First Person: "I Am Going to Die"

"Over there on the left, Dick. The young woman on the phone is waving at us," I said. We pulled the ambulance up to the curb, climbed out and gathered our equipment.

"It's my mother," said the daughter, who in her early 20s, spoke in a scared voice. "She has cancer and is in bad pain."

My partner, Dick, and I were responding to a call for a female with right flank pain who lived in one of the sketchier sections of the city. Like every other town and city in New England, this one had populations of lower social and economic standing. Many good hard working people in low paying jobs were doing their best to provide for their families, in addition to some who knew how to work the system. Entering the apartment I couldn't help but think that in this neighborhood I had a good chance of dealing with a drug seeker.

I was wrong.

Lying on the couch in a fetal position was a 40-year-old female with tears running down her cheeks, moaning then screaming as the pain hit her in waves. Small, thin and still in her pajamas, she had mousy uncombed brown hair, pale skin and large brown eyes, pleading and showing pain. Her voice, a weak whisper said, "Help me, the pain." My patient had spoken, and my thoughts of this being a drug seeker went out the window. No one could fake it this well: This was the real deal.

Dick and I moved quickly. Dick set up equipment and took vital signs. I set up for an IV and blood draw, preparing to medicate. All the while I explained to my patient, Robyn, what we were doing and going to do, and what I wanted to give her for her pain.

As I was doing this, Robyn's daughter kept yapping in my ear, "What are you doing? She's in pain. Help her."

Hoping I could sidetrack her a little, I asked about Robyn's past medical history and her current medications.

"She has cancer. I called her doctor this morning and told him she's been throwing up and in pain since last night. She hasn't had any of her pain medications since last night. You do not need to know anything else except that she needs to go to the hospital. That's where he wants her."

"Jesus, what a little snot," I thought as Dick and I worked as fast as we could.

"Mikey," he said, "B/P is 96/58; heart rate 126; O₂ sat 98%; temperature 101.9. Do you want to draw blood cultures and do a lactate reading?" Dick was helping to move things along.

"Yes Dick. That sounds like a plan," I said. What is going on? Where did that fever come from? Has this metastasized? Turning to Robyn I asked, "What can you tell me about this?"

In gasping breaths she told us, "I had--myelin sheath carcinoma--two years ago. Had radiation treatment--okay after that. Last check up--saw something on my lungs--biopsy last month. Lung cancer--started chemo this week. Cannot cure me--make me comfortable--I'm going to die. I'm okay with that."

Like being hit in the gut, my feelings started to explode within me. Cancer has wrecked havoc on my family--Dad, colon rectal cancer; Aunt Mae, brain cancer; Uncle Bill, pancreatic cancer; Uncle Ben, we never knew which kind except it was cancer; my brother, Tim, bladder cancer; and my best friend, Vinnie, lung cancer. Thoughts of fear, despair, hatred of the human waste this disease causes and the suffering for both the family and patient raced through my mind. I wanted to sit there and cry along with Robyn for all the losses past, present and future. Will this disease never end?

Robyn read my mind as everything flashed through it and showed on my face. In her pained, halting voice she said, "It's okay, I'm comfortable with it. Please, help me now with the pain."

"The IV is in," I told her. "I'm running some fluid and giving you morphine for the pain and Zofran for your nausea. Dick, let's get moving."

"Okay Mike," he said. "Her blood sugar is 126 and the lactate is 1.7. The stretcher is right outside the door."

Her numbers were good. Sugar was on the high side of normal range and no sepsis, yet.

The daughter was still yapping, like one of those little ankle-biting dogs, as Dick and I helped Robyn to the stretcher, but I ignored her.

We transported to the hospital in the next city where Robyn's oncologist was located. During transport I monitored her vital signs. They remained stable. Throughout the ride, she felt every bump in the road, moaning in pain.

When she could, we talked about her disease, the recent biopsy and her pain in the same area as the incision site. Could it be an infection? We talked about her prognosis and the fever she awoke with that morning. Her skin was so sensitive her clothing irritated her where it touched, and now she had a headache.

I re-medicated her with morphine, 5 milligrams each time. The first dose didn't touch the pain. Holding her hand, I provided what comfort I could. Every time the pain came, she would squeeze. She had a strong grip that surprised me. At other times the pain would be so intense her eyes bugged out and she couldn't breathe. That was when I could see the fear in her face, from not being able to catch her breath, maybe death. Then the pain would let up and she would breathe again.

I remedicated twice more during the transport to the hospital--20 milligrams of morphine, enough to put most people out for a long sleep. It didn't even start to relieve her pain. As we passed through the ER, the usual noise that accompanies a busy ER subsided. The on-duty physician looked up. Evidently the cry of Robyn's pain caught his attention, along with everyone else's.

He followed us into her room. "What have you got?" he asked. I gave him a quick re-cap of our call and Robyn's medical history.

"She's got to be in the computer. I'll look her up," he said. I followed him out the door to the desk. He pulled up her information on the computer. Halfway through the first paragraph his body position changed slightly. Escaping through his lips in a low whisper he said, "Oh my." Looking over his shoulder there it was "incurable, make comfortable, going to die, patient aware and comfortable with the outcome." We looked at each other, knowing what the other was thinking. She is going to die.

I went back to Robyn's room to say goodbye. She saw my face. I was having a hard time containing my emotions and the demons I battle, and she was reading every emotion. She took my hand and in her halting pain-racked voice said, "Thank you for helping me. It's okay. I'm going to die and I'm comfortable with it."

I left thinking I would never see her again. She is going to die.

Some days this job really sucks. But, I love that I get to do it.

Mike Kennard has been in EMS for 33 years. He currently works as a paramedic at Frisbie Memorial Hospital in Rochester, NH, and is a program coordinator for the State of NH Bureau of EMS. Married with two daughters and five grandchildren, Mike is a retired assistant chief from the Nottingham (NH) Fire and Rescue Department. Contact Mike at grumpy1medic@gmail.com.