Prologue – I’m a fan of the Dean Koontz’s Odd Thomas series. The main character is a clairvoyant quick order cook afflicted with the ability to occasionally see and interact with the dead. I like to cook but I’m not clairvoyant by any means and I don’t interact with the dead. I do occasionally see dead patients in my thoughts. Nothing vivid or triggered by external events they seem to randomly float into my thoughts. Kind of like leaves caught in the eddy of a bend in a slow moving river…occasionally swirling to the top only to sink from sight….

If you ask any new EMT why they decided to enter the field the phrase “I wanted to learn how to help save someone’s life” probably gets uttered. In reflection of my career I know I learned how to do my job to help save lives but I probably learned as much about death.

I don’t mean death in a morbid way. More like coming to the realization that sometimes death is the best outcome. In this post I’ll talk about two clinically dead patients. In one case I chose to intervene and they moved from clinically dead to alive. In the other case I chose not to intervene and they went from almost clinically dead to biologically dead. I sleep fine with the decisions I made on both calls. I can still see both patients clearly in my mind. The latter does swirl to the surface more often.

The dead to alive patient was unique. I was not actually involved in EMS when it occurred. It as fairly early in my career and due to philosophical differences with my employer in a private ambulance company I chose to leave the field. I wanted to stay in the area so I changed vocations and actually had been working as a manager of a new sporting goods store for several years.

It was a beautiful summer day at the coast and the front door was open. Someone was taking advantage of the weather and I could hear a lawn being mowed. A customer walked in, laughing and said “that guy is taking a nap and left his lawn mower running”.  I expect I did some kind of eye roll and mumbled under my breath. I looked at my partner in the store and asked her to call 9-1-1.

I went out the front door and could see a man on his back on the lawn next door, mower next to him still running. I jogged over, killed the mower and did a quick assessment. Male, about 60, 90KG, pulseless, apnic, color pale, pupils dilated and I started CPR. I had run plenty of codes and done lots of mouth to mouth in my career so I just kind of went into auto-mode.

My partner poked her head out the front door of the store. She was still on the  line with the dispatcher and hollered into the phone “he’s kissing on him”. Repeat eye roll and mutter and I hollered back, “tell them they have a cardiac arrest”. The ambulance pulled up within 5-6 minutes, I gave them a report and happily let them take over. It wasn’t until I stepped back that I noticed the patient was actually one of the regulars in the store. About 3 weeks later he wandered back into the store, kind of stared at me and proceeded to buy a very expensive rifle. Neither of us said anything about what had happened.

Patient two happened 5-6 years later after I had moved and gone back into EMS. I was working a shift and we were dispatched to a report of some kind of accidental injury less than a mile from our location. Upon arrival on scene, I could see a man sitting on the ground cradling a boy in his lap. He was sobbing over and over “I’ve killed my son”. It turns out he had been hanging a large metal sign outside his business. One side was attached to the building and he was raising the other end with a line which gave way. The heavy sign swung down striking his son squarely on the head.

The father was obviously distraught. The boy was about 6-7, 30 KG, apnic, dilated pupils, no respiratory effort, mouth full of blood. There was a large open wound to the head actively bleeding with brain matter showing. My partner had hooked the child up to the monitor, it showed a bradycardia rhythm. My partner and I made eye contact. I told him I was calling the doc on duty from the ambulance. I gave the report to the doctor and she asked me what I wanted to do. I told her I did not want to run a code on the patient and she concurred with our choice. In this case the young boy stayed dead.

I wouldn’t fault a reader for saying they would have worked the child. I’ll explain my thought process. First off the father had already accepted his child was dead and was beginning a grieving process. I’ve worked plenty of pediatric codes where I did it for the family so they could find some comfort in knowing everything possible had been done. In this case based on the injury I had no doubt it was a lost battle. I also know there is nothing clean and sanitary about working a code. What we would have done to his son with him sitting in front would be horrible for any parent. In this case we got them both out of public view, stayed with him and called professionals to help manage his loss.

Epilogue – Get education to become an EMT or paramedic, the knowledge and skills will serve you well in all kinds of situations. Enjoy the victories. Understand you can’t win them all. Maybe I’m unique in the patient’s who continue to wander my head but I doubt it. It comes with the territory. 

Lesson to Learn: It’s great to gain knowledge, skills and abilities to help save a life but sometimes you have to know when to let life end. Death is a natural part of living so use those skills wisely.

If you’re willing to share I’d like to hear about those you let go rather than tried to hold on to.