People With Stethoscopes

Meghan W. appreciates EMS. She told me so almost every time she served me a burger and beer at a popular downtown tavern.

I'd stop in after work once or twice a month, just to get away from pagers, Plectrons, sirens and supervisors. When Meghan was there, I got the best seat in the house—the one by the picture window. It wasn't because I was a regular customer or a big tipper; Meghan thought my partners and I had saved her mother's life.

If only that were true.

Meghan and I first met on a mild May evening on the mean streets of metropolitan New York. It wasn't the best of circumstances; someone had just shot her mom. That's one of the reasons I can't use Meghan's real name.

I was part of the second crew to respond. We weren't requested, but we heard the alarm and we were ALS—well, mostly. I had almost finished paramedic school and was hanging around headquarters when one of my former preceptors invited me to ride along. I haven't met many medic students who would say no to that.

On a chaos scale of 1 to 10, where 10 has something to do with nuclear winter, our scene was about a 4. There were cops, family members, neighbors and seven or eight EMS providers. The victim was conscious and supine on the second floor of a house that would have been characterized as "distressed" by an honest but politically correct realtor.

I found two EMTs cutting away the clothing of a petite 40-ish brunette, looking for entrance and exit wounds. Another crew member had been sent back to the ambulance for a long board and cervical collars.

EMS had been on scene for a little more than 10 minutes when the ALS crew chief asked one of the first responders for the patient's vital signs. The search for penetrating trauma ended abruptly. "We're working on it," was the reply.

Partial vitals were announced as an empty backboard was propped up against a wall at the top of the narrow staircase. The patient was tachycardic and tachypneic—perhaps 120 on the pulse, with respirations close to 30. She kept turning her head from side to side, silently surveying the commotion. Breathing must have been a higher priority than speaking.

Someone wrapped a collar around her neck, and I helped roll her onto the spine board. Half of one belt was missing. We improvised with a cravat. A non-rebreather mask was placed loosely between the head blocks. It fell away as we maneuvered the loaded long board down the stairs.

Meghan was waiting at the ambulance. Our eyes met. I expected her to ask questions I didn't want to answer, but she just stood there, remarkably composed. Someone suggested she meet us at the emergency room.

En route to the hospital, Meghan's mother remained conscious, but only her femoral pulse was palpable. There were three IV attempts (the successful one wasn't mine). It was crowded and dangerous in the back of that ambulance as we chased the last traces of the "golden hour."

By the time we arrived at the ED, our patient was in severe respiratory distress. Our crew chief made a brief presentation to the attending physician as the victim was wheeled into one of the treatment rooms. The five of us who had accompanied transport gathered in the reception area to write reports and await word from the trauma team.

The news wasn't good. Meghan's mother had a collapsed lung and was paralyzed from the chest down. A small-caliber bullet had entered under her right arm, ricocheted off the thoracic spine and lodged beside the left scapula. You didn't have to be a radiologist to read that x-ray. The signs of shock—tachycardia and absent distal pulses—were apparently caused by a developing tension pneumothorax that was compromising cardiac output.

Our return trip to base was neither somber nor introspective. It was more of a gripe session.

"We didn't call for you guys."

"Dude, how could you miss that bullet hole?"

"She was supposed to go in the other bus."

"I thought I was driving."

"Next time don't tell me what to do. I know what to do."

I don't remember any discussion about providing oxygen, checking lung sounds, evaluating neurological deficits, replacing or repairing defective equipment, monitoring vital signs during transport, assuring BLS before ALS or minimizing on-scene time.

I waited many months before returning to Meghan's pub. Meghan greeted me with a hug. "I never had a chance to thank you," she said in a voice barely above a whisper. "I was so scared, but when I saw all those people with stethoscopes, I knew we'd be OK."

I didn't tell Meghan that her mother survived despite our care. Conscience-cleansing would have been self-indulgent, I convinced myself. Truthfully, I was ashamed I had not lived up to Meghan's expectations. Had I confessed to her, I think we both would have suffered.

That call taught me to value quality over quantity in EMS. I learned to appreciate partners who critiqued their cases, accepted responsibility for errors, tried to better themselves and suppressed personal agendas. Such practitioners understand what my crew and I did not on that spring evening long ago: The public has to trust people with stethoscopes.

Mike Rubin, BS, NREMT-P, is an EMS educator and consultant based in Nashville, TN, and a member of EMS Magazine's editorial advisory board. Contact him at mgr22@prodigy.net.