment tools I have described above is much more specific and useful. When confronted with a patient with LRQ abdominal pain it is very important to determine the likelihood of an acute appendicitis as it is an emergent surgical case and a ruptured appendix can cause profound septicemia.
The most common signs and symptoms of an appendicitis are abdominal pain, loss of appetite, nausea, vomiting, and fever. When you have this presentation along with tenderness over McBurney's point and a positive oburator sign...think acute appendicitis
Friday, March 23, 2012
- Suicide Scale
- Homicide Scale
Monday, March 19, 2012
Thursday, March 8, 2012
- D: Demographics
- Age, Gender
- C: Chief Complaint
- What are they complaining of? Not to be confused with what do you think is wrong with them.
- H: Patient History
- Pertinent past medical history, surgeries, medications, allergies
- E: Events leading up to the 911 call
- What happened just before they called for help that contributed to the emergency
- A: Assessment
- Your physical assessment findings
- B/P, Pulse, Respirations, O2 SAT, Blood Glucose, EKG, 12-Lead, Lactate, and whatever other numbers are pertinent to the patients emergency.
- T: Treatment
- What did you do for the patient?
- R: Response to treatment
- How did the patient respond to your treatment plan?
- Asking for another opinion is never a sign of weakness. It shows a desire to be thorough.
- It's not about "emergencies", it's about being good to people, being kind, holding the bucket when they vomit, picking them up off the floor at 2 in the morning and holding their hand when they are scared.
- Nothing is above being a patient advocate. They called you for help and it's your job to do that to the fullest extent and to the best of your knowledge
- Always carry a pen....
- Learn and think on every call. Forever.
- Never stop studying, you are either getting better or getting worse.
- Noone knows everything
- Treating everyone like you would want yourself or a family member to be treated.
- Remember it is not your emergency it's the patients. And if you think you know/ seen everything then you need to quit, because that's when you are going to hurt someone.
- Learning the patients name and addressing him or her with it.. oh and a DOB wouldnt hurt either... :-)
- make the less experienced part of decision making
- know the basics
- Show compassion even when it's not really warranted.
- Keep your hands out of your pockets and show compassion.
- Most important of all....don't forget to put the ladder truck in service for routine calls.......we need to get back to the firehouse as soon as possible to clean and cook for the Engine and Medic guys and gals, and the Deputy Chief and his Aide!!
- People call us when they have lost control of something in their lives. It is very humbling. Sometimes they call us for something major, but, more often than not, it is something minor... but it is a situation where they need someone else to come in and take control.
- Also worth remembering is that we have the publics trust. In very few other occupations can you go up to a person and they willingly hand you their child or give you unrestricted access to their life, home and property. Do not ever forget or betray that trust.
- You have to put all your heart in to it and have the compasion to care for others. When we lose that things become boring. Thats when we tend to burn out.
- Expect the unexpected, be aware of your surroundings at all times, use the buddy system,
- The public call us when their lives are suddenly spiraling out of control. It is our job to restore order to their life, when possible, calmly with integrity, professionalism, and compassion.
- Treat everyone equally and love what you do.
- Do no harm.
As you can see there is a central theme in these comments which you can read in the title of this blog. The art of hauling humans is a vocation best developed with humanity, intelligence, compassion, and respect for our fellow man.
I want to thank everyone who responded to this Facebook post. It is all of you that has inspired me to create this blog and share the humanistic approach to fire and EMS with our brothers and sisters around the globe.
Wednesday, March 7, 2012
Monday, March 5, 2012
Sunday, March 4, 2012
Saturday, March 3, 2012
I just read a tweet from a friend of mine that said "Nothing feels better than knowing that you have Jesus in your heart." I couldn't agree more but I wasn't always that way. Today I think the fire service needs to get closer to God. In order to understand how I came to that conclusion let's take a step back in time and meet Craig Christ. A nickname that causes me to cringe now but used to bring a smile to my face every time it was uttered in my presence. You see, I spent the majority of my adult life as what I called a devout atheist. This was an oxymoron I found quite humorous as I sat around the firehouse kitchen table each Sunday morning and preached my special brand of devotion to nothing. I was dubbed Craig Christ by my peers as I always had a quick retort about the origins of Christianity or Jesus himself that would bring most Christians to their knees and cause others to go to church twice the following Sunday. I was raised to ask questions. Never rely on a single source. Seeing is believing. Skepticism was my calling. I used to follow black cats around, break mirrors, and walk under ladders just for the fun of it. Tempting fate and challenging God at every turn. All the time daring God to show himself. I would stand outside during a thunderstorm and dare God to strike me down. Open the kitchen door at the firehouse with horizontal rain beating into your face as you look up and ask to be struck down by lightning and see how quickly the room clears out. I had it all figured out. Mother Mary was a harlot who cheated on poor Joseph behind his back all the time claiming immaculate conception. If we had DNA testing 2000 years ago I would have bet the whole issue would of been cleared up in no time. Jesus was actually the son of the blacksmith up the road with zero morals and a silver tongue that seduced poor Mary into an impossible situation for the times. So what happens to a child that is raised from birth being told he's the son of God. He goes crazy of course. Schizophrenia manifested itself in Jesus' late teens and compounded itself into his early 20s. Hearing voices, having hallucinations of angels, and talking to himself as he spread the good word all the way up to his inevitable execution by the state. Sure enough if you have enough followers and are preaching a way of life that is against the grain of society eventually the government will kill you. Just ask Jesus Christ and more recently David Koresh. I had fashioned a most intricate version of the past to justify my lack of faith and devotion. It was an entertaining version of events, but not one bit of it was based on a shread of evidence. Then I met Marc Racette. Marc and I shared a kinship for EMS, as well as, fantasy and science fiction. We instantly bonded on every level except religion. Marc was a devout Christian and I was a devout Atheist. We would spend hours on the medic unit debating the meaning of life and the origin of man. We both swore that before we retired one of us would convert the other. I would leave atheist propaganda on the inside of his food locker and he would leave Christian writings for me to find throughout the firehouse. This went on for years and neither of us budged. One morning in 2007 I awoke at the firehouse to find a book on my nightstand entitled "I Don't Have Enough Faith to be an Atheist". An interesting bit of propaganda. I was impressed by the title but I hardly found it compelling enough to read. So it collected dust for years. Then following my divorce I met someone and we became very close friends. We could talk for hours about anything...anything except God. She didn't find my special interpretation of the events humorous at all. In fact they would bring tears to her eyes, and this broke my heart. One day she looked me in the eyes, took my hands, and asked me to take a serious look at God. She told me that I was a smart guy and stressed how important it was to her that I stop kidding around and seriously look into it. I was completely taken back. I was used to debating and arguing with whatever the antithesis of fire and brimstone was. I was used to having the last word and completely frustrating or causing even the most devout catholic to doubt their beliefs. No one had ever asked me to look at the other side with such sincereity and concern for my well being. I was accustomed to being either agreed with or simply dismissed. I was speechless. So I did the only thing I felt I could being faced with such kindness and concern. I told her I would. Thus began my journey to God. My co-workers will tell you I changed my mind overnight. How quickly time flies when you aren't the one thinking and studying during every waking hour. I had no idea where to start. I spent the next several weeks confused and wondering how my lack of faith could be so upsetting to her. Then one day as I was driving to work I remembered the book Marc had left on my nightstand. I had no idea where it was. When I got to work I looked up the title on iBooks and sure enough there it was. So I spent the best $9.99 of my life and began reading. Over the next several months the transformation was complete. Soon after that I was Baptised and I haven't looked back since. I felt like my eyes had been opened. In a profession where any day could be your last, a profession that has more than it's share of morally questionable people; just watch a couple of episodes of "Rescue Me", or listen to the old adage: "cops and firemen, trust them with your life but not your money or your wife," I couldn't agree more. Nothing feels better than knowing that you have Jesus in your heart. Don't misunderstand me. Some of the bravest and most honorable people I know are firemen. Both men and women, but like any profession we have to populate it's ranks with mankind and mankind is flawed. Unfortunately the type of personality that is willing to risk their life for a perfect stranger is also the same personality that tends to live for the moment. When you live for the moment you tend to make poor decisions. So, back to our original question: Jesus and the Fire Service? Amen to that!
Friday, March 2, 2012
There were three of us; we were professional firefighter/paramedics employed by the county of Fauquier. Fauquier County has been described as the bridge between northern and rural Virginia. For emergency response purposes, the county was divided into three areas: north, central, and south. Each area encompassed approximately two-hundred twenty square miles of beautiful Virginia countryside. We worked from 6:00 AM until 4:00 PM, Monday through Friday. This was the time paramedics were most needed because the volunteer paramedics had normal nine to five jobs. Although our official day ended at 4:00 PM, I often procrastinated and marked off duty usually no earlier than 4:15. It just didn’t feel right leaving sharply at 4:00 PM when I knew there would be no volunteer paramedics around until at least 5:00 PM, or in the worst case scenario, until I marked on duty the following morning.
I was sitting in the ready room at Company Two, the Remington Volunteer Fire Department. I was passing time and contemplating the ten minute drive back to company thirteen. The Lois Volunteer Fire Department was where I marked off duty and left the title of ALS-2 behind each day and returned home. I had nothing planned for the evening, and paramedics were a scarce commodity that time of day. I had just listened to my two peers, ALS1 in the central area and ALS-3 up in the northern area mark off duty. I was now the only career personnel on duty and, therefore, would be dispatched on any call in the county.
I’ll wait until fifteen after, then drive back, fill out the logbook detailing my calls and actions for the day, and mark off duty at 4:30. That’s about all the time I can justify without actually being dispatched on a call.
As I completed this thought, the radio came to life with a piercing tone signifying a medical emergency, “Companies six and one, 4780 Red Spruce Lane, for a cardiac arrest.” Time immediately screeched to a halt. This was the address where I had spent the majority of my life, my parents’ home. Thoughts of my father were thrust to the forefront of my mind. He was sixty-seven years old and had several heart blockages he had been ignoring for years. He had been afraid to undergo the essential cardiac bypass surgery that would save his life. He still smoked cigarettes and had been doing so for the past fifty years.
Dispatch did not send me on this call because they know it is my parents’ house. They are supposed to dispatch me on any call in the county. No matter, I will certainly be responding to this emergency.
“Craig…Craig…are you okay?” asked Zoey, a young volunteer who had just completed her initial emergency medical training.
I had stopped talking mid-sentence, and all the color drained from my face when the address echoed throughout the room. I stood up, quickly walked to the phone, and dialed the phone number to my childhood home.
“Hello!” my father answered in an exasperated tone. His breathing was harsh and fast. He was panting, and his voice was clearly faltering as he struggled to utter a simple hello.
I was taken back. My father was the sick one. My mother had high blood pressure, and she smoked as well, but otherwise, she was healthy. What could be going on here? I had prepared myself for my father’s death, and now I was speaking to him on the phone!
“What’s wrong dad?” I asked in a determined voice.
“Your mother is dead! I came home from the store and she’s dead.”
My father was never one to mix words, but when he said this so abruptly, a switch flipped inside of me. I became very tactical and calculating. The world slowed even more around me. I would not let my mother die. I can fix this. I am a paramedic for God’s sake. I’ve done this before. I can do it again. This is my mother. I have to do this. I needed a few simple bits of information, and then I would be on my way. My vehicle was idling out front.
“Is she cold and dead, or warm and dead?”
“She’s not that cold,” he answered.
“I’ll be right there!”
Click…I dropped the phone back on the receiver. That was all the information I needed. I began quickly walking with a purpose out of the building to my awaiting vehicle. To run would
be to lose control. I was not going to lose control. I was going to be completely in control of this situation. This is what I did for a living. I took chaotic situations and brought them back to order. I did this several times a day for other peoples’ families. Now I was going to do the same for my own.
“Do you need any help?” I heard Zoey say in the background as I headed out the door.
“If you can keep up!” was my response, and I meant it! Nothing was going to stand in my way. Zoey scrambled across the room and out the front door, barely shutting the passenger door before we peeled away.
I grabbed the microphone, “ALS-2 responding.”
“ALS-2 responding 16:10,” answered the dispatcher.
I activated the lights and siren and began the 15 minute drive to my parents’ house. Not a word was spoken inside the vehicle during the trip, but my mind was racing. The air was ladened with tension. The monotonous siren was a distant white noise blending into the background as I mentally prepared myself to work a cardiac arrest on my mother.
I can do this. What good is all of this training if I can’t perform now when it really counts?
The drive was down country roads. Trees and signs flew by me in the blur of my peripheral vision. Suddenly, one particular sign instantly took shape. It formed out of the haze as we approached the first sharp turn: “Maximum Safe Speed: twenty-five miles per hour.”I glanced down at the speedometer. It read eighty-five miles per hour. I eased onto the brakes.
Slowing down too fast at these speeds could be detrimental. I don’t remember how fast I was going when I entered the turn, but I pushed the Ford Explorer to its limits. As we rounded the turn, I lifted my foot from the brake and slammed back on the accelerator powering out of the turn at maximum speed. I felt the centrifugal force pulling my body out the window as we steered through the turn. The seatbelt did its job holding me firmly in place, the vehicle struggling to keep all four wheels on the pavement. Zoey’s handprint probably still can be found on the passenger door handle, her knuckles turned white as she held on with everything she had. Having successfully navigated the first major obstacle, my thoughts trailed from driving and returned to my mother.
She’s probably going to vomit. I have to be able to put in the breathing tube before she vomits. I can’t let any vomit get into her lungs.
I grew up driving these roads. I knew every turn and every bump in the road. If I had only known I would need to make this trip in record time. If I had only known my mother’s life would depend on how fast I, the only available paramedic in Fauquier County, could get there, I would have practiced it more.
Why did I get a job in this damn county? I shouldn’t be here. No one should have to do this, but I was the only one who could do this. I had to keep it together.
The Explorer was not going fast enough for me. My foot was to the floor, and it felt like we were crawling up this large hill. As we crested the hill, all four tires briefly left the road, my stomach leapt into my throat as we touched down. On the downside of the hill, my speed increased to a more satisfying level. I didn’t feel I was getting there fast enough unless I pushed the vehicle to its breaking point at every moment.
I need to make sure the IV gets placed quickly. Mom has good veins on her hands. It’s better if I can get an IV closer to her heart, but I will start in her hands just to make sure I have access. The sooner I can give her medications, the more likely she will come back.
The last long, straight stretch came up. I hated this part of the trip. The forty-five mile per hour speed limit was onerous on a normal day. I could feel the vehicle steadily gaining speed. I didn’t have the resolve to look down and see how fast I was going. I just concentrated on not making a mistake. Two more turns and I would be at the half mile gravel driveway to the house.
Get there fast, but don’t wreck on the way. That will help absolutely no one. But, I’ve got to get there first. I’m the only paramedic for miles around. If I can’t get to mom in time, she will never make it. How am I possibly going to get through this? Shut up, you freaking wimp. I’ll tell you how you’re going to get through this, one damn step at a time. And you are not going to make one mistake. Mom’s life depends on everything you do. Sometimes every single thing counts, and this is one of those times. Keep it together!
I made the last two turns and began driving up the long gravel driveway. The house was at the very end. Dust surrounded the vehicle as I went as fast as the gravel would allow. The rear end occasionally swerved right or left as my speed caused a loss of traction on the loose gravel. I pulled into the front yard and stopped ten feet from the front door, sliding through the grass and leaving brown ruts in the lawn as the Explorer came to a halt.
“ALS-2 on scene,” I barked into the radio as I swung open the door, leaving it open and bouncing against the hinges from the force of my exit.
“ALS-2 on scene 16:18,” replied the dispatcher. I had made the fifteen minute drive in eight minutes.
Eight minutes. Oh my God, that’s too long. Brain death occurs in four to six minutes. I can still do this. I have to do this. I’m the only one who can do this. God help me!
I grabbed the bags, the cardiac monitor, careened into the house and floated up the stairs. I could hear my father in the master bedroom, so I knew where to go. I rushed to my mother’s side. She was sitting up in her bed, pillows propping her up, with the remote control for the television in her hand. How many times had I seen her sitting in bed like this watching her favorite soap operas? She looked peaceful. The blanket was pulled up to her chest. I could tell dad had not disturbed her. I dropped the bags and placed the monitor by her side.
Rapid defibrillation is the key. I have to deliver shocks as fast as I can to save her life.
When I reached out and touched her for the first time to feel for a pulse, I was startled by how cold she felt…so incredibly cold. There was no pulse. Her jaw was frozen in place, as was her hand around the remote control. I couldn’t open her mouth at all. Her arms were stiff and ridged. Rigor mortis had set in. I grabbed the cardiac monitor and began placing the electrodes on her chest to read her cardiac rhythm. The room began populating with several people, but I remained fixated on my task. They were like flies buzzing around me. The ambulance had arrived. The police had arrived. My boss had arrived, and I was oblivious to them all.
To this day, I don’t know why I began to attach the cardiac monitor. There was no need to see what her heart rhythm was if rigor mortis had already set in. Such diffuse rigor mortis meant she had been gone at least three or four hours. It was a complete waste of time, but I wasn’t ready to let go. I didn’t get a chance to save her. I didn’t even get a chance to try!
A voice entered the din of my existence as the ambulance driver piped up, “You don’t need to do that, Craig.”
I glared in his direction. How dare him! I wanted to unleash a fury of anger on him for having the nerve to interrupt me. Before my anger was fully formed and able to lash out, I felt my resolve begin to lapse. When I was finally able to respond, I simply answered in a meek, cracking voice, “I know…but do you know who this is?”
Silence was my only answer. His silence disarmed me even more. A tear began to run down my face as I finished hooking up the cardiac monitor. All hope and determination was siphoned from my body, and numbness took its place. When I was done, I just starred at the flat line as it crawled across the screen. A flat line signified no electrical activity. There was nothing I could do. I was powerless. I was defeated. All of my training meant nothing. I collapsed onto my knees beside the bed and began crying uncontrollably. I don’t remember when I stopped.
The funeral was held several days later. The death certificate stated sudden cardiac arrest as the cause of death. The doctors said it was either a massive heart attack or stroke. My father had gone into town several hours earlier and returned home to find her. She must have died shortly after he left. No autopsy was performed. There was no need because there was no suspicion of foul play. She was elderly with several risk factors for both heart attack and stroke. As I sat in the funeral home listening to different people speak about my mother, I thought back to that horrifying day. I didn’t feel responsible or guilty about her death because she had been down for so long. There was nothing I could do. I felt guilty for risking my and Zoey’s life on that eight minute hell ride only to find my mother beyond all hope. I was angry that I was robbed of the chance to try and save her. If only my father had not gone to town. If only he had come home earlier. These were just a few of my thoughts as I tried to make sense of all this. Throughout those days, I came up with so many what-if situations, but not one of them helped bring my mother back. I did not blame my father. He was just following his routine and taking care of his daily chores. He had no way of knowing the love of his life would be taken from him that day.
When it became my turn to speak, I rose from my seat and approached the front of the room to deliver my mother’s elegy. I reached into my inside coat pocket and pulled out a poem I had written. I don’t think a single person in the room understood a word I read because I was sobbing throughout the entire reading, but this is what it said.
Regarding the Loss of My Mother
In times like these it seems that sorrow is the norm. No matter how much the sun is shining, I can feel the tears swelling up like the coming of a storm.
There are no words to express such a tremendous loss, loss of a mother, loss of a life, not to mention the loss of my father's wife. So I will spend no more times remembering the bad, only the good things that bring me to what I now have.
The memories of a mother that was unsurpassed. A woman who could make a house into a home, that could create a family and make it last. A woman who welcomed children into her home, they were just friends of the family, but she raised them like her own.
For 44 years she took on this task, never thinking of herself, for richer or for poorer, in sickness and in health, till death do they part. That's how it should be and that's how it was done.
If you can hear these words please remember your mother. If there is ever an undying love it exists in no other. If your mother is gone you can feel my pain. If you've forgotten to love her, never do it again.
Yes, in times like these it seems that sorrow is the norm. But we must remember the good things in life as we continue to morn. With each breath of a new baby's life another mother is born. This undying love now exists in another. But still, there are no words to describe the loss of my mother.
I returned to work two weeks later. When I marked on duty, I opened my log book and turned to the date October six. The date was neatly inscribed at the top of the page. A sea of white followed without a single blemish. It remains blank to this day. Somehow it didn’t seem right to record my actions of October six like it was just any other day. It was anything but a typical day. It was my final exam to remain a paramedic, and I passed. When I sat in class learning how to be a paramedic, I memorized human anatomy, cardiology, pharmacology, and treatment algorithms for various medical emergencies. I completed the course with flying colors. It all seemed so easy. I was so proud of the knowledge, skills, and abilities I had learned. I felt very comfortable managing medical emergencies, and I relished the challenges, but nothing I learned in any class or anytime throughout my life had prepared me for that day. It was difficult to return to work even two weeks later, but I did. If I had failed that exam, I wouldn’t have returned to work, and I wouldn’t be a paramedic today. It could have easily stripped away my identity.
Lesser trials have broken better men. That particular October six occurred fifteen years ago, and I still work as a paramedic today. Since my exam, I have been tasked with training many new paramedics. I have dedicated myself to helping prepare paramedics for their individual final exams. I often tell new students that all the initial training and certification does not make you a paramedic. Don’t worry about the test to become certified. That part is easy. Successfully passing the simple classroom trials only gives you permission to learn how to be a paramedic. The real test will happen one day when you are least prepared, and it will occur when you least expect it.