Stories From the Streets: Part of Something Special

On a recent Tuesday night, I participated in an ambulance shift on one of United Hatzalah’s mobile intensive care units in Tel Aviv. In addition to being a volunteer EMT, I’m a medical student, and in truth I should have been studying for my final exam in organic chemistry. But participating as an EMT on an ICU ambulance is something I love to do; I’ve been a volunteer EMT for six years and ridden ICU ambulances for four of them. I have found being out in the field gives me renewed energy for my studies—it makes me remember why I chose to study medicine in the first place. 

During the shift we had a CPR call. I was with a terrific team of first responders that included Yagel Bar Kama, a first-time driver on an ICU ambulance but an experienced EMT and a wonderful person all around; paramedic Yoni Rosenfeld, who is always ready to teach and instruct others and is incredibly giving and helpful; and Dr. Oren Sagiv, about whom I simply cannot say enough good things. His professionalism and patience know no bounds. His bedside manner is second to none, and he is truly a pleasure to learn from. In spite of my years of experience, I found that with this incredible team, I still learned an immense amount about patient care in the field. 

A few hours into our shift, we received an emergency alert from dispatch for an unconscious person. We rushed to the scene, arriving in less than three minutes. The man was in his apartment, located up four flights of stairs. When we arrived inside we found the man lying on the floor. He was conscious, and as we took an oral history, he responded to our questions. Suddenly he slipped out of consciousness. We connected a heart monitor and saw his pulse was down to around 20. His blood pressure was unreadable. We began treatment and attached him to the defibrillator. We opened an IV line, administered medications, and assisted breathing. 

Over and over again he kept losing his pulse. When we performed compressions it came back, only to disappear again. At one point after the man lost his pulse, I began another round of compressions when the patient suddenly opened his eyes, looked at me, and took my hands off his chest. Then he lost consciousness again, this time for a while. I was impressed by how hard all the first responders fought for this man’s life. There was vomit everywhere, and not a single person paused for even a minute.

From the readout on the monitor, the man was suffering from myocardial infarction in his lower ventricle. Another ambulance arrived, and its team of paramedics attached a LUCAS chest compression system, which began to deliver compressions automatically. After the patient was intubated and stabilized, we decided to get him to the ambulance below—no small feat, as the stairwell was too narrow to bring down the stretcher bed. We had to put him in the elevator in a sitting position while he received compressions from the machine.

As I was the smallest person among the staff of the two ambulances present, it was my job to go with him in the elevator and make sure the machine stayed on target and kept delivering compressions properly during his ride down. This was something way out of protocol—something that happens maybe once a decade somewhere on the planet. As crazy a decision as it was, everyone in that room would do the same thing again if it meant giving the man a chance to live. 

When we got downstairs we turned the stretcher back into a bed and brought the patient to the waiting ambulance. On the way to the trauma center, Sagiv had to push adrenaline numerous times to keep the patient alive. When we arrived at Ichilov Hospital, we transferred the patient to the trauma center and proceeded to disinfect and restock the ambulance. 

We continued with the shift and responded to other calls, but for me that was probably the most dramatic and one of the strangest emergencies I have ever responded to. The man we treated got his life back that night. The next morning I took my exam, and thankfully, in spite of my exhaustion, I passed. On Thursday I went with Sagiv to visit the man in the hospital. His wife was ecstatic to see us and kept thanking us over and over for saving her husband. The man told us he was recovering well and the only thing that hurt was lingering chest pain from the LUCAS machine. May all our CPR patients end up this way!

Learning medicine during the COVID-19 era can be very frustrating, as all learning is now conducted remotely. I have heard from many of my fellow students how frustrated and confused they are by how the material is being taught and the lack of hands-on application. Some of them even feel a sense of helplessness now that it’s exam time, because they feel underprepared by the curriculum. This emergency centered me and reminded me very clearly why I chose to study medicine in the first place. I witnessed a doctor who arrived at a scene that threw a whole series of complications at him, and he stayed cool, collected, composed, and professional and never for a second let the scenario distract him from his mission. He simply refused to give up. I feel like a part of something very special that night.

Ravit Staub is a medical student and volunteer responder with United Hatzalah in Israel.