I’ve hammered down the road, fast as I dare trust the tires on wet Christmas roads. Control rousing me from a much needed doze with the words I didn’t need to hear.
“Topcat job for you…”
Edinburgh’s Topcat paramedics are a small team who are despatched to cardiac arrests with the sole purpose of managing the scene. We try to ensure high standards of resuscitation and assist crews with decision making, leaving them free to concentrate on the hands-on clinical role.
I shove through the front door and am pointed into a back room by a young, blasé looking woman.
“Twenty eight, twenty nine, thirty. Breathe.”
The patient’s chest flexes and a long, farty exhalation bubbles up out of her throat. The paramedic at the head swears under her breath and readjusts the tube poking out the slack mouth.
“I fucking hate LMAs…”
They tell you that a Laryngeal Mask Airway is the ultimate “fire and forget” for a cardiac arrest, just stuff the tube blindly down the throat and know it’ll end up ventilating the lungs. I’m yet to find a para that likes them, raised as we are on only trusting an airway that you’ve *seen* enter the trachea.
“You need a spot?”
The Community First Responder nods, a ox-bow of sweat spreading across his chest. He was here before us, turning out, unpaid, in the middle of the night when most others in the town have been enjoying the festive festivities.
I step over the patient and bend double from the waist, counting the responder down and taking over the CPR as he straightens up. It’s not the best angle to do compressions from, but it works in a pinch and reduces the time off-chest to an absolute minimum. I press and pound, looking left to right. The para at the head catches my eye and smirks, thinking the same as me.
She calls to her partner, a new technician.
“Are you planning on taking over CPR from Kal at any point? That’s not a comfortable position to work from.”
There’s a wee surprised “oh…right…” and she kneels down alongside us. I regain my feet.
“So what’s the story?”
“Found….about twenty minutes ago now. Asystolic so far.”
“Not when we got here.”
Shit. Her chances aren’t good, but…
“She’s *young*, Kal.”
I nod. She is. Barely older than me.
“Ok. So here’s the plan. We stay on the chest, we push adrenaline on time and we rhythm check every two minutes. We concentrate on compression depth and hold out for a reversible rhythm.”
The para nods, bagging gently.
“Do we know anything about her? Drugs? Drink? History?”
There are medicine bags on the bedside table, a quick sift shows nothing more sinister than anti depressants, vitamin b12 and a bottle of methadone. But no incriminating empties to point us down a route.
I shove an IV into one limp arm and brief the First Responder on how to set up a prefilled syringe of adrenalin.
“The paramedic will need one of these every five minutes or so. You can get them ready if you’re not doing compressions, yeah?”
“I’ll go and get some history.”
Outside in the corridor I find a young man, skinny and pale. Teary.
“What’s your name, mate?”
“Alright Martin, I’m Kal. How are you connected to the lady next door?”
“She’s my mum.”
We sit down on the floor. The blasé young woman, Martin’s girlfriend, sits next to him.
“How old are you, mate?”
But an adult nonetheless.
And that makes things, if not easier, then more straight forward.
I write his name on my glove, I’m terrible with names, can’t be forgetting his.
“Martin…your Mum is very ill. Her heart isn’t beating and she isn’t breathing. We’re doing everything we can for her, just the same treatment that she’d receive at the hospital.”
He nods, lifting his face up from his shoes.
“Saying that, Martin…your Mum is really, really sick, ok? Dangerously sick…do you understand what I’m telling you?”
“Where’s your dad?”
He mentions a village several miles away.
“And your mum and dad, they get on?”
“I think he should be here. Seems like tonight would be a good time to have your dad with you, right?”
He nods, digs in his trackie bottoms for a phone and finds a number, he’s about to dial when I reach my hand out to him.
“Would you like me to…?”
I take the phone from him and I’m about to push the green button when there’s noise from next door.
“Is there someone else in the house?”
“My wee brother,” he nods towards a closed door “in there.”
“How old is he?”
I take Martin’s phone from him and stand outside the front door. The man who answers has been drinking, but sharpens up fast when I introduce myself. There’s no time for niceties on the phone, he needs to know exactly what’s going on and I tell him, finishing with.
“Can you come to the house? I need you to look after the boys.”
There’s a woman screaming in the background of the phone call, “Is she dead? Is she fucking dead?” but the man ignores her.
“I’ll get a taxi, pal. Thankyou for phoning.”
He hangs up.
Back in the house Martin is standing in the corridor chewing his thumb bloody.
“What’s your brother’s name?”
“I think he should know what’s going on, what do you think?”
He nods sadly.
“I’ll speak to him, but maybe you want to come in and back him up a bit?”
We walk in together, Gerry is playing XBox in his room, there’s lad mag posters on the walls, a smell of socks and dope, a bmx leaned up against one room. Martin sits down next to him on the floor and I sit opposite, using the exact same words as I did with Martin earlier. The lad stares at me like I’ve punched him, nodding when I ask him questions. I’m not convinced he’s taking it in, so I clarify with him.
“Gerry, do you understand that your Mum might not get better?”
He nods again and shuffles under the wing of his brother.
“OK, I’ll go see how we’re getting on.”
Back in the bedroom and the picture is unchanged. Twenty minutes have passed since we arrived on scene.
“What’s the rhythm?”
“Ok. We due another adrenaline?”
“She just had one.”
“So…we give it a few minutes and see if it has any effect?”
“Went in three minutes ago.”
If it was going to do anything, it would have done it by now.
“Anything to suggest OD or poisoning?”
They’ve thought of all of this, they don’t need me checking, but I’m fucked if I’m giving up without dotting the I’s.
“So to recap, adult female, unwitnessed arrest, no bystander CPR. Airway is secure, we’re getting good chest movement, good CO2 trace on the monitor, high flow o2 throughout, minimal cyanosis with CPR. She’s had maximum time on chest, good quality CPR, she’s got IV access and drugs as indicated. She’s had twenty minutes of ACLS and has shown no signs of responding and is neurologically unresponsive. ”
It’s a comprehensive summary and I’m confident of the answer that I’ll get, but I ask the question anyway, because I don’t like pronouncing people without asking it.
“Can anyone think of anything else we could do for this lady?”
Three heads shake at me.
“Then we stop, all agreed?”
I check my watch.
“Zero two thirteen…I’ll go and speak to the family.”
There’s clearly something on my face, because the para frowns at me.
“You ok? You want me to do it?”
“No…it’s ok…I’ve got it.”
I’m in the corridor, calculating. Do I tell the boys what’s happened, or wait for their Dad to get here? He’s miles away, sounded pretty drunk, will need to wait for a taxi, at this time of the year that’ll take a while.
I can’t have them sitting in one room with her growing cold in the next.
I turn the handle, swing the bedroom door open, step into the room again.
They look up at me.
“Guys? I’m afraid I ha…”
My throat closes, the backs of my eyes burn.
Jesus, come on, Kal. Get your shit together.
Look down at my feet and breathe in deep.
“I have some very bad news. When we got here your Mum’s heart wasn’t beating and she wasn’t breathing on her own. We’ve done everything we can, but she hasn’t responded to treatment. I’m afraid she died a few minutes ago.”
They implode into each other, both of them screaming. I stand with my hands folded behind my back, looking at their trainers.
The younger one stops howling, breathes in hard and lifts his head over the parapet of his brother’s shoulder, stares me in the eye.
“Is she dead? Is my Mum dead?”
“Yes mate. I’m sorry, she is.”
The second time he hears it looks like it hits harder than the first.
He shrieks again, they cling to each other, gripping at teeshirts, scrubbing their eyes against each others bony shoulders.
I sit on the edge of the bed with them, as scared of being in this room full of grief as I am of the damage I could do by standing up and leaving them alone.
I need to be here, to stay here, to answer any questions.
And while I’m here, I have to listen to their world fall apart.
Dad arrives and any fantasies I had about his steady parental hands vanish as he crashes about the house like a frightened horse, lost in his own grief and shock. He screams and swears, while his girlfriend sits in a drunken haze on the sofa asking if we’d “done that heart shock thing”.
The boys split like atoms.
Martin sits in the living room with a cop and Gerry curls into a ball in the corner, lit by the screen on his mobile, texting frantically.
I shiver to think of the messages he’s sending.
Their father grumbles and curses, shouting at the police officers, occasionally throwing his arms like a blanket around his face and sobbing from his guts.
I stand on the side and stare and all I can think is:
“This moment. This confusion and grief. This terror and uncertainty about the future. This empty feeling of making adult decisions with absolutely no preparation? This is Christmas now.”
It makes me cold.