By Achibis
The cool morning air in the mountains did little to lift the spirits of the
dark-haired man as he wearily drove home. It had been a long, hard shift,
constantly spent on the run with little time to prepare for the next call.
One especially weighed heavily on his heart and mind.
When he arrived home, he puttered around the ranch for a while in the hopes
he'd soon feel tired enough to get some rest. But after a while he realized
it was not to be. That one call—why did it bother him so much? He grew
frustrated out of weariness and self-torment and decided he had to do
something—anything—to help himself out of this funk!
He quickly threw his camping gear into his Rover and drove toward the mountains.
The long drive did little to help him feel any better. Once he had reached
the forest ranger's station, he parked his vehicle, took out his gear and
checked in—he knew he'd be staying at least the next twenty-four hours
and wanted someone to know where he was. Then he began hiking the long, isolated
trail to his favorite spot.
Two hours later, hot, sweaty and somewhat out of breath, he arrived: the
meadow was virtually hidden by the surrounding mountains, and unless one
knew where to look for it, it was usually undisturbed by anything but the
local wildlife. In short order, the man had set up his tent and firepit,
and had located the fresh water spring which ran through the trees nearby.
Then he lay down on the grass, closed his eyes, and hoped the peaceful atmosphere
along with the warm sun shining down on him would lull him to sleep.
A half an hour later, he sat up, sighing in frustration. He couldn't understand
it. Why did that particular run keep replaying itself in his mind? Was there
anything more he could have done? Shaking his head, he grumbled to himself
No! Second-guessing himself on a run would not help, and it certainly would
not bring her back!
He began rummaging through his backpack for something to eat when his fingers
brushed against a small notebook. Puzzled, he pulled it out and looked at
it. Now how did that get in there?
It was a notebook to be used as a journal—a birthday present from his
partner. He smiled slightly at the memory of that day. What was it he had
said? "Junior, sometimes it helps to put your thoughts in order if you write
them out. And someday, maybe you'll let me read some of those entries so
I can figure out what DOES go on inside that head of yours!"
The dark-haired man chuckled at that last remembrance, then sobered up again,
looking at the blank pages before him. How should he write this out? Why
was he even entertaining the thought of writing? He chewed thoughtfully on
his pen for a few minutes, then began writing:
Dear Journal…
He frowned and scribbled that out. It sounded so silly, like a little girl's
diary! He decided to try another method.
0030: The klaxons go off, waking us. My heart is pounding in my throat from
being startled out of a sound sleep. My partner and I are being sent on an
'unknown illness' call—one of the worst kinds to get. It can mean anything
from a toe jammed in a bathtub tap to a cardiac arrest. The address is near
the station and we arrive within five minutes of receiving the call.
0035: I can tell just by looking at this woman—Helen—that she is
gravely ill. She's gray, unable to sit still and gasping for breath, the
picture of pain, fear and anxiety. I set up the monitor and biophone while
my partner checks her vital signs. He tells me the numbers of her B/P, pulse
and respiration while I write them down and simultaneously contact the
hospital.
I tell the doctor about this patient: Woman, 72 years old. Sudden onset chest
pains and shortness of breath. Pale, diaphoretic skin. B/P 86/42, pulse of
116 and thready, respirations of 40 and shallow. Monitor showing frequent
PVC's with runs of V-Tach. The doctor gives us the orders for IV, oxygen
and medications and I in turn relay this information to my partner.
0045: The ambulance arrives and we load her up. By mutual, unspoken agreement
it is decided that I am to ride I with her. I climb in, grab the drug box
and biophone and adjust the monitor to where I can see it. With two loud
slams followed by two thumps on the ambulance doors, the vehicle takes off
for the hospital.
I comfort Helen as best I know how and reassure her that she would soon be
at the hospital. I try to focus on her as a person, rather than focusing
on just her vital signs and heart rhythm. But there is little I can do other
than that…and it makes me feel so very helpless. She is now so air hungry
that she cannot sit still: She pleads for help with every gasping breath.
Even now, her voice echoes over and over in my mind, "Help me!"
0058: We arrive at the hospital and quickly unload my patient into room
#1—the resuscitation bay.
0100: There is a flurry of activity taking place around her as the doctors
and nurses swarm around her, hooking her up to the various machines on hand
to monitor her heart rhythms, her blood pressure, her breathing. Soon she
is a mass of wires. Blood is drawn for lab work, an EKG is performed, then
a second one for comparison and a chest x-ray is obtained. The picture of
her heart and lungs is not good. Her heart is very large, indicating a weakened
organ, and there is evidence of fluid build up in her lungs—she is
drowning.
She is given medications: to ease her pain, breathing and anxiety as well
as to stabilize her heart rhythm.
0115: Suddenly, her skin takes on a mottled appearance and she becomes
unresponsive. We cannot rouse her with our voices, and a painful rub to her
chest fails to elicit a response of any kind. Her blood pressure plummets.
Is there a pulse? I cannot feel one in her wrist, but I do find one in her
neck.
The doctor makes the decision to intubate and place her on the ventilator.
At the same time, we note that the waveforms on the heart monitor have changed,
and a third EKG is performed.
The diagnosis is made: an inferior myocardial infarction—a heart attack
in the lower portions of the heart.
0120: What we feared happen, does—we lose the pulse. While the defibrillator
is being prepared, I begin CPR. I can feel her breastbone give way with my
first compression. The doctor shocks her twice, and I continue to perform
compressions in between each attempt. After two minutes, I'm ordered to stop.
We've regained a pulse, but her blood pressure remains terribly low. More
medications are added to her IVs in the hopes of raising it.
0125: Again we lose her pulse, and once more I start compressions. This time
her stricken heart resumes beating after only one minute.
The doctor goes out to the waiting room to consult with her family. The nurse
accompanies him, so I stay behind. I hold Helen's hand, talking to her all
the while. It feels so strange, seeing her like this…just fifteen minutes
ago she was talking to me.
A chill sweeps over me, and I know that Death has arrived.
Her family is brought to her bedside, and the news is broken to them, as
gently as possible. They are aggrieved, but not really surprised—she'd
been ill for a very long time, and they had all felt that the next time she
had a heart attack, it would be her last. The decision is made to withhold
any further CPR, opting for comfort measures instead.
A room is prepared for her in intensive care. She is dying, and it weighs
heavily on all of us. We all have the same unspoken question: How long?
0145: There is nothing more for me to do, so I leave the treatment room and
look for my partner. I find him in the lounge—fast asleep on the couch,
still clutching a cold cup of coffee in his hands. I hate to waken him, but
the HT crackles to life; it's the dispatcher wanting to know our status.
I tell him we are available, while shaking my partner awake, and we are sent
off on yet another call.
For the rest of that shift, my thoughts return continually toward Helen and
her family, wondering if she is lingering still, wondering how her family
is coping.
0730: We are at the hospital on yet another follow-up. We lean against the
counter at the nurses' station, too weary to stand. As we gather our supplies
so we can return to quarters for shift change, I hear the operator page Helen's
family to return to ICU.
The watch is over.
He paused and tried to read over what he had written. He realized with a
start that the daylight was rapidly fading. How long had he been writing?
His stomach growled, reminding him that he'd had nothing to eat since breakfast
that morning. He set the journal aside and began to make preparations to
build a fire and cook his supper.
After eating, he picked up the journal once again, and by the firelight re-read
what he'd written. He scowled a bit, thinking it all sounded a bit too clinical.
Then he paused over the portion where he'd written about focusing on her
well being as well as to the clinical details. It made him think, Do I do
that with every patient? Without a further thought he knew the answer to
that.
Next he looked at the last sentence he'd written, The watch is over, wondering
what it was that made him write that. Watch? Whose? The family's watch over
the dying Helen, or was he referring to the end of his own shift? He shook
his head and couldn't decide.
He sighed as he pondered something else. That chill he'd felt after her pulse
returned the second time…he'd felt that same sensation many, many times
before. He just knew it was Death! And that's another thing….Why did
he insist on personifying that condition; giving It a proper name like a
person?
Because It was real.
Because Death was the enemy he'd fought against so many times before. Sometimes
he'd beat Death, other times It won. And then there were those times that
Death was merely delayed…just like this time.
Suddenly he felt he knew what it was that bothered him so much: the fact
that despite all his efforts, Helen still died! No, he corrected himself,
that couldn't be right. He'd seen other runs, all too similar to this one,
ending the same way. So that couldn't be it.
He recalled sitting with Helen, holding her hand and talking to her when
he had sensed Death's arrival. It made him feel so helpless, so small,
so….
"Humble."
The word echoed so loudly in the evening's quiet that it startled the man,
making him look around for the person who said it. He chuckled in the darkness
once he was reassured that he was still alone, and realized that he must
have spoken the word aloud himself during his musings. He stopped when the
kernel of a thought budded in the back of his mind, along with a glimmer
of peace. He nodded, grabbed the journal, and began writing furiously. He
wanted to get this down before he forgot!
When he'd finished writing, he looked over what he had scribbled, nodded
and closed the notebook with a satisfying thunk. He lazily stared at the
sky for a while longer, half-intent on deciphering its secrets when he caught
himself falling asleep. He got up, doused his fire, and with one last look
at the heavens, the dark-haired man climbed into his tent.
His sleep was deep, dreamless and healing.
He awoke the next morning, stretched and peeked out at the sun-soaked meadow.
He grinned to see several deer had joined him, grazing for their breakfast.
Above, he heard the keening of an eagle, also intent on getting a meal. He
watched its flight awhile longer before his own stomach reminded him that
he too needed something to eat. When it growled again, the deer sharing the
meadow looked up at him and then began running back for the cover of the
forest. He laughed out loud and began to fix his own breakfast.
Six hours later, after he had explored some of the smaller trails branching
off the main one, he returned to break camp.
As he finished loading his backpack for the two-hour hike back to his car,
his eyes fell on the notebook. He picked it up, tempted to re-read what he'd
written the night before. He actually started to open it when he
stopped—and realized something else.
He had poured out his most private thoughts and griefs onto the pages of
this journal, and that was exactly where they should stay. That was the true
reason for this gift! With that final revelation, he stuffed the notebook
into his backpack and started down the trail toward the ranger's station.
The sun was setting behind the mountains by the time he returned to his car,
and it was fully night by the time he turned into his own driveway. He hurried
into the house, dropping his gear on the floor as he entered and headed straight
for the telephone. He dialed the number from memory and waited impatiently
for an answer.
"Hey, Roy…about that journal…"
*****
In memory of Helen P.
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