Robert J. Lanz, LCSW
When I was a young man, I was drafted into the army during the Vietnam war and yes, of course, I was scared. Having been an adventurous kid growing up in Southern California I had already traveled in Mexico and South America and was familiar with the jungle. I knew the risks presented by the third world: dangerous roadways, cutthroat banditos and remote beaches with monster waves and such. Still, those forays were voluntary endeavors with a degree of acknowledged danger and I would frequently be able to reassure myself whenever things got dicey, “Hell, I’m an American. I have an American passport. I have an American Express card. No matter what, just get me to an airport and fly me home.” Safe and sound. Well, safe anyway.
Vietnam, of course, was another matter. There was no surf to speak of and there was no surf banditos, just guys in black pajamas with guns hell bent on killing me. No highway robberies to watch out for, just snipers and land mines. I knew I was going to need a whole new skill set for this adventure.
The guy who delivers that skill set is called the drill sergeant. When you arrive at your new army post for basic training in the art of killing and surviving attempts to kill you, the drill sergeant is one of the first guys to start yelling at you. He’s one of many guys whose job it is to initiate you into Armythink. Armythink is what puts you on automatic pilot when the lead starts flying and tunes you in to one of the most important rules of any emergency situation: the best time to try to learn a survival skill is not during an actual emergency. The learning process is brutal, but only a fool wouldn’t take every advantage of what the drill sergeant can teach. My drill sergeant had done two tours in Nam, killed several of the enemy and saw the enemy kill his guys in return. He had knowledge. I needed knowledge, specifically, the kind of knowledge he was teaching.
The process was painful and there were plenty of times when some of us gave serious thought to turning our rifles on the drill sergeant and even on ourselves to end the misery. We were all going to die in Viet Nam anyway, so why go through all of the pain and suffering beforehand?
The drill sergeant is the guy you learn to love to hate, and in the eight weeks you are under his tutelage, you finally grow up and just learn to love him. No matter what happens to you later in life, your drill sergeant will always be your ultimate tough love dad, always there when you need him. At the time, I thought he was teaching me how to survive a 13-month tour of hell in Southeast Asia, but, as with most valuable lessons, their application often proves to be universal.
Fast forward a few decades, on a night when I thought my work in the ER was finished, only to discover that it was just beginning. Why do these things always seem to happen when I’m just about to go home? Why don’t I just go home anyway and let the people who have arrived at the ER in distress deal with their difficulties on their own? Because they are in crisis and I’m merely exhausted, I guess. Fair is fair.
When a giant man shows up in the middle of a giant heart attack with his giant, frightened family at his side, what can you do? There’s a good chance that a husband and father will die despite our lengthy interventions and his family is here to watch it happen. My hot tub and cold beer at home are pretty far down the necessities chain, so I introduce myself to the family and start the process of bracing them for the strong possibility of the loss of a loved one. While preparing them for that awful eventuality, it’s also my job to explain to them what we are doing to try and keep their loved one alive. Juggling what I know with what they do and don’t need to know yet is always a little painful. Sometimes it even feels like I am being somewhat deceitful. But as long as hope remains, I’m not going to be the one to dash it. Not until I have to.
The man lying with his eyes closed hooked to a heart monitor was large: six-four and more than 250 pounds. The monitor was the first step in the procedure, followed by an IV in the arm, the openers for what will come next: a host of medications and a few rounds of shocks and maybe some hands-on CPR. The monitor tells us in what ways the heartbeat is going wrong so that we can try various fixes. That’s called cardioversion: changing what’s wrong with the heartbeat to get it back to a normal rhythm. Your heart has four chambers that fill up and pump out blood to keep your circulation going all working in a well coordinated choreography of life. One side pulls blood from your veins and sends it to the lungs for oxygen and the other side of the heart pulls blood out of the lungs and pushes it through your arteries back into your body. When one of those chambers goes too fast, its ability to pump is compromised and sometimes the only way to stop that from continuing is to give the heart a big jolt of electricity.
Everybody has seen that on TV where a doctor puts the paddles on the patient’s chest, yells “clear” and then basically electrocutes him, hoping that the heart will stop and then start again with a normal rhythm. It’s kind of like hitting the “restart” button on your computer when it goes inexplicably haywire and the screen goes blue. The restart button might not provide a total fix but at least you are back to a situation in which the basics are working. The problem that caused the heart attack still exists, but the resuscitation team can start looking for a workaround. That’s what they were doing with the big guy and his heart. The first step was to get him stable so that the cardiologist on call could figure out the finer details when he brought his findings upstairs.
That is, if he got to bring his findings upstairs. At that point, the ER team was still trying to stabilize the patient. There is a good reason for shouting “clear” when you shock a person with a heart defibrillator. The device delivers enough voltage to lift even a very large person off the gurney and I’ve seen staff members who didn’t respond to the “clear” warning fast enough end up helpless on the floor for a few minutes—kind of like getting tasered by the police. Luckily, when a patient’s heart is in need of defibrillation, he is usually unconscious and can’t feel the pain of the mega-volt jolt. Usually.
The family watching their loved one getting shocked back to life can be in for a shock as well. No matter how many times you see it on TV it doesn’t hit home until it is your loved one bouncing off the bed, arms and legs flailing in an obscene dance with death.
Sometimes shocking doesn’t work, so we try more medicines and more shock and then more meds and more shocks until we finally give up, recognizing the futility of further beating this person with shocks, drugs and CPR. When that happens, it is the doctor who calls a formal end to things by saying, “That’s it. I’m calling it. Time out 2:27.” Then the medical team is done and I take over.
But if the patient isn’t particularly old and appears to be in otherwise decent health with no significant cardiac history, we go the extra mile, so to speak, and that’s what happened with the giant patient having the giant heart attack. The family kept telling me what a tough guy he was, impervious to pain. That was good to know because we had to shock him ten times before he was stable. Ten times, the man’s 250-pound body was jolted off the gurney, his arms flapping like a flag in hurricane. Ten times, the physician called “clear” and that mega-volt charge was applied to his heart, enough voltage to render anyone unconscious. It was a truly brutal beating and horrid to witness, but finally, it achieved the desired outcome.
The staff cleared the room and the cardiologist wrote orders to admit the patient upstairs. I took the family in to see him and I explained, as I always do, that even though he was unconscious, he might still be able to hear what is going on, as hearing is the last sense to shut down. Some patients who have been in comas are later able to remember some of the things that happened to them during their comatose state, but I was hoping this wasn’t the case. It was really a brutal save. I can imagine the patient thinking, Damn, can’t you all just let me die of a heart attack? Do you have to beat me to death, too?
The man’s wife, mother and half-dozen children approached him, crying, speaking to him and touching him. “Daddy, Daddy. We love you.” That’s when daddy opened his eyes. He couldn’t talk, of course, because he was hooked up to the ventilator and had a breathing tube resting on his vocal cords. The tube didn’t keep him from smiling, though. The family had a lot to say, as together we had watched for almost two hours as the ER team brought their dad back from the brink of sure death.
He made strong and piercing eye contact with me, like he was in possession of some knowledge. Maybe he knew I had been helping his family. Maybe not. In any case, he looked quite calm about the beating we gace and his near death experience. After several minutes of tears, laughter and touching, the family was ushered away to fill out some admitting paperwork and I was left alone with the patient for a few minutes. He was still smiling.
“Do you remember any of what happened to you tonight?” I asked.
“Do you remember being shocked?”
“Were you awake the whole time?”
He nodded again.
I shook my head in disbelief. He had just taken what had to be the worst beating of his life without flinching. Later I remarked about his incredible resiliency to his family. His oldest daughter walked in, shaking her head and smiling. “He’s tough,” she said. “He was a drill sergeant for twenty-five years. He had to be tough. His men meant a lot to him.”
Thirty years ago, guys like him relentlessly hammered the necessary lessons into me to prepare me for war. They valued my life even though they didn’t know me from a hundred other guys who looked just like me. Tonight, I was part of the team that returned the favor. Thanks, Drill Sergeant. I owed you that. I hope sometime you remember this night and think about us with the same warmth we soldiers had for you. You saved some of us and you didn’t give up on any of us, even when we looked hopeless. Tonight, we didn’t know who you were, but we didn’t give up on you either. Thanks for granting me the honor of paying you back.