Cold Water
Sid was under his Hilux when Martha came out to tell him about the call. The plug was out and the oil draining. He wiped off his hands and took the handheld from his busy wife. He could hear the kids screaming upstairs.
“Yeah?”
“This is Paradise dispatch. We need you at the ER for a dead body.”
Sid sighed. “I’m going to need a bit more than that Julie.”
Sid knew Julie. She was sharp as a tack but stuck on a loser.
“Yes, Doctor Hawthorne?” Everything is recorded so she’s got her snappy self in check. Sid appreciated it must be hard for her.
“Can you tell me anything about this supposed dead body?” He hears some other radio traffic in the background and some side talk, and she divulges, very professionally.
“A young boy, maybe 12 years old was pulled from the river down in Reward and they are bringing him to the ER.”
It was late spring, and the rivers are still cold up here. Sid started thinking temperature.
“Are they doing resuscitation?” More radio squawk and side talk, then:
“Unknown”
Sid did another big sigh and decided to let Julie’s day get easier. “I’m just going to call the ER doc and see what he knows.”
“So, you will respond?
“I am responding at this moment.” Sid hit the big button and saw his oily thumb smear. He’d get in trouble for this mess. He poked the numbers for the ER with his clean left hand. He was deflated when he found Dr. Winston on. But that’s who he talked with.
“Do you know anything about this drowning victim?”
“Well, I’ve heard they are about five minutes out.”
“Are they doing resuscitation?”
“I don’t know.”
Sid sighed. He hated telling another doctor they were stupid, but that’s just what you have to do sometimes. “You are the medical director for EMS, and we have a cold-water drowning. I was called to come in as the coroner, but you must know we don’t know if this kid is dead yet.”
Sid knew this from his training, from his medical school, residency, and ER shifts. But it seemed this guy didn’t. Sid knew there was a lot this guy didn’t know. “Are you going to start CPR when he arrives?”
The long pause told Sid this guy didn’t know. “I don’t know.” Confirmed that.
“Well, doctor. You’re going to have to make a call. You should know the time of submersion and the water temperature and respond appropriately. I’m coming down there in about ten minutes. But I’m the coroner, not the treating physician.” Sid sighed again; this Winston guy was a real pain. “Please get a core temperature when he arrives, at least.”
Cold water drownings are a shit show. There are documented resuscitations after 30 minutes of submersion. When the face hits cold water the heart slows down. When the heart slows down and the blood vessels constrict, the lethal acid that kills us is postponed. If we can’t let out the carbon dioxide, we start to get acid build up, but if we slow down our burning of oxygen, less acid is formed. It’s all about temperature, metabolism, chemistry, physics, thermodynamics and all that shit we were supposed to learn before we got our medical degrees. Some learn, some don’t and let the buyer beware.
Maybe it’s supposed to be a mystery. Maybe we just can’t know the exactly right thing to do.
Sid knew he had an engine without oil in the Hilux, so he wouldn’t be driving her down to the ER.
Sid went in to change. He took his motorcycle to the ER. The Hilux oil change would have to wait.
The Reward ambulance was in the bay as he pulled in. They were putting stuff away. “Hey John.”
The older man looked sad. “Yeah, doc?”
“Tell me about this call.”
John was folding up a sheet that would probably need washing, but Sid appreciated the neatness. John was a retired teacher who now volunteered for the Reward ambulance. It was a small town south of Paradise. John had taught math in the high school for 30 years and now did ambulance runs as a volunteer. He’d gone through all the trainings. Sid had dealt with him often when, as a moonlighting doc, he’d covered the Paradise ER on weekends. John was solid.
Moonlighting is what doctors called this. Sid did it a lot, medical school debt and all. He did the clinic work, then another 24 hours on a weekend and hoped he’d get ahead.
John seemed reluctant to talk.
Sid began. “Who pulled him out?”
John looked up, maybe happy to relate the events, not the choices. “That was Devin. You know, the sheriff deputy? He heard about it from the scanner and was diving in the pool below the bridge before we got there. We didn’t get called until the kid was out of the water, up on the bank.”
“Did he have a pulse?”
Shakes his head and looks down.
“Was he cold?”
John looked Sid in the eye. “He was laying on the bank in the full sun when we got there, doc. We didn’t start CPR. We thought he was gone.”
He was explaining his decision. But he went on. “Devin had gotten him up off the bottom and was there all dripping wet. He hadn’t started CPR. He told us it would just be more trauma for his family. And all the people standing around.” Sid imagined the bridge onlookers.
Sid felt some guilt with this questioning of a volunteer, doing their best for his community. Sid’s training and reading taught him only of the possibilities, the risks, the choices. There were no clear best ones here.
Some cold bodies come back with strong effort. Some of those that come back are breathing, drooling vegetables. Some don’t come back after minutes, even hours of chest compressions and warming and drugs.
So, what’s the right choice here? Sid didn’t know and he for sure knew John didn’t either. You just have to make the call. Then live with it.
“Thanks John. I’m going in.” Sid went through the ER doors.
Doctor Winston was at the nurse’s station as Sid came in. That told him no resuscitation was being done. “So, what temp did you get?” Sid asked.
Winston kept chatting with the nurse, a pert blonde. She looked away and Winston slid his gaze to Sid. “Yes, Doctor Coroner, how can I help you?”
Sid felt the steam going out his ears. “What’s the core temp?”
There are so many variables here. Warm dead people are dissolving in their acidotic juices and not good donors. Their vital organs will be mush. Cold dead people might be donors. We take corneas hours after death. Kidneys? Sid didn’t know all these calculations. But he knew who to call.
Sid thought about the talk he had given to the local EMT’s a couple years back after a young man he knew had shot himself. “If you come on a young suicide, head wound, small caliber, start CPR and go fast. Don’t wait for police to clear the scene. This could be a donor. If we get perfusion back, heart beating, blood flow, keep the acidosis down, we can keep the organs alive for donation.”
That’s how you have to think now days, on the cusp of life and death as a treating physician. Consider the donor’s contribution.
It didn’t seem Winston had this in his wheelhouse. The loser looked off to a passing nurse in scrubs, “Say, did you get that core temp?”
The busy guy looked at Winston with a blank gaze, telling Sid the request had never been done. Sid steamed some more and looked down to hide his disgust. That’s what loser doctors always do, blame the nurses.
“I’ll get it.”
Sid looks at the pert blonde. “Can you get me a deep rectal thermometer probe?”
“Yes doctor.”
Sid went into the bay.
He was a young dead white body, still in his white underwear. His hair was still wet, plastered to his scalp and forehead. The lips were parted, unblemished with the trauma of a resuscitation attempt. His weak chest was white, no one pounding on it to keep the blood flowing. He was very dead. But Sid knew there was a graph, a nomogram, physiology. Was he cold?
Pert came in with the probe.
Sid got her to help him roll the 100 pounds so he could push the probe deep into the rectum. Gloves, finger, then lube. Need to check for stool. Then the probe. Digital read out shows 90 degrees Fahrenheit.
He looks cold, but his insides are kind of warm. Might be too late and too long. Maybe Sid could start cooling him down and get some advice. Call the transplant centers, call the University, get some advice. But then we would need consent to do all this. Yeah, Sid feels the shit show in his brain. He thinks it could just be easier to be chatting with a pert blonde.
“Is there any family here?” He asks Pert Blonde holding the body sideways.
“I think his mother is coming in. She might be here.”
Sid finds her in the family waiting room.
He does his best to explain the situation and his role as the coroner, and the painful need for her to decide.
The wan, creased sad face looks down. “No, I don’t want that.”
Sid’s tasks just got easier. Maybe some folks wanting healthy organs just got their wait extended. Maybe none of this was really possible. Maybe that decision was made back when this poor dead boy first came up out of the bottom of the river.
Maybe when he went in.
The poor dead kid’s mother had the balls to make it right here. Winston hadn’t even thought about it. Probably Devin hadn’t but made his call back on the muddy bank after he’d pulled the lifeless white body up from the cold deep. And the ambulance folks had done what they were told. So, Sid just did, now what he was told. He made his call.
“Okay. I will fill out my report.”
Cause of Death: Drowning
Manner of Death: Accidental
Don’t you wish the story stopped here?
No organs donated, no lives saved from a tragedy, no happy ending.
How can we people get worse? To be, or not to be. And it’s all just shit.
Sid got a subpoena.
He was called to testify as the county coroner in a civil suit against the Reward Ambulance District and the Paradise Hospital. It seems the mother of the deceased young man was unhappy with his treatment. More shit.
Sid knew how this would go. He was being called to testify as the county coroner, public servant, so the claimants would not have to pay him for his time. He could be seeing patients and making money, but he would have to cancel their visits. No wonder he could not get any of his colleagues to take this job. It costs.
Sid further knew they’d use his medical training as an MD to try to get some of his “expert” testimony for free. Expert witnesses cost money. Coroners are free. The claimant’s attorney would try to get him to give “expert” testimony on the cheap.
Sid didn’t really respect the legal profession. But he sure didn’t respect some in the medical one he belonged to either.
So, it went.
The young lawyer did his best. The bereaved mom was sitting there, looking sad. The young guy ran through the first twenty minutes of coroner shit but then he got to it.
“So, Dr. Hawthorn, in your estimation shouldn’t the responding ambulance have started resuscitation?”
Sid looked down at the linoleum floor. It was cracked at the edges of the one-foot square tiles. It needed to be redone. It was worn out.
“I am here to testify as the county coroner.”
The cracked linoleum was clean. Somebody had cleaned this worn space.
“But you are a trained physician. Please share with us your knowledge given what you know of this.”
Sid looked at the eager young lawyer. He was doing his best for his client. Sid looked at the loser mom looking down at the same cracked linoleum. She wouldn’t meet his gaze.
“I have no opinion on what the right choice was for the providers who responded to this tragic situation.”
The young guy kept at him.
Sid kept his part. But he started to see, as he repeated himself and the lawyer did the same, questions again, same answers, that a different dance was being done. It might be about the bigger picture.
Justice.
Not who got what organs, who got blamed, who felt the worst about the whole shit. Maybe it was about coming to peace with the shit we are dealt.
The woman has lost a son.
Nobody got any of his organs.
His life might have been saved, or not.
And here we are.
Sid went back to the clinic. There were no patients, just paperwork.