Looking forward to that post! 🙂
Eh, retrospectively, it's not that good - not nearly as good as my other stuff.
Still, I wrote it for a guy I know - smart guy, but not involved in EMS or medicine (he's a paralegal). It is dated by several references - this was 2001.
So, here it goes...
Woke up dead
So I worked today - and, man, can Fred Mohr talk. I mean, I flap my gums, too, but it is very easy to find a gap where you can cut me off. Not Fred, though - he has to finish his point. Anyway, I left last night, after continuing to talk (or be talked to) after leaving your residence, and drove home. Screwed around online for a while (in that this broadband thing is "the living end"), and got about 2 1/2 hours of sleep. Not exactly awe-inspiring, if I'm going to go off and save lives.
Got to work on time, even though I had to stop off for gas. I use my credit card now, and it is so cool to just pump the gas and leave. After a little of my righteous indignation (we were given a call to take with an agency that has declared me "persona non grata", and I am not welcome to respond with them (because of "the emperor's new clothes"), and I reminded our dispatcher of same, who thereupon reassigned the call; bullet dodged), and a close call (sent for an assault in progress, but was the same call as a colleague was on, but seen from across the street), my partner and I were tapped out for a "code" (a cardiac arrest). The city dispatcher (who works mainly nights, and is somewhat demotivated) calls us, we acknowledge, and he just says, "You're going for a code. Instructions being given." While he's broadcasting, we can hear one of the other 911 dispatchers giving "prearrival instructions" - what to do until EMS, fire, and/or police arrive. This is the "morning DOA" - early AM, spouse rolls over, can't rouse the other occupant in the bed, becomes frightened, calls 911, advised how to check if the victim (for s/he is not a patient until care is started) is alive or not, and awaits rescue. Occasionally, the DOA is in the bathroom, and rigor mortis has started (usually because the victim expired enroute to or from the can); much more frequently, though, the victim is cool to warm (because the victim has been in the bed, under covers, next to a warm body), and rigor hasn't set in yet.
This is when we decide whether to "call it" (declare the patient dead, and wait for the police), or "code" the patient, and take them to the hospital; now, though, there is a "twilight" where we can work the code, AND call it on scene (to be crass, we get the best of both worlds - do some procedures, and not have to extricate the body). To call it, we look for signs the patient is beyond clinical death, and at biological death - lividity (pooling of blood in dependent areas, like the flanks, small of the back, back of arms and legs), rigor mortis, frank decomposition, "injuries incompatible with life" (in re. 'burnt to a crisp', decapitated, drowned and bloated, eviscerated (gutted), and so on), and some other subtle and arcane things.
Well, this fellow was still warm in the core (because the torso will hold heat for a while, due to the physics of water and how much heat it can hold), so he was too warm to call DOA, but we knew he was going to be in asystole ("silent heart"), and stay there. And he did. This house was strewn with clutter, with the rickety banister, old vacuum in the doorway, and the patient on the floor. Buffalo Fire is jammed in there, and we only have enough room to be in a single file. I intubated the patient, started an IV, and gave him some medications. He didn't respond, just like he was supposed to not do anything. I called the doctor at ECMC, and we called it. Fire picked up and left, I did my most heartfelt explanation to the wife (who was rapidly becoming aggrieved with the loss of her spouse), and went up to wait with the body; since he was NOW "DOA", we wait for the police to come, to keep the evidence chain together.
I found out about the earthquake in the afternoon, and now it all makes sense. While waiting for the police, the deceased, who was obese, and supine, and expired, began shaking in the abdomen, and the house rattled a little. I thought someone was walking with a heavy foot along the first floor. All I could say to myself and think, though, was, "No way! This guy is not still alive! He is gone!" But it was the earthquake that was shaking his belly.
Because he woke up dead today.
And here's an addendum to the final paragraph (before the last line):
I found out about the earthquake in the afternoon, and now it all makes sense. While waiting for the police, the deceased, who was obese, and supine, and expired, began shaking in the abdomen, and the house rattled a little. I thought someone was walking with a heavy foot along the first floor, or maybe a truck was rolling down the street. All I could say to myself and think, though, was, "No way! This guy is not still alive! He is gone!" I started to panic for just a moment - thinking that I "called" a guy that wasn't dead - and what do I do now? Put my thumb over the end of the tube until he stops bucking? Is this the end of my career? (I was a med student at the time, still working on the weekends as my schedule allowed.) But it was the earthquake that was shaking his belly.
Because he woke up dead today.
