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.
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