“I can accept failure, everyone fails at something. But I can’t accept not trying.” – Michael Jordan

Michael laid there on the bathroom floor with two EMTs pushing on his chest, and one breathing for him. And I had finally realized who he was.

“YOU ASSHOLE!” Someone screamed from outside and I turned to see the commotion just outside the bathroom door. The sheriff deputies and Chief were blocking the way in, keeping us safe from the crowd. Heightened emotions and alcohol do not mix.

I went back to my work, readying the next Epi and preparing to shock again if needed.

“200 compressions,” Chadwick called out and I hit print on my monitor to capture the rhythm while everyone felt for a pulse that wasn’t there.

V-fib. Charging – continue compressions. Alarm. All clear? Shock. Continue compressions. We were like a machine.

I pushed the next Epi and wrote the time down on my glove. I started checking off what had been done in my head. Jase was still bagging but something wasn’t quite right.

“Guys?” I asked, “Did he look like that when we got here?”A faint purple color had started to appear on Michael’s chest and neck.

Cory spoke up first. “You thinking PE?”

Yup. It was like it was happening in slow motion and fast forwarding at the same time. The faint purple was starting to darken, forming a distinct line between his upper chest and his lower chest and stomach.

“Let ‘em through!” I heard Chief call and Matt, Becca, and Marco walked in with their own equipment. The calvary had arrived.

Matt set down his equipment and kneeled next to me. “Hey guys. Where do you want us, Holly?”

I looked around at the chaos of our equipment and people. “He started hooding. Can you get a tube?”

Becca had already taken her place to relieve one of the firefighters and began to take over compressions. Matt grabbed the intubation kit and instructed Marco, who happened to be his medic student that day, to get prepared to intubate. They took their place on either side of Jase.

“What’s the story?” Matt asked, readying the intubation equipment.

I launched into my summary of events. “He was our last call and complained of some muscle soreness and generally not feeling great. He’d been riding all day. We did all the tests we could and he refused. When we got here he had coded.” Matt nodded. “Bystander CPR initiated. We have Epi and Amio on board and a couple shocks for vfib. Carl was here, though and that’s partly why I called you here.”

“We can deal with that later,” Matt said and turned to Marco. “You ready to tube?”

Marco, with ET tube and laryngoscope in hand instructed Jase to pull the IGel. He inserted the laryngoscope into Michael’s mouth and lifted his jaw.

“I don’t see it,” he told Matt. Matt helped him maneuver Michael’s throat, tongue, and padded his shoulders to help expose the vocal cords.

I went back to my drugs and checked the time. I don’t know if Marco placed the tube or if Matt took over, but when I looked back up to reassess, the tube was in place and Marco was bagging with a BVM. I glanced at the monitor and saw an end tidal reading appear – confirming the correct placement. Matt took the stethoscope and listened to Michael’s lungs while Marco squeezed the bag.

“Tube’s good!” He announced.

Great… but now what?

“200 compressions,” Becca called and everyone did a pulse check.

The monitor showed asystole. Flatline.

Becca continued compressions.

“The only way this guy has a chance is if a surgeon removes the clot.” I said, defeated.

Matt perked up. “Does flight have a Lucas?” (A Lucas device is a mechanical compression machine. It delivers compressions at the appropriate rate, freeing up hands for the crew.)

Since Jase had a radio, I put him on the task of communicating with dispatch to coordinate a flight crew. We continued CPR, Epi, and bagging while we waited.

At some point Brandon and Dean, one of our BLS crews had arrived. They were on their way back from a transfer when they heard the commotion on the radio and stopped to help. They each took their place on either side of Michael to relieve Becca and Cory.

Another pulse check. Another flatline. Continue compressions. Epi, compressions, epi, compressions…

Jase came back to the group with radio in hand. “Flight’s Lucas is out of service for mechanical. The closest flight crew with one is 40 minutes out.”

I met Matt’s eye. “What do you want to do, boss?” Matt asked.

It’s not lost on me that, even though he was my boss, Matt never stepped on my toes. The first medic on scene was the lead, until they relinquished their position.

I could feel my eyes start to water. “What should I do?” I asked. “We’ve been working him for at least,” I checked my watch, “over half an hour. Another 40 minutes? That’s not going to work. He’s been asystole the last few pulse checks.”

“Time to call?” He asked. Michael was still, except for the bouncing of his chest from compressions. There was no light in his eyes. He was gone.

I nodded. Matt nodded back and I knew he was on my side. “Mind if Marco does it?”

“Sure,” I said reaching to grab the printout from the monitor, “let me just write everything down.” I noticed I’d never told the monitor to stop printing and ribbons of pink paper were piling up everywhere. I pressed the button and ripped off a strip to write on the back.

As I started to recall and write all the events leading up to now, I noticed a pair of shoes under one of the stall doors. A bystander that never got out? I’d hoped they hadn’t heard anything they shouldn’t. While we take our job seriously, at the end of the day, it’s a job just like any other. We sometimes socialize and misspeak, just like I used to do at a desk job.

I crawled over the compressors over to Marco at Michael’s head. Brandon had tried to move out of my way and nearly tripped over the monitor. With so many people we had outgrown our already small space.

“Actually,” I said to Marco, my notes in hand, “I think I should call. We ran on him earlier and it would just be easier for me to relay everything to the doc.” Marco agreed and I pulled out my phone.

“ER,” the nurse answered.

“Hi, this is Holly on Medic 3. I need a doc for termination and time of death.”

I waited on the line while she transferred me to the doctor on duty. It felt like a long time, but realistically about 30 seconds later I head his voice, “This is Dr. Rolland.”

“Hi Dr. Rolland, this is Holly on Medic 3. I have a code in progress and I’m calling for termination and TOD.” I gave him Michael’s name and date of birth. “We ran on him about an hour and a half ago now for muscle soreness and a period of dizziness that had subsided. All vitals were good, EKG sinus, negative orthostatic. He refused transport at that time. About 20 minutes later we returned to the same location and he had coded. Bystander CPR was in progress.”

I proceeded to lay out the sequence of events, what and how much of each drug I’d given, how many defibrillations – and a current set of vitals – blood pressure which we couldn’t obtain, asystole on the monitor, pulseless and apneic, ET tube in place and ventilating with a BVM, blood glucose, and pupils.

“About halfway through we noticed significant hooding. I mean, he’s blue from about the nipple line up. At this time we feel we’ve exhausted our resuscitative efforts and are calling for time of death.” I finished.

De. Rolland thought for a second before speaking. “It sounds like you have done your due diligence. Time of death twenty oh-three.”

“I copy. Twenty oh-three,” I repeated, “thanks, doc. Medic 3 clear.”

I hung up the phone and looked at my crews. “Stop CPR. Doc called it.” Becca stopped compressions and Matt felt for a pulse on Michael’s neck – a last chance for Michael to pull through to us. He removed his hand from Michael’s neck and everyone started to pack up.

I stood between the urinals while everyone cleaned up my mess.

I don’t remember exactly what happened next. It’s either a mental block not allowing me to remember, or I wasn’t paying enough attention, but I know I told Matt I couldn’t deliver the death notice. Someone had mentioned that Michael’s family was outside, maybe they were part of the motorcycle ride.

“I feel like I failed. He should have lived,” I said. Chadwick had been standing next to me and wrapped me in a hug while I finally let the tears fall.

“Hey, some times people just die. You do what you can. And we did the best we could,” he said. “Don’t go back on the what-ifs. You did good.”

I dried my eyes as Cory stood up from picking up my miles of EKG paper. “Where have you been?” He asked Chadwick.

“Dude, I got stuck in the stall! I got booted off compressions and couldn’t go anywhere else!”

I didn’t want to laugh over a dead body – but I couldn’t help it. In EMS, we might see the worst of the worst, but our humor gives us our humanity.

—-

1 year later.

I hadn’t been back to Marshall’s. I couldn’t even look at the big signs promoting their rodeo grounds when I passed it on the highway. I used to eat there regularly, but no longer. I couldn’t go back without thinking about Michael. I felt haunted.

But almost a year later, the fire department had invited Jase and me to celebrate Chadwick’s goodbye party. He was leaving the department to go to nursing school.

“You good?” Jase asked as we turned into the dirt parking lot. We had talked about Michael often and he knew my hesitation going back to Marshall’s. After delivering my son my hormones were flying and plummeting all the time.

I nodded, “Yep. It’s as good time as any. At least it’s a happy occasion and not another call.”

When we walked in, we greeted each of the firefighters and hugged each one. We sat down together and traded stories and laughed with each other.

We were a family. A support system. A distraction. If I’m going to continue to do this job, I’m thankful for the people I get to do it with.

But I still remember. Every time we are called to a code and I don’t know if my efforts will be enough. Every time we have a patient that vitally looks fine and I can’t find a reason for their complaint. Every time a patient refuses to come with me and I have laid out my very real concerns.

I see Michael’s gray face.

I’m still haunted.