THE LIFE FLIGHT CHRONICLES
or, I don’t think that’s what he meant by party
Originally posted in May, 2016, I’m re-posting it as part of my Paramedic Notes From The Inside series.
Critical care flight medicine is not my usual gig these days. To maintain my paramedic status I have to work one twelve hour shift in the flight program every six week cycle. Usually I find it is just enough to keep my feet wet, not let any skill sets get too rusty, and keep a hand on my theory base.
Though after leaving the field full time, what has never ceased to shock me during the infrequent, short spurts when I return, are two oddly competing truths. First, there is no shortage of people who will always do blindingly stupid things. Second, is that for those of us in what are often called the helping professions, the complexities of engaging human empathy and compassion can occasionally become uncomfortably personal.
Both of those truths were evidenced in the call I completed a few weeks ago. The shocking level of complete boneheaded vacuousness is easy to laugh at in a gallows humor kind of way we in emergency medicine share, yet at the same time, I recognize what occurred as a profound tragedy for one rural family. A Saturday night bush party, routine in most of the small communities a few hours north of a major city turned tragic at midnight, when police raided the farm it was held at.
Police raids on bush parties? Not frequent, but also not unexpected. In my day, I became quite adept at four in the morning obstacle courses through dark forests. We really didn’t have much to worry about, after all, it was just beer and a bonfire.
Apparently things take a different turn when the preferred substance is crystal methamphetamine. Evidently a few of the small town high school kids had been introduced to the powerful stimulant by a local drug dealer. When the tragedy occurred, no one had even tried it yet. Fearing the cops, a fifteen year old kid on his high school swim team, a kid who had never once been in trouble with police before, swallowed the bag of meth. I suppose no one thought to tell these kids that sixteen grams will keep a rather seasoned user cranked out of their mind for an entire week, with enough drug for 70 to 80 hits.
Not finding what they were looking for, the officers left the group with a stern warning. Ten minutes later the party resumed and the beer flowed freely. That was until two young students currently taking a lifeguard training course began CPR on their friend who had fallen over, stopped breathing, and begun to projectile vomit.
By the time my partner and I arrived at the rural hospital to stabilize and fly the boy to definite care, he had been successfully resuscitated in the ER, moved to the ICU, and when I noted the time we took over care, the staff had just completed a thorough job packaging him and the myriad tubes, lines, solution sets, and adapters we would need to maintain his cardiac and ventilator support. But it was while we were moving him I caught myself taking a mental snapshot of his face. He was a cute, fifteen year old boy, with chubby Campbells soup cheeks, and round, denim blue eyes. The innocence, as it always is when they are completely dependent, was profound. Normally able to depersonalize easily, I suddenly felt dangerously debased. This one was tough. I wondered if I had been away from full time EMS for too long. Or perhaps, not long enough.
Just before the approximate forty five minute flight back to the city, his mother asks me if she can kiss her son, whose name is Aden. Of course she can, I say. I take time to carefully explain what the bags, tubes and lines are about, what they are doing for him, and how it looks really scary but they are what’s helping him right now. Though it is when she looks at me with tears in her eyes, asking if her youngest son will be okay, that I think I hear my voice betray me.
“Is Aden going to come home?”
“He’s very sick right now. but you need to remember it could have been worse, okay? I promise you we are going to do all we can for your son, but right now we need to go”, is the best I can offer.
She hugs my shoulder, and with a squeeze of her shaking hand I offer the only comfort I can. The ICU doors swing closed behind us, and we are gone.
Working in this field for any length of time you learn to place heavy reliance on what your gut tells you. This didn’t look good. Fifteen minutes later, while the family is driving into the city, I realize my gut as accurate when my partner and I are deep in the art and construction of deftly organized chaos. Busy attempting to thread a central line through his veins, inject anti arrhythmic drugs and calcium channel blockers into his central coronary vassculature, while at the same time, trying to electrically resuscitate his heart which has, by now, stopped beating.
“The time is 5:41 am. I’m calling it. People, thank you”, an exhausted 3'rd year resident says without expression, unintentionally tripping over and pulling out the femoral line I had threaded so carefully at 8000 ft just over an hour earlier.
“5:41 am. Charted”, says the RN team leader, noting it on the resuscitation record.
As the dark red blood runs from the boys thigh, pooling on the floor below, everyone moves a few steps back avoiding eye contact, while a few shuffle awkwardly.
From a vibrantly alive and laughing fifteen year old at bush party, to the dead, naked slab on a gurney in the windowless trauma room. What is there to say, from us, the ones distanced from impact by an arms length abstraction.
I replay the details in my head. This, this I will do for hours. We had landed at 04:50 am, crossed the ER doors three minutes later. Since the first time the kid had passed out, his heart had started and stopped nine times. Two minutes after we moved him to the trauma table he lost his pulse for the last time. We then worked in vain for 51 minutes, while a reluctant awareness of the futility hovered around us unspoken. But for a 15 yr. old kid, you pull out the stops and do what you can.
Running my hands over my head I exhale slowly, wishing we didn’t have another two hours on shift. The chance of another call is high. Emily, the triage nurse signals me, nodding in the direction of the trauma room, she gives me the look. His family have just arrived. I quickly head in the opposite direction, ending up in the the cafeteria. As I send quarters flying into the machine, I silently wonder if there is a specific hell for the kind of person who would sell sixteen grams of meth to a bunch of kids from the sticks, all of them stoked because they heard they might “get a buzz”. I don’t think this is a buzz the boy with the round blue eyes was expecting.
“Is Aden going to come home?”
As I down my can of Pepsi in four swallows, I think of the mother who will never see her youngest son again, and I think of the two, soon to be lifeguards that kept their shit together while performing perfect CPR on a boy they’d known since the first grade.
Just then, the pager rings. Three, quick beeps.
Another call.
Fuck.
As per industry protocol, we need to be airborne in 2 minutes. As I start my quick but controlled jog down the hall back to the ER, I read the update for the call on a highway east of the city.
Three vehicle collision, two fatalities on scene. Update from the ground crew states your patient is an unresponsive 23 year old female, Glasgow Coma Scale of 3, who is seven months pregnant, Gravida 2 Pra 1. Ejected through the windshield, multiple fractures, possible cervical spinal injury, closed head injury with facial avulsion, ground crew unable to intubate.
My stomach flips a little at the last detail, since “unable to intubate” usually translates to my partner and I having to perform a surgical airway. In twelve years, I’ve performed two.
As the blue film of dawn becomes visible on the horizon, we lift off, and I remind myself that yes, there is a reason I only do this once every six weeks.
The events described below are based on an actual critical care air ambulance call I logged in 2009. Names and certain minor details have been changed to maintain confidentiality.
A qualitative researcher exploring the intersections of HIV, stigma & PTSD through the use of personal & community narrative, alto left a career as a flight paramedic to obtain his MFA in creative nonfiction. Stray dogs, satire, & Starbucks do not displease him.
