This Week In Other People’s Disasters

There’s an ebb and a flow.
months and months will pass and you’ll only bring in chronic neck pain, chest colds, the occasional migraine and the same five drunks again and again. A minor MVA will seem exciting. These are the months i want to quit and never see an ambulance again in my life. Then, just when you’re starting to drop your guard and accept that you’re really just a glorified taxi for the inept and accident proned and chronically vaguely unwell, some real ass shit goes down.
And while you’re still marveling that anything worthwhile happened at all, it happens again. And then you’re pivoting and splicing your way through a whole barrage of megacodes, epic disasters, medical mysteries and whatever other series of other people’s misfortunes the world has to offer. Fun!

These past two weeks were in that vain. First a perfectly healthy looking fifty-year old just up and died for no apparent reason in the West 4th Street train station in the middle of the mid-afternoon rush home. So death became a spectator sport because let’s be honest, who wouldn’t stop and stare at such a sight: A team of firemen, EMTs and medics pumping up and down on the guy’s chest, yelling commands, disagreements, possibilities, drug administration numbers, semi-coded curseouts, intubating, sticking in IVs, glancing at monitors…All that. The gapers irritate me, but the truth is i’d watch too.

He came back. And well he should’ve, young fellow like that, plus he dropped in public, which means everything happened fast and speed is everything in those situations. Still, you never presume someone will come through. Well, I don’t. But yes, there was that bounding pulse at his neck and then we heaved him up four flights to ground level and loaded him onto the bus and lo behold, the pulse was gone. Crap. Did some shit, got things ready to move and enroute he came back, good strong pound pound and a solid blood pressure to boot and last time I checked he was still at it.

Then some dude who’d been coughing for like six weeks called from around the corner from the hospital because he was “coughing a lot.”

Ok.

Then was the 40 year old that nearly passed out in a swank uptown bistro. She’d had a sudden bout of unfathomably intense abdominal pain ( did she say “unfathomably?” maybe not. But her face did. ) and when she went to the ladies room everything got bleary. She slid down the wall and we found her sobbing, holding her tummy and with no blood pressure at all. No blood pressure, unless there’s a good healthy reason for it like you’re an athlete or extraordinarily chill or a yoga master, is a very very bad thing. It usually means you’re about to die. Your heart should be zooming at that point, to compensate, pumping as much blood as it can and if it’s not you’re really really about to die. So, her heart wasn’t going that fast, another bad thing.
Why do people have no blood pressure? Either their blood vessels have suddenly opened up wide to fight off a perceived threat, like with an infection or a allergic reaction, or the heart isn’t pumping right, usually this would be a massive heart attack or someone with a cardiac problem already in the works, or you’re losing blood or massively dehydrated. Since she’s not febrile or breaking out in hives it’s not the vessels, and she’s not having chest pain or a cardiac patient so it’s almost definitely not cardiogenic shock, so we’re left with the fluid. She’s not visibly bleeding out, she hasn’t been shot, so the bleed is internal. Usually, these are in the GI tract and they eventually find their way out in the form of blackish tarlike poop. No fun. Sometimes it comes out all fresh and bri…you get the point.
Anyway, ok, that’s a good possibility here, but there’s another piece of the puzzle to consider. The patient’s last menstrual period was two months ago — she could be pregnant. Anytime you have a hypotensive, almost passing-out woman with sudden onset lower abdominal pain and any possibility at all of being pregnant you pretty much have to assume she’s having an ectopic pregnancy. This is when the egg fertilizes in the fallopian tube and then ruptures, causing massive internal bleeding. Which is exactly what happened with our lady.
There’s not much we can do for that prehospital. We put a huge IV in to replace as much fluid as we can as fast as we can. We throw an oxygen mask on her, we lean her back and move fast, plowing rudely through the shocked diners and whispering waiters. We haul ass to the bus and then haul ass to the hospital and let ’em know what we comin’ with so they have fluids and surgeons standing by.

Then some lady called for her grandad, he was having “chest pain”, even though he hasn’t spoken or moved any of his extremities since 1998, still, he was having chest pain. And difficulty breathing. And he had to go to the hospital. Right.

Then a slew of drunks. All familiar.

Then an old guy laid out in his own piss, squirming, moaning, writhing. Home Health Aid epically unhelpful, but still, he’s a diabetic so we just go head and check his sugar figuring that’ll be that. And it’s low! So low the monitor just says “LO” which is great for him, because sugar is a thing we can fix up, so we do. Except then he’s still not with it. And his blood pressure’s insanely high, 240/130 or somesuch disasterness. This is all very bad. It means he’s having a stroke and there’s absolutely nothing we can do except move fast, and even in the ER they’ll be pretty helpless because with stroke treatment, timing is everything and since we can’t get a straight story from the HHA, who’s probably high and definitely…not bright, we don’t know the onset time. So, grandpa is basically on his own as far as healing. We package him up, drop a most difficult and delicate IV in one of the meandering little slipstream veins hiding along his forearm and go go go, knowing all the while the deal is basically done.

Dead Guy In An Elevator

maybe I should start having more chipper names for these posts… Maybe that’d be deceitful though. I dont want people coming here thinking it’s gonna be all care bears and unicorns and then getting traumatized when people keep dying. Yeah, okay. *keeps title*

ANYWAY: job comes in as “MAN ACTING WEIRD, DIZZY IN ELEVATOR” and the address is an old people home on East 128th Street. Apparently by “acting weird” they meant “dead” because when we get there there’s a crowd of geris staring at an open elevator door and inside there’s a guy lying there on his back, dead. Well, damn near dead, I should say, because just as we roll up he takes one, final gurgly breath (gurgley? Gurgle-y? …whatever) and then he’s really dead. 
Oy. 
We gently, respectfully and very quickly drag him out because when you’re working up a cardiac arrest the last place you want to be is in a cramped little elevator. We park him right in front of the door and start a round of compressions.
Now normally, i think i’ve probably said this before a bunch of times here but there it is, normally when you have a cardiac arrest they send two units so the EMTs can pump away at CPR while we get our advanced life support on, intubation and IV meds and electricity, but here since the job came in as “acting weird” they just sent us. So, there’s a lot going on. I can’t even tell you the exact order of things happening, because there’s a few moments in there where your hands just move in automatic pilot, compressing the chest and tearing open packages and setting up IV lines and tubes and compressing the chest more and getting the oxygen tank and tube in order. At some point the elevator door opened again and a gaggle of elders was traumatized and then the elevator door closed and we pulled the guy a little further into the lobby.
We called for backup but they were still a few minutes out. The only other person around with less than a century of living was the security guard and he was about 12 with the wispy beginnings of a ‘stache just starting to make an appearance at the edges of his mouth. 
I ask him if he knows CPR.
“No,” he squeaks. 
“Well, time for a free lesson, c’mere.”
I gotta give the kid credit: he jumped in even though he was clearly boggleyed at the whole situation. 
Push right here, I said, pointing to the sternum. Just like on TV.
He did some kinda timid, halfassed finger dips and I told him he had to put some back into it, which he did. The ugly truth about CPR is that usually if you’re doing it right it means you’re breaking some ribs, a dull crunching with a little extra give that you actually get used to pretty quickly, but probably less so when you’re bar mitzvah age and have never done it before. 
Cardiac arrests always feel like you’re fourteen steps behind, because every second that something isn’t done yet is another second that the guy is dead and not getting the oxygen or circulation he needs. Still, it’s not stressful in the way paperwork or organizing concerts or meeting deadlines is. You know you can only move so fast with precision, and you move just that fast. Yes you feel behind but once you’ve done em for a while you also know you’re never nearly as far behind as you feel. It always starts with a flurry of movement: There’re so many things that needs to happen right off the bat and then as shit falls into place I always take a second to step back and say out loud what’s going on. 
75 year old male — i mumble — cardiac arrest, asystole on the monitor IV in place with cold fluids running and epi, vasopressin and dextrose on board intubated with CPR in progress for 10 minutes no change on monitor unknown history allergies meds…hmmm…
By this time the EMTs have arrived and relieved the anxious security guard just when he was getting the hang of things. I’m thinking we might have to call this one. There’s no point in transporting a dead body to the hospital just so they can pronounce him there and he hasn’t had any changes in his rhythm since we started. Plus he’s old, and the older you are the smaller you’re chances of popping back around after you code. I tell them to hold compressions and check a pulse. One of the EMTs is getting into it with the cluster of ancient onlookers, (“Keep it moving people, nothing to see here” riiiiiight…whether from Alzheimers, non-English speaking or just not giving a fuck, they all just stand there, mouths hanging open). She gives up and puts her fingers on the guy’s neck and says “Oh! Pulse!”
We recheck and indeed, the man has his very own pulse and, it turns out, a halfway decent blood pressure to boot. Then things happen fast. They have to, because people don’t necessarily stay back when they come back and we’ve already emptied half the med kit into this guy. We do a cursory wipedown/cleanup, load the guy onto the stretcher, careful not to pull out any IVs or disrupt the tube and take off in a blaze of screeches and lights. 

THIS WEEK IN DEAD PEOPLE

Lord my blog is morbid! i forget sometimes, because it all’s become a pretty harmonious aspect part of my everyday life, but then I scroll down the past bunch of entries and make boggly eyes at some of the shit that’s come up. Anyway, for an ongoing collection of stories that are so much about death, the thruline really is Life: sustaining life, living life amidst death, letting go of life when the time is right. Alladat.
aaaand, this week is no different. It was a morbid ass week, i won’t lie, but only in that tumultuous, joyful, challenging way that it so often is in my job.

Started with The Stench. Never a good job to get. I think PD gets it as the FOUL ODOR, for us it’s a CARDIAC ARREST because if something smells SO bad you have to call 911, it’s probably dead. Fire trying to get themselves canceled the second they get there- “Um, you really gonna need us? It says Possible DOA in the job descrip…” which is an absurd excuse to leave because “possible DOA” can mean anything from dude taking a nap to…well, to what we ended up finding.  So i tell Fire no, y’all comin up there with us, possible DOA or not. As I’ve said before, the main thing you need on a Cardiac Arrest is enough hands to have CPR ongoing while we do the other stuff, and I wasn’t about to be the jackass that cancels Fire only to have a just-died dude on his hands and no one to pump the chest.

When the elevator door opened on the third floor, the whole Fire crew literally took 1 step into the hallway, did an about face and went poof. And at that point, I couldn’t blame ’em. The smell of human decay is singular, unmistakable, unshakable. Some EMT showed up out of nowhere acting all cocky and loudmouthed about something, I don’t remember what, so we let him go in first. He opened the apartment door and then we all had to move out of the way while he ran retching in the other direction and then was never heard from again. Poked my head into the apartment, not breathing through my nose at all. Didn’t see anybody, just a dingy old onebedroom, cluttered with old magazines and piles of clothes. I peeked alittle further in, but the door was one of those swings shut quick behind you joints so I kept one foot blocking it. The air was thick and nasty and ahhhhh yes, there on the couch was the gentleman, lying peacefully on his back in a state of total Indiana Jones style decay/damn-near mumification. I hadn’t noticed him because he was so perfectly still, obviously, and so many different colors that a human being should never be. 
It’s possible that I said “Where’s the dead guy? Oh.” But I can’t confirm that.
Anyway, we made a quick retreat, ganked PD’s paperwork so we could write the guy’s info down from the safety of our air conditioned ambulance and then went out to breakfast.

The next night we started out with a 55 year-old dementia patient who’d turned up dead on the floor of his nursing home room. He was on the young side, but otherwise, it was the same nursing home “we just saw him alive 5 minutes ago” routine, when clearly he’d been down much longer. It’s maybe one of the saddest parts of my job that I’ve come to expect that kind of utter-incompetency and negligence from nursing homes, but that’s what it is. He probably didn’t have a chance but we did what we could. The family showed up halfway through, and we tried to have them stand outside but the son, a tall cat in his late 20s who was fasting for Ramadan and had been an EMT for a few years, just stood there shaking his head and saying he’d seen it all before. Family reactions are hardest when the death comes out of the blue, there’s no time to brace for the impact and it just seems to sweep people up and knock them over like some angry wind. The son stood there solidly while the patient’s wife bawled on his shoulder. I don’t like prolonging the uncertainty. As long as we’re working on him, all that maybe maybe shit gets drawn out, when really, it’s not a maybe maybe situation. So i call, get a time of death and that’s that. The son thanked us and then swooped around his mom like a big bird and the true mourning commenced.

Then some lady called us because her back had been hurting for like 18 years and she just couldn’t take it anymore.

At six or so that morning, an asthmatic woke up barely able to breathe. He told his brother to call 911, put himself on a treatment and died. We got it as a DIFFBREATHER first, “…unable to speak in full sentences…” (never good) and then as we approached it became a CARDIAC ARREST. The brother had started CPR right away, and the EMTs were doing those real good ribcracking compressions, and the guy was only fifty-something, so everything was basically in place for him to pop back around, but still, he was flatlined, which is the deadest rhythm your heart can possibly be in, and he didn’t change in the first 20 minutes of working on him. I did a round of compressions, felt the crunching of breaking ribs beneath my hands, then handed it off to fireman and stepped out the room to call Medical Control.
Passed the guy’s ancestor shrine on the way down the hall. I was on hold with telemetry, so I just gave them a nod and mumbled ‘go take care your homeboy,’ and then the doctor picked up. Laid the presentation out to him, got a few more medications to give and came back in the room. The EMTs are still pumping on his chest. I push the meds, we do some more CPR and then stop to check a pulse.
“Pulse!” the EMT yells. “Strong one!”
Indeed it is – a good solid pounding up his carotid artery. His blood pressure’s a healthy 148/72, his heart’s a little fast, but that’s to be expected considering everything. Okay. now we have to move. People that come back like that can look really really good until all the sudden they’re not, and then there’s a tiny window when you might be able to get ’em back stable but it’s real touchy, and really, they need an ER at this point. So we scoop him up, gather our shit, carefully carefully lift him on the board, because if we dislodge the tube right now it’s a wrap, and bustle him off to the ambulance. Downstairs we recheck everything: his heart rate is still good but his pressure’s diving. The recently-undead can be so finicky and unpredictable with their blood pressures! It’s not low enough to intervene yet, and given said finickiness I tend to be a little tentative about putting major gamechanging medications on board prophylactically, which is what the lieutenant on scene thinks we should do.
So i hold back on the dopamine, and sure enough when we get him in the ER and they take his pressure it’s through the roof high, 180/100 or something, and any kind of intervention would’ve skyrocketed it into guaranteed stroke territory. We give the report, the doctors are always a little wideeyed that such things happen outside of hospitals, and they take over. Before the shift ended we check on him up in the CCU and he was in an induced coma, his body being inundated with cold fluids to preserve the tissue, but he was still alive.

‘TIS THE SEASON TO BE…DEAD

Apparently. Cuz people always in bad shape during the holidays. Folks with families get stressed by their families. Folks without ‘em wish they had ‘em. Everyone’s stressed. It’s like your birthday, when you spend so much trouble tryin to have fun that it sucks, except the whole damn world’s doin’ the same way.
So last week was the triple shooting and the crazy come-back arrest. Then Saturday at 5:40 they wake us up for an “UNCONCSCIOUS” call up the block, but you can tell within 2 seconds of walking in the door that she’s dead. She wasn’t the kind of dead that comes back either: 76, morbidly obese, a million medications and disorders, living in utter squalor and sitting up in a puddle of her own pee. The folks around her thought she was still alive, which is always unnerving, so we cleared the room and started working.
My partner intubated while I poked around for an IV. She had big veins but they wound in crazy angles all up and down her arm, none long enough to really land a catheter in. I put one in but it was reeeeeeal tentative, like the slightest jolt would knock it out of place, which is exactly what happened after I got a few rounds of epinephrine and atropine in her.
Meanwhile, the EMTs arrived and started pumping on her chest- ribs cracking, the smell of pee and stickiness underfoot…you just learn to ignore it. The monitor’s showing us nothing- just that flat flat flat line that means the heart isn’t even considering doing anything different than being still. I’ll be honest people, I don’t like disturbing the dead. I believe in giving people the best chance they got and I wanna keep my job so we work up anyone without Rigor Mortis or other signs of Obvious Death, but the least amount of intrusion I can do on a body the better, and it seemed to be this one’s time to go.
So we get on the phone, make a call to our medical control docs to see if they want us to do anything else. It’d been 45min or so and the time had come, and just when we’d dropped in an amp of dextrose and two of sodium bicarbonate, lo and behold, the lines on the monitor go all squiggly wiggly- v-fib. A shockable rhythm. But still – even that…well: we shock (“bla bla bla I’m clear, yer clear, we’re all clear…KAZAM!”) and lo and behold once again, she has a nice real normal rhythm and—check a pulse: a PULSE, a bounding pulse no less, to go with it.
“I’ll be damned…” I say out loud, cuz I really was caught off guard. We roll her body over to one side, shove a sheet underneath, roll her back over. 1, 2 ,3 and heave ho all that dead but alive weight up and on to the stretcher. As we clamor out the cluttered apt door, the lieutenant’s explainin’ 2 the family what’s going on, and their squinting at her like- the fuck you talking bout lady! And I would be too, quite frankly.
I truly don’t expect our lady to last very long and that may seem negative, but consider that most folks who do make it end up purely vegetative, especially after being down for so damn long- it was literally and hour and a half from the time we arrived when we rolled her in2 Long Island College Hospital, (still with a pulse)- and I wouldn’t wish that on anyone endless alive but dead nothingness on anyone. But there it is.

Then on Sunday it was a super rich doctor dude on the Upper East Side. Lord, I’m talking doorman, massive lobby with a fountain, the full spread. The guy’s layin on the carpet, had just vomited, pale as shit, sweatin’ and was having a sudden onset of crushing chest pain. AND then we put him on the monitor- his hearts going a sluggish 40 beats a minute (should b btwn 60 and 100, and this dude was no athlete…). His pressure was 92/60, probably on the way down as he decompensated from such a slow heart rate but he’d also just taken ahem, a you know a, um…
“A WHAT?!”
a, er, y’know a, well, wanted to have a good night…and…Levitra…
Ah- erectile dysfunction medications don’t mix well with nitroglycerin, by the way, cuz they both drop yer bloodpressure out. He hadn’t done that but his low bp meant we prolly wouldn’t be giving him any nitro either, which once we checked his 12 lead, we saw he badly needed. Once his heart sped up some. Too much going on with this dude, I thought, setting up the IV for my partner and eyeing the monitor like it was an nasty little creature about to attack. Jobs like this can go sour so damn fast you won’t even know what hit you. His 12 lead- which is a more indepth EKG that shows the heart from various angles and tells you if there’s any damage from oxygen deprivation, i.e. heart attack- looked like ass. It was ass. Besides his heart rate being slow as shit, his 12 lead was ass.
“fuckshitass,” I said under my breath.
“What?” The doctor said, grabbing his own 12 lead from off the floor and tryin to read it.
“Nothin,” I said, grabbing it back. “You’re have elevations and your bradycardic, but you’re not treating you, I am.”
He smiled. “Fine. What’re you gonna give me?”
I don’t like to treat any more than I have to. We were setting up to give him atropine, which would bring his heart rate up, but if that didn’t work and he stayed shocky we’da had to sedate his ass and send little electrical volts through him to stimulate each heart beat. Which I really didn’t wanna do.
“I’mma give you some fluid first, and some oxygen, and take it from there…”
“Ok,” he said, like I need his fricken signature to do it. But I just went about my business.
We attached a fatbag a fluid to his IV and squeezed it in hard. The stretcher was set up and ready to move, and we were about to drop the atropine in him when those effed up little complexes of his started coming faster and faster across the monitor. Now 52, now 56…
“wait for it,” I said, my partner with the full syringe poised over the hub.
60. Beautiful. We held off atropine, the rate evening out at a steady 64.
“How’s the pain?”
It’s gone, he said, almost laughing.
I gave him some baby aspirin to chew on- not 2 b condescending, that’s really what we carry, and we wheeled him out the door.
By the time we rolled him into the hospital even the 12 lead was looking better. He was pain free, had a solid bp and was ticking away at a healthy 70 beats a minute.

BUSY WEEK ON THE BUS

MOOD: slightly tipsy, it’s true
MUSIC: Erykah Badu
She was pregnant and lying in a pool of blood. There were 2 others, deeper in the deli, but a quick glance letme know they weren’t nearly as bad. The project across the street was already emptying out, folks screaming and yelling, breaking towards us at a run as PD scrambled to control the scene. Bright lights bouncing across the brick buildings. Utter chaos.
While my partner and an EMT strapped the patient to the long board, I set up an IV and liter bag of saline fluid so everything would be ready when they loaded her in.
The thing about most shootings: they’re a) usually not THAT bad- a in and out tib/fib shot or a hand, and b) the patients are rarely surprised to have been shot. Always wanna act like they saw it coming, like it’s just some of run of the mill shit, bla dee bla. Or like the guy two months ago who wanted us to take a picture of him for the cover of his album (Sweartogod). But this lady was both very near death and very afraid. She had no blood pressure, because she barely had any blood- what she hadn’t left on the corner store floor was quickly soaking through the bandages, and she kept teetering in and out of consciousness.
My partner put one IV in and I yelled to the driver to go, but not go crazy – cuz mofo’s will drive like hotholy hell on jobs like these and make things much worse- and we speed off. There’s no trauma center in North Brooklyn. If we’re any further up than we were we usually haul ass over the Williamsburg Bridge to Belleview but were slightly closer to Kings County, so off we went, slipping along through the rainy night towards Atlantic Ave, then Eastern Parkway. She had a juicy vein along her forearm, so we dropped the second IV there, bouncing along with the Brooklyn potholes and stubborn, non-clearing stopngo early evening traffic.
She wakes up some with the fluids flowing through and wants to know if she’s going to die, if her baby will make it.  The truth is, it’s looking good for her but there’s no certainties with jobs like this. I tell her as much, but with a more positive spin, and give as clear and update as I can while I try to staunch the bleeding and not fly across the ambulance. We screech around a corner, the cop in the back with us looks like he might lose his lunch at any moment, and then we roll up the hill into the County ER bay.
The other two victims roll in soon after us, one in handcuffs from a previous warrant—dang imagine gettin’ shot and arrested in 5 minutes for separate shit… And the hospital staff jump into their frantic dance.  When we leave, I’m happy to say, our patient is stable and the baby is out of danger.
Later that night, we’re in the train station, looking at an elfish Puerto Rican pothead who’s pretending to have chest pain. When we get him away from the cops I raise an eyebrow at him: Really, dude?
He sighs. “No, I just smoked A LOT of herb.”
How much?
“No, bro, I can’t even. No. Too mothafuckn much.”
I won’t write it down on the paperwork, I swear.
“Well,” he laughs hysterically for a few minutes and we wait for him to collect himself. “Three grams. Plus I tripled up on my antipsych meds. Hehehe…”
Damn.
“Yeah, son.”
Hungry?
“You have no idea.”
Chest pain?
“Nah. I was just…you know.”
You just want somewhere to take a nap.
“Basically.”
No problem.
Then, two nights later, we’re chilling in Marcus Garvey Park, whiling away the night, when the cardiac arrest comes over. Everything happens fast and efficiently: we’re there in two minutes along w/ the BLS, the dude is 41 with no medical problems lying dead on his bedroom floor. Wife and 3 kids looking stunned, staring in at us from the doorway as we setup our shit. I pass my partner and the student the tube kit and they get to work putting an airway in him. The EMTs start chest compressions and pull out the oxygen. I throw the EKG pads on and take a look.
Quick cardiology lesson for those that don’t know: when you’re heart stops beating, it doesn’t necessarily mean all the electrical activity stopped. When that happens, you get the flatline. But sometimes there’s still a ridiculous little floppy line of current running through- it’s called ventricular fibrillation. It’s rare and usually fleeting but if you catch it you can sometimes shock it back into a nice normal working rhythm.
When they stop compressions so I can get a look, I see our guy’s in a rare form of v-fib called Torsades de Pointes. It’s pretty, a windy, spiraling squiggle. “Clear away from the patient,” I say, charging up the monitor. Everyone takes a few steps back, I hit the button and the patient flops up in the air, his inanimate limbs jolting around eerily. When he lands, we do another round of compressions and check again. A  few gimpy complexes float past on the monitor before it settles into a nice steady regular rhythm. We check a pulse and voila- miracle of miracles the man has a beating heart. The tube is in, we drop an IV and begin setting up for transport. We’re exchanging glances but trying not to get all excited cuz the shit could fall apart at any given second and usually does.  Even in the rare case that folks DO come back, they almost never come back to be anything beyond total vegetable.  But there’s always a chance.
Our guy stays quite stable throughout transport.
He coded and was revived twice more in the hospital (where a tox screen revealed large amounts of cocaine in his bloodstream) and at last check was still comatose but expected to pull through.

THE BABALU AYE SPECIAL EDITION: 2 BACK FROM THE DEAD STORIES (sorta)

Well: I was really planning on the next piece i wrote being about all the mundane bullshit we do, which is like 90% of the job, especially cuz now i got fricken jud and saraivy telling me how i’m just trying to show off on facebook with all the gory shit we do…BUT, f them- cuz this week was Babalu’s day, and in his catholic form, Babalu was Lazarus, who Jesus famously raised from the dead, and in honor of this I somehow ended up with 2 Babalu-relevant jobs, and I’m sitting here bored out my skull so I will now share them with you.

1.
There’s this crackhead motel on 125 and Park. Everytime we go there it’s some scene out of The Wire or Pulp Fiction. Job comes in as first DIFFBREATHER, then UNCONCSCIOUS and then, inevitably, ARREST. Means the guy’s supposedly dead. We get there, walk up the rickety stairs and our dude is laid out doing a very loose impression of a dead person, surrounded by a swath of mortified and confused cops and fire fighters.

On a sidenote: this is a classic firefighter maneuver called The Circle Of Death: it’s when they get there first and form into a small circle of curious white faces looking down at the patient. It’s FDNY sign language for ‘what the fu-u-ck?’ Many a time we roll up on scene to find this peculiar huddle and it’s usually not a good sign.

Anyway, if you’re any kind of medical personnel you get good quick at knowing the difference between a true cardiac arrest and a guy that wants attention (the best are the fake seizures, when they go “I’m having a seizure!” and squirm awkwardly till they realize you’re not buying it). But firefighters and cops are not trained in this art, so they really were convinced. O and I took one look at the man and O set up the stair chair and i said “Get…up!”

First he squirmed and moaned and the firefighters all gasped. “Get up and get in my chair,” and reluctantly, he struggled to his feet and planted himself in our chair as the room fell completely silent.

We had ourselves a good chuckle driving back to our spot when it was all over. Not so much at the fireguys’ expense (a little though…) if not at the whole situation in general: here we are again in the midst of this whole huge bureaucratic clusterfuck, dozens of different agencies and crossed lines and legalities and so much work done covering ass and so little done treating patients, between dispatchers and insurance companies and godknows what kind of existential spiritual lifendeath tug-of-war, and right smack at the center of it all is five guys with helmets standing in a circle around one old bobo trying his best to look dead so he can get a night of sleep away from the other crackheads.

2.
That was Wednesday, December 17, sacred to San Lazaro, who shocked everyone by

emerging out of his grave on Jesus’ request and hobbles around town with his crutches and pack of dogs. On Saturday, the night of the annual Babalu cleaning ceremony, we had two back to back cardiac arrests.
The first was a 96 year old lady who was clearly well past gone, but when we walk in the fire guys go “oh! She was up and talking just before you walked in!” like it’s all our fault. This is pretty standard procedure especially when it comes to nursing homes- we get there, the patient’s rock solid with rigor mortis and the staff is talking bout how she was laughing and chatting not seconds before and how they can’t believe it, in fact she was walking around, walking I tell you! Playing freeze tag even! Lord- look how quick she went!
This lady was, as i said, gone but she didn’t fit the criteria for us to leave her in peace (rigor mortis, decomposition, dependent lividity-which is the pooling of fluids at the lowest point in your body, or a grim catch all called Obvious Death, which is for those guys that are just DEFINITELY not coming back, i.e. decapitated) . So we went ahead and started working her up. It ended up messy, firstly cuz she was old and must’ve had a terrible case of osteoporosis, because literally all of her ribs collapsed on my first round of cpr. Secondly, she had zero veins for iv access, (and we tried plenty) except as it turned out, a nice solid 1 going right down the center of her forehead, and that is exactly where the iv ended up. It seems crude, it is crude, i guess, but this is what it is: if you’re in or about to be in cardiac arrest, having a little saline-lock antenna popping out your head is not what matters, all that matters is that you have one. In that iv goes all the good medicine that we carry around that will bring you back, directly into your bloodstream and all across your body. So in retrospect, or from the comfort of all of our not-imminently-to-die selves it’s easy to squirm at the thought of all these gruesome details and invasions, but I’m telling you them precisely because that is the very heart and soul of emergency care. It’s by definition a sticky mess of bloodied gauze, discarded syringes and stained suction tubes matched only by the colliding and collapsing human disaster zones that it’s created to revive.

Which brings us to the second cardiac arrest of the night.
No wait, first, another sidenote:
Approximately 100% of the recently dead on tv and movies who are treated with a touch of poorly performed CPR come springing right back to life and go back to killing bad guys. Most notably, James Bond, who just one movie ago defibrillated himself back from the beyond and then went on playing poker straight away.
Yeah- that’s not how it works. First of all, it’s literally about 1-2% of people we get in arrest ever get a pulse back at all. In my five year career I’ve gotten 2 maybe 3 pulses back total. Second of all, and maybe most importantly, of those few the vast vast majority of them are total vegetable matter from then on out. You just can’t deprive a brain of oxygen for that long and pop back around like nothing happened, it doesn’t work that way. In NY the situation’s complicated even more by tall buildings, projects, traffic and numerous other obstacles delaying patient contact.

So, so so so, that means when it’s your time it’s your time, and most guys that’ve been working the field long enough know better than to walk into every arrest that comes over and raise the dead.

I was particularly feeling that way on Saturday, not just cuz of the first messy arrest, but because i was working with, oh let’s call him Gerk- a certain medic that I just wouldn’t trust giving treatment to anyone i knew or cared about or had ever met. At all. I mean- well his name says it all. And then I was even less thrilled, you can imagine (maybe…) when the second arrest of the night came over not long after we finished cleaning up the first one. Oh lord, i said to myself, this poor whomever, wrong night to flatline…

Whomever turns out to be a 72 year old Indian gentleman lying flat on his back in his underpants with a bright red flare of blood at his lips and nostrils and a burly EMT thumping up and down on his chest,. He has no signs of trauma and appears to be in good health except for a large unsightly triple bypass scar stretching across his chest (and the fact that he’s dead).

Our monitor says he’s flatline, so there’s no movement at all in the electricity of his heart, nothing to shock in other words, so I start looking for a place to put my iv while Gerk prepares his tube kit to get an airway. This guy has only slightly better veins than the last lady, and having no heartbeat doesn’t help, but i manage to sneak one in right along the top of his left hand. Gerk’s having trouble with the tube, to his credit the blood in the airway means he’s just staring into a dark tunnel of fluid, with surely no vocal chords in sight to pass the tube through. Eventually, we do get it though, and just when I’m thinking the EMT is gonna have his own cardiac incident from how hard he’s pumping and sweating, someone announces that they felt a pulse.

No shit, i think, but there it is- a vigorous thump-thumping along his carotid artery. There’s some excitement now as the crew shifts course, one EMT running off to get the stretcher, the other taking the blood pressure, Gerk on the phone with our on-line medical control to get more meds, me and the lieutenant prepping the patient for transport.
The family’s all there screaming and praying as we load up our post-arrest patient and stick him in the ambulance, and though I’m trying to be pessimistic I’m feeling good about this one right up until he arrests again as we’re flying along to the hospital. He’d come back strong with a solid blood pressure and the pulse way up in the high 140’s but halfway to Wyckoff his heart dropped back down to the 60’s, then 30’s, and while we’re frantically working on him he loses pulses again completely and we’re back to thumping his chest while trying to keep balance amidst the tossing and turning of Brooklyn streets.

As we pull up I check again and miracle of miracles, there it is, that rhythmic murmur of pressure against my finger… In the ER bay they do their usual half-joking complaining about how we have all the fun and get right to work on him, setting up a dopamine drip, getting a ventilator set up, etc. I can’t help but feel good, and I’m literally typing the first words of a jubilant text message to Gabi when I see all the nurses run over and a doctor start compressions again.
Crap! I shut the phone right quick and walk over cringing. For a third time though, our man decides to live that night, and this time he stays for good. When we leave the hospital he’s pumping away all by himself, but he’s still, and maybe always will be, a vegetable.