Grand Central Station

I walk through the ER. There are beds in the hallway. I step aside as a tech pushes a portable X-Ray machine past. I call a greeting to a nurse who steps out of a room carrying an IV tray. In another room a doctor intubates an extremely large patient. The intercom pages a cleaning crew to the trauma room. A nurse answers the CMED radio. One of crews is coming in with a heroin overdose. Ahead of me a black man maybe sixty stands naked in the middle of the bustle, a foley catheter in his penis. In his hand he holds a catheter bag filled with fruit punch colored urine. Another ambulance crew comes down the hall, one EMT pulls the stretcher, while another rides the rails doing CPR on the patient's chest, while the medic at the head ventilates the man through an ambu-bag and ET tube. A nurse's aide sits outside a room reading a book, guarding the door where inside, a man restrained to a bed utters a string of obscenities. I go into the EMS and sit down to write my run report. I sit there for a moment. I get up go look down the hall. I see my partner gently escorting the naked man back to his room.

Diamond in the Rough (More Chapters)

I have now posted the first 20 chapters (out of 50) for Diamond in the Rough at the following link.

Diamond in the Rough

I have also attached the following preface:

"This novel is based on a true incident, and grew out of a challenge I gave myself to find out why someone did what they did, and to try to write a story that might explain how someone would come to do such a deed. However, this is a work of fiction and while inspired by a true story, it does not depict nor is is based on any real persons. All of the characters are entirely fictional. Any resemblence to real people is entirely coincidental.

I do have a strong concern about the book, and that is, unless written carefully, it may reflect badly on EMS as a profession. There are characters in this book (particuarly Fred) who do things that I do not obviously endorse. My main character (the narrator), who I hope will be viewed as ultimately symphathetic, will do things that are clearly unacceptable. Because the lead characters are certainly not role models, I am hoping that I will be able to find ways, either through the character's self-realization or by adding a more positive character or two, to at least show how EMS should be.

I also want to caution readers that some of the content is sexually explicit and should not be read by those who are offended by such writing.

I plan to post the entire book on this site, but then only keep it up for a short period of time (perhaps two weeks or a month). I hope to have it all posted by the end of March if not sooner. I expect that I will do at least one additional rewrite after finishing this draft.

Thank you all for reading."

I welcome comments.

ECG Changes

It's pouring rain and we get called for anxiety. 40 year old female sits in her kitchen holding her chest saying it feels heavy. We ask if she has been under stress and she says, "You don't want to know."

But she has never felt a pressure like this before and she says it feels like someone sitting on her chest. Her skin is warm and dry. BP 150/90. P- 108. Sat 100% on room air.

No prior history, though given her race and weight, she looks like she might have hypertension and high cholestrol.

Out in the ambulance, I put her on the monitor. Doesn't look too bad at first glance. Of course I am just looking at the inferior leads.

This could just be stress I tell her, but we are going to treat you like its your heart. We're required too.

I do a 12 lead.

Looks a little suspicious. V-6 is troubling. V-5 just a touch. The inferior leads look ever so slightly up. Maybe it is just a variant for her.

I give ASA and NTG, which brings no relief. Her pressure holds steady. I call the hospital, and let them know I have a chest pain with a borderline ECG, possible ST elevation in lateral leads.

I do another 12-Lead. The patient asks how it is. She sees something in my face as I stare at it.

Holy. Looks nasty. Particuarly in V-4 -V6. Such a change in ten minutes. In addition to the lateral there is fresh change inferiorly with an ominous cove shaping of the ST.

At the hospital I tell the triage nurse I believe my patient is having an MI. She says they are getting a room ready for us. I ask who the doctor is. She tells me it is a new physician and points in her direction. Sitting next to her I see one of hospital's best physicians, who is very EMS oriented. After I give a report to the nurse and get the patient on the bed, I go over to the doctor I know and show him the strips. He asks what room and I tell him. He immediately shows the strips to the new physician. He tells her the process for calling the cath lab.

I write my report and as I am bringing it back to the room, they are already wheeling the patient out, headed to the cath lab.

Nice turn around.

Carolina Tall Tale

I'm working on the computer when we get the call. I am in fact in the middle of downloading a program. Bad timing. There is no way I can wait for the download to finish. I decide to just minimize the window amd leave it at that.

Only when we are on the way to the call do I start to worry. This isn't a typical day at the barn where when we go out no one is there. Today there is a class going on. During break up to twenty people will wander into the front room. Some will sit down at the computer. I realize I have forgotten to log out of my email. I start to imagine people reading my email. Worse sending out emails under my name, then changing my passwords, depleting all my accounts. Damn, I think. I hope this call doesn't take long.

20 year old female with severe abdominal pain. History of gallstones. She is a large girl with big doe eyes. She is crying. She says she is scheduled for surgery later this week in Carolina where she lives. She says she ran out of her pain meds two weeks ago because she hasn't been able to refill them.

She is in the upstairs bedroom. I figure she is about twohundred and twenty pounds. I am working with two partners who are not quite up to carrying half that load. I tell her the stretcher is set up at the base of the stairs. She stands reluctantly and then bends over holding her abdomen. The first responder on scene puts a hand on her arm and then eyes me. Her look says, "Are you sure you want her to walk? Can't you carry her?" I raise my eyebrows to the first responder in a look that says, "She is two hundred and twenty pounds and there is nothing wrong with her legs."

She makes it down the stairs just fine. We get her out of her baggy NFL football jacket and sit her down on the stretcher, and then wrap her up in a wool blanket. We get her out to the ambulance, and I tell my partner to head to the hospital on a nonpriority.

I take vitals and check her from head to toe. 130/80. Pulse of 80. Her pain is in the upper to upper right area of the abdomen. She says she has thrown up six times. Her pain is 10 out of 10.

I ask her if she has ever had to go to the hospital by ambulance before for this. She says yes, six times. I ask her what they have done for her. She says well, down in Carolina, they give her an IV and fluids and drugs for the pain through the IV. I think well I can't let Carolina show us up.

I wrap a tourniquet around her arm, and go for an IV. Her veins feel hard for a 20 year old's. Hard in the sense that they are sclerosed. I miss. Feeling Carolina's crowd doing the wave, I check the other arm. Sure there is a huge AC. No doubt the vein Carolina used. I slam a 16 in. And take four tubes of blood. Take that Carolina.

We are not that far from the hospital. Maybe ten minutes. As I sit there cleaning up the IV wrappers, I see her big doe eyes looking at me. She turns her head and batts her eyes. They seem to be pleading with me.

"What was it again they did for you in Carolina?" I ask.

"They gave me drugs through the IV."

"What did they give you?"

"I don't know. Something for the pain."

She stares at me. She looks so pathetic.

My mind is on many things. I'm thinking about about the class sending out emails under my name. I'm thinking about Carolina medics dancing around holding their fingers in the air, chanting "We're number one! We're number one!" I'm thinking about how long it will take her to get pain medicine in the hospital. I'm thinking about how if I give her medicine, I will have to call for medical control now, and then afterwards, I will have to track down the doctor to get his signature, and then walk across the street to the other building and then down the stairs to the basement to the pharmacy where I will turn in my used set, and pick up a new kit, and fill out all the paperwork, all the while they are sending out emails under my name and stealing all my passwords, spending all my money.

I move seats to reach the CMED radio. I ask for a patch, and at the last moment, request medical control.

I just can't stand to look at those pleading eyes.

I get permission for 5 mg of Morphine. Not a huge dose, but enough to start to take the edge off. I get the narcs out of the locked cabinet, and then sit down beside her.

"All right, I've got some pain medicine for you."

I see a slight, appreciative smile -- an I'm not such a bad guy after all smile.

And I am thinking of my own state's cheerleaders, chanting "Go State! Go State!"

I give her the medicine and throw in some phenergan for her nausea for good measure.

We get her in her room in the ER, and she seems sedated now. I ask her about her pain, and she slowly says its down to a six. Since she is talking in slow motion, I consider the mission a success.

On my way out the triage nurse calls me over. "She's a regular here," he says. "She's got that bullshit story. She's going to have the operation in a couple days in another state. Her prescription ran out. Etc. Etc."

"She seemed in pain," I say.

He just looks at me, shaking his head like I am the biggest sucker.

"Are you saying she's drug seeking?"

"I'm just saying she's a regular and she's always just about ready to have surgery."

Oh well.

I do all the paperwork, walk across the street, change the narcs, and on the ride back to the base, I'm think maybe I should call up Carolina and commiserate. Got you, too, with that tall tale, huh, old partner, they'll say to me.

Out! -- I Mean Safe! -- Legacy of an Ear

A number of years ago, one of our ambulances was involved in an MVA. The EMT in the back went flying forward and banged his head against the cabinets and sliced his ear against a sharp edge. When he regained conciousness, his ear was just hanging there. Shortly after, he recieved (I believe) a prosthetic ear and a nice cash settlement. And the rest of us started getting nets hung up in the back of our ambulances at the end of the bench seats.

The nets are sort of a pain when you are getting in the side of the ambulance. There is much less room to maneuver. When I respond to a nursing home, and if I want to bring my monitor and house bag in, which I always do, instead of just tossing them up on the stretcher, I either have to lean way in to get around the net, or I just take them out of the side and dump them on the stretcher after it is pulled. No big deal, but a tiny little bit of a pain.

Anyway, yesterday I am in the back with a patient when I stand to get over to the cmed radio to call the hospital, when my partner slams on the brakes to avoid a car cutting him off. I go flying forward -- right into the net. It absorbs me like an Ozzie Smith baseball glove snaring a fastball. But instead of being out, I am safe.

Good as New

An old woman in a group home slips and hits her knee. She mutters "I broke my leg, I broke my leg" so her aides call us. We find her sitting on the floor. I ask her how she is. She mutters, "broke my leg, broke my leg." But she didn't break her leg. There is no deformity, no pain on palpation. She has good movement. My partner says, "There, you're all better. You rested and its better." We stand her up and I say, "Your leg is good as new." She nods, seems pleased, and then she putters away chanting "good as new, good as new."

Call 911

Ruby has been taking care of old Mrs. Johnson for seven years. This afternoon she finds Mrs. Johnson has been a little too quiet, even for a 93-year old. And she just won't wake up. Her skin is cool, and she doesn't respond to the throat rub that the doctor taught Ruby to do whenever Mrs. Johnson is hard to awake. So Ruby calls Hattie, the next door neighbor, and asks her to come over and see what she thinks. Hattie comes over and examines old Mrs. Johnson closely. When Ruby asks Hattie for her opinion, Hattie has a response for her.

"I told her to call Nine-One-One!" Hattie tells me.

This conversation takes place after we have ceased our rescusitation efforts.

Paramedic Journal: A Year on the Streets

A year ago I started another EMS blog, called Paramedic Journal: A Year on the Streets.It was my intention to only record "a year" of being a medic, so anyone interested in knowing what the day to day life of a medic was like could have a reference. In Paramedic Journal the entries are rougher and, like the job, at times the entries are tedious. I try to make at least a small mention of each call I go on.

The benefit of writing about each day is the act of writing every day sometimes produces stories or insights that might otherwise have been lost. Sometimes something from the day that I paid little attention to comes into focus. It is for this reason that I am going to continue keeping that blog going.

People do EMS for many reasons: to help people, for the excitment, for the challenge of medicine... For me one of the big reasons is for the view into people -- people at their best and worst. I am happiest when I can capture one of these moments. I don't do it everyday, but by the sheer act of writing, sometimes these nuggets fall onto my paper.

I use Street Watch to post what I feel are the most interesting stories, moments or thoughts about the job of being a paramedic. Most of what appears on this blog originally appeared in the Journal in a rougher form. Some readers, particularly those who like a daily dose of the paramedic life, may prefer that site.

Thank you all for reading. Knowing that people click on this link gives me the impetus to sit down and try to make certain that each week there is something new to read.