A Heritage County Tale
"So what's this one for?" Sydney Redding, the EMT or emergency medical technician, of Medic 8 asked her partner. She was driving the blue and white ambulance at sixty miles per hour through the moderate mid-afternoon suburban traffic, the red lights flashing, the siren blaring.
"Unresponsive person," replied Jim Hartman, the paramedic assigned to the rig, as he read the text from their dash mounted computer terminal. The "Mobile Communication Terminal" or MCT as it was called was state of the art equipment for Western Life Support, the great empire that they worked for, which was to say that it was a product of early 1980's technology. The screen was four inches across and was capable of displaying nothing but monochrome text. The memory was a staggering 32 kilobytes. "Caller states that an 84 year old man is down and does not appear to be breathing."
"Does not appear to be breathing?" Sydney asked with a groan. "Great. Another CPR. We had one last week goddammit, I thought we were good for the month." The reason for her annoyance was that, as the EMT of the unit, she would have to be the one to clean up the mess after the call was over; and running a CPR made a huge mess of both the ambulance and their equipment bags.
"It might not be a CPR," Jim said with a shrug. "Maybe he's been down for awhile. I'll pronounce him dead, we'll call the coroner, and let the firemen babysit him until the little white van shows up. Be optimistic."
"There's no such thing as optimism in my philosophy," she replied, changing the pitch on the siren and blaring the air horn a few times to get a woman in a SUV out of their way.
They traveled on, Sydney piloting the converted Ford van through intersections, around stalled traffic, and occasionally on the wrong side of the street. When the call came in they had been posted in the suburb of Springwood, about ten miles from the city of Heritage, that bustling Sacramento Valley railroad and farming city that was the seat of Heritage County. Springwood was where most of the elderly people of the metropolitan area resided. It was full of old, established neighborhoods, senior apartment complexes, and convalescent facilities. Many a medical aid call had been dispatched within Springwood's unincorporated borders.
Morning Glory Court, the scene of the unresponsive man call, was a small cul-de-sac tucked deep in a residential neighborhood along the Heritage River. The houses on the court were large and solidly constructed wood frames, all about forty years old, most with immaculately maintained lawns. 123 Morning Glory was at the far end of the court and was one of the larger houses. A Cadillac El Dorado, the standard mode of transportation for the well to do of Springwood, sat in the driveway. A red fire engine belonging to the Heritage County Fire Department was parking in front of the house just as Sydney entered the court, it's own red lights flashing authoritatively. In Heritage County, like in most jurisdictions, a fire crew was sent to the scene of each medical aid call to act as first responders and to assist the ambulance crew. Medical aid calls in fact constituted 8 out of every 10 alarms that firefighters responded to.
"They were a little slow getting here," Jim commented as Sydney parked the rig behind them. Usually, during the day shift anyway, the fire engine arrived a few minutes before the ambulance since there were about four times as many fire stations as there were medic units.
"There was probably a good movie on cable TV back at the station," she replied, unsnapping her seatbelt and stepping out. "You can't rush those guys you know."
Jim stepped out his own door and met her at the back doors. They pulled out their gurney. Strapped to it were a cardiac monitor, a portable oxygen tank, and a large blue bag that contained just about anything that they could conceivably need inside of a house. They wheeled over the sidewalk and up the driveway, following the fire crew to the front door.
The three man fire crew were all wearing their standard uniform for medical aid calls: black uniform pants and dark blue T-shirts with HERITAGE COUNTY FIRE stenciled on the back. The captain of the crew carried a metal clipboard in his hands while the firefighter and the engineer carried their own basic life support equipment bags.
"Hey guys," the captain greeted cordially as he walked up the small flight of porch steps. "You get the update on the call?"
"About the person not appearing to be breathing?" Jim asked. "Yeah, we got it."
"I hope it's not a freakin CPR," the engineer grunted. "It's too hot to be doing that shit today."
"Yeah," the firefighter told Jim. "Call him if you can. Remember, dead is good. We all hafta go sometime."
"I'll do what I can," Jim promised. He was not in the mood to run a CPR today either.
The hope that they would be able to pronounce the victim and go about their business faded as soon as the door was opened. A woman ripped it open at their knock, her eyes full of tears, her face showing extreme anguish. She was about forty years old or so Jim estimated, and not a terribly bad looking forty either. Her attire immediately attracted everyone's attention, including Sydney's. She was wearing a pair of tight blue jean shorts that were cut about as high as shorts could be cut without being considered obscene. Her long legs were attractive and toned. A white t-shirt covered her upper body and bulged outward with an impressive set of store-bought mammaries. The jiggle as she moved betrayed the lack of a bra confining them. Her face was streaked with running mascara.
"He's not breathing," she sobbed at them. "Please, get in here before he dies!"
They pushed their way into the large formal living room, which was filled with antique furniture on a polished hardwood floor. Lying next to a beautifully restored 18th century rocker was an elderly man, sprawled out on his back. He was shirtless, his lower body covered in a pair of tan slacks. His mouth was open, as were his eyes. Jim looked for rise and fall of the chest and saw nothing. The man was indeed not breathing.
"What happened?" Jim asked the woman, whom he assumed was the man's daughter, as he unstrapped the cardiac monitor from the gurney.
"He just... collapsed," she cried. "He was fine one minute and then... and then..." she couldn't finish.
"It's all right," the captain told her comfortingly, putting his arm around her and surreptitiously catching a small feel of her right breast.
Jim set the monitor down next to the man and then kneeled at his head. "How long ago did this happen?" he asked the woman.
She seemed a little hesitant to answer for a moment and when she did, she was somewhat vague. "Just a few minutes."
"How many minutes?" Jim asked her. "It took us four to get here. How long before we called did he go down?"
"Go down?" she asked, jerking in the captain's arms a little. "What do you mean by that?"
"I mean how long before you called did he collapse?" he rephrased.
"Oh," she said, shaking her head a little. "It was just a minute or so. No more than five."
"I see," Jim said, starting to sense that something strange was going on here. He dismissed the feeling as irrelevant and felt at the man's neck for a pulse. There was none. "Let's start CPR," he told the fire crew. "Sydney, get the airway bag out and start setting me up for intubation."
"Right," Sydney said, grabbing their large red bag from the gurney, a resigned look on her face as she contemplated her future clean up.
While she unzipped it and started pulling supplies out, the firefighter opened their own bag and pulled out a bag-valve setup, which he quickly assembled and began using to force air down the man's throat. The engineer kneeled down on the floor, found a landmark on the man's chest, and began compressions. He winced as the first one fractured several ribs at the sternum, a common consequence of CPR.
While they were doing this, Jim hooked electrodes up to the man's chest and turned on the monitor. It went through a series of self-checks and finally, after about twenty seconds, graced him with a display. The green line that made up the tracing was jerking up and down in rhythm with the engineer's chest compressions.
"Hold CPR for a sec," Jim said.
The engineer stopped and Jim continued to stare at the reading. It was what was known as an agonal rhythm, the sign of a massive blow out in the heart. Every five or six second there would be just enough electrical activity in the ventricles to make a spike on the display. There was no actual heartbeat to go along with the spikes. It was just one small step above being completely flatline.
"Resume CPR," Jim said, his voice monotone, his face expressionless, his mind already knowing that his efforts were going to be futile. But, he had to try anyway. "Sid, you got my airway stuff ready?"
She did. She handed over a laryngoscope, an endotracheal tube, a roll of tape, and a 10cc syringe. "Here you go," she said. "I'll start getting an IV ready."
"Thanks," he told her, taking the supplies and setting them down next to the man's head. He looked up at the woman again. "What kind of medical problems does your father have?" he asked.
"He's not my father," she said, wiping her eyes and watching everything they were doing intently. "He's my neighbor."
"Oh... sorry," Jim said. "Anyway, does he have any medical problems?"
She said that as far as she knew he had none.
"Well what was he doing when he collapsed?" Jim asked next. "Was he just sitting here or was doing some sort of exertion?"
.... There is more of this story ...