Boca a boca - mouth to mouth

6-18-08 – Esmeraldas, Ecuador

I was on my way to the cafeteria when two other med students zipped by, screaming over their shoulders “come on – emergency, 3rd floor”. So I raced up with them looking ridiculous: a cup in one hand, a spoon in the other. At 75, she picked an awful hospital to go breathless and without a pulse. We got to it right away. My friend was at the chest, so naturally she was on compressions. I was at the head – that’s the airway station: throat, mouth… rescue breaths. But there is shit nothing in the hospital – not a backboard in the ER, not a facemask on the floors – and I’m still too young and idealistic for my own good, so I put my face down and blew into her mouth; a well intended impulse to give her her life back. Big mistake. I don’t remember if I heard the gurgling before or after the spit-up hit my mouth – either way it was disgusting. We called it quits and I came to my senses, which was the worst part.

My colleagues gave me a hard time for giving breaths without a mask, and they were only half joking. There are too many diseases you don’t want to have regurgitated in your mouth – too much to leave to chance. I know this, but can’t stand seeing people suffer. Suddenly the thought of contracting tuberculosis made me nauseous. My mind churned through the worst possibilities and jacked my innards like a sledgehammer. I doubled over as if to vomit but nothing came out. Dry-heaving is worse than vomiting because it accomplishes nothing. So I spit out what I could and stuck my finger in my mouth for the rest. But nothing came up and I’m too sissy to stick my finger deeper. In the background people were laughing, and for three minutes I hated Ecuador.

I’m still learning to be concerned but not emotional, alert but not excited, and quick but not hasty – the foundation of basic trauma life support. Fortunately, as my pops always says, “Every mistake that doesn’t kill you teaches you something. When you stop learning, you’re dead.” Here’s what I learned: no mask, no breaths – and no excuses to the rule. That, or get to the chest before anyone else calls it.

*The charts at the nurses’ desk indicate the patient had no known communicable disease.