August 25, 2014. I was still a baby EMT with about a year and a half of experience under my belt. At the time, I was working as an Operations Supervisor for a private emergency ambulance company in a system that sometimes necessitates the use of the ALS and BLS Supervisors together as part of the 911 system in a transporting unit. It had been one of those days – scorching hot and busy from dawn until dusk.
I was working with a Paramedic and fellow Sup with whom I had become quite comfortable – we worked well together, got along fantastically (thanks in large part to heavy doses of sarcasm and cynicism, and competing “I’m going to hell” senses of humor), and we knew how to function as a team on scene. We also had a rep for getting “those” calls. I worked my first cardiac arrest with him, also earning my first “code save,” among many, many other EMS firsts.
My time working with him made me a better EMT and a better person, and I can think of very few other people in my life who have taught me more than him. By the time we got to our posting location on this August evening, we had already run many calls, and were looking forward to the end of our shift, with less than 30 minutes to go and a relief crew on the way out to us. The County dispatch radio crackled to life, announcing a possible drowning in the first-due area for a rural, volunteer fire department directly to the South of us – a call we knew would be ours based on our geographical location. We also knew that my partner would very likely be the only Paramedic on scene.
The call was at a large lake, popular with locals for summer recreation, and also the site of previous drownings, thanks in part to an area of the lake near a much-trafficked picnic area where a large creek enters the lake bed; running year-round, it has carved a deep gulley in the floor of the lake, and continues to flow when the lake is high, creating a large drop-off with an under-current. While there are life vests available to the public and the standard signage about wearing them around water, there was not any signage yet regarding the dangerous drop off or current. This being the 4th or 5th possible drowning tapped out in that last few days, all which had turned out not to be serious, we approached it with no more or less urgency than any other code 3 call dispatched that day.
As I flipped the lights on and left the parking lot, my partner began to guide me – I knew the general direction in which to travel, however I had never actually been to this lake. A few minutes later, the County Dispatcher came back to us with our readback, which went something like this – “Units responding to the lake, caller says they found a 2-3 year old male face down in the water a few feet from shore. They are unsure how long he has been in the water and are unable to locate family. They have pulled him to shore and are performing CPR.” In that stomach-churning, gut-wrenching moment, I knew that I would never be the same, regardless of the outcome. I knew that this call would be a make-or-break call.
I glanced briefly at my partner, knowing that he had a young son waiting for him at home, and with the look in his eyes and the set of his jaw, I knew that my only option was to make it. Seemingly without conscious input, my right foot pushed closer to the floor. My partner looked at me and asked “Have you done this before?” “Nope” was my only response, and the only response needed. We were in sync, and we both knew that the other would do everything that needed to be done, regardless of past experiences. For me, this was my first drowning call and my first pediatric cardiac arrest, rolled into one.
After several more minutes of driving, we reached the ring road that encircles the lake, allowing vehicular access to the various day use areas. The one we were aiming for was still clear on the other side of the lake. We knew from the radio traffic that the first fire unit was only about a minute ahead of us, and that the local air ambulance had been put on standby. As we proceeded around the lake, we watched not only our cell service disappear, but also our radio reception – we were isolated to the outside world. The air ambulance was launched just before we left radio range, with a 60+ minute ETA (we weren’t the only ones who had been busy that day).
After about 15 or 20 minutes of code 3 driving, we reached the scene – the fire rescue unit had pulled as close to the shoreline as possible, and we followed suit, backing our unit down the grassy hill next to theirs. As I climbed out of my door, I looked up to see a tall firefighter in jeans, a station shirt, and a baseball cap, his romeos caked in mud, carrying the small, limp body of a young boy with only swim trunks on, hurrying towards us. I threw open the back door while my partner retrieved a backboard and placed it on the gurney. The firefighter laid the child on the board and we all dove in, performing a quick assessment before resuming CPR, as it had been bystander only until our arrival.
We confirmed that he was without a pulse and not breathing. He was cold to the touch, but other than that, he looked no different than any other child, perhaps taking a nap. I don’t remember the exact number, but we got at least four firefighters, EMRs and EMTs, in the back with us. My partner asked me to shut all the doors and moved the ambulance back up the hill to the parking lot to allow us easier access to the planned landing zone. I did so, and then climbed back into the box. Everyone was moving a mile a minute, but we somehow managed to control the chaos.
I looked around as I assisted my partner in prepping our intubation supplies while simultaneously bagging the patient. I looked into the eyes of each of my teammates, knowing the name of only one of them besides my partner, and I saw what I am sure was a mirror image of mine – wheels turning, tires squealing, panic lurking just below the surface along with all of the other emotions that are kept at bay by the muscle memory and automation of the skills we work so hard to ingrain in our systems. I switched places with my partner so that he could work on establishing an advanced airway, and checked in with the young firefighter performing compressions – the one whose name I knew.
I traded out with him and paused to allow a rhythm check and for my partner to visualize the airway. He dropped the tube in, and I resumed compressions. Clockwork. Working in tandem, we confirmed that his airway was properly placed. He moved on to established access for meds, first confirming that no one else was able to do so. Watching him, I found myself holding both fear and admiration for him – at that moment, he was carrying a lot on his shoulders. He established intraosseous (in the bone) access quickly so that we could begin following the algorithms for Pediatric Advanced Life Support (PALS). I focused on the rest of the team, coaching a new EMR on compressions while I continued providing ventilations.
With nothing left to establish, we all focused 100% on the patient, and to this day I have seen the quality of teamwork I saw on that day only a handful of times. We worked the code for 40 minutes before we heard the radios crackle to life with a transmission from the air ambulance crew, providing a 10-15 minute ETA. We were several rounds in with PALS, and we were still yet to see anything resembling a viable rhythm on the monitor. My partner located a cell phone that had service, and called our local Medical Resource Hospital to discuss the options. Mark down yet another image I will never lose – his face after he hung up, and before he addressed the team.
The team discussion essentially amounted to “I think we all know what we have here, and what the next step is. I would like to wait until the air crew has arrived and their nurse confirms the airway, but I believe we have to call this after that.” We all watched each other’s hearts sink, but nodded our heads in agreement, knowing that we had done everything there was to do. I believed then and believe still that deciding to cease resuscitation efforts on a child is one of the most difficult things we as providers face, whether in the field or in a clinical setting.
After this discussion, I took over compressions, and continued them as I listened to the chopper land. I pushed until I looked up to see the flight nurse standing over us, having entered from the side door. She confirmed that the airway was good, she reviewed what we had done up until that point with my partner, and then he looked at me pointedly, and I delivered one final compression to our patient’s tiny chest, after nearly 60 minutes of working this code. And then everything stopped. No one spoke, no one even really moved.
The only noticeable sound was the chirp of our monitor and the chopper’s engines still winding down. I looked to the back of the ambulance and saw the fire chief there, a silver-haired country boy who had been chief for nearly a decade, from what I knew. I watched him as he wiped tears from his cheeks and turned around to step out of the ambulance. His crews followed quietly behind him. I lamely thanked them for their help, not knowing what else to say. The flight crew returned to their chopper.
I sat on the bench seat next to the boy’s head. My partner closed the back doors of the ambulance and came around to the side – “Fire is going to request the medical examiner when they get back into radio range. We don’t know how long it will take the examiner to get here. Someone should stay with the body. I can, or we can switch out, or..whatever works.” Looking back at him, picturing his little boy at home, I told him I was ok to stay in the back. He nodded silently, and shut the door.
I placed a sheet over the boy, up to his chest. The monitor was still on. Two parallel flat lines marching along. It occasionally alarmed, and printed a 30 second strip. I never turned it off. I guess there was a tiny little piece of me holding onto hope. My partner came back a few minutes later to update me – the police had located several pairs of shoes, both children’s and adult’s, some towels, a cooler along the shoreline near where the boy was found, and a lone vehicle left in the parking lot with no apparent owners – but no one had returned to the site, and they were calling in a dive team. He didn’t have to explain the implications there. This had now turned into a possible recovery mission.
We still had no word on the arrival of the medical examiner. He asked if I wanted him to take over, I told him no, that I was ok. He shut the door once more. To this day, I’m still not completely sure what my end goal was, only that I was doing what I felt needed to be done – for the little boy on our gurney, for my partner, and for myself. I reached out and I took the boy’s lifeless hand in mine, and I started quietly talking to him. For some reason, I thought my incredibly astute partner didn’t notice. There was a part of me that felt silly – the purely logical side. But I didn’t really care. I found out later my partner had noticed, but apparently felt the same way I did. Each time he opened the door, I assured him I was ok to stay. He never asked me why I stayed, and I’ve never told him that it was as much to help protect him as anything else. I watched as he became restless and agitated, as the minutes dragged on, waiting for the medical examiner.
Nearly two hours after we ceased our efforts, nearly two hours after I took our young patient’s hand in mine, nearly two hours of watching the monitor, holding back tears, and worrying about my partner, the medical examiner arrived. After she was shown the scene she came to the back of the ambulance, and I finally let go of the tiny hand, and told him goodbye. My partner and I looked at the back of our ambulance, mud caked on the floor and gurney, our kits torn open and strewn about, several feet of monitor paper leading out of the monitor, and decided it could wait until we had returned to headquarters.
I looked at my watch and realized I was almost three hours late getting off and had not been able to communicate with my fiancée waiting at home during that time. My partner and I were mostly quiet on the way back to headquarters, with the exception of a couple phone calls and some limited radio traffic. We did discuss the technical aspects of the call, working to reassure each other that we had done all we could. Upon our return, he started in on his chart and I started putting our ambulance back together. Sometime later, we both decided we were done. He had the next two days off, but I still had another day of work ahead of me. I had received texts from both my direct Manager and our Clinical Director advising me to stay home if I needed to, but I knew that wasn’t going to help me. I needed to come back the next day, I needed to keep working.
I got home and held my fiancée. I let myself cry. I checked the news for any information, texted to check on my partner, and then went to bed. The next morning I woke up and knew I had a decision to make. I showered and put a clean uniform on. I headed into work and was met by my curious and concerned coworkers. The Clinical Director pulled me into her office to check in with me. I assured everyone that I was where I needed to be, and that I just wanted to work. It wasn’t that I was pushing the call away. It’s really quite the opposite. That call, that little boy – they have never left me. I think about them every day. But it is not with fear, or anger, or questioning – I have found that this call inspired me to work harder, to learn more, and to grow, to make sure his death could lead to life down the line.
This call drives me, and he, along with my small collection of ghosts, live on through all of my patients after them. This call is one of the reasons I know that I am on the right path, and it has shaped who I am as a provider and as a person. Since then, I have run many difficult calls with the same partner, and we have, for the most part, discussed the call very little, save for the one short conversation we had while running together on another busy day a few weeks later, during which he asked how I was doing, and then promptly told me to get off my ass and get my Paramedic licensure already. I’m not sure I ever thanked him for providing me with an example of the kind of Paramedic I strive to be, and for how much of a role model he has been for me. I still look back on that day, and see our patients’ face as clearly as if it were yesterday, as well as the faces of everyone else on scene in the moment after everything stopped.
Later the next day, the dive team recovered the bodies of the boy’s mother, uncle, and grandmother from the bottom of the lake, from the trench that has been carved out by flow of the creek, about 30 feet further out than our patient was found. There were no witnesses, so we will never quite know what happened that day, but with or without that knowledge, the tragedy of an entire family lost stands. For better or worse, I soon learned the name of the boy, and those of his family members. I was presented through media outlets with pictures of the four them, happily smiling with each other. I have the anniversary in my calendar, I keep one of the EKG strips in a box with a few commendations and other things near and dear, and I visit the small memorial on the lake shore from time to time.
The first time I visited, I left a small stuffed animal that my company carries on our rigs for kids, next to the handmade wooden cross that was placed for him, because I never got to give him one on that night, and it felt wrong that he never got one. It was, thankfully, still there last time I visited, late last summer. I will likely carry this call with me not only for the rest of my career, but for the rest of my life, no matter where it leads me. The first of many that will stay with me. And that’s ok. I have never viewed it as a failure. I will gladly take it with me and revisit it when I need a reminder as to why we do what we do. Because even though we were not able to bring him back, the simple act of showing up and doing our jobs gave hope, and gave him that last chance some never get.
I am sharing this now in the hopes that it will demonstrate that the worst calls of your career can also be the best, if you let them. They don’t have to destroy you. We all handle them differently, this I know, but just know that no matter what – it is ok to cry, it is ok to be angry, to question, and to curse. If you find that a call tips the scales, reach out – someone else is right there with you. Your partners are your support, even if all you ever do is quietly acknowledge occasionally that the call happened, a little can go a long way. I don’t talk about this call often, at least not in depth. Occasionally I bring it up as a relevant learning tool, but other than that, it mostly stays in the background.
I would be lying if I said that it doesn’t still occasionally bother me. I still randomly tear up (as I write this, for example), and feel that same knot in my stomach that I had when we got the call. But that’s ok. I chose to let this call make me – to draw strength from it, rather than letting it break me, but that doesn’t mean I’m not still broken, at times.
I have battled with depression for 17 years, off and on. I attempted suicide. Once. When I started working in EMS, a career I had admired since I was a child, I discovered and incredible outlet, and a haven. My depression and my past have allowed me to connect with many patients. I know I will never leave my depression completely behind, but this was call was a true turning point for me.
– Story written by a 27 year old AEMT, 3.5 years in EMS.