The paradoxical life of a palliative care nurse practitioner who’s an EMT

I am a nurse practitioner committed to expert level end of life care. I a consultant for hospice and palliative care organizations, a clinical educator and a volunteer in my town on the local emergency medical service. My life is paradoxical.

It’s not a happy partnership having a palliative mind and responding to 911 emergency calls to save lives.

It’s not even comfortable being an NP and wearing an EMT hat, you can’t check your clinical mind at the door. I struggle with the discomfort that emergency medicine brings for the patient:  an endotracheal tube against your will; getting tied down because you are flailing too much; an uncaring medic who doesn’t get a detailed history because your suicide attempt seems to be a waste of his time; a medic with crazed eyes because he loves the drama and chaos of emergencies. This isn’t the vision of being in service to my community that I had in mind and the kind of end of life care we provide during emergencies isn’t what I wanted either. Come to think of it, I hadn’t thought about it too much until the day of my biggest challenge.

I recently went on a call with my fellow EMT early one Sunday morning, a nursing student at a local college, who has been a stellar member of the ambulance service since she was a teenager. Quiet, resolute, reliable. Our call was nothing special, just someone who was a little dehydrated who wanted her blood pressure checked and needed a pep talk about rest and fluids. On our return to the ambulance building we stopped at the crossroads nearby. There seemed to be a bag in the driveway.

“What is that?” I said.

“Did something fall out of your car?”

As we turned the corner, it became obvious it was a person and we both knew immediately who it was.

Like a well oiled machine, we pulled up close by, hopped out calling for help over the radio.

“Get the medics here!”

My partner grabbed the stretcher, the AED and emergency bag. It runs like a movie in my head. He can’t be breathing with his head stuck in the snow like that, I am thinking as I approach. It is our fellow EMT Johnny (not his real name) who was also responding to the call but missed the ambulance.

“He’s dead,” I hear myself say, not even believing it myself. How can he be dead? He’s younger than me? He was thirty seven years old.

I don’t know how I managed to turn this four hundred and thirty pound man over all by myself.  Yes, he was that heavy. There’s a lot to be said for adrenaline and what you can do under its influence. He’s blue. Not breathing. No pulse. What happened, is screaming in my head! Are you serious? Is this really happening right now? CPR starts. I watch myself do it. That’s a weird feeling. What’s that scar? It’s the heart surgery he had as a kid. One and two and three and four. Get an airway in. Bring the oxygen. Are the medics on the way? Good. Who else is coming? Five and six and seven and eight. Where’s the AED? Oh good the cops are here? What next? Nine and ten and eleven. Get the ambu bag and start bagging. His color is changing. That’s a good sign.

Please come back, Johnny, we are here for you. I have to do this right. AED pads on, all clear. The analyzing takes an eternity. Shock advised. Excellent! Means there’s some beat of some sort. Shock given. What now? Continue CPR. Twelve and thirteen and fourteen and fifteen. Let’s get him on the stretcher and get to the hospital. Where are the medics? Tell them to step on it. Sixteen and seventeen, eighteen. Lift! Come on. We can do it. The same adrenaline picks him up and puts him on a stretcher with one other EMT and two police officers. Phew! Made it to the stretcher. CPR continues, into the rig. More help arrives. I’m still incredulous. I notice that I’m really short of breath. My lungs are burning. I have to do this right. Keep pumping. Don’t stop. Billy, another EMT who happened to be listening to his EMS radio arrives and takes over compressions and we begin our trip to the hospital. The medics meet us on the way. Johnny’s father in law, an EMT on our service, comes to help and is duly ejected from the ambulance. It’s too personal to stay. Ok, follow behind.

ET tube next. Keep pumping. Billy looks purple and blue too. He has a pained look on his face, mouth breathing. Are you ok Billy? Shall I take over again? I don’t want you to be suffering too. Interosseous catheter drilled into the right shin. I’ve never seen one of those before. That must hurt. Hope they don’t do that to me when my time comes. Better put that on my advance directive. Medications administered. More compressions, I’ve lost count now. Pushing as hard as I can. I don’t know if they are good enough. He’s a big man. Please come back. Flat line. No response. My sweat is dripping on him now. Not so lady like.

Keep pumping. ET tube is in the stomach. Where’s the suction? Right here. Got it. The medic says, “You’re doing great!, Keep pumping.” I needed that. Not so great if he doesn’t come back. ET tube is placed correctly and confirmed.

I think about Johnny and how young he is. That could have been me. I’m sixty pounds overweight and only a few years older. Granted, I don’t have a cardiac history or a problem that I know of. I shouldn’t be overweight, and it’s my fault that I am.  I should know better. I wonder about the damage I’m doing to my heart, just by using food to cope with stress. I have got to change that. I hate to learn the lesson this way. I bet Johnny had no idea that he was going to die. He never would have chosen this if he had known.

At the hospital, they tried to resuscitate for a while, to no avail. The family arrive. I feel their pain. I feel my pain and thoughts of failure. Still can’t believe what we just went through. I offer comfort and want to take their distress away. Although the distress is high, this feels more comfortable for me to do.

I can deal with anything. That’s what I learned. I need to live a better life though. No lesson lost on me. The diet has begun. Walking and yoga with my EMT family. Fond memories and good discussions about our fallen family member. Much support from our community. Would I do it again? Absolutely, in a heartbeat … as they say.

Niamh van Meines is a nurse practitioner who blogs at Hospice Navigator.

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