Lights Out

Death is not like a light switch.

I was thinking today about a few of the more interesting events I've witnessed in the back of an ambulance (or at the scenes it takes me to). It got me contemplating the way we go.

I've always been with the crowd that says when the lights are out, the party's over. There's nothing else. We are, and then we aren't. It's my hunch more than a strong belief and of course there's no way to know if I'm right until my own lights are turned out. I'm in no hurry to find out.

Just because our lights can go out doesn't mean we run like a light bulb. The one thing I've noticed is that death isn't a black and white deal. Life for us carbon based organisms is not binary -- not simply on or off. Life is messy and death is not a light switch; it's total system failure. We shut down part by part.

Sometimes, we kind of coast to a stop, slow and easy. Other times, we have a catastrophic breakdown that causes a chain reaction. It's those catastrophic malfunctions that I deal with most often and I'm constantly amazed how common it is for part of the body to fail while the rest of the body ticks away completely unaware that it's already dead.

I've watched a couple of sudden cardiac arrests happen right in front of me. In both cases, the victim didn't know he or she was dead until I pointed it out.

I didn't exactly say, "Hey, do you know you're dead?" Instead, I asked both of them if they felt OK after I saw the heart stop beating on the EKG monitor. She was in the middle of telling me about her recent vacation cruise and was still talking when I interrupted her.

Patient: "...so we had a great time and came back just Thursday night. It was fun, but I didn't like the food all that much. I did get to eat as much as I wanted, though."

Me, looking at the fact that during the last ten seconds, her heart hasn't been beating: "Are you feeling OK?"

Patient: "Ummm..." (eyes roll up in her head and she shudders one last time)

Me: "Sorry I asked."

The second time it happened was just six months later. This time I had a grandpa and his grandson in the back with me. He was feeling pretty crappy and didn't talk much.

Me to the grandson: "So, what are you gonna be when you grow up?"

Grandson: "The President."

Me: "Oh. You're not planning on doing too much with your life, then?"

The hospital RN on the radio interrupts, and I start telling her what's going on. The report is a couple of minutes long. I'm near the end of it when Grandpa's heart decides it's done.

Me: "...started an IV and given nitro and aspirin. I'm just about ready to give him some morphine for the pain." I notice Grandpa's heart is no longer beating, but Grandpa is still looking at me. I continue on the radio. "Susan, my patient just coded. I'll have to call you back." I toss the radio down and look at the patient. "How are you feeling?"

Grandpa: "Arrrggghh..." He has a seizure.

Me (Note to self: stop asking the dead patients if they're OK) to the grandson: "Do you ever watch medical shows on TV?" I'm now digging the defibrillator patches out of the EKG case.

Grandson nods his head.

Me: "You ever see them shock somebody on those shows?" I'm now peeling the backing off the patches and placing them on Grandpa. "You know, they say 'clear' and then the person kind of jerks?"

Grandson nods his head.

Me: "I'm gonna do that to Grandpa right now, but it'll be alright."

Grandson closes his eyes (good call, kid).

It worked, but Grandpa was about as Hollywood dramatic as I've ever seen a patient when they get shocked. He found me several months later and thanked me with a big hug.

Many times I've witnessed death in progress and it's never been an on-off switch. It's a system shut down, kind of like when you log off your computer. Or, when the power goes out. It doesn't happen everywhere all at once; it's more of a block by block, city by city, state by state kind of thing, the messiness of total system failure.

Are You Myopic?

It means nearsighted, but I'm not asking about whether you can read roadsigns without glasses. I'm wondering if you can see past the nose on your own face when it comes to understanding what others are doing and thinking.

When you are interacting (read: arguing) with others, do you see their point? Do you get where they are coming from?

I posted a few weeks ago about my epiphany regarding heroin addicts. I have become convinced that ice down the pants must work sometimes to wake up those narcotic overdoses that we don't get called on.

I also believe that convalescent home nurses always say the patient isn't their normal patient because it's true. How often do we pick up nursing home patients and get the same line from the nurse? Maybe, just maybe, it's because that's the most common reason for a convalescent home nurse to call an ambulance.

Just do the math. There are a lot more nursing home patients not going to the ER than there are patients going to the ER. Why? Because the vast majority of the patients have the same caregivers today that they've had for the last 3 months.

I was in a heated discussion today about customer service and work ethic. The person I was talking with believed that the current lack of work ethic commonly viewed in our society's younger workforce is a problem with the workers.

Maybe not.

I've always thought younger -- newer -- workers learn how to behave by emulating their older peers. It's the reason my daughter, a baby air traffic controller, and my son, a fairly new Army medic, think it's cool to complain about their jobs all the time -- even while they love doing them. Because they're mimicking the older, more burned-out crowd.

So if newer workers are looking to their older counterparts to figure out how to act, aren't they also taking cues from their employers? Doesn't corporate culture figure into the equation?

If an employer does only what's necessary to fulfill a contract, doesn't that give its employees the impression that the minimum is all that's expected? Haven't we all heard bosses complaining that employees don't do anything without being asked?

What message does that same boss convey when he refuses to refund a broken product because the customer was a day late returning it? The absolute minimum, folks, that's all we need to do.

That's what I mean by myopic. Are you looking at the world only from your own point of view, or do you see how things look from the outside in? The next time you complain about other people being lazy, stupid or making mistakes, try to see it from their point of view.

Maybe it's the message they were getting.

Why Do They Always Have Ice in Their Pants?

Narcotic overdoses have three signs that are universal, call it the holy trinity of heroin:

1. Apnea (not breathing)
2. Pinpoint pupils
3. Ice in the crotch

The first two make pharmaceutical sense. Opiates make you stop breathing and squeeze your pupils into tiny black dots. It's the third sign that has baffled paramedics for decades.

Ice down the pants.

Imagine: junkie shoots up with friends. Friends notice (after an unknown duration) that junkie isn't breathing. Friends attempt to wake junkie to no avail. Friends run to the ice machine in the motel hallway and dump the whole bucket down junkie's Wranglers. Junkie is still heading for the light. Friends call 911, gather up all the drugs and cash -- including junkie's wallet -- and skedaddle before the fuzz gets there.

We show up to find junkie lying on the bed, sweating profusely, blue lips, arms outstretched like Ted Neeley, cubes in his drawers and wallet lying open on the nightstand entirely devoid of any founding fathers. In no way, shape or form will we find any illegal substances on the premises. The fuzz, by the way, couldn't care less.

This presentation results in almost every paramedic I know shaking his or her noggin wondering how professional heroin users like this guy and his acquaintances haven't figured out by now that the only thing that's gonna wake him up is Narcan, a magic little concoction we paramedics carry to wake up junkies. It's like the heroin antidote and it's only available by special delivery.

Don't these guys get that the ice trick doesn't wake the dead?

The concept is solid, I mean a Big Gulp on the twig and berries should really give you enough of a jolt to come back from the edge of the abyss. It's like a convenience store defibrillator.

CLEAR! Jamba Juice all over your Fruit of the Looms -- ZAP!

So we, the self-righteous paramedics who obviously know how futile ice in the pants is, continue to shake our collective heads as we prepare our Elixir of Life and mainline it directly into our junkie's last remaining vein, smugly grinning as he rolls over and tosses lunch all over the motel room floor from his instant heroin withdrawals. The only problem with this line of thinking is that the junkies are still using ice. You'd think by now they'd have noticed they were still calling 911 and leaving Bubba for the cops to find even after dumping their smoothies down his tighty-whities.

Unless they're not. Maybe -- just maybe -- this ice trick works better than we sheltered, non-IV-drug-using paramedics realize. Maybe this is the ultimate junkie home remedy, and only when a deep freeze to the nether regions doesn't bring Bubba back from the brink do his junkie friends decide to jump ship and call out the troops.

Maybe. It. Works.

Maybe there are junkies overdosing three or four times as often as we think they are. Maybe overdosing is like the choking game, a way to play with fire and only when you get burned do your best friends make off with all your money and drugs and leave you to wonder how you got in this motel room with a rubber tube in your nose, puking your guts up, surrounded by firefighters and a paramedic with a Cheshire Cat grin.

The next time I find a heroin overdose patient with ice down his pants, I'll know that indeed his friends did everything they could before they called an ambulance -- and made off with his unemployment check.