Accepting Mortality

Throughout one’s journey through their EMT and paramedic education, a student is taught a lot of skills, assessment techniques, and they are expected to retain a lot of medical knowledge.  All of that is done with one thing in mind: to make sure that their patient has the best possible outcome.

Early on, we are taught CPR to help get someone’s heart going again.  We are taught to splint, to take vital signs, to administer medications that are intended to reduce suffering and save their lives.  No where in paramedic class are we taught to “just let them go.”

I did my first code when I was just shy of my sixteenth birthday.  Like most cardiac arrests at the time, we did not save the patient, who died at home with his family.  I did not know how to react.  I did not know if I should be sad, if I should just brush it off, or if I should be angry and disappointed in myself for not getting him back.  With time, I was able to accept that death was part of this job, but it is not easy.  It goes against every prinicple that we are taught.

I remember once I had a patient code right in front of me while we were transferring them from the stair chair to the stretcher.  Our time with the patient was short, but it was a typical code: IV, Epi, lots of CPR, and a quick transport to the hospital.  After we got there, the code continued for some forty minutes with the heart rhythm bouncing from PEA to Asystole to V-Fib to V-Tach, back and forth from rhythm to rhythm.  Despite the efforts of two paramedics, two EMTs, two doctors, some nurses, and a respiratory therapist, there was nothing that we could do.

In my eleven years as a paramedic, I have done my fair share of cardiac arrests.  I have some saves, but have lost far more people than I have gotten back.  My attitude at this point: “I did my best for them, they did not make it.  It was their time.”  The call I just described was one of those.  A valiant effort was put in by everyone involved, but it was the end of the line.

Some might look at the crew who then just packed up their stuff and went back in service as being heartless, but the fact is, there are other lives to save out there.  Someone else might have a better chance than that last patient.  The four of us walked away from that call knowing and confident that we had done everything we could have, and it was time to get back to work.

During the lectures that I gave to those two brand new EMT classes last week, I shared with them a lesson that I was taught on my first night of paramedic class.  Bob Moore, one of my instructors and a reader of EMS in the New Decade, laid it all out for us from the start.  He shared with us his two rules of EMS:

Rule #1 – Sometimes, people die.

Rule #2 – There is nothing that a paramedic can do about Rule #1.

Truer words have never been spoken, and I felt the need to share those two rules with this brand new group of prospective EMTs getting ready for four long months of class.  It is not an easy lesson to learn.  Death is a part of our jobs everyday at some level.  Our services experience it, our trucks experience it, and we experience it in our personal life but that exposure to it is so much more common in EMS, and it is something that we must do our best to prepare ourselves for.

Walk into every code with the goal of that patient walking out of the hospital under their own power no matter what the downtime, or what might have been going on with the patient.  Do the best that you can for each and every one of them and give 110% for all of them.  Remember though, that despite all of that, despite every tool that you might have in your toolbox, and every once of energy your pour into that code, sometimes people die.

  • Railrob

    As always, very nicely said Scott.
    I need to relate how I learned that lesson. In the fall of 1983, I was a NU medic student and not to brag but I did very well in class. Near the end of class we had an instructor named Joe Duecy run one of our last mega codes before exams. He put me theough each and every rythm known to man and I hung in there with the correct treatment and got the patient back with a pulse. After 30 minutes of playing with me Joe turned off the monitor and told me the patient died. The group and I looked at Joe and I managed to get out the words” What did I do wrong? “. He turned to me and said ” Nothing, but you just learned the most important lesson that you will need to carry you successfully through your time in EMS. There two rules to remember, 1. Sometimes people die and rule 2. Medics can’t change rule 1.”
    Later on, I had the chance to be Joe’s partner for a brief moment in time.
    That lesson has let me survive in this business since. I, like you, gave my patients the best effort I could and then when done walk away with the knowledge I did the best I could do and move onto the next patient.
    Thank you for passing on this knowledge.
    Bob