Cool Breeze

This day, my partner is "Cool-Breeze." He worked in NYC for 20 years. He’s always cool and working with him is always a breeze. Right. We’ll call him "CoolBreeze" or "CB" for short.

Our first call of the day comes 2 hours into our shift. Over here, when someone calls the general emergency line, it’s picked up by a security supervisor. Once the "supervisor" (with no call-taking training) realizes that it’s a medical call, he patches in the "dispatcher." The "dispatcher" is just a fleet manager; he’s a contractor who understands more about vehicular maintenance schedules than about actual emergency response. Fortunately, we have an extension of the "red phone" in the emergency room. This is how we know what the heck is going on.

Imagine this: You’re calling the emergency hotline (911 for you Americans and 999 for many other folks) and what you get is some guy who doesn’t speak English as well as you, asking you for your ID number and the location of the incident. He asks nothing meaningful about what’s really going on. Often, when we have the chance to pick up the "red phone" the caller is so confused that our important questions ("Is she breathing? Has he stopped seizing? Is anyone doing CPR?") are met with puzzlement and a desperate plea to come right away. It’s often a struggle to get basic information out of the caller as he may be exhausted by all of the irrelevant questions he’s had to answer before he’s had a chance to talk to an actual medical person.

What info we get on the phone is that it’s a "seizure." CoolBreeze and the driver are in the front as we race to the scene. (Our ambulances have drivers who do nothing but drive. Our driver today, Ali, is better than most.) I’m in the curtained "box" of the ambulance, bracing myself against the turns and trusting completely in the two fellas up front.

When I hear Ali put the ambulance in "Park," I feel safe to open a door. I’m greeted by a group of men at the entrance to an office building, frantically waving at me as if I haven’t noticed them yet. CB and I pull the stretcher, already loaded with all the gear we might need, out of the ambulance and calmly follow the frantic gesticulations.

We wind our way through a cubicle-maze to a restroom. There’s an audience of Arab bystanders around the restroom door. On the floor inside is a small Bangladeshi man receiving perfect CPR from a westerner who gives us a worried expression when we arrive.

Game time! CB cuts to the left and I to the right. I grab the little Bangladeshi and spin him so we can get at him from both sides. He’s still on the floor but now there’s room. I connect him to the EKG monitor/defribrillator (an antique Phillips MRx) while CB files through our response bag and expertly intubates the patient (He pulls out a metal "mouth shovel" and uses it to allow him to stick a tube into our patient’s mouth and into his lungs, thereby taking complete control of his breathing).

As the two of us take over, our western CPR expert (we’ll call him "Bob") has rolled off his knees and is sitting against the bathroom wall. He’s wearing a bewildered look on his face.

Our patient (He’s "ours" at this point, really.) needs a whole lot of stuff to happen quickly if he’s going to have any chance of surviving. I say this because the EKG is showing ventricular fibrillation. Basically, his heart is having a seizure. It’s not doing the organized "swell-squeeze-fill-swell-squeeze…" business that all our hearts have done for all our lives.

He’s dying.

I dial up my defibrillator and push 150 Joules of electricity back and forth across this guy’s chest, in hope of causing his heart to reset. Whether it works or not, I pop up onto my knees and start slamming down on our patient’s chest with all my upper body strength. I’m forcing his heart to pump, no matter what. The whole point is to push blood from his lungs to his heart and from his heart to his brain. It’s all about getting blood, filled with oxygen, into his brain.

CB has already attached a bag to the end of the tube he stuck in our patient’s lungs. This will allow us to push air into him, as if he was actually breathing. I see the worried Bob against the wall and I see CB’s eyes and body-language look to the drug bag. CB knows I’ve got the chest compressions and electrical therapy (all those Joules of electricity, repeated) handled. Like me, he knows that there is much more that needs to happen right now.

I see that Bob is not in shock. He’s leaning in, ready to help. I tell myself that, by starting the CPR, he has bought into this rescue process (and he may have bought our patient some time). He helped because he’s the kind of person who helps.

"Bob, hold this bag and breathe for him like this, ‘Squeeze, two (letting go), three, four, five. Squeeze, two (letting go), three, four five…’

He gets it right away and by doing so, frees up CoolBreeze and I to really go to work.

It’s a ballet on the bathroom floor: CB opens access to our patient’s veins and administers drugs on cue. Bob is perfect and regular in "Squeeze-two, three, four, five…" and I’m slamming the chest of this poor man while shocking our patient’s heart (it won’t stop having a "seizure" despite our best electrical efforts), directing others to get the stretcher & backboard, clear the door, pick-up our gear & remind CB it’s time for another adrenaline (epinepherine) injection.

Our driver, Ali, is nothing less than magnificent. There is a smoothness that cannot happen without people like Ali.

Bob gets in the ambulance with us. He has become part of the team as he enters the back door ahead of the stretcher. He continues to squeeze that bag. He crab-walks backwards as we load up and then he sits in the "captain’s chair." He was hired as a manager. Today, he’s on the team.

"Am I doing ok?" He asks me.

"You’re the MAN, Bob! Keep doing that. You’re perfect!" I say. There’s sweat pouring off me. I’ve been banging on this poor Bangladeshi man for 12 minutes without pause.  … This is why I run. …

Somehow, with body mechanics, a lot of help from CB, and a clean pair of gloves, I manage to alert the ED by phone.

The handoff is smooth and the doctors (who have learned to trust the paramedics over the past year) continue our treatment pathway. I was standing on the carriage of the stretcher, doing chest compressions (when I wasn’t therapeutically electrocuting my patient) and I slid right into the resuscitation team in the Emergency Department (ED).

We worked him. We worked him for more than an hour (from Bob to the doctor at the hospital).

Everyone who met this man at the last moments of his life (Bob, the brave regular guy; CB, maddog, the nurses & doctors in the ED) did their very best to make sure that this man had the best chance at living.

He didn’t live.

He had every chance.

I cleaned the bus, restocked and got ready for the next call.

The next day I got an email from "Bob." It was not morbid curiosity. He had started a movement in his office to raise some money for the family of this dead Bangladeshi guy. The patient was a contract worker from an impoverished country and, without his income, his family will be destitute. Bob wanted information on the patient, his family and his local sponsor so they all could send some help to the poor guy’s family.  Bob was asking me to help.

In his email, Bob calls us "heroes." I don’t know the truth of that.

I am humbled.

–maddog

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