Winning the Battle, Losing the War
The inhaler said it all.
It lay there on the carpet, just a couple of inches from the patient's outstretched hand, right where it had fallen when he collapsed during his asthma attack. It was supposed to keep him alive, to open the bronchial passages and allow him to breathe. But it was too late. First he'd stopped breathing, and then his heart had stopped, and now a firefighter was pumping on his chest, while an EMT forced oxygen into his mouth and nose.
My partner hooked him to a cardiac monitor. The EKG looked surprisingly good. "Somebody check for a pulse," my partner said. Hands reached for the man's neck and arms. "I've got one," said one of the EMTs. "It's fast, but I can definitely feel it."
As if on cue, the patient took a deep breath. Then another. Soon he was breathing deeply and regularly. One moment he'd been dead, and the next he'd come back to life.
This doesn't happen often. Producers of movies and television shows would have you believe that CPR can save almost anyone. A character collapses, a hero performs CPR, and a few minutes later, the victim comes back to life, good as new.
But in real life, it doesn't work that way. Not without medications, anyway. CPR doesn't often bring people back from the dead. Its purpose, really, is to keep oxygen flowing through to the brain, to prevent neurological damage until the heart can be started again.
Sometimes that requires defibrillation. Sometimes, medications. But CPR alone almost never causes a silent heart to start beating again.
When the heart stops beating because of an oxygen shortage, however, and not because of a blood-clot-induced heart attack, CPR can make all the difference in the world. This is one of the few circumstances in which CPR can restore a heartbeat without any other intervention. And that's what seemed to happen this time. The patient had suffered an asthma attack, and when his heart ran out of oxygen, it stopped beating. Once the flow of oxygen was restored, the heart started beating again, giving him blood pressure and a pulse.
We lifted him to the stretcher and wheeled him out to the ambulance. He was breathing quite well by this time, though his eyes remained closed and he made no attempt to move. This troubled us. The problem had been corrected, and he hadn't been in cardiac arrest for more than a few minutes. Why wasn't he waking up?
His condition didn't change on the way to the hospital. Every so often I'd squeeze his fingertip, hoping to elicit a response to the pain. But the man never flinched. His heart was alive, but we couldn't be too sure about his brain.
"Maybe he's got a bleed," my partner said as we brought him into the emergency department. "The way he's breathing, he looks like somebody bleeding into his head. There's something about his breathing that looks like a neurological problem. If they do a CT on him, I'll bet they find a bunch of blood in his brain."
I had to admit that he was breathing like patients I've seen with ruptured aneurisms. It's funny, but after you treat enough critically sick and injured patients, you begin to identify certain conditions more through hunches than anything else. And most of the time, those hunches prove correct.
This time, though, it really didn't matter. The man had died, and we'd brought him back to life. Maybe it was a ruptured aneurism that was preventing him from waking up, or maybe he'd suffered permanent brain damage during the brief period of cardiac arrest.
But who really cares? Nobody's going to care about the cause if he spends the next forty years in a nursing home somewhere, existing in a vegetative state. His family won't care, and the patient certainly won't care. It's not the heartbeat that matters, but the brain function.
Because if we bring him back to life, but he never wakes up again, then we've won the battle, but lost the war.