My Latest EMS Story started in a most unusual way: with my wife, Kit, loudly asking, “Randy?! Are you OK?! I’m calling 9-1-1.”
My eyes popped open to give me a view of the floor, and the memory of what happened flooded back. It was yesterday, and I was in the middle of writing this week’s stories; I had grabbed a bite to eat while working at my computer at the dining room table. My first bite got stuck in my throat.
Luckily, Kit was in the kitchen, and I got her attention with a gesture. I grabbed my water and tried to wash the obstruction down, but it didn’t work and the blackness started closing in on my vision. I moved to get onto the floor for two reasons: to use gravity to hopefully keep the blood in my brain, and to make it a much shorter distance to the floor if I collapsed. And that’s the last thing I remembered before dropping to the floor, unresponsive.
Let Me Back Up a Bit
In your neck, in addition to blood vessels, your esophagus, and your windpipe, is “the” vagus nerve (it’s actually a pair of cranial nerves that run from your head to your body between your carotid arteries and jugular veins, but they’re usually referred to in the singular).
The problem is, what’s in Vagus doesn’t stay in Vagus: they’re quite sensitive to pressure, causing a rapid full-body effect. So even though I could easily have stayed conscious without air for a minute or three, the pressure on my vagus took me down in a matter of seconds. I was completely unconscious.
As Wikipedia puts it, “Parasympathetic innervation of the heart is controlled by the vagus nerve. To be specific, the vagus nerve acts to lower the heart rate. The right vagus innervates the sinoatrial node [in the heart]. Parasympathetic hyperstimulation predisposes those affected to bradyarrhythmias. The left vagus when hyperstimulated predisposes the heart to atrioventricular (AV) blocks.”
Got that? OK, let’s simplify it a little: stimulation (pressure) on the vagus has an immediate effect on the heart, slowing it down dramatically. The resulting lack of blood flow to the brain can knock you out in a jiffy.
Goes Back Centuries
The effect is well known: a 17th century Italian doctor, Antonio Valsalva, is credited for what’s known today as the “Valsalva maneuver,” which can calm a racing heart (particularly, for you geeks, supraventricular tachycardia). If you’ve ever passed out while straining on the toilet, or thought you might, that’s thanks to an accidental Valsalva maneuver, stimulating your vagus nerve.
Anyway, since I had gotten Kit’s attention, she watched it all happen, and was immediately by my side, shaking me and getting no response. My body was convulsing a bit, trying whatever it could to clear my throat.
She didn’t know what was causing this (I didn’t, for instance, do the “universal choking sign” as I went down), but she could see I was in quite a bit of distress: she said I quickly turned purple. After calling out to me a couple of times, she went for the phone, about 10′ away, and called 9-1-1 to get help on the way before she decided what to do next. She kept calling out to me, and I finally heard it just before the call connected, and looked up from the floor.
“I’m fine,” I croaked. “My husband says he’s fine,” she told the 9-1-1 operator. She wasn’t having any of it, though, since she immediately added, “but send the ambulance anyway.”
I didn’t protest, since as I started taking stock of my situation, I realized my heart was really, really mad at the insult it had suffered: I could feel it palpitating wildly, so I didn’t mind the thought of the duty paramedic putting me on the heart monitor to see how it was doing.
Indeed my pager was on my belt, and it went off when they paged the ambulance to my house. I knew the scramble it would cause.
I went from purple to pale, and cold. Kit kicked into medic mode, getting my vitals (which were fine) and starting the paperwork for the ambulance crew, just like when we’re on a call together.
By the time the troops arrived I was feeling much better, and my heart was calm (“can’t get more ‘textbook’ than that,” said my paramedic buddy Ruth, who was on duty yesterday, as she looked at my EKG).
Much Ado About Nothing?
Well, it was a good lesson all around. Medics are commonly known to be terrible patients — we second-guess everything when we are thrust into the “victim” role, especially when it’s our own agency doing the rescuing. I was determined not to be like that.
I’ve had medics as patients before, and they’re a massive pain in the a— …um, not as cooperative as we like our patients to be. So I cooperated, answering all the “dumb questions” like we want all patients to do. Otherwise known as “Let the professionals do their frigging job.” Done, even though it felt awfully weird.
And that’s another good lesson: it’s OK for such a situation to feel weird, or to be mad at your body for doing something you don’t want it to. It’s part of being human, and if you need help from first responders, so what?
A good friend recently told me about his cousin, who realized he was having a heart attack …and drove himself to the hospital because he didn’t want neighbors to wonder about the lights and sirens. It was so serious that they had to life-flight him to a bigger hospital. He came pretty close to dying from the delay, not to mention that driving while so distressed could have caused an accident, hurting someone else. You pay a lot of taxes to have first responders available: when you need them, use them! You, nor I, don’t have anything to be embarrassed about.
Follow the Protocol
Even though (or is it “Since”?) my own wife is a medic (aka first responder) herself, she didn’t fool around: she got help on the way. We medics always say we’d rather be called and have it be nothing than not be called when we really could have helped, so get things rolling and, if it does turn out to be nothing, so what? They don’t have to take you to the hospital if you don’t actually need to go.
I let her follow that much-given advice, rather than second-guess her. This time it was neither nothing nor critical, but rather somewhere in-between. I had a medic with me, and she knew what to do first: get help rolling. Unless you have a fully-equipped emergency room physician in your house, you might take a lesson from that. When in doubt, call!
Ruth agreed I was OK, and it was a simple matter of me signing a “Transport Refusal” form. It was their first call of the day, and I told the crew that at least I had given them something to do.
“I’ll take it!” said Ruth’s partner, Greg — another buddy. Someone said that this moment was naturally time for another call for the crew. If so, “I’ll race you there!” I told them, which brought a good laugh, because we all knew I’d win that race.
I handed Ruth a Get Out of Hell Free card and told her to staple it to the refusal form. With a huge grin, she said she would. (I’m holding you to that, Ruth!)
“Could I” have died? Well, sure, if it was a chunk of meat instead of a fork-full of buttered rice, and if I was alone rather than with a medic who knows the Heimlich maneuver, which she didn’t even need to do.
It’s definitely sobering to realize you can go about your normal activities and be gone in a few seconds. But the truth is, I made it back without any intervention, and that’s the most likely outcome in a vagal event: you pass out, which makes you go horizontal, which brings blood flow back to the brain, and you wake up feeling a bit foolish, or at least let down by your own body. But ask Kit: it’s scary as hell to watch, and calling for help was the right response.
The first responders left, Kit went back upstairs, I had a little more to eat, and I finished writing this week’s stories. After all, you’d all kill me if I didn’t get them to you! 🙂
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