Code blue

I watched a man die tonight.

In a way, I feel partially responsible. While I know this is completely untrue and irrational, the guilt remains.

From the time I first learned CPR at the age of 17 to present day, I've wanted to be a part of the resuscitative efforts of a patient.

A few weeks ago, I participated in final practicals for EMT students and part of their practical exam was that midway through the "call" the patient goes into cardiac arrest and out comes the CPR dummy. Being the assistant to the student being tested, I performed fake CPR multiple times, thinking that in the two years I've been healthcare provider CPR certified, this is the closest I'd get to actual cardiopulmonary resuscitation.

As my summer has progressed working in the emergency department, I admit, I'd always day-dream about the opportunity for a real live CPR in progress case. Whenever a cardiac patient would present, I'd think to myself "Is this it? Is this person going to code?"

Today, I didn't want to work. I don't like working weekends and I was not in the mood to spend the whole day indoors. Strangely enough, I found myself taking mental notes throughout the day; what I'd blog about if something emergent actually happened. We had the routine emergency visits; lacerations, back pain, nausea, motor vehicle accidents, but nothing to really get the long desired adrenaline rush.

This afternoon during my downtime, I went through the stacks of paper held inside one of the desks in the emergency department. The first paper to catch my eye was the Organ Donor Authorization form. As I scanned through it, marveling at the morbidity of getting to choose eyes, various organs, and tissues, I admit: I thought to myself there was no chance I'd ever actually see that form being filled out.

And then the call.

Dispatch paged EMS to a local hotel, stating "CPR in progress".

Initially, I thought I misunderstood. CPR? Watching EMS rush out the door though, I knew that this would be the call.

Setting the trauma room up, I asked the nurse what to expect, what a code is like. She explained how it would be chaotic and oftentimes there would be more help than needed. Pulling out the bag valve mask, we discussed protocol and then, we waited.

Over the radio, EMS stated they were on their way, the patient was bradycardic, but that CPR was in progress. They said to expect them in four minutes.

It was a long four minutes.

The ambulance finally pulling into the bay, I hear the patients wife screaming "Baby, come back! You can do this, I love you so much. Come back baby, we need you".

One paramedic is on the side of the stretcher, doing CPR.

The patient is unresponsive, skin tone is gray.

A rush of staff; on hand we have lab, x-ray, multiple nurses, EMS staff and of course, the doctor. The scene of a code is maddening; people yelling, IV's being started, CPR being done, drugs being injected into the patient and the cardiac monitor screaming, seemingly more amplified than ever.

The patient is quickly hooked up to what is called an AutoPulse, a machine that in basic terms, wraps around the patient's chest, compresses, inflates and does CPR. Next to the patient, a bag valve mask is hooked up and every six seconds, we breathe for the patient.

Thump, thump, thump. CPR in progress. Everyone is talking over each other, orders being shouted left and right. "Get the piggy back tubing!" "Get the coflex!" "Got an arterial stick over here!" "It's been two minutes, check his pulse".

Checking both carotid and radial pulse, there was nothing. CPR was resumed.

Stepping out of the room to grab something, his wife grabs me, screaming "Please! Tell me if he has a pulse! I need to know! I can handle it if he doesn't have one. If I were in that room, I'd bring him back to life". I tell her we're doing all we can, well knowing that this man is pulseless. She starts screaming, pacing, crying out to God that this can't be happening.

I enter the room again, and nothing has changed. Glancing up at the monitor, I see that he has a "pulse" but this is only due to the CPR being performed. His rate changes from tachycardic to asystolic. Every two minutes, he's re-evaluated for a pulse, every time I expect to feel something, but there is nothing.

His skin remaining gray, I look at his face. In between the tubes, the suctioning, the bag valve mask, I see a man who is no longer there; his blue eyes non-responsive. He is intubated, but no matter what is done, no matter what drug is infused into him, there is no pulse.

His wife enters the room, CPR efforts still in full progress. She is instructed to stand in the corner and an EMT hands over the bag valve mask to me, instructing me to breathe for the patient. And every six seconds, I squeeze that bag, hoping that at some point, he will return, that at some point, his heart will beat for him, that his respirations will resume.

The doctor tells his wife that his pupils are unresponsive, thus indicating no brain activity. She rushes to her husband's side, kissing his face, telling him that he needs to live, he can do this, they have grandchildren, that God has too many wonderful plans for him on this earth and that he can't leave her, not now, not yet. She cries "You can't leave me baby, you didn't say goodbye to me. You can't leave me!"

I squeeze the bag. His wife jumps up and yells "He's breathing! I felt it!" But it was me who was breathing for him.

Moments later, the wife announces "This is a dream, this isn't happening".

And then, the code is called.

CPR is stopped.

I stop ventilation.

The machines are turned off.

Staff quickly exits the room.

And suddenly, it's the wife, her now truly deceased husband, the doctor, the nurse and me. The wife announces that she needs her family to come in, to say goodbye.

In a truly heart wrenching moment, family members stream in, crying, yelling, pouring over this man, mourning his untimely loss.

In the following moments, the police arrive, victims advocate comes to meet with the family, the coroner is called.

I help prepare his body for organ donation.

I continually check his chest, feel his arm, squeeze his hand, hoping that maybe he'll come back. Maybe he'll be one of those crazy ER stories of "the guy who came back to life" after dying.

But he's gray. And he's cold. Rigor mortis is apparent.

Closing his eyes and placing a wet gauze over them for possible donation, I say goodbye to a man I never knew.

Thirty years and two hundred pounds on me

I've been traumatized.

I'm never going to be okay again, ever.

I also now know what kind of man I attract.

...

There I was, having a nice day at the vet clinic.

A couple hours earlier, I had a conversation with what you'd call an eccentric man. May I give you a description of this man? Unfortunately, the description I give won't even touch the surface. Just picture someone you find to be incredibly unattractive and then times that by oh, a trillion.

• 50+ years old.
• Overweight. Beer gut.
• Straggly, greasy, greying hair.
• Wearing a felt hat with a feather attached.
• Beard. You know the kind of beard he had, if you're following my description.

He's wearing a sleeveless shirt, and on his left upper arm is an orange bear, in mid roar, looking as threatening as only an orange bear can.

He approaches me and asks how long I've worked at the vet clinic, and then asks if I'm planning on becoming a veterinarian. I recite my script (because I'm asked this question weekly) and go into my story about how yes, I work at a vet clinic, but I'm actually an EMT planning on becoming a nurse, etc etc.

He tells me about his days as a cop and mentions an ex-girlfriend who couldn't stand the sight of blood. He also mentions how he rescued a woman's life once by holding pressure on an artery after she'd been in a horrible wreck.

I was so impressed.

So, he leaves and I think nothing of our meeting.

He returns, hours later, breezes in the door and asks "did you miss me?"

I jokingly said yes.

And thus, my downhill journey.

He begins by telling me that I should come down to his farm in Berthoud and "help take care" of his animals.

I was in an honest mood today, and told him no, that's too far away.

He tries to entice me to come to his farm, telling me he even has a "two story house". 

Be still, oh beating heart of mine!

I again reply no thanks.

So then he asks, "are you single?"

I give him the truth. Cursed honesty!

He then says "Hey so am I!"

Oh gee!!!!

Let's stop here and see what thoughts are going through my mind:
"Oh please no. Please God, anything but this. Let this be a joke, a silly bet, ANYTHING."

But no. This was no joke. He then says, "I should get your number. Let's go out to dinner"

Hint: hillbilly's are not my type.

Time stops. The world comes to an end.

Or so I wished.

Dinner? DINNER?!? Dude! LOOK AT YOU! You're ancient! You have a hat with a feather sticking out of it! You've got an orange bear on your arm!  

(As one co-worker said afterwards: "Sarah, he's got thirty years and two hundred pounds on you.")

I quickly decline this oh so wonderful dinner invitation.

And what do you do in moments when you've been shot down? You make it even MORE awkward!!!!!!

What does my gracious asker-outer say?

"Oh you're cold. You're cold. You are cooooooold".

Silence ensues. I mean really, what in the world can I say?



Me and Andy

Enter: Andy! The one, true love of my life.

Andy and I have been friends since I first met him almost five years ago. He's been with me through thick and thin.

So, Andy comes along, and in his usual treat begging fashion, comes alongside me and stares at this man who is making things worse with every passing second.

This man, seizing on the opportunity, says that Andy would want me to go out with him.

No. No he would not!!!

As he's making Andy go nuts, and continues to give me a hard time for saying no, I then decide to cut my losses and walk away.

Actually, more like run away.

A woman told me last week she'd set me up with her son, but after discovering my age, she changed her mind and said "You're too old."

I finally understand what she meant!

Dead bodies

I was warned that seeing cadavers would affect me in ways unthought of. Surprisingly, it wasn't their exposed muscles, their organs that were passed around, or their faces seemingly frozen from those final moments before death.

You know what got to me?

Their hands. 

The skin had not been dissected from the cadavers. The first person I examined was a ninety-one year old woman who had perfect long manicured nails. Her skin was dotted with age spots, and her hands, oh her hands looked as fresh as the day she died, pardon the morbidity. 

The second cadaver, a seventy-something man also had hands that strangely enough evoked emotion. On his right index finger was a band-aid; he had died with it on and it was never taken off of him. That band-aid strangely made me think of who he was when he was alive. How did he cut his finger? On the day that he died did he happen to place that band-aid on his finger, unaware that his demise was quickly coming?

My professor told us to be respectful of the bodies we were about to see, re-named "Kate" and "Paul". Being respectful entails not making jokes they'd be"horrified" to hear if they could indeed still hear and only saying things that they'd approve of. (How am I supposed to know what perfect strangers would/would not approve of?) 

Very somber, my classmates enter the cadaver lab. Somehow I get a spot right next to our first cadaver, Kate. Her body is wrapped in towels, each section covered. Her chest is first revealed. Her first layer of skin is carefully peeled back, revealing the very thin layers of skin. Beneath that, her adipose tissue is removed. Kate had spent her life taking care of herself and her innards clearly display this. As her ribcage is removed, we see her lungs and her heart. Her heart is quite enlarged. Cause of death: congestive heart failure. 

Next comes her organs: stomach, liver, gallbladder, large and small intestines. We pass around her liver, and random fact: the liver is a pretty huge organ. 

Out comes her small intestines, and we stretch them around the length of the room, approximately twenty feet. 

We examine her uterus and ovaries; apparently it's pretty impressive that she still had them at the age of 91 though it is speculated that she never had children. 

Kate also had a hip replacement, but it looked more bionic than anything else.

Her brain is later passed around and there is evidence that she had a small brain tumor that she likely never even knew about.

Paul is next. He was a large man both in height and in weight. All I knew about him was that he was a man who did not take care of his body, and his innards truly did not lie. As we peeled back the skin from his still hairy chest, the first thing I saw were his lungs. They were black. Non-smokers will have some black tinge to their lungs from everyday pollution exposure, but this man's lungs were solid black; it is unknown how long he was a dedicated smoker.

Paul also had many broken ribs and the bruises and burns on his chest were indicative of CPR and defibrillator efforts.

As Paul's heart was passed around, I finally got a chance to hold his heart in my hands. It was surreal. It also gave that phrase a new meaning.

As we progressed through his body, there was evidence of fatty liver disease, cysts on his kidneys, and more surprisingly, the size of his stomach. Text book stomach measurements are eight inches in diameter. Paul's stomach was more like a foot and a half long. Also, his intestines were madly disproportionate--the large intestines were huge, the small intestines too small and short.

As we went back and forth between Paul and Kate, I couldn't help but wonder what sort of life they had lived. Why they decided to donate their body to science. What it was like for them to die.

All too soon though, cadaver lab was over. We pieced the cadavers back together putting organs, ribs, and skin back in their respective places. 

Dead bodies are weird. Especially their hands.

"You are a person and then you cease to be a person, and a cadaver takes your place." 

Timing is everything

My day started off fun. I got a jolly email from my bank saying "You got charged a fee!" then another email stating again "You got charged (another) fee!" Okay, so I've been pretty poor lately. After almost dying from influenza back in April and then taking some time off for my brother's wedding, my bank account was never the same.

I promptly called the bank and all my not-so-friendly customer service guy would tell me is that I need to consider getting over-draft service (gee thanks buck-o) and that he'd "work with me" on the charges, because, well, it wasn't entirely all my fault. When I inquired how I could get the charges taken off (this was after all, my first time ever getting back to back charges for insufficient funds) he said not so kindly, "I just told you I'd work with you" So I guess that means.....?

After that dandy start, I went to school. It was pretty dulls-ville. I dissected a cat for the millionth time, took a look at my classmates' dissected cats, and took my lab-partner's blood pressure (the guy who isn't happy about anything. Seriously.)

Today though, I had an important meeting to attend after class.

Last night, as I was studying the veins and arteries in the body (thrill a minute, let me tell you), I got a phone call.

The phone call was from the director of the Emergency Department. She wanted to know if I was still interested in doing seasonal EMT work for them. After my botched interview in April, I had begun to think that all the time I had spent pouring over my studies to become an EMT were perhaps in vain, and that my next best chance at getting to work in the medical field would be after I had become a nurse (about 2.5 million years from now).

So as my non-interview finally transpired, I was simply asked if I want to be an ER tech. DO I WANT TO BE AN ER TECH?!? I have dreamed of this since before I became a certified EMT!

Even more important:
Did I actually not botch my job interview?

And so, I have accepted the job. I was informed that in addition to taking vitals and getting a medical history, I will also be starting IV's, doing blood draws, and.....doing CPR when necessary!

Of course, then I realized that the hospital actually trusts me with people's lives and then admittedly, I got a little nervous realizing how important my job will be. But, this is what I have been waiting for.

So, if you feel like you're dying, head on over my way.

Friggatriskaidekaphobia

I'm not superstitious. But today, Friday the 13th, has been a day from h-e double hockey sticks.

Here's a glimpse at my day:

Work. Always fun.

My first few calls of the day were frantic pet owners calling because today was the day to put down their pets. It's always so hard distinguishing what is being said in between the sobs. I schedule one euthanasia in between appointments--a huge no no because of the typical chaos, but this was a bit of an emergent situation.

She comes in right before the tidal wave of calamity hits.

While her cat is being euthanized, everyone in the world comes in to the clinic. Lest you be fooled, the reception area is not large enough to hold the entire world's population.

One woman comes in with her dog and does not like the placement of the chairs, so she does the most logical thing: she drags a chair clear across the floor, with the chair screeching along, similar to the sound of nails on a chalk board.

Enter: the family with four large dogs. A wild time is had by all.

While the front reception area is filling up, the door to the exam rooms is closed because of the eternal euthanasia that is taking place behind closed doors. As a result, we're re-directing people back into the animal treatment area.

Meanwhile, my phone is ringing off the hook. People are staring at me. There is complete chaos everywhere. Typical phone conversations today go like this:

"Um yeah, hi. Iiiiiiii neeeeeeeeeed toooooooooo briiiiing innnn myyy doooooggggg......."

"Ok, what do we need to see them for?"

"uhhhhhhh....Iiiiiiiii thiiiink heeeeeeee haaaaaaasssss ________" and then they go into some wild story about something that I really have no idea what they're talking about that certainly has nothing to do with the problem in question. Trying to steer them back in the general direction of normality is a long forgotten thought.

Finally, the door that leads to the exam rooms is opened, but the owner of the cat has opted to stay in the room with their deceased pet. For four hours. Literally. That means unknowingly, people are walking by a woman and her dead cat to enter the second exam room.

Things calm down. In walks dapper young man. When he had called to make his appointment today, I said I was looking forward to seeing his puppy again and he said "Likewise. I mean, uh, you too, uh, yeah. See you"

So he's got the cutest chocolate lab puppy, and all things considered, he's a pretty nice guy. Except I found out recently that he threatened to beat my brother up many years ago, so it's pretty swell having this piece of secret information on him. I'm not going to tell him I know about his sordid past. Besides, he treats me great. Way to make things awkward by saying "Hey! Remember when you were a punk, back in the day?"

As he's checking out, he begins to test out the waters, first by saying that I can help the people behind him because he's got some things to ask me. 

My response: ?!?

Most every time I talk to an attractive young man, I feel like a buck tooth hillbilly with no ability to impress what-so-ever. I start thinking "Do I have food on my face? Are there things stuck in my teeth? Why did I wear this outfit today?" I'm very self conscious, contrary to popular belief.

He doesn't ask me, but tells me that we should go hiking sometime. I've noticed guys are very unique in their approach towards woman: some straight out ask, some hint, some are direct, some are indirect. It's all a jumbled mess. (And yes, I know: females do the same). As he's leaving, he tells me that he'll stop by in a few weeks to discuss hiking. You're going to do what? 

Guys, I've noticed, like to leave as little room as possible for girls to say no. Boys. So tricky.

After he leaves, I check in on the woman sitting with her deceased cat. I walk into the room, hand her a water bottle and proceed to talk to her about life in general. It struck me though as odd, (and slightly creepy) when we're both petting her cat who is lying quite dead on the table. She tells me "This is the longest I've ever been able to pet her! In the past, she would always bite me. This is nice" Yeah, I love petting dead cats, too. Favorite past time.  I kept expecting the cat to move. But what am I to do? There is no easy exit here. So we chat for an hour about death. Utterly uplifting.

She left with her cat, but hours later, another family member came back, dead cat in tow to shave off some of her fur for a keepsake. Did I mention they laid her body on the front counter? Excuse me ma'am; please don't put your purse down on this here counter. We had a dead cat here earlier getting a haircut. 

 Among other things that happened on this gem of a day:

• Somehow, my debit card "floated out" of my pocket while on my lunch break and some men who were cleaning the sidewalk (who cleans sidewalks?) found it and returned it to me in a completely mysterious fashion.
• A woman with a full blown goatee came into the clinic to buy some dog food.
• A woman with many missing teeth came in to schedule her dog for a dental because dental care is "vital" 
• I called a woman to remind her of her dog's upcoming surgery and she told me she couldn't, just couldn't talk to me or take a message. Then she disconnected. Mind you, she was an elderly lady.

 That's Friday the 13th for you. No men in hockey masks, but my goodness. I should have stayed home today.

I'm disgusting

Everyone does it. 

I know I'm not alone.

Have you ever purposefully avoided someone? Pretended you didn't see them or worse yet, seen someone you really didn't want to see and ran away from them, fast as your little legs can carry you? Twice in the last thirty days, an individual (whom I considered myself friends with) has ran for the hills upon realizing that I was in the same room as them. What I have done to them, I cannot fathom. It's awkward. I mean, what do you do about that? "Hey pal! Where ya headed off to?"

But, what goes around, comes around. 

There are two extremes that you ought to know about me. The first is, if I see you, and I really want to talk to you, I will turn into something akin to this picture on your right.

However, if I really don't want to see you, this is what will happen:

The above is an example of what I tried to accomplish this morning. I saw someone today that admittedly, I didn't really feel like talking to. So, I made a joke out of it, largely because that's how I handle awkward moments. I laughed, they laughed, and we all went on our way, laughing. No harm done. Right?

WRONG.

An hour later, I get a text from the person in question. 

The following is verbatim, spelling errors and all.


"Si for now, u pretty much said I'm disgusting uh?"


I thought he was joking, really I did. So I texted back:

"Unfortunately. Sad day." 
Okay, so in hindsight, this was not an intelligent response. Shoot me.


You ready for his response?

"Well, in that case u maybe the one disgusting, but ur not able to see it, and u think that other people is, I think you need to see ur doctor"


?!? 


Moving on with my day, I see my old African friend. (read this if you are confused) . After telling me how much he appreciates that I am always happy amidst all the unhappy people that he interacts with, he tells me, solemnly:


"You deserve everything you want. I'm serious. You'll get it."


You hear that, guys? I'm going to get everything I want! I'm making my list now! 

Interviews and Gonorrhea

Does anyone like job interviews?

Has anyone noticed that primarily what job interviews are is puffing yourself up in the presence of a potential employer to show them that not only are you great, you're also the best in your field (or have the potential), you love everything about life, and pretty much, you have absolutely no faults. At all. I once told an interviewer when asked "what is your biggest weakness?" "My biggest weakness is that I care too much".

*puke*

So I had a job interview today that I'm pretty sure that I will not be getting the position.

I walked into the Emergency Department, and while I am still currently employed there, I haven't worked there since November. I tell admitting who I am and then I take a seat, and I get those "I want to run away/hurl/vanish" feelings because little known secret: I get nervous really pretty easily. And when I get nervous, I turn into a foreign version of myself.

For example:

• My hands shake like a well advanced Parkinson's patient
• My heart beats about 1,000,000 beats per minute. Maybe more.
• That thing called "butterflies" in your stomach? I must have a butterfly infestation that threatens my life.
• I can't stop talking. I become this chatty Kathy, and start spewing off random information that no one cares about.
• If you think I smile a lot normally, you should see me when I'm dying from nervousness. It's like my facial muscles lose connection with my brain. Muscle spasms galore. 
• I laugh a lot more, even at things that really aren't all that hilarious. I'll catch myself and be like "SARAH! GET A HOLD OF YOURSELF!"

It's really quite terrible. And it's not just in job interviews that this happens; no. This happens whenever I meet with someone I don't really know. I know the party in question leaves wondering how such a demented person could make it so far along in life.

But I digress.

So the interview progresses and the first question is:

"Tell us about yourself. Is that a question you're comfortable answering?"

No!

I blab on for decades about who I am before I realize these people don't care who I am; they merely want to see if I am qualified for the job. 

Then: "If you were going to advertise yourself in the newspaper, what three words about you would be in bold?"

I would never advertise myself in the paper. Why the heck would I ever do that?

So I say, after much thought, with my two interviewers staring at me, "Honest....compassionate...dependable"

"If you absolutely had to choose between working in the ambulance and working in the Emergency room, which would you pick?"

This is where I blow it. I say, "Emergency room". I am asked why. I say some sort of nonsense about liking the environment and everyone working together in unison. 

Have I mentioned which position I was applying for? 

It's a job on an AMBULANCE. Not in the emergency room which has, in the past, bored the living daylights out of me. 

I was then asked, if I've spent any time in the back of an ambulance. I flash back to one of my clinical's back in EMT school when I spent almost the entire day sitting in one, chatting with a paramedic. 

After some more awkward "why I am so great" questions and answers, I am then asked to come down to the ambulance director's office for an "activity".

The activity? Starting an IV and doing a blood draw on a fake hand. It's been over a year since I started an IV. My first thought? 

I can't do this! What's a needle? What's an IV? What's a vain?!?

I take a moment, and then, just go with it. I had learned in anatomy that it takes a person a couple hundred times of repetition to get an action down so that they don't have to think about what they're doing. The action is solidified if you go over the steps in your mind. Lord knows last year I went over how to start an IV about a billion times for a moment such as this one.

Grabbing the fake hand, I start reciting the steps, announcing too, that above all else, I'd be wearing gloves. (Thanks EMT school. BSI forever).

And then, I go. I get my materials ready, I clean the area, pull traction, insert my needle (with hands shaking),  and.....nothing. There's supposed to be a flash of blood, but all this fake hand has is deadness. I'm assured that this is okay, and to pretend that Mr. Hand has had quite a nice flash. I extract the needle and then proceed to draw fake blood that doesn't actually come out. Finally, I flush out the area and proceed to tape the IV, but....there's no tape. This is probably the worst fake IV and blood draw ever.

Have I also mentioned that during this test there is a steady flow of EMS personnel filtering through the incredibly small office staring at me? 

Quite soon though, I am on my way with promises that they'll "be in touch" 

Right.....

~~~

Before I end, I do have one more small tidbit of a story to share.

My microbiology class had an awkward lab to do today.

Titled "How did I catch THAT???" My classmates and I each had to carry around a beaker filled with what was pretend body fluid. We had to randomly choose three people in which to....erhm...."sleep with" and exchange body fluids. 

Unfortunately, one person was, unknowingly, "positive" for gonorrhea and so by sharing their beaker of fluids with their three partners and so on, good ol' gonorrhea would be spread around, because in this instance, everyone was, well, you know....

Turns out, with the addition of the additive Phenolphthalein, we could readily test the beakers of fake body fluids and see who got gonorrhea because the fluids would turn bright pink. In turn, it would also (hopefully) be able to be traced back to the original carrier.

All my "partners" tested positive, which means, they spread it to their successive partners, which means that yours truly was the secret carrier of this STD. 

Hardy.

Har.

Har.

Higher education. Always edifying.