The Ramblings of a Quixotic Dad, Firefighter, EMT, and God-knows-what-else…

Posts tagged “ACLS

To wonder, “Do I dare?” and, “Do I dare?”

When she put the poster in her office (which had, until the day before, been a small closet), I couldn’t help but stare. For National Poetry Month in 2009, the American Academy of Poets put out a beautiful image of these two lines written into the condensation of a piece of glass.

“Do I dare /Disturb the universe?”

T.S. Eliot’s The Love Song of J. Alfred Prufrock is a complicated poem, one whose analysis is way beyond my scope. But I love it.

“Do I dare /Disturb the universe?”

I love that thought. It haunts me.

Mainly, it’s because I find myself asking myself that question all the time. Oftentimes, first responders (regardless of what field – EMS, Fire, Law Enforcement, etc) find themselves in futile situations. Anyone who has ever worked a cardiac arrest at a nursing home will understand what I mean.

“Do I dare /Disturb the universe? / In a minute there is time / For decisions and revisions which a minute will reverse.”

If only it were that simple. But still, I wonder.

Do I dare?

Do you?


My gut tells me…….I have no idea.

I’m not trying to brag. In all honesty, I’m a pretty modest guy. But I have good instincts.

At least, I have good instincts in the back of a box. They haven’t really let me down yet. Granted, I don’t have the kind of experience many medics and providers have. But I have enough, combined with my gut, to generally carry me through the day.

The guys I work with know this. I work at a multicompany station. That is, we have a truck company and an engine company. 10 people. Out of these, 90% of our medical calls are handled by myself and FireMedicBA. He has about 3 times the experience I have, but trusts me enough to ask my opinion and evaluation.

Typically, that’s not a problem.

A few weeks ago, while roved out to another station, we were dispatched to a report of a patient suffering from an altered level of consciousness at an assisted living facility. We arrived to find a man in his mid-80s laying on the floor. The nursing staff had found him this way. His blood pressure was well over 200/100, and the medic on the engine I was with (who is a relatively new medic), tried to do a full assessment. I told him we needed to load him up and leave. The arriving ambulance crew agreed. Long story short, our patient ended up being admitted for a massive stroke.

I’ve learned to trust my gut.

Today, I hung around a few extra hours to work for a friend of mine on the next shift.

About an hour in, we catch a run to a local sorority house for a report of an unconscious female in the doorway.

In a college town, this can typically be stereotyped as an inebriated sorority sister. That’s typically what it is when we get there.

Today, though, it was different.

We arrive with the local EMS service to find a young female seated in a chair. She’s pale, diaphoretic, and barely responsive.

She didn’t look drunk. She didn’t look high. But she had the empty, glazed stair of someone very sick.

When we left, one of the firefighters with me asked me what was wrong with her.

I honestly didn’t know.

I figure it was one too many diet pills and one too few waters. But that’s just a guess. What I do know is that she was sick.

And my gut let me down, because I didn’t really have an answer for him.


Station(ary) on Sunday

I composed a long posting over professionalism based on a recent experience I had with an EMS crew in my area.

All it lacks is an ending.

I can’t seem to give it one. I’m not sure if that’s because I can’t really condemn the crew for the way they acted, or if it’s because I’m stuck at the station today and just don’t care enough to finish.

Who knows.

So far today I’ve seen one person having a massive stroke while the staff at the assisted care facility kept passing the buck around as to whose patient he actually was and another lady who’s had four heart attacks, two in the last three weeks, one last Monday, and quite frankly was probably having one today (didn’t get to stick around long enough to see the 12-lead).

So quite frankly, I’m just not feeling it today.

Plus, I tend to miss my wife when I’m at work. Seeing as she’s the only real reason I have a blog, I’m sure that’s a contributing factor to my inability to come up with anything remotely interesting.

C’est la vie.


Respice post te! Hominem te esse memento! Memento mori!

It may be just a legend. No one is really sure.

Picture this: The streets are full today. Plebeians and senators, soldiers and scholars; all are there. The delineations between classes are not as apparent today as they usually are.

Over the roar of the crowd, you catch the slightest echo of something. You strain harder to hear it, and there it is again, only louder. Horns. The deep, throaty rumble of horns. The clap of iron sandals on stone. The harsh crack of drums. As the noise grows, the shouts and yells of the crowd slowly meld together into a colossal cheer.

Then you see him.

He rides in a chariot pulled by white horses. His armor is draped with the skins of leopards and the deep purple of royal robes. On his brow sits a laurel crown, the gold leaf glinting in the sun. Behold, the victorious general, returned to Rome and honored for the glory he has brought it.

But it is not the general who catches your eye. It is the lowly slave behind him, the one who almost seems to disappear in the general’s splendor. You can see him whisper into the victor’s ear, but you can not hear over the cheer of the crowd.

Respice post te! Hominem te esse memento! Memento mori!”

“Look behind you! Remember that you are but a man! Remember that you shall die!”

Maybe it’s true. Who knows. The Romans didn’t always keep the most accurate histories. It’s been argued that the story of the servant is more a moral reminder than a literal history.  Perhaps it was meant to serve as a warning to the rivals of Caesar – remember that while you are the victor today, you may fall tomorrow, especially if Caesar wills it.

Remember, thou art mortal.

I’m rambling again. It’s what I do. But this is the story that came to mind this morning as I sat at work. While I was roved out to another station, my regular engine crew ran a cardiac arrest today. I honestly don’t know the specifics, but it wouldn’t matter if I did. They rarely differ. This one did slightly, as resuscitation was ceased on scene. We often ride in, still performing compressions. Not today. No need.

In a recent med refresher course in which they stressed the importance of quality compressions and minimized interruptions (because we didn’t know that already, apparently), they pointed out an interesting fact. I don’t recall the doctor’s name, or what his title was, but I do recall that he was a major player in resuscitation research. One of his key points is that the success of a cardiac arrest resuscitation is almost always determined on scene. If they don’t regain pulses before we put them in the ambulance, they probably won’t get them back at all.

When I first got into EMS, I had to take my CPR class just like everyone else. I was lucky. I had a burned out, retired medic as my instructor, and there were only two of us in the class.

She didn’t sugarcoat it. She told us the things they don’t typically tell you about CPR.

She told us that we would save less than 8% of our cardiac arrest patients. She told us that we would break ribs. She told us we would stare into open, empty eyes while families screamed at us, and that we would begin to feel remorse for working most. I’m glad she prepared me for that.

That’s not to say that I’ve lost my compassion. Far from it. If anything, the calls that haunt me the most aren’t the bloody traumas or massive AMI’s. No, for me, it’s the wife hugging her son in the corner, crying into his shoulder as we pump on the cracking chest of her husband of 50 years. It’s the tears in the crystal blue eyes of a 50 year old man as we tell him not to be scared while we hand squeeze saline bags to try and force fluid into him and to force his pressure above 70. It’s his quiet whisper of “I’m not scared,” while the monitor shows a massive heart attack that has pushed him into cardiogenic shock, and that will ultimately take his life in the next two hours.

What we do is important. CPR is important, and it saves lives. But the ones we don’t save slip in line behind us as make our triumphal entry through the sliding ambulance bay doors with the patient we just snatched from the jaws of death, whispering in our ears:

Respice post te! Hominem te esse memento! Memento mori!”