The Visitor

Marian Durell awakens quietly to the familiar red numerals on the old alarm clock that once prompted her to get up for work. It’s nearly 5, yet she’s exhausted. She’s been helping Harry, her husband of 60 years, through a long battle with lung cancer, and she sighs before rolling over to check on him.

Something’s very wrong. The old man is warm, but he’s oddly still, and there is no hint of his noisy breathing. She grabs his shoulder and half-calls, half-asks his name. Harry. Harry?

The old man’s been in agony throughout the past month, and suffering in the months before that. Marian has been praying for this moment, and a hospice worker has tried hard to prepare her for it. This would be a peaceful, private time, he had said, and perhaps a time for tears. But that’s not how it feels at all. She should be doing something. She enters three digits.

Three firefighters arrive, then two paramedics. They appear to be listening when Marian says terminal lung cancer, hospice, advance directive, do not resuscitate. But hospice has the document, and in this state the responders must see the original signatures. Despite the old woman’s tearful protests, they drag Harry down the hallway, clear the living room and begin running a code.

Q. We hate these calls. None of us wanted to resuscitate this old guy. We found him in asystole, but he had none of the signs of obvious death listed in our protocols: rigor, lividity, evisceration of vitals, incineration, decapitation, decomposition. The old lady was pleading with us—holding her hands as though praying to us and begging us to stop. What were we supposed to do?

A. I know just how you feel. The answer sounds obvious; but when you’re a stranger in somebody else’s home, your smallest assumption could become the mistake of your life. People have a right to live, and they have a right to die. We’re supposed to ease their suffering, not prolong it.

Q. That’s what I’m trying to tell you here. We get it! In this case, the hospice simply didn’t do their job. The original document was supposed to be accessible to the wife, and she should have been prepared for this. Not only that, but if people don’t want us to resuscitate, why do they call 9-1-1?

A. You may not believe this, but as tough as it is to be an EMT, some folks’ jobs are even tougher. Pediatric oncology nurses, for instance. Burn care nurses. CNAs, and certainly hospice workers. A hospice worker once told me that no matter how well you prepare someone for the end of a spouse’s life, you can’t predict how they’re going to do when the time comes.

Q. It just seems like we keep getting overlooked in the whole process. When you think about it, each of these survivors has one or more physicians, a hospice, a preacher, an advance directive, and family members to support them and prepare them for death. And still they call 9-1-1. It just doesn’t make any sense.

A. I used to feel the way you do, until I was faced with the death of someone I loved. As comfortable as I am with the end of life in strangers, I never anticipated how it would feel when it happened in my own home. It changed me, and I started seeing EMS as part of that list of potential supporters.

Q. What on earth are you talking about?

A. I think we can do two things to make this better. One is to contact the hospices in our service areas and invite them to include us in the support of families who are expecting  deaths. We don’t spend 100% of our time running calls. What if we were to take a few minutes to visit the homes of these folks in advance, sit down with them, tell them what to expect if they call 9-1-1, and explain to them what we do? Then, if they do call, we could arrive as friends rather than intruders. It would certainly take some of the awkwardness out of that ultimate moment for people who don’t see death more than a few times in their lives. It would also ease their fear and facilitate the death notification process for us.

Second, there was a good reason why most of us started calling our medical advisors “medical directors.” Death visits every one of the people we serve. As systems, we should be planning for that.

Not just hoping it won’t happen on our shift.

Thom Dick has been involved in EMS for 40 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a
member of EMS World Magazine’s editorial advisory board. E-mail boxcar_414@yahoo.com.