"Hey...hey Man...yeah you" The man smelled as if he had used beer for bodywash and sauntered up to me as I was gathering my patients belongings.
"You got an ambulance out there?"
"I sure as hell hope so" was my reply.
"Cmon. Let me drive it"
"Nah......My partner would get upset. Its the highlight of his night to drive and I couldn't take that away from him"
"You guys suck"
And to think. This wasn't even the dude I was picking up. Turns out the guy I was picking up was built like a linebacker, clutching an apple juice in one hand and a bible in the other. Apparently He had been hearing demons tonight that had been telling him to kill himself. My only question to the man was this "What are they telling you to do to me?"
Most of us have the common sense to ignore those inner voices rather than try and start meaningful dialogues with them. Either that or we assign the inner voices to our housepets. Cats apparently lead the way in this due to the increasing frequency of crazy cat ladies.
"Nope. They aren't talking about you. They don't even know you" Boy was I relieved..
We all have inner voices. The ones that have separate conversations in our head while we are having another. The shoulder devil and angel that we all have but can never see unless we are in the middle of a bugs bunny cartoon. How many of us listen to them? We all have had moments where we have said "Was that my out loud voice?" Thats the demons getting out. Maybe its the ones of us who hold them inside and never give them voice eventually go mad.
So guess what I am saying is that we shouldn't fight these inner voices, rather we should embrace them and listen to them. but give them the same consideration we do that that crazy friend we all have, or that uncle that you just knew somehow that you didn't want to be in a room alone with. I've seen what happens when you don't accept your entire personality. Both sides, good and bad, right and wrong. To deny our feelings and innermost thoughts will only lead to madness and a trip to the zoo
Sunday, May 30, 2010
So I thought we would have a little discussion of the term "Sick"
For starters, sick can mean any number of things.
According to Merriam Webster
affected by physical or mental illness : nursing very sick children | we weresick with bronchitis [as plural n. ] ( the sick): visiting the sick and the elderly.
• of or relating to those who are ill : the company organized a sick fund for its workers.
• figurative (of an organization, system, or society) suffering from serious problems, esp. of a financial nature : their economy remains sick.
• archaic pining or longing for someone or something : he was sick fora sight of her.
2 [ predic. ] feeling nauseous and wanting to vomit : he was starting to feel sick | Mark felt sick with fear.
• [ attrib. ] (of an emotion) so intense as to cause one to feel unwell or nauseous : he had a sick fear of returning.
• informal disappointed, mortified, or miserable : he looked pretty sick at that, but he eventually agreed.
3 [ predic. ] ( sick of) intensely annoyed with or bored by (someone or something) as a result of having had too much of them : I'm absolutely sick of your moods.
4 informal (esp. of humor) having something unpleasant such as death, illness, or misfortune as its subject and dealing with it in an offensive way : this was someone's idea of a sick joke.
• (of a person) having abnormal or unnatural tendencies; perverted :he is a deeply sick man from whom society needs to be protected.
So for the purposes of this discussion I am going to use a typical call in order to try and illustrate this point.
We are called by the local police for a sick person. Yeah. Thats all we get over the radio for dispatch. So for as far as we know this could be just about anything.
Our guy turns out to be a young male in the company of the local authorities walking around and spitting on the sidewalk......Joy......So after the police motion to us proceed in we finally get the skinny on what I would personally consider a bad night. Lets see what you think.
"So what happened?"
"Well I was passed out on a bench when I woke up somebody stuck me with a needle. Then I got up and started throwing up all over the place and felt all weak and dizzy. Then I started to feel better. I just want to go and lay down somewhere."
"Well I don't really handle the hotel reservations around here but if you want to go to the hospital to get checked out then I'll be more than happy to take you there and get you checked. Could have been kool aid or drain cleaner in that needle. Only way to find out is to take you in"
(A pretty convincing argument I thought. I mean the man did wake up and begin projectile vomiting.)
"No dude. I'm fine. I feel better now. I just want to go lay down"
"Well heres the thing. You could go to sleep and not be able to wake up again. I mean I dunno about you but I don't get stuck by random psychos wielding needles while passed out on the bus stop bench. Might have been something bad in that needle."
(Again I think I was making my persuasive face and the persuading words come out)
"Nope. I just want to lay down"
So lets examine this with Mr Webster.
So the guy was sick.
Figuratively, because the man was carrying his worldy possessions in a backpack and sleeping on the bus stop bench.
In the Archaic sense he was pining away for a horizontal surface where he would not be disturbed by the constant annoyance of diesel fumes, stray dogs and cats, or those annoying bastards who have nothing to do but run around town sticking needles into people (Which ironically sounds like what we do but we use clean needles and neither kool aid or drain cleaner.)
He was also feeling nauseous and said he had vomited
He did look pretty sick and miserable
And of course off the cop looked pretty sick that he had to deal with this.
All in all you can use any one of the definitions for sick for this guy. Did he go to the hospital? No. Should he have gone? Probably :)
Wednesday, June 4, 2008
You never know what you are going to be doing that day. I think about it sometimes while checking my gear for the day. Be ready for anything.
The call goes out for a fall off a parking structure. We pull up to find the police already on scene as well as the fire department. I go to grab the backboard and collar bag as a state trooper comes over to me
"Do you have a blanket? I think they are going to pronounce her here"
I hand him a sheet, and walk over to the patient, not wanting to give up the only blanket I had in the ambulance.
She is an elderly woman, lying on her back with obvious angulated fractures of her lower legs as well as the left side of her face being uncannily flat save the large hematoma on her forehead. Her pupils are fixed and dilated and the ground is littered with teeth and blood as I kneel down and place her on the monitor.
The monitor shows V-Fib, the womans heart is still quivering.
"You have got to be shitting me" my preceptor says as I grab out the Defib pads as the fireman is doing CPR.
I get the pads on him and am turning to begin charging the monitor when my preceptor and I see that the rhythm has changed to a single flat line telling me there is no electrical activity.
We resume CPR while doing a quick assessment and cataloging the injuries in my head as my partner calls medical control. Its no surprise when the doctor on the other end of the line tells us to go ahead and presume. Due to injuries sustained she is not a viable patient.
Time on scene is less than 9 minutes.
Those are the calls in which time just seems to stop. You start doing things faster than you ever thought you could and everything feels like second nature. After the call you look at your scene time and find it hard to believe you were there such a short time.
I can't help but try to imagine why these things happen. How difficult it would be to just make that decision and step into the void. I can't imagine things would ever be that bad and I hope in my life they never get to that point.
Saturday, May 31, 2008
630 in the morning and the call goes out for a working code.
Shaking off the power nap I had just taken I jump into the jump seat as my preceptor signs us onto the radio. The call is for a 6 week old who is pulseless and aepnic. CPR in progress.
After what seems like a slow drive at 95mph we arrive at the house and find volunteer firefighters in their pajamas out front. "We are bringing him out now" they tell us so I get what I can set up in the back.
He is a little thing. So tiny, limp and blue it almost doesn't seem real. He barely reaches the gray area of the Broslow tape. We cut away his onesey and put the pads on him while ventilating him and doing CPR. A flat line burns its way across the screen telling us what we had already suspected. We don't even have a name as we close the doors and speed off to the hospital. Luckily there are three of us in the back. I am kneeling on the stretcher doing CPR and ventilating the best I can while my partners grab the IO drill and the intubation kit.
The first IO goes in and it does not look stable and we confirm the miss as we see the site infiltrate. I remove the mask and my preceptor is attempting to intubate but he sees nothing so we resume ventilations. The ambulance rocks back and forth down the road to the hospital as we place another IO needle in her right leg and draw up Epinephrine. One more try for the intubation while the Epinephrine goes in and we pull up to the hospital. Still nothing on the monitor except artifact and CPR. We move her over to the hospital stretcher and give report to the doctor as he tries to intubate. The hospital staff takes over care and I step back exhausted. My stomach is burning and my throat is tight.
The doctors calls time of death at 659. I walk out to my ambulance as the doctor goes in to tell the family who is still in their pajamas and I hear the sound of her mother screaming and crying as I clean up and restock. I am thankful my shift is over.
Wednesday, April 30, 2008
sleep at a decent hour. Its a good thing though because I function
best on about 4 hours of sleep anyways. Yet another fire in our small
city raged through another house in the lower income part of town
displacing 4 adults and 8 children. No one was injured in this one
There was even a hamster that was rescued from the blaze after the
firefighters had knocked it down. I can only imagine the horror that
hamster has experienced and if anyone knows of a small furry therapist
that is accepting new patients, please let me know.
It is not very often that I get to write about let alone participate in what we in the EMS field call a "Code Save"
But today was a spectacular day......
So as I am enjoying my mid morning snack of Fig Newtons and Mountain Dew, for unlike others in EMS I am a healthy eater *cough* *cough* a call goes out to my buddies car sending him to a "Working One Hundred" or what we commonly refer to as a witnessed arrest. My preceptor and I looked at each other, shrugged our shoulders, and called upstairs to let dispatch know we would be "wandering around the area" if they just happened to need a second unit for help. With that we left the bay and meandered towards the location.
Which ironically is actually in a Doctors office that is ATTACHED to the hospital. But they do not like us doing the "George Clooney" (which is the act of riding the rail of the stretcher as it is being pushed into the ER while doing compressions or *ventilating the patient)
*Only corpses and groceries are "Bagged"
So of course we get toned and just happened to be the closest unit for the assist.
So into the doctors office we go with a backboard and a collar bag because the other equipment would not be needed as the other crew should have everything but going in empty handed seemed rude. As we enter the building and walk to the elevator a poor young lady carrying Fed Ex packages is surprised as I stick the backboard into the elevator stopping the door. So she is startled but still has the presence of mid to ask which floor we were going to.
I can only imagine what was going through her mind as three men walked into her elevator and began nonchalantly putting on rubber gloves with no patient in sight. We kept our composure and refrained from making the obvious jokes that would most assuredly come later after the call.
Entering the doctors office one of the nurses at the desk told us "There is already an ambulance here" We thanked her for the info and another staff member explained to her that the more the merrier in these types of situations. So into the room past a very distraught doctor we go. You can hear the AED (Automated Defibrillation Device) chiming "Analyzing Rhythm in 2 Minutes" and we enter the room to find A Paramedic supervisor and her preceptee (A fellow classmate from my paramedic class last year) trying to move the patient on the backboard, attach the monitor, ventilate the patient, start an IV, and get meds ready. So my preceptor began helping them get the patient on the backboard while I opened our bag to get out straps (Which for some reason I brought our bag and it turns out they forgot theirs) and then went to get a brief history and story from the staff. Turns out the guy was there for routine labs and just went unresponsive when he was about to get blood drawn. The staff put the AED on him (Annoying little things but they are the best thing since Pez and I absolutely love them) and it had delivered a shock to the patient TWICE before our first unit arrived with a monitor. So at this time the man is breathing by himself at a rate of about 8 and he has a pulse and a blood pressure. Good Ole Lidocaine. So we "Clooney" him out to the ambulance (Of course the only way out was through a waiting room FULL of patients) and to the ambulance. I am setting up the intubation kit while we are securing him in the back when my partner asks me "Who's Driving?"
Now I have to explain that while I am on the clock I drive, tech etc. But while doing precepting we are not allowed to drive the ambulance. So we run crews of three. One Paramedic, One Preceptee, and one EMT-B to drive. Their driver was in a meeting in another part of the hospital (which explained why they got called to it first because they were already parked there)
"You are dude!" I say to my partner who just laughs and jumps in the front. So I am helping set up a Lidocaine drip, my friend is sitting on my lap trying to get the patient intubated, another medic is trying to get new vitals, and I am ventilating with one hand and trying to get a patch set up with the other.
Thank god we were LITERALLY in the parking lot of the hospital about 500 feet from the ER door.
So we are piling out of the back looking like what Barnum and Bailey envision EMS to be and wheel the patient in and get him transferred over while I magically produce a full history, meds, and his latest Lab results and hand them over to the receiving doctor who looks at me with surprise and a grin.
The patient has a bounding pulse, a strong Blood Pressure, and a stable rhythm. Thats all we could ever ask for.
15 minutes later I go in to the room to grab copies of the paperwork for the report and the man is not only conscious, but he is answering questions. I tell the rest of the guys and they don't believe me. 10 minutes after that he is sitting upright in a hospital bed, talking and he even signs for treatment and HIPPA information. He thanked us. After signing he was told to take it easy and hope he feels better soon.
"Well I could only be worse if I was dead"
"Sir you already were once today"
we walk back to our ambulance and laugh about what the woman in the elevator must have thought and make a few rubber glove jokes
Happy to be of service
My pager goes off and vibrates as they call our car onto the air for a routine call. I sigh as I see we are doing a transfer from the maternity ward of one of our small community hospital to UConn medical center. "I probably cant count this one" I say to my partners as we pull out of the bay and onto the road. My disappointment is further fueled as we hear a call for an overdose coming over the radio as we are leaving the city.
We arrive on the maternity floor and the nurse gives us report, she mentions how quiet we all are and makes a joke at the other nurse at the desk.
"Here's a lively bunch"
I smile as I look over the paperwork, making mental notes for my report and trying to figure out how I can count this as one of my precepting calls.
"She came in for a checkup and has one of the highest urine proteins I have ever seen. She is also pre-eclampsic so we have given her labetolol and have Lactated Ringers running"
I look at my preceptor quizzically and he knows what I am thinking.... Why would you be running fluids into someone that is already hypertensive?
"She is a very pleasant woman, she is from Tanzania, this is her second pregnancy, she had a previous miscarriage, but if you ask her this is her first pregnancy. She does not know anything about the father"
These transfers are pretty routine for us. They tend to be uneventful (which is a good thing) but kind of awkward because you are in an ambulance doing vital signs every 15 minutes and there is not much care to be done.
Sometimes I hate myself for coming to conclusion based off of first impressions. She is a young immigrant woman living in a town where there is a large immigrant population living and working for the local mills and stores. So in my mind I put her into that category. Not maliciously mind you but just to start building that file in my head.
She is very pleasant and we talk about baby names and I tell her about my son. After hooking up the monitor and getting my baseline assessment I have run out of medical questions to ask so I do what I normally do and try and start a conversation. Thats when I begin to feel like an ass.
She has been in the United States for 6 years now and is just over a month away from her PhD in Anthropology. She already has a BS in sociology and a masters in cultural anthropology. We talked about the places we had lived and the differences in climate both weather wise as well as socio-economic. She was honestly one of the most intelligent and interesting to talk to people I have met in a long time.
I checked her vital signs every 10 minutes or so and we continued talking about her home in Tanzania, where it is very cold. You never really think about Africa as a cold place. But they have their mountainous regions where is is very much so. She lived near the base of Mount Kilaminjaro. She told me about driving down the road and seeing elephants, lions, zebras, giraffes, gorillas, and other animals I only see in a zoo or on the discovery channel. She talked about them like I would talk about seeing a hedgehog, squirrel, or deer on my way to work.
Too often we are blinded by our own preconceived notions of people. I am as guilty of it as the next man even though I try and put myself above that there are the inevitable times where I let it take over. A convenience of dealing with the many different people I do on a daily basis. I make no excuses for it and it is a part of my personality and thought process I would like to one day be rid of. I doubt that will ever happen but on days like today, it shows me that taking the time to talk to a patient can sometimes be more educational than you would ever think it could be.
I am glad I got sent on this call. It reminded me that no matter how many patients you take care of and however many situation you find yourself in to never take anything for granted and to take the time to appreciate the slow and easy "routine" calls.
My long time friend and colleague PMRN Cleared up a few things for me that I should have known.
1. The reason they were running Lactated Ringers is because "in pre-eclampsia you administer hypertonic IV fluids to speed up the process of getting rid of excess body water" Citation
2. Elevated proteins in the urine is a late sign of Pre-Eclampsia
3. since there's a loss of protein in the urine they're probably losing electrolytes renally more than usual (since proteins are big bastards), so the LR replaces em, while still being hypertonic enough to draw out all that third-spaced liquid
Seriously this man is a wealth of information that he can just pull out of a hat at anytime I need it. His blog is very informative and I would recommend it to anyone interested in Nursing or medicine in general.