Harley’s Birthday Bonus Story

Disclaimer: While this story is based on true events, some names and details may be changed for privacy and legal reasons.

….

I had met John in August or so of 2021 when he called 911 to report difficulty breathing. When I arrived with my partner, lights and sirens blaring in the night, John was sitting in a broken, plastic patio chair with his hands on his knees and gasping for breath. His lips were blue and his face was ashen gray. He had a history of COPD and was a chronic pack-a-day smoker. We weren’t able to find out much else as he was only speaking one to two words between desperate gasps. We placed the defibrillator pads on his sweaty chest, attempted to capture an EKG reading, and put him on high flow and high-pressure oxygen. Most importantly we administered a high dose of diesel fuel – fast transport.

As I watched John lying in the ER bed, sedated and intubated and not responding to two separate shocks to restore a normal heart rhythm, I knew I would never see John again.

….

05:30 came very quickly that October morning. The sky was clear and blue, but the breeze chilled me. A faint scent of smoke drifted through the air as the mountains were being cleared by controlled fires. Harley and I begrudgingly prepared for another exhausting shift, but thankfully we had each other. We had managed to get through the toughest situations side-by-side and come out the other side with jokes and a smile.

The tones dropped as soon as we checked our equipment, and we hauled ourselves to our first call – a 34-year-old woman who intentionally ingested an overdose of Tylenol after a fight with her boyfriend. She was awake, alert, and stable. There wasn’t much we could do for her pre-hospital, so we started an IV and monitored her vitals on the way to the hospital. Harley and I exchanged a knowing look at the hospital. If this was the way the day started, there was no telling what we were in for.

The second we cleared the hospital, the dreadful words crackled over the radio: “Medic 1 code three for difficulty breathing in Skeleton Valley.” Harley punched in the address, and we sped down the two-lane road heading to the rural town 40 minutes away from our current location.

Harley didn’t bother with the lights or sirens because there wouldn’t be any other drivers on the winding back roads. He still drove quickly and with purpose, but there was no sense in damaging our hearing from the wailing on the way. The fields upon fields broken up by the hills and mountains were scenic and serine. As we made it into the small town, ranches with horses and livestock filled our windshield.

We arrived at the same time as the volunteer fire department, two guys in plain clothes driving an old firetruck. They may have been certified in CPR, maybe even carried a First Aid card, but they had no formal medical training. We said our greetings as we walked into the patient’s house.

Carol sat hunched forward with her hands on her knees on a brown leather couch in a small clean house that smelled faintly of smoke. I noticed an ashtray on the coffee table and made a mental note for my assessment questions. Harley attached the blood pressure cuff, pulse ox, and EKG stickers to Carol as I asked my questions. Medical history, allergies, medications, any change to medications, recent travel, recent Covid test. Carol explained that she had woken up to a pain in her chest that radiated to her neck and was causing her to be short of breath.

Harley printed out the initial EKG and handed it to me before turning to the firefighters.

I took one look at the squiggly lines on the printout and didn’t like what I saw.

“Harley, can you get a quick 12-lead for me?” I asked, Harley gave me a thumbs up and set to work attaching more stickers to Carol’s chest. “I just want to take a closer look at your heart.” I explained to her while continuing to ask questions about her current symptoms. When the EKG finished analyzing and spit out the printed sheet, it confirmed my concerns.

“So, Carol, I’m not going to sugar-coat this. You’re having a heart attack.” I said evenly. Harley set to work instructing the firefighters where to move the gurney and shifting the coffee table. “We’re going to take good care of you.” I reassured her.

Carol was loaded onto the gurney and secured with the seat belts before we reattached her to the cardiac monitor. Harley heaved her into the ambulance and started following my direction. I handed him the defibrillator pads, and he looked at me inquisitively but placed the pads in the correct place on Carol’s chest.

“I’m going to need you back here with me. Do you think one of the volleys can drive the ambulance?” I asked. Harley finished affixing the last of the EKG leads back onto Carol’s chest and then jumped out to ask.

He returned a second later and shook his head. “They can’t drive it that far and definitely not with lights and sirens.”

“Then we’re going to need to land a helicopter.” I told him. Then I turned back to Carol, “So here’s the thing Carol, your heart is beating too fast and showing signs of a heart attack at the same time. To get you to the hospital safely and quickly, we’re going to fly you from here in a helicopter.”

“How fast is it?” Carol asked tentatively.

I looked at the monitor and confirmed what it said by feeling her pulse at her wrist. “Your heart is beating at one hundred ninety beats per minute. The average adult should be around sixty to one hundred.” Harley’s eyes went wide. “The other thing is that your heart is in a rhythm called ventricular tachycardia. It’s a lethal heart rhythm, and we need to correct it. Soon.”

Without my realizing it, Harley had already delegated the logistics of calling for and landing the helicopter to the firefighters. “There’s a landing zone about a block away,” he said urgently, “The flight crew is thirteen minutes out.”

I held my breath for a second. “Okay. Let’s get rolling then.”

Harley drove record speed to the landing zone and immediately jumped in the back to assist me. “What do you need?” he asked as I was pulling vials and needles out of my drug box.

“I need an IV. An eighteen gauge or greater in an A/C or greater.” The words fell out of my mouth. Four years after medic school and the repetition of practicing this exact scenario sent my brain into auto mode.

Harley searched up and down Carol’s arms. “I think I can get a twenty-two in the hand.” He looked at me apologetically, “But she really has nothing.”

“It needs to be a big enough IV to push the medicine through fast.” I explained. “I want to give her Adenosine. It only has about a six-second half-life, so we need the IV in a big vein and closer to the heart.” Harley nodded and felt around Carol’s elbows again as I set up the medication and saline. I had missed the IV twice while driving to the landing zone. After Harley missed two or three attempts, I realized we had only one other option.

The helicopter was still about nine minutes out. Carol was still awake, talking, and stable – all things considered. Her blood pressure was rising and the less invasive techniques we’d attempted to lower her heart rate had failed.

I pulled out my sedation drugs. “Okay Carol, since we can’t get the IV we are going to move on with another treatment,” I informed both her and Harley. “I’m going to give you a shot in each arm. This is a sedation medication called Versed. After I give this to you, we’re going to wait a little bit. And then I’m going to do an intervention called cardioversion. Basically, we’re going to shock your heart back to a normal rhythm because you can’t sustain what your heart is doing for so long.”

Carol nodded and stated she understood, “Just help me.” She begged. I administered the Versed and we waited. And waited. Time seemed like it was moving backwards.

Harley jumped out of the back of the ambulance to check on the firefighters and get an update on the helicopter. I called him back as soon as he stepped outside. “I need you in here, please.” He nodded and, probably noticing the apprehensive look on my face, stood by my side.

“Okay, Carol, I’m not going to lie, this is going to suck. But it’ll be over in a second.” Carol nodded and I punched in the settings on my monitor. Harley grabbed my hand and gave me a squeeze. With a deep breath I called, “Everyone clear? One, two, three.”

ZAP.

Carol jumped in the air and Harley went to her side to reassess her. “Damn! That did hurt!”

“How do you feel?” Harley asked her while my eyes were glued to the monitor.

Carol nodded her head, “Actually, I feel a little better.”

I looked up at Harley and smiled, throwing my arms in the air. “Ninety and sinus!” We high-fived. The cardioversion had worked. Carol’s heart rate had decreased from 190 to a normal rate. I printed out a new EKG which still showed the possibility of a heart attack, but the rate was now under control. “Okay, now just get me any IV you can.” Harley easily got the small IV on the top of Carol’s hand, and we started running saline through the line. I reassessed Carol’s chest pain and administered her medication.

We chatted away, waiting on the helicopter, when Carol’s head involuntarily fell forward. I shook her shoulder, and she lifted her head sleepily. “Guess the Versed finally kicked in,” Harley said with a nervous laugh.

The roaring overhead sounded like a thousand angels reigning down. The flight nurse and medic hopped into the back of the ambulance. I gave them the full history and a rundown of our treatments over the last 20 minutes. I handed over my printed-out EKGs and vitals with a written history we’d obtained from Carol.

Once Carol was loaded into the helicopter and the flight crew had launched, Harley began cleaning the ambulance while I paced the back of the rig, full of adrenaline.

“What the actual f- just happened?” Harley almost whispered, eyes wide. “We just shocked a patient. A LIVING PATIENT. I didn’t know that was a thing.”

I continued to pace. “I need something to do with my hands,” I said, “I don’t know what to do with my hands.”

“You can clean the monitor?” Harley offered.

I jumped over to the airway seat where the monitor was haphazardly leaning. “I’ll clean the monitor. That’s a great idea.” I set to work winding the wires and putting the equipment back together. “That was the first time I did that by myself,” I whispered. In the past, I had seen a cardioversion in the hospital or preformed in the field with another medic, but this was the first time I had been the highest level of care.

With some reassuring words of affirmation from Harley, I started to calm down. We were in the middle of nowhere, knowing if we’d had to transport Carol by ambulance she would have possibly deteriorated. We lucked out that it was a clear day after such a rainy summer and autumn.

We took our time on the way back, jamming out to Taylor Swift to decompress the stress. We were assigned and canceled off of two other calls on the way back into town, but it would have been about an hour before we reached either one of them.

As we made it back into town, I turned to Harley. “I couldn’t have done that without you,” I choked.

Harley smirked, “Sure you could have.” I let him know that he was wrong. In my four years of being a paramedic, my confidence had evolved beyond what I had imagined. But the strength that came from an unconditional partnership carried me through the most challenging moments of my career.

….

On that freezing February night, I found myself sitting in the airway seat on our way to a call for difficulty breathing. Harley was training Sam, a new hire who was doing well for her first day on the job. Sam drove lights and sirens to the familiar apartment complex that I recognized as soon as I jumped out of the truck.

“I know this guy.” I said to Harley as I made my way to the front door. I poked my head in through the screen and watched as the firefighters hastily applied oxygen and EKG leads to the patient.

John sat on the living room couch in the smoke-filled apartment with an ashtray of dead cigarette butts on the coffee table.

“His oxygen sats were low,” Eddie told me, “So we put him on oxygen. He says the difficulty breathing started about an hour ago. He also says he had a heart attack sometime last year.”

I nodded, knowingly. “I’ve run on him before. He’s probably in SVT again. Last time we did CPAP with a breathing treatment. They tried to cardiovert him twice at the hospital and it didn’t work.” I explained. I glanced at the cardiac monitor. Heart rate: 162, oxygen saturation 63%.

We decided to “load and go” since John was not making much improvement on the oxygen. Eddie hopped in the airway seat and called the hospital. I attached the CPAP – an alien-spider-like breathing apparatus – to John’s face and attempted to stick the defibrillator pads to John’s wet chest. DeJa’Vu all over again, I thought.

Within minutes, Sam and Harley had transported us to the hospital where we transferred John to the ER bed. The nurses, techs, and respiratory therapist took over, and we moved our equipment out of the way. Dr. Ansari ordered a dose of medication, Diltiazem, through IV, followed by an infusion of that medication. John had such poor blood flow at this point because of his rapid heart rate and fast breathing that an IV had been difficult in the ambulance. Luckily, Harley was able to snake a twenty-two gauge in John’s hand amongst the bustling of other providers in the room.

The nurse pushed the medication through Harley’s IV. I leaned over to Harley and Sam who had come to join me in the hallway. “It’s not going to work.” I said, not lifting my head from my chart.

Harley tilted his head, “Why don’t they just shock him? Like we did in Skeleton Valley?”

I shrugged, “Oh they will, but that won’t work either.” I looked up at both of them. “I ran on this guy last year. They gave him a bunch of meds, intubated him, shocked him. Nothing worked. I know he eventually went up to ICU, but that was the last I heard. I thought he was going to die.”

Dr. Ansari had been standing at the back of the ER room monitoring the vitals as his orders were carried out. Noticing that the medication hadn’t made a change, he ordered John to be sedated and intubated in preparation for cardioversion – the electric shock to restore his normal heart rhythm.

Harley nudged Sam toward the ER room and told her that this would be the perfect time to observe. As an EMT, Sam would be tasked with assisting her paramedic partner with all of these steps if they needed to be completed in the field. I watched as Harley explained every step of the process, calmly and with the knowledge of a seasoned medical provider.

I called out to him from the hallway and let him know I’d be in the truck, finishing my chart. I had already seen how this would go with John and I didn’t need to stick around to watch it again. When Harley and Sam returned a few minutes later, they relayed to me what I already knew. The cardioversion hadn’t worked, and the additional medications did nothing. John was going to be in the hospital for a while waiting for the ER team to stabilize him. Then he would be transported to a cardiac ICU if this hospital didn’t have any beds available.

“You did a really good job explaining everything,” I told Harley. “You were right on point.”

Harley smiled and put an arm around my shoulders. “Everything I know I learned from working with you,” he told me. “Remember that time in Skeleton Valley? That’s how I knew he was in SVT.” His statement made my heart warm.

It’s one thing to discover your own success and confidence, but for Harley to credit me with his was a true honor. He had put in the work and effort to become a better provider and clinician. He had paid attention to the signs, symptoms, and treatments so he could anticipate my next moves. He had taken on brand new EMT’s to train and mold into competent employees who could face the challenges EMS throws in our faces.

Harley, you have been one of the best partners and EMTs that I’ve had the absolute pleasure to work with. But more importantly, you have been one of the best friends I could have ever asked for. Happy birthday!