Purple Plus
Today, I went out for an observation shift with Steve and his crewmate in posh, leafy South London. I’ll write about the other calls we did later; one deserves a post to itself. Every time I’ve been out on the road with Steve, I’ve told him that I want to see a suspended patient (otherwise known as a cardiac arrest, or a dead body, depending on how long they’ve been like that). Every time the MDT (ambulance computer) rang with a new call, I’d jump up and down and go “Is it a suspended? Is it? Is it?” and of course, it wouldn’t be; it would be “old woman fallen over” or “cut toe” or suchlike.
Well, this time the MDT rang and Steve turned to me and said:
“You know you wanted to see a suspended? Well, we’ve got you one.”
“Hahaha,” I said, not believing him. “What is it really?”
“It’s a suspended!” said Steve, igniting the blue lights and nee naw sirens and launching the ambulance on to the wrong side of the road.
I looked at the screen and saw he wasn’t joking. Then I panicked. Then I said some bad words. Then I turned a bit green.
The call, which was to an “85 year old male, ? suspended, ? purple, been ill with [this, that and the other]” was about 10 metres from an ambulance station, so despite getting there in four minutes, we were the third vehicle on scene, along with an FRU and another ambulance. It is usual practice to send at least two crews to ‘working’ suspendeds, because there are various things that need doing, eg., CPR, cannulating, intubating, defibrillating, getting equipment ready and herding upset relatives to a safe distance.
Steve cattleprodded me into the room, where all six of us proceeded to stand in a line and look at the scene in front of us. The other crews had already established that this was not going to be a working job: the patient was, in ambulance speak, purple plus. In other words, very obviously dead. I had always imagined that dead bodies would be found lying flat on their backs with their eyes wide open, blank and staring, but this gentleman had instead got himself into a most odd position. It appeared as though he had realised something was wrong in the night and got up from his bed, then thought better of it and sat down and curled up in a ball where he was, his head resting on the bedside cabinet, his face turned away so you could only imagine his expression. I was grateful for this; I imagined it to be peaceful, as in sleep, but for I know it could have been grossly contorted, frozen as he cried out in pain. Maybe that’s why he didn’t want anyone to see it. His skin was waxy and almost white. The FRU woman told us that he’d probably been dead for hours — he’d last been seen at bedtime the previous night and by now rigor mortis had completely set in — he couldn’t be moved at all. My only experience of death before today involved various small rodent pets, who generally crawl away and hide somewhere to die, and this gentleman’s position struck me as similar. Steve’s crewmate told me it was actually very common to find dead people in that kind of position.
Handling suspendeds is very different from a call taking perspective, because as a call taker, you never give up hope and always act as if something can be done. In no circumstances do you acknowledge that the patient is dead. Even if the caller does not perform CPR, you still have the fact that you are sending an ambulance to fall back on, as if the appearance of the ambulance will somehow make everything alright. Today I had no magic ambulance to absolve me; I was part of that ambulance. As all six of us stood there, doing nothing, a somewhat eerie feeling of ineffectiveness crept over me. As the last crew in, we were surplus to requirements and shuffled out to leave the others to deal with the formalities (mainly arranging a GP to certify) and give the relatives space to grieve. As we left, we encountered the patient’s daughter, who was walking aimlessly up and down the corridor clutching a mobile phone and keys. The other crew had already told her that her father was dead. As she saw us, leaving — testament to the fact that there was nothing we could for him — she broke into tears. I didn’t know what to say to her, so I told her that I was sorry, feeling that this was an incredibly inane thing to say but still better than saying nothing at all.
Back in the ambulance, Steve selected “Deceased, not removed” as the outcome, then checked to see if I was traumatised or anything by my first encounter with a dead body. I was relieved to find I wasn’t traumatised, just that it had been somewhat different from how I expected — the position of the body, the way that he was so obviously dead that no examination was needed, the feeling of “what now?” once the certainty of the death was established.
“That’s about as good as they get,” remarked Steve’s crewmate. “Sometimes you find them in pools of vomit, pools of blood or pools of faeces. Sometimes you find them in pools of all three. Sometimes you find them a week later when their face is moulded into the bedside table; sometimes you find them when the flies have moved in and the smell won’t get out of your hair for a week.”
“Next time,” said Steve, “we’ll find you a working job. Pumping the chest, shocking the heart…”
“Noooo!” I said. “Can we please just have nice little old ladies who have fallen over from now on?”
Then it was back into Green Mobile, ready and available for the next call.
on May 31st, 2007 at 9:38 pm
D’you know, I was about to come on here and go “Ahhh, you never forget your first one…” but after a phone conversation with the paramedic that I observed my first arrest/body on earlier tonight, it turns out you do. They just all merge into one, I can remember details, but only because I’ve blogged them.
Life goes on, mate; funny how the ‘glamourous’ jobs seem less desirable once you’ve been to them, though, doesn’t it?
on May 31st, 2007 at 11:51 pm
Ive had four DOAs and in three of the cases CPR was in progress, unfortunately none of the four made it (the fourth was in rigor in the shower so it was damp). Luckily in all four there was none of the “three” you mentioned above!
on June 1st, 2007 at 8:43 am
I’m a neighbourhood responder, and we have the same jolt every time the pager goes - half hoping to have to resus some poor soul, but secretly grateful if it’s Mrs Wobbly fallen off her commode again. I’ve attended three suspended, two as first on scene, one attempted (but hopeless) resus. Definitely NOT glamorous for anyone involved. A successful resus might be exciting but as poor neenaw has discovered in reality purple mostly means dead, not ‘waiting to spring back to life having been defibbed by a hero’.
on June 1st, 2007 at 10:53 am
I had a similar feeling on my first resus (although this was a working resus/code/suspended)
I had thought doing CPR on a person would come with strange feelings - it didn’t - but what I wasn’t prepared for were the feelings when the lead paramedic said “ok, cease resus, we’ll call it there.”
Doing something is easier that not doing something - sitting back on your legs and realising they ain’t gonna get up (and they’re someone’s mum/dad/etc).
on June 1st, 2007 at 3:21 pm
Your first dead body is always tougher than you ever realise. You get told to remain detatched, but how can you when you have the relatives looking at you expecting you to do a’casualty special’ and resus them, even when its obvious its just too late
Life really is not that peachy, great though it would be if it was. (I used to work in an a&e unit, many years ago)
When its the other side though and you are watching the paramedics tying to resus someone you love, its much much worse. Maybe thats why I can’t detatch? Because I saw my son die, nothing that could be done, but it was hard to see the paramedics shake their heads and say it was too late for him, I wanted to shake them and hit them , make them save him, but all the time I knew deep down that it was no good.
Sending you a hug neenaw, tough call xx
on June 1st, 2007 at 8:40 pm
Emma
So very sorry to read about your son. I’m sure you know deep down that if there had been the slightest chance he could have been saved, the crew would have done all they could.
Your comment about wanting to shake and hit them though is actually not that uncommon. It’s reminded me of a post I really should write on my blog, which I’ll do tomorrow.
on June 1st, 2007 at 11:40 pm
I recently saw my first dead body, but it was surprisingly OK. I was an HCA with the local Hospice at Home team, and I was psyching myself up for it as I drove us there, but because we knew for certain he’d be dead, and because he’d been expecting his death for several months, it was more peaceful than anything. It was very sad when the patient’s wife and grown-up daughter were crying, but we all knew that he wasn’t in pain any more.
on June 4th, 2007 at 1:53 pm
I had the unhappy experience of finding my father dead one morning while we were on holiday down in cornwall. I didn’t phone for an ambulance, as to quote you, he was purple plus. So I called the police, as he was cold and had been for a while I think.
It was a very unnerving time, I had to deal with the police, let the family know and drive 300+ miles home later that same day and only then could I start to even begin to grieve for my loss.
Each of us are different in the way we handle things, 5 years later I still wonder if I had done things differently would it have made a difference, clinicially no, emotionally maybe… too much doubt for me.
on June 4th, 2007 at 5:39 pm
For ambulance crew, I guess that’s just another day at the office. But for us civilians, that’s an eye-opening read. Keep up the good work…
on June 4th, 2007 at 7:44 pm
Hi Mark
My first experience of of dead person was when I was 17 and lived in the Bahamas. Friends of mine had been called to the hospital to identify thier 9 year old brother who had drowned in a swimming pool accident. As they were only 12, 14 and 17 they asked me to identify the brother on thier behalf. It was something I will never forget. The morgue is not the best best place to see someone you were only talking to the day before. The family never got over it and were beset with problems from that day on.
Gladly I have not hasd to deal with a suspended whilst out on duty with SJA. The only thing close was two major seizures. Both fully recovered.
The guys on the front line must be affected each time they are unable to revive a suspended, probably the worst types being an infant or child.
Hope you do get out and observe but have a better result the next time.
Regards to all out there
Trooper Man
on June 5th, 2007 at 12:38 pm
Well you asked for one, things never seem to turn out the way you think they would. Glad you were not traumatised.
The Driving Instructor
on June 5th, 2007 at 10:19 pm
A definate case of be careful what you wish for…
on June 6th, 2007 at 10:13 am
erm “Treasure” after reading your post I now completely understand why ambulance staff dislike community responders so much.
>>the same jolt every time the pager goes - half hoping to have to resus some poor soul
>>A successful resus might be exciting
>>waiting to spring back to life having been defibbed by a hero
absolutely pathetic is what I think of these comments. I’m hoping I don’t live in the community that you operate your “heroric” (snigger) scheme.
on June 6th, 2007 at 8:31 pm
Be careful what you wish for.
Back in my first observer shifts I was asked what sort of work I wanted. I joked something along the lines of a bus crash with lots of patients… our first job was a school bus crash. Luckily only a few minor injuries.
on June 7th, 2007 at 2:57 pm
Emma, I’m so sorry to hear about your son as well.
And your comments about the “casualty effect” is so, so true! These programs have a lot to stand up to. Similarly, there’s also the “CSI Effect”, which is a huge problem in the US. Named after the TV show CSI, it’s where lawyers, etc aren’t getting the same convictions as they would have been before, because juries have too high a regard for forensic evidence, and too high an expectation of it.
Regards
Nick
http://nickhough.blogspot.com
on June 7th, 2007 at 7:29 pm
OK, might regret this, but Sharon - why did Treasure’s comments offend you so much?
I can well imagine how this feels.. I’m a member of SJA and frankly, to be stood around for hours on duty is pretty dull, and you do wish for a patient to liven things up again - but then you catch yourself and go “christ, no, I’d much prefer it for everyone to be just peachy”, cos no-one REALLY wants someone to suffer for their entertainment. If we wanted people to be ill just for our pleasure, we’d not be giving away our free time learning how to provide first aid - that would be a touch counter-productive!
Neighbourhood responders give up their time for free too, and they must want to practice their hard-learned skills as much as anyone - I think Treasure was just trying to give insight into the way your mind works when you get the radio call/pager bleep that swings you into action.
on June 8th, 2007 at 8:03 am
Oh so you want to talk about the psychology of it all. Ok tell me this, how does it feel when you’ve performed an unsuccessful resus? Still excited are we? OOoohhh look it’s a dead body!! I can just imagine - never mind eh, they brightened up my voluntary shift, got to practice my herorics on a real person, beats sticking on plasters! Only broke a couple of their ribs.
Listen, as someone who works as a health care professional I think it’s damn right shocking anyone should get their rocks off on a seriously ill person - that’s PERSON, another human being, someone’s loved one! They deserve to be treated with respect and compasion. Anyone that sees them as a mere excuse to practice their life saving skills shouldn’t be allowed anywhere near. Find another hobby!
on June 8th, 2007 at 8:03 am
Oh so you want to talk about the psychology of it all. Ok tell me this, how does it feel when you’ve performed an unsuccessful resus? Still excited are we? OOoohhh look it’s a dead body!! I can just imagine - never mind eh, they brightened up my voluntary shift, got to practice my herorics on a real person, beats sticking on plasters! Only broke a couple of their ribs.
Listen, as someone who works as a health care professional I think it’s damn right shocking anyone should get their rocks off on a seriously ill person - that’s PERSON, another human being, someone’s loved one! They deserve to be treated with respect and compasion. Anyone that sees them as a mere excuse to practice their life saving skills shouldn’t be allowed anywhere near. Find another hobby!
on June 8th, 2007 at 10:05 am
Sharon, back to the psychology, I am wondering if one of the reasons that community first responders don’t always articulate their experiences, in what seems to be an appropriate way (and I agree, Treasure sounded a bit ‘over excited’ about attending an arrest.) and they come over as ‘bit high’ to say the least; is because being a trained member of the public and walking in to your first arrest, on your own, is a bloody scary place to be. You only have to read the ambi blogs to see that it’s a common trait of many ‘newbie’s’ to be a ‘bit toooo keen,’ indeed Mark seemed a tad so himself, quote. ‘I’d jump up and down and go ‘Is it a suspended’?
The difference for new crew is that after a job, they spend the rest of the shift with older, wiser and very experienced crew member’s who keep the newbie’s feet firmly on the ground, and help them ‘deal with it,’ in addition they will go to a many such calls in a short space of time and quite simply learn how to ‘get over it’ It becomes everyday stuff for them.
A CFR can be back at home, on their own a few minuets after dealing with an arrest thinking, WTF happened! It is just so out of the range of their usual experience it can be hard for them to make sense of it, it’s unlike any thing else they have ever dealt with.
Yes, there some ‘odd ones’ and they should be weeded out before they even hit the training room; but for each one of them, there are many, many more who are quite simply trying to help to save lives in their community. The defibrillator isn’t ‘what it’s all about’ at the majority of calls (and I would lay blame for ‘shock box cures all’ culture partly on TV drama.) CFR is, for the vast majority of responders, simply about being a good neighbour and in my view the worlds a better place for that.
So please don’t ‘tar them all with the same brush.’
on June 8th, 2007 at 8:58 pm
I take 999 calls as an EMD - we find ourselves getting bored during quiet spells, waiting for someone to need an ambulance and pick up the phone to ring us. But we don’t really WANT someone to be ill or injured - but as we are trained and paid to assist them when they need us, we might as well be taking that call. Does that make us bad?
We all know the statistics - most of the patients you attempt CPR on will not live. Doesn’t mean we don’t try though does it? Dealing with many unsuccessful resus attempts (and all the other types of calls), whether road or control staff, are outnumbered by that one person who survives. Hearing a not breathing baby start to cry and wake up, or a Polish chap being helped by his Polish friend with limited grasp of our CPR instructions over the phone and making it to hospital and recovering, beats all the ‘unsuccessful’ jobs. So what’s wrong with wanting the chance to try to help?
on June 9th, 2007 at 2:27 pm
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on June 10th, 2007 at 10:18 am
Sharon - I know your comment was directed at treasure, but since I’m guilty of being a bit overeager to see a suspended, I thought I’d reply to. The way I see it, it’s not that I want horrible things to happen, but I know they do happen, and I want to be there to see it, to see what the ambulance crew actually do when they are on scene. Having taken many ’suspended’ calls, I just want to know what happens next. I want to go to the serious calls rather than the minor ones because that’s when I really get to see the crews using their skills, and that’s when I will really learn something. The same will apply when (if!) I am one of the crews, and I imagine it’s just the same for community responders. I read Treasure’s comment as being ‘gallows humour’, not as someone who seriously wishes that people would die to brighten up her day.
on June 10th, 2007 at 10:57 am
Spot on Mark, I was going to say you can study and train till you are ‘blue in the face’ (maybe not such a good choice of words) but sadly nothing teaches you more than ‘hands on experience.’ I say sadly because in terms of CPR that means some one has died, a fact of life/death.
Now you have at least seen what you spend your day talking about!
on June 11th, 2007 at 11:28 am
In response to Treasure’s and Sharon’s comments:
I understand where both of you are coming from. For CFRs and newbies you always jump when the phone rings or the pager goes off and there is that feeling of ambivalence – one part of you wants it to be a juicy job (a bit of trauma or a suspended), but deep down you want it to be Mrs Smith who’s fallen over again and needs putting back to bed. However, it is only natural that you want to attend or at least observe some challenging jobs, because you want to gain experience and learn how to deal with that situation in the future.
As Sharon points out, no one should get pleasure out of someone else’s pain or misfortune. Unfortunately, for a CFR/EMT/paramedic to have a good day, some other poor soul has to have a bad day. But that has been the order of things for many years. It is important however, that once you have dealt with “that job” you reflect on your experiences in the correct way and learn from it – and don’t expect to revel in glory, because most days when those defib pads come out, you’re not going to win.
on June 11th, 2007 at 5:22 pm
Er- am I the only one who can see that the comments were quoted grossly out of context? The first part- sorry, I think everyone who does on call hopes that when they are called it’s for something that they aren’t going to feel annoyed about answering (and yes, if it’s something someone could have sorted out without waking me up at 4am then I do fume to myself. Like this morning. Because I then have to go and work an 8 hour shift, and I did one the day before, that means I am now Very Tired).
“A successful resus might be exciting but as poor neenaw has discovered in reality purple mostly means dead, not ‘waiting to spring back to life having been defibbed by a hero’.”
That was the full sentence. A successful resus IS exciting; you get an adrenaline rush, the family are excited, the patient’s life may have been saved, it is a Good Thing. There is nothing wrong with that.
The second part of the sentence- that in reality, purple = dead. That means (and here is where the punctuation is important) that the person is:
“not ‘waiting to spring back to life having been defibbed by a hero’.”
It was a parody of Casualty scenarios: the ‘dead’ person is resuscitated, the paramedic is a hero, it’s all fine, the end.
I have never seen such wilful misreading of anything in my life.
on June 12th, 2007 at 10:48 am
>>I think everyone who does on call hopes that when they are called it’s for something that they aren’t going to feel annoyed about answering (and yes, if it’s something someone could have sorted out without waking me up at 4am then I do fume to myself. Like this morning. Because I then have to go and work an 8 hour shift, and I did one the day before, that means I am now Very Tired).
Claire, I wouldn’t comment on others use of punctuation unless your own is up to scratch (I won’t even start on your grammar)
Adrenaline is a natural reaction, the excitement we’ve been speaking of is entirely different. Perhaps it is you that has in fact misread the previous comments.
Betterlate - I’ve read your reply and totally agree with you. I apologise for bad mouthing CFR’s, I agree there is a place for them and they do a good job, it’s just the unprofessional attitude of some that I find goading.
In the real world of emergencey response, crews don’t get excited driving along on blues and twos, they don’t get a rush of excitement and glee that they’re on their way to a cardiac arrest and they certainly don’t consider themselves heros at the end of it. If you worked in the ambulance service with that attitude, you would soon have it knocked out of you believe me.
on June 12th, 2007 at 11:31 am
Sharon, I think we have reached full agreement, yes there are a very small minority who are unprofessional, that let the side down and it is a sad fact they will attract more attention than those who are just quietly getting on with what they do.
( Now I am worrying about my grammar and punctuation, never mind I shall publish and be dammed!)
on June 14th, 2007 at 8:26 pm
That’s it, this discussion has degenerated into grammar dissection. Next some will call someone else a Nazi, and then it’ll all be over. This thread will spontaneously combust in sixty seconds.
on June 19th, 2007 at 12:17 am
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on July 5th, 2007 at 12:53 pm
I love reading your blog Mark, it’s great too see how the other side of the ambulance service works.
I’m a CFR who, like yourself was always waiting for ‘that’ call to come through. I’m not morbid, I don’t get excited about the prospect of seeing a dead body but I wanted to attend a cardiac arrest call. Not because I wanted to be a ‘hero’ and try to save someones life, but becaue I wanted to see a seious case so that I could get a view on the reality of the job.
I had to assist with CPR for the first time last week, the patient died. Even though I didn’t know her, she made a difference to my life. Now I know that I can handle death and I can focus in a an emergency and I will always be gratefull to her…sounds weird I know.
Anyways, I’m absolutely s******g myself about when the next call will come.