Housefly

October 2007     San Francisco

Last night we had a cardiac call at 3am. Usually, these end up being not too serious, or even improperly dispatched, so my partner and I didn’t know what to expect. We arrived at the house to find a 70-yr-old Chinese woman complaining loudly in Cantonese (through a family interpreter) of heart palpitations. Having spent some time in Chinatown, I guessed that talking *at* me in Chinese at a high volume and speed was probably her natural state, so that didn’t concern me. We wired her to the EKG monitor, and found her heart to be banging away at over 180 beats per minute, and not likely to improve. This condition is called supra-ventricular tachycardia, which is a cool name for a bad thing.
We had a few treatment options, and tried the first one, to no effect. The second option was not yet appropriate, so we moved to the third: a rarely used drug that resets the heart rhythm by stopping the heart completely for a few seconds. OK, never used it, but sure, we’ll try that one. No worries, right? We carried her down the narrow, twisting stairs to the ambulance, ran a couple of tests, and stuck an IV in her arm. I checked the monitor display again; no change. By now, the woman was tense and sweating with anxiety, gripping my arm and watching me closely, probably scared and not feeling so well. In no way did she know that we were about to send her into the unknown, and I wasn’t looking for the interpreter. I retrieved the vial of this medication and drew it up with a needle, shooting a little into the air to clear a bubble. I pressed “record” to start a paper printout of her heart pattern. One more look at the monitor, damn, almost 200 bpm, and then slid the needle into the IV port. This is counter-intuitive, but I hope it works. I smiled at her, held her hand, wondered what my own pulse was, and pushed it all into her vein.

1,2,3 seconds… flatline… 4,5… a puzzled look… 6,7…eyes rolled back… 8,9,10… stopped breathing… 11,12,13,14 seconds …I don’t remember the duration of this drug…15,16,17,18… still flatlined … I may have treated this improperly… 19 one-thousand, 20 one-thousand, 21 one-thousand seconds… I felt like I had just run someone over… 22,23,24,25… I’m going to have a lot of explaining to do… beep, flutter, beepbeepbeep, the rhythm started right back up, at 130 bpm and falling. She breathed again and awoke shortly after, unaware that we had just killed her, and more calm after that little nap. We arrived at the hospital a few minutes later, showing a heart rate around 80 bpm.

The nurses went to work on her, the woman resumed her verbal exhortations, and I thought about a sweet, delicious beer.

Tags: paramedic work

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