I have never met him -- will never meet him, not really -- and yet he still gives me a gift, in an odd way. Maybe not intentionally, certainly not knowingly, but a gift nonetheless. It's not even really a gift for me; just one for me to hold for a while -- I don't know how long -- until I find the ultimate recipient.
* * * *
It's a long drive, and the fire department EMTs have been there for a while when we arrive.
They're still doing CPR.
My partner heads for the monitor and asks the firefighter what she's got for access and what drugs they've given.
I sling the heavy green canvas airway bag at the foot of the staircase, and lean over the firefighter squeezing the BVM. He's got the mask clamped over the patient's face. A crumpled King airway lies on the floor.
"Hm," I say, almost to myself. The red-and-black intubation roll is already coming out of the airway kit. "King didn't work?" I ask the fireman - a good EMT who is in paramedic school - and he shakes his head.
"Nah, man, it just wouldn't advance."
It takes me maybe ninety seconds to get everything together, and then I edge in. Slip the largyngoscope in his mouth, no, no, keep doing CPR, that's fine, aaaand --
I see why they had trouble with the King, and why I will have trouble with the tube. I can barely reach his epiglottis with the tip of the Mac 4, and I certainly can't see the cords.
In a second, I know what I have to do. I just wish I'd practiced it more.
I pull the blade out and turn back to my kit. "Bag him," I tell the confused fireman.
"You're not even going to try?" he asks, wondering why I never asked for the tube.
"Nope," I say, unscrewing the cap on a short length of PVC pipe in the bottom of the kit. "Not with that."
The bougie is a long, flexible plastic rod, a couple millimeters across. I slide an ET tube onto it, making sure I have a good eight inches of bougie below the end of the tube. A quick swap for the long Miller blade, and I'm back in the mouth.
Wait - yeah - there. I can just see the bottom of the cords. I hold up my hand, and the fireman carefully passes me the loaded tube. I fish the bougie down until I see it go between the goalposts, and as the fireman holds the top I can slide the tube in ...
* * * *
Of course it doesn't really matter, other than confirming a dismal end-tidal CO2, for the man is dead, and has been dead for some time now. All we are doing is confirming that he is really, exceptionally dead. I never met the man.
So why does it matter?
If we are not challenged, we don't grow. To be challenged by another, to be placed in a position where we have no choice but to stretch our capabilities or risk failure -- that is a gift.
I rarely use a bougie, because it's rarely necessary, and so I am thankful for the unknowing gift of a dead man, who pushed me to use this tool -- because someday there will be someone who isn't dead, who desperately needs an airway, and the bougie is going to let me put it there.
1 month ago