Note: This chapter takes place about 40 pages into the book as Seth Sumner, age 17, starts to “learn the ropes” on duty with the local EMT squad.
This past Thursday night, Zelma, Jim, and I start the shift with a quiet evening. I check one of the rigs to make sure it's properly stocked and ready for action. Jim checks the other ambulance. Zelma makes a few phone calls to schedule the weekend crews. Around nine-thirty, Jim orders a pizza—he's obsessed with pizza—and it arrives about twenty minutes later. After that all three of us sit together in the ready room, which is the shabby but comfortable fake living room where we wait between calls. There's a TV set, two sofas, and some overstuffed chairs. It's as good as any other place to eat a pizza. The pizza itself isn't so great, but I'm tempted anyway—I can't believe how hungry I feel while on duty.
Zelma holds a slice New York style, folded lengthwise, and devours it. She says, "Sweet Jesus! This is just what a big gal like me needs right after dinner!"
Jim tells her, "Well, you really must fortify yourself." He pronounces really like rilly. I know even less about him than I know about Zelma. According to someone else in the squad, Jim is a yogi. He speaks fluent English but with a slight accent, so that his name sounds like "Chim," the rigs are "ricks," and most words that begin with th start with t or d instead. ("I tink I'll go see anodder movie on Tursday.")
Zelma, flexing her biceps, asks, "Are you saying I'm not fortified?"
Just then the alarm goes off. We all turn and stare at the walkie-talkie sitting on the table.
I can't make sense of the staticky words.
Zelma says, "Probable M.I. Let's hustle."
Within seconds we're in the rig and heading out. Jim drives fast, wrenching the ambulance around corners and speeding on the straightaways. I almost panic—I've never gone on a call so fast. I know that an M.I. is a myocardial infarction, a heart attack, and I understand why we have to rush, but I'm scared anyway. Luckily the ride is short, just a few blocks, before we pull over.
The police are already on the scene. They hustle us into the house, down a staircase, and into the basement. The patient lies face-up on a concrete floor. I see right off that she's wearing a pink nightgown, she's about sixty years old, and she has waxy hair and yellow-gray skin. Two cops are performing CPR on her—one does chest compressions while the other ventilates her with a bag-valve mask. A younger woman—thirty or thirty-five—stands near the staircase with her hands clasped together, and she wails, "Oh my God! Oh my God!"
Zelma asks, "What's her down time?" She and Jim take over doing CPR from the cops.
"Unclear," says one of the officers. "Could be ten minutes or longer."
Zelma holds the mask over the woman's face and squeezes the ventilation bag; Jim does chest compressions.
I stand nearby but don't know what to do.
Zelma says, "Get me an oral airway."
I obey, fumbling. I open the big green kit, find the curved plastic airways, pick out the right size, and hand it over. Zelma puts the airway into the woman's mouth— it's like sliding a question mark down her throat. At once Zelma puts the mask back onto the patient's face. "Here," she tells me. "Take over bagging."
I move closer, kneel, and start squeezing the bag. I can't believe I'm ventilating the patient. I've never performed CPR on a human being before, only on practice dummies, but there's no way out of it now.
Zelma scolds me: "Fifteen to two!"
I've got the ratio wrong, so I correct myself: two breaths for every fifteen compressions.
Now she's preparing the AED, the little computerized defibrillator. After using her EMT shears to cut open the nightgown, Zelma sticks the electrodes onto the woman's chest. She powers up the AED. There's a lot of racket: the daughter's wailing, the cops' calm words as they lead her upstairs, Zelma's and Jim's shouts back and forth, and now the AED's robotic voice: "Check for pulse!"
Jim stops doing compressions and checks the woman's neck for a carotid pulse. He shakes his head.
The AED says, "Analyzing rhythm!"
I'm appalled and fascinated. Some words start to echo in my head: Don't die! Don't die! Don't die!
The AED says, "Clear the patient!"
"Stand clear!" Zelma shouts.
Everyone backs away from the woman.
I expect her body to jolt—legs and arms flopping, torso twitching—as if a little explosion has detonated deep inside her. Nothing happens. The woman just lies there. For some reason the AED has refused to shock her.
Jim says, "Okay, all stand clear."
"Clear the patient!"
Zelma says, "Everybody clear."
Everyone pulls back, waits, and watches.
Again I hear that voice inside me: Don't die! Don't die! Don't die!
Once again there's no shock.
I'm puzzled when Jim starts doing compressions again. Zelma, speaking into the radio, consults with someone, maybe one of the E.R. doctors. I can't follow the exchange. There's too much static, too much background noise—the cops' own radios all around us and the daughter's shouts upstairs. Zelma shouts, "Where's the medics!" Almost at once she gets a garbled answer. Then, irritably, she says, "Twenty minutes off."
Jim signals her, they stop doing CPR, and Zelma turns on the AED again.
Within seconds Zelma tells me, "Get the Reeves." She takes over doing the ventilations.
I clear out at once—I slip past the cops, run up the stairs, sprint to the rig, and fetch the rolled-up Reeves stretcher. Then I race back to the house and half-stumble down the stairs.
By the time we've slid the woman onto the Reeves and carried her upstairs, some of the cops have brought the wheeled stretcher from the rig to the driveway. We transfer the woman onto the stretcher, then get her aboard the ambulance, with Zelma bagging her and Jim doing compressions the whole time. Then suddenly the doors slam shut, Zelma and I are in the compartment with the patient, and I find the ventilation bag in my hands again.
Zelma shouts at me: "What are you waiting for!"
I stare at her for a second, then snap back to my senses and start frantically squeezing the bag.
Zelma says, "Hey—slow down! Fifteen to two!"
I restrain myself, squeezing twice only after Zelma has shoved fifteen times against the woman's chest.
The rig jolts. We're off. Jim drives so fast I can scarcely stay seated. How Zelma manages to keep doing compressions, I have no idea. As the rig veers and sways, she sometimes clutches a metal bar overhead with one hand while shoving the other hand against the patient's chest. Not exactly how they demonstrated CPR in class...
The whole time we lurch through town I'm chanting that little chant to myself: Don't die! Don't die! Don't die!
The patient dies anyway. We race her to the hospital, the E.R. docs and nurses shock her again and again, they inject her with cardiac drugs, they bag her, and they do compressions for almost half an hour, but she dies. I watch at the edge of the E.R. cubicle as the staff goes through their procedures. Eventually one of the doctors pronounces the patient dead. E.R. staff members start to leave.
After that, Zelma spends a long time with the daughter, explains what happened, and consoles her. I stand outside the room and listen. Then Jim and I pack up our equipment and we all return to the rig.
I sit up front with Zelma, who's now driving.
As we head back to the squad house, Zelma says, "You did good."
"Doesn't feel so good," I tell her.
"For a first CPR call, I'd say you did great."
"She died, Zelma."
She swings the rig onto Springfield Avenue. "Seth, nothing in our power could have saved that patient."
I can't help staring at her. "What are you telling me?"
"She was a goner. The cops said she'd been lying on the floor ten, maybe fifteen minutes. That's way too long to bring someone back."
"Is that why the AED wouldn't shock her?"
"You got it, honey. The gizmo couldn't detect a rhythm worth shocking. No V-tach, V-fib—zippo."
"Then why bother at all?"
"'Cause sometimes it's not the patient we're treating."
I'm so stunned I can't respond.
Now she turns onto Boyden Avenue. She says, "The daughter found her mom lying on the basement floor. How long? Who knows. But she'd been there so long I could see her skin starting to discolor. Remember the technical term? Lividity. Nothing was gonna revive that gal."
"I don't get it. All that CPR, the AED, the whole nine yards."
"It's important for the family—"
"—so they feel something's been done."
"We just went through the motions?"
"For legal reasons."
"Partly—but mostly so they won't feel so futile."
I don't know what to think. "All that work so the relatives can feel better?"
"When we do CPR," says Zelma, "sometimes it's not just the patient's heart we're trying to resuscitate."