Sep 08
How does it taste?
I’m noodling around Parliament Square on the High Street, chatting to stewards and watching shows when my phone blares in my ear. I’ve got all SAS numbers set to a particularly obnoxious ringtone, a submarine’s dive alarm.
I blip the handsfree button at my jaw.
“This is Kal.”
“Kal…where are you?”
“On the High Street. Where’s the job?”
“We have a male colla….correction…we have a male in cardiac arrest just down the road, can you attend?”
Damn straight I can, even with the dense crowds between myself and the patient I’m on scene in just over a minute. A man lies on the floor and a couple are performing textbook CPR on him, bobbing up and down in perfectly timed synchronisation.
My wheels stutter on the granite setts in the road as I approach.
“Paramedic!”
The man doing compressions looks up as I approach.
“We need a defib!”
“No problem.”
There’s a crowd around the patient and I point at the largest member, a burly, tattooed man with mirrored shades on.
Dismounting from the bike, I thrust the handlebars into his hands.
“You. Hold this.”
Congratulations, dude, you’ve just become my bike stand.
The bike is a big heavy mother fucker to try and unpack in a hurry, with six weeks experience under my belt I’ve learned to do it without dumping everything all over the pavement, but the simple act of pulling the bags out can make the front wheel swing from side to side. Far easier to get a bystander to hold it tight.
The defibrillator lies right at the top of my panniers. Funnily enough, it’s remarkably similar to the model I first trained on with the British Red Cross almost eight years ago, a simple “shock-box” with one cable, one socket and one button to press. They’re hard to screw up, but I realise as I unpack it that I’ve never actually used one in anger.
Thankfully the defib proves to be simple plug and play, truly idiot proof. As soon as I plug the pads in it starts shouting at me in its Mid-Atlantic twang.
“Apply pads to patient’s bare chest.”
I shred the patient’s teeshirt, cutting right up the front and through the collar, the fabric flops backwards over his shoulders in a tattered yoke.
The couple are still pounding away at CPR and haven’t delivered their classic panicked bystander lines of “We’ll get out of your way?”.
That’s odd.
I nod at them both.
“You guys doing ok?”
They nod back.
“I’m a GP, my wife’s a midwife. He just dropped in front of us. We could see he’d gone off.”
“No pulse since collapse?”
“None.”
“You ok to carry on?”
He’s red faced and sweating, but nods steadfastly, putting his hands back on the patient’s sternum.
“Sure thing.”
The pads in place, the defib is now yelling at us “Do not touch patient, press flashing orange button to deliver shock”.
Its cheap LCD screen shows coarse ventricular fibrillation, the first thrashes of an arresting heart. It is arguably the healthiest “dead heart” rhythm to be in.
“Ok, I’m shocking. Stand back, please.”
The GP and midwife sit back on their knees, I swing my eyes from the patient’s head, down his arms and torso, legs and feet. No puddles, no metal grates, no-one still clinging to a hand.
“All clear! Shocking now.”
I push the orange button and the patient turns rigid for a second, before flopping limbs back down onto the pavement.
The screen still shows VF, the defib recharges and yells again for us to shock. The GP reaches for the button, before I stop him
“Hang on, please mate, let’s give him another round of CPR first.”
The heart can only take too much punishment and we’ve just electrocuted it, plus we’ve been “off chest” while we did it. A phase of CPR will do the myocardium the world of good, flooding it with oxygenated blood and giving our next shock the best chance of a good result.
“Back on the chest, please, somebody?”
Compressions start again. I kneel by the patient’s head, pull his chin up and back and snag the intubation board from my bag, push a mask over his mouth and nose and breathe for him.
A voice in the crowd shouts out.
“I’m a cardiologist…can I help?”
“Right here, please, doctor.”
He’s by my side.
“What can I do?”
“I’m going to tube him, everything’s on the board there, can you prep for me, please?”
This is clearly not the role to which he is accustomed, but he makes no complaint, busying himself with endotracheal tubes, lubrication and laryngoscope blades. He passes me every piece of equipment as I need it and I’m just pushing the ET tube through the patient’s vocal cords when I hear the chord of siren and engine behind me. Squaddie jumps from his response motorcycle, flips up his visor.
“Do you need any kit?”
I shake my head and he jogs over to us, all creaking leather and armoured boots.
“You got any access yet?”
“Nope.”
“I’m on it.”
Returning to the patient’s airway I find my ET tube has slithered back up the throat and is lying, useless, in his mouth. How the hell did that happen? Dead folk don’t spit back.
I feel like I’m in an emergency Punch and Judy show, whenever I turn my back someone steals the sausages - “Now children, if that naughty crocodile extubates himself while I’m away, you will shout for me, won’t you?”
I’m sliding the laryngoscope back down his throat when the defib starts up shouting again - “Push orange button to shock!”
The GP takes his hand from the patient’s chest and reaches for the defib.
“All clear please.”
At this point I’m still holding the laryngoscope, all steel and carbon fibre, inside the patient. A defibrillation at this point will probably fire me across the street.
“No shock, please, doc.”
He stifles a quiet laugh, my voice clearly had hints of panic in it.
“It’s ok, we’ll wait.”
Once again I push the ET tube through the cords and again the patient’s gag reflex fires it back up the trachea at me. I’ve never met a person who’d lost their pulse and breathing, but maintained the ability to protect his own airway.
My textbooks come back to me - “If the patient repeatedly rejects intubation, reconsider if the procedure is necessary.”
It’s not just the procedure, I need a moment to reconsider the whole job. This is the first arrest I’ve run as a paramedic. There’s plenty to be gained in a resus situation from backing off and taking a moment. I sit back on my heels.
“Go with the shock, please.”
The GP checks us up and down, Squaddie puts his hands in the air, as do I. The patient jolts from the shock and slumps down again.
The defib screen shows pulseless VT, a cardiac rhythm that is significantly more coordinated than VF, but just as bloody useless at sustaining life.
Of course, VT is “more coordinated” than VF in the same way that a cat is more likely to organise a successful jumble sale than a set of patio furniture.
A dark blue Beemer pulls up alongside us and TopCat, our resus doctor, hops out in shirt and tie. He appraises the situation while Squaddie shocks the patient a third time.
The violet patient’s face suddenly regains its pink hue. He drags one long breath into himself. I feel for a pulse at his neck and grin when I feel it hammering along under my fingers.
“What’s the story, Kal?”
“Witnessed collapse, immediate bystander CPR, shocked three times, VF, VF, VT, now regained an output, rejected a tube twice, no drugs yet. “
He surveys the scene and smiles, satisfied.
“Cool.” He looks me up and down in my shorts, bike shoes and teeshirt.” ..are you on the mountain bike?”
“Yup.”
“Sweet.”
An ambulance arrives and we hoist the patient onto the trolley, lifting his head and shoulders with his shredded teeshirt. He vomits copiously over everything and I regret not getting that tube into him, but within minutes he’s fully conscious and asking the ambulance crew what happened to him.
Squaddie and I are left to tidy up the wreckage on the pavement, both grinning like idiots. TopCat hops out of the back of the ambulance and snaps a shot of the two of us, arms round shoulders, grinning at his camera.
“The day the Parabike proved itself!” he declares, before returning to the patient.
Squaddie and I return to picking up, he rips into me.
“You’re not going to claim this is a save for the Parabike are you? You wish. It was MY finger that shocked him the third time.”
“Fuck you cunty baws!” I retort “It was my legs that got the defib to him in the first place!”
The head of security for the Fringe is standing on the sidelines. We used to work together at the Edinburgh Dungeon as actors before we both got ourselves proper jobs. He’s shaking his head at the two of us.
“That was the most amazing thing I’ve ever seen. You just saved that man’s life.”
“Pretty much.” we answer.
“What does it feel like?”
I’m beaming at him, jiggling up and down in my shoes.
“It tastes pretty damn good.”
I take my bike back from the man in the sunglasses who shakes our hands, a barman from a nearby pub offers to drive the patient’s family, total strangers to each other, to the ED.
I restock my panniers from Squaddie’s kit and we say our goodbyes. We clip helmets back onto our heads and he claps my shoulder.
“Good job, son.”
“Cheers mate.”
He starts his bike, revs the engine and is about to vanish into traffic when I wave him down.
“One last thing?”
“Yes mate?”
“I think you’ll find you owe me a fiver.”
He laughs, gives me the finger and roars off.
The taste lingers for hours, I spend the day smacking my lips, running my tongue over my gums. The potent visceral rush of life from death clings to my teeth; it shines when I grin.
The security guard and other bystanders tell each other the story at coffee breaks.
I duck my head, shy now and bashful of the attention, but still breathe out the flavour into my collar and, while no-ones looking, inhale it back inside me for one (just one more, I promise…) last illicit taste.
September 8th, 2009 at 9:26 pm
1) Congrats. I have heard that the whole “bringing back” thing is fairly rare, so I’m glad to hear it isn’t always Grim Reaper time. Good Job.
2) (Planting tongue firmly in cheek) Damn that NHS anyhow. You all with your quotas and your rationing and not letting people choose their own physicians and just letting folks die because everyone “knows” that government-run “Socialized Medicine” is the FAIL….. How I wish I could forward this post to EVERY. Single. RETARDED. MOUTH BREATHING. ARSEHAT “Compassionate Conservative” currently fighting our President over health care reform.
September 8th, 2009 at 10:47 pm
Hey Kal! really well done mate.
glad that worked out as well as it did
Nice to hear that CPR and defibs do work sometimes, and like Sewmouse said, its not just body-bag o’clock.
will buy you a drink the next time I see you mate
Again, well done
September 8th, 2009 at 11:13 pm
Do you tell all the girls you’re in the SAS? I know the taste (and the jelly legs). A puppy crashed on me at 5am this week when I was all alone. Rigid, then floppy with eyes rolled, then (after some deft finger work) magically gasped a big breath and licked my nose. New pants, please.
September 9th, 2009 at 12:58 am
Very nice work, saves like that are indeed a rare thing.
Getting there in 1 minute, that really makes the difference, he owes you that fiver.
And again, very well written, that too is a rare thing. You have the gift.
September 9th, 2009 at 2:28 am
Awesome.
September 9th, 2009 at 3:11 am
Nice one!
We have to see the pic taken after that post though!
September 9th, 2009 at 3:20 am
“I’ve never actually used one in anger” is an excellent turn of phrase, and identical to my own sole CPA resuscitation, wherein I used a hospital defibrillator to shock a patient I had just delivered. One shock and he opened his eyes and said “What happened?” To the utter amusement of those around me, I spoke my mind and said “Your heart stopped and I about crapped myself.”
Also, to Sewmouse, the US has various forms of local emergency medical services system that are utterly unrelated to and largely unaffected by the current national healthcare debate. But don’t mere reality stop you from prattling on.
September 9th, 2009 at 6:08 am
So cool, SO COOL!!!
:-D *jumping around on floor singing “Don’t stop me now”*
This just does not happen in real life. How does it feel to know you did everything right?
September 9th, 2009 at 6:57 am
Nice one Kal! Wheres the picture
September 9th, 2009 at 7:10 am
Good work that man. That’ll do.
September 9th, 2009 at 7:28 am
Nice One
Just a pity that in your total amazing praise of yourself at the end you failed to mention that it was the GP and his wife, the midwife, who were more likely to have saved the patients life as they maintained his circulatory system, therefore oxygenating his brain, whilst you prattled down the high street on your bike… if it hadnt been for them, 2 innocent bystanders there more likely would have been a negative outcome from this job!
September 9th, 2009 at 8:40 am
Four words - fanny on a stick….. And now that you ave the taste for reviving dead things wanna come and resuscitate my two goldfish that have snuffed it overnight?! Well done, nice to see the training and experience kicks in when the calls come in.
September 9th, 2009 at 9:04 am
Fantastic!!!
My heart was pounding all thru that!!
Good Job guys x
September 9th, 2009 at 9:13 am
Ohhh great story - what a brilliant day, what a fantastic outcome and how seriously lucky was that guy! Talk about not being your time - a GP, a midwife, a doc in the crowd, and a paramedic a minute away!!!
September 9th, 2009 at 9:55 am
Fuck off Eric.
Great post Kal.Rewards like that are better than a Banker’s Bonus eh?
September 9th, 2009 at 10:10 am
Brilliant post! Reads like the script for an episode of Casualty. Been in situations in my previous job as Big Davie the Polis that read like The Bill and they don’t half give you a real kick when they do.
Enjoy it but remember that you will lose some too. Just a job!
September 9th, 2009 at 10:24 am
troll alert! well done ALL of you! obviously just make sure the next time you attend someone lying flat on his back that his name’s not Eric…tho the application the of defib pads to his (eye)balls amuses me. When all’s said and done you did a job probably he can’t and the guy on the floor’s living to tell the tale.
September 9th, 2009 at 10:39 am
Awesome! Congrats to you and everyone that helped
September 9th, 2009 at 11:00 am
RE gag reflex on cardiac arrest patients - just wait until one tries to push your arms away while doing compressions while they are in full cardiac arrest - freeky!!
September 9th, 2009 at 12:24 pm
PJ Darling - I wouldn’t DREAM of starting a flame war in the comments on Kal’s site. How about you mosey on over to my blog and I’ll give you the thrashing you so obviously RICHLY deserve?
*smiles sweetly* Have a WONDERFUL day… Dear.
September 9th, 2009 at 12:38 pm
Brilliant! Great job, great co-operation, just great! And a top piece of writing to boot…
September 9th, 2009 at 2:49 pm
Wow. Just wow.
He really picked the right place and the right time to drop down, didn’t he? I wonder what his lottery numbers are - since I can’t get through to Derren Brown.
September 9th, 2009 at 2:54 pm
Great post! Good job.
September 9th, 2009 at 4:12 pm
Well done !
September 9th, 2009 at 7:25 pm
A great story well-told. I’m a hospital nurse so I call for help right away, but it seems the patients haven’t read the text book either and I have to do the problem solving while juggling the emergency.
September 9th, 2009 at 9:29 pm
Bloody well done!
September 9th, 2009 at 10:33 pm
Well done fella. Saw the story on SAMSON last week. So soon after your appearance on the news…You’re turning into the posterboy of the service haha!
S’pose some good publicity for a change couldn’t hurt
September 10th, 2009 at 9:14 am
Nice one, enjoy the feeling. No matter what the outcome I am just so grateful there are folks like you out there doing this job. THANKS.
September 10th, 2009 at 2:08 pm
Actualy, I agree with Eric!.. while this is a very good outcome and the post clearly demonstrates the importance of teamwork and the application of the chain of survival it does start to sound a little arrogant towards the end! not that a bit of job satisfaction isnt a good thing though! its an awsome result and one shared by evrybody involved!..
September 10th, 2009 at 7:24 pm
Hurray for the chain thingy, idiot proof shock boxes and medics doing text book CPR
September 10th, 2009 at 9:35 pm
Oh my! Eric and AK!! Give us medics a break!! Allow us to feel good about what we do, and to shout it from the rooftops, if that is what we want to do. From another who has tasted the sweet taste of success, of dragging another human being from the jaws of death on more than one occasion, let me tell you this: IT FEELS GOOD!!! Arrogant? No, just the biggest high anyone can have. Kal has included all the efforts and contributions that the GP and his wife, the cardiologist and Squaddie have made to this save, but this is Kal’s blog, and this is how HE feels. Go for it, Kal!!
September 10th, 2009 at 9:40 pm
Heya dude, just started reading your blog tonight and can I say, you have some fantastic stories to tell!
I’m a first aider with the British Red Cross up in Elgin, and have been for 2 years now. I too write a blog based on my RC adventures, but it’s great to find a blog based in a city I actually know! And your pictures are brill too - loving the mix of RC and sas stuff. Would love to chat some time!
You now have a new fan =)
keep on blogging!
September 10th, 2009 at 10:12 pm
It’s just like on TV! The dream scenario!! Everyone knows exactly what to do, listens to the medic, no one tries to take over or peace out - the way every call should go
Well-told, very exciting! 
September 11th, 2009 at 8:30 am
Well Done mate
September 11th, 2009 at 9:20 am
God Kal, that’s wonderful.
September 11th, 2009 at 1:24 pm
Well done. Even with all the MD training, the simplest interventions are the best. Funny, we had a paramedic unit that called in to base on the telephone for a PNB that was also clenching such that they couldn’t intubate as your patient was. I agree the gospel is that dead people don’t fight tubes but there must be some tone or reflex left in VF/VT we don’t fully appreciate. Well run code. Underscores how valuable paramedics are.
You guys have resus MDs in the field?
September 11th, 2009 at 1:26 pm
As for the trolls, just because it takes more than one rescuer to run a code doesn’t mean Kal can’t feel good about a job well done. Him feeling good doesn’t exclude what the GP did. And, he complemented the cardiologist for adjusting to a role he isn’t used to. Sheesh.
September 11th, 2009 at 3:28 pm
Bravo!! Keep ‘em coming, Kal!
September 11th, 2009 at 8:40 pm
Bloody brilliant! You saved a persons life.
Congratulations to all involved.
September 12th, 2009 at 3:01 am
Nice job mate.
September 12th, 2009 at 5:33 pm
awesome. Didn`t think that ever happened. Well done!
September 13th, 2009 at 2:18 am
Strong work! And on a mountain bike no less! It is nice when we can get them back. It’s so rare too.
September 13th, 2009 at 2:20 am
[…] Trauma Queen » How does it taste? September 12, 2009 Wanderer Leave a comment Go to comments Trauma Queen » How does it taste?. […]
September 13th, 2009 at 4:38 pm
Did you ever get your fiver?
September 13th, 2009 at 4:50 pm
Awesome. Story, writing, outcome - all just awesome
September 14th, 2009 at 10:46 pm
Absolutely awesome, well done!
September 18th, 2009 at 6:40 pm
Brilliant. Delighted reading this story. Bet it was refreshing to get on scene with everything moving along nicely…..and a happy ending!
September 21st, 2009 at 9:23 pm
Good Job………Eric and AK you are the sort of fannies that normally turn up at street jobs and talk out your ass! Go and play with some traffic
September 22nd, 2009 at 9:11 am
Amazing story and you have every right to enjoy the taste. What happened here was phenomenal and took huge effort from all parties involved. Kal lead the charge and has every right to walk with head held high after this one. Eric and AK, maybe before posting next time, stop first, engage brain second, then post!
October 9th, 2009 at 3:00 pm
I know I should be focused on the story but, sorry, I’m a word nerd, I’m blown away by your writing. Christopher Brookmyre should worry. Great style!