By Eugenia Klopsis
The New York Sun
Copyright 2007 The New York Sun, One SL, LLC
All Rights Reserved
Editor’s note: Klopsis is an emergency medical technician on an ambulance in Brooklyn. This column details her observations and experiences. Some names and identifying details have been changed to protect the privacy of patients.
Playing “I Spy - Spring” while driving through a grassy stretch of Canarsie, I spot a crocus and Bronson spots two tulips before we get a call to back up medics on a cardiac. We’re the first to arrive at the attached brick house with a dented aluminum awning over the porch and three daffodils on the lawn. A woman in her 30s lets us in, telling us her mother isn’t breathing. “We lost Dad a few years ago, and ever since then her blood pressure’s been a problem,” she says. The woman seems remarkably free of anxiety.
“You seem very calm,” Bronson says.
The woman leads us up the stairs to a bedroom. “Mom has a DNR.” A Do Not Resuscitate order is a form many elderly people possess. It instructs emergency workers to let them go with a certain amount of dignity should they suffer large heart attacks - telling them not to insert invasive breathing tubes down their throats or perform CPR. “My brother panicked and called you,” she says.
Inside the bedroom, a 40-ish man stands by the old woman’s bedside, his face tear-streaked. We check out the woman. No breathing, no pulse. But no rigor mortis, and no dependent lividity - the woman passed away quite recently. Ordinarily, we’d work her up. “Where’s the DNR?” I ask.
The daughter produces one from her mother’s bedside table. But the son is adamant that we start CPR, an aggressive method for trying to sustain circulation in the dead until the medics can use more invasive methods. He is equally aggressive in demanding that we perform them. He’s big, and we call for PD, an EMS lieutenant, and start working up the woman. When faced with a dilemma, and a man with a big fist, you err on the side of saving your own skin. The patient is dead, and the dead don’t know Brooklyn.
Bronson delivers chest compressions, and I bag with supplemental oxygen.
The daughter is protesting: “Dwayne! Mama said to let her go!”
The son is punching the wall and crying. “Bring her back!” he shouts.
Medics arrive, and we explain that there’s a valid DNR, but that the children are against each other.
“Err on the side of life, huh?” one of the medics says.
“Yeah,” I say. “Ours.”
PD and the EMS lieutenant arrive, and the decision is made to continue resuscitation attempts, bring the patient to the hospital, and let the hospital staff pronounce her. The medics rip out the woman’s dentures, jam a tube down her throat, hook up the EKG, start an IV, and push a few vials of liquid drugs. Then we carry her down to the ambulance. We want to honor a patient’s wishes, but when a family member protests the DNR, we’re obligated to attempt to resuscitate the patient. I personally don’t agree with this, but like I said, the dead are dead, it’s the living who have to go on, and they usually go on better if they think that everything had been done to help their loved one.
At the Kings County ER, I’m washing my hands in a filthy sink with lukewarm water and Bronson is tearing off a copy of our paperwork to give the desk nurse, when the daughter comes up to us. We brace ourselves.
“I’m sorry for that,” she says. “But I wanted her to die with dignity.”
We say we understand, that it was a tough situation.
Outside, her brother is leaning against the brick wall of the ambulance bay, his head in his hands. “Uh-oh, here’s the other one,” I mumble to Bronson.
He stands, approaches us, and apologizes. “Sorry,” he says, “but I couldn’t let her go.”
We say we understand, that it was a tough situation. Then we hightail it out of there.