Called for a possible stroke. Find a middle aged woman lethargic, skin very warm, blood sugar reads HI, which means over 600. Delayed capillary refill. Pressure 76/40. Heart rate on the monitor - 120. Respiratory rate in the low 30's. Can't get a SAT. History of IDDM and a kidney transplant, with subsequent infection problems.
I put her on a non-rebreather and tell the family I will be doing an IV in the ambulance and giving her some fluid. "You won't get an IV," the daughter says. "She has no veins."
I like a challenge. Patients or their family members are often saying they have no veins. Usually that just means they are a tough stick, not impossible. When you get an IV in one, they are very impressed and you are the IV stud, but when you miss after they have told you they have no veins, well, then you're an idiot. I've been the stud and I've been the idiot.
When I check her out in the ambulance as we head lights and sirens to the hospital, I spot a tiny blue vein on her bicept. Can't feel or see anything else. The tiny vein I see will only take our tiniest catheter -- a 24. A 22 is way too big for it. I go into my zen like trance and manage to pop the 24 in and get a good flash. I hook up a bag of Saline, and by the time we are at the hospital I have run in 250 ccs. Not as much fluid as she needs, but better than nothing, and she has access for the IV insulin she needs.
I have patched ahead, and we are quickly hustled to a critical care room, where we are greeted by doctors and staff. Someone says they need to try to get another IV.
"Let a paramedic do it," a flight medic says. "Get me a 18 or a 16."
I am standing there watching as I write my report. This I have to see to believe. Either this guy is the world champion IV stud or he is not just an idiot, but a flamming idiot.
He puts a tourniquet around the woman's forearm, and then getting the 16 needle from a nurse, pats the woman's wrist, then plunges the huge needle in. He digs around. Nothing.
"I'm going to put a central line in," the doctor says.
The medic takes the needle out, then to my surprise plunges it back in -- the same needle. He roots around some more.
"I'm concerned she's really not reacting to your poking," the doctor says.
The medic finally pulls the needle out, and announces, "She's completely shut down."
I guess he was the latter of the two.
Tuesday, June 28, 2005
Thursday, June 23, 2005
"Where's My Son?"
Ahead we see two state police cars and two private vehicles pulled over on the left side of the highway. Down in the gulley of the median, I can see the rear end of a car sticking out of the trees and bushes. The men near the car suddenly look frantic. A large man is holding his arms out bellowing to the heavens. The others scatter and start searching the bushes. We advance toward the car.
"He's missing his boy," a man who stopped at the scene in his private car tells us. "He had his boy with him and he can't find him."
People are fanning out looking in the bushes. I watch the man at the center of the scene -- the father -- the driver. He is fat, his belly sticks out from underneath his dirty black tee-shirt. He is sweating profusely. It's hot out, but not that hot. I ask him if he is okay. He says he's fine, but he seems dazed. "My son! My son!" he shouts. "I can't find my son."
I feel his pulse. He is banging away at 140-150. I ask him if he hurts anywhere, if he has neck or back pain, but he says, no, he's all right. I ask him about the accident. He says a car cut him off and he had to swerve to avoid it. I go over and move some branches out of the way so I can get in the underbrush to look at the car. The windows are all closed. Only the driver's door is open. There is little damage. He is lucky the branches and bushes slowed the car down. There is no invasion. No deformity to the steering column, No starring of the windshield. In the backseat there is an empty child seat. I look on the car floor for beer cans, but see nothing.
"No, no, wait a minute," the man now announces to the state trooper who is talking urgently into his radio. "He's not in the car. He's at home. I forgot. I got confused. He's at home. He's at home."
The trooper looks relieved, but anger flashes in his eyes. The word is quickly passed to the searchers. A phone call made to confirm the boy is safe at home.
The officer's anger turns on the man. Are you on anything? What have you been using? Am I going to find anything in your car? The man is spread against the car and patted down. He denies any drug use. Well, at least not for a couple months. Well not today anyway. The needle marks and bruise under his wrist are old, he says. A couple days. Yes, there is a needle in the car, but he didn't shoot up anything. He was going into the city to buy drugs, but then he changed his mind. The officer gets word from his dispatcher that the ID check revealed the man is driving on a suspended license.
The driver's eyes shift from one trooper to the next to us as he is peppered with questions.
His pupils are pinpoint. Sweat is pouring off of him.
"You need to go to the hospital," I say.
"I'm fine," he says. "I was just confused. I need to go home and see my son."
"No," the officer says. "You need to go to the hospital."
"Listen to what the officer is saying," I say. "Make the smart choice and go to the hospital with us. You don't want the alternative right now."
He quickly says, okay.
We c-spine him and take him in. His heart rate is in the 130's. His pressure 180/110. I put in an IV lock and draw bloods.
When we are leaving the hospital, the state trooper is walking in the ER door.
"He's missing his boy," a man who stopped at the scene in his private car tells us. "He had his boy with him and he can't find him."
People are fanning out looking in the bushes. I watch the man at the center of the scene -- the father -- the driver. He is fat, his belly sticks out from underneath his dirty black tee-shirt. He is sweating profusely. It's hot out, but not that hot. I ask him if he is okay. He says he's fine, but he seems dazed. "My son! My son!" he shouts. "I can't find my son."
I feel his pulse. He is banging away at 140-150. I ask him if he hurts anywhere, if he has neck or back pain, but he says, no, he's all right. I ask him about the accident. He says a car cut him off and he had to swerve to avoid it. I go over and move some branches out of the way so I can get in the underbrush to look at the car. The windows are all closed. Only the driver's door is open. There is little damage. He is lucky the branches and bushes slowed the car down. There is no invasion. No deformity to the steering column, No starring of the windshield. In the backseat there is an empty child seat. I look on the car floor for beer cans, but see nothing.
"No, no, wait a minute," the man now announces to the state trooper who is talking urgently into his radio. "He's not in the car. He's at home. I forgot. I got confused. He's at home. He's at home."
The trooper looks relieved, but anger flashes in his eyes. The word is quickly passed to the searchers. A phone call made to confirm the boy is safe at home.
The officer's anger turns on the man. Are you on anything? What have you been using? Am I going to find anything in your car? The man is spread against the car and patted down. He denies any drug use. Well, at least not for a couple months. Well not today anyway. The needle marks and bruise under his wrist are old, he says. A couple days. Yes, there is a needle in the car, but he didn't shoot up anything. He was going into the city to buy drugs, but then he changed his mind. The officer gets word from his dispatcher that the ID check revealed the man is driving on a suspended license.
The driver's eyes shift from one trooper to the next to us as he is peppered with questions.
His pupils are pinpoint. Sweat is pouring off of him.
"You need to go to the hospital," I say.
"I'm fine," he says. "I was just confused. I need to go home and see my son."
"No," the officer says. "You need to go to the hospital."
"Listen to what the officer is saying," I say. "Make the smart choice and go to the hospital with us. You don't want the alternative right now."
He quickly says, okay.
We c-spine him and take him in. His heart rate is in the 130's. His pressure 180/110. I put in an IV lock and draw bloods.
When we are leaving the hospital, the state trooper is walking in the ER door.
Saturday, June 18, 2005
Check it! Check it out!
The guy sits on the cement floor when we enter the warehouse. Co-workers kneel on either side of him, holding his hands. There are tears coming down his cheeks.
“What happened?” I ask.
“The beam dropped on his boot.” The co-worker points to a twenty-foot long steel beam that lays nearby under a hoist, but not connected to the hoist.
“Let me take a look,” I say.
I undo his boot and look at his foot. On first glance I don’t see any marks. It looks like a normal foot to me.
“My toe don’t look like that,” he says. The big toe is pointing more toward two o’clock than high noon. I take off his other boot to compare. That toe points to high noon. I notice then that that toe looks much fatter than the toe in question. The toe in question looks rather flat. I touch it lightly and he winces. Okay.
We lift him to the stretcher and get him in the back of the ambulance.
“How bad is your pain?” I ask.
“It hurts some,” he says.
“I can give you some medicine for your pain. Are you allergic to any meds?”
“No,” he says, “but I don’t want to pass out.”
“No, I’ll just take the edge off.”
“That’s okay. It’s not too bad.”
“Are you sure?”
“Yeah, I’m fine. It’s not too bad.”
Okay then. I turn the call over to my BLS partner, and go into the front to drive.
As we are driving down the road, we pass the ambulance headquarters where I see our paramedic student has just pulled in. I stop and motion her toward the ambulance. “Hop in,” I say, “We have a call. We have a patient in the back.”
She gets in, and I start off again to the hospital. The next thing I know I see a car racing behind me in the side mirror, pulling out and trying to pass me, then instead of passing, just driving side by side like we are in the stretch at Daytona. I glance angrily at the mad driver, only to recognize my 8:00 A.M. EMT partner and her husband trying to flag me down. I ask my partner in the back if he wants to do a switch on the fly, and he says yes, so I pull over. The 8:00 A.M. EMT gets out of the car, and he gets out of the back. I have her drive and I get in back, while the other EMT gets in the car with her husband.
Now that I am in the back with the patient again and the paramedic student, we press him on his pain again, and he relents and agrees to get a little of the pain medicine. We give him 3 mg of morphine to start, just to see how he takes it. He is not happy having to get an IV, and when we push the medicine, he feels flushed, and says he doesn’t want to pass out. It's common to feel flushed, I tell him. It will pass. But he is apprehensive, and says he can take it, so we hold off on any more for the time being.
When we get to the hospital, I hear him admit to the nurse his toe is really hurting now. The x-ray will show he has fractured his foot.
That night when I see the EMT who was first on the call, he tells me that as soon as I got out of the ambulance to drive, the guy confided in him "This pain is baad!"
“Dude,” the EMT said, “But you just told the medic you were fine!”
The point of writing all this is so many patients try to be stoic at first. I see the same scenario all the time, particuarly with men. They all try to suck in their pain. And while I am much more aggressive with pain management than I used to be, I need to be more so. I am tired of hearing people deny pain, only to watch them suffer as we near the hospital and at the hospital while they wait to be treated. There is no need for people to suffer trying to be macho.
The guy could tell my partner about the pain, but not me because I was the authority figure -- the Man.
But if I am the Man, then the Man needs to do his job and sell his patients on his specialty wares -- on the pain relief that they need.
I’ve got to work on my rap:
"Hey, Check it! Check it! I got Blue Star, man, Blue Star. This stuff is premo, premo, man. Code three rating, man. I got the best, right here, man, right here! Check it! Check it out!"
***
Postscript: Several Days Later
Lady falls coming down the front steps, carrying her baby. She twists suddenly as she falls so she will land on her back, and protect the baby. She does, but she hears a snap in her ankle and is in severe pain -- lying there on the front lawn.
I don't need an X-Ray to see it is broken. 10 out of 10 on the pain scale. No allergies. Medication time. She weighs 200 pounds. I give her 5 of Morphine. It takes the pain down to a 7, but she is considerably calmer. My routine has always been to give 5, wait a few minutes, then move the patient, and then give them more if they need it in the ambulance. Today I decide to give her another 3 before we move her. I can do that now under the new weight-based protocols. I give it to her. We wait. She has been having a conversation with the neighbors. All of sudden she says something about not buying ice cream sandwiches, when she starts laughing. The laugh does not end. It goes on and on. She is laughing so hard I am worried she is going to pee herself.
"Looks like the Morphine is working," her neighbor says.
In the ambulance, I give her the last milligram allowable under standing orders. She is still cracking herself up.
I'm thinking: I've got the product.
“What happened?” I ask.
“The beam dropped on his boot.” The co-worker points to a twenty-foot long steel beam that lays nearby under a hoist, but not connected to the hoist.
“Let me take a look,” I say.
I undo his boot and look at his foot. On first glance I don’t see any marks. It looks like a normal foot to me.
“My toe don’t look like that,” he says. The big toe is pointing more toward two o’clock than high noon. I take off his other boot to compare. That toe points to high noon. I notice then that that toe looks much fatter than the toe in question. The toe in question looks rather flat. I touch it lightly and he winces. Okay.
We lift him to the stretcher and get him in the back of the ambulance.
“How bad is your pain?” I ask.
“It hurts some,” he says.
“I can give you some medicine for your pain. Are you allergic to any meds?”
“No,” he says, “but I don’t want to pass out.”
“No, I’ll just take the edge off.”
“That’s okay. It’s not too bad.”
“Are you sure?”
“Yeah, I’m fine. It’s not too bad.”
Okay then. I turn the call over to my BLS partner, and go into the front to drive.
As we are driving down the road, we pass the ambulance headquarters where I see our paramedic student has just pulled in. I stop and motion her toward the ambulance. “Hop in,” I say, “We have a call. We have a patient in the back.”
She gets in, and I start off again to the hospital. The next thing I know I see a car racing behind me in the side mirror, pulling out and trying to pass me, then instead of passing, just driving side by side like we are in the stretch at Daytona. I glance angrily at the mad driver, only to recognize my 8:00 A.M. EMT partner and her husband trying to flag me down. I ask my partner in the back if he wants to do a switch on the fly, and he says yes, so I pull over. The 8:00 A.M. EMT gets out of the car, and he gets out of the back. I have her drive and I get in back, while the other EMT gets in the car with her husband.
Now that I am in the back with the patient again and the paramedic student, we press him on his pain again, and he relents and agrees to get a little of the pain medicine. We give him 3 mg of morphine to start, just to see how he takes it. He is not happy having to get an IV, and when we push the medicine, he feels flushed, and says he doesn’t want to pass out. It's common to feel flushed, I tell him. It will pass. But he is apprehensive, and says he can take it, so we hold off on any more for the time being.
When we get to the hospital, I hear him admit to the nurse his toe is really hurting now. The x-ray will show he has fractured his foot.
That night when I see the EMT who was first on the call, he tells me that as soon as I got out of the ambulance to drive, the guy confided in him "This pain is baad!"
“Dude,” the EMT said, “But you just told the medic you were fine!”
The point of writing all this is so many patients try to be stoic at first. I see the same scenario all the time, particuarly with men. They all try to suck in their pain. And while I am much more aggressive with pain management than I used to be, I need to be more so. I am tired of hearing people deny pain, only to watch them suffer as we near the hospital and at the hospital while they wait to be treated. There is no need for people to suffer trying to be macho.
The guy could tell my partner about the pain, but not me because I was the authority figure -- the Man.
But if I am the Man, then the Man needs to do his job and sell his patients on his specialty wares -- on the pain relief that they need.
I’ve got to work on my rap:
"Hey, Check it! Check it! I got Blue Star, man, Blue Star. This stuff is premo, premo, man. Code three rating, man. I got the best, right here, man, right here! Check it! Check it out!"
***
Postscript: Several Days Later
Lady falls coming down the front steps, carrying her baby. She twists suddenly as she falls so she will land on her back, and protect the baby. She does, but she hears a snap in her ankle and is in severe pain -- lying there on the front lawn.
I don't need an X-Ray to see it is broken. 10 out of 10 on the pain scale. No allergies. Medication time. She weighs 200 pounds. I give her 5 of Morphine. It takes the pain down to a 7, but she is considerably calmer. My routine has always been to give 5, wait a few minutes, then move the patient, and then give them more if they need it in the ambulance. Today I decide to give her another 3 before we move her. I can do that now under the new weight-based protocols. I give it to her. We wait. She has been having a conversation with the neighbors. All of sudden she says something about not buying ice cream sandwiches, when she starts laughing. The laugh does not end. It goes on and on. She is laughing so hard I am worried she is going to pee herself.
"Looks like the Morphine is working," her neighbor says.
In the ambulance, I give her the last milligram allowable under standing orders. She is still cracking herself up.
I'm thinking: I've got the product.
Saturday, June 11, 2005
Old Partners
I work 12 hours (noon to midnight)with one of my old partners, who I don't get to work with much anymore. We have a good laugh right off the back with our first call.
Our patient is being transfered from intensive care to a rehab hospital. She has a trach and is on a vent and requires suctioning and cardiac monitoring. When we arrive at the floor to pick her up, her parents are there, and then they leave for the hospital. As always happens, for one reason or another we are delayed leaving the hospital. The paperwork needs to be put in order, the patient needs to finish her tube feeding, the foley emptied, the feeding tube disconnected, etc. We finally get on the road.
I hate these transfers. I hate suctioning, and I'm not really wild about intrafacility transfers, particuarly on real sick patients. About halfway there, the woman touches my leg and looks like she wants to say something urgent to me, but I can't for the life of me figure of what she wants to say. They teach you not to rely on your machines, but as long as her pulse is staying where t is --120 -- normal for her of late, and her SAT is staying at 100%, I take some comfort. I never can figure out what she is trying to tell me. I just kept telling her we'll be there soon, and wishing my partner will just drive a little faster and get us there before anything goes wrong and I actually have to work besides periodic suctioning.
When we get to the place, her parents are there already, waiting for us. The mother approaches me and says what company do you work for. I give her the initials. She asks again. I tell her the full name, and then she says, "Where you at the Food Sack?"
"What?"
"Where you at the Food Sack?"
"The Food Sack?"
"We saw an ambulance at the Food Sack."
"Oh, no, that wasn't us. We were delayed at the hospital."
I think my complete befuddlement convinces her we didn't abandon her daughter to run in and buy cheetos and scratch-off tickets.
Before we leave, she thanks us.
The Food Sack?
***
Working with my old partner is fun. We rehash old laughs. When you work with someone long enough their ecentricities really come out. People have said partnerships are often like marriages, and many hit a wall after a year where people have to breakup because they can no longer stand each other. We worked together for a number of years and had our times when we would get tired of each other. Its good every now and then for us to work together though I don't know if I could last full-time again with him.
While in some ways a Type B personality in his friendliness to patients and his, where's the stress we get paid by the hour philosophy, he is a type A driver. He gets very irritated with the traffic. Today at one of the hospitals we see a nurse who rode with us years ago during his orientation. "Hey," he says to my partner. "I saw you on the highway yesterday and you flipped me off."
"I did not. I would never do such a thing. That's vulgar. I wouldn't do that."
"It was you. I came up on you fast, and sort cut you off, and I looked up and you were shaking your fist at me and you flipped me off."
"It wasn't me."
"There's nobody else who looks like you."
"Had to be someone else. I wouldn't do that."
"Dude, it was you. I've know you for years. You flipped me off."
The conversation is good natured. The nurse almost feels it is a badge of honor to be flipped off by my partner. My partner on the other hand is insistent it wasn't him. "I'll swear at someone," he tells me later, "But I never flip them off."
Yes, you do, I say.
No, I don't.
***
He is driving much better than he used to. At work they installed these computers in the cars that beep if you go too fast or stop too quickly, and every month we get a grade based on the number of violations, including backing up without a spotter (there is a spotter switch that your spotter has to hit when you backup) per mile. My partner is always in the top tier. His competitiveness has harnessed his speed and sudden braking, but not curbed his anger at other drivers.
At one point during the day, he buys a lunch of chicken fricasese from an Italian Mom and Pop restaurant, and as soon as he comes out we get sent on a transfer. I offer to drive while he eats, which he accepts. I get behind the wheel, and immediately backup.
"Hey, you're on my fob," he says. I've just cost him a penalty point.
"Sorry," I say.
Ahead the light turns yellow. I start to brake, but there is no way I can stop in time without setting the brake alarm off and also sending the buttery fricasse all over my partner's shirt, so I cruise through the yellow. "I just saved you a point and your shirt," I say.
"Please fob in," he says.
I reach down and touch my fob -- my identifier -- to the command button so all future violations on this trip will be on me.
I am also a top ranked driver. Last year one month I won the free DVD player as the raffle winner from among the top drivers. The only violations I ever get are the backup alarms. Sometimes I just backup without thinking I need to ask my partner to get out and spot me.
***
One of my partner's other eccentricities is he loves to get a McDonald's ice cream. Today, everytime we try to get one, we get a call. He is getting very annoyed. It is cracking me up. "What are you laughing at? he says, as he get back in the car, empty-handed and slams his shoulder belt on.
"Nothing," I say. Then I pick up the radio and tell the police dispatcher we are enroute.
***
We do six calls. Its hard to even remember what they are. After awhile the job sometimes doesn't even become about the calls. Its about the people you work with, driving the streets, the things you eat, what you talk about.
He and I are both recently divorced, so I listend to tales of his ex-wife and her lawyer. I tell him about my trip to the Dominican. We listen to the baseball games, switching back and forth, me listening to the Red Sox, him to the Yankees. Both teams lose.
***
The last three hours we do nothing. I take an hour nap in the back. He finally gets his ice cream cone and buys one for me. We tell stories of the old days. He keeps the air conditioning on. I finally roll the window down and ask him to shut off the engine. "The constant rattling is killing me," I say. "I need quiet. Besides its nice out. There's a breeze."
"Its hot," he says. He seems annoyed. He likes the AC to keep the air cleaner. He gets out and goes inside.
Ten minutes later he comes back out. The car next to us is running their diessel. "I have to roll the windows back up," he says. "Its too muggy."
"Okay," I say.
At 10:30 the dispatcher tells us to go to Area 9. My partner thinks he says "bring it in." I try to tell him the dispatcher said area nine, which is just a post. He calls the dispatcher on his cell phone and the dispatcher reiterates Area 9.
My partner doesn't hear as well as he used to. Several times he says, "Huh?" and I have to speak louder. I should talk because I find myself saying "Huh?" alot too. that's what years of sirens will do.
***
We shake hands like we always do at the end of the shift (after resupplying and washing the ambulance).
Good working with you.
Always a pleasure.
See you at Food Sack.
That's right.
Have a safe drive home.
You too, my friend.
Our patient is being transfered from intensive care to a rehab hospital. She has a trach and is on a vent and requires suctioning and cardiac monitoring. When we arrive at the floor to pick her up, her parents are there, and then they leave for the hospital. As always happens, for one reason or another we are delayed leaving the hospital. The paperwork needs to be put in order, the patient needs to finish her tube feeding, the foley emptied, the feeding tube disconnected, etc. We finally get on the road.
I hate these transfers. I hate suctioning, and I'm not really wild about intrafacility transfers, particuarly on real sick patients. About halfway there, the woman touches my leg and looks like she wants to say something urgent to me, but I can't for the life of me figure of what she wants to say. They teach you not to rely on your machines, but as long as her pulse is staying where t is --120 -- normal for her of late, and her SAT is staying at 100%, I take some comfort. I never can figure out what she is trying to tell me. I just kept telling her we'll be there soon, and wishing my partner will just drive a little faster and get us there before anything goes wrong and I actually have to work besides periodic suctioning.
When we get to the place, her parents are there already, waiting for us. The mother approaches me and says what company do you work for. I give her the initials. She asks again. I tell her the full name, and then she says, "Where you at the Food Sack?"
"What?"
"Where you at the Food Sack?"
"The Food Sack?"
"We saw an ambulance at the Food Sack."
"Oh, no, that wasn't us. We were delayed at the hospital."
I think my complete befuddlement convinces her we didn't abandon her daughter to run in and buy cheetos and scratch-off tickets.
Before we leave, she thanks us.
The Food Sack?
***
Working with my old partner is fun. We rehash old laughs. When you work with someone long enough their ecentricities really come out. People have said partnerships are often like marriages, and many hit a wall after a year where people have to breakup because they can no longer stand each other. We worked together for a number of years and had our times when we would get tired of each other. Its good every now and then for us to work together though I don't know if I could last full-time again with him.
While in some ways a Type B personality in his friendliness to patients and his, where's the stress we get paid by the hour philosophy, he is a type A driver. He gets very irritated with the traffic. Today at one of the hospitals we see a nurse who rode with us years ago during his orientation. "Hey," he says to my partner. "I saw you on the highway yesterday and you flipped me off."
"I did not. I would never do such a thing. That's vulgar. I wouldn't do that."
"It was you. I came up on you fast, and sort cut you off, and I looked up and you were shaking your fist at me and you flipped me off."
"It wasn't me."
"There's nobody else who looks like you."
"Had to be someone else. I wouldn't do that."
"Dude, it was you. I've know you for years. You flipped me off."
The conversation is good natured. The nurse almost feels it is a badge of honor to be flipped off by my partner. My partner on the other hand is insistent it wasn't him. "I'll swear at someone," he tells me later, "But I never flip them off."
Yes, you do, I say.
No, I don't.
***
He is driving much better than he used to. At work they installed these computers in the cars that beep if you go too fast or stop too quickly, and every month we get a grade based on the number of violations, including backing up without a spotter (there is a spotter switch that your spotter has to hit when you backup) per mile. My partner is always in the top tier. His competitiveness has harnessed his speed and sudden braking, but not curbed his anger at other drivers.
At one point during the day, he buys a lunch of chicken fricasese from an Italian Mom and Pop restaurant, and as soon as he comes out we get sent on a transfer. I offer to drive while he eats, which he accepts. I get behind the wheel, and immediately backup.
"Hey, you're on my fob," he says. I've just cost him a penalty point.
"Sorry," I say.
Ahead the light turns yellow. I start to brake, but there is no way I can stop in time without setting the brake alarm off and also sending the buttery fricasse all over my partner's shirt, so I cruise through the yellow. "I just saved you a point and your shirt," I say.
"Please fob in," he says.
I reach down and touch my fob -- my identifier -- to the command button so all future violations on this trip will be on me.
I am also a top ranked driver. Last year one month I won the free DVD player as the raffle winner from among the top drivers. The only violations I ever get are the backup alarms. Sometimes I just backup without thinking I need to ask my partner to get out and spot me.
***
One of my partner's other eccentricities is he loves to get a McDonald's ice cream. Today, everytime we try to get one, we get a call. He is getting very annoyed. It is cracking me up. "What are you laughing at? he says, as he get back in the car, empty-handed and slams his shoulder belt on.
"Nothing," I say. Then I pick up the radio and tell the police dispatcher we are enroute.
***
We do six calls. Its hard to even remember what they are. After awhile the job sometimes doesn't even become about the calls. Its about the people you work with, driving the streets, the things you eat, what you talk about.
He and I are both recently divorced, so I listend to tales of his ex-wife and her lawyer. I tell him about my trip to the Dominican. We listen to the baseball games, switching back and forth, me listening to the Red Sox, him to the Yankees. Both teams lose.
***
The last three hours we do nothing. I take an hour nap in the back. He finally gets his ice cream cone and buys one for me. We tell stories of the old days. He keeps the air conditioning on. I finally roll the window down and ask him to shut off the engine. "The constant rattling is killing me," I say. "I need quiet. Besides its nice out. There's a breeze."
"Its hot," he says. He seems annoyed. He likes the AC to keep the air cleaner. He gets out and goes inside.
Ten minutes later he comes back out. The car next to us is running their diessel. "I have to roll the windows back up," he says. "Its too muggy."
"Okay," I say.
At 10:30 the dispatcher tells us to go to Area 9. My partner thinks he says "bring it in." I try to tell him the dispatcher said area nine, which is just a post. He calls the dispatcher on his cell phone and the dispatcher reiterates Area 9.
My partner doesn't hear as well as he used to. Several times he says, "Huh?" and I have to speak louder. I should talk because I find myself saying "Huh?" alot too. that's what years of sirens will do.
***
We shake hands like we always do at the end of the shift (after resupplying and washing the ambulance).
Good working with you.
Always a pleasure.
See you at Food Sack.
That's right.
Have a safe drive home.
You too, my friend.
Saturday, June 04, 2005
Paperwork? Paperwork?
Busy day, five calls all in a row, three transports and two refusals. My ambulance is down for service so I'm working in another one. The medic who works in that one reguarly has the cabinets locked with pull ties so he doesn't have to check the shelves unless they're broken. I check my gear -- everything looks in order.
We always keep a couple refusals in the house bag so if the call turns out to be a refusal we don't have to go traiping back out to the ambulance to get the run box.
The call is for a woman who has fallen and hurt her hip. She is in her nineties and has no family members. She describes her pain as terrible and winces when I palpate her hips. I give morphine before we move her, and she is now, as she says, quite calm.
We get her out to the ambulance no problem, then I can't find the run box. No where to be found at all. I open up the house bag to get one of the backups we keep in there. Used them both up on the refusals. I break open a tab on the cabinet where I usually keep extra paperwork. There is no paperwork there. Not a run form on the ambulance.
I look at my partner. There is no family going with us, no one following. The patient is resting quite comfortably, eyes closed, feeling no pain. What do say, you swing by the bay on the way out of here. It's not but a couple minutes out of the way. No one else is back at the bay. The place is empty. My partner knows where the run forms are. There's a big box under the desk in the office.
When we arrive at the hospital, my paperwork is done. No one the wiser.
We always keep a couple refusals in the house bag so if the call turns out to be a refusal we don't have to go traiping back out to the ambulance to get the run box.
The call is for a woman who has fallen and hurt her hip. She is in her nineties and has no family members. She describes her pain as terrible and winces when I palpate her hips. I give morphine before we move her, and she is now, as she says, quite calm.
We get her out to the ambulance no problem, then I can't find the run box. No where to be found at all. I open up the house bag to get one of the backups we keep in there. Used them both up on the refusals. I break open a tab on the cabinet where I usually keep extra paperwork. There is no paperwork there. Not a run form on the ambulance.
I look at my partner. There is no family going with us, no one following. The patient is resting quite comfortably, eyes closed, feeling no pain. What do say, you swing by the bay on the way out of here. It's not but a couple minutes out of the way. No one else is back at the bay. The place is empty. My partner knows where the run forms are. There's a big box under the desk in the office.
When we arrive at the hospital, my paperwork is done. No one the wiser.
Thursday, June 02, 2005
Que Sera Sera
We took a dialysis patient back to his nursing home. I was surprised when my partner told me the guy was only 55. He seemed much older. He'd had a stroke and couldn't communicate. His body was all contracted and he seemed in pain, whenever we moved him like he may have had bed sores. I don't know whether he was with it in his mind, but just couldn't communicate, or whether his mind was also flawed. I was just thinking, man, I hope I don't end up like that.
Who knows what lies ahead for each of us. A week or so ago a guy who rode with me several times as a medic student and also briefly as a EMT, went down to Florida to see a girl. Hadn't been there long enough to get a sun tan when they went out on a watercraft. Reports were they were in a no wake zone watching dolphins or manatees when they got creamed by a catamaran. Didn't even see it coming. Dead. Twenty-three years old. The girl, also dead, was 19.
I think about myself these days. Here I am working everyday so I can own my house, and put enough money in my 401K so I won't eat catfood when I'm old. I didn't use any vacation time last year. At least I work out so my stroke risk is low. I hope so.
Anyway, I was walking out of the nursing home, making certain like I always do to say hello to all the old people sitting lost there in there wheelchairs. They always look suprised when you say hello. It seems to startle there, jarrs them out of their funk and they brighten up for a moment and give you a smile and say their best hello back. I'm saying my hellos, but I'm thinking stroked out in middle age or wacked by a catamaran in your youth. What kind of choice is that? How about dying in your gentle sleep on a stately ranch, surrounded by gennerations of your progeny?
My mother had multiple sclerosis. She got it when she was thirty. She used to beat me in tennis, then she stopped playing. I guess I was ten then. She had trouble walking, had to balance against the furniture. A lady down the street broke her pelvis skining and was back on the slopes the next winter. I didn't understand why my mother could't get back on the tennis court. The disease stayed mainly in her legs for the next twenty years. She'd have attacks, then remissions. She was always going for new experimental treatments, none of which panned out. She used a cane, a walker, sometimes a wheelchair.
Then the disease got into her brain. It was so slow, we didn't see it coming, didn't even recognize it for a long time when it was there. She was a bright woman, but she seemed to loose her sharpness. She'd say the same things over and over. Just enough to frustrate you because you were too busy to pay attention to her decline. "I just told you that," I'd snap when she'd ask me about my day after just having asked me about shortyly before.
And she was all the time using the same stupid phrase. She'd say, "Well, que sera, sera." What will be, will be.
She'd say that constantly, sometimes two, three, times in five minutes. It drove me nuts.
She used to sit on the couch and read. She was a voracious reader. Then we discovered she hadn't just been reading the same book for three weeks, she was on the same page. She'd sit there reading for hours, never turning the page. Shows how well we were paying attention.
Anyway, long story short, her decline was quick. She couldn't be left alone. My father would tell her not to move while he ran out to the store, she'd get up and fall. I was away living in a distant state so I didn't have to deal with it. She ended up in a nursing home. My father visited her everyday. It was a good home -- one of the best -- and they took good care of her. When I visited, I wasn't certain sometimes if she knew who I was. She got a UTI, one of many, and she passed away. She was a DNR by then. That was fourteen years ago.
So today as I'm walking out of the nursing home, saying my hellos, and thinking about the nasty ends many of us have coming at us, I go by the community room where a guy in a Hawaiian shirt, accompanied by another guy in a Hawaiian shirt on piano, is singing "Que Sera Sera," to a packed room. I go past the room, then the song sinks in and thinking of my mother, I stop and go back and stand in the doorway, and watch. I am hoping for some revelation, some sweeping emotion or meaning. I look about the room. Some people are smiling and nodding along to the song, some are asleep, some are drooling, some don't even seem to know they are there. The guy singing seems like a nice man, and he is working the room hard, focusing in on the few alert ones. He's touching hands and making eye contact where he can.
"Que sera, sera, Whatever will be, will be," he sings, as he smiles endearingly at an old woman, who blushes like it is some lost idol from her youth serenading her.
But there is no meaning for me, no deep message, no answers to my questions. It's just a bunch of old people in wheelchairs -- all with their own stories, their own heartaches, and their own joys, their own harsh and varying declines.
I don't know if there is ever meaning just handed to you when you want it.
I leave the singing behind and continue on out of the home, and out to the ambulance, get behind the wheel, and head out for the next call.
Who knows what lies ahead for each of us. A week or so ago a guy who rode with me several times as a medic student and also briefly as a EMT, went down to Florida to see a girl. Hadn't been there long enough to get a sun tan when they went out on a watercraft. Reports were they were in a no wake zone watching dolphins or manatees when they got creamed by a catamaran. Didn't even see it coming. Dead. Twenty-three years old. The girl, also dead, was 19.
I think about myself these days. Here I am working everyday so I can own my house, and put enough money in my 401K so I won't eat catfood when I'm old. I didn't use any vacation time last year. At least I work out so my stroke risk is low. I hope so.
Anyway, I was walking out of the nursing home, making certain like I always do to say hello to all the old people sitting lost there in there wheelchairs. They always look suprised when you say hello. It seems to startle there, jarrs them out of their funk and they brighten up for a moment and give you a smile and say their best hello back. I'm saying my hellos, but I'm thinking stroked out in middle age or wacked by a catamaran in your youth. What kind of choice is that? How about dying in your gentle sleep on a stately ranch, surrounded by gennerations of your progeny?
My mother had multiple sclerosis. She got it when she was thirty. She used to beat me in tennis, then she stopped playing. I guess I was ten then. She had trouble walking, had to balance against the furniture. A lady down the street broke her pelvis skining and was back on the slopes the next winter. I didn't understand why my mother could't get back on the tennis court. The disease stayed mainly in her legs for the next twenty years. She'd have attacks, then remissions. She was always going for new experimental treatments, none of which panned out. She used a cane, a walker, sometimes a wheelchair.
Then the disease got into her brain. It was so slow, we didn't see it coming, didn't even recognize it for a long time when it was there. She was a bright woman, but she seemed to loose her sharpness. She'd say the same things over and over. Just enough to frustrate you because you were too busy to pay attention to her decline. "I just told you that," I'd snap when she'd ask me about my day after just having asked me about shortyly before.
And she was all the time using the same stupid phrase. She'd say, "Well, que sera, sera." What will be, will be.
She'd say that constantly, sometimes two, three, times in five minutes. It drove me nuts.
She used to sit on the couch and read. She was a voracious reader. Then we discovered she hadn't just been reading the same book for three weeks, she was on the same page. She'd sit there reading for hours, never turning the page. Shows how well we were paying attention.
Anyway, long story short, her decline was quick. She couldn't be left alone. My father would tell her not to move while he ran out to the store, she'd get up and fall. I was away living in a distant state so I didn't have to deal with it. She ended up in a nursing home. My father visited her everyday. It was a good home -- one of the best -- and they took good care of her. When I visited, I wasn't certain sometimes if she knew who I was. She got a UTI, one of many, and she passed away. She was a DNR by then. That was fourteen years ago.
So today as I'm walking out of the nursing home, saying my hellos, and thinking about the nasty ends many of us have coming at us, I go by the community room where a guy in a Hawaiian shirt, accompanied by another guy in a Hawaiian shirt on piano, is singing "Que Sera Sera," to a packed room. I go past the room, then the song sinks in and thinking of my mother, I stop and go back and stand in the doorway, and watch. I am hoping for some revelation, some sweeping emotion or meaning. I look about the room. Some people are smiling and nodding along to the song, some are asleep, some are drooling, some don't even seem to know they are there. The guy singing seems like a nice man, and he is working the room hard, focusing in on the few alert ones. He's touching hands and making eye contact where he can.
"Que sera, sera, Whatever will be, will be," he sings, as he smiles endearingly at an old woman, who blushes like it is some lost idol from her youth serenading her.
But there is no meaning for me, no deep message, no answers to my questions. It's just a bunch of old people in wheelchairs -- all with their own stories, their own heartaches, and their own joys, their own harsh and varying declines.
I don't know if there is ever meaning just handed to you when you want it.
I leave the singing behind and continue on out of the home, and out to the ambulance, get behind the wheel, and head out for the next call.
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