In EMS we often talk about our “Saves”…. The times we’ve done CPR and gotten a ROSC. We get all giddy about seeing a rhythm come across the screen of that lifepak… Especially when there was nothing but a very stable asystole before that.
You do compressions until your arms are numb and sweat soaks your uniform. For some of us, our hearts race, resulting in an adrenaline rush that seems to last way too long and results in many of us really needing a nap. Some of these runs stick with us… The patients show up when we least appreciate it. While we’re trying to sleep. And the most memorable ones keep reappearing. For years. And we do this, some of us every shift, some of us just once a year… All for that anonymous person who’s heart has up and quit on them.
I’ve done CPR a grand total of 14 times. Considering the fact that I’m approaching five years in EMS, that’s not terribly impressive, I know. Out of 14 codes, I’ve had a ROSC one time. Recently.
I cleared the patient so that the monitor could check him. With sweat running into my eyes I yelled (probably too loudly), “Holy hell, is that a rhythm?”
“Brady, but yeah. Definitely a rhythm on the screen,” Craig reached instinctively for our patients carotid to see if the the pulse was perfusing. “We have a pulse!”
I felt my stomach do a flip. I’ll never forget what hearing that felt like. He had a pulse. We saved him. We won.
**********
According to several of my coworkers, this was a “win”. A save. A feather in my cap.
At first I believed them.
Then I learned that the patient, complete with an ET tube down his throat and perfusing pulse was a DNR. The ECF forgot to include that useful tidbit of information.
Thanks ya’ll.
Then I learned that the patient, a DNR (did I mention he was a DNR????) was now residing in ICU. With his ET tube and perfusing pulse. On a vent for God only knows how long.
Probably a vegetable.
Definitely NOT a win.
Definitely not.
Sometimes a win is not a win.
**********
(Something more positive tomorrow, just venting tonight.)
Very sorry to hear that Epi. Sad as it is the public should be grateful to know there’s people like you who will keep on trying even though they’re exhausted.
Hell, Tim, I’m always exhausted :) It’s a part of me anymore! I’m always tired :))
It’s the act of doing CPR on someone, and hoping like hell that they’ll come back and remain neurologically intact. And unfortunately that doesn’t happen as often as so many think.
For the record… I’d work with you any day.
Vent away Epi, vent away.
We do need to re-evaluate what a win is in this business. Sometimes offering another blanket or help down the stairs is a win. It’s not always the glory, thanks for the reminder.
Hey Happy :)
I knew it before, but thanks to this run I’ve got confirmation. It’s not always about the glory. More often than not it isn’t.
Sorry to hear that Epi. I know it sucks, I’ve been there recently myself, with a pedi no less. CPR is exhausting, mentally and physically.
Love reading your stuff, and am super excited that you’re back in medic school. Good luck!
Thanks Whit… I’ve done a pedi code once… Worst thing I’ve ever been through. Stuck with me ever since.
Thanks for your good luck wishes, god knows I’ll need ‘em… especially ten months from now when I’m flipping out :)
ROSC is a win. It’s a win for the Healthcare Professional over nature. The only question is
Which team is the patient rooting for?
Epi,
I know exactly how you feel (from personal, not professional) experience. But this one was not anything you did wrong- no one told you guys that there was a DNR in place! therefore, you did exactly what you were trained to do! It’s a 50/50 crapshoot anytime you resucitate someone!
You didn’t know that he was a DNR. You did your job.
An ROSC is a good thing. It’s horrible that the past had a do not resuscitate order, but had they told you this, you would not have resuscitated him. It’s a win/lose situation.
16 years in volunteer EMS here; I’ve done CPR more times than I can remember…and I’ve had exactly ONE where we converted back to a rhythm and corresponding pulse.
The patient in question, a heavy smoker in her 50s with COPD, was transported for acute shortness of breath early in the evening, and (frustrated with a perfectly normal wait in the ER) signed out AMA and caught a cab home. Three hours later, the same dispatch went out again – “female with difficulty breathing”, and when I walked into the house, I found her in agonal respirations on the floor, where she coded within seconds, as I assembled the BVM. We performed CPR, defibrillated and transported her, and got a rhythm and pulse back en route.
If it’s any consolation, the patient lives right down the street from me to this day (one hazard of small-town life) – and hates me.
Literally crosses the street to avoid me when we see each other.
:)
I feel your pain, Epi. Was in this situation myself not too long ago. It sucks.
http://manchmedic.blogspot.com/2009/08/stuck-in-middle.html
Epi… can you catch a break? I’m sorry. :-(
I think I need to write more about the good days. Thanks Doug :)