One night while working as an Air Force Medic, I had the privilege of meeting a former Tuskegee Airman.  The Tuskegee Airmen were a group of African-American fighter pilots during World War II.  They were segregated from others in the military due to the color of their skin.  This patient was of course, African-American as well.

Early in the shift it was discovered that this man needed a new IV.  Another medic I worked with mentioned that to me, so I went to his room to start the IV.  I had scarcely placed the tourniquet on his arm when a Registered Nurse (an officer) and a Medical Technician (an enlisted person who outranked me) from the SCU (Special Care Unit) entered the room.  They asked what I was doing and I informed them that I was starting an IV.  Apparently the other medic on the Medical Surgical Unit I had talked to, thought she couldn't get the IV, and had called the SCU to try.  They asked why we had called them.  I informed them that "I" hadn't called them.  They made several other rude comments, insinuating that my IV skills couldn't possibly match theirs and that I shouldn't bother calling them back and wasting their time.  Then they left.

How unprofessional for coworkers to have a disagreement and for them to treat me that way in front of this patient.  After they left the patient asked me my name.  He then informed me, "Holverson, you are going to start this IV.  I don't care how many times you have to stick me.  Those women had no right to treat you like that."  I started the IV.  I don't remember how many sticks it took for sure.  I do remember that each time this man was admitted to the hospital after this he specifically asked if I was available to start his IV, so it probably only took one stick.

I always enjoyed listening to retiree stories about their military careers and casually asked this man what he did in the military.  When he informed me that he was a retired Tuskegee Airman, I initially didn't believe him.  He looked way too young.  I of course checked his age in his medical record.  He was indeed old enough to have served during World War II.  When I found time, I returned to his room to hear more about his experience.  He proudly shared stories with me.  He talked about how unfairly they were treated by being segregated.  He told me how they hadn't been allowed to actually go to war.  He told me how President Roosevelt's wife came to visit.  He said she demanded a ride in a plane with one of the Tuskegee Airmen.  She asked their commanders why they hadn't been allowed to go to war, given they had been properly trained.  He told me that Mrs. Roosevelt was instrumental in getting them into the war, allowing them to demonstrate their abilities.

He told me about more challenges he had after the war.  In the military most pilots are officers or warrant officers.  The black fighter pilots weren't given that opportunity following the war.  He was made an enlisted man, even though he had demonstrated the same skills as his superior officers.  He had endured mistreatment and I came to understand that was the reason he stood up for me.  For that man, principle was very important, more important than how many needle sticks it took to start his IV.

Taking care of patients, like any job has its good side and its not so good side.  One of the things I love best is when I get time to visit with an elderly patient.  They have lived longer than the rest of us, and have learned more.  The elderly patients who are the happiest are the ones that talk about their family a lot.  They also are usually the people with the most visitors in the hospital.  Of all the things they have learned, it is family they value highest.

I was working at the Kansas City VA Medical Center, located in Kansas City, Missouri.  I had been floated for the day.  Floating is when a nurse works in a different department than where they are normally assigned to.  This helps fill gaps when one floor is short people and another has extras.  My own grandfather was in an ICU in southeast Idaho.  I was expecting to hear that he passed away any time now.  It was a somewhat normal shift for me, but my grandfather was on my mind frequently.  During the course of my 12-hour shift I did get a phone call confirming my grandfather had passed away.  He was surrounded by many members of our very large family when he was taken off of life support.  I knew it was his time to go, but it's hard losing someone you love.  Our family would be making the trip to Idaho for the funeral.  I returned to my duties and finished out my shift.

I had given report on a couple of my patients and walked around the corner to give report to another nurse when the charge nurse saw me and asked me to get the rapid response cart. A rapid response cart has many of the same things that a code cart does.  Items that we may use in an urgent situation, but not when a patient may need defibrillated (shocked) or intubated (having a breathing tube inserted).  I ran and got the rapid response cart, while another nurse paged the rapid response team.  When I was almost to the room she told me that the patient was coding and sent me for the code cart.  Overhead a code blue was being called throughout the hospital now.  When I returned with the cart 2 people (other than the patient) were in the room.  

One of them was watching, the other was doing chest compressions.  I opened the cart and turned on the oxygen tank, grabbing tubing and and AMBU bag.  An Ambu bag has a mask to place over a patient's nose and mouth, a self-inflating bag, and a port to which oxygen can be connected.  In his haste to be helpful, the person doing chest compressions stopped to help me.  Knowing that minimizing breaks in compressions increases survival rates I began compressions, while he hooked up the oxygen tubing.

I could feel the ribs cracking and rubbing together.  Crepitus is the medical term we use to describe bones rubbing together.  I had heard about ribs cracking during CPR, but had never done CPR before, even with 4 years as an Air Force Medic.  I had imagined the ribs would break at the cartilage joints where they connect to the sternum.  They actually broken along the sides of the chest.  The crepitus decreased as time went on, perhaps because the edges of bone were becoming rounded.  An ICU nurse showed up after about a minute or 2 of CPR.  She began asking who did what, and why hadn't they called a code sooner.  I looked her in the eyes and told her that now wasn't the time for critiquing, it was time for her to do her job.

She looked as me for a second, seemingly in disbelief that a nurse who didn't even work in the ICU dare speak to her that way.  However, she then began running the code as was her job.  Other ICU nurses, residents, and other doctors soon arrived and the room got very full.  Occasionally the dying patient seemed to gasp for air.  It was hard to tell at first if these were real breaths, but as time went on it was apparent that they were agonal gasps.  These are seen in dying people, sometimes even after heart function has ceased.  It was more of a reflex, than a breath.  Gurgles could be heard with compressions.  The patient was intubated, suctioned out and given breaths via the AMBU bag.  The smell of stomach contents was apparent and at times it seemed vomit was being coughed up.  The smell is one I remember to this day.

Every few minutes we would stop compressions briefly and check for a pulse.  Large defibrillator pads were attached to the patient's chest, which allowed us to watch the electrical impulses of the heart on the monitor.  On the monitor we would see very erratic electrical activity.  The rhythm looked far from normal and did not improve with time.  Eventually the rhythm changed to asystole (the flat line you see in the t.v. shows and movies).  After about a half an hour, a doctor finally 'called the code' as we say.  That meant we were stopping our attempts to revive the patient.

I had participated in my first full blown code involving chest compressions.  The patient wasn't mine.  I knew I had done nothing wrong, in fact I was surprised at how well I kept my cool.  Still it was a sad occasion.  The man had no family present and though he was in his 80's, had not been expected to die so rapidly.  I would remember this day, for ironically my own grandfather had passed away too.  The smell seemed to linger on my hands and in my nose for days.  My shoulders and pecs were sore from doing compressions.

When our Labor and Delivery department at the Air Force Academy Hospital closed, we were assigned to work in other hospital areas.  A few of us ended up working on the Medical/Surgical unit, which we referred to as Med-Surg or MSU.  Most things were different working on Med-Surg, but some were the same.  We seemed more accustomed to emergencies, having dealt with resuscitation on a regular basis, and it took a little more to get us worked up.  We had many things to learn about everything that didn't have to do with tiny babies or pregnant ladies.  In any case it can always be easy to underestimate or not believe a patient.  Such was the case of answering a call light one night.

It was several hours into our night shift when I noticed a particular room was repeatedly using the call light.  It wasn't my assigned room, so I asked the assigned medic and nurse what was going on.  I'll call the medic Gertrude.  The RN stated she was too busy and hadn't been in to see the patient.  Gertrude rolled her eyes and said the patient thought he was having a heart attack, but that he was just fine.  I offered to answer the call light and went in to assess the patient.

The patient was a retired service-member.  If my memory serves me correctly, we were told there were about 80,000 retirees in the Colorado Springs area.  In addition to our active-duty personnel and their families, we also cared for retirees and their spouses at our hospital.  This patient fit the profile of many statistical risk factors for heart attack including age, race, and fitness level.

This patient was African-American (a risk category), in his 60s (the older a person is, the more risk of heart attack), and he was not in great physical condition.  In fact he had the body shape known as an 'apple'.  This body shape is one in which a person gains extra weight in the middle.  I asked the gentlemen what he was calling for.  He advised me that he thought he was having a heart attack.  I asked him what it felt like and he began to describe a heart attack: tightness, pressure, shortness of breath, weight on his chest, etc.  I could see he seemed a little short of breath.  He was also a little sweaty.  Either this guy had read the book on heart-attack descriptions or he knew what he was talking about.  I asked if he had ever had a heart attack before and he told me he had.  I asked him how it felt and he told me it felt 'just like this'.  I reassured the man that I would make sure he was taken care of and then placed a non-rebreather mask on him and turned the oxygen up to 15 liters per minute.  

A non-rebreather mask has a bag attached which acts as a reservoir to store oxygen until a person inhales, and it then gives them near 100% oxygen.  I knew that if he was having a heart attack some extra oxygen would buy a little time and maybe a little heart muscle.  In any case it wouldn't hurt him to have some extra oxygen for the time being.  I went out to the desk and reported my findings.

I told Gertrude and the RN that I thought this guy was having a heart attack and that he had one in the past and that it felt like this one does.  While the nurse called the doctor, Gertrude and I obtained a 12-lead EKG and a set of vitals on the patient.  In short order a doctor arrived, blood labs were drawn and the patient was transferred to our Special Care Unit, or ICU.  That was the closest thing we had to and ICU, and it would have to do for now.

Cardiac medications were run through the IV line as they tried to get the patient stable enough for transport to a larger hospital.  The doctor didn't feel like the patient would survive the trip in his current state.  The doctor stayed the night in the SCU, watching over the patient.  After a long night, the patient was finally transferred at around 6am.  

I know he survived the transport and I'm pretty sure we would have heard if he died during that hospital admission.  So I really think the guy made it.  I don't know if he required heart surgery or got a pacemaker or anything else about him.  Sadly we don't often know how a patient fairs down the road.  No matter what department we are in, in a hospital we usually just see a patient long enough to get them well enough to be discharged from our care.  It's pretty rare that we see these patient's again unless they are sick again and are admitted for more medical care.

That night I learned that there are many types of patients and hospital workers.  Their personalities do not always match up in an ideal way.  As providers of medical care it is our responsibility to listen to our patient's concerns and act on them, the patient knows their body better than the rest of us.  Only the patient can really describe pain or discomfort, and only the patient knows for sure when it feels better.