1 : incapable of being felt by touch
2 : not readily discerned by the mind
3 : the quality of not being physical; not consisting of matter
I have wrestled with death. It is the most unexciting contest you can imagine. It takes place in an impalpable grayness, with nothing underfoot, with nothing around, without spectators, without clamor, without glory, without the great desire of victory, without the great fear of defeat.
The morning sun illuminates the interior of the church in a kaleidoscope of color from the stained glass windows. I slowly walk up the center aisle towards the coffin that is on display at the front of the sanctuary, with a backdrop of systematically aligned vertical pipes from the organ. A nine foot crucifixion is mounted to the wall and the eyes from the depiction of Jesus seem to follow me as I make my way up the aisle. The candles along the wall are giving off the slight smell of burning wax that mixes with the occasional whiff of recently burned incense. After what feels like a very long and somber processional, I finally reach the front of the church and kneel – as if accepting communion – and place my stethoscope in my ears.
“Hold CPR.” A firefighter rocks back on his heels with sweat dripping from his brow as I feel the neck for a pulse and listen to the chest for respirations and heart tones on the pale, lifeless, body laying in front of me. No heart tones and I can’t feel a pulse, yet I catch the occasional autonomic gasp for air as the body attempts to breathe even when all of the control centers of the brain have been turned off by death. I look at the monitor and see the organized complexes of pulseless electrical activity (PEA) march across the screen, each having failed to stimulate the heart to form a contraction. “Continue CPR.”
The flash chamber of the IV fills with blood as the needle finds a vein and saline is pushed into the body by a pressure bag which is pumped up on the IV bag to force the saline into the vein faster. The standard medications are pushed into the IV tubing at regular intervals in accordance with our county’s protocols, as a CPR machine replaces the tired firefighter and applies perfect compressions at the push of a button. The floor of the church is littered with the remnants of our resuscitation effort: the purple and gray medication boxes, various wrappers, etc.
A man in a white shirt and gray hair is leaning into our little clearing here in the middle of the church and trying to get close to the patien’s head. With tears streaming down his face and a cracked voice of anguish he’s pleading with my new patient not to die. “Mom, you’ve got to come back to us. You can do this. It’s not time yet. Please mom, come back…” I take the IV bag from the firefighter and hand it to the man in the white shirt.
“Sir, can you hold this for me? Hold it up high and make sure it keeps flowing. Thanks.” He continues to plead with his mother not to die but at least he’s standing up and out of my way as I prep my intubation equipment. I tend to think that CPR and drugs have a better chance of bringing her back – more so than pleading – but it seems to make him feel better to be doing something so I’m okay with getting him involved by giving him a job. This is obviously one of the worst days of his life and he’s going to remember it vividly for as long as he lives. He came here to say goodbye to a loved one and watched his mother clutch her chest and fall to the ground not ten feet from the casket of another family member.
Kneeling in the aisle of the church, under the watchful gaze of Jesus, I bow my head – as if in prayer – and insert the laryngoscope into a lifeless mouth. The autonomic reflexes of the body are still attempting agonal respirations as I expose the vocal cords and pick my landmarks to sink the tube into the trachea. Like a surfer sitting in the line-up waiting for the perfect wave, I watch the vocal cords come into view every eight seconds or so. On the next rhythmic exposure I sink the tube home and inflate the cuff while securing it to my new patient. The firefighters begin strapping my patient to a back board to facilitate transport to the ED.
At the next break in CPR I’m feeling for a pulse and watching the monitor as the rhythm changes to the erratic zigzag of ventricular fibrillation. The drugs and perfect mechanical CPR have created an electrical change in the heart – or possibly she’s deteriorating as the heart can no longer create an organized complex. Either way this code just turned into a mega-code and we’re going to chase the rhythm with electricity and different drugs in the hopes of restoring a perfusing heart beat.
I push the charge button on the monitor and the high-pitched whining sound increases in volume until the modulating alarm tells me that it’s ready to deliver a shock.
“Clear.” The simple word is repeated by the others as they move slightly away from my patient. The son is a little confused as he stands holding the IV bag next to me. I reach up and take the bag from his hands and set it on the ground. In the background the monitor’s alarm impatiently reminds me that it’s time to deliver a shock. I let the son know, “You’re fine right there,” and I push the button.
Electricity courses through my patient’s body and her muscles contract and release tension as her arms splay to her sides. Nine feet above me the lifeless eyes of the crucifixion stare at our futility and the religious parody taking place on the floor of the church. Have I not tortured this poor woman by stripping her to her undergarments, stabbing her in the hands with needles, strapping her to a board, affixing a mechanical compression device to her chest, and finally sending electricity through her body only to create the mirror image of the crucifixion on the floor of the church?
The CPR machine is still doing its tireless job of compressions on my patient’s chest as we put her on the gurney and prepare to leave the house of God to go find the house of Science. Jesus’ eyes seem to watch our little procession of first responders push a gurney past the empty pews towards the back of the church. At His feet lies a casket with another dead body in it.
A priest in full robes stops us at the door. He says some words in Latin that I don’t understand and moves his hands in well rehearsed motions – passing on a blessing for my patient as the rhythmic noise of the CPR machine circulates blood in a lifeless body.
We exit the church and head toward the ambulance, walking past easily one hundred people standing around in black suits and dresses. All I can think as we slowly roll towards the ambulance is that it’s likely that all of these people will be back here in a week to pay their final respect to my patient.
We enter the ambulance and I have two firefighters with me – one squeezing air into the tube and one taking care of the monitor and CPR machine. I’m prepping drugs and reassessing my patient as the doors close and the four of us are finally alone – away from our somber audience.
As the rig accelerates away from the church I look through the back window to see mourners start heading back inside. Parked alongside the church in the spot that we just vacated, a black hearse waits for its occupant so it can begin the slow transport to the final resting place.