Your Honor

There's an article in the paper this morning about a family suing an ambulance company because the ambulance allegedly got stuck in the mud while at the scene where a family member -- a previously healthy young man had collapsed while running. The article also reports that the ambulance arrived within minutes of the collapse and the patient was still brought to the hospital within seven minutes.

I have no details of the case. But just reading it, you want to shout out "Shit Happens!" More so during emergencies than not.

I've gotten the ambulance stuck before -- not on purpose, and not really through carelessness. I've been stuck in a snow bank and my partner once got us stuck in mud -- both times we got out. When it came to the snow bank we got out with an assist from the patient who helped push us out. (He really wasn't that sick -- he just wanted a ride to get his prescription refilled.)

I have dropped patients. Again, not on purpose. Once it happened on ice. The wheels went up, the patient went down. Believe me I felt bad about it. I felt like an idiot.

Another time I did a call once at a nursing home where we found this big fat woman who wasn't feeling well. Her family wanted her transported, even though the staff felt she was fine. She is on one of these big double wide beds, so we push our stretcher over next to the bed, then instead of sliding her all the way over in one pull/push, we decide to go to the edge first. My partner is on the stretcher side, doing the pulling. I'm on the bed side doing the pushing. We go to the edge. I am now up kneeling on the bed, holding the sheet we're using to move her. Then it happens.

She appears to start to sink. I look up at my partner and he is very slowly moving away from me. Now she starts to sink not quite so slowly and I see now, she is falling between the bed and the stretcher, as the stretcher slides away from the bed and the hole between the two where the woman is now descending, is swallowing her up. I hold on to the sheet and quickly scramble across the bed, and do my best to control her fall. She still hits with an audible "Thud."

Oh, my God.To hear the family and the patient go on.

Daughter: "I can't believe you dropped her."

Mother: "They dropped me, Oh Lord help me, they dropped me!"

Daughter: "I'm getting my lawyer. You dropped her. Right in front of my eyes. Right in front of my very eyes."

Mother: "Oh, put me back in bed. You ain't taking me nowhere now. You dropped me. You dropped me. Oh Lawd, have mercy!"

Daughter: "You dropped my mama. They dropped my mama!"

Me: "Sorry, sorry, sorry."

While continuing to apologize, I assessed her. I went and got the staff. Told them, what happened. Had a nursing supervisor come in and document it all, including on the W10, so the hospital could check her out for the fall as well. I documented it later on my run form. Told the hospital about it. I wrote an incident report. Etc. Etc.

The lady wasn't hurt and I heard no more about it, though who knows five years from now I may be called in to court, and find the lady wearing a neck brace, and instead of being in a double wide wheelchair, she is now in a triple wide one.

Mother: "That's him, your honor. He is the one who dropped me! I recognize that rascal anywhere!"

Daughter: "That's him. He's the one, who dropped my mama, my mama who suckled me with her own breast milk. He dropped her on the cold ground, heaven have mercy."

There are so many things that can go wrong on a call. I had no idea my partner stood on the stretcher railing whenever we moved a patient. At my height I am always on the ground, anchoring the stretcher, but I guess a lot of people stand on the rail. Things you don't know. We slide the lady a little too far over. Her weight pushed the unanchored stretcher away from the bed as she fell into the slight hole that turned into a giant opening in the earth.

***

Get a call while I am writing this. Check this out for things going wrong:

Lady with pulmonary fibrosis having severe difficulty breathing. I find her in the upstairs bedroom on home 02. Barely moving air. Heart rate in the 160's. The first responder is standing there. She's already on home 02 by cannula. I ask my crew to hook her up to a nonrebreather.

Guess what?

Our tank is empty. We used it on the last call for about ten minutes at 2 lpm. I didn't check it. I wrote the run form and put away my gear. My partner is supposed to put the stretcher back together and check the 02 and change the tank if it is low. Should I check on the crew? Yeah, I guess I need to. Maybe there was a leak. Maybe they didn't change it. I'm the medic. It’s my responsibility. (And I'm the one who looks foolish.)

Fortunately, the responder has a tank, and we use that.

One crew member sets up the stair chair. He's done it many times before. I've gone over it with him. He doesn't lock it. I point it out to him. You have to lock it. I make certain it holds. I get the woman on the chair, buckle her in. I say, I'm going to take the feet. I ask the first responder to take the top because he has some strength, which my crew members do not. I look for a crew member to carry the 02 and one to watch my back, but they have both disappeared.

The woman is having a really hard time breathing. I shout for my crew. They are outside. What they are doing, I don't know.

I have to enlist the woman's daughter to carry the 02 bottle behind the responder who grabs the head of the stretcher while I take the feet. I almost tumble coming down the stairs. I have no one on my back and this responder is not one who likes doing the medicals and is not really used to doing carry-downs. We make it outside where the crew is trying to get the stretcher into the proper down position. They are having a terribly hard time working the stretcher. It seems on this call they have forgotten everything they know. (I can't say it hasn't happened to me before. My crew forgetting on me and yes, sometimes me forgetting things I know).

When we finally get her loaded on the stretcher, the heavens open up suddenly and it pours rain on the poor patient and us. The ambulance has been turned off because we have a anti-terrorism policy that says you have to take the keys in the house with you and this ambulance doesn't not have the system installed that lets the car stay running without the keys. I always tell my partners unless they are parked in front of the Osama Bin Hussein Society or other such place (where terrorists and other evil people might lurk) to leave the truck running, particularly in the winter. Most of them do despite the policy. Today my partner is patting their pockets trying to find the keys that might be lost. No, here they are -- in the pocket all the time.

I look around for monitor. Not there. Where's the monitor? I shout.

Left in the house.

Where's my house bag?

Left in the rain.

Finally we get enroute lights and sirens and nothing I am doing for the woman is helping. She keeps saying help me -- I give her a breathing treatment, but that is about it. Her Sats are only about 80%. Heart rate is 140. She is diaphoretic. She is breathing about 40 times a minute. Help me, she says again, give me something. I am tempted to say, I don't have anything I can give you until you stop breathing (or get worse), then I can tube you. I suppose I could try to nasally tube her, but I don't think she'll sit still for it.

She has crappy veins. I miss my first IV attempt. Then as I am getting it on the 2nd try, I see we are getting close enough to the hospital to patch in. They will need some notice, because I want them right there when I come in because I think she will need to be intubated. I have a partner start the patch, but the radio operator gives him a hard time because the driver didn't put us enroute. I am trying to draw bloods and talk to the hospital at the same time. For some reason I say "respiratory sarcadosis" instead of "pulmonary fibrosis." Differnet diseases.

When we pull the patient out of the ambulance, the blood pressure cuff catches on the wheel. I lean to pick it up, but my partner keeps pulling, and the patient's daughter has to grab the end of the stretcher before it careens around and spills her mother. I throw the blood pressure cuff into the back of the ambulance like I am throwing a brick at a window.

We get in the hospital, no one looks at us. They are all on the phone or doing paperwork or talking to each other. The woman is still sucking. Finally (maybe only thirty second later, but my frustration level is so high is seems longer) they notice us and tell us the room.

We go in there, and I unhook the woman from my monitor and unhook the straps, and then we have to slide her over, but niether of my partners (due to strength issues) are able to effectively help, and I have to reach across and lift her by myself.The staff comes in, helps change her and my partner switches the 02 to their plug as I give my report. The nurses are very nice, say they know the patient, but have never seen her this bad before.

A doctor comes in goes right to the patient, starts asking her questions. Then he looks at the nonrebreather, which doesn't look too inflated. What 02 level is she on? he asks. He then reaches over and cranks it up. The 02 whooshes out. I mean he has it on max -- way above 15. The woman's SAT is now 97, even though she is still struggling to breathe. "There you go," he says, "A little oxygen does it every time," he says, then walks out.

Whether he says it or I merely imagine it, I think he says, "There was your problem."

I know this guy so I approach him later. "What was with the oxygen comment?" I ask.

"I've got too much on my mind right now," he says, dismissing me, "Must have just been my magic touch."

Normally things don't bother me, but I'm bothered now. I feel somehow belittled. And I'm frustrated about everything to do with the call, the clumsiness, the lack of help, my inability to help the patient, the doctor's flip comments -- and most of all the awful feeling of our response not being professional.

A nurse tells me later, my partner may not have turned the O2 up enough when she switched the connections in the hospital, or else the conection wasn't stiff enough to hold at 15 and slipped down on its own. Maybe she must have a temporary brain lapse and thought the patient was on a cannual and not a mask so she set it at only 3lpm., or maybe it did just slip. But I'm also wondering why my SATs were so much lower than what they are getting. Could the difference between 15 liters and 25 liters make the difference? Or maybe my oximeter was giving me too low readings? Or maybe the treatment kicked in? But I doubt that.

I go back and look at the patient. She is SATing at 97 now -- an improvement, but she is still huffing away, holding the mask tight to her face. Her respiratory rate is in the thirties, her heart rate is 138. I ask her if she is feeling better. She just stares at me, as if to say, "Do I look like I'm comfortable sucking on this oxygen mask?"I don't want to sound like I am blaming my crew. They are nice people, and I am not without error or failing myself. This is a hard job to be infallible in. And why should I assume my crew should know what they are doing when one is new and the other works infrequently. My crew is my responsibility. If they fail, it is my failing for allowing them to fail. Instead of trying to teach them on the way back, I just ride silently. I need to teach them better, but feel without patience today.

I imagine if this was a worse call, if the patient had arrested. There are so many ways a call can go wrong, particularly when you do not have a sharp experienced crew who you work with on a regular basis. Most days I manage to handle it, not today.

"Your honor, their oxygen tank was empty."

Who do I sign the deed over to? Take my house, take my money, take my car, take my childhood baseball cards and my record collection.

I didn't mean to get stuck in the mud, honest.

***

I guess lawyers are just starting to turn toward paramedics and ambulance companies. I have, at times, thought about going to law school. To go on in medicine I would have to take many years of prerequisites. Law school, its just three years of class, four if I go at night. As a paramedic lawyer I would be a hot commodity. But what would that entail, using my knowledge to show how some other medic screwed up. I could do that, but I could also illegally dump toxic waste for a couple hundred dollars a barrel.

Maybe I could represent paramedics and ambulance companies, using my knowledge to show shit does happen, and people do the best they can with what they have.

On the other hand, the EMS system could be a lot better than it is. Maybe people have a right to sue. I mean, who do you want coming to your house?

I guess there are always two sides. What you should expect and what the world delivers, and lawyers are there to argue each way.

At Bay

4:00 A.M. Twenty-two hours into a twenty-four hour shift. The tones go off for the third time that night.

They send us for an unconcious man. It is an address we were at the previous afternoon -- a lift assist for a man who's wife needed help lifting him off the toilet because he felt to weak to lift himself up using his walker as support, and he was too much dead weight for her to help as she sometimes had to do.

At the time I was thinking I see this all the time, a person living at home, who just reaches the point where they are too weak to live in their house. They can no longer transfer themselves from their wheelchair to their bed, or standup from the toilet with their walker in front of them. And for a few days we get called over and over to give them a lift assist until they either go to a nursing home or get some better help in, or get a hospital bed from which they now spend their day. As I left I wondered when we would be back -- a couple hours later, that night, the next day. I had even said to his wife. If he can't get up now by himself, he's not going to be able to do it later. You can't hold the inevitable off forever.

But "unconcious" -- I wasn't expecting that. The problem with doing a lift assist, and not transporting is if the patient happens to die in the next twenty-four hours -- related or unrelated to the fall -- you are in the stew. I know a medic, picked an old lady up who said she'd slipped out of bed. He put her back in. An hour later another crew was doing CPR. Not good, but what are you going to do. We do lift assists all the time. People slip or fall -- they're not hurt, they don't want to go to the hospital -- they just need help getting up. Thank you very much. Sign here. Call us again if you need us. You have our number. What's that agian. 911.

On the way to this call -- the cops update us -- keep coming lights and sirens. I am thinking maybe I should have really pressed him on going, maybe something else major is going on.

We find him now on his bed -- his skin is pale and yellow, almost opaque. His eyes are glassy, open, not blinking. He looks dead, except there is some movement when I touch him, and he says a few words slowly. I have to keep nudging him to see that he is still alive.

I ask the wife about his medical history. She says he has a heart history. I ask for the list of medications. His pressure is a little low. 100/60. His heart rate is in the 60's. I do a twelve lead -- he's in a bifasicular block -- Right Bundle Branch with a left posterior hemiblock. Could be normal for him. I don't know.

Given how he looks I am sort of suprised his vitals aren't worse. He is Satting at 93%. He is acting almost like he is drugged. His grips are equal but very weak, he can't even hold his arms up. His abdomen is distended. His capillary refill is a little delayed.

I ask again about medical history. The wife repeats he has a bad heart with many blockages. She is very distraught. I ask my partner to see that she finds all the meds and writes them down.

A police officer and I carry him down on the stairchair, which is hard because he is a big man and dead weight, plus the stair chair is an old old model, and one of the pins comes loose, so I am holding tight and pressing at the same time to keep it together. I keep looking at the patient to make certain he is still alive. I have had many patients code on me while I was carrying them in a stair chair. He is still there.

Finally in the ambulance, I get a line, then get out the glucometer. My partner checks the sugar for me.

"83," she said, then adds "Last result."

I'm not so sleepy that I don't remember 83 was the number of the last patient I checked a sugar on -- the pedi seizure I had the prior morning.

"Give me that," I say. I put a new strip in the machine, then apply a drop of blood to it. She must have hit the botton on the machine, thinking the button was what turned it on. Instead, you just put in a strip, then the machine reads, "apply blood now."

The result comes up -- 27.

"You can shut off the sirens," I call to my partner, who is bombing us toward the hospital now. "And do you have the list of medicine?"

She reaches into her pocket, unwrinkles the paper and holds it out for me. I run through the list. There's glyburide. What do you know -- he's a diabetic.

I give him an amp of D50, and he comes around to the point he says he feels better, his grips are strong, and he even knows where he is. He says this has never happened to him before. He only had a small lunch -- no dinner.

I think there is something else going on with him -- nothing that will kill him tonight, but some disease process or something working on him. I'm glad he's going in to the hospital. I recheck his sugar -- 200. By the time we are at the hospital, we are actually having a decent conversation.

I wonder if I knew he was diabetic when I was there earlier, if I would have checked his sugar, and what would it have been? It seemed just like a simple lift assist, with a mandated persuade him to go to the hospital. I don't think it would have been too low -- he was fully alert then, just feeling weak. I'll be curious to see if we go to his house again, or if his name shows up in the obits sometime in the near future. When I reviewed his medical history after he came around, I found he had been on diaylsis in the past. Not a well man.

***

We stop at Dunkin Doughnuts on the way back. My partner gets a doughnut and a coffee. The day before someone left a dozen doughnuts for us, and I ate one -- one with pink frosting and sprinkles on it. I ate it in four parts over a course of two hours. It was good. Doughnuts are one thing I don't eat. About ten- fifteen years ago when I had a coat and tie job, I ate two doughnuts every morning and I must have weighed a soft 240. I stopped cold turkey. Now I'm 215. Lean and Mean. I really want a doughnut.

As I write this I am eating All-Bran. I went home and went to bed for about three hours, sleeping with a blanket draped over the curtains to better darken the room, and with a black sock strapped to my eyes under some swim goggles. In a few hours I will go to the gym. I need to stay strong, need to be able to lift myself off the toilet when I am old, need to hold diabetes and other diseases at bay.

I'm Walking

I had the day off today so this morning I went to a Jamaican church in the north end of the city. I arrived late and was escorted by chance to the front row just as the lead vocalist and gospel choir started singing "Highway to Heaven," which was great because I knew the song, so right away instead of feeling awkward I was clapping my hands and rocking along with the congregation.

(Lead solo) My way gets brighter; (Choir) Walk on!
My load gets lighter. (Choir) Walk on!
(Choir) ‘Walking up the King’s highway.
(Lead solo) Christ walks beside me; (Choir) Walk on!
His love to guide me. (Choir) Walk on!
(Choir) Walking up the King’s highway.

(Choir) It’s a highway, it’s a highway,It’s a highway up to heaven.
None can walk up there
But the pure in heart.
It’s a highway, it’s a highway,
It’s a highway up to heaven.

(Lead) I’m walking. (Choir) ‘Walking up the King’s highway.
(Lead) I’m talking. (Choir) ‘Walking up the King’s highway.
(Lead) I’m singing. (Choir) ‘Walking up the King’s highway.
(Lead) I’m shouting. (Choir) ‘Walking up the King’s highway.

(Choir) I am walking up the King’s highway.

I'm not really very religious and I haven't been to a church for years. When I do go I sometimes finding myself wanting to be suddenly overtaken. I want my eyes to tear up and a wave of tingling to come over me, I want my burdens lifted, but I never quite get the feeling. People come forward and get on their knees and profess their love for Jesus. I just stand back and watch.

It was a nice service. (I sometimes had trouble understanding the minister Jamaican accent.) At one point they had all the children come up and they asked them questions like "What does Easter mean?" The first kid said, "The Easter Bunny comes." The minister laughed. Wrong answer. Some precocious kid, said, "It's when Jesus died and was resurrected from the grave." That's right!

A baby was baptised. Later the minister asked people who were feeling desolate to come forward and give their lives to Jesus. Probably about thirty people come forward and knelt before the alter.

While I mainly work in the suburb north of the city, I still do a lot of calls in the city's north end, and am very fond of the community. When I first started in the city -- I was always posted north. I have no doubt been in the houses of some members of the congregation, and cared for them and or their family members.

I thought of all the children standing up at the front of the church listening to the woman tell them that all we want is peace, no ill feelings to anyone, just to live our lives with love. I wonder if I will ever take care of any those kids in years to come. Will Jesus protect them? Or will I have to wash their blood from my ambulance? I wish them only love and health.

I think it is good for a paramedic to know his community. I used to think it was better to not know anyone because then you didn't become emotionally attached, but I think there is too much emotional detachment in the world. It is better to care.

Jesus didn't show himself to me, but as I was leaving, several old women in Sunday hats shook my hand and thanked me for visiting.

It’s a highway, it’s a highway,
Walking up the King’s highway.

The Gift

A forty-five year old man lays slumped against the storefront of the Erotic Palace. He is out cold, drooling. He clearly has done some drinking from the smell of his breath. Doesn't respond to a sternal rub. We take his jacket off so we can get access to his arms. No track marks. He is clutching a small box in one hand. We get him up on the stretcher and then into the back of the ambulance, and get him stripped down on the top. His pupils look pinpoint, but he doesn't respond to narcan, which I give him in two doses, .8mg, then 1.2mg IV. His blood sugar is 244. He is tachycardic at 120. His blood pressure is fine. His respirations are snoring so I put in a nasal trumpet that slides in easily and helps with his breathing. In his wallet there is a non- driver's ID card, and a mental health clinic appointment notice.

I look at the box, which sits by my clipboard now. There is a gift bow around it.

In the ER, I give my report, running down what I have done. The doctor and nurses ask many questions.

"The answer," I say, "is in here." I open the box and show it around.

A small diamond ring.

"It's his heart."