Had another fantastic Pyrrhic victory last night. We had a call that a full arrest was coming in. Young guy--44. We all thought "Game Time!" and got ready for the maximum effort. And waited, and waited. Because of so many California ER patients don't pay their bills (and because the state doesn't) ER's are closing left and right. Which means this guy had a long ride to the ER and when your heart isn't beating that has grave consequences. Seconds really do count. So he came in, dead and intubated, with no pulses. Idioventricular rhythm which is awfully close to flat line. We put the hammer down and pushed epi, atropine, bicaarb, mad, calcium and I'll be damned if the guys heart didn't snap back for us. Nice thudding pulse. Ah, the beauty of a healthy young heart. More meds and then fifteen minutes later his heart dropped out again, all of a sudden. We jumped on him again and brought him back. But from that point on I was amped up and on edge waiting for the next time his heart dropped out on us and trying to plan what I would do. Spoke with his family--wonderful, loving, appreciative people. Called the ICU doc in. And waited with bated breath. No ICU beds, of course--financing and nursing ratios make those beds the most precious in the hospital. So he lay in the ED for hour after hour. Towards the end of my shift things looked grim. His blood pressure went from very, very low to very, very high and I interpreted that (hopefully wrongly) as his injured brain swelling up like a sponge. Alas--he has a grim prognosis I fear. It's something about this job. The furious effort to preserve life, but with the sense that the odds are stacked against us. Poor infrastructure. I guess I have the sense that Death holds all the good cards. U-561