You ever had a call where you wished you could have done more? Where after a call you can’t help but have this nagging feeling that just doesn’t leave you? Where you feel bad inside, guilty, like you owed your patient something, something more than what you have given. But deep inside you knew you did what you could at the time, that your decisions weren’t incorrect, it just could have been better. Yet despite knowing this, you can’t get rid of that horrible feeling inside.
I absolutely hate that feeling.
There’s a call quite a while back that stands out in my head. We were dispatched to an elderly lady, who was having shortness of breath (SOB). When we got there, she was clearly having SOB, but she was also having discomfort in her chest. She had a nasal cannula on, but I found out that the O2 she had was out. So I asked my partner to swap it. All that time I see her eyes, pleading, fear filled. I remember she got super distraught when I started inquiring a bit more about the situation; I was trying to figure out if the SOB was causing the chest pain or if the chest pain started before the SOB. She squeezed my arms, saying she can’t breath, she can’t breath. I tried to calm her down by talking to her, but she was panicking and wasn’t answering my questions properly. It must’ve only been 30 seconds (although it felt way longer) since I introduced myself when I asked my partner to put a normal face mask on. She still says she can’t breath. I don’t know if she was staring death in the face or not, all I know was that she stared at me like I was the only one there that could save her and I wasn’t doing enough. To her, help had come, but help is not helping her.
Her lungs were tight on auscultation, and decreased on one side. It was difficult to hear clearly. We got her onto the cot switched to a NRB (non-rebreather) mask and into the ambulance quickly. En route, I decided to assist her breathing using a BVM (bag valve mask) because she clearly was not getting better and needed assistance. I talked her through being assisted to breath. She resisted the BVM initially, it took quite a bit of encouragement and coaching before she realized it was helping her. I could tell she was getting tired and I did my best to keep her awake and breathing.
I continued bagging her into the hospital until we transfered her over to a bed and the nurses hooked her over to a BiPAP (bilevel positive airway pressure) machine. The patient was exhausted from the efforts of trying to breath. I later found out she had a collapsed lung on one side (spontaneous pneumothorax), I also noticed she had a masectomy. It’s clear that she’s gone through a lot in the past, and I wished she didn’t have to go through what was going on now.
After the call, I thought I could have done better to calm those frightened eyes. It’s not that I didn’t give her oxygen, but I should have given it to her earlier instead of asking a few more questions. With the slight delay I made, I emotionally tormented her. When she called 911, she expected someone to come in, and alleviate her breathing ASAP. When I showed up, I didn’t look after her emotional needs as much as I should have. I asked her questions that were pertinent, but perhaps not at the right time. In her mind she was probably thinking, “I’m dying, I can’t breath! Stop asking me questions and help me breath!” I don’t think I can forget the way she gripped my arms, those big frightened eyes, the soft airy whisper of I…can’t…breath. It rips at my heart.
I took that call, which was one of my first more serious SOB calls, as a lesson. One that I will never forget. It’s one thing to feel bad about a call, but another to learn from it. Each patient, each call, is a lesson. On each call you go on, your patient is sharing a part of their life, with you. It is only up to you to take this gift and make it a part of you, so you can benefit the next patient in a similar situation.
The next serious SOB call I ran, it was smooth and worked like a charm. After the call, I remember leaving the ER thanking her, thanking that one patient that had pulled at my heart strings and made me a better paramedic.