Codeless

Dennis Fox

September 2002

MERGINET.com (Worldwide Website for Emergency Responders)

"You shouldn't have coded her," my partner for the day instructed me.

Wiping my mouth after my first CPR attempt, I began to learn that on-the-job reality doesn't always follow the formal rules. Twenty years ago, just a couple of months after taking a course to become an emergency medical technician and a week or two into my new job with a private ambulance company, I had a lot to learn.

The three-month EMT course taught me basic skills, but never how to tell if someone is dead. Declaring death, the teachers insisted, wasn't in our job description. Upon discovering a body breathless and pulseless, we had only one legal and moral requirement: Commence cardiopulmonary resuscitation.

So when I stared at the breathless, pulseless old woman lying on her bed, I commenced CPR on what turned out to be the first dead person I ever touched.

My partner rolled his eyes but said nothing as we lifted her onto the stretcher and transported her downstairs and into the ambulance. Only after I compressed her chest and breathed into her mouth for three or four minutes, and after we left her with the doctors who quickly declared her dead, did he tell me I'd screwed up.

Back at base, the guys ribbed me about mouth-to-mouthing a corpse.

Apparently I learned too slowly. After a second pointless by-the-book resuscitation effort, a different partner took me to see a comatose patient in a hospital room. "This is what happens when you code someone who's too far gone," he warned. "You don't want to be responsible."

The jokes continued.

During my four months on the job before returning to graduate school, I coded six people, three of whom I should have left in peace. Only once did even I realize the person on the bed was stiff, cold, colorless. "There's nothing we can do," we euphemized, avoiding the doctor-owned d-word. I was educable, after all.

One attempt remains vivid. A woman, whose husband had apparently overdosed, called 911 late one afternoon in a panic. When we got to the apartment we didn't know how long the 31-year-old man been unresponsive. My partner and I looked at each other and he gave the command: "Let's do it."

As always, the more experienced EMT drove, leaving the new guy -- me -- compressing, breathing, compressing, breathing. The patient's wife cried in the front passenger seat while my partner drove onto the bridge to the downtown hospital. The shrieking siren had no impact on the crawling rush-hour traffic. Even drivers who cared had no place to go.

In the back, I counted compressions, breaths, minutes. I tried not to slip on the man's vomit, the part of CPR they don't show on TV. In 1981, before AIDS depersonalized emergency protocols, mouth-to-mouth still meant lip-to-lip. The man tasted sour, but I breathed and compressed, breathed and compressed.

My partner turned on the loudspeaker, begging. "We have a patient in cardiac arrest! Please move your vehicle!"

The wife reacted instantly: "Cardiac arrest!? Is that a heart attack? Is he dead?"

I performed CPR for 13 and a half minutes, listening to my partner plead, the wife wail. I hoped it would end like those episodes on TV, where fresh young docs would save the day, and afterward this man a year younger than I would thank me, and his wife would stop screaming.

When we finally escaped the bridge and reached the emergency room, those young docs worked on him a long time. And although I was disappointed when they stopped, I felt a sense of accomplishment, with a touch of pride. At least this effort made sense.

Then a matter-of-fact nurse stopped us on our way out, pronouncing words I've resented ever since. "You know" she said, "you shouldn't have brought this one in. He never had a chance."

On the way back to base, I sank exhausted in the passenger seat. My partner, after a moment, said we'd done the right thing -- despite the scolding, despite knowing that every code cost the hospital thousands of dollars. The patient was young, the wife frantic, even the doctors didn't give up right away.

Of course, if he'd been older we too might have said there was nothing we could do. I wondered even then where I would draw the line.

But this time, neither of us regretted the effort. "I'd do it again," I told my partner. By the book, if I had the chance.