I posed a question in my previous post. I asked, "Do the dead hear us?"
I asked this because I had a very strange interaction with a "dead" person who couldn’t seem to decide whether he was going to be dead or not. There was some talking.
Not many people are calling for ambulances on this particular night. As I’ve mentioned before, I’m based out of an emergency room and frequently jump in to help the nurses when I see a need. Tonight Melvin had been having chest pain for a few hours and finally drove himself to the hospital at his wife’s insistence. He’s an overweight Filipino in his early 50s. He walks in under his own power looking slightly uncomfortable. I don’t see where I can contribute anything valuable and wander back to my little corner of the ER.
Five minutes later, Melvin is lying in the bed in the resuscitation cubicle (it’s the space in the ER with all the cool toys you need to stop someone from dying right away). I find my place doing chest compressions while Dr. "B" gets ready to intubate. The monitor shows persistent ventricular fibrillation (the heart is just wiggling instead of pumping blood) and in between trying to shock it back to function and dose it with medicine to make it wake up and work right, I’m beating him up to make his heart pump.
Things go well with the emergency physicians and nurses (and paramedics). Dr. B can’t intubate the patient. Melvin is intermittently clenching his jaw and once we get him paralyzed and sedated (RSI), Dr. B goes in with a laryngoscope (A metal "shovel" to push the jaw & tongue out of the way, enabling Dr. B to put a tube into Melvin’s trachea.) but discovers that Melvin’s obesity and odd mouth shape (short jaw) make it impossible to see where he’s going.
Maddog is a smart ‘medic sometimes.
I had noted Melvin’s odd jaw and such when he walked in. When I heard the code get called, I ran into the trauma room and grabbed our brand-spankin’-new GlideScope.
Tools in the toolbox, I’m all about tools in the toolbox.
The GlideScope is, basically, a camera on the end of a laryngoscope ("mouth shovel") that let’s me see around corners and intubate patients that we can’t intubate by looking directly. It’s pretty dang cool.
I’m doing chest compressions and I point with my chin at the GlideScope I had placed by the oxygen tree. "Used it before?" I ask Dr. B.
"No. I even missed the training." He tells me.
A Lebanese nurse relieves me on chest compressions while I do my paramedic thing! Using the GlideScope, I promptly intubate Melvin and we now have much better control of how much oxygen we can get into his body. We even have the chance to suction out his stomach (which had filled with air before we intubated him) thereby allowing his lungs to expand further and take in more oxygen-rich air.
Once the breathing tube is in place and secured, I go back to my preferred role performing chest compressions. The nurses here have pre-assigned roles for a code. My job is not assigned so I help out where I can. By taking over the chest compressions, I have freed up a skilled nurse to get supplies, pull drugs from the pharmacy (I don’t have an access code) and otherwise benefit the patient further.
And so I pound away while drugs are given, cardiologists mutter and Melvin’s wife sits across the room looking stunned. I get short breaks while Melvin’s heart rhythm is analyzed and he occasionally gets zapped with therapeutic electricity.
Time passes. We all do our thing with aplomb and grace. Melvin shows little signs of improvement. One of the cardiologists notes that we have been performing CPR for over 40 minutes and he doesn’t think it would be worth it to transfer the patient to the cardiac operating room.
I and all the staff have been working really hard to save Melvin. His wife has been watching the entire process. None of us are ready to give up yet but the facts are the facts. I look down at Melvin as I’m pushing on his chest and I say, "C’mon, buddy! give me something to work with!"
Suddenly, the Irish nurse to my right yells, "He’s grabbing my hand! He’s grabbing my hand!" Sure enough, Melvin has got a solid grip on her first two fingers. Then he’s squeezing her hand in response to questions! Holy crap! This guy’s alive! We pause chest compressions to check his heart rhythm and he stops responding. The rhythm we see on the monitor is still V-fib. He stops squeezing or otherwise responding.
Back to the compressions and ventilations and drugs and shocks and all the rest. He comes back a few times like before but each time we let off the CPR, he slides back to unconsciousness. Things don’t look too good. The cardiologists start muttering again.
Once more, I find myself looking at him and not wanting to give up. Half hoping and half joking, I say, "Hey, Melvin. No slacking on the job, buddy. We’re all working hard over here. This ain’t no time for lying around."
And then he does it again!
This time, we get his heart beating in an organized manner but it’s too slow. I step off of chest compressions to start "pacing." This is a process of delivering rhythmic shocks across his chest to make his heart beat faster. I’m always amazed at how much we can "take over" for an organism. The cardiac pacing works and his blood pressure comes up. He also starts biting down on his endotracheal tube. The drug we gave to paralyze him has worn off and he’s starting to fight back.
Melvin gets re-sedated, re-paralyzed we transfer him up to the cardiac operating room. As the cardiologist scrubs up for surgery, he expresses his admiration for the team in the ER and calls this patient, "nothing short of a miracle."
We did it. We delivered a viable and (mostly) living heart attack patient to the cardiac surgery. After the hand-off, I clean up and start thinking about what happened. I realize I wasn’t thinking about it as it happened. Everything that happened and what I did about it seemed a normal, natural part of what I do. When I was talking to Melvin, I wasn’t thinking that he could hear me. I don’t necessarily believe in spirits, souls afterlife and all that. I was just talking as a way of expressing myself. I wanted to feel like all of our effort meant something.
I certainly didn’t expect a response.
One of the comments to my previous post mentions effective CPR perfusing the brain sufficiently to generate a neurological response even if the heart’s underlying rhythm is ventricular fibrillation. Looking back, I’m sure that’s what was going on with Melvin. We had a good airway and we were working his heart to good effect. Once or twice during CPR, a doctor thought Melvin had converted to ventriular tachycardia (where the heart actually has a regular rhythm) because my chest compressions were creating a consistent and regular waveform on the EKG.
So, yeah. Melvin heard and responded to us, not because of some mystical, spiritual connection. I didn’t pull his soul back down into his body by calling out to him; I just pushed enough oxygenated blood to his brain that it kept working. It was a surprise to get a response like that.