Sunday, December 17, 2023

Not Even Not Zen 332: Biomythography - Note 76, Good (Enough) (Learning to be Mediocre, Pt. 5)

Good (Enough) at Basketball

Part V


This part is not about learning. It is not even about basketball. 

But it started with a basketball game. 

In the spring, I'd gotten my graduate degree. With it, I approached a headhunting company. They seemed eager to connect me to better jobs. My initial choices were a system analysis spot working for the Department of Defense or a programming position with the National Institutes of Health.

I toured the defense contractor offices, where my job looked like it would take a lot of sitting in a light grey cube and revising analysis paperwork. In contrast, at Building 13 in the NIH I would work among the dingy green tiles from the 1950s. None of the furniture matched in Building 13. The rooms looked like the scientists had only decorated them under orders from the HR department. The place smelled like a machine shop. But the supervisor there told me I would get to stalk the corridors underneath the hospital to fix the back-end instruments and data servers. I would be allowed to help the patients at the largest research hospital in the world. 

Two years earlier, I'd seen the NIH cure a friend of mine of his rare type of cancer. The experimental medicines worked. I'd witnessed them. I accepted the spot in the NIH clinic. And I gave my notice to Hood College.

My friends saw it coming. We had two weeks to say goodbye. They said they wanted to throw a going-away party for me. Of course, they wanted a basketball game to feature in it. 

Around noon on my last day, we started playing a half court matchup, four to a side. It was an cloudless June day, so the sunlight shone through the high windows of the gym. After the second or third basket of the game, we switched sides between offense and defense. As I took position just east of the three-point arc, I turned to look at our group. The men were chatting. A couple of them shuffled into position to set picks. Jim Miller, short and dark-haired, stood among them. Jim set himself.

Then he collapsed.

He had taken a spot among three others, facing his defender. His salt-and-pepper hair had flown loose. Otherwise, he had looked happy and fairly neat. He'd worn a smile behind his close-cropped beard. He hadn't had time to sweat into his light-colored jersey yet. 

But as I watched, he stopped moving. His face went blank. The muscles in his body slackened. He fell in a jumble, like a puppet with strings cut. His momentum flopped him onto his side, then his back. His body made a wet sound. His head hadn't bounced. He didn't groan. He didn't try to lift himself back up. 

He lay still. Even his chest seemed motionless. 

I started running before the men standing beside him realized what had happened. A moment later, I was holding Jim's wrist. He still didn't move. I counted the time I didn't feel a pulse. Twenty seconds, nothing. I pressed the vein on his neck, under his jaw. 

"He's not breathing," Bruce announced.

"I don't feel a pulse," I said. I was pretty sure I was in the right spot. It's hard to miss.

"Try the other side?"

As I moved Jim's head, a slight huff of air fluttered his lips. I could hear the movement of his tongue, too. My first aid certifications had long ago expired but I had trained three times. I remembered parts of what to do. One of the problems for unconscious people is that their tongue slips back in the mouth to prevent breathing. Choking is pretty common even when the primary problem is a heart attack or stroke.

After a few more seconds with my fingers on what I was sure was the right spot, I still couldn't feel a pulse. I started to turn Jim's head so he would have less of an obstruction to his breathing. It would be irrelevant if we couldn't get his heart started. It might be helpful then, though.

"Help me turn his whole body on his side," I said. 

For a moment, I looked around. I had been so concentrated on Jim that I'd forgotten about the other players. They were standing in a rough circle. As soon as I asked for help, they relaxed enough that I could see how tense they had been. 

That's part of the training, too, I remembered. They say, don't try to do everything yourself. It's not possible. Other people want to help. Give them clear directions. Listen to their directions and follow them. Do your part. In an emergency, everyone wants some way to make things better.

The other players started asking questions. I explained my ideas about Jim's breathing. We needed to keep his tongue from sliding down his throat. The others nodded. It seemed right to them, too. We rolled his body so that it held steady on its right side. I started feeling for a pulse again, wrist and neck both.

Bruce crouched next to Jim's feet. He said, "What can I do?"

"You can call 911."

"Okay." He stood and started to leave.

"We need someone to tell the athletic center staff," I announced to the others.

"I think Henry took off to do that," said Allen.

"Okay." That was smart. He hadn't waited. "Next, we need to look for a defibrillator."

"That's a good one," Allen agreed. Everyone straightened up. 

"That would be the best thing." John, one of the security guards nodded. I could see him thinking about it. "This would be a building for one. I don't think there is one, though." 

"Does anyone know CPR?" asked one of the professors.

"No." I shook my head. I had already been kicking myself about it, somewhere in the back of my head, but there wasn't time to wallow in my stupidity about not training for this. 

"No." Others started chiming in, too. They didn't know how to do CPR. I heard murmurs of 'no,' 'nope,' and 'damn,' and saw their heads shaking.

I hadn't let go of the hope of finding a pulse. 

"If someone finds an emergency medical kit," I suggested after another moment of consideration, "that might have something to hold his tongue to the side. We can put him on his back and try artificial respiration or chest compressions."

"Want me to look for a kit?" one of the professors asked.

"Absolutely." Secretly, I was hoping an emergency kit would have a few pages of CPR instructions. I was willing to try.

While I waited another fifteen seconds, I discovered that I could move air in and out of Jim's chest. Although I had to move his left arm first, I could make his chest expand and contract. 

"I found the coach." Someone raced back into the room. He talked while I tried to get Jim's breathing going. "She made the call. She says an ambulance is on the way."

"Great." I nodded.

"Should we try CPR anyway?" someone asked. It was what I had been wondering, too. Getting air into Jim's lungs didn't mean anything if the heart didn't pump his blood to move the oxygen around.

"Is anyone certified?" 

I had to shake my head no again. The other men around me repeated the same sentiments they had before.

"She said if no one was certified, wait. The hospital is right next door. I mean, we can see it from campus. The ambulance will be here within a minute." 

It had already been over a minute since Jim had fallen. I'd heard a human brain shouldn't go without oxygen for more than four minutes. Still, the athletic director had made a definitive statement. It seemed sensible in its way. We could go against her wishes and try CPR but that only made sense if we got instructions on how to do the procedure. No one had returned yet with a med kit, CPR instructions, or a defibrillator, which probably didn't exist anywhere on campus anyway. Those cost a couple thousand dollars, so apparently it was just a crazy idea I had.

The longer we waited, the more it seemed like a bad decision to wait. Any pause in the action would be fatal. Having no defibrillator was another potentially fatal decision. If Jim's heart was stopped, and I thought it was, he needed the pads on him right away.

I stayed next to his body and pumped air in and out. I kept stopping to feel for a pulse. He kept having none. His skin felt clammy and cool. Finally, someone said, "They're here."

I rose. A glance at the clock told me it had taken five minutes. 

The two men in white jackets asked questions. I don't remember my answers but they seemed happy with what they were hearing from our group. They rolled Jim onto his back and, maybe due to my pleading or simply because it was the obvious step, they got out a yellow defibrillator.

As I'm writing this, I know defibrillators have gotten smarter than they once were. They can listen for a heartbeat and respond. At the time Jim went down, the only feedback they provided was a readout of the heart signal. Humans had to adjust the settings and make the decisions. The medical technicians shocked Jim once, twice, and got no change in the broken, static pattern on their screen. They changed settings and shocked him again. On the fourth try, they got a heartbeat. I could see the waveform on the readout. I started to cheer a little. But the technicians ignored me. They didn't like what they were seeing in the heartbeat or maybe they were just going through the motions and not really looking at their readouts. They shocked Jim's body again.

"Stop!" Even though they were ten yards away, I reached out my hand.

The heartbeat disintegrated. The electrical signals in Jim's chest fell back into static, a non-rhythm. 

The technicians kept at it. They adjusted the settings and shocked him seven more times. It seemed to take them a long time before they gave up. 

They never got his heart to beat again.

I'm not sure how we got to the hospital. Plenty of times, I've ridden in ambulances with friends and family. It seems unlikely in this case. I don't remember the ride. What I recall is pacing the halls. Eventually, we heard the doctor's pronouncement, passed by a nurse to a handful of us standing together in a waiting area with white curtains next to the emergency room. Jim was dead. I didn't feel defeated so much as defiant. I was angry the medical staff hadn't seemed to try much. (In retrospect, by then it was too late and the staff recognized the fact.)

Later, at work, we straightened up Jim's office. One of our co-workers knew how to get Jim's family contact information. Our boss started the process of calling his family members. 

The next workday, a Monday, I reported to the NIH in Bethesda. My new supervisor showed me around the clinical center. He demonstrated how to start programming for the DICOM image servers. We hiked through the basement corridors between buildings. He logged into his dedicated image collectors. We inspected the medical images from CT scans, PET scans, and MR scans. It seemed like a different sort of world here, a bigger one.

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