Murderer.

Jolly and I are on night shift at the main clinic when we get a call for a security guard who's collapsed at a facility about 45 minutes away.

We roll.

On the way, we're advised that the patient has been loaded into a security vehicle and they are racing to rendezvous with us. We meet on the dusty shoulder of a desert highway. A panic-eyed security guard opens the back door of the SUV and I see our patient.

He's blue. It's been at least 20 minutes since we got the call.

That's not so good.

BVM, good air movement. I holler over my shoulder to Jolly. He slides in and we quickly transfer our patient to the ambulance. No pulse, no respirations.

Load and go, pump and blow!

The drivers hired by our company for the ambulances are not medical personnel. They are local employees who are sliding towards retirement. They have NO training in emergency vehicle operations and no concept of what it's like to be in the back of an ambulance. They also drive like locals.

Our particular driver has been infected by the urgent panic of our patient's colleagues. He goes screaming down the highway, around corners and over speed-bumps in such a way that Jolly and I can barely keep up CPR, much less attach a monitor, intubate or start an IV.

Chaos.

Jolly is alternating between chest compressions and bracing himself against the movement of the ambulance. I'm doing my best to manage the airway with basic adjuncts while screaming "Schweiah, Shcweiah, F*****g Schweiah, already!!!" Over my shoulder. ("Schweiah" means "Slow") The panic makes the driver deaf.

*Sigh*

At the ER, we work the code with the rest of the staff, most of whom were my students in an ACLS class I had taught 3 days before.

Asystole on the monitor.

Tubed with a 7.0. Bilateral 16s, wide open. Enough Epi to make a sloth break a 4-minute mile.

We call it after about 30 minutes of working. We went that long mostly for the benefit of the patient's coworkers who were looming outside the door.

51 years old. This was only the second time he's ever seen a doctor. Also the last. His previous visit was 7 years ago and it ended with a prescription for cholesterol and blood pressure meds that he never filled.

We did our best but there's always that let down. Maybe it's the adrenaline wearing off, maybe it's the obvious grief on the faces of his friends.

It's late. I clean up and hurry over to the commissary next door to grab a missed dinner before they close.

The Indian guy at the checkout looks at my name tag. He pronounces my last name carefully.

"Do you know what your name means in my language?"

I shake my head. I'm really tired.

He wears a big grin. "Murderer!"

Great. Just great!

--maddog