The following events are not fictional, but they may have happened at different times, with different patients, at different places. Each one of the authors has had patients just like these, in situations just like those described. If you want to know what it’s like to live a day in the life of an ambulance driver, or a small town cop, or a small town ER nurse, join us for the story.
It’s the same story. On the same day. With the same people.
This is what we do, and working with paramedics and cops like these is part of the reason we do it. What follows is part 3 of the story. Start with Lawdog, the cop, for part 1. Then follow along with Ambulance Driver for part 2 as he picks it up and carries it before handing it – and the patient – off to me.
Then come back here for the conclusion. I’ll still be here.
Murphy’s Law Corollary Number Something-or-other: No Good Deed Goes Unpunished.
Right up under that is a little section of the code that’s very well-known throughout the entire working world: If You Come In On Your Day Off, All Hell Will Break Loose.
But there’s another old adage: Time Is Money. So here I am for some overtime. AD’s working anyhow, so I might as well make a little extra Christmas money. The way I look at it, the day will be done in 12 hours regardless but I’ll be glad I did it come payday.
Wolfing down the last crumb of my biscuit from Vern’s, I clock in for the 11a-11p shift, throw my backpack up under the desk, and stand up straight for a quick stretch before turning to the day nurse, who appears to be catching up her documentation on a chart.
“So what we got?”
“Shhh.” She winks at me.
I grin as I look around at the empty rooms. To my surprise, Moonlighting Paramedic walks out of an exam room that he has just cleaned from the last patient.
Whoa. Three people on? Sweet! But what did they call me in for?
MP tosses the bagged-up trash into the bin. “Ambulance is out, though. Hopefully it’s nothing.”
“Yeah, I know. They’ve gone out to Ms. Schenk’s house,” I tell them as I wash my hands and begin to double-check the crash cart and room supplies.
Day Nurse picks her head up from her chart. “Miss Helen? What’s wrong with her?”
“That, I dunno.”
Picking up the phone, I call Medical Records to request Ms. Schenk’s old chart. A floor nurse and the unit clerk tag along as she brings down a very thin folder containing nothing more than some old bloodwork and a couple of x-ray reports.
“What’s wrong with Miss Helen?” They’re all concerned, and rightfully so. As her old file attests, she’s not what we would call a frequent flyer. She’s notoriously stoic and stubbornly independent. If she’s had an ambulance called out to her, something is seriously wrong.
Bodie calls in on the radio. MP answers it, motioning for paper to write down the report as we gather around to listen. Shocky, paced, grey, morphine. Shit. 72 years old and from the sound of it, she’s had a massive heart attack. Shit. Not today. Not Miss Helen. Not on my shift. Damn.
Mrs. Shenk, or “Miss Helen” as everybody around the hospital knew her, was a beloved Pink Lady for years after her husband died until she got to be too frail to keep up the pace anymore. Most Pink Ladies were just bored, rich, “proper” blue-haired ladies doing the volunteer thing because it was expected. They avoided the ER, commonly known as the Bargain Basement, because it was too…dirty. Noisy. Hectic. There’s blood there, and people often aren’t bathed and are cussing up a storm. It’s not as “polite” as the little 15-bed inpatient floor and so it just wasn’t a place for “polite company” to be. They always smiled sweetly, but you could always pick up a smidgen of condescension in their smiles and the saccharine dripped from their voices.
But Miss Helen was different. Rich, definitely, and proper, I suppose, but if you got her riled…she could be, let’s just say, very opinionated and very vocal in her opinions, caring not what anyone thought about her language.
I like ‘em spunky, because I’m spunky myself. Every day, Miss Helen would come back to the ER just to say “hey” with a genuine smile and wish everyone a wonderful day, often sticking around to chat if patient census was low. If we needed something for a patient, she’d run to the floor or to the kitchen to get it and bring it back. If we needed dinner ourselves and were too busy to get it, she’d retrieve it from the kitchen or even make the dinner runs to town for us.
Being something of a saucy little lady herself, I think she liked the action and unpredictability of the ER and she definitely took a liking to the brusqueness of the ER staff. She got the chance to be irreverent, bringing out a side of herself here that she couldn’t show to most of the rest of the world. And she knew that what she said in the ER, stayed in the ER. Out there in the world, around the community and especially around the menfolk, she had to be proper and keep up appearances. In here she could let loose in the safety and confidentiality of the nurses’ lounge. A special relationship developed between her and the ER staff.
That relationship was cemented with the icing on her cinnamon rolls.
At least once a week she brought in these huge, moist, to-die-for homemade cinnamon rolls and danishes, still warm from the oven. Cream cheese, blueberry, raspberry, and “regular”. She took great pride in those rolls and we took great joy in them. I can probably attribute a good 10 lbs on my frame to those things. Licking the last bit of glaze from my fingers I’d tell her, “I don’t know why I bother eating these things. I should just apply them directly to my ass.”
She’d always laugh and wink at me.“Well, darlin’, they probably wouldn’t taste nearly as good to your ass as they do to your tongue. If you’re gonna tote ‘em, might as well enjoy ‘em.”
Got a point there. She knew she had a good thing going with her pastries. Should have marketed them – she’d have made a killing. Instead, I suspect she’d been using them as enticement to extend the company of those strapping young lads who came to her door at the whim of her – ah, Ghosts. Heh. She always did like excitement and she could play “Damsel in Distress” with the best of ‘em.
As if on cue, a family of four and a couple of other people arrive to triage and one appears to be vomiting. Day Nurse volunteers to start triaging while MP calls Country Doc to Come On Down! and I ready the room stretcher before running to the Little Girl’s Room while I have the chance. Day Nurse brings a couple of patients back to the other exam rooms, getting them situated.
I emerge just in time to hear “Code Blue, ER” being called out over the PA system.
Country Doc squeezes into the room with me behind the medics as the x-ray tech rolls down with the portable machine and RT follows right behind. Country Doc has been around awhile and has partaken of the legendary cinnamon buns, and he now stands beside the empty ER stretcher, awaiting her and looking on gently. Floor Nurse, the Medical Records clerk, and the floor Unit Clerk are looking on in horror, following the crowd as AD continues compressions with the stretcher on the move and he slams out an updated report as we quickly and in one motion move her over to the ER stretcher. RT and the registration clerk enter as I get the monitor leads switched over from the truck’s to ours and MP takes over compressions.
“We’ve got it from here, boys”, Country Doc drawled in the direction of the medics, and he said something else to them but I wasn’t listening. He closed the door and returned to Miss Helen’s side.
“Back off the compressions a second. Let’s see what we have.” MP stops, hands hovering just over Miss Helen’s chest. We look at the monitor: V-fib. Day Nurse starts writing on the Code Record as I deliver 360 joules, and Miss Helen’s body rises and falls in response to the electrical current. Ohhh, no, Miss Helen. You don’t get out of baking those rolls that easy, little lady. You owe us a batch now. A BIG one.
Did I say that out loud? Surely not. But maybe she heard me, because all at once she had little blips on the monitor. The pacer? Nooo…that was removed in the transition and with all the compressions going on.
I think I hear a little something amongst the hiss of the oxygen. RT frowns quizzically and raises the mask just a little.
“Quit…beating… me,” she barely croaks out. “What… I…do to you?”
Surely AD and Bodie heard the whoops coming out of that room with that. The whole town could have heard that. Country Doc just smiles. “Let’s get another line, hang some Lidocaine and let’s get her TNKase’d.”
Day Nurse steps out to check on the other patients in the ER, leaving the door open. I see that AD and Bodie have left already, but in walks Old Family Doc, who has been looking after Miss Helen for close to 30 years.
“She’s too spunky to let this beat her,” Old Family Doc says as he looks her over and listens to her chest.
“Old Perv…always…did…like…my…chest…” came from underneath the mask.
He pulled back and laughed. “She’ll be fine,” he said. “I’ll call Dr. GoodHeart and see if he can take her on over at Big City Hospital.”
God Bless Old Family Doc. They just don’t make ‘em like that anymore.
MP and Country Doc step out to check on the other patients for a minute while I pull up a stool and sit down by Miss Helen to start another line, still keeping a close eye on her and the monitor. She’s got a rhythm but it still ain’t pretty. Looks like some sort of heart block, maybe second degree. Still kinda grey there. Blood pressure’s up to 90/50, which ain’t too bad for a lady her size. I’d feel better if it were 120/80, though.
“Miss Helen, you gave us a pretty good scare there. I hate to do this, but I’m gonna have to put another needle in your arm so it’ll be a little horsefly bite but just for a second, okay?”
“Do what you have to do, Honey.”
She didn’t flinch as I pushed the needle in and flushed it, hooking up the little port for IV access later. Odds are she’ll have a central line placed after she gets to the ICU, but this will work for now.
“Miss Helen, I’m going to put some medicine into your IV that will break up any clots that might be getting in the way of the blood flow to your heart, okay?”
“You got any bleeding problems or had any surgery recently?”
“No, hun. This is the good stuff, isn’t it?” She’s seen this before.
“Yes, Ma’am, this is the good stuff.”
MP and Country Doc are peeking in and out as I ready the TNK to give her. Country Doc rolls in to watch her and the monitor as I push the dose into her IV.
“It was pretty,” she said.
“Heaven. It was pretty. Blue sky, peaceful…”
I raised my brow at that and watched the monitor, hoping to see something different there. Hearts throw some funky rhythms, pretty scary ones, when they re-perfuse. Right now, I’d give anything for something a little prettier than what we have right now. It’s too slow.
Come on, Miss Helen. Perk on up, now. Anytime now would be fine.
MP peeks his head in. “We got in touch with her daughter, but it’ll be a couple of hours before she can make it here. Old Family Doc made the transfer arrangements to go to Big City Hospital. I just called dispatch for transport. Hand me her chart and I’ll get it copied for you.”
Country Doc moseys back in and peers at the monitor, frowning. “What’s her pressure?” he wants to know.
“Her hands are cold, too,” he muses. “Tell ya’ what – hold off on the Lidocaine. Let’s try a fluid bolus and start a dopamine drip before the ambulance gets here.”
I break open the crash cart for the pre-mixed dopamine and set it up. It seems odd somehow that we’ve coded Miss Helen and haven’t even had to break the seal on the crash cart, until now. I look at my watch.
Not even thirty minutes since LawDog, AD and Bodie brought her in here. It seems like hours.
I have to look up the dopamine drip rate, but I get it hung in short order. AD can figure the dose in his head, and he’s taught me the shortcut, but it never sticks. I’ve worked too many night shifts and overtime for the past twenty years. The hard drive is full, and new stuff keeps getting deleted. Even the shortcuts.
“Well. That was interesting,” came from under the mask. I look up at the monitor and see a short run of v-tach march across the screen.
You cannot faze this woman.
“It’ll be over in a sec, Miss Helen,” I reassure her. “It’s a sign that the clot’s breaking up.”
At least, I hope it’s reperfusion arrhythmia.
Miss Helen reaches for her mask. RT, still standing behind her head, starts to pull her hand away but I shake my head at him and he pulls away. She raises up the mask and speaks, still weak but starting to gain some strength.
“You know the song, ‘In the Garden?’”
I smile. “Yes, Ma’am, I sure do.”
She takes my hand with hers. “Will you sing it for me?”
A quick glance at the monitor, her color, and her eyes tells me that it’s fine to take a minute to sing this old hymn for her. I’ve got the dopamine going, fluids running wide open, and she’s had her TNK. All we’re waiting on is her ride and I’m not about to leave her side right now anyway. Choking back my own shyness about singing in front of anybody, I slowly and quietly begin:
“I come to the garden alone…while the dew is still on the roses…”
Weakly, she begins to join in. A small town nurse and her patient who not even an hour ago was being kicked back from the Pearly Gates, singing:
“And the voice I hear…falling on my ear…The Son… of God… disclo-o-ses….”
Miss Helen’s eyes are gleaming. I smile at her and continue with her:
“Aaand..He…walks with me, and He talks with me….And He tells me I am his own…And the joy we share… as we tarry there…None other…has ever…known…”
RT looks up as her voice fades, and the monitor screeches its alarms. Her rhythm is unbroken v-tach now, and Miss Helen’s eyes are closed. She’s not breathing.
I turn around and see AD and Bodie standing there with their empty stretcher, ready to load Miss Helen up for transfer. They seem…pensive. Resigned.
“Call the Code again,” I tell Bodie sadly as AD starts compressions. “Get everyone back in here,” I called to his back as I charged the defibrillator paddles…
We worked her, Lord knows we did. We tried everything we could think of. Country Doc pulled out all the stops. AD threw in a suggestion or three. None of it brought her back. There comes a time when enough is enough, and you just have to let go. Miss Helen wasn’t there any more, and all we were doing was beating her up. Finally, Country Doc called it and we pulled a sheet over her chest before stepping away and taking in the sight of this once-spry spirit now lying there, lifeless.
I’ve seen a lot of different looks in the eyes and on the faces of the dead. Many held stark fear. Many were dark. And quite a few were like Miss Helen’s: they held peace. It was impossible to miss. I smiled tearfully at her and wished her well in her new life before taping her eyelids closed.
She was at peace.
Her daughter, Abigail, got there not twenty minutes later. Of course she was heartbroken. Providing some tissue and a shoulder, I pulled a chair to the bedside and brought Abigail in to say goodbye.
Meanwhile, I went on with my work. They don’t let you be a human being, not and still do everything a nurse has to do. The ER backed up while we were working the code, more patients signed in to triage, and I still had yet to call the funeral home, call Big City Memorial and cancel the transfer, and call the organ procurement folks. Work to be done now. Feeling comes later.
Miss Helen’s funeral was held the following Sunday afternoon. The entire Schenk clan had come home to Bugscuffle for the weekend and the whole county turned out for the service. The ER called in temp staff to help cover for the full time nurses who wanted to attend. Lawdog, all decked out with his bolo tie and church gun, served as one of the pallbearers. The procession was at least a mile long.
After the service, Abigail approached me and wanted to say “thank you” for that afternoon in the ER. I had let myself forget about it, but she hadn’t. She had planned to come visit that day, she said, but she had to postpone at the last minute and so was feeling the guilt for not having been there for her mother’s last moments. She needed to hear something – anything - about that day. So I shared the stuff that was uniquely Miss Helen. The way it all started with the ghost call and Lawdog’s having to convince her to come to the ER. The remark about having seen Heaven. The comment to her doctor. The hymn. The peace in her eyes. Abigail listened intently before breathing a long, deep sigh…and then she smiled her mother’s smile before hugging me tightly.
At home today, I heard a horn outside. I went outside to investigate, wondering if I had just maybe bumped the “panic” button on my car and then bumped it again, as it was a single horn blow.
As I stepped outside, she was approaching the back door with a foil-wrapped tray in her hands. Even through the screen door, I could smell the cinnamon.
“I am just so grateful that Mama didn’t die alone,” she smiled. “She was with people she knew. That was her favorite hymn, you know.”
At a loss for any words, I just smiled.
She looked down at the tray and fumbled for words. “I, I brought these for you, from Mama’s recipe..I never could match hers, though…but…” She looked up at me and sighed. ”I just wanted to bring you something to tell you how much I appreciate the fact that she didn’t die alone.”
Humbled by the gesture, I accepted them and her hug. It was then that I realized one very important thing:
This is why I call this place home.