tearing through the streets with blue lights flashing and sirens wailing. All we know is a name, an address, and the fact that the patient is having difficulty breathing.
Stefan, Sina, and I pull up outside a house. I grab my emergency backpack and the mobile oxygen cylinder, while Stefan takes the ECG machine.* We head straight for the front door of the house. I am buzzing with motivation; nothing can stop me now. Well, almost nothing. My mission comes to an abrupt and premature end when, in my boundless enthusiasm, I run headlong into the locked front door. Steady now! Ring the bell first. A light goes on.
‘I’ll be right with you,’ we hear the voice of an elderly woman from inside. Through the glass door, we see the silhouette of a human figure. She’s hunched over and walks very slowly. ‘I won’t be a minute,’ she says through the frosted glass. We wait. I’m charged like a live wire, but I can’t help but be impressed by the sense of calm emanating from the woman behind the glass.
Finally, we hear the sound of the door being unbolted, and a lady with a snow-white perm opens it. She smiles. ‘Do come in,’ she says politely and ushers us inside.
‘Did you call an ambulance?’ asks Sina.
‘Yes. My husband’s in the living room. He’s having trouble breathing again,’ she sighs.
Weighed down by all my equipment, I trot after my colleagues down a dark hallway and into a barely brighter living room. The window blinds are half-lowered, and the flickering television screen is the only direct source of light. The furnishings in the room are old-fashioned — probably older than I am — but well cared for: a dark wood shelf unit, holding a few books and china plates; the television next to it; a coffee table with a brown-tiled top; and a couch, where a man aged around 75 sits, his face bright red. He is clearly struggling to breathe.
While I switch on the light, Stefan introduces us and immediately turns his attention to the patient. ‘You called us because you can’t breathe properly? When did this start?’
‘I …’ he gasps with difficulty in response, ‘I was just getting up from the couch, when …’ He pauses for breath. ‘It was as if I was being strangled.’
In the background, I prepare the oxygen supply. I have two ways to give the patient this life-saving gas: via a mask placed over his mouth and nose, or via a nasal cannula. The latter is a plastic tube attached at one end to the oxygen cylinder, splitting into two branches at the other end. Oxygen flows out of the branches, which are placed in the patient’s nostrils. The amount of oxygen flow can be controlled by a valve on the cylinder.
I try hard to remember what I learned in training. Six litres per minute is the maximum amount to administer through a nasal cannula. Otherwise, the membranes inside the patient’s nose are in danger of drying out. And in his condition, our patient has enough to contend with without that as well. After all, the oxygen is supposed to aid breathing, not make it harder. I could also opt for the mask. But then he will need at least six litres, or there’s a danger the patient will not get enough of the oxygen. I waver. I might not give him enough oxygen through the cannula, but patients often find wearing a mask uncomfortable. After much consideration, I decide the patient will just have to deal with the discomfort of the mask.
Stefan ascertains the man’s medical history and symptoms. ‘Are you in pain, and if so, where does it hurt?’
‘Here,’ the man wheezes and points to his chest, on the left.
‘Do you have any allergies?’
‘No!’
‘Do you take any medication regularly or have you taken any today?’
‘No!’
‘Do you have any other medical conditions?’
‘Yes, diabetes.’
‘Type 2?’
‘Yes,’ he coughs, ‘type 2.’
‘Do you take insulin?’ asks my colleague.
‘Oh, yes … but just a little injection before each meal.’
Aha! This is something I was warned about in training, and now it’s happening during my very first call-out. It is in fact extremely common for patients who take regular medication to deny it with full conviction when asked. I can’t offer any explanation for this. It seems as if, for many people, taking medication regularly becomes routine, like brushing their teeth every morning. So they consider their pills, or even the contents of a syringe, no differently from the spoonful of sugar they take in their coffee or tea. It is certainly not deliberate deception on the patients’ part — but in an emergency situation it can be deadly dangerous.
Stefan continues to question the patient about his medical history. ‘Have you ever had difficulty breathing before, or have you been ill with anything other than a cold and your diabetes?’
‘No, just diabetes!’ answers the patient resolutely.
Yet suddenly, as if from nowhere, his wife joins the conversation. She has slowly but surely shuffled down the hallway into earshot. ‘Tell them about your angina!’ she shouts. ‘Angiiiiinaaaa!’
With a slightly annoyed roll of his eyes, the elderly man tells us he was diagnosed with angina pectoris* two years before, but no longer takes medication for it. He reports intermittent difficulty breathing, but says it always went away again and has never been this bad.
While Sina places the blood-pressure cuff on his arm, I offer him the oxygen mask, which he literally snatches from my hand and presses over his mouth and nose. I decide to begin with eight litres per minute. Using a pulse oximeter attached to his finger, I measure the oxygen saturation of the patient’s blood. It seems pretty normal at the moment. But the man’s blood pressure and heart rate are both high. This may be due to stress, or it could have a much more serious cause. Chest pain, breathing difficulties, and heart problems in the past — all the alarm bells are ringing.
My colleague takes an ECG reading while I prepare an infusion. As soon as the first lines appear on the ECG, our suspicions are confirmed: it’s a heart attack!
Less than two minutes have passed since we arrived, and the patient’s condition is rapidly deteriorating. He’s having increasing difficulty breathing, and although I have turned the flow up to maximum, the oxygen saturation of his blood is plummeting. My colleagues do everything in their power to help him, while I feel rather at a loss. I follow my colleagues’ instructions, preparing a needle and antiseptic for an intravenous catheter. As Stefan prepares to insert the needle, the man, now pale and blue-lipped, looks at me with fear in his eyes. His blood pressure is falling, his ECG is becoming ever more erratic, and the atmosphere is growing ever more sombre.
Sina speaks to him, trying to reassure him; the man never takes his eyes off me. His look screams, ‘Help me!’
This is the worst feeling of my life so far. Inside my head, there’s complete turmoil. What else can we do for him? Did my grandfather suffer like this? The man’s gaze seems to pierce right through me. For a brief moment, I have the feeling that it’s my own grandfather looking at me. Then, all of a sudden, the old man keels over to one side and loses consciousness. Before he can slide off the couch, Stefan catches him and lowers him carefully onto the carpet.
A quick check: breathing — yes; conscious — no. Place the patient in the recovery position and prepare to unblock the airways by suction if necessary; I remember my textbooks, and act accordingly. Get suction pump out of the rucksack, attach suction tube. A quick test and we’re all set. If the man should start to vomit, I can quickly jump in with my pump.
The man’s wife sits silently on a chair by the living-room door. We hear the howl of a siren coming from outside: the emergency doctor has been called and is on his way. Thank God for that! Sina asks the lady to go open the door. Just as she leaves the room, it happens: there’s a piercing beeping noise, and the lines on the ECG begin to jump crazily. Ventricular fibrillation! A condition in which there is rapid and uncoordinated contraction and relaxation of the muscles of the ventricles of