“I remember the first death perfectly.” Read an excerpt from the book “Lifeguard. I am not a god”

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I always tell my students about this woman. Although I had not known her before, her story permanently changed my approach to life and death.

I was on call with a great neurologist. I used to ride with him many times, I liked working with him. We understood each other. We got a call to a villa district of Wrocław. A large, beautiful house, modern but classic at the same time. There was something dignified about him. A spacious living room with antique bookcases filled to the brim with books. Dimmed light, such as from a bedside lamp with a large lampshade. In the middle of the room, in a stylish armchair, sat our patient.

This lady was thirty, maybe thirty-five years old, and some time ago she heard a diagnosis that sounded like a death sentence: breast cancer. She had had her breast amputated and her hand was extremely swollen, like an elephant’s. This is a common complication associated with impaired lymph circulation after lymph node dissection. Perhaps she already had metastases, maybe the chemotherapy exhausted her body so much that it no longer had the strength to act. She was suffocating, desperately gasping for each breath.

There is no time to lose in such situations. You have to fight for your life. We started with medication to help her breathe. They helped, but she still struggled to take a single step. So we started packing her into a wheelchair to take her to the hospital. But then we exchanged one look with the neurologist and everything was clear to us. It does not make sense. She will not survive this journey to the hospital. As soon as we started to move her, when the position of her heart and blood vessels changed, everything started to go crazy, her vital parameters dropped, the heart became inefficient.

We sat her back in that stylish chair, on a cream woven blanket. Her husband and two children were there. Babies, such blisters, maybe after a few years… Her husband approached her and grabbed her hand. The children sat on her lap and hugged tenderly.

I hooked up the defibrillator, all those wires that monitor the heartbeat. I was in the other room, standing in the piercing silence and hearing it beep and fade with each beat. She died in less than fifteen minutes…

Now I think it was the most beautiful fifteen minutes of their lives. They talked about how much they loved each other, how much they would miss her. She kept repeating that they would surely manage, that the children would grow up beautifully and that they would not forget about her and the fact that she loved them, that they were the most important thing to her.

When none of us could hear the defibrillator beeping anymore, I went over to my husband and confirmed that my wife had died at that exact moment. I left them alone and they continued to hug without saying a word. We wrote her a ticket to heaven with a neurologist (in the slang of rescuers, a death certificate). Then my husband came to us and said:

– Thank you very much.

It’s a beautiful story and I think you have to look at it from the perspective of this family. They could be with each other when mom died, when her life ended, they could say a lot to each other. I couldn’t hear the whole conversation, but maybe they had finished some important business, said something to each other that they hadn’t been able to say all their lives. Or what they couldn’t say. It is incredibly important that she passed away among her loved ones, in peace, in her home. There was a smile on her face as she died.

Death is, I guess, everyday life in the work of a paramedic. Do you remember the first time you met her on your shift?

I remember my first death very well. I turned nineteen and worked as a volunteer in a hospital. I decided to learn by doing because I had some spare time during my studies. I was fascinated by saving people. The first man whose death I saw with my own eyes died in the emergency room. It hit me a lot. I remember that, according to hospital procedures, it was necessary to remove all the things after resuscitation from the body – punctures, tubes, ECG electrodes – and thoroughly wash the body of traces of blood and everyday dirt. I remember an experienced nurse who taught me that you have to stick one patch with his name, surname and PESEL number on the leg, then wrap the person in a sheet and stick the second patch on it. Then another sheet and another slice. These safeguards are there to ensure that no one confuses the identity of the deceased on the way to the morgue. It was a difficult situation – suddenly I had to prepare a dead man for transfer to the morgue. I mean, I’ve already had an anatomy class that should prepare me for similar situations, but life is completely different than in the laboratory room. I think the point is that the patient has an identity and the preparation is nameless.

Why did this man die in the emergency room?

He was a fifty-four-year-old man who had actually died ten meters from his home. He walked to the stairwell, near the bushes that grow in the backyards, and there his life ended. Cause of death not specified. Perhaps he had a heart attack, pulmonary embolism or stroke. Why did he die at home? Very often people, having a sense of security, let go of the fight for life. It happens, but this particular situation shocked me a lot. First, fifty-four years old – this man was my parents’ age. Second, death under the house. I imagined his family had found him, perhaps tried to save him, but he died anyway. The ambulance team took him away after a resuscitation attempt, which we continued at the hospital.

Working in the emergency room at the hospital was the beginning of your work as a medic. How was the preparation? Do you remember the first difficult moments in the ambulance?

I came to the ambulance service while still in college, shortly after volunteering at the hospital. First, I helped in the ambulance service in Głogów, and then I was employed under a contract of employment as a paramedic in Wrocław, where after obtaining my diploma I worked for many years. My first ambulance trip was December 25 or 26, it was Christmas for sure. The call was about shortness of breath, it sounded dramatic. I remember my hands trembling as we set off on the signal. All around snow and uncertainty of what will happen. We got to the patient. In fact, she was seriously suffocating. On top of that, during this shift, I came across a team that was neither composed nor supportive. I couldn’t count on co-workers, I had to take care of myself – without professional and life experience. Panic at home – the patient was suffocating, relatives were crying, begging for help.

I remember that I was able to insert the line, with the emphasis on “succeeded”. Before that, I had learned it while volunteering at the hospital, but I definitely lacked experience. We administered the drugs, the patient breathed deeply, we transported her to the hospital. We saved her. It was then that I felt for the first time how deep the meaning of this work was, that something amazing had happened and I was a part of it. However, I did not get any support from my co-workers at all, everyone acted on their own, nervously. Back then, I didn’t realize how important the atmosphere in the band was. Fortunately, I experienced it already on the second duty, when I had the first resuscitation in my life.

You had your first resuscitation on the second shift?!

Yes, but in general I started this duty with leaving until three deaths in a row …

It must have been a great experience!

Correct. I remember coming home and thinking, “Well, that’s cool, working in emergency services. Three people are dead, and I’ve been watching all this.” However, I quickly rationalized the fact that the ambulance at that time usually went to confirm deaths, so I had no influence on it, because the time had come for these people, and we were completing the formalities.

You say “rationalized myself”. Can a rescuer get used to death?

In general, it is difficult to get used to death itself. We commune with it practically every day, we go hand in hand. I really like the movie “Joe Black” with Brad Pitt who plays Death. Personifying it fosters the feeling that we are on our side with death, that we can negotiate with it and make concessions. When resuscitation fails, there is always a taste of failure, no matter if it was young or old, healthy or sick. It’s easy to come to the death of some grandmother, aged ninety-eight, and say: I’m very sorry, grandmother has passed away, you can say goodbye to her, hug her and something, it’s natural. But if you start resuscitation and fight for this man, and suddenly you have to decide that boy, nothing else can be done, you feel that you have lost to death. This time she had better cards. It’s a bit like a missed penalty kick in soccer. You seem to know how to shoot, you know where, and the ball lands shamefully in the stands, having missed the goal. When you come back from such a shift, thoughts automatically appear: “Did I do everything right? Were we on time? Did the family perform resuscitation before we arrived?” Years later, I know that you have to slow down here, because such thinking only drives you down.

And when the patient leaves, what is the hardest part for the rescuer?

For me, that’s the moment when you know you’ve failed this time, and you have to remove all the things you put into the person’s body to save him. You take out the venflon, which is still oozing blood. You take out devices that are inserted into the throat and windpipe to assist breathing. You peel off the electrodes one by one, you see burns after defibrillation. You touch broken ribs, sternum. You think to yourself, “Damn, that would be it…”. You cover the body with a sheet, and then you have to put it on the bed, because it is on the floor or between the toilet and the wall. And these are difficult things, even for the most experienced medics. When you do all this, it’s very quiet, everyone is thoughtful, concentrated. Before leaving the patient who had just died, I would close his eyes and cover him with a sheet – a bit like in the movies.

So that others don’t see, right?

This is a difficult sight for loved ones. Now I know that it’s just muscles and bones, but people don’t see it that way, it’s still close to them. Often, before covering the corpse, I would tie my chin with a bandage, thinking about how the deceased would look in the coffin. This is what I learned on my first shifts in the ambulance. I don’t remember who said to me then: “Jarek, you need to tie your chin, because usually when people die, their mouth is open and then they look bad in the coffin.” It is also about taking care of those who stay – so that this man is not remembered with a weird face.

The book “Rescuer. I’m not a god” has its premiere on April 22, published by Wydawnictwo Marginesy.

Lifeguard. I’m Not God – Cover Margins