102

“… the assignment.”

Force my eyes open… the dash clock reads 0300…

The radio blares again “30 for the assignment!”

“30. Go.”

“30, head over to ‘that nursing home’ for the cardiac.”

Wake my partner up and we’re on the way. 7 minutes later and we’re on scene. Upstairs we find a 102 y/o woman in respiratory distress with a SPO2 of 70% (above 95 is normal). She’s tachy at 150, resps around 30 while on albuterol, eyes barely open. I toss on a quick 3 lead, get a BP, and our own pulse oximeter while my partner starts an 18ga in her left hand (I swear the needle was bigger than her thready veins, but he got it on the first stick).

Quick read of the ECG shows no acutely significant findings other than a rate that was way too fast. Our pulse oximeter can’t even get a reading with her on 100% O2. BP is 88/48. A liter of NS is hanging at this point, running slow even with it wide open. While my partner auscultates her lungs and heart look back at the monitor, the rate is becoming irregular and dropping to 120-130, yet we haven’t pushed any drugs and the saline just started running. Partner says it’s time to go to the closest hospital (he says this with a begrudging tone, foreseeing the outcome at this particular hospital). We package her and get her downstairs. Did I mention she has a DNR?

As we get to the hospital my partner says “she’s gonna code on the bus, I know it”. We had called a notification on the way down in the elevators. 3 minutes after closing the doors we’re at one of the worst hospitals in Brooklyn, at least if you want aggressive treatment.

As I pull the stretcher out my partner is bagging her, so we roll her inside to the resuscitation room, where a grand total of one doctor (a resident) meets us. Keep in mind that at nearly any other hospital or for a non-DNR patient there would be a team of 3-5 (or even more sometimes) doctors surrounding the patient. The doctor is a resident, and the first thing she says to us as we are giving our report is “why are you bagging her if she is DNR?”

“She is still breathing and we are allowed to aid her breathing unless she goes into respiratory failure.”

“Take that off her and just put her on a non-rebreather.”

Fine, the patient is technically under the doctor’s care at this point so we let them put her on a mask. Then they waited for her to die. That may seem a little extreme, and she very well may have died regardless of treatment, but the decision to not help her breathing other than provide passive oxygen was a choice nonetheless.

After that she started having agonal breathing, and about a minute later went into respiratory arrest. We watched the monitor as her heart continued to beat, about 30 times a minute (normal is 60-100), with no visible P or T waves, just these tiny little R waves every couple seconds. She actually had a carotid pulse, just barely. About a minute later she was asystole (flatline). This is about the time that someone in the room says something to the effect of “can’t save them all”.

The doctor proceeded to complain about the amount of nursing home patients that have died on her lately.