Time of Death

The night was bitter cold. The kind of cold that makes your bones ache.

My new Under Armour shirt and gloves doing me well in the 20 degrees. I can’t fit a coat over my tactical vest and really wouldn’t want to. Working and adrenaline send me to overheating quickly so it is usually better to brave the cold instead.

The call was a stone’s throw from the hanger. It was going to be bad. For some strange reason the subtleties of the initial call are what sets my sixth sense off more often than detailed information.

From the air, the large glow around the rear door of the ambulance gave away the shear number of firefighters gathered. Doing nothing. That is never a good sign.

The snowmobiles to the east of the road we landed in the middle of, were like big blobs of black against the snow. Their passengers, bundled up, were gathered in groups, heads hung, shoulders drooping.

Red lights flickered on the periphery, unable to penetrate the flood lights making the night scene into something resembling day.

The firefighter who walked out to meet us briefed us quickly on what we were about to deal with. Snowmobile vs tree. Helmet cracked up the middle.
My doc went to the side door of the rig, I went to the rear. There are some habits that you should not alter when all around you chaos is attempting to win. He gets to the airway from the side door, I get the rest of the patient from entering rear door.

I grabbed the latch. As I swung the door open, immediately enveloped in a wave of heat, the brief thought that medics may be able to compete with clowns for shear numbers packed into a small space, crossed my mind. Strange how the obscure finds its way in to my conscious at the most inappropriate times.

The Medic at the head was having a hell of a time. In general, maintaining an airway on a patient with facial trauma or who is just bloody, is near impossible. This was no exception. Secure a trauma patient’s head down with spinal immobilization head blocks and straps and it is almost a three person job.

The medic at the chest was getting a work out. Compressions were being counted in short, deliberate spurts. Until you have done CPR you cannot imagine the energy and force it requires. Wimps need not apply.

We worked the code. As is my habit, I verbalize what my mind is going through.

Airway was patent. My doc got the tube on the first go. We have an intermittent, weak pulse. It is the last ditch efforts of a young, dying heart. Good breath sounds. No needle decompression needed. Rest of exam negative. Nothing we can immediate change. We are suspecting all head injuries, maybe spine. Neither of which we can fix.


For the first time in my short flight nursing career, I am worthless in the back of the ambulance. My doc tells the team we are going to try another round of medications and call it. We no longer had a pulse. At that point I tell him I am going to step out of the rig and let the law enforcement officer know what was happening.

The firefighters got him on the radio.

I climbed back into the rig to help with the rest of the code. In a voice that they could all hear I told them our patient’s name. None of them knew until that moment. Sometimes oxygen is more important than learning who exactly we are caring for.

The doc called time of death. As the exhausted medic team looked around not quite sure what to say next, I thanked them. Told them they did a great job. They know how to do this, some of them, better than I do but having been that medic, I know it is always important to hear it.

I then asked for a towel. I thought of Kip, telling me about taking care of the bodies of his friends in Afghanistan and Iraq after he did everything to keep them alive. As a medic in the military, the stakes are higher. You are not keeping a stranger alive, you are keeping your friends alive. His last act of love and friendship was to prepare their bodies for their final trip home.

I made my way to my patient’s head. The towel gingerly soaked the small pools of blood from the corner of his eyes. I wiped the rest of his face, his cheeks, his forehead, his chin.

I thought of my first death as a flight medic in the Army. Shrapnel through the back of his head, no longer able to sustain a perfect 18 year old body. This patient triggered those snapshots forever burned in my mind.

Maybe I said this patient’s name out loud, maybe I didn’t. He wasn’t just a tragic code that we called in the field. He, in that moment, became another mental picture, of another person, captured in my mind, in the place I save, close to my heart.

I just wish I could tell his family we did everything possible.

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