Slipping

In a counselors office at a state run facility specializing in juvenile psychiatric issues a mother and daughter sat in their therapist office in an attempt to hash out their differences. The girl was sixteen, her mother thirty-six. Things got heated during the session, words as weapons, hostility, some yelling, anxiety and stress. The mother was so upset she passed out, and could not be roused.

The counselor asked the receptionist to call 911, she did, and we responded.

Having seen it all, and quite familiar with these kind of "anxiety attacks," I walked nonchalantly through the doors of the place I have been to dozens of times for similar reasons. The receptionist directed us to an office toward the rear of the building, and we made our way down the corridor. I entered the small office;the therapist, who had also seen it all gave me a quick rundown. The daughter sat in her chair on one side of the room, her mom the other.

"Half way through our session things got a little crazy," the therapist said. "There was some emotional outbursts, some shouting, and Elizabeth had an anxiety attack."

I approached Elizabeth, tried to rouse her but couldn't.

"Does she have a history of seizures?" I asked.

"No, no medical history but she does take zanex for her nerves," said the lady behind the desk as the girl in the chair looked bored and the lady in the other chair remained unresponsive.

I lifted her eyelids-nothing. I noticed she wasn't breathing, then found no pulse.

"Derek, get the stretcher and the monitor."

"Rescue 1 to fire alarm, send a company to this address, Code 99."

She was in  Pulse less Ventrical Fibrillation. The therapist and daughter looked on as I got her to the floor and started CPR. She remained in V-fib the entire time, three shocks, EPI and Atropine ineffective.

Her daughter rode with us as we raced to the ER.

The woman never came back. Thirty-six years old.

I hope her daughter recovers.

I felt responsible to some degree. Should we have driven faster? Should we have brought the stretcher, and all of the equipment instead of just the bag like I used to do on every call until thousands of similar calls with borderline patients wore me down? Should I call it quits, and let somebody unjaded by decades of non-emergent calls take over?

It's been a while since that call, and dozens more emotional patients since that time. I'm always ready now, but at what cost?

I'll never really know.

 

 

 

15 Comments

  • Melanie says:

    Michael, the same thing kind of happened at Bob's nieces's wedding. Her step father was having a massive heart attack. It felt like forever for the rescue to get there when it was right across the street. Then when they pulled up, the werent moving very fast. I was outside watching them.  I could not stay inside and watch. With our history, it just freaked me out. But anyway, I got kinda mad cuz they probably got a call for an elderly person down in the church. Which was hot, no A/C. They probably have seen this a milion times….but I yelled at them! HE'S STROKING IN THERE!! And when the moved, they moved! Web died 4 days later,but my point is, your not the only one! I think you guys ( and girls) have seen so much. As Dad would say, Keep the faith!
     

  • michael says:

    Hi Mel, I remember you telling me that, got to stay on the old toes! Have a great Columbus day!

  • Erin L. Blackman says:

    In this particular instance, since she was in the office of a person who is considered to be part of the medical industry (even if she is not a medical doctor), she should at least be able to take a pulse and tell whether or not someone is breathing.  I have NO medical training and I know how to take a pulse and tell whether or not someone is breathing.  I would fault the therapist more than anyone else.  You were not properly informed – which is a MAJOR problem when people call 911.  If somebody has a friggin' hangnail at 3 in the morning, they call up hysterical saying that their hand is falling off.  If a 36 year old woman has a heart attack in an therapist's office, that therapist should be trained to administer CPR if they find that the person has no frigging pulse. 
    I do not fault you, Michael.  You are many things and you, by nature of your job, are required to be many things (INCLUDING a therapist!), but nowhere in the firefighter/EMT job description does it require you to be psychic.
    Just sayin'.
    I love you, my friend.  Please don't beat yourself up over this.  We all look back and assess what we could have done differently.  Maybe you could have brought all of your equipment – and if you had, maybe she would have been one of those people just throwing a tantrum.  Who knows?  Fact is, the people who were sitting in front of her when it happened were oblivious to the fact that the poor woman was dead.

    • Michael Morse says:

      Thanks for the commentarry, folks, I wrote this as a reaction to a reaction some people I work with had concerning an emotional patient. I too fall prey to underresponding to these calls, but you truly never know what to expect. We just need to stay ready.

  • Bob Lincoln says:

    Several times got a call for "person ill" or "unknown medical aid" (before they rolled an engine on all unknowns).  Got caught off-guard twice with a code.  First time was my first time doing CPR ever.  81-yr old man, cracked his ribs, they were so fragile.  Didn't make it.
    The other time, I mentioned here before, went to the 6th story of a high-rise with just the bandaid box and stretcher and found a code.  And found that I had left my portable in the charger at the station.  Called by phone for an engine.  He had been dead for at least a few hours, but with the heat up, the body was warm.  Didn't make it.  Don't feel bad – bad dispatch info = less than optimal response.

  • Suz says:

    I agree with Erin. The patient was not surrounded by stoned felons or helpless children.  She was surrounded by educated professionals who, like you, have seen a lot of physical manifestations of extreme anxiety.  At least ONE of them should have had the sense to look a little more closely when she remained unresponsive.  
    People who are "educated" by television may be excused if they think that 911 is a viable substitute for basic first aid.  "Semi" medical professionals, whose employers probably require them to be CPR certified, should know better.  Do you suppose you would have arrived so nonchalontly if the 911 dispatcher had been informed that the patient wasn't breathing and had no pulse?  I think not.  You are NOT the one who dropped the ball.

  • Which is why generally we end up taking in more equipment than we need on "BS" calls. Phone triage is an inexact science at best. If it's even science. More than once we've had units dispatched for a "Minor Illness" only to find a dead patient at the scene. It's not perfect, but any means, but we are only human. Treating every call as if it's a life threatening emergency is going to lead to burn out.
    This sort of thing happens to everyone now and again. Which of course reminds me of an incident from long, long ago. New post to follow soon.

  • Rob says:

    I work in an inpatient facility that has therapists. Most are 100% useless in a medical emergency  or any kind of non normal daily activity (Suprise Fire Drill). We only have BLS level equipment (AED), etc. Even if there was a Psychiatrist in a facility like this which sounds like an Office they would be lucky to have a CPR barrier mask and extremely lucky to have an AED.
    You never know…I still find it pathetic that some of these therapist argue medical things with me. Like Lithium causes Tardive Dyskensia (Wrong!) someone there should of checked breathing status and pulse and called again! You did the best you could… I always believe that if you spot something and do your best to fix the problem them you have done all you can.

  • Billy, NREMT-P says:

    Yeah, you are jaded and should let someone else take over if you can’t spell Xanax, specify that vfib is pulseless and then give atropine for it.

    • PGSilva says:

      Hey, why don't you take the "P" after your name and shove it up your ass.  Was the spelling of the drug uber critical? Was the "pulseless" statement and the drugs adminstered all you took from this?  For a call that (may or may not have) happened and was being used to illustrate the need to not let the the BS get the better of us, you focus on a misspelled drug and a other minutea.  I notice that you didn't focus on the semi-medical professional not noticing an absence of a pulse, you didn't pick up the fact that EMS abuse has diluted the significance of the word "emergency" to the point where it's almost meaningless, you missed the obvious fact that the responders learned from this, etc.  Instead you focus on a misspelling.  Kudos to you! That "NREMT-P" really shines through in the quality of your work, huh?
      Hey, let me just make it even more clear for you: I'll take a Lt. Morse with a "C" after his EMT number to treat me and my family before a person like you with a "P" after their name any day, all day.  Clearly your vision of EMS is much different than ours.  Do yourself a favor, stop reading this blog and go back to telling yourself how superior you are to all of us. 

      • Michael Morse says:

        Thanks,PGS what the heck is the matter with that guy, anyway? She (theoretically) started in V-Fib without a pulse and went asystolic enroute. But that isn’t even the point, thanks for pointing that out, much appreciated.

  • hilinda says:

    A lot of things to say to this. Most have already been said by previous commenters.
    I agree that the therapist should have been more aware, and checked for a pulse when the woman stayed unresponsive. I've seen a few panic attacks in my time, and none of them resulted in an unresponsive person who stayed that way.
    I also agree with the person who said that of all the things you are required to be, Michael, psychic isn't one of them.
    We had a call a while back that was a similar reminder that you just never know what is going to happen. Called out as "general illness" and we arrived to find a guy on the couch who "didn't feel well." Vitals within normal limits, not one of those patients you look at and just know they're in trouble.  Long story short, he stood up to walk to the stretcher and dropped dead on the spot!  And of course, it was the ONE time we had gone in without everything.
    As good a lesson as it was to always be prepared for anything, truthfully, it would not have made a significant difference had he been in the ER when he dropped. Sometimes people just die. It likely wouldn't have made any difference with your patient, either, if you had had every possible piece of equipment with you, or if you had gotten there a little sooner. I think the damage had already been done by the time you got there. Still, I understand your feelings.
    We're in this to "save lives," right? The thing is, the entire chain of events has to go well, and the entire team has to work together, in order for that to happen, especially in a cardiac arrest situation. A lot of the time, the first few links on that chain aren't in place.
    Horrible for the daughter. :-(

  • Michael Morse says:

    Lokking forward to the post, TOTWTYTR, always good things there, strange situations every day, Hilinda, we somehow muddle through!
    Nice save Billy Paramedic, you win the prize, a One Month Subscription to Rescuing Providence, for FREE!!!!

  • Medic2RN says:

    Sounds like PSG needs a little "zanex" him (or her) self.  Take a deep breadth Ladies & Gents.  It's all good.
     
    Be Good,
    Medic2RN

  • patrick says:

    Sometimes, we need that little boot in the ass to keep us on our toes. It's happened to me and that is why I always make sure I have at least AED ( myself and my partner are both EMT's)  and the o2 bag with a BVM at any call

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Michael Morse

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