Halfway Down The Stairs

Halfway down the stairs his head rolled back and he stopped breathing.

—–

It was one of our usual types of daytime calls, a person who is housebound calls out their GP for a long running health problem, the GP arrives, assesses them and decides they need to go to hospital. The GP then phones for an ambulance and asks for one in a given time frame.

On some day shifts this can be the sort of jobs we go to all the time. We do so many as a service we have a 'Green Bus' that does mostly this type of call. It works for us because the staff on these ambulances aren't trained as much as EMTs and so their pay packets are smaller (quite a lot smaller I think).

We had been asked to get to this patient within an hour, the GP had told our Control that he had difficulty in breathing. This was our second 'Green' call of the day, something that doesn't require lights and sirens. The flat was only a little way from the hospital but as the patient was housebound and ambulance was needed.

The third floor flat was situated in a really awkward place, big gates stopped us parking the ambulance nearby – they have padlocks on them that we should have keys for, but I've never seen any such keys in existence – I suspect that the Fire Service has the keys though. Due to this we had to park the ambulance 200 yards away from the entry to the flats, not ideal at all.

We were let into the flat by the next door neighbour who does a bit of volunteer care for our patient, as soon as I entered the patient's flat I could taste cigarette smoke, it was so bad my crewmate (who is young and has baby pink lungs) stayed outside.

Our patient was sitting on the edge of his bed smoking a cigarette, he was obese, edging on the weight limit of our carry chair. I'll be honest and admit that my heart sank a little when I realised that I'd be carrying him down three flights of stairs.

It also struck me that this patient was really rather ill, I could hear their bubbly breathing from across the room, the signs of heart failure were obvious and it was plain to see that this patient needed hospital treatment sooner rather than later.

“I'm not going to hospital”, he said between puffs on his cigarette.

Great.

So began the long process of persuading the patient that hospital was their best solution and that they shouldn't really wait for tomorrow when they would be 'ready' for hospital. It was only after I got the GP to phone the patient up again and essentially order them to go to hospital that the patient finally agreed to go.

I sensed that the patient was agoraphobic, he probably hadn't been outside of his house in years. During the discussion to get the patient attend hospital he smoked another two cigarettes.

After gathering all the things that our patient would need we wrapped him in a blanket an strapped him to our carry chair. It was going to be a heavy lift down those three flights of stairs.

The first flight went well, but halfway down the second the patient started to become agitated and complained that he was slipping out the chair – we stopped and checked that this wasn't the case and spent some time reassuring the patient.

Then halfway down the final flight of stairs his head tipped back and he looked me in the eyes. Then stopped breathing.

There is a moment, just a moment when your mind refuses to parse the fact that the person you are looking after has stopped breathing, you just aren't sure and can't quite believe that they have just died.

“He's suspended”, I grunted at my crewmate. By now the effort of carrying this patient down the stairs had sapped me of much of my strength but the shock of what had just happened flooded my system with adrenaline as we flew down the final few steps.

I started CPR, unfortunately the only place that we could lay the patient flat was under a stairwell, it was incredibly cramped – my crewmate ran the 200 yards back to the ambulance to call for help and grab some more equipment, she had to do this again to get the trolley. The running backwards and forwards had turned her cheeks a rosy red.

Our patient had rapidly taken on the pale and waxy colour of the dead.

We worked on our patient, help came in the form of another ambulance and we moved the patient to the ambulance. Doing CPR under the stairs followed by running to the ambulance with the remnants of our equipment caused by back to seize up, at one point it was all I could do to sit on the floor of the ambulance and whimper.

Which gave me plenty of time to realise that the last thing that my patient had seen was my face, with an expression that showed my shock at having them suddenly die in front of me.

The other ambulance crew took him to the hospital, my crewmate travelling with them while I followed up behind n our ambulance. The hospital did their best but there was nothing that they could do.

I sat at the hospital filling out my paperwork while my crewmate restocked and cleaned the ambulance – it gave me plenty of time to sit and think about the job.

It seemed undeniable that our carrying the patient down the stairs had frightened them so much that his, already failing, heart had given out. We'd killed him.

We hadn't had any choice in the matter, there was no way that he could have walked down the stairs, so the chair was the only route. If we'd left him at home he wouldn't have survived the night. If we'd blue lighted to the call it wouldn't have made any difference. There was no possible treatment that the patient could have had at home. There was no treatment that we could have given that we didn't already give.

It was just that person's time to die, sadly not in their own bed but in our carry chair, halfway down the stairs.

22 thoughts on “Halfway Down The Stairs”

  1. Spooky, I have just had an incredibly similar moment tonight, with a woman just deceiding to stop doing all those importand hearty lungy things that I prefer my patients to do.We tried our hardest to get her back, but as you say, it was her time…

  2. This is rather heartless but people have to take responsibility for their own lives, if they hadn't smoked or eaten so much they might not have needed you at all. Perhaps if the GP had provided more info there could have been a better resolution. At least he had proper “skilled paramedics” turn up rather than the green bus driver.ps I hope your back is feeling less painful.

  3. He got his last three cigs in, so he was as happy as he would ever be. Granted that wouldn't have been much, but we only live the lives we can.If the GP hadn't pressed, the pt would have died shortly, alone, anyway.

  4. This will sound facetious but is meant to make you smile:-I ricked my back yesterday dragging a dead teenager along on a blanket – Snow White ate the poisoned apple and has to get dragged offstage by the ugly sisters – it's panto season. Given the state of my back, Snow White will now be swooning then resurrecting long enough to stumble off under her own steam.

  5. It wasn't you that killed him, it was years of fags, not looking after himself and possibily a touch of mental illness. It could have happened when the GP was there, while he was on the loo or, if you had been divereted to another job, to a different crew….not wishing to disrespect the patient but it was a case of pass the parcel, it just happened to be you who heard the music stop.

  6. He had the cigarettes he wanted and he died in company of caring people that tried to help , you and your partner could do no more ! Much better than kicking the door in and finding an even sorrier sight !

  7. fear or the stress of having to leave his bed & remain upright in a carry chair? i am sorry that your back is ricky. i hope it's better now. i agree with the other posters–your patient brought his death on himself. i rather think that he didn't want to die alone–which is why he called out his gp to get help.

  8. I suspect that the Fire Service has the keys though.
    The Fire Service has keys for *everything*. They're called bolt cutters.

  9. that is true 🙂 some years back there was a smoky fire in the apartment i was in. (turned out the chimney was blocked so when the downstairs neighbor started the fireplace, the smoke filled the house instead of the chimney) the landlord started to fuss with the fire chief over having to come over & unlock the 3rd floor apt. the chief gave him 2 minutes to shift his butt or they would knock the door out themsleves. took the landlord less than that to hustle & unlock 🙂

  10. I agree with you there Joan, had you not have encouraged him to go to hospital Tom he would have most likely died alone, at least he died in the knowledge that you and your crewmate tried the best you could and did your best to reassure him.Take care

  11. Guilt at death….it gets you every which way. Either you think of all the things you did/didn't do, and feel guilty about them, or you don't feel guilty and then you catch yourself feeling guilty about that.Deaths are like births, I find. However many you witness, you never get blase. Or, if you do, then you are in the wrong job.

    Get a good night's sleep.

  12. it's good to have the fearless tom back again.as others have said – it wasn't you/your transport that killed him – it was his life that did. years of abusing his own body (whether his fault or not?…) did it to him.

    at some point, an end does come.

  13. I've read that a lot of people with similar problems die on the toilet. Compared to the indignity of that, dying strapped into a carry chair halfway down some stairs doesn't sound too bad…

  14. Tom,All I can say is, sterling job! Nothing more anyone could have done, and lets face it, both you will know of some paramedics and/or EMTs that would have taken one look at the patient, heard him say “I dont want to go”,taken that as a refusal and left him with a fall back referral to his GP.

    Its just one of those jobs, that goes pear shaped, and I really dont think that the chair and the move to the vehicle would have made any difference. If I was a family member I would be grateful that you and your mate had tried so hard.

  15. Three ciggies in rapid succession probably didn't help either, what with carbon monoxide & constriction of the blood vessels and all that.

  16. I had my first resus attempt this week and there is no other feeling like it. There are no words to change it. I think it's just about moving on and letting the memory fade.

  17. 'the GP had told our Control that he had difficulty in breathing.'Does that not qualify for an eight min response time then?

    I imagine if your heart is going to stop beating, better with the boys and girls in green, than without; not sure halfway down the stairs was such a good move though, maybe without the fags he would have made it to the ambulance or the hospital.

  18. As someone who is not employed by the NHS, I couldn't remember the right term so that's why the wording is in “”.If I have used the wrong term sorry no offence was meant.

  19. I'm minded of a quote by Neil Gaiman in the Sandman”You lived what anybody gets, Bernie. You got a lifetime. No more. No less.”

    * Death, in SANDMAN #43: “Brief Lives:3”

  20. I find it interesting that the GP who thought the patient was in dire need of emergency treatment did not hang around to provide a handover or provide continuing care for the patient until such help (ambo) arrives.Is this common?

  21. Nope, they do it up here in NWAS.Sometimes I get so annoyed that a very sick person has been left alone that I ring up the surgery and ask why they had been left alone and not been given any further treatment…

    You get the usual “I'm very busy and have lots of patients to see..” You won't have any if you keep leaving very sick patients alone doc!

    I guess it's just the way it is

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