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Jeff hadn’t felt well in a few weeks but he thought it was the seasonal allergies, something he had ate, or a touch of stomach flu. He hadn’t realized that years of stress was catching up to him today. 

As Jeff walked through the bed room he felt an immediate paralyzing pain. As his legs folded underneath him the last thoughts were the burning mashing pain in his chest. The nausea hit him just as hard and a cold sweat covered his body. As he fell on the bed his last animalistic thoughts were just to fill his lungs one more time with air. As the last life in Jeff flickered the lips turned blue, pupils dilated, and the last urination. 

As fast as Jeff had suffered this massive coronary, it had stole his life. All that was left of Jeff was a 50 year old, 258 lbs. clinically dead body. That dying corpse would become a battle ground in a losing war to reverse the damage that stress and a pea size arterial plaque could reap. 

As Jeff was laying on his back on the bed for several minutes. His eyes were open stirring at the ceiling. His mouth was open too as his body progressed through death. His skin cut off of fresh oxygen began to gray and his lips were purple.

Alex the step son walked into the bedroom finding Jeff on the bed. He shook Jeff who was cold and unresponsive. Alex had never been trained in CPR but knew he need to call 911. He punched 911 on his smart phone. It rang once and then a female voice at the other end responded. “911 what is your emergency”! “Uh my step dad, he’s collapsed and I don’t think he’s breathing”! “Ok sir have you tried to wake him up”? Calmly asked the dispatcher. “Yes all he did was this gross gurgling noise” answered Alex. The dispatcher flipped a light on her consul at the 911 center. That light indicated she was taking an urgent call in which a second dispatcher would listen in and start alerting responding units. The second dispatchers screen lite up with the same location info for the phone. The first dispatcher told Alex to make sure Jeff was on his back. Alex did so and now Jeff was face up eyes and mouth open, his face purple. The second dispatcher toned the closest Fire/EMS unit as well as PD to respond. The protocol for their jurisdiction. The first dispatcher told Alex to put his phone on speaker and lay it next to Jeff, she then told him that if Jeff wasn’t breathing to start CPR. Alex told her he didn’t know how. Alex was shaking with great fear. The dispatcher told him to put one hand on top of the other in the center of Jeff’s chest. Alex did so and heard her say to push down hard and fast. He did that too, but he wasn’t pushing quite hard enough to push the blood around Jeff’s chest. As the dispatcher counted Alex pushed. The dispatcher asked Alex if Jeff was still gray colored or more pink. Alex told her Jeff was still gray so she instructed him to push on Jeff’s chest hard. As Alex did he noticed Jeff’s belly distend upward as he push the chest downward. Alex paused a minute remembering watching CPR on TV as a kid. He tilted Jeff’s head back and gave Jeff mouth to mouth ventilations. Jeff’s lips felt cold as Alex pressed his against them. Alex blew hard trying to get Jeff’s chest to rise. Alex repeated chest compressions which with Jeff in bed had little effect. Alex did realize that all he was doing with the mouth to mouth was to inflate Jeff’s belly. It had been several minutes and Alex was about wore out. He also heard a siren outside and could tell it was getting close. He continued as the siren stopped apparently outside and then he heard a knock at the door. He stopped CPR to open the door finding an EMS crew ready to go to work on Jeff. 

Joe the medic in charge walked in the bedroom and quickly scanned the scene. Looking for an dangers or clues to the cause of Jeff’s apparent cardiac arrest. He mentally noted clean surroundings and sat his equipment down next to the patient. Joe and Beth grabbed Jeff’s body and hurriedly pulled it into the floor. Joe’s partner Beth sat her stuff down on the other side of Jeff. Joe immediately started CPR on Jeff. He noticed that Jeff’s mouth and eyes were open and Jeff’s pants had a large wet spot at the groin. He pushed hard and fast making Jeff’s belly push up as Joe pushed down on his chest. Joe felt a pop on Jeff’s chest as he had dislocated some ribs. Beth retrieved a yellow bag mask and when Joe had completed the first cycle gave Jeff to ventilations. Both medics noticed Jeff was very gray and his eyes were open with a glassy appearance. They both knew without saying that Jeff was probably not a viable patient but they continued his resuscitation.  Joe looked at Beth and said “We need to see if he’s got any electrical activity in his heart.” Beth asked Alex about Jeff’s medical history as Joe tore Jeff’s t-shirt open exposing Jeff’s hairy chest. Joe then slide the defib paddles from the Lifepack 20 and applied a puddle gel to one of them. He pushed the paddles together and gently rubbed spraying the gel on both metal shocking surfaces. He then pushed each paddles against Jeff’s hairy chest making good contact with the skin. Joe pushed the paddle monitor read button showing Jeff’s heart in the erratic ventricular fibrillation.  The unit ran through the automatic sequence of tones indicating that it had charged. Joe then shouted “CLEAR”! After a quick glance he pushed the shock button and Jeff’s 250 pound body jerked involuntarily.!

Jeff’s dying body relaxed and Joe held the paddles watching for a conversion. The monitor registered a flatline as Beth felt for a pulse. She shook her head confirming Joe’s knowledge that Jeff was still in cardiac arrest. Without hesitation Joe started CPR again as before and Beth prepared the laryngoscope and a ET tube. 

Beth extended the blade of the scope which switched on the light at the end of the blade. As she advanced it towards Jeff’s partially opened mouth she flicked the light into Jeff’s opened eyes. She noticed no pupillary response from the dilated black spheres almost obscuring the brown irises. She then inserted the blade into Jeff’s mouth as she pivoted the handle. The light illuminated Jeff’s airway. Beth noticed that the throat was clean and moist. She didn’t she any tail tail signs of tobacco use and visualized the vocal cords. She rooked the tube and passed it into the trachea then retracted the scope blade. She then followed protocol in securing and confirming the tubes placement.

Joe has continued chest compressions which he secretly enjoyed doing. Joe had a resuscitation fetish which he’d never shared but with his friends online. This patient was the right age and build to spark his interest. He could feel his strength and power pushing down on Jeff’s chest. Joe’s interest in his patient was the reason he started the resuscitation with the paddles. As he firmed against Jeff’s calmly chest he felt so powerful as if the paddles were extensions of his own hands. Now he paused the compressions as Beth ventilated Jeff. Joe pulled out the quick comb pads and applied them to Jeff’s chest. He then plugged them into the Lifepack 20. The monitor showed Jeff was still in asystole as Joe went back to CPR. Beth radioed our the the next arriving unit to bring in the cot and long spine board. She next set up an IV, selecting 500 ml bag of Normal Saline and a micro drip tube set. She had Alex hold the IV bag as she inserted the IV cath in Jeff’s arm. Once she saw the blood in the cath then she attracted the tubing from the bag. Joe continued the compressions fast and hard. 

Now that the second EMS arrived with the cot and board Joe and Beth could switch roles. Joe took over ventilations and Beth opened a box of Epi to inject. The other crew took over compressions. Beth emptied the Epi and looked at Joe saying “Recon we need to push some bicarbonate”? Joe looked up with a “oh yes he’s been down a while.” One of the other medics readied 2 amps and handed them to Beth. As she injected them Joe watched be aroused by the site of the large syringes being emptied into Jeff. 

Jeff’s wife Maureen has arrived home with their daughter. Maureen looked to be a bit older than Jeff but was only 45 medium build and brown headed. She was visibly distressed as she watch the EMS crews tending to her dying husband. Their daughter started sobbing at the site. 

The drugs had caused Jeff’s heart to have some electrical activity again. The wavy line of fine VF traced across the monitor screen. Beth hit the charge button as she shouted “Clear”! The medics stopped their activities as she pressed the shock button. Jeff’s body stiffened, jerked, and relaxed as the electricity traveled through him. Joe had laid the attached bag mask against Jeff’s check. The shock cause Jeff’s head to bob back slinging the bag up and then back down. Joe watched the lifeless gaze in Jeff’s eyes as this happened. He was even more aroused by this.  The monitor continued to read fine VF as Beth pushed another Epi. Jeff’s heart rhythm was still VF so Beth prepared to shock the 50 year old man. When she called clear Joe again layer the bag against Jeff’s face and again he watched the bag being slung up as the wave of 360 joules contracted the back muscles. He also watched Jeff’s expressionless face with the ET tube protruding from the mouth. When Joe picked up the bag and squeezed he could here the gurgling noise indicating some fluid in Jeff’s lungs. “Beth we need to get him moving” called out Joe. He then looked over at the older of the 2 other medics and said “Why don’t you get the family and start driving them to the hospital”. That medic named Randy nodded and walked cover to Jeff’s family. 

The kids were near distraught watching this unfold to the dad. Maureen still in a state of half shock and distressed watched too but was also was craving a cigarette. She was a nervous smoker and this stress was triggering her addiction. 

“Mam what is your name?” asked Randy. “I’m Maureen” she stuttered nervously. Randy took the opportunity to get a little more medical history on Jeff. “Maureen has Jeff been sick or complaining of anything?” She said “No”. “What about medical conditions or issues we need to know about?” He continued. She looked and said “Well he had an abdominal abscess several and surgery several years ago. That why he’s got that scare.” In the background Beth could be heard calling clear again as she zapped Jeff with another 360 joules. “Ok well I’m going to drive you all to the hospital now”as he patiently herded then to the door. As Joe watched them leave he thought about all those times he’d drove family. Driving a car that he had never driven with total strangers trying to find something to talk around other than the obvious. 

With the family gone Joe, Beth and the other medic name Monica readied Jeff for the last trip to the hospital he would ever make. Beth and Monica rolled Jeff on his side and slide the spine board under him. Then they along with a couple policemen who had arrived lifted Jeff onto the Stryker cot. Joe started one handed compressions as they rolled Jeff through the doorways and the rest of the house. They rolled the cot out to the ambulance as Joe continued. Beth got in the back with Joe and Randy got up front to drive. As the cop shut the door he said he would lock the house. 

On the way to the hospital Beth continued bagging now and Joe took back compressions. Jeff’s condition had changed one bit as he was still in the grip of clinical death. Joe called “Clear!” After charging the Lifepack 20 and shocked Jeff. Jeff’s outward lifeless appearance failed to change but the monitor showed him in asystole now. Joe pushed 3 ml of atropine and Epi with Jeff still in asystole. Beth was having trouble ventilating Jeff so she suctioned him. The suction tank collected a little yellowish pink sputum. 

Some where ahead of them was the car Randy was driving. Maureen cracked the passenger side window asking Randy “would you mind if I smoked?” Randy said that was fine uncomfortable at trying to make conversation. She pulled a long white cigarette from the box in her purse and lit it the lighter. She brought the flame to the end of the long white shaft dangling firmly from her lips. As she inhaled deeply the end of the cigarette flowed orange. She exhaled a white cloud of smoke. As she held the burning cigarette between puffs she looked at it and remarked”He always was on about quitting, saying that I wouldn’t live as long as him.” As she repeated puffing away she asked Randy “Do you think Jeff will make it”? Randy be as professional as possible gave her the only answer he could        “Maureen we’re doing everything for him that can be done.” Randy knew from what he saw at the scene the outcome wouldn’t be positive. 

As Joe continued pumping away on Jeff’s chest Beth pick up the radio mic to call the hospital.  “Med 2 to Memorial.” The voice respond over the speaker “ Memorial go ahead.” Beth continued “transporting a 50 year old male in cardiac arrest, ACLS on going, ETA to u 5 minutes”.” Memorial standing by”. Joe was sweating as he pushed down and relaxed his arms a hundred times a minute. Jeff’s face was still expressionless eyes fixed on the ceiling. Only wearing trousers obviously still wet around the groin. His belly round and distended. The monitor continued to show no electrical cardiac activity. Beth and Joe switched positions and she began her turn at compressions. Joe had wore hisself out but enjoyed every compressions in his heart. Beth did care to let him since she was in her 40’s, morbidly obese and a smoker. She could only do CPR 5 minutes and get out of breath, the harbinger of her own early death.  

Randy and Maureen were standing at the ER entrance as the ambulance pulled up and backed in. Maureen was nervously puffing away on another cigarette as she watched them unload Jeff still doing CPR. 

Monica hopped out of the drivers seat and walked to the back of the ambulance. She opened the door and waited for Beth and Joe to secure the medical items being used in Jeff’s resuscitation. Joe nodded he was ready and Monica pulled the cot with Jeff from the ambulance. She held it and released the undercarriage allowing the wheels to drop and lock for rolling. Joe came out continuing compressions as best as he could. Beth held the bag mask attached to Jeff’s ET tube squeezing it. Jeff’s lungs had filled when some fluid and that could be heard as a snoring noise. The Lifepack monitor was between Jeff’s legs and the audible humming of asystole could be heard. They rolled Jeff into the brightly lite treatment room. The ER doctor today was Claire a fit and energetic practitioner. The medics rolled Jeff over and along with the staff  they lifted the spine board over onto the treatment bed. An obese young female nurse began chest compressions and a guy RT took over respiration’s. Joe looked at Claire and gave her the info on this patient.

“50 year old male in cardiac arrest upon our arrival, no history, we’ve shocked him several times with no rhythm changes accept VF and asystole.” 

Claire began a quick head to toe examination of her dying patient. She grabbed the wall mounted Coaxial Ophthalmoscope and stretched our the black coiled cord. As she was doing this another nurse was attaching the monitor cable to the wall mounted ER unit. Another nurse went ahead and pulled Jeff’s pants off then his underwear. Jeff was now completely nude laying on the long spine board. Claire looked up at the monitor which was tracing cardiac stand still. She called for a 5.0 of Epi which the nurse who had just pulled the cloths. Claire had a scribe to record what was being done during the code. She shined the scope light into Jeff’s eyes and called “Pupils equal, fixed, and totally dilated.” Claire quickly scanned Jeff’s torso for issues as the obese nurse, a ginger, pushed down on Jeff’s sternum. Claire called out “Patient has a significant prior surgical scare on the lower abdomen which looks to be years old.” She then laid the scope down as she slide each hand on either side of Jeff’s groin. As she felt for the artificial pulse conforming adequate CPR Jeff’s partially erratic penis was extended. “I’m detecting a pulse during CPR hold compressions please”. The nurse stopped chest massage and Claire couldn’t feel any pulse. “Ok he’s got no detected pulse or heart beat.” “He’s also got a partial priapism.” As the nurse continued chest compressions. Claire then took her reflex hammer and held up each of Jeff’s knees. Each strike failed to get any reflex from Jeff. 

As all this was unfolding Randy took Maureen into the small waiting room. She was setting their with the 2 kids waiting for news. They were all quiet as Randy left the room to go back to the treatment area.

Claire looked up at the monitor as the rest of the staff continued the resuscitation. She looked at the RT and ordered an ABG be collected.Joe has took over as Randy took over ventilations for the RT. Monica took over chest compressions for the nurse who needed a break. Claire asked Joe to switch on the pacer which he did at 100 bpm at 50 mA which began sparking spikes on the monitor screen. Claire ordered the nurse to inject a 0.5 of Atropine, another 0.5 of Epi, and 40 units of vasopressin IV. 

Another several minutes had passed without much change in Jeff’s condition. He had been in cardiac arrest for an hour. Claire noticed that the monitor was showing Jeff’s heart making attempts at beating but they weren’t regular and strong enough. The pacer impulse along with the drugs were the only things responsible for this agonal rhythm. Claire asked Monica to hold compressions and as the spikes continued Claire palpated the neck for a carotid. She felt no pulse and announced her findings as Monica continued. Claire decided to try one last thing, she asked the nurse to assemble another Epi with a intra cardiac needle. The nurse pulled out the Epi box and then attached a 4” needle. Claire then asked Monica to hold compressions. Claire gentle palpated down the left margin of the medastenum to the 5 intercostal space. She then stabbed the needle into Jeff’s chest already bruised and discolored from the hour of CPR. She inserted the needle slowly then drew back on the plunger. A little wisp of dark blood danced inside the syringe. Claire having the needle in the heart emptied the medication and with drew the needle. 

In the small waiting room the kids quietly cried at the situation they were facing. Maureen sat nervously wondering what would happen next and if Jeff did pass what she needed to do. Suddenly she realized Jeff had two large life insurance policies and she would collect. Now the slight grief she felt passed to a since of relief. Secretly she had a massed a significant gambling and credit card debt. If Jeff wasn’t resuscitated she would pay off all those. Now she was hoping that Jeff didn’t survive putting her on easy street. 

Joe stepped over and started compressing Jeff’s chest. As he began again the feeling of pushing down on Jeff’s chest made him grow more aroused. Never before had he had this feeling for a male patient. His groin grew firm and tight and Joe was afraid the others would notice. Everybody else was busy going about their parts. With each compression the erotic feelings Joe felt got stronger. He didn’t know why but it was happening. Jeff’s gray hairy chest and breasts called to Joe as he pushed down. The noises of the failing resuscitation attempt was so stirring. Joe had these sorts of feelings before but it had always been for woman patients. Jeff’s body was so different, hairy and not as big as the woman who had aroused Joe before. In those occasions it was always fleeting for the patient always ended up dead. Joe looked down at Jeff’s  face with a facial hair, the ET tube projecting from the mouth. His eyes opened with that empty stare at the ceiling. Every squeeze of the bag mask would cause that gurgling noise then the chest would rise and then as it fell more gurgling. 

Another 5 minutes Claire looked up at the monitor as the erratic spikes danced across the screen with the pacer impulses. She asked for the Doppler stethoscope which the nurse handed her. She called out to hold CPR. Then the nurse squirted a puddle of KY gel on Jeff’s chest. Claire took the Doppler head and stuck it through the gel against the chest wall. No auditable noise could be heard as she moved it around the chest wall over the heart. She looked up at the wall clock and called time, pronouncing Jeff dead.  The medics went about collecting their equipment and replacing the drugs they had used on the ambulance. The nurse switched off the heart monitor and the RT disconnected the bag mask. Claire slipped off Jeff’s wedding band and proceeded to the family waiting room. 

Claire stepped in and sat down next to Maureen. She looked at Maureen and gave her the bad news. Jeff’s massive heart attack had been fatal as they had exhausted all treatments for his cardiac arrest. Maureen nodded without outward concern hiding the relief that she felt. Claire handed Maureen the ring and padded the kids on the back to console them. She told the family that the nurse would come and get them, to see Jeff in a few minutes. Maureen asked Claire if she had time to smoke a cigarette before they went back. Claire with a total look of amazement nodded yes. 

Jeff laid nude covered with pads and EKG leds on the spine board which was on the treatment bed. Both arms stretched out and hanging down. His eyes and mouth open with the body beginning to model. The ET tube was secured by a white cloth strap that wrapped around his head. The salt and pepper hair was short and his lips were now turning blue. The blue lips almost complemented the salt and pepper facial hair. His penis was fully erratic as his body proceeded now unhindered in death. The nervous system was already dead as well as the internal organs. The skeletal muscles and hormone control would take a few hours to terminate with the skin being the least to die. Monica the nurse carefully laid a white sheet over Jeff as Joe attached the toe tag. The small Midwest community EMS worked out of the hospital which meant that Joe would be able to help with the rest of Jeff’s journey. Claire walked back in the room amazed at how unconcerned Maureen was in finding out that Jeff was dead. She completed the notifications and documents. Considering Jeff’s age and apparent good health an autopsy would be conducted in the days to come. 

While that was going on right outside of the ER entrance Maureen walked up to Beth. Beth was finishing her cigarette after leaving the ER while they team worked on Jeff. Maureen pulled out along white cigarette, pinched it between her lips and life it. Beth spoke watching Maureen inhale deeply making the burning end of the cigarette glow brightly. Beth was attracted to the newly widowed Maureen. Beth asked her if she could do anything. Maureen nodded no as she exhaled a large white cloud of smoke. Maureen asked Beth if she had worked a lot of patients like Jeff and she said a few. Beth told her that if she needed anything, help making arrangements, calling family, of even just somebody to talk to call her. Beth then gave Maureen her phone number with hopes that she would hear from her. As soon as Maureen puffed the last bit she walked back in the ER to the waiting room where Monica was waiting to take the family back. 

The family entered the room and Monica pulled back the sheet. The kids were again over came with grief as they looked down at their father figure. They sobbed at the site of Jeff laying their dead. These images would haunt them for the rest of their life. They both felt guilty for not being better toward Jeff and even more guilty for the way their mother always treated him like garbage. Maureen was a little oddly unbothered at the site of her husband laying their dead. For her plans we’re moving fairly quick in her head. She did console the kids as for her this was a wind fall. After a few minutes Monica escorted them out.