ems

46. A Higher Level of Care

~ toddgoddard ~ 1 Comment

The Pitt is a masterful rendition of a fast moving Emergency Department. Like its predecessor, ER, the pace, emotions, and procedures reflect my own experiences in ERs around the region. With my wife, with over 40 years of Labor and Delivery experience, and my experience running EMS and Psychiatric Assessments, we love to watch each episode, call out bull shit when we see it, fill in blank spots in our knowledge. To a large extent, Hollywood gets it right. 

Shout out to ED staffs of doctors, nurses, respiratory therapists, and techs. I loved them all. Some became more than professional acquaintances; friends even. There would be middle of the night calls, when everything was settling down and paperwork was complete, when one would pull up a chair and we’d begin to talk about theology, family, politics, cases. 

It was always a huge relief to transfer care to ER staff, professionals with a higher level of care than my meager Intermediate Life Support Emergency Medical Technician certification allowed. Responsibility for life and limb weighs heavy on every medic. Training only goes so far; it kept me focused in the center of the hurricane, yet, each and every one of us responding to the cry for help from a neighbor remained deeply human. I felt, and cared, deeply for the human hurt and pain I heard and experienced.

—

The man sitting on the gurney opposite from me in the small psychiatric ER room was dressed in uniform. He had just completed his work day, jumped into his pickup truck and drove straight to the ER. He knew he was in trouble, just as serious as if he had crushing chest pains and difficulty breathing. 

Except, he didn’t. 

This soft spoken member of the law enforcement community had been hearing voices recently telling him to kill his wife. He knew they were not real, for he could not locate any source of the voices outside of himself. His experience, he reported to me, was more real than mere fleeting thoughts that could be brushed away by refocusing on a different tasks. He reported to me that he heard these voices plain as day. They began when he woke, continued through the day and into the night. 

He loved his wife, and children. From his world view there was no reason to want to bring harm or violence to his wife or family. Unnerving. Frightening. Terrifying, even. With no history of mental illness, this gentleman came to me desperate for help.

“The voices tell me to shoot her,” he reported. “They are breaking me down, and I’m afraid the only way to make them stop is to do it, even though I don’t want to.” My heart broke for this man, all the while, my brain is franticly searching for cause, treatment, and a path leading to a healthy outcome. He checked the homicidal box, had the means, and desire to carry through on his plan. 

Doing nothing wasn’t an option. He was also armed. 

People who experience homicidal ideation can be very dangerous, not only towards their target, but also to anyone else on the sidelines. Experience and crisis intervention training taught me to establish a non-anxious presence, de-escalate and maintain calm, and compassionately remove the threat. My affect was laid back and empathetic, words were soft and eyes expressed kindness. My brain was praying for God’s mercy to work in and through me. 

My legal pad was full of notes taken, a life spilled into my lap, emotionally flailing in an attempt to find a way out. Even during our interview I could see him wince, blink hard, when he heard his command hallucinations. Maybe he was attempting to block that which was assaulting him. 

“Give me one moment,” I said as I stood and stepped towards the door. “I’ll be right back.” And I left him, sitting in silence, on a hospital gurney, in a small ER room, armed with a gun. 

I went straight to the attending ER doctor, pulled him aside and gave him the brief run down. “And he’s armed,” I told him, driving home the life held by a thread, serious nature of the patient. Fear wasn’t on my radar. Training and experience kept me laser focused. Yes, there was mortal danger, but thinking about that could be postponed to later. Then I could collapse in the staff lounge with a case of the he-be geebies. 

No. He-be geebies cannot be found in the clinical manual of psychiatric disorders. That doesn’t mean they aren’t real. “I’m on it,” doctor Mark told me. “Go back in and keep him calm.” 

So I re-entered the exam room, pen and legal pad in hand. Memory fails regarding what we spoke about, but it must have been effective because he remained calm and quiet. Time passed, as if I could hear every tick of a sweep second hand on the clock. Our conversation was almost casual. There was a knock at the door. 

Turning to stand and open the door, it exploded open and in rushed the A-team. Cops, hospital security, lots of big burley men. I slipped out, unseen. It was over before the patient knew what was happening. He was restrained and disarmed, not of just one handgun, but two. Later, his pickup truck in the parking lot also sported a cache of firearms and ammunition, now secure. Whew!

A tragedy was averted that evening. A story was written that never made the evening news. A tortured mind was made safe, and I can only hope and pray, he was able to find the cause of his hallucinations, to be effectively treated, and to return to a life filled with love and family. 

Why? I wondered. There are many possible causes for such a condition. Medical, chemical, disease, abuse, hereditary, you name it. UTI? Brain tumor? Late onset Schizophrenia? Sometimes it is nearly impossible to nail down a cause, let alone treatment. There but by the grace of God goes any of us. It was by that same grace that I was effective and safe that hot summer evening so long ago in the ER. 

Thank you, Lord. 

—

Every lap in the pool this morning was shared with a fellow traveler on this journey called life. He was kind is offering to share a lane, faster than me – aren’t they all? – completing three laps to my every two. 

Each time we passed I squeezed tight to the lane markers, compensating for the violence of water, splash, and wave. It was as if his displacement pushed against me. It wasn’t intentional, just physics. 

Water has to go somewhere. I reflect on the wet spring we are experiencing, breaking records I hear from the evening weather report. Streams, running chocolate brown, fill their banks full to overflowing. Low dams that used to support mills long since gone have been swept clean of debris, water swift, flowing so fast over the crest it registers as hardly a bump. Low lands, fields, and lawns flood, basements fill, and rain continues to fall. 

Pool water refreshes. River water cleanses. Filtered water nourishes. Baptismal water stakes a claim. 

—

All the classroom training cannot prepare an EMS medic for the full reality of traumatic injury and death. Experience is the only calming effect I know of. Debriefing helps reduce the debilitating effects of post-traumatic stress. But that comes after the fact. This is where having experienced leadership is essential to the effective deployment of an emergency medical services agency. 

We were blessed with Vince and Jean. Retired, but not inactive, a husband and wife duo who had been in on the ground level of emergency medical services in the 1940’s and 50’s, when local undertakers gladly passed responsibility to someone else, anyone else, usually to volunteer fire departments! The ubiquitous black hearse with a gumball light would be replaced with municipally funded, hand crafted ambulances, complete with trained medics and drivers, lights and sirens. Trauma medicine had advanced by leaps and bounds during WWII, Korea, and Vietnam. It was making the leap into every neighborhood and community in the country. 

Vince and Jean, lifelong members of the Reformed church, had seen it and done it all. Some new bucks rebelled against their authority, but quickly were told to toe the line or get out. That’s what the other ambulance service in town was for; our rejects, and it showed, or so we believed. 

Her name escapes me. She was alive when I got to her. Her elderly body trapped by steel and plastic, covered with cubes of broken safety glass, violence now ended, leaving her with exposed bone, blood, and brains. But, she was breathing and had a heartbeat. “Launch Mercy Flight,” I requested in my radio. Standing back, ever the leader and safety officer, Vince agreed and relayed my request to dispatch. 

Our rescue crew fired up the Jaws of Life, its small engine powering a hydraulic set of pincers, coughed and came to life. All I could get at was covering her nose, or what was left of it, with a non-rebreather mask and 16 liters of pure oxygen. A fireman threw a blanked over the two of us, shielding us from shards of glass and flying plastic parts. Her vehicle had been obliterated, engine separated from frame, axels departed, steel twisted, steam hissing, electrical connections severed, one wheel 150 feet down the road resting in a ditch. 

Pulling into the path of a car doing 55 will do that to a vehicle. I know, from personal experience, both as a medic, and, later in life, as a patient. 

Firefighters set up a landing zone a few hundred yards away on a driveway well clear of overhead obstructions. Mercy Flight landed with sound and fury, just as my patient was freed from entrapment. C-collar. Back board. The non-rebreather reservoir inflating and deflating with every breath, until it didn’t. 

Shit. Respiratory arrest, I called out. The Bag-Valve-Mask (BVM) came out and we took over breathing for our unconscious patient. Unbelievable, but she had a pulse. 

The impeccably coifed flight paramedic approached from behind and snarled at me, “what did you call us for? She’s in arrest. We can’t transport a patient in respiratory arrest.” 

“Well, she wasn’t when I called you,” I responded, anger rising. Now he was on the scene, as a paramedic, he was a higher level of care than me, so the ball was in his court. His call. What was he going to do?

First things first. A is for airway. We loaded her temporarily in our ambulance so he could sink an Endo-Tracheal tube. That meant starting an IV and the paramedic pushing drugs that sedated and paralyzed her. We worked like demons with the house on fire. Success meant a possibility, however slim, for life. Failure, and, well. We might just as well call the undertaker and go home. 

Oh. Yeah. There was blood, bone, and brain all over the place. But she still had a heartbeat. 

“We fly,” he decided, as he looked at me and said, “and you’re bagging her all the way to the hospital.” 

My heart jumped. The prospect of flying in a helicopter, a new experience. “Sure,” I smiled, wiping away the sweat dripping into my eyes.

Bagging was made easier because the BVM was connected to the ET tube. We extracted from the ground ambulance, and with the assistance of big, burley firefighters, rolled the gurney to the idling helicopter, helmeted pilot still in his seat. We ducked beneath the blades, and steered clear of the tail rotor, just as instructed in training, ball caps removed and secured under the belt. The backboard slid between the clamshell doors. I entered the starboard side door, of a very small, cramped compartment. As the patient slid into place, I resumed respirations, knees sandwiching her ears, hunched over, head above her belly. The paramedic behind me monitored the EKG, drugs, and IV lines.

I couldn’t move, shift my weight, or adjust my position. Other than my hands squeezing the breath of life into our critical patient, I became one big cramp. If only I could have looked up or out a window.

The flight to Strong Memorial Hospital was all business. We landed with a thump. Only when the patient was slid from beneath me was I able to move, barely. Fortunately, plenty of hospital personnel took over and I was freed to work my aching muscles.

The broken woman delivered to trauma care remains nameless to this day. I don’t know if she lived or died. If she lived, God help her, for her broken body and bones, and lacerated brains, would need something more than the balm of Gilead.

The turn around was fast; much faster than I was used to on a ground ambulance. The roof top helicopter pad needed to be opened as soon as possible. “Let’s go,” the aeromedical paramedic said to me. Up and out we went.

He helped me strap in and dawn a flight helmet, complete with intercom. “Welcome to my bird,” the pilot said to me. “Time to go home.”

“Can you take me back to Palmyra?”

“No can do, buddy. Rules say I have to take the chopper back to base in Canandaigua. Don’t worry, we’ll get you home.”

“Okay, then,” I said, thinking to myself that my little joy ride just made a three hour ambulance call into a six.

“No worry,” the pilot replied. “Rules don’t say I can’t give you a guided tour back home.”

And so we went, flew up and straight south-east, out of the Rochester airspace. Over Mendon, not quite half way, the pilot began to dive and swoop, banking left and right, giving me a joy ride unlike the best rollercoaster anywhere. It was glorious! I laughed until I cried. The views were fantastic.

The pilot straightened up approaching the Canandaigua airport, set the skids down on a wagon slightly bigger than a Radio Flyer, shut down, and a John Deere lawn tractor towed us into the hanger. I wondered how that was done. Now, I knew!

The owner of Mercy Flight, Paul H., met me as I got out of the aircraft. He shook my hand and thanked me for the help. Hey, I was free labor; why wouldn’t he have a smile on his face? Paul was nice and offered me a ride home to Palmyra. “Sure,” I smiled. “Thank you.” We talked EMS and Mercy Flight all the way back.

I was dropped off at the fire station and everyone crowed around, welcoming me home. “How was it?” “Enjoy the ride?” “Did she make it?”

All the while Vince and Jean stood back, arms folded across the chest, waiting, quietly smiling. When the crowd thinned, then dispersed, Vince came over and said to me, “Good job, Todd. You did real good.”

That was all I needed to hear.

Thank you Lord, for great training and the support of a professional team, all volunteers. Thank you, for higher levels of care. Thank you, for Vince and Jean.

44. Man Down

~ toddgoddard ~ Leave a comment

A good EMS call is an adrenaline rush no pharmacological recipe could come close to replicating. After years of training and experience all of us medics were never out of earshot from our portable pagers. They recharged batteries on the bed stand. They hung on our hips as we made our way throughout the day. Pity the poor fool who lost their pager, or worse, were unwitting accomplices to their destruction. 

Driving a pumper on a Thursday training evolution, I parked the water heavy iron monster, set the emergency brake, and bent over to chalk the wheels. Little did I know, my pager slipped off my belt, slid to the ground, and landed right in front of the rear wheels. After training, hanging up my gear, I felt for my pager. It was one of those “Oh, crap!” agonizing moments of frantic searching, all for naught. I lived with a spare replacement and the shame of losing face in front of the other members of my EMS crew and line firefighters. 

The next spring, at the annual banquet, I did the requisite chaplain duty of saying grace and introducing the M.C. for the evening, a well-known local radio personality. Introductions were made of the incoming team of officers. Thanks were extended to the outgoing group. The awards came after steak and deserts. Many in attendance were six or more drinks into the festivities. The chief called me forward.

“Oh, great. Now what did I do?”

He held a wrapped gift and began to make his presentation, pulling slowly on his prepared speech to wring out the maximum drama. He told the story of my lost pager and frantic, unsuccessful attempt to locate it. A lot of cat calls, hooting, and laughter was hitting me like a fire hose. My cheeks burned red with embarrassment. I smiled, forced a thank you, and accepted his gift. 

“Go ahead,” he said. “Unwrap it right now in front of everyone.”

One hundred fifty firefighter, spouses, and distinguished guests shifted forward in their chairs and looked intently at my unenviable position. Gift paper shredded to reveal a homemade plaque, on which was glued thousands of destroyed pieces of my former pager. The chief saw it on the ground after I pulled the chalks and drove off, crushing it beneath the real wheels of my fire truck. He saw the opportunity and seized the day. Good on him. 

It was the only pager I had to replace. 

___

“Man down” was an EMS call we all lived for. The response was always balls to the walls, drop everything, and hit the gas. Calls were generally categorized by type: either medical or traumatic, and, severity: Critical, Unstable, Potentially unstable, and Stable. Training gave us the acronym we used by memory: “Fit to CUPS”. Our department ran “Ya’ll come” calls, as opposed to shift work, like paid and other agencies. The tones dropped, tripping everyone’s pager, and you responded. On EMS calls, some responded to the barn to drive the rig, others of us carried equipment in our personal vehicles and drove directly to the scene. You’d see medics who made a bare minimum of calls per month show up at “man down” calls and try to take over. Talk to the hand, dude. 

Some were funny, despite the fact that a life was dangling by a thread.

“Man down. Not breathing,” the 911 dispatcher told us after dropping our pager tones. As per protocol, an Advanced Life Support paramedic team was dispatched from 20 miles away. The call was a good six miles from our station into our neighboring fire district. I was the Intermediate Life Support medic, so I’d be the first on scene and be able to initiate immediate care. If the paramedic made it there before we left, great; join the party. If not, we were told not to delay transport and head for the hospital. Maybe we could meet enroute, but today, it was unlikely.

The call was to a large farmhouse at the end of a long country lane. “AM-24 on scene,” Vern, my driver, informed dispatch. On the gurney I loaded the medic bag, Oxygen tank, defibrillator, portable radio. The kitchen door opened to my banging. “You call for the ambulance?” I asked the woman who answered the door. She was barely dressed with a toddler on her hip. Another near naked woman with a baby on her hip was cooking bacon on the stove. “He’s in there,” she pointed over her shoulder with her thumb. 

Vern and I pushed in to the bedroom. We found a middle aged buck naked male laying face up on the bed. Full Monty. Was there a smile on his face? I don’t know. He wasn’t talking. Or breathing. I called on the radio for more help and pulled him off the bed to the floor and began CPR. Memory fades, but I probably attempted to jump start his heart into a survivable rhythm. In time, more of my crew arrive. They took over the thump and pump while I sunk an E.T. tube, taking control of his respirations. The IV could wait until the back of the ambulance. ALS was still fifteen minutes out. Time to hit the gas and haul ass. 

Stretcher and patient, equipment, and crew pushed out the bedroom, through the kitchen and out to the idling ambulance. Barely pausing to notice, the two mommas and babies continued to go about their business in the kitchen, as if it was another ordinary morning. I paused for a moment, “What is his name?” I asked, the Patient Care Record (PCR) and clip board in hand. One looked at the other; they both look back at me, in unison shrugged their shoulders and said, “I don’t know.” 

—

Most were not. 

Two a.m. Nothing good happens at 2:00 a.m. “Man down.” The address was well known to me, elderly members of my parish, the parents of one of our village cops. In a flurry, I dressed, called in route, and met the wife at the back door. “Bill is in the bathroom,” she cried.

Lots of cardiac arrests take place on the commode. We were taught in training that the same nerves that are used to strain are also the ones that control normal heart rhythms. Push too hard or too long, and that predisposed vessel or electrical pathway just might blow. Poop is often involved. It isn’t pretty and I’ve been at that retching call far too many times.

Problem was, this evening, Bill was wedged unconscious against the bathroom door, preventing it from opening more than a sliver. “Bill!” I shouted. No response. “You awake?” Pushing hard, I could see there wasn’t any movement. Eyes closed, head down, chin buried in his chest. Grace, his wife, sobbed in the background. Still by myself, I got on the radio and called for more help. Shit. I couldn’t get in to get him out. I needed beefy firemen with wrecking tools. Fast. 

Yet, never one to give up easily …

I pushed and pulled with all my might. Leaned my shoulder into everything I had to give. “Sorry, Grace. The door has to go,” I apologized. Seeing this unsolvable puzzle blocking any hope for a successful outcome, she mumbled, “Do what you gotta do, Pastor Todd.” 

BAM! I hit the bathroom door, breaking it off its hinges, knocking Bill completely off the commode. I struggled through the debris and dragged him by his nightshirt, pajama bottoms down around his ankles, into the kitchen. “CPR in progress. Hit our tones again for more help,” I called into my radio. I thumped and pumped all by myself. Five compressions, one breath. Wash. Rinse. Repeat. 

Exhausting. Sweat in the eyes. Where was my crew? Sirens wailed throughout the village. If Bill had any chance, it was with me. His pastor. His medic. From experience, the outlook didn’t look good. Crews began to call on scene. Between compressions, I caught a glimpse of highly polished shoes and a police officer’s cuffs. “Give me a hand, buddy,” I called to the cop talking on his portable. 

He froze. “Come on, dude. I need a hand.” He didn’t move. I continued CPR until I rolled off completely whipped by my arriving crew. “What in the actual …” I was about to cuss just as I caught sight of the frozen police officer. Recognition was immediate. It was Bill’s son. “I can’t,” he cried. “I couldn’t.” 

At the end of the day, it wouldn’t have mattered. Bill had been down and not breathing long enough on the commode nothing could have been done to change the outcome, even though we tried. Minutes matter when brain cells go without oxygen, and they only get oxygen from the blood cells pumped by the heart. The pump stops, the brain dies. That’s all she wrote.

The family recognized our effort and memorial donations came into our Fire Department and the church. I sat in the same kitchen with a cup of coffee with Grace and her son a few months later. “How would you like the memorial money used?” I asked. 

“Bill loved stained glass windows at church. What do you think? Is there any way this could be possible?”

Above the East entrance to the Palmyra (formerly) United Methodist Church there is a stained glass window in memory of Bill. May it long stir fond memories and witness to the benefits of a depth of faith.

—

The lap pool called my name twice this past week, instead of the usual Monday, Wednesday, Friday two-step. The transition weather we are experiencing between winter and spring tends to give wild fluctuations off the beam of emotional stability. Nothing quite like a forecaster’s prediction of snow after a week of mild calm. In a lame excuse to myself, a vigorous walk on the indoor track would have to do.

Laps are reflective, meditative; uninterrupted silence where thoughts tend to invite and invoke critical moments in life. Man down calls invoke memories of my father’s sudden cardiac death over forty years ago, September 30, 1985. He had recently completed a cardiac stress test and received a clean bill of health. He jogged multiple times a week, keeping his weight under control and his inner demons at bay. Newly appointed to a church in Central New York, one morning he fell weak, tired, lost consciousness and died.

On the ambulance, we called it DRT. Dead. Right. There.

Mom had just gotten him in the car to drive to the doctor’s office when his mortal fire was extinguished. The medic on the ambulance who responded? Yeah. Unbeknownst to me, she would become one of my instructors when I went through training and recertifications. It’s a small world, filled with divine agents of God’s amazing grace.

As my arms and shoulders tired, I thought about the anxiety carried forward attributed to my father’s death. He died at age 59, three months, nine days. Translated to my own life, that year was one where I watched the calendar closely. Would I survive the old man? There are thousands of reasons for a heart to stop, which gives pause to downing that greasy hamburger and fries. Was I fated by poor genetic sequencing?  I inquired of my siblings, each expressing relief when they aged one day older than dad.

Last year, visiting my brother, a retired physician, we were talking about dad’s unexpected sudden cardiac arrest. We both outlived our fated genetics, I observed. “What do you mean?” Bryan responded. “It wasn’t genetics that killed dad. It was a virus.”

I blinked once. Twice. Three times. Did I hear what I thought I heard?

Yep. My brother gave me the detailed account of how he insisted on having an autopsy performed after Dad’s unexpected death. The finding? His heart was inflamed by a viral infection and had swelled to over three times it’s normal size. Swelled heart inside a fixed container resulted in a heart that grew progressively inefficient and eventual death. “Moral of the story?” my brother paused for effect. “Always get your vaccines.”

And for all those years of worry? Thankfully, they are all behind me, like the final stroke on my last lap before the showers.

___

Some “man down” calls just made me angry.

Memorial Day. Kids off from school. Big parade planned in the village. High school bands were marching in hot, wool uniforms. A brief service at the village cemetery planned by the American Legion completed the annual ritual. As fire department chaplain and local church pastor, my roll was to provide the invocation and benediction in my fire department dress uniform. As a N.Y. State certified medic, I’d ride shotgun in the ambulance, tucked nicely behind every truck the chief could get on the road. We had both our rigs in the parade, each loaded with a full crew in dress uniforms. Siren jockeys deafened the crowd. Firefighters riding the trucks dressed in bunker gear tossed hard candy to scampering children in the crowd.

In front of our ambulance marched the American Legion color guard. You’ve seen them; guys dressed in spit polished shoes and starched uniforms, toting flags of state and nation, or, sporting rifles used for a twenty-one gun salute in the cemetery. Most had beer bellies hanging over their belt, or long hair and a beard, a far cry from their active duty days. Lots of gray hair were tucked underneath service hats, adorned with pins and patches.

The route was long through the village under a hot sun. Didn’t bother me; I closed the window and turned up the air conditioning. The parade concluded at the cemetery; a right turn, roll under the arches (while fire trucks returned to base), then snaking our way to the veteran’s memorial, on a hill, center rear. Podium and bleachers under beautiful hardwood branches waited for our arrival. Thousands of patriotic neighbors lined the path and crowded in at our destination.

It was a beautiful day for a parade.

I saw him drop. It was called a witnessed arrest. The moment his heart seized to a stop, the Legionnaire 20 feet in front of our ambulance lost consciousness and slumped like a bag of potatoes to the ground. Vern hit the brakes and got on the radio, calling for help. Within 10 seconds half the medics in our department were on our feet, hauling equipment, and rushing to the unconscious veteran’s side. The marching band stopped playing. People surrounding the entry road to the cemetery bunched into a crowd. Hundreds came together like subway riders at rush hour, each straining to see what often isn’t seen by the general public.

We know CRP and put it to practical use nearly on a weekly basis. Basic Life Support (BLS) medics started the thump and pump. My Advanced Life Support (ALS) partner opened the airway kit and prepared to intubate. Another of our crew used trauma scissors to bare the patient down to his shorts and socks. I worked the semi-auto cardiac defibrillator, placing sticky electrode pads on his hairy chest, ankles and wrists.  

“Everybody! Clear!” I ordered. This gave us a clean strip to read, record, and interpret, as well as, healthy separation of my crew from the massive amounts of joules I was prepared to release from the unit’s high-tech batteries. I switched to manual. I wanted full control of the trigger in the right handed paddle. Conductive jell was spread liberally. “Charging to 120.” The internal capacitors filled with the tell-tale whine. I paused to survey the scene.

A pulseless, breathless patient. Everyone on my crew letting go and stepping back. Time slowed. I saw the crowd and squinted, the hot sun in my eyes, humidity as thick as molasses, sweat rolling into my eyes, perspiration soaking my shirt, soon to make me clammy. Spectators, hushed,  watching the drama unfolding before their very eyes, seeing what shouldn’t be seen. A man’s life account being settled, his existence held at the precipice edge, the raging current pulling at his lifeless body.

And there was an idiot with a camcorder. Red LED blinking not 20 feet away.

“Aug!” my inner voice turned rage inside out, “Stop CPR. Clear.” Everyone obeyed. “Shocking 120!” as I depressed the trigger, the patient shuttering as expected. Normal sinus rhythm was nowhere to be found. The tape printed an exotic cardiac rhythm way beyond my pay grade to make hide or hair of its meaning. All I knew was that it remained a shockable rhythm even though there wasn’t a pulse or breath. “Stop CPR. Clear.” The scene remained safe. “Charging to 200. Shocking 200!”

The neanderthal with the camcorder perched on his shoulder squeezed in closer, tighter. The captain of our ambulance stood back, arms crossed, doing his own survey of the scene, taking it all in. “Clear,” I called out a third time. We only got three chances in the field. Someone trained to a higher level of care might have different rules, but I was three shocks and done. CPR stopped a third time and everyone backed off, yet again. “Charging to 360.” I waited for the alerting tone indicating a full charge. “Shocking 360!”

Nothing, damn it. “Resume CPR.” Jimmy would try his ET and IV sticks inside the rig, away from prying eyes. “Let’s load and go,” I yelled. Swinging onto the rig, I looked back for a moment, right into the lens of the camcorder staring me in the face. The brief pause almost irrupted like a volcano of rage, veins in my temple bulging. Lips tightened, less I say something regrettable, the door slammed shut behind me. For a moment I let the anger dissipate before refocusing on the task at hand. All hands were needed. A job needed to be done.

It didn’t come as a surprise. No, the patient did not survive. Few did. What surprised me most, is that the entire Memorial Day parade “man down” call, fully recorded on videotape, did not end up on the evening news. Thank you, God.  

42. Don’t Look Under the Tarp & Be Careful For What You Pray For

~ toddgoddard ~ 1 Comment

There is a reason police, fire rescue, and EMS people cover up a corpse. There is a dignity angle to it. A dignified conclusion to life should highlight the positive aspects of a person’s legacy. Final memories should be of love, warmth, butterflies, and licking puppy dogs. Covering a corpse protects a person’s dignity.

There is a modesty angle, too. Sometimes private parts of the body are exposed by the violence of injury or the circumstances of intervention. Avert the eyes, shield the view of others. Use a blanket, sheet, or tarp. If ever there is a time to be serious, this is it. Be the professional. 

There is a respect angle to be considered. Those old bones and brains propelled a person through life, the good and the bad, down valleys filled with the shadow of death, and back up to mountain peaks. Those arms held newborn babies. Those eyes witnessed a thousand sunsets. That butt occupied chairs in countless classrooms. Those feet completed marathons or took romantic strolls in the park. Props to God’s creation for the gift of cells and sinew, teeth and bones.  

For the Christians in the room, there is a theological angle to be considered. We are Jesus people, resurrection believers. The soul has left the body and now resides with God. No need to watch flesh decay to dust. Close the casket and celebrate the greatness of our God who forgives and saves! 

Yes, rubberneckers slow and stare, hoping to sneak a peek, as if some mystery is being withheld, as if some conspiracy is unfolding. Maybe, if I rush home I’ll see it on the local news.

The tarp, tent, or blanket is there for other reasons, too. I have covered the deceased to stop the trauma, to limit the shock to a minimum few, and to preserve the mental health of everyone involved. 

Such occasions are not for the squeamish. The topic isn’t covered in training, leaving first responders to default to instincts, experience, or a gut feeling. Some are blessed with more insight, others, less. Many are the rookie responders who get one look or whiff of a traumatic scene, drop everything, and quit on a dime. It is a shame that we invest a lot of time and money into training, but when it comes to prevention and preservation of mental health, first responds are often met with the sounds of crickets. 

Old school responders might play the “time to get tough, kid” card.

We shouldn’t shoot our wounded. Jesus told a story of how a mixed race immigrant found a beaten man by the side of the road, bound his wounds, and took him to an inn to rest and heal up. He even paid the bill before it came due. So should we. There is a lesson here.

Wise veterans of shock trauma have to protect ourselves. One look is all it takes. “Okay, everybody out.” Evacuate the scene, establish a perimeter, work with police to use tarps or tents. Look once, but again only if necessary. No need to burn that memory into your own synapse so completely it takes years of therapy to break up and get it out of your system. I learned the hard way.

Mature, first responder leadership will also take into account the composition of responding crews. Does an eighteen year old rookie need to look for body parts, or would they better be posted at the intersection detouring traffic? Some are more psychologically vulnerable than others. The big mouth, tall-tale master of exaggeration might better monitor the pump panel or stay at the base monitoring the radio. The parent of many children probably shouldn’t be eager to volunteer to troll the bottom of the canal with grappling hooks in search of a drowned child (especially, if other first responders are available). Leaders need to know their crews. 

Take care of your first responders. For the rest of us, mind our own business and go about our day. Don’t stare. Refrain from gossip. Discipline engagement on social media. If television reporters show up, step back, count to ten, talk it over privately with trusted others (professionals, if available), then, and only then, should one consent to carefully engage with media. First responders should always seek the advice of command. 

Unfortunately, someone has to clean up. Sometimes that person was me. The coroner needed assistance, an undertaker needed a helping hand, the hose line needed someone on point to dilute and dissipate blood, an officer seeks a pastor to assist with a notification. Here I am, Lord; take me.

Each time it happened I tried to answer the call with eyes wide open, knowing full well that I was taking a bullet so someone else didn’t have to. I knew beforehand that I would need follow up care and was risking a lifetime of therapy. My mental and emotional health is good today, only because a community of professionals have invested in me best practices to manage stress and limit the impact of trauma. 

Education has been really important for my wellbeing. Taking part in a county-wide Critical Incident Stress Debriefing (CISD) Team, resourced by recognized leaders in in trauma, has been instrumental for my own healing, as well as the healing of others. Furthermore, I’ve been blessed with a good psychiatrist for nearly thirty years; we’ve been through the shit together.  

Even the strongest have our limits. I take myself with a grain of salt.

—

Monday morning and it is back in the pool. No fuss. No muss. Just 15 hard fought laps. Not even a flesh wound to someone going through Seal training or preparing for an Olympic medal.

I’m just a little known, retired clergyman, trying my best to stay healthy and limber.

As I pull through the water, I think of my latest book, written about the Krupp dynasty in Germany. This family of industrialists made the arms and weapons of war, from – the first Kaiser and the Franco-Prussian war, when steel overcame brass canons, through the first world war, to the National Socialist Party (led by the Evil One who shall not be named) of the second world war, – to the modern era. Politics, fortunes, and racism brought about mass slaughter and atrocities that shocked the world. Millions died in anonymity. Disappeared. Simply vanished.

“Please, Lord,” I petition, “wash my sins away, the sins of my generation and those who came before me. Create in us a pure heart, to navigate your ways of peace and justice, of love and grace, that such evil may be extinguished and never appear again.”

Fifteen and done.

The shower is hot and restorative.   

—

“Now I lay me down to sleep, I pray thee Lord, my soul to keep. God bless Mom and Dad, and please send me a baby brother.” My son had been making his nighttime petition to God for nearly ten years. It wasn’t like he was dissatisfied with Cynthia or me; he just observed other kids in the neighborhood, church, and school who did have brothers or sisters, and he wanted one, too. 

Specifically, he wanted a brother. 

Circumstances of life and health made the probability of another pregnancy highly unlikely. We didn’t want to bust his bubble, but we also wanted to parent with honesty and love. After all, who was I to suggest that God couldn’t perform the miraculous? I’m an Ordained pastor, after all. We are in the business of miracles (at least God is), so, what’s so wrong with giving in and allowing our son to pray for a miracle brother? 

I’m not saying Christian, our second born son, is the result of an immaculate conception, but the hand of God was somehow involved. An angel, lightning bolt, or seductive dream? I don’t know. One day the rabbit died. All three of us were thrilled with the prospects of a second child. An ultrasound confirmed my wife’s suspicions. The water in the pool of Siloam rustled and the Holy Spirit breathed new life into our family. 

Throughout my life I’ve witnessed prayer answered so frequently I wonder how anyone can remain an atheist. Prayer is often answered differently than what was asked for or expected. But, answered, none-the-less. God’s ways are not our ways, and they certainly are not mine.

When the Lord heard my nine year old son’s nightly petition for a baby brother, eventually something had to give. Nicholas wouldn’t let up. He wouldn’t cave in. My wife is a career labor and delivery nurse. Experience taught us to temper our enthusiasm. Too many things can go wrong. So, let’s put off telling others for as long as possible, so we thought. Her gynecologist was as surprised as any of us. Given her history, she didn’t think it was possible. 

Everything held fast. Eventually we informed family, church, and friends. We made prenatal appointments and I attended birthing classes once again. At this point in our lives, we were both in our late 30’s; old, but not really old. Nicholas was filled with excited anticipation. By golly, he asked and God answered! From his perspective, he was responsible for my wife’s conception. 

Delivery was planned with the Midwifery practice where Cynthia worked. She knew all of the providers and was comfortable with their care. They had just opened a state of the art, free standing birthing center. We were given a due date. The women in our life threw baby showers. Everything seemed like the trains were running on time.

The day arrived, but the baby just refused to budge. Stop the presses! The midwife made a sudden change of plans. We’d have to travel the ten city blocks to the hospital for delivery, if necessary, by cesarian section. Who doesn’t like driving through one of the most dangerous urban sections of town in the middle of the night with your wife in labor?

Christian was born with great difficulty. He made his appearance in this world as white as 20-pound Georga Pacific copy paper. He made no attempt to breath. White quickly turned to blue. Alarms sounded, crash carts appeared, and highly energetic clinicians gloved up and dived in. Blood splattered on the ceiling. Our newborn son was whisked away faster than I could process what was happening. “Come with us,” a member of the perinatal resuscitation team invited. 

Stay with my wife? Or go with our baby? I had never faced such a dilemma. With Cynthia’s post-partum nod, I followed my newborn son to the intensive care nursery, while cardio-pulmonary resuscitation was taking place. 

Christian survived, thankfully so. During his discharge, he experienced what was thought to be a seizure, so, instead of home, he was rushed by ambulance to the highest level of care, a pediatric intensive care unit across town. For days specialists ran tests and continuous EEG’s. In the day of analog paper records, Christian did his part to clear the rain forest. 

Finding nothing, he was discharged to home a week or so later. Cynthia, Nicholas, and I were thrilled. Family and church celebrations ensued. Everyone and everything was progressing according to plan. Christian was baptized by his beaming grandfather Irving and we all enjoyed a big pot roast meal after church. 

Every baby who goes through the NICU has a follow on assessment at six months. Just the policy, I assume. Cynthia was back to work, so I packed up baby, stroller, and diaper bag and went to the Kirsch Center for what I thought would be a routine appointment. 

A parade of Medical Doctors and PhDs made their examinations, often with a gaggle of interns, residents, and post docs in tow. People smiled but didn’t say much. Hush whispers made the whole hospital floor seem more like a monastery than a highly specialized regional medical center. I thought to myself, “we aren’t in Kansas anymore.” I was in over my head and out of my league. 

The final assessment was conducted by a developmental neurologist, a brain doctor without knives for infants and children. After his evaluation, he picked up his clipboard and began to fill in the paperwork. Check boxes were labeled “Normal” and “Abnormal.” Christian got a perfect score. Every abnormal check box was checked with a deliberate stroke of the pencil and a verbal confirmation.

It was like an anvil being pounded without mercy. “Abnormal. Abnormal. Abnormal.” Page two. Three. Four. The walls started to breathe and I broke out in sweats. I grabbed Christian in my arms and hurried out the exam room and made haste to the closest men’s room. As soon as the stall door closed, I broke out in sobs. 

The universe tore, and it felt like I was falling through the crack. 

On the way home I called my brother, a primary care physician, who lived and practiced on the other side of the state. It was a first generation cell phone, the size and weight of a brick, with a rigid foot long antenna sticking out the top. Cell phones were so new there wasn’t any stigma about talking on the phone while driving. My brother must have been between seeing patients because he immediately took my call. I cried on the phone. I relayed what was taking place, fighting static and distorted sound.

“Todd,” he said to me, “take a deep breath. It’s going to be alright. Just breath. Everything is in God’s hands.” He assured me that our hospital had some of the best in the world specialists in developmental medicine. He had heard of the developmental pediatrician assigned to us, even had attended her lectures. This was the major leagues. 

I pulled into the parsonage and parked the car, next to a car that didn’t look familiar. I got Christian out of the car seat, grabbed all his gear and made our way to the door. 

On the porch was a woman waiting for us. “Hi, my name is Rosemary,” she greeted me. “I’m from the county health service. I was told that you are just returning from the hospital and had received bad news. I’m here to help.”

I was floored. Overwhelmed. Swamped by God’s amazing grace. 

God was working though science and technology, medicine and communication, to activate a network previously unknown and unseen, of therapists, specialists, educators and providers – angels, every one – who would become a part of our lives and family. Each worked to maximize Christian’s developmental potential, the thought being, early intervention leads to lifelong benefits. 

Cynthia and I recall each name with fondness: Maida, Diane, Kathy, Eric, Rosemary, Dr. Hyman, Annie, Sue C., and Sue M. Occupational therapists, physical therapists, speech therapists. Craniosacral therapy; brushing Christian’s entire body, head to toes. Early child intervention. Our front door became a revolving door of specialists coming and going. By twelve months of age, Christian was on the peanut bus to a specialty school operated by Wayne County ARC (Roosevelt Children’s Center) that offered the exact early child intervention he needed.

No one had a name for it beyond the DSM catchall: “pervasive developmental delays, or PDD for short.” No one could predict what the outcome would be. Could he grow to be a doctor or lawyer, or a plumber or electrician? Would he be in a group home or confined to a wheel chair? No one knew, and false hopes and speculation was discouraged. 

“Just enjoy your baby,” Doctor Hyman told us, “and make certain Christian makes all the appointments with the services I prescribe.” “Will do,” Cynthia and I promised, outwardly confident of God’s amazing grace, inwardly scared as chickens being chased by a fox in a hen house. 

We were entering a brave new world. And neither of us felt especially brave.