As medics and EMTs, we are taught several rules during our schooling:
- If it's wet, sticky and not yours, don't touch it!
- Don't drop the baby.
- It's all ethyl-methyl-bad stuff until someone higher qualified, and higher paid, tells us it's not.
- Beware of the quiet psych patient.
- Bring a change of uniform...a complete change of uniform.
- Eat, sleep and pee as often as you can. You never know when Murphy will rear his ugly head so you can't do one of the above...when you really need to.
- And above all else: Patients' don't die in the ambulance.
From the beginning we are taught how to save lives. From the first responder who learns how to use an AED, stop major bleeding and conduct CPR at the start of his EMS voyage to the paramedic who is given an arsenal of drugs, tubes, needles and other devices, we are told that all of our tricks and tools will help us save lives. That performing ALCS, CPR and whatever else properly, will save lives.
However, we are not taught how to respond when things don't go as planned.
We've all been on scene of a DOA--that patient who has ceased to breathe a long time ago. We hold the hands of family members, give them our full moral support, help them understand subsequent events such as calling the coroner/medical examiner in suspicious deaths, getting in touch with the patient's doctor, and calling a funeral home) then we pack up our toys and leave.
Now, let's look at it from a different angle.
You run a perfect code. The American Heart Association would be proud of your flawless delivery of ACLS. Your tube is in the right spot, you have all your lines in, CPR is being delivered continuously and flawlessly...yet the line on the monitor is unwaveringly flat. You couldn't get a straighter line with a ruler.
Now change the patient's age from 84 to 34. Notice how she looks shockingly like your wife or daughter. Notice he has the same tattoo as your brother. Notice how the car you just pulled him out of looks like your husband's car. Notice your patient needs the tiniest of tools you carry on your ambulance.
The loss of that patient takes on a whole, new and disgusting feeling. Our shoulders slump forward. Our whole demeanor changes.
We can rationalize the natural death of an elderly person. "She lived such a long life." "He was really sick." "It was just her time." But we can't say anything even remotely close to that for other patients.
We feel we've somehow failed for not saving them. We scrutinize ourselves, our crew, the hospital, whatever. We find something to blame death on. We bang our heads against the ambulance walls trying to come up with a solution, yet the solution is staring us in the face.
No matter what we do, we cannot stop death.
Sure, we can delay the inevitable. I've done it a few times for my patients, and I've gotten lucky a few times myself and cheated death. But when it's going to happen, there's nothing we can do.
As medics and EMTs, and even nurses and doctors, we need to stop taking death as a sign of failure. Death is something we can't control.
During my medic class, it was drilled into my head that we can save lives, that we are always going to save lives. As an EMT, I got lucky. I've had three honest saves. I say honest because all three walked out of the hospital and went back to living their lives.
My first honest loss, someone I felt shouldn't be dead, rocked my world. I was lost for a few days. I felt I had failed miserably. I wanted to hang up my stethoscope and card and just disappear. Slowly, but surely, I came out of my funk with a new understanding.
Yes, CPR and ACLS work, but not all the time. People are going to die, no matter their age, gender, medical health or anything like that.
I, as a paramedic, cannot stop that, no matter what I do. No one can stop it. So, here's my addition to the rules: Above all else, people, sick or not, are going to die. We can delay the inevitable, but we can't stop it ... no matter how much epi we push.
Have fun and be safe.
Shao Trommashere is a paramedic who has worked for close to a decade in EMS and in the fire service. She completed paramedic class in 2007 after working as an EMT since 2002 in the Northeast corner of the United States. She also has a blog called Looking Through A Pair of Pink Handled Trauma Shears.