A Glimpse of My Glimpse...

During my last tour at work, my department sent my squad to a vehicle extrication training exercise in a neighboring jurisdiction. This drill was sponsored by an insurance firm, which was generous enough to donate a vehicle that had been totaled in a car crash, as well as dinner and drinks for all the area firefighters who attended the free training (who could ask for anything more?). Such training is offered as an altruistic public service of the private sector insurance company to help firefighters prepare in advance for the obstacles and dangers they may face in the course of extricating a person from the heap of wreckage that could once be described as an automobile. A car can be a tricky thing to navigate when it has sustained an impact with a stationary object after traveling fifty-plus miles per hour. It becomes a crumpled puzzle that takes some ingenuity to unravel. This drill also helps increase our situational awareness to the dangers that exist during extrications, such as undeployed airbags, which pose great risk to our own personal safety.

In my department, the reality of it is this, when the police need help rendering aid they call for the firefighters, when the firefighters need help rendering aid they call for the rescue squad. The specially trained rescue squad sweeps in and with a bevy of tools and hydraulic machinery (such as the 'jaws of life'), they quickly dismantle the car, piece by jagged piece until all that is left to do is lift the patient to safety. As a firemedic in my department, it would be a rare occasion that I would be called upon to operate such machinery. I will more likely find myself tucked under a wool blanket inside the vehicle compartment, providing soothing words and emergent medical care to the injured patient who is the focus of our rescue efforts. So, for me the drill was interesting but what happened after was even more so.

After the car was broken down into several pieces and the drill concluded, I returned to my medic unit with my Lieutenant. Just as we were doffing our turnout gear, a thin 30'ish, light-skinned African American man and his 13 year old son approached us. He asked that his son be checked out as he was complaining that his heart was racing. Racing it was, the young boy had an elevated heart rate of about 145 beats per minute. The father explained to us that the boy was suffering from anxiety and stress due to his mother dying only two months before. The young man started crying as his father explained this to us, and the father confided in us that he and his son were seeking counseling to deal with the loss of the boy's mother. The father also looked like he was under considerable stress as he explained that he had been a single, part-time father who loved his son but had not been prepared to care for him on his own. He was trying to find his way as a full-time father while also being a support for the boy that sat hunched over in tears on my cot in the back of my medic unit. Within less than five minutes time I was given a most intimate glimpse of this father and son's life and relationship. We were outside of our jurisdiction, but my partner and I conducted a thorough check of the young boy, even hooking him up to our cardiac monitor, to ease his mind. After several minutes of calming reassurance the boy's heart rate slowed down considerably. He was a well spoken young man, going through a very difficult time and he needed a few minutes of attention and an opportunity to talk about his feelings. After a short while, the boy climbed out of the unit with sense of relief and higher spirits than before. The father thanked us for all that we had done (although in truth it wasn't much) as he shook our hands before walking back into the night with his arm around his son. I know time would be the only thing that would truly ease the boy's pain.

This job gives us a glimpse into people's lives, often at most trying and vulnerable times. We see people when their guards are down and their emotions are raw. This glimpse is what I feel gives me perspective - perspective to understand the depth of emotion that life can entail. I am fortunate enough to gain this perspective without having to experience the raw emotion first hand. I am invited into the bedroom of the dying affluent 38 year old female who seemingly has all the finer things in life except her health, I am called upon to tend to the 4 year old little girl who smiles at me from her wheelchair as she shows me the pictures of heaven that she drew because she has a rare form of muscular dystrophy and knows she will not reach adulthood, I try to start the IV on the 6 year old child with cerebral palsy wearing fire truck pajamas as he seizes in his bed, I check the vital signs on the intoxicated alcoholic mother who is in stage 4 liver failure as her 14 year old son looks on. Sometimes I feel enraged by things I see, sometimes I feel humbled and frustrated by my limited ability to assist, and often I want to rescue those I treat (especially the children) from the situation they are in. I'd like to save them from the sadness and chaos, and bring them to my home and tuck them safely in amidst the soft pillows and clean blankets in my guest bedroom. I have learned that I have to accept that everyone has a road they must travel, and lessons they will be faced with along the way. This is part of their journey, and I am but a momentary observer. I truly believe that everything happens for a reason, although when you are in the middle of the storm the reason may not be so clear. In the moment, we see a little girl dying of a debilitating disease, but perhaps what we can't see is that her brother will be so motivated by her loss that he will go on to study and find a cure for the illness which stole his little sister. Subscribing to this philosophy is what helps me, and probably many in my field, accept the things we see without being totally crushed by them. Blogging about it all doesn't hurt either. :-)

I am grateful to have these glimpses, and that is why I pass them on - a glimpse of my glimpse as it were. It reminds me of how appreciative I am of my life. I am fortunate to be able to come home and hug my healthy little girls and loving husband. I feel life has so many layers, and it is easy to be distracted by the superficial things that seem so important on a daily basis. Such experiences help to remind me to "not sweat the small stuff". I feel a great connection with life, I feel that I am truly plugged into the highs and lows that life holds, and the lows make me appreciate the highs all the more. This is all part of my journey, and I am trying to learn as much as I can along the way.

Not Quite Saving the Day...

I experienced a serious incident this past Monday. It was the first time I was truly called to act while off-duty, and I didn't expect it to effect me in this way. My husband , 4-yr old daughter and I were shopping at our neighborhood supermarket when a frantic voice came across the PA announcing, "There is an emergency in the seafood department, call 911". My husband looked at me and I said, "I'll be right back". I ran across the store and found a middle aged man lying unresponsive on the floor. His face was flushed and his lips were starting to turn blue. He was breathing, but not very well. I adjusted his airway and asked the bystanders if anyone had seen what happened. One employee told me that the gentleman was pushing his cart when he suddenly proclaimed, "Oh my!" and fell backwards. I instructed the store manager to search for the man's wallet and look for a list of medications, while another bystander looked for a medic-alert bracelet and lifted his shirt (I was looking for signs of heart surgery, pacemaker or even hives). It is important to try to figure out the underlying cause of the present illness so that it can be corrected as quickly as possible, but that can be difficult to do when you have an unconscious patient. I learned his name was Tom* (*changed to protect his privacy) and that he had several medical problems that could be contributing to his poor current condition.

The adjustment of his airway seemed to help because his respirations improved and suddenly he looked up at me. "What are you doing?" he asked me in a strained but quiet way, his eyes searching for some understanding of what was happening. I told him, "I'm a medic and I'm trying to help you, you passed out and I need to know if you are having pain anywhere." Tom tried weakly to sit up, but I told him he should remain lying because he was ill and could be injured. I asked again if he was in pain or had any medical problems. He began gasping and said one or two words that were impossible to understand. I repeated my question and again he made a few guttural sounds that were straining to be words but were yet incomprehensible. At that moment, as I was holding his head in my hands, he looked up at me and his eyes got wide, he took one last labored breath and then there was nothing - he had stopped breathing and I lost his pulse. I immediately started doing compressions on his chest. My husband stepped in and took over the compressions as I delivered mouth to mouth ventilations. I asked the manager for an AED, but the store did not have one. I was helpless to do anything more for this man than to offer him what air I could. Had I had my equipment, I could have seen what his heart was doing on my cardiac monitor, I could have given him high-flow oxygen and I could have established vascular access to provide him with emergency medications. I felt powerless and frustrated. I knew there was more that I could be doing but I didn't have the tools I needed.

We continued performing CPR, and a Deputy Sheriff arrived with an AED, but an electrical shock was not what this man needed. He needed more advanced lifesaving measures than what I could provide as a lay rescuer with limited resources. The medics arrived after several intolerable minutes and advanced measures were taken. We were able to get a pulse back, and Tom even started spontaneously breathing on his own for a brief few moments, but no sooner than we got him to breathe he began seizing and then we lost him once again. His body was fighting, but it was a battle that would not be won. Tom died as a result of his sudden illness in spite of the measures we took to try to save him. I believe that his passing was the result of a pulmonary embolism that blocked the flow of blood from his heart to his lungs, and unfortunately the mortality rate of such a sudden condition is almost 100% fatal. Even in a hospital setting with unlimited resources, such a massive complication often cannot be overcome. Even knowing this, I was greatly saddened to hear that he had not survived. A part of me was foolishly optimistic because he was fighting to live and he had started breathing again.

I encounter a fair amount of death through the course of my job. I have seen people die, and I have even had to let people die but the circumstances are usually very different and they often include an unconscious individual, advanced in age with a DNR (Do Not Resuscitate order). We standby and offer supportive measures to make the person more comfortable as their heart slowly winds down and they drift away. Moments such as these are expected at work. When I put on my uniform I am mentally prepared to deal with the challenges of the day. Even when a call hangs heavily on my heart I can usually leave at least some of that burden at work. I get in my car and the ride home cleanses my psyche, the longer I drive the lighter I feel. But I didn't have my impenetrable uniform on this day at the market with my family. My work life had crossed over, intersecting with my private life on my home territory and I was caught off guard.

After Tom was whisked away by the medics and I had provided my personal information to the remaining rescue crew my husband and I looked at each other. The question ringing in my ears was "What now?". We finished our grocery shopping where we had left off - in the dairy aisle. My beautiful little girl looked at me and said "Mommy, you saved the day!". I only wish she was right. I looked for Tom's obituary but I haven't been able to find it. I don't know what it is I am trying to learn from it, I just want to know. I wondered what happened to his car in the parking lot and if he had a hungry pet waiting for him at home. Death is a funny thing because life goes on in spite of it, seemingly without missing a step. When I am at work everything is so much more controlled. There are procedures and protocols we have to make sure all the loose ends get neatly tied. I am not usually left having felt so helpless with so many unanswered questions.

Due to privacy laws and patient confidentiality I will probably never know more about Tom than I do today, but I know I will carry this incident with me. I am glad I was there and tried to help. I hope Tom found some comfort in knowing that he had several concerned people trying to help him as he left this world, I hope he did not suffer greatly and I hope he is at peace.

On the Knob at a Car Fire

I was a few months out of the academy when we were dispatched to this car fire on Rte 66. It was my first time being on the nozzle in an uncontrolled setting. My captain had to pull me back because I was being too aggressive - but we train to go hard or go home, right? In the end we got this extinguished without any injury or other property damage. The commuters on 66 got quite a show, and I felt a sense of relief to know that I really had learned something during the 20 weeks I spent in the brutal summer heat at the Fire Academy.

It is hard to believe it is 2.5 years later! Time is flying by -- I guess that is what happens when you love your job. I remember at one point in my early 20's I finally accepted the fact that I would never find a job that I enjoyed. I would be sentenced to a monotonous, flat existence that comprised of awaking on countless mornings with the feeling of dread for the day ahead. I had already worked too many jobs where the hours felt like days and the weekends were so short that they felt more like a tease than an escape from the monotony. Somehow, with a little help from the hand of fate, the pieces fell together and I am enjoying myself and my career. The best part of all is that almost every shift leaves me with a feeling of satisfaction for knowing that my efforts have made a positive impact on someone's life.