Journey into Medicine – Asystole

I arrived for my shift in the ER as usual. Sweeping around the corner an open door showed about half-a-dozen doctors and nurses ‘working’ on a patient. One member of staff leg’s straddled his body, he performed CPR and others injected the drugs epinephrine and atropine into his system. Not prepared for this visual image I turned another corner and saw a mother holding her young boy (about 8 I guess), she glared at me, she knew what was happening. The boy had asked questions and wanted to know what was going on. A drunken homeless man offered words of comfort breathing a sweet, rancid smell of stale liquor all over them. She wanted to get out of there.

About 5 minutes later I walked past the room again. This time no-one was there and he lay still upon the bed. My immediate thought was great they did it they saved him and now he’s sleeping. About few seconds later I realized that this was not the case. This was the first dead body I had ever seen. Embarrassed, I walked away not wanting others to know that I had just crossed that threshold and seen someone whose life had ended. It was not time for the boy to see that, so I pulled the door closed.

Several minutes later the EMT asked me if I could give her a hand moving a patient. “Which patient” I said. “The patient in room 64” she replied. I knew that room well, staff referred to it by room number because it was the room where drug-addicts, the homeless and psychiatric patients were held. It has a closed circuit TV screen and a permanently had a strange smell. I never liked cleaning that room as you had to be extra careful of stuff of the floor, bits lying around or patients in handcuffs.

The patient in 64 was the patient I had just seen. She wanted me to help take the body board from under his back, she couldn’t lift him alone. “I guess,” I said. “Put your gloves on”, she reminded me.

My first instinct being so close and actually touching him was how perfectly normal it all seemed. He lay still, serene, freed of his difficult life. He was only one year older than me, a homeless man with blond hair, matted in several places. Catheters had been inserted into his hip; the tubes were still attached to him. His fingernails jammed with dirt and his hands brushed with a thick impenetrable coating of dried on dirt. He had probably not washed in weeks. I wondered how he lived his life, what drove him to live a life on the streets. But I knew nothing about him, perhaps he was happy. I honestly kept expecting him to wake up and say “what’s going on”?

“What happened to him?”, I asked. “Probably just hard-living” the tech told me. I picked up the chart and saw that he had arrived in ‘Asystole’ and he had been found on a sidewalk somewhere. They had done what they could but there wasn’t much else they could have done. So young and alone, his family doesn’t even know where he is I thought. Someone, somewhere, I HOPE, will contact them and let them know that their son is dead. Not from murder or violence, just that his heart stopped. I since learned that he had no illegal drugs in his system, just probably one of those random events that happens at times.

Lifting his body was heavier than I thought. We pulled the body board from beneath him and then zipped him up in the body bag. This was totally strange to me; I found out that patients in a very serious condition when they come in have a body bag automatically placed beneath their bedding. So efficient and practical.The body bag was very much like bedding, white and would be very difficult to detect. My mind was RACING, I just zipped someone up in a body bag.

“Can you help me take him to the morgue?” she asked. M.O.R.G.U.E., the words flashed across my mind. Yes, the morgue which I had wondered about in the past. “I guess”, I replied.

We wheeled him quickly through the ER. It felt like a strange TV show. People quickly moved to the side and I heard someone say “Oh My God”. We showed no emotion as we passed by, I did not look in their faces, I felt oddly embarrassed by it all. The smell of death was already penetrating my nostrils. It was a smell that brought a flurry of memories as I remembered the huge buckets in school that contained animal parts soaked in formaldehyde (don’t ask that’s a longer story, I grew up in the country where agricultural biology was taught to us all). That smell, although unpleasant, took me back 15 years.

We pressed the button of the elevator that only serves the ICU, ER and surgery. The elevator in which the deceased are carried to the morgue. The elevator in which the smell of death was ten times more pungent. The elevator in which I only wished to spend seconds, not minutes, in. The elevator in which I held my breath. It was so small that we could not move the gurney around properly. When we had to pull him out, he got bumped and jostled many times. I still kept expecting him to get up and say “what the hell are you doing?”

It was now that it took a humorous turn. I know NOT funny, just black, tragic comedy. We had to pull him off the gurney and on to the thin, silver morgue cart. He was NOT a large man, actually quite thin, but tall. It was night and the pathology workers were not there. We assessed the situation, applied the brakes and discussed how to best move him from one bed to another. “Should I pull or push?” I asked. “Should I move his legs or his head?” Somehow between the two of us we got him half-way onto the morgue cart. We had to leave the door propped so that it would not lock us in. The prop didn’t work so I had to stretch out my leg and balance as I pulled him over. I envisioned him falling on the floor and what we would do then. Call a team of people to help, trying and lift him ourselves, who knows, it was too awful for me to imagine. We didn’t want to ‘hurt’ him. He was still very much a patient that we treated with the same respect as if he were alive. I thought of his family and we took him on the next part of his life’s journey.

Inside the morgue were five other bodies, it was chilly, dark and smelly. Still it looked EXACTLY like the refrigerators that we had in the supermarket I once worked. There was an odd familiarity about it.

I was glad to leave and was handed his possessions to take to the nursing office. All he had was a social security card and two dollars in change. I saw his name. I was certain that I would always remember that name forever. Strangely I do not recall it at all. I am sure that my mind has blanked it out. Still I will never forget him. I said a prayer as I left him there, I wanted his family to know that he got good care in the final moments of his life. I sealed his items in a biohazard bag and took the Coroner’s paperwork to the office.

We took the bed upstairs wiped it down with germicidal wipes. A few moments later another patient arrived to take his place, oblivious to the life that had passed.

** These are based on events, but genders, details and so on have been changed to protect identities. When appropriate consent was obtained.

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