Sunday, January 19, 2020
Corpsman Chronicles XXX: The Big Touchstone
What's the difference between a fairy tale and a sea-story? A fairy tale begins, "Once upon a time..." A sea story begins, "This is no shit!"
I try to be careful to change names, but to the best of my recollection the events and locations are substantially correct. Of course I can only describe events from my perspective, so there's that. Readers who were present will doubtless have different recollections of any particular event. This is what it was like to serve in my tiny slice of the U.S. Navy between the late 1970's and early 1990's. It really was an adventure.
This is no shit!
Oh what a night!
Late December back in, um, '86. Actually early December, and there were no wimmins involved whatsoever.
My boat would be departing on deployment in late December. She would be making an around the world cruise, and at the end of that she'd be parking in Washington State rather than at NOB Norfolk, the home port she'd always returned to previously.
There were rumors that my Airwing, which was not changing home port, would bid her old carrier adieu and henceforth deploy on the Navy's newest aircraft carrier. The rumors were somewhat strengthened when a number of airwingers were asked if they'd like to make a little 10-day pre-shakedown float on the new carrier to "familiarize" themselves with the ship. They didn't have to ask me twice.
Underway for a bit of larking about in the VACAPES operating area, I was of course TAD to medical (TAD from TAD. It's a thing. So is TAD from TAD from TAD, but that's for another post). I was assigned to sick call and asked to share my experience as much as possible with some of the less salty ship's company corpsmen working in the treatment room. Which was great. They were a fine bunch.
There would be zero fixed wing flying. That would come later. There were several airwing helos and crews on board, though. They had a number of missions lined up including photography, a bit of radar calibration, press and dignitary rides, drills, and of course availability for real emergencies like man overboard and medevac. I was able to fly a couple of times and also work with the new carrier's flight deck corpsmen.
All in all it was a great time and I made some good friends.
On day eight I was in the duty section. After everyone had rotated through chow, at about 1830, the duty section LPO (Leading Petty Officer) was giving his watch briefing in the treatment room for the overnight. A fellow clad in sneakers, shorts and a sleeveless tee-shirt walked in. I'd never seen him before but I somehow knew he was a Chief. He was sweat-soaked and looked like he'd just come from the weight room. Kinda. I didn't like the "kinda" at all.
"Hey guys," he said, "I really hate to bother you but I really feel like shit."
His color was awful, pale and ashen. He was trembling and breathing hard. Firetruck!
I was the only paramedic on board, and while each of the physicians on board were ACLS (Advance Cardiac Life Support) certified, I was the only one presently in the treatment room with that certification.
I started to move toward the Chief.
"I feel like I'm gonna," he said. I'd taken maybe two steps toward him.
He went down like his strings had been cut.
I quickly went down on my knees and rolled him onto his back. Time did its slowing down thing. I felt for a carotid pulse with my left hand, put my left ear close to the Chief's nose and mouth to listen and feel for breathing, and looked closely at his chest to see if his lungs were expanding and contracting.
This was a heart attack. Cardio-pulmonary arrest. The sudden cessation of heartbeat and breathing was probably secondary to myocardial ischemia -- the fancy term for part of the heart muscle being starved of oxygen. Myocardial ischemia doesn't always lead immediately to cardio-pulmonary arrest, but often it does.
For the Chief, two things had to happen within four minutes or his brain would begin to die. His lungs needed to start moving air, and his heart needed to start circulating blood through the lungs to pick up oxygen and carry it to the brain where it was needed most. In the best case the Chief's own heart and lungs could be teased back into doing the job immediately. In the next best case we could do the job for him temporarily with CPR, but if his heart and lungs couldn't take over soon, he would perish.
The chief's sudden collapse and his pulselessness and breathlessness meant that his heart was either dysrhythmic -- beating out of rhythm in such a way that it couldn't move blood throughout the vascular system -- or asystolic -- at a complete standstill. I was praying for a dysrhythmia rather than asystole. In my limited experience asystole just wasn't survivable.
The ACLS drill for observed sudden cardiopulmonary arrest at that time called for a precordial thump, then CPR if needed, then defibrillation.
The precordial thump is a rude punch to the sternum. The theory is that the impact will cause the heart's inherent electrical system -- the system which causes the heart to beat and keeps it in rhythm -- to depolarize and restart a normal(ish) heart rhythm.
With seconds ticking away I knew what needed to be done, and I knew that my fellow corpsmen needed direction. They would and could do everything that needed to be done, but they didn't know what to do. Several of them were regular treatment room corpsmen, so that made things easier.
"Baker, Cagle," I said, "CPR board (a varnished plywood board to provide a firm surface for CPR) on the table, prepare to start CPR. Yates, large bore IV, D-5 and half, hang it. Jefferson, crash cart there (pointing to where I wanted it). Break the seals and open it. HM1, call away medical emergency in main medical, do it now."
Time for the thump. I was on my knees on the Chief's right side. Which was kinda the wrong side. I needed to apply a strong (but not too strong!) thump with the bottom of my fist directly to the middle of the sternum. I wanted to use my right or dominant hand, but I also needed to guard the xiphoid process with my off hand. The xiphoid process is a little pointy tag of bone at the bottom of the sternum. If you break it off you can cause all kinds of problems.
A snippet of advice from ACLS training popped into my mind. In some cases it can be better to guard the xiphoid with your dominant hand and then thump with the non-dominant hand, so long as you can be accurate with placement. You'll better guard the xiphoid and probably not be able to hit too hard. In theory.
With my right hand I palpated the xyphoid and lower sternum, then covered them with my hand. I raised my left hand in a fist, bottom side down, and called "precordial thump!"
The Chief gasped and started to breathe. I felt a strong, rapid carotid pulse. The Chief's eyes fluttered open and darted around. Thank God.
"Easy Chief," I said, "you're gonna be okay. We're gonna pick you up and put you on the table, just relax."
Strong hands helped me lift and as we lay the Chief down on the treatment room table the medical emergency was called away over the 1MC, or ships announcing system. That was a little trick I'd learned -- and now shared -- for getting the ship's physicians back to medical as fast as possible.
While Yates prepared to start the IV I turned on the LifePak 5, which was sitting atop the crash cart. The LifePak was a combination cardiac monitor (like a mini-EKG) and defibrillator.
The monitor part would show us the heart rhythm on a tiny screen and also on a strip printout, and that information would come via three small leads which were affixed to the patient's chest. The defibrillator could also, and would if needs be, apply a jolt of electricity to the heart. The jolt of electricity was more refined and controllable than the precordial thump, but the end goal was the same in either case. To get the heart beating more or less normally again.
As I untangled the lead wires and affixed them to the Chief's chest I gave him a running commentary of what had happened and what we were doing. Leads in place, I started the strip printout rolling and peered at the heart tracing. It looked very much like sinus tachycardia, which meant a normal rhythm except for the heart rate, which was something like 150. Anything over 100 is called tachycardia, while less than 60 is called bradycardia.
I didn't really like the looks of the tracing. It wasn't quite right, but it was impossible to tell what was wrong with just 3 leads and such a small tracing. We needed to get a proper 12 lead, but that would have to wait.
I watched Yates prepare to start the IV and noticed that his hands were shaking badly. Adrenaline can be a problem. You learn to work through it, but you have to work through it to learn. We were on thin ice so far as the state of the Chief's heart went, but we were okay for the moment. The youngster part of me wanted to jump in and start the IV. The grownup part of me knew that this was an important moment for Yates. The grownup prevailed, but the youngster chimed in with a dirty IV starting Limerick. The Chief grinned. Well, he was a Chief, right? Yates chuckled, steadied his hands, and started the IV.
At that moment every medical department and dental department khaki flooded into the treatment room. The ship's doctor and nurse anesthetist jumped right in, took my report, and got busy while the ship's Senior Medical Officer supervised and began chasing excess khaki from the room.
"A precordial thump, no shit?" This was the nurse anesthetist, a Lieutenant Commander. "That's cool, I've never seen that work!"
"Me neither," I said.
I backed off and sat down. My own hands began to shake. I secretly hated -- I mean, really, really hated -- cardiac arrests. People having heart attacks are extremely sick, literally at death's door, and the margins for successfully resuscitating a patient in cardio-pulmonary arrest are razor thin. In those days it just didn't work out very often, and every failure I was involved in was utterly crushing. Not that I ever let on. "Don't mean nothin'" was my mantra. But of course it did, and that's one of the reasons I was sitting there with shaking hands and in danger of blubbering. Adrenaline can be a problem.
I hard-assed myself back into compliance with my standard of behavioral norm. Unless the Chief went south in a hurry he'd be medevacked to the beach very soon, and that meant the day wasn't over for me just yet.
"Medevac?", I asked. Emphatic nods from physician and anesthetist.
"I'll get the ball rolling," said the SMO as he quickly headed for his office and the phone.
"I'll need a helper," I said, "you up for a helo ride Yates?"
A look of relief flashed between physician and anesthetist, while Yates' visage was immediately suffused with a look of absolute joy.
I dragged Yates out of the treatment room and over to the SMO's office where I barged right in. He was hanging up the phone anyway. "I need a helper Captain and I think Yates is the right guy, but he's got no training, it's December, and it's night."
The SMO paused for perhaps 10 seconds.
"Okay," he said to Yates. "It's dangerous. You don't have to go. You do have to volunteer. Nobody, me or anyone else, will think badly of you if you have second thoughts."
"Yessir," said Yates, eyes shining. "I mean yessir. I want to go. I volunteer."
In the back of my mind I thought about the fact that NAVY stands for Never Again Volunteer Yourself. Made me smile.
"Arright," I said, "let's head up to the paraloft. Thanks Captain."
Up in the paraloft while we were getting him into wetsuit and flight gear I gave Yates a thorough brief on what we'd be doing medically, what I expected from him, what to expect for his first helo flight, and what to do if shit went sideways. I gave him the usual ditching brief, then added a bit of guidance.
"If we go in the water, You get yourself out of the aircraft. I'll take care of the Chief. You get out fast so you're not in the way."
He looked at me, paused for a moment, then nodded.
The medevac was pure vanilla. We turned a worried but appreciative Chief over to the tender mercies of Portsmouth Naval Hospital, then saddled up and headed back to the boat. It was very dark and cold that night but the skies were clear and the air was smooth. Yates had the time of his life and chattered endlessly on the ICS. It was okay, the rest of us knew how it felt. And unlike the rest of us, Yates' first helo ride was a full-up mission. When we got back I showed him the requirements and instructions for applying to aircrew school as a corpsman.
Less than 48 hours later I walked off the boat. A couple of weeks later I walked back aboard a different boat and set sail once again.
As a crew we received Sikorsky Awards for that medevac, somewhere in the middle of the deployment. Yates received his aboard his own carrier. Which was cool.
The Chief had a bad case of coronary artery disease and underwent multiple vessel bypass. Those surgeries weren't new by any means, but they were still a very big deal. He did well and had a fairly quick recovery. Partly because he was quite fit and partly because of his youth. He was only 39. That still seemed kinda old to me at the time, but not as old as it had once seemed!
Sarge has a very cool post over at his place today (yesterday as you read this), marking four years since little Belle was baptized in San Diego aboard USS Theodore Roosevelt.
The images in those posts are simply awe inspiring. The story of Sarge and his family is a love song to the world about America. Of course there are many thousands of such songs, and such have been sung by many thousands more going back to '76. But in this slice of the blogosphere, and in my heart, those images Sarge shared are incredibly powerful and indescribably beautiful.
I've walked those decks, I've heard that bell sing, I've been in that chapel, I've stood on the very spot where future cousins would gather in contemplation. Once upon a time I was part of the helo crew which made the very first landing of a naval aircraft aboard that ship.
Until I met Sarge and his family on the interwebz TR was a rather small slice of my naval experience. Just another nuke carrier I'd gone down to the sea in.
In 2016, when Sarge posted about the baptism, TR became a touchstone for me. I don't know exactly why, but I think I understand some of it. The fact of the thing is far more important than knowing the how and why.
Be well and enjoy the blessings of liberty.