Leaving the urban areas behind I accelerate into an increasingly empty freeway as the lights trail off, replaced by trees and scrub brush hills. There is solitude in the darkness, yet the open roof allows judgment from above as I navigate the quiet freeway home. With a crescent moon overhead I see the airliners strung out in their landing pattern like white Christmas lights hanging in the sky. I feel the rush of wind as I pass the big rigs hauling goods to far off destinations. Cold wind is still on my face, and I have a tightness in my chest when I breathe deep, so I allow my breaths to become increasingly shallow – it’s just easier that way. I wonder what he thought just before he took the last breath of his life.
“It’s Jimmy, looks like his asthma is acting up again.” Kevin pulls us up to the bus stop where Jimmy is sitting down and sucking hard on the Albuterol treatment provided by the fire medic.
We’ve seen Jimmy every few weeks over the years. Sometimes it’s drunk in public, sometimes it’s his asthma, or weakness, or hunger, or just a little cold. On occasion we even get the calls from the cell phone heros who think he’s dead yet keep driving so we have to show up and wake him up in the morning. Although he’s usually not in any serious distress he does have every chronic problem in the book: hypertension, CHF, diabetes, asthma, COPD, previous heart attack, etc. He’s an urban outdoorsman (a.k.a homeless), and a frequent flyer. It seems like he’s been in the county forever. The fire medic doesn’t even bother with a hand off because we all know him.
As I load Jimmy into the rig I hear the fire engine accelerate away from us. Jimmy’s having a hard time holding the Albuterol treatment so I convert it to a mask for him as I tell Kevin to start transporting – I’ll do everything en route to the ED because he’s looking pretty serious.
As I lean Jimmy forward to listen to his lungs I can actually hear the fluid level increase – filling up his lungs as I work my stethoscope higher on his back. FUCK ME!!! The asthma exacerbation triggered a flash pulmonary edema episode. Uncontrolled high blood pressure and congestive heart failure are pushing blood into the most porous organ in the body – his lungs. He’s drowning in his own fluids!
Just as I pull out the CPAP (continuous positive airway pressure) and affix a nebulizer to it, I see Jimmy’s head slump to the right. Fuck! Can’t use CPAP on an unconscious patient.
Looking out the window I see that we’re basically on the same block where my last patient checked out on me. I tell Kevin to upgrade to Code-3 and let them know we’re coming in with respiratory arrest. I switch the nebulizer over and attach it to the BVM (bag valve mask) and squeeze the football to try to oxygenate the lungs that have decided they are going to stop working tonight.
One minute later we’re at the ED and I’m watching his heart rate slowly drop; 60, 50, 40. “Start compressions.” The doc states the obvious – Jimmy just coded. Fifteen minutes later they are throwing the “Hail Mary” drugs at him in an attempt to counteract years of abuse to a body plagued by addiction and street life. Twenty minutes later I’m finished with my paperwork and the ED tech, Nick, walks up. “Man, I hope you’re going home now because I’m tired of working codes tonight.”
“Yeah, that was my last call, I’m done. It’s the end of my week – no more patients fixin’ to die on me.” I wave at him as I head out the doors. “Have a good one.”