Losing the fight
It felt like we should have saved him.
Most of our patients that come in full cardiac arrest look like they’ve had it coming for a while. Either they are elderly, obese, or have the signs of a hard life or long term illness all over them. But not this guy. He was young as far as these things go, maybe fifties, regular build, and looked like he could have been out fishing yesterday, or playing with his grandkids – enjoying a normal, fairly healthy life.
We worked hard… doing all the cycles of all the things we’re taught to do to save someone, but none of them were working. We would get his pulse back, start to transition from resuscitation mode to sustaining mode, and all of a sudden his pulse would be gone again and we’d be back at square one, doing more CPR and pushing more drugs. Finally after losing his pulse again the doctor made the normal decision to call an end to our efforts. I held the doppler to his femoral artery and listened to the silence where the ‘woosh woosh” of a pulse should have been.
The doctor stepped out to speak with the family as we began unhooking the cardiac monitor with its dismal flat line and turning off the breathing machine. I stood and stared at my patient. I just didn’t feel like he was done. Watching him for a few moments I saw his body’s final agonal gasps for air. But then…. it seemed like more than that.
“It really looks like he’s trying to breath.” I said looking up at the Respiratory Therapist. He eyed the patient uncertainly as I stepped a little closer. “He looks like he’s still alive to me.”
I grabbed the doppler again and held it to his femoral artery. And there it was. “Woosh, woosh, woosh.”
“Get the doctor back in here!” I yelled to one of our ER techs. The Respiratory Therapist started hooking the breathing machine back to the tube in his windpipe and another nurse started clipping the heart monitor leads back on.
Moments later the doctor stepped back in the room and looked up at the monitor. “You’re kidding me!” He exclaimed and stood looking at the monitor for a moment. “Well, alright!” he said finally. “Get a dopamine drip started and…. I think I need to go have another talk with the family…”
We had a pulse and a fairly reasonable blood pressure. I found myself having trouble moving from my post with the doppler, listening to the reassuring sound of his pulse, afraid that if I moved it would disappear again. And sure enough, not 20 minutes later, it was gone.
“Come on, buddy!” I found myself saying, as though I could will his heart back to motion. We started CPR again, and someone poked their head out of the room to yell for the doctor yet again. It was like dejavu in the worst sense. We did more rounds of chest compressions and medication and IV fluid, but we couldn’t get his pulse back. For the second time, the doctor called an end to our efforts, the doppler silent and the heart monitor line depressingly flat. I knew it was time to call it, but I didn’t want to. It felt like he had been fighting to live and I wanted to keep fighting for him.
I knew that his heart had probably been too damaged by the heart attack that most likely proceeded his cardiac arrest for it to ever be strong enough to sustain his life. And I knew that in the grand scheme, someone’s life never really rests in our hands. But sometimes it doesn’t seem to matter what you know. It still felt like we should have saved him.
