Blood Ran Cold

I never want to have that feeling again. That cold rush of fear that runs up and down my spine, instantaneous and unexpected at the utterance of just a few words. Normal one second, the next I am sweating and anxious, shifting my weight from foot to foot and staring intently at the scene ahead.

My patient is dead. He is spread out on the cot, naked and surrounded by nurses and doctors performing CPR, looking over my cardiac strips, pushing drugs, yelling out commands. The scene is organized chaos, but my focus is set upon just one person there, at the head of the stretcher.

Its the doctor saying that my tube is in the esophagus.

The feeling of fear and shame was so intense, so immediate and powerful that I still remember it with utmost clarity today. Surely any paramedic who has been in a similar position can sympathize. I was taken by surprise, having run this cardiac arrest for more than thirty minutes to the best of my ability, exhausted from the effort and glad to turn over care to the emergency department, only to hear this.

The doctor ordered an intubation kit and the nurses scrambled to comply. I caught a few eyebrow-cocked glances from those in the room. An unrecognized esophageal intubation is probably one of the worst things a paramedic could possibly do, and there I was, helpless in front of my jury, waiting for the verdict from a white-coat at my patient's head. My god I didn't know what to do. My blood ran cold and I just stood there, my mouth half open and staring at the scene as it unfolded. What the hell do you mean my tube isn't in??

The doctor put the laryngoscope in the patient's mouth and almost immediately made the claim again. "Yup," he said, "It's in the stomach." I remember the words exactly.

He asked for another tube with an outstretched hand and a nurse quickly complied. With my tube still in it's place, the doctor directed his new tube slowly, deliberately. It bent upward. He tried again, and again. Each time the tube would contort out of place and resist forward motion. He tried moving the blade around, lifting higher and harder. No luck.

I stared at my monitor printout. It listed the end-tidal CO2, which showed readings in the high teens and twenties for the entire trip. I remember listening to the lung sounds and hearing them clearly. Positive in both lungs, negative over the epigastrium. I SAW the tube pass through the cords, and it fogged up with my first few squeezes of the BVM. The patient's stomach remained perfectly flat for thirty minutes of bagging through that tube, and I re-checked the position at least three times on the way into the ER. God dammit, I was sure about that tube.

...But the doctor continued to insist that it wasn't in. He went back with his laryngoscope and dug harder, peering into the mouth from only a few inches away, squinting his eyes and contorting his face. The tube continued to bend on each of his attempts.

A nurse tapped me on the shoulder and I almost jumped. I was so focused on the events at hand, I didn't pay attention to anything else going on in the room. Now it was the doctor getting the half-cocked looks, and the nurse tapping on my shoulder whispered in my ear. "Don't worry about it," she said, "thats a good tube."

It was. It took the doctor a few more tries before he gave up, pronounced the patient dead, and signed my paperwork acknowledging that I had a good tube. He never said a word to me about it and carried on with whatever else he had to do.

Exhausted, relieved, and trembling, I found a quiet corner to write my run form. Its amazing how quickly things can turn around on you with this job.