Last Shift Before Christmas


Reading Christmas-themed EMS 1 articles by Kelly Grayson, Nancy Magee, and Michael Morse, I was reminded of a night I worked 9 years ago. The 14-hour shift began at 1800 and ended the morning before Christmas Eve, when our supervisors were taking us out to breakfast as a gift. After checking the truck, I checked my email and browsed the EMS websites. I remember reading Bryan Bledsoe’s column in JEMS called Christmas Night, which was a story about urban, rural, and flight paramedics, as well as soldiers and Border Patrol officers, who all had quiet nights when they worked on Christmas.

It has been a perfect Christmas night. Nobody was ill. Nobody was injured. Nobody violated the law. Nobody needed to be rescued. Nobody died. What was it about this night that was different? Was it the star? Was it the benevolence to our fellow man that we unfortunately see only during the holiday season? Who knows? Let us hope and pray that our colleagues who protect and serve us on Christmas of 2006 have a shift like the one described here. Let us hope that, at least for one night, there will be peace on earth and good will among men.

 As a chronic Christmas procrastinator who had not yet started shopping, I was hoping a shift like that. It was not to be. The night was filled with alcohol and drug-fueled illness and injuries. One person was hit by a car walking out of a night club, and was combative with a head injury. Another was stabbed four times in the back after a domestic, and another combative after using PCP. There was a pulmonary edema patient who we put on CPAP, along with some calls at nursing homes mixed in. The clock just did not seem to move, and we were never able to catch up on paperwork.

I had difficulty staying awake while driving to a seizure call around 7 AM. My partner rode with the postictal patient to the hospital, and I hurried to restocked our equipment and escape from this horrific night. It was 0810 when I looked at the CAD, ten minutes after our shift was supposed to be over, and saw a cardiac arrest for a 40 year old around the corner being dispatched. The next closest paramedic unit was thee miles away, and we could have walked there in five minutes. My partner’s head sank when I told him, but said in unison, we have to go.

We threw our gear in the truck, told the dispatcher we would respond, pulled up behind a firetruck that had just arrived. We all walked into the row house and followed a family member up a spiral staircase, and I dreading the thought of carrying someone down it. We turned down a hallway and into a bedroom, where we found a woman who weighed at least 600 pounds, lying on a bed in cardiac arrest. I just want to go home, I thought.

So we did CPR as best we could. Even a muscular firefighter had difficulty getting his hands in the center of her chest to do compressions.  My partner was in charge of the airway. Her head was against a wall, and he and two other firefighters did the best they cold to ventilate her with a BVM. She actually had a good vein in her arm that I was able to start an IV in, and I gave an epi. A ladder truck was called in to assist. When my partner was ready to intubate, eight of us slid her down on the bed to make room. When we slid her down,  the top layer of padding on her bed came with it, and dust flew everywhere. The padding was embedded in her skin skin, and the springs of her bed were exposed. We all stopped for a second when that happened, then went back to work. My partner had to lean over the side of the bed to take a look with the laryngoscope, and asked for the Combitube a few seconds later later.

Meanwhile, the firefighters moved the bucket of the tower ladder outside of the bedroom, and were preparing to cut a hole in the side of the house to move her out. Her end-tidal was below 10 mmHg after an epi with the best compressions that were physically possible to do. I asked them to pause. Our supervisor showed up, and we discussed calling the code. He agreed. We would still have to find an ambulance big enough to transport her, and this had reached the point of futility. After some discussion with the base physician, we called the code.

The patient had a fiance and parents that were on scene. They were upset, but did not seem surprised that she was dead. They said she had not left the bedroom in over a year, and I did not ask why. I offered my condolences and wished them well. We went to our base hospital to restock the equipment we used, then back to the station. We still had charts to write from before that call, and I had a long narrative to write with this one. I left the station at 1100, three hours after it was supposed to end, and a half hour after the rest of our shift left the restaurant.

I took a long shower when I got home. I was exhausted, but too wired to sleep, and ended up going Christmas shopping in a zombie-like trance.I thought about the different people I took to the hospital, what their Christmas would be like this year, and what a normal Christmas would have been like. I thought about how lucky I was, with the family and home I have to go to, and how easy it is to take for granted. EMS work provides no shortage of reminders.

 

 

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