Eyes Dark as Night

A loud noise awoke me with a startle, the tone reverberated from my ears to my head creating a ringing that eventually creates your heart to skip a beat each time it is rung.  The lights were out, and the windowless room was unrevealing to the current time.  I began to breathe deeply though my nose repeatedly which normally signifies I have had less than 4 hours of sleep which as a young paramedic student was an often occurrence.  I sat up quickly placing my face to my palms while my hands moved upward dividing my hair as if it was an oversized comb.  I gripped and tugged at the ends as I took another long exhausted breath.

Having slept in my pants to save time,  I felt for my bulky scissors and hemostats in my right pocket along with my Advanced Cardiology Life Support (ACLS) book and what I had come to call my “pocket Jesus” in my left. My lower left pocket held my tool to open the oxygen bottle just in case it was not opened at the beginning of shift.  My 8 pockets on my medic pants had strategically placed gear ensuring I would be ready for any situation. I placed my feet into my oversized SWAT boots and left the zippers undone as was habit. I reached for my shirt hanging on the wall and quickly buttoned it up as I have done many times before without the requirement of thought.  Then I threw my sweat shirt I regularly and proudly wore that read “BYU-Idaho EMS,” over my shoulder as I opened the door to my room and began walking towards the ambulance.  The call was read over the intercom from dispatch which gives a short time for my mind to allow me to guess what it might be.  Could it be shortness of breath? A young student wanting to commit suicide again? Or something I fear worst a pediatric accident, or obstetric complication.  Regardless the chief complaint (CC), we will go anyways.  The CC was read, “Full Code” more info was given but I was no longer listening.  I had never seen one as a young student yet.  My excitement grew and my pace quickened, I threw on my sweat shirt as I walked into the frigid garage, placed my beanie to fight the never ending winter in Rexburg, ID.

The crew entered the ambo, and we were off.  With two preceptors up front and myself and an intern in back.  With the sirens becoming white noise we, prepped the equipment and insured charged batteries were in the monitor.  I zipped up my boots which was a rare occurrence (I was nervous), I quickly pulled out my ACLS and reviewed the cardiac arrest algorithm.  Then I repeated to myself.  2 minutes compression, Shock, EPI, 2 Minutes, Amioderone (if VFib/Tach), 2 Min, advanced airway.  “I got this” I say to myself bracing myself for the excitement to follow.

We arrive, to a nursing home and was pointed in the correct direction.  As we approached the room my respiratory rate (RR) increased, my heart rate (HR) quickened, and my pupils constricted narrowing my vision.  My sympathetic nervous system became profoundly apparent and welcomed as I find adrenaline to be a drug for me.  We entered the room   to find an elderly adult, his mouth was open, and no one was performing CPR which I thought was odd.

We walked to the body and I began chest compressions without a second thought.  I felt each of his ribs break beneath the power of each compression, “PoP…pop..Pop..” until there were no more to breaks and I pressed firmly on a floating sternum again and again and again.  The defibrillation pads were attached, “I’m clear, you’re clear, are we all clear?” the precepting paramedic asked?  We all stood back as we looked down.  The body jumped, chest contorting outward with an inhuman arching of his back, “Shock delivered, resume CPR” This process was repeated again, and again.  The endotracheal tube (ET tube) was placed and with me covered in sweat and with complete regret for wearing a sweatshirt indoors I was gratefully accepted the assignment to ventilate the patient (Pt) with the bag valve mask (BVM) so my aching back could get a break.  Every six seconds I remembered from my ACLS algorithm, though there was no counting correctly during this situation.  An experienced staff showed my learning mind that all I needed to do was look to an attachment on the ET tube which showed a red light with flashed every 6 seconds.  Made things simple.  The code carried on and things started to become familiar or routine.  The light would flash I would squeeze the bag, flash… Squeeze…  Looking for this flash caused me to continuity hold my gaze towards the Pt’s face.  Flash… Squeeze… my eyes were drawn to his.

 

Time and perspective change for me when I did this, my thoughts calmed as did my HR and RR.  His eyes were held directly towards mine, but not holding any type of focus.  It was as if he was looking right through me.  His head continued to bounce from the continued CPR.   As I stared into his eyes it was a majestic darkness that I could not look away from.  The pupil and the iris shared the same midnight black color.  The sclera seemed to have each blood vessel pronounced to the point that white was no longer the prominent color.  The longer I stared the more I was mesmerized.  As I stared at the eyes I saw the patient's (pt’s) eyes change position with a 3mm shift to the left.  The movement startled me and made me jump a bit then chuckle.  It made me think of the scene in "Empire of the Sun" when CPR was being performed.  The code was called after 45 minutes. We called the physician and the patient was pronounced dead.

I looked back down at his eyes one last time to commit that time to memory.  I then took my gloved hand and without realizing it attempted to close the Pt's eyelids.  As the eyelids went down and closed my hand left the restricting touch, then they "popped" right back open showing the same eye I described previously.  Again, I was startled and the experienced medics and EMTs that were cleaning the mess we made began to chuckle, stating, "you watch too many movies." Which, apparent to my ignorance was indeed true.  I have tried this on several of my deceased patients, all had the result. It is the remembrance of his eyes, the inability to focus, and how they were dark as night that has not left me and I suspect never will.  We returned to the station after the events of the code with enough time for an hours sleep before we were due to rise.  I pondered on my experience for that hour until it was time I left shift for class (which I totally slept though).

I have had numerous experiences such as this since that time.  Even to the point that I rarely feel remorse post the death of a patient since I do not normally have an emotional attachment to all my patients. 

I recognize that when it comes to healthcare, most medical providers are calloused, emotionless, and overly direct. However, we do this mostly for our sanity and self-preservation. After a call, the medic students and I would gather and joke about what we had seen. We hold calls of trauma as trophies that we would display for each other through our stories. They always seemed to end in laughter.  In my defense it is much easier to joke about a call rather than to allow emotion to creep into my heart from an emotionless relationship with a patient.

Following my last semester (2012) in Rexburg, ID we had approximately 800 hours of experience, all we had left was an internship in Oklahoma City, OK.  Before then we had a 6 week break.  I returned home to Mesa, AZ where I was born and raised.  I was reunited with friends, time was spent shadowing providers for exploring graduate opportunities.  Life was going easy on me, and it was good.

One stormy night I received a text from a good friend inviting me to go cliff jumping at Saguaro Lake.  I “jumped” at the opportunity, myself and a girl I had taken out a few times met off the freeway to carpool the rest of the way to the lake.  When we arrived it was a cloudy night with thunder and lightning flashing consistently though the sky, but there was not a drop of rain.  Monsoon season is absolutely fantastic in AZ. I was led by a friend named Buster (yes that is his name) to the very edge of a cliff that I had never jumped before.  He explained that it is about 40 feet high, I would need to jump out strait as far as I could to avoid the rocks at the bottom.  I approached the edge, looked down, and I saw darkness only to be revealed with intermittent flashes of light from the dry thunderstorm.  I took a look over the horizon of the lake at the cliffs edge, a strobe of lightning stretched across the sky. Another repeated, again, then again.  It was an absolutely beautiful sight to see.  I took a look back down, my respiratory rate increased as did my heart rate, my vision narrowed as adrenaline began to pulse though my veins and increase with each beat of my heart.  I thought of my situation, lightning and water (not advisable). Jumping off a cliff into water that I cannot see and never jumped off before (again, not advisable).  At that time I remember having a very distinct feeling that I have never felt since.  I could not pinpoint the feeling, I did not feel my safety was threatened or the feeling one gets at the beginning of a new relationship.  I like to think it was the addition of a new guardian angel.  I took another look down into the nothingness, and jumped.  The hang time seemed especially long, I took my breath far too early as I did not see the bottom, then splash.  I came to the top and let out a yell as I often do when my adrenaline is pumping.  Time went on and we started to head home. 

My date and I were forming other plans as my phone blew up with texts, missed calls, voicemails.  I was on a date though and did not want to check them in front of her.  As my phone continued to vibrate, I raised an eyebrow of concern to the abnormality of the situation.  She commented with, “Dang Mr. Popular,” I blew it off casually masking my concern.  I picked up my phone and checked the first text.  It was from Bishop Denton who I worked out with several times a week and consider a good friend.  It read, “I heard about Brian which hospital are you guys at?”  My eyebrows lifted before I could continue to investigate.  Before I could read another text my father was calling.  I apologized to my date and told her I was going to take it. 

      “Hello?” (Long pause)

      “Stephen… We lost Brian.”

There was a pause of tearful sobs, my thoughts began to scatter. Then softly respond as emotion entered my voice.  Not truly understanding the gravity of the situation but recognizing that emotion was a rare occurrence from my father, something dreadfully wrong. I subconsciously knew the answer to the next question.

                 “What do you mean lost, Dad?”

                 “Brian, passed away…”

Followed by another pause of sobs and tears from my father. I immediately thought of training as a paramedic and how we are never supposed to tell a patient a vague answer that could be subject to misinterpretation such as what I had been given.  My pulse quickened, respiratory rate increased, pupils narrowed, irrational thinking, and light tremors in my hands.  The response I gave my father did not reflect my thoughts or physiologic changes.

                “Oh no, it can’t… Where are you?”

                “The heart hospital, do you know where that is?”

                “Yeah… I will be there as soon as I can.”

I don’t actually recall the words previously said, but the conversation was short.  There was also a miscommunication in that conversation.

I explained the situation to my date who at first thought I was joking.  I do not remember what I said or did to convince her otherwise.  I am sure she gave her condolences, my thoughts were racing, in fact overwhelming.  We drove down Bush highway in silence, I don’t even remember dropping her off.  I really should not have been driving.

During my travel to Banner Baywood Heart hospital I received a phone call from a close family friend David Johnson, who had been with Brian that night.  He explained to me that it was a different hospital and all I remember was he had to tell me the directions 3 or 4 times. Breaking it down so a 4 year old could understand where to go (like I said I should not be driving). 

I pulled into the parking lot of the hospital ignorant of any situation, how Brian died or even if I believed him to be dead.  I saw David Johnson standing outside the emergency rooms entrance in a skin tight white shirt, short blue shorts with black underarmor extending past his shorts, and (a humorous memory) Vibram 5 fingers for shoes.  I walked up to him and he put his arm around my shoulder and asked, “Do you know the end result?”  “Yeah,” nothing else was said. 

I walked into a familiar scene, Doctors sitting at computers, nurses walking to and from rooms and sliding doors common in emergency department.  Dave escorts me to one and it begins to open.  The room is full, I see spiritual leaders, President Toone, President and Sister Cowley, Bishop Denton, then my family.  My father approached me and hugged me, though I did not pay much attention to it, my mother the same, I hardly remember. 

My mind turned, flipped, and the situation changed.  I did what I always did when in a hospital.  I looked to the wall and noticed that there was no bag valve mask (BVM), there was no suction canister, and the EKG leads were spread across the floor with the BP cuff next to them, this was all abnormal and neglectful practice.  They were all in the unemptied trash.  The room became mine, I owned it.  My parents stepped back, everyone else even became a haze in my mind. My medical training pushed to the forefront.  I was perpendicular to my patient approximately 2 feet away, all bystanders at the foot or the far side of the room.  No one was to my posterior, my scene was safe, there is only one patient, and no additional help will be needed.  There was a white sheet draped over the patient leaving only his face and head exposed.  Upon further assessment abdominal (ABN) distention is apparent and disproportionate to the body.  Patient has endotracheal tube inserted with excessive yellowish/green secretions within, securing device in place.  Consider possible esophageal intubation related to ABN distention and secretions.  Apparent signs of rigor mortis present with obvious signs of lividity posterior to ears and exposed neck.  Suspected DOA (dead on arrival). Initial assessment complete. Detailed assessment required.

I took two steps closer to my patient, reaching for my esophageal detection device (EDD) which is kept in my bottom right cargo pocket in the 8 pocket EMT pants I used (I remember how excited I actually get to use it in the field).  I found my exposed leg.  Confused, I then realize I am in sandals.  Then I recognized I was wearing board shorts given to me by an ex-girlfriend, and had on an American flag tank top I made myself from a pattern off Pinterest.   I was not at work, nor is this my patient.  My eyes returned to the person on the hospital gurney with a calm sense of panic. I saw something new from this new vantage point.  His exposed hand with another’s in it.  I followed up the arm and saw Paula Layton.  In my confused condition I was still able to deduce and recall the previous conversation with my father. I looked back to his face, unintentionally focusing on his eyes.  The sclera was outlined by stagnant vasculature showing a dark blue dominance rather than a white back ground.  The iris and pupil were both dark as night.  Just like every patient I have had previously left lifeless on a hospital gurney.  Never had I thought I would ever look into such dark eyes and recognize the face.  My adored brother, Brian.

My heart rate rose, followed with an increasing respiratory rate even to the point where I was unsure I could even breathe, I had never felt this kind of fear mixed with adrenaline and anger.  But still, the tears did not flow.

I grabbed his hair in my fist, then placed my forehead on his.  I remember thinking if I gripped his hair hard enough or pulled on it maybe he would come back.  I don’t remember if I knelt on the floor or even what happened in the near future after that time.

Time became a blur.  Friends and family that were aware of the situation helped us clean Brian and Paula’s home.  During this point things began to settle and the understanding that he would never becoming back began to set in.  As we all were cleaning at 1 in the morning in a home full of people I love, one by one someone would break down and someone else would be there for them.  It hurts and pains me to say but as everyone took a turn in complete and utter emotional agony, I do not remember participating, all I remember was holding back tears the whole night.  When things were completed all we did was sit around, no one really said anything. After some objection, I chose to return to my parents (where I was living at the time) where I could be alone.

                I walked into the front door and did the normal things I had a habit of doing, just slower.  Finally, I sat on a chair in my front room opened up my computer, checked emails, school emails, and then Facebook.  I scrolled out of habit, not looking at anything, really.  Numbness, shock and partial denial were present now that I was not with my family.  Then I looked at my Google voice account (which can act as a message machine).  I looked at previous messages and found one that was from Brian about a week previous.  I hesitated, then hit play.  As it began a weight was placed on my shoulders, I feel to the ground in an uncontrollable fit of tears.  My knees found my chest and I dare not let go.  No, there was no comfort.  Not that night.  In a truly desperate attempt for some type of relief from my despair I found myself falling asleep to, “Pride and Prejudice.”  For the next three nights (like I said, truly desperate).

                I am a paramedic; I have seen death find those who never thought it would come.  In that same light, I never thought it would find me or those I loved most.  But, it did and it has changed me, for the better I hope.

                Two weeks after Brian’s funeral I found myself in Oklahoma City, OK staring though the open double doors of yet another patient whose eyes were dark as night.  Sweat was dripping down my face as I once again regrettably was wearing my BYU-I EMS sweatshirt while performing CPR.  We had just passed care to the hospital staff who decided to pronounce the patient dead after 7 more shocks following the 6 of mine.  The smell of burnt flesh found my nostrils.  I stood and waited for a time as the family was escorted back after the ER room and patient was made somewhat presentable.  I felt their sobs and grief; it felt all too familiar to me.