Thursday, August 11, 2011

Anything Can Change in a Moment

You could be sitting in your car one afternoon on a gorgeous summer day in your driveway. Maybe you just got home after depositing your paycheck plus some cash-back for a little shopping. Girl needs a reward after working so hard for that paycheck. Middle-aged, successful, well-coiffed and adorned with real-precious-metal jewelry, you've got a good job, a husband, children, in-laws that live close-by who care a lot about you. You're a religious woman, with a large cross pendant on a chain around your neck, or maybe you just like to show people how religious you want to be. You live in a great neighborhood-expensive, even- everyone knows everything about everyone, because they care, you know... not because they're super nosy.

What happens next is unknown, but your neighbors start to notice that you've been sitting there a while... they think you're just sleeping, taking a nap, maybe. Something doesn't feel right, though, so someone calls 911. The EMTs show up and realize you're pulseless and not breathing. Suddenly, they begin pushing up and down on your chest and attaching you to all sorts of wires. A mask is pushed on your face and a bag used to push air into your lungs. That might not work well, since you've already lost control of your breathing, so some air might get pushed into your stomach. The simultaneous pushing on your chest might make all that air and lunch come spewing out. But that's ok, as long as they keep your blood circulating around your body.

More people show up- paramedics, this time. They begin IV's and attach pads to your chest and back. The fancy defibrillator machine will rev up, beep, and announce "No Shockable Rhythm" because you're asystolic- you have no heartbeat. In the wailing ambulance, the paramedics will call our hospital, give us an arrival time and shortly, you will wheel into our prepared room filled with people and meet yours truly, S, gowned up, masked, and ready to go.

When you get transferred to our bed, you'll find it's rather uncomfortable- there is a hard board under your thoracic spine. As soon as you are transferred to our bed, you'll find yours truly next to you. I will quickly cut off all your lacy, feminine clothes with some sharp trauma shears, place you on a cardiac monitor, an oxygen reader on your finger, and a blood pressure cuff on your arm. Many fingers will be probing your neck, groin and upper arm for a pulse at this time. Before you can process all this, if you can, I will hop up onto the bed, kneeling next to you. At the doctor's order "begin compressions", I will push up and down on your chest, manually pumping your heart for you at about 30% of its natural capacity. This buys us time to keep your tissues perfused and alive for now.

Nurses will be pushing IV's in, doctors will be pushing a tube down your throat to help you breathe, and I will be pumping away at the rhythm of the Bee Gee's "Stayin' Alive." It's hard work for me, but worth it if you come back to us. I've had people come back before, but you were sure stubborn yesterday. "Hold compressions." I guess I couldn't bring your pulse back this time. The doctors would check your heart with a bedside-ultrasound machine, but it decidedly wouldn't budge. "Resume compressions" might sound again, so I might just lock my arms again and keep going. My breathing might get a little harder, but that's ok- this is why I run miles and miles at a time, so I can keep up with the physical demands of pumping your heart for you. After several cycles of this, the doctor might ask me to hold compressions a final time. "Would anybody mind if I called it?" ("No" is thought by everyone, but no one voices it.) "Does anybody object to my decision to call it?" the doctor tried again. Again, nobody wants to take responsibility. The doctor sighs- he knows the responsibility is his. "Time of death, fifteen oh three."

Everybody will leave the room, leaving the tattered room and your tattered body alone, except for me, your trusty tech. I will stay by you. It will be strange, where there were so many people surrounding you just a few seconds before, there will be just me. First, I will be removing all your jewelry- don't worry- I will document everything, removing it all with care, locking it up with security for safe-keeping before your family gets here. Likewise, I will take your tattered clothes and put them in a bag, they might want those, too. Finally, it's time to clean your body, wipe off the vomit, blood, debris, urine, feces. Another tech will be lining a stretcher with our post-mortem bag and clean sheet. I will tie another hospital gown over your neck for your privacy. We'll transfer your body over to the new stretcher, fixing a toe tag and more ID-bracelets.

The move might make your eyes pop open, but I will gently close them again. Your jaw will be slack and I will try to close it (this is the hardest part)- open-jawed rigor mortis looks terrible. Your body will be outfitted with clean sheets and blankets folded just so. I will pull out an arm, still warm, to lie on top of the blanket for your loved ones to hold when they come in soon. We will wheel you out with a little mask on your face, so as not to scare the other patients, into the special mourning room. I will look around the corner for any grieving relatives. If any are in sight, I will wait until they leave- the grief sometimes causes people to become homicidal. I need to stay around and stay healthy because I have 12 other critical patients begging me to come in to help them.

Finally, you will be parked in your temporary place of rest in the mourning room, awaiting loving family, the chaplain, and a doctor to come in and explain everything was done, and truly, everything was done. The mortician technicians will come for your body when all is said and done, where you'll be placed with the other bodies for a little while until your funeral home picks you up.

I am so sorry. So sorry that you didn't get to go shopping this afternoon, sorry that your family is grieving, sorry you had to meet me. But who could predict that moment in your life, whether you are young, middle-aged, or old, that you might meet me in your dire moment of need?
Anything can change in a moment.

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