Stories from the Streets: Pulseless
The kid was alive when Engine 3 arrived but died a few minutes later. The radio transmission was cold, lifeless and heartbreaking.
“Engine 3 to Fire Alarm, 11-year-old male, code 99.”
“Rescue 1, received.”
I put the mike down and put on the gloves. My new partner, Adam, picked up the pace, instinctively knowing this was the real thing. We arrived on scene 30 seconds later and entered the home. Two firefighters knelt on the floor, one doing compressions, the other bagging the lifeless body of an 11-year-old kid.
“He was breathing when we got here, then he stopped and went pulseless,” said the officer of Engine Co. 3 as his crew performed the mechanical movements that kept the blood flowing. If the little guy was breathing a minute ago, and CPR started right after a witnessed arrest…I let myself believe. Years of unsuccessful resuscitation efforts that ended the same way they started—a pulseless patient—had taken their toll on my optimism. Some made it a few days, some a few weeks, one even walked out of the hospital and sent us a letter. Most did not. I was beginning to take it personally.
We put him on a backboard, continued CPR, picked up our equipment and the patient and carried him out of his home and into the rescue. The boy’s mother sat in the front, peering back as we worked. The monitor showed asystole, no shock advised. Joe worked like a madman trying to find a vein while Donna and Adam continued CPR.
“Does he have any medical problems?” I asked his mother, trying to keep my voice steady.
“A neurological disorder that causes seizures. He was at the doctor’s today for trouble breathing.”
She sounded calm; I think she was in shock. Joe found a good vein and sank the IV.
“Go,” I said to the firefighter who was now driving Rescue 1. He sped toward Hasbro Children’s Hospital while we continued to work. One round of epi, still pulseless. We tried an atropine; nothing. I attempted to tube him, the potholes made it difficult; I failed, then picked up the phone.
“Rescue 1 to Hasbro. I have an asystolic 11-year-old male, CPR in progress, IV established, ETA two minutes.”
The doctor on the other end of the phone asked a few questions. I gave the best answers I could, then hung up the phone. Another round of epi was ineffective; we brought him into the ER and transferred care to the medical team that had gathered. I gave the story and stood back, watching them work. Watching the team do their thing on a patient I no longer was responsible for was far different than working on him.
Before becoming a Providence firefighter, I wondered how I would handle death and trauma, and honestly didn’t know if I could. It wasn’t long before I found out. I didn’t have a choice—things happen fast and frequently here. I developed a coping strategy that lasts to this day: I tell myself that the events transpiring around me, no matter how dramatic or horrific, happened without my consent, permission or anything to do with me. What happened happened, and would have happened whether or not I was in the middle of it.
Obvious? Yes. Simplistic? Absolutely. Effective? For some reason, very. I don’t have to detach, block things out or suffocate them. I am able to work with the knowledge that no matter what the outcome, my presence on the scene is the result of somebody’s misfortune and not the cause of it.
Five minutes passed. More epi, atropine and then sodium bicarb. I gave up hope. The room was a flurry of activity, noisy, a little chaotic. I saw the boy’s parents outside the door, the mom now crying, stunned, the father numb yet hopeful.
Through the chaos a voice rose above the others.
“We’ve got a pulse!”
The room went still. Sure enough, a rhythm appeared on the monitor, sinus tach. A few minutes later I saw my patient open his eyes and look around the room.
It’s kind of strange what happened next. I was fully prepared for him to die. What happens happens, right? Whatever it is we have inside us that makes it possible to do this job was in full operation. I didn’t feel anything—not sadness, despair or frustration. I knew we did our job and the outcome was out of our hands. I was at peace with that.
Whatever it is that allows us to do this job disappeared as soon as I heard he had a pulse. When I saw him open his eyes, my own eyes filled with tears. It was strange, but I’ll take it over emptiness any day.
It’s good to know I still have a heart.
Michael Morse, EMT-C, is captain of Rescue 5 in Providence, RI, and has served on the city’s busiest engine, ladder and rescue squads as a firefighter, rescue technician and lieutenant during his 21-year career. He is the author of the books Rescuing Providence and Responding.
