Last Moments

Reading Last Days by ThatNursePatty reminded me of something. My medical experience as a Hospital Corpsman was largely emergency medicine, and I rarely got to follow up on patients we admitted. I tried because it’s good to get feedback from the wards, such as why they hated our antecubital IVs.

It was an overcast day as I pulled into the apartment complex in New Smyrna Beach when in the middle of the roadway a woman flagged me down, a phone in one hand, tears streaming down her face. I pulled over and got out.

She was someone I had not seen before, and she was screaming at a million miles an hour. Following the general direction where she was waving I found an elderly man laying on the ground, and remembering my old days as a Navy Corpsman, I did a quick assessment. He was unresponsive.

There was a pool of blood on the ground below his head and I could not get an answer from the screaming woman how he had gotten on the ground. I told her in the calmest voice I could she needed to call 911 and get an ambulance there, but she was… not listening, screaming instead, and finally I projected my voice and got her attention.

She called, and promptly started screaming into the phone at the poor 911 person, and I could hear it going nowhere.

My assessment of what I now knew was her father was a possible C-Spine injury, eyes not equal or reacting to light, and a really thready pulse with low respirations and decreasing. I was holding a rag I had grabbed from my car against the back of his head, where the wound was. The blood on the ground wasn’t clotting, he’d lost at least a pint on the asphalt before I got there and it wasn’t coagulating. I suspected he was on blood thinners. CPR wasn’t called for at this time, so I just maintained his C-spine while keeping my fingers on his carotid so I could keep track of his pulse.

I got her to come over and place the phone on my shoulder so I could talk to the 911 operator. I fell back easily into ER talk, giving the operator a rundown which she couldn’t understand. She couldn’t connect me to the ambulance. She couldn’t connect me to an ER to talk to a doctor. I knew this old man didn’t have the 15 minutes she said it would take for the ambulance to get there.

She was back in the middle of the road screaming her dismay at the Universe, and her father was not likely to last that long. His pulse became increasingly thready, his respirations became slower and more relaxed, and I called her over to hold his hand and talk to him. She was, unfortunately, not done with the Universe, and still had much to say to the Universe. He was slipping away.

I spoke to him quietly,focused on him, and I waited while counting his respirations, feeling his pulse slip away, managing his head wound as best I could while keeping his neck in line.

The ambulance eventually arrived, and I did my handoff to the paramedics. He was pretty much gone, his pulse still faintly there, shallow respirations down to about 4 a minute. I gave one paramedic the look, he nodded curtly and quietly, and I got up and walked to my car and drove off to my parking spot for my apartment.

I would find out that he didn’t make it, as I expected. Too much time had been lost. His daughter would end up finding me the next day and thanking me for helping, breaking down into tears. She had been so wrapped up in herself she had not spent the time with him when she could have, but that was not for me to tell her. It wasn’t even necessarily right for me to tell her.

In the moment, people react to emergencies in different ways. Not everyone is trained for them. Not everyone is good at them. And when it’s a person we care about we become compromised, some more than others, but we all become compromised in one way or the other.

I don’t know what happened to her. I saw her off and on over the course of a few months. She kept to herself, possibly reliving that time herself in dark moments. Did she have regrets? Would she have them? I do not know.

It wasn’t the first time I’d seen such a thing, and it wouldn’t be the last. People thought highly of me in that complex afterward.

I hadn’t saved his life. I hadn’t even made it better for the short time we were in contact. Hopefully he was a little more comfortable. In the end, that’s what we can do on the worst day:

Make someone a little more comfortable.

The Surgery

doctors-call-768It was planned, this surgery, and while the particulars aren’t important, I found the process worth writing about. After all, people poking about in one’s body has become remarkably commonplace in the last century.

No one holds the gas light anymore, since Nikola Tesla blessed us with alternating current and Edison takes credit for the light bulb. Centuries prior to that, bacteria was discovered by Antoni van Leeuwenhoek in 1676. Robert Hooke who described the fruiting structures of molds in 1665, which also puts him in the running on that. We could go on and on about all the technology that brought us to modern medicine, and we probably should at some point though I leave it to the reader to affect their own diversion on this.

Suffice to say, medicine has come a long way, and as an old Navy Corpsman who had peered into the insides of others, I was well heeled for this. I went in at the appointed time, was promptly tested for Covid-19, the ever present reality of our time. I then found myself upstairs with a Cuban nurse who matter-of-factly told me I should take everything off and put on a gown, surgical slippers and a hairnet which I was told was for my hair – and I had to wonder where someone else had placed it in the past to create such a need.

A young man, 19 years old, was in line before me for the Surgeon, so I knew I would wait until he was off the assembly line. He looked calm up to the last moment I last saw him, but his calm was that of a bomb, appropriately scared of what would come next. At 49, with the life experience I had, I had an idea.

The anesthesiologist came in and saw him – quite clear and calm, hailing from India if I had to guess, brisk and efficient, which promoted confidence in me but not as much in the younger man as I heard his voice quiver with answers. He would not be getting the general anesthesia I would, and he had concerns that he felt he was being rushed through – but it was just the unfamiliarity of it all, I think. There is little that really prepares you for this sort of thing except actual experience, and mine was not that of being on the bed that much.

Myself? I have been poked, I have been prodded, I have been stitched and I have stitched, having performed minor surgeries myself in the Navy. Still, the mind wanders. I would not calm him with the history of why Surgeon’s are called ‘Mister’ in the UK, a history of the surgeons being that of butchers – really, butchers – that came in through the back door to homes to ply their trade. We are all simply slabs of meat made kinetic through ways we still do not fully understand. Admittedly, I am more marbled than I used to be, but this surgery would allow me to lean up again.

The anesthesiologist then visited me, a loud and clear voice, and we spoke at length about pain management, alternative pain management (he had just read a paper out of Jamaica on the use of marijuana for pain management, a topic we both warmed to), and I was comfortable with him as I was the surgeon who showed up not much later. 

The young man left for surgery, and I wish I had brought a book though I was not comfortable with the gown. I understood why I needed to wear it, but I did not like wearing it, but preferred an attempt at dignity provided rather than what I knew was coming.

Time passed.

I heard him come back and his discomfiture. The nurses had their hands full, he was panicked and possibly in pain and cold. I empathized knowing my time was coming, but with a bit more experience. I’d never worked the OR myself, only in emergency situations at that old Naval Hospital in Orlando, now a VA clinic. My experience was all about emergencies. It was not about the planning and hoops one must jump through for a planned surgery. He calmed, I suspect that they sedated him while piling a blanket on him.

Now they would be prepping the OR for me. It took an indeterminate amount of time – my timepieces were not with me, but it seemed long waiting and short in retrospect. And then I was wheeled off, an uncomfortable experience. And then the worn ceiling tiles made way for the solid ceiling of the OR, two lights above and I commented to the nurses and anesthesiologist and scrub nurses that they really had a nicer ceiling than elsewhere. We wrestled me over to the surgical table, parts of me helping and parts of me not for reasons I could not describe. I was told firmly that they would be doing everything and I should stop helping.

“I’m not used to that.”
“We know. But you have to let us do this.”, the Cuban nurse said.
“OK.”, I responded, sounding hollow. I do not like losing control. I do not like it at all, but I knew I had to, and thus… I tried.

The gas mask came down, “Breathe in deeply, then breathe out”. Simple instructions, easy enough, though the gas took me back to when I was a young boy – I knew the smell. It was the smell of the gas that a dentist once tried to use on me and failed – his mistake being telling me about pink elephants, which through power of suggestion, I saw. He and I did not know until then that I was not fond of pink elephants, trunk to tail, one baleful eye each staring at me as they slowly trudged.

I struggled, surprising myself. The anesthesiologist had it under control, “You are anxious. It’s ok. You know this, you can do this, breathe in and out.” Perfect. Had a dentist told me that 4 decades prior, I would not have reacted this way that time, but there it is. In, out. Deeply in, deeply out. Deeply in, deeply out. 

The recovery room. Surgery was over, I was awake and hooked up to monitors – my oxygen saturation was low 90s and high 80s, so I focused on my breathing through the remaining haze of the anesthesia. I needed to get that sat up. I could hear the young man going downstairs in the wheelchair. It had not taken that long, this surgery.

Within about 15 minutes of consciousness, my mind was clearing – I had latched onto my pulse oximetry as a thing to focus on and change, and change it I did – getting back up to the high 90s, then rewarded with the removal of all the equipment and the ability to get dressed – the nurse let me know that she could help. I dressed, practiced as someone who had pain but working through and around it. She was back within moments, I told her to come in – I was fully dressed.

And within another 10 minutes, I hopped in a friend’s car after following protocol to be wheeled down. That part was over.

Now, the recovery, which seems to be going well enough at this point. Everything works. Swelling is going down, and pink elephants no longer are an issue.