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.
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.