Mrs. Rosenberg is still dead.

I was there when Mrs. Rosenberg died. I knew her from the five previous times I had responded to her apartment. She had a bad heart. She didn't like to call for help -- she'd wait until the pain was unbearable before she dialed 911. Even after all the polite lectures I had given her about calling right away when the pain started. Mrs. Rosenberg always said she didn't want to disturb anyone. She was sweet but stoic.

She told me all about her three sons and seven grandchildren. And her husband who had passed away last year. She said it was hard to go on without him but she looked forward to each family visit. She loved her grandkids. She showed me pictures of them - part of an enormous collection of framed photographs she kept on her coffee table. There they were in little league baseball uniforms and school graduation portraits and with girlfriends and wives.

Mrs. Rosenberg always offered me a glass of orange juice. I'd give her oxygen and check her blood pressure and her pulse and hook her up to the cardiac monitor and she'd be sure to offer me my juice. She was everybody’s grandmother. I was there when she died.

She dialed 911 after enduring crushing chest pain all night. She said she didn’t want to wake anyone up. Mrs. Rosenberg was gasping for breath. She didn't offer me any juice. I told her to hang in there as we waited for the Urgences Sante [Montreal EMS] ambulance crew who would take her to the hospital. I told her to think about her grandchildren and to keep on breathing. She did her best. I gave her oxygen. I talked to her. My partner checked her vital signs-they were terrible. We only had to look at Mrs. Rosenberg to know she was dying.

Her electrocardiogram indicated a significant arrhythmia. I could have established an intravenous line. But I didn't. Mrs. Rosenberg lost consciousness a few moments later. Her breathing was ragged and slowing down. I could have prepared an endotracheal tube to secure her airway. But I didn't. I assisted her breathing with a bag-valve-mask. My partner affixed the defibrillation electrodes to her chest - just in case. We could have intervened a long time before this moment to prevent this from happening. But we didn't.

Although I'm a paramedic and trained to provide advanced life support care under the direction of a physician, I am not permitted to so in the Province of Quebec. We don't have legal standing in the province - the only jurisdiction in the G8 that has failed to recognized advanced care paramedics. It is illegal for me to attempt to save a life using advanced life support. Even everybody's grandmother's life.

I was there when she died. It wasn't pretty. Urgences Sante sent a physician to assist because Mrs. Rosenberg had lapsed into cardiorespiratory arrest. The physician arrived after we had completed 15 minutes of CPR. Unless advanced cardiac life support is initiated within the first six to eight minutes after cardiac arrest there is almost no chance of recovery. Such was the case for Mrs. Rosenberg.

The physician arrived, verified the electrocardiogram, and told us to stop our resuscitation efforts. Just like that.

Mrs. Rosenberg died on the livingroom floor in full view of the photographs on her coffee table.

It’s been more ten years since Mrs. Rosenberg died.

I wrote about her death in the newspaper. I read about her passing on the radio. I shared her death with thousands of people across this land.

Wherever I talked and/or taught I told folks about Mrs. Rosenberg and how she died, gasping for breath, on the floor of her livingroom within view of the dozens of photos of her children and grandchildren.

She died because I refused to break the law. I probably could have saved her.

I could have inserted an endotracheal tube into her airway. I could have established an intravenous line in her arm. I could have administered drugs to combat the deadly arrhythmia in her heartbeat.

I don’t know for sure that Mrs. Rosenberg would have made it home again.

All I know is, like every other Advanced Care Paramedic in Quebec, I didn’t do anything more than the law allows.

She died.

Almost ten years have passed and Mrs. Rosenberg is still dead.

She’s going to be dead a very long time before advanced care paramedics [ACPs] are recognized as an essential part of the emergency health care system in Quebec. We’re the only jurisdiction in North America that doesn’t recognize advanced care paramedics as an integral component of the emergency medical services system.

Be well. Practice big medicine.