I did nothing to save the first person who died in front of me. I simply stood watch and let her go. She was old and white and wasting away in a nursing home. Her death was unceremonious, but fast, and I was the only witness, earth’s final sentry, there to do nothing but close the gates as she slipped through.
I was only twenty-six when she died, but already I’d squandered away two lives—the first as a failed salesman, the other as a reporter in exile. EMS was an accidental third act. It was early 2004, centuries ago. When I look back, I find it hard to believe this death and countless others happened, that at one time my sole purpose was to be present, as either anxious participant or indifferent witness. As with much of my EMS life, the memory is fuzzy: soft light filtered through gauze. It’s only the details—the little ones that don’t seem to matter at the time—that carry on. So really, what I have is more sensation than recollection, more feeling than anecdote.
This is how it all feels to me now.
It’s my second night, and I’m partnered with a guy who never goes home. He’s a firefighter in the next county, but he’ll do anything for money and works a handful of part-time jobs. When he isn’t here or at the fire station, he sweats over the fryer at McDonald’s. Just before ten, we’re called to a nursing home for a sick woman. My partner is tired. He walks slowly, eyes to the floor, as we push the stretcher off the elevator and wander down the long corridor to the patient’s room. We ease alongside her bed. A nurse hovers in the background, saying the woman didn’t eat dinner, isn’t acting like herself, and needs to be seen. I take her blood pressure, her pulse, count her breaths. Her eyes are closed; her skin—white and crinkled like parchment paper—is dry and hot. My partner asks for her papers. We don’t ever leave a nursing home without papers. Most people in a nursing home can’t talk, and those who can don’t make sense, so even a question as straightforward as Who are you? doesn’t yield usable results. So we get the papers, a thick manila envelope stuffed with everything from medical problems to next of kin. More important, it’s in this packet that we’ll find insurance information and whether or not there’s a do-not-resuscitate order.
Ostensibly, we’re here for the patient, but really all we care about is the DNR.
The DNR is the word of God Himself, written in triplicate and handed over not by Moses but by a big-boned woman in orthopedic nursing shoes. It’s in these papers that we’ll find answers to the uncomfortable questions that absolutely must be answered. What if she loses consciousness? What if she dies? Do I go all the way—CPR, electric shocks, slip a tube down her throat, drill a hole in her leg for medication? Or do I watch her swirl the drain until she disappears altogether? What does her family want? What would she want? The existence of this piece of paper, even its absence, means a lot. To everyone. At the hospital, the nurses will ask about it, and the doctors won’t look at us until we’ve answered. At her age, in her condition, everyone will agree resuscitation, even if it could be accomplished, would be cruel. So does she have a DNR? The nurse says she does, that it’s atop her packet, the first page in the stack. She leaves to get it.
And that’s when it happens. Before my partner—who’s leaning against the wall—coaxes his mass into action. Before I pull back the sheet. Before anyone addresses her directly. She opens her eyes—milky and unfocused—and tilts her head forward. Her lips part and then, without ceremony, she relaxes. Her last breath escapes. A single tear runs down her cheek.
I know instantly what’s happened. But is it really that simple? That easy? The nurse has just said the patient has a DNR, so that drilled-into-my-head-during-school compulsion to act doesn’t kick in. Instead, I spend the first few seconds staring into her vacant eyes, tracing the arc of that single tear—her final corporeal act—and marvel at this woman. Moments ago she was something to pity, bedridden and in a diaper. Now, plucked from her stained nightgown, she is cloaked in the wisdom of the ages. She knows why we’re here and, more important, what’s next. And if it’s not