Life and Death in the Southern United States

Lord, make me an instrument of your peace,

Where there is hatred, let me sow love;
where there is injury, pardon;
where there is doubt, faith;
where there is despair, hope;
where there is darkness, light;
where there is sadness, joy;

O Divine Master, grant that I may not so much seek to be consoled as to console;
to be understood as to understand;
to be loved as to love.

For it is in giving that we receive;
it is in pardoning that we are pardoned;
and it is in dying that we are born to eternal life.

-The Prayer of St Francis of Assisi-


I was riding down US Route 47A on a beautiful Sunday morning when a young girl stepped out to wave me down. When I asked what was the matter, she said "are you a doctor?" "No, but I am a medical student." She pointed down the road a few meters and said, "go there."

I saw the truck first, then the old man thrown out of the truck. There was a small croud of people around him trying to hold him still. He was conscious, but clearly completely unaware of his surroundings. I asked the guy next to me to try to maintain his c-spine and we waited. The others had already called an air-medic for transport.

That's when things started to go really bad. He stopped breathing and the two people feeling for pulses, stopped feeling them. He vomited blood. I tried to clear the vomit and start CPR. Airway. Breathing. Circulation. Those become so confused when you're staring down at somebody who needs them. I started to do compressions, then mouth-to-mouth, then compressions, then he'd throw up blood. Somebody said later that lasted just 8 minutes. There was no greater eternity when I had no idea what I was doing. 8 minutes.

That's when the air-medics landed. You would think that I'd remember them landing, but I don't. She handed me a BVM so I could stop with the mouth-to-mouth; I have never loved a person more. I continued with the airway, another guy took over the compressions, and the air-medic tried to put in some lines. She had trouble with the lines because apparently his humeri and his femurs were broken. All of them. I hadn't even noticed.

We continued until they attempted to put in an endotracheal tube. They tried twice and then switched to a combitube, a tube that will enter both the esophagus and the trachea. By this time, something like 20 minutes had passed since he stopped breathing and stopped having a pulse. There was blood coming from his ears. The EKG on him said asystole. That's not a shockable rhythm. Shit.

The air-medic called it. I guess they can call it in this state. That was it. He was dead on the side of the road. I'm kneeling beside of him like a vulture, covered in his blood from my mouth to my shirt to my jeans. My knees burned as I stood up. I didn't know what to do. While once he was alive, now he is dead. I asked for an alcohol whipe for my face.

After I got cleaned up and changed my clothes, the flight nurse came over to say thank you. We hugged afterwards. I don't know if that's standard procedure, but it was nice.

Now, what do I do about my obvious pathogen exposure in my obviously immunocompromised state. Yikes. I've gotta say I normally wouldn't care, but I just stopped a round of temazolamide yesterday. So, I went to the local ER and called my own oncologist. The ER had a Physician's Assistant on duty who really didn't know what the deal was and my Loyola oncologist was in a conference. So I had to wait about 2.5 hours for my oncologist to give me a call and say it's not worth taking the drugs.

I don't know whether I did the right thing with this patient. I'm writing this as I'm trying to work them out. Did I get his airway open; there were times when it wasn't open enough. Did I do compressions right; sometimes I just lost count. I didn't maintain his c-spine when I was trying to clear his airway. I can't stop thinking about it right now, as much as I try. I guess I have to go back to that original conversation with the young girl. "Are you a doctor?" "No, but I'm a medical student."

I'm not a doctor.