Author Mike Cyra & Emergency Laughter
Award Winning Essay: I Should Have Let Them Say Goodbye Again
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The London based, "Final Chapters: Writing about the end of life" creative writing competition drew almost 1,400 entries. I was honored to receive one of only 12 'Highly Commended Awards' for this essay.
 
I would like to thank the Dying Matters Coalition and the distinguished panel of Judges. 

I Should Have Let Them Say Goodbye Again

 

Memories of emergency calls are strange. After so many patients and so many years, my mind only picks out bits and pieces of different calls.

It’s like watching a stage play as my mind’s eye fades in and out of scenes. Sometimes memories come as a daydream while I’m sitting at a stoplight, sometimes I’m asleep and they invade my dreams.

My mind picks out a memory and plays it for me. I’m standing in a stranger’s living room, bending over a frail old man. He is a portrait of exhaustion. The Earth pulls at his body and he sits, wilting. Each breath seems grueling.

His face no longer winces from endless pain. His gaze is fixed on the floor, staring at something far away and his eyes reflect tears.

I already know he is a no-code, a DNR, a “do not resuscitate” patient.

The man’s wife and son are gathered around him along with numerous other people but the others are blurred figures without faces that fade into the background.

I’m asking his wife and son questions; How can we help? Did they have plans for him dying at home? Could they show me his living will and the signed “Do Not Resuscitate” document? Is he alert enough to give a verbal consent? Questions that never gets easier to ask.

I see myself kneel down in front of the man and put my hands lightly on his shoulders. He slowly raises his head until our eyes met. He looks so tired.

“Sir, you know you are very sick and I know you’re in pain. We are going to take you to the hospital so they can help you. But Sir, I have to know, if your heart stops or you stop breathing on the way to the hospital, do you want us to do anything Sir? Do you want us to try and start your heart or keep you alive?”

He looked at me with those exhausted seventy-odd year-old eyes, straight into my twenty-year old eyes and slowly shook his head.

In a barely audible voice I heard him say, “No.”  His head sank back down and our foreheads touched.

“Ok Sir, I understand.”  We stayed like that for a moment, both of us looking at the floor, our foreheads touching.

I stood up and looked at the wife and son. Both nodded at me. I asked, “Would you like to spend a few moments with him?”

My partner and I backed off a few feet while the family gathered around him. We didn’t give them much time.

The scene fades to black.

I think as EMT’s our natural reaction is to run for the hospital. I should have thought more of the family, the survivors, rather than trying to rush him off to the hospital. I feel we unfairly snatched him up and out of their lives. If I had been older or had more experience, on the ambulance and in life, I would have done things different.

The lights on the stage of my memory come back up and I’m in the back of the ambulance, the old man on the gurney. The somber beeping of the heart monitor keeps time with his heart.

As we drive away, I’m looking through the four little windows in the rear doors of the ambulance. The gravel road grows behind us and the wife and son get smaller in the distance, but their faces and the way her hands are clutched to her chest stay close, as if they are right outside the windows.

I’ll never forget the look in their eyes. For a split second I almost told my partner to stop the ambulance so they could come in and say good-bye one last time. For the life of me I wish I had.

My gut feeling told me he wasn’t going to make it to the hospital. I knew I was going to watch this man die in front of me.

They disappeared from sight and I put it out of my mind, or so I thought.

There wasn’t much to do now except try and make him comfortable. We were quite a ways from the hospital. I held his hand and squeezed it gently and he squeezed back, but he never looked at me. He looked so tired, so ready for whatever it was that awaited him.

My partner was running code 3, with the emergency lights on but using very little siren. We were rushing, for no other reason but to get him out of our ambulance, so he wouldn’t die in it.

I called ahead to the hospital and talked with the Emergency Room Physician. I told him I had received verbal agreement from the patient and the family that he was to be a DNR. I wanted a doctor to back me up, which he did.

I sat there watching his respirations and holding his hand. I slowly stroked his forehead, maybe like his wife would do, I don’t know.

I felt weird not doing anything. Medics are not trained to just sit. It is a foreign feeling. We are trained to take action. We are aggressive people.

The EKG screen showed a bradycardic normal sinus rhythm one minute; the next there was the irregular beats of arrhythmias and just as quick, the flat line of asystole. His heart had stopped beating.

I leaned over and stared into his almost closed eyes wondering if I would see anything at the moment of death. Nothing. He just stared at me but I knew he didn’t see me. I was a veteran of death, but I’ve always wondered what happens when we die. Is there something else?

I went about the task of confirming that death was here.

I felt for a radial and carotid pulse and there was none. I listened to his heart and lungs with my stethoscope and I heard nothing. I shined my penlight into his pupils and they didn’t respond.

I reached over and pushed a button on the EKG machine and it printed out 12 inches of paper showing a straight even line. I wrote the time on it along with his name.

I sat there for a few minutes just looking at him. I wondered again, what the hell happens when you die? I had just seen the exact moment of death and I didn’t see anything, feel anything or sense anything.

I’m not a very religious person after doing nine years in a catholic school in the late 60’s and early 70’s, but I found myself silently saying a prayer. I made the sign of the cross on his forehead with my thumb and then reached for the phone to call the hospital.

The E.R. Doctor came on the line again and in the language of medicine I told him that Death was riding in my ambulance. The Doctor asked for the time of death and said he’d see us when we got there.

I let my partner continue running code 3 until we were close to the hospital. I caught his eye in the rear view mirror and made a slashing sign across my throat, indicating he should shut off the emergency lights. He turned around in his seat and mouthed, “He’s dead?”

We arrived at the emergency room, took the gurney out and wheeled it through the doors. I didn’t cover him up, as there were quite a few people with children sitting in the waiting area. For all they knew he was sleeping.

We transferred him to an ER gurney, gave our report and left.  I was certain I wouldn’t see his wife and son arrive at the hospital. We had traveled fast. I was glad for that. I didn’t need to see their faces again. I had already seen their eyes through the back windows of the ambulance and that’s the picture my mind plays for me to this day.

Why are regrets such headliners on the stage of our memories?

I wish I had stopped the ambulance. I wish I had opened the doors and just let them say good-bye once more.

The lights fade and the curtain closes.

Email Mike Cyra at: medicalhumor@earthlink dot com   
 
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COPYRIGHT 2011 MIKE CYRA