1. Virgilio, Mary RN


Death had been pronounced, but it didn't have the final word.


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We took Highway 101 past the lettuce fields and vineyards along California's central coast. It had been dark for several hours, and we could see only taillights ahead and headlights behind. Just south of Santa Maria, a line of vehicles idled, a cloud of smoke rising beyond them. I parked the van and walked forward along the road's shoulder. The emergency flashers of a California Highway Patrol (CHP) car washed the scene in red and blue. A small white car was upside down in the left lane, the engine whining, wheels still spinning. Lying facedown was a woman, her body below the hips beneath the overturned car.


My husband is paralyzed from the waist down, but 30 years ago we worked together as emergency medical technicians. We were heading to a meeting about his chronic pain. An off-duty paramedic who'd witnessed the accident was leaning over the woman, frantically trying to open her airway by clearing the vomit from her mouth.


The skills I'd practiced as an ED nurse returned quickly. In my sandals and summer skirt I knelt beside the woman, feeling her wrist and then her short, thick neck for a pulse. Nothing. Her face was puffy and blue, vomit clung to her lips, and there were no signs of respiration. A physician wearing tennis shorts and sneakers stood nearby, hands in his pockets, talking to the CHP officer about calling the CALSTAR helicopter ambulance. As I drew on a disposable glove and reached into the woman's mouth, pulling open her jaw and pushing down and forward on her tongue with my first two fingers, I heard the doctor say, "She hasn't got a chance." At that moment the woman gagged and appeared to inhale. I called out, "She has a gag reflex and she's trying to breathe!!" The doctor said, "No, she's cyanotic-she's dead."


The paramedic checked her pupils. "They're not reacting," he said, and the doctor again said, "She's dead."

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The paramedic shouted, "Let's get this car off her and turn her." A CHP officer urged me away, but I was sure the woman was trying to breathe. I covered my head with my left arm and crouched down, keeping my fingers in her mouth to keep her airway open.


In a few seconds the car had been lifted off her legs. The paramedic spread out cardboard. I made sure at least three other people rolled the woman as a unit to prevent rotation of her spine. It was awkward, but I was able to keep my hand in her mouth as she was turned. When she was on her back, her chest rose and I thought I felt her breathe.


By now, the fire paramedics were at her side. As they were preparing to intubate her, she took another large, spontaneous breath between my fingers; I yelled, "We've got respirations!!" and one of them slipped an oral airway into her mouth. He covered her mouth and nose with a plastic breathing mask and Ambu bag and began to squeeze oxygen into her lungs after each of her gradually strengthening breaths.


I couldn't locate a pulse in her wrist or groin, but in the spaces along her sternum, I felt a flutter that changed to a strong heartbeat of more than 120 beats per minute. I called, "I've got a pulse," and one of the fire paramedics prepared an IV. I took over on the Ambu bag from a clumsy CHP officer; my hands remembered to squeeze the bag with each of the victim's breaths.


The woman's eyes began to move and appeared less dull. She exhaled and moaned after each breath I squeezed into her lungs. Soon, she was moving her head and moaning as if conscious of her pain. I backed away from her side.


A short time later, as we again drove south, my husband reminded me several times to drive at less than 80 miles per hour. Only when we'd reached the hotel room did I notice the cuts on my knees and ankles. On our return trip two days later, we learned at the local hospital that the woman had been transferred from the ICU to the medical-surgical unit. The rest we'll never know, and I'm not sure that it really matters.