Breathing I

It was an almost warm day in later winter. One that teases you to come out without a coat but makes you shiver. I distinctly remember standing in the parking lot and looking up at the pale blue sky and being aware of the chill on my skin under my clothes. If felt like I and my surroundings were simultaneously contained by and distorted by a fish eye lens. In the center of the lens was not me but Mrs. A. Or not Mrs. A. but Mrs. A.'s mortal coil. I had just ceased CPR. Maybe 10 minutes earlier I had been in an exam room having a routine visit with a routine patient concern. My front office person, Zed, knocked on the door. My umpteenth interruption of the morning. The face that greeted me was flushed and frightened. A rush of words: Mr. A. just walked in. His wife got her blood taken downstairs and when she got back in the car she passed out. I dispatched Zed and Sweetie my only staff with a wheelchair and blood pressure cuff. I wrote a prescription and dismissed my patient took my cell phone and walked through the full waiting room and out the only door to the office. "Just ignore the phone." I said over my shoulder. In the parking lot I see a car with both front doors open. Mr and Mrs. A are side by side inside. The small cluster of people parts to make way for the doctor. I see Zed's face. Redder still. 911 she says. I nod. Mrs A. is waxen and still. Very clearly dead. I look at Mr A. who knows this. "I'm just going to check for a pulse." I say placing my hand on her neck. "Mr. A. do you want me to try CPR?" "If you think it'll help." he says. I don't but I try anyway. I find the lever and recline the seat. A precordial thump produces nothing. A rescue breath causes her rib cage to rise and fall. I compress her chest three times and repeat. One minute. No pulse. No surprise. Her lips are blue now. Ruben from the lab comes and offers to breath for me. We carry on. Four minutes. Nothing. We stop. "Mr. A. we're not going to be able to bring her back." An unmarked police car pulls up. Two plain clothes detectives climb out. They have badges hanging from chains around their necks like dog tags. Sweetie explains what's going on. "Do you think she would want us to keep trying?" I can hear sirens. I'm counting the minutes it took Mr. A. to try to rouse her, come back into the building, catch the elevator, come down the hall, return with Zed and Sweetie. She was most likely without oxygen for at least 5 minutes. I know she has atrial fibrillation, depression, she's been loosing weight. When she was in the hospital last time she was miserable and frightened the entire time. She believed Mr. A would die of his colon cancer long before anything happened to her. "Not unless she was going to be okay." is his reply. The paramedics are here. I give them the story in medical-speak and explain the decision Mr. A. and I have made. They radio their supervising physician, a person I know is an Emergency Medicine Resident who rides around in a jeep that says "physician" on it and reads Board Review books in a coffee shop. They tell me that they have been instructed to take Mrs. A. to the hospital. I do a little more quick math, this of the metaphysical type however. My patient is now Mr. A. What will be best for Mr. A.? See me make a scene literally over his wife's dead body or have her corpse subjected to pointless resuscitation efforts? I opt for the latter. They scoop up her corpse and whisk her away. Mr. A. refuses to be driven. The detectives follow him to the hospital. I call the ER and tell them to cease all efforts upon her arrival. I give a statement to the police who've arrived in the meantime. I order some tests on the blood specimen at the lab to help detect a cause of death. Zed is already rescheduling the rest of the day. Sweetie saw her own father die of a heart attack and is very shook up. She and I go over to the hospital to meet Mr. A. and make sure he's okay. The next time he sees his wife she has a tube protruding from her mouth and is wearing a hospital gown. He is shocked by these things. We help him remove her wedding ring.

medicine