60-year-old female (a frequent flyer know to us) with low temp this am (87.6 --Shouldn't they have maybe taken it twice to see if that was really what they got?) and low blood sugar(given 2 mg glucagon by nursing staff at 6 AM), now this afternoon (5 PM) has high blood sugar (400) and a normal temp (98.6). Family, who has come to visit, wants her evaluated at the ED.
Here is her medical history taken from the nursing home W10 exactly as written: HTN, CHF, dementia, IDDM, hyponatremia, dehydration, anemia, depression, PVD, seizure, GERD, acute respiratory failure, CAD, hypothyroid, UTI, mental status changes, agitation, dsyphagia, pancyoponia(sic), bilateral urethra stents, chronic/acute renal failure, facial fractures, cellulitis, hematoma R hip, constipation, coagupathy(sic), PE, GI bleed, hemolytic anemia, high cholestrol, mediastial mass, edema, high K, OBS, atonic bladder, DJD, hypocalcemia, hypoxia, sepsis.
Code status: Full
I checked her sugar. It was 266. Vitals stable. Patient mental status -- babbling per norm.
And did the family come to the hospital?
No.
Monday, February 27, 2006
Thursday, February 23, 2006
Scenario
Here’s the punchline to start: You intubate a patient who is a DNR, but not a DNI while they still have a pressure and are breathing. Then they lose pulses and BP, and they cease breathing on their own, but instead of going to asystole, they maintain a PEA in the 40’s along with a capnography of 14-18. This is a patient that you would do compressions on if they weren’t a DNR, so you obviously don’t start compressions, but what about the ventilations you are already doing? Do you stop or continue? Now if they were asystole, I would stop. But a ?PEA regular rhythm...
Here’s how it went down.
We’re dispatched to a nursing home for a woman in respiratory distress. The nurse meets us at the door and says the patient's pulse SAT is dropping. "She was in the 70's, then we put her on a nonrebreather at 4 lpm, and she is now down to the 30's."
Do'oh.
We try to explain that unless you have the 02 up to 12 or so, she is just going to be rebreathing her own carbon dioxide. You might as well put a plastic bag over her head. But she needed a mask, the nurse says, her SATs were dropping. We try to explain, but she doesn't get it.
I look at the patient and ask what her code status is. She is taking shallow gasping respirations.
“She’s a stage 2 DNR.”
“And what does that mean? Is she a Do Not Intubate.”
“It means do everything except rescusitate her if she is cold and stiff. The family is very involved. They want aggressive care.”
“So I can intubate her?”
“Absolutely. The family will meet you at the hospital.”
Out in the ambulance while she is still breathing I intubate her. Inside they had a BP of 50/20. We can't hear an BP or feel a pulse. She is now in full respiratory arrest. On the monitor she is in a bradycardia in the 40's.
Her capnography is 20, then slowly goes down to 14. We should be doing compressions, but she is a DNR.
I find myself in a little bit of a dilemma. I intubated her when she still technically intubatable, but now that she needs resuscitation do I stop bagging her? I decide to call medical control for permission to cease, which they give me. I detach the ambu-bag. "I guess that's it," I say. Her rhythm is still in the 40's. She has no pulse or detectable BP. I stare at her. My partner throws a sheet over her. But then it suddenly looks like she is moving imperceptibly or is it just the shaking of the idling ambulance? I pull the sheet back. This is very confusing to me. She is a pulseless, apneic DNR. Her pupils are fixed and dilated. But her rhythm holds steady and her capnography actually rises. Maybe if I had a Doppler it would show she had a BP, and maybe even though I can't see it she may be breathing imperceptibly. I doubt she is -- I don't see any signs of it, but how can she be generating a capnography of 14. I would think anyone with a capnography of 14 has to have some kind of perfusion going on. Admittedly I could use a course in capnography because I am still new to it and have a lot of questions. But what should I do right now? I am uncomfortable putting a sheet over the head of someone who may not be completely dead. I don't know whether to start bagging again or what. If she wasn't a DNR, I'd be doing CPR. I look at the monitor hoping for the patient to brady down, but she stays strong and steady at 40.I am tempted to tell my partner, “Drive really really slowly.” I call the hospital back and say, "About that presumption..." I tell them I am uncomfortable putting a sheet over her just yet, and will continue to bag her, but withhold compressions. Just then she starts to brady down, and by the time I am at the hospital, about twenty minutes after I intubated her, she is almost completely flat line.
I have stopped bagging her again. The doctor calls her dead and that's that.
***
The doctor later tells me that he has just read her recent discharge notes from several days ago. She was supposed to be a DNI/DNR. He says I had to go on what they told me.
You can’t come up with enough scenarios sometimes.
Here’s how it went down.
We’re dispatched to a nursing home for a woman in respiratory distress. The nurse meets us at the door and says the patient's pulse SAT is dropping. "She was in the 70's, then we put her on a nonrebreather at 4 lpm, and she is now down to the 30's."
Do'oh.
We try to explain that unless you have the 02 up to 12 or so, she is just going to be rebreathing her own carbon dioxide. You might as well put a plastic bag over her head. But she needed a mask, the nurse says, her SATs were dropping. We try to explain, but she doesn't get it.
I look at the patient and ask what her code status is. She is taking shallow gasping respirations.
“She’s a stage 2 DNR.”
“And what does that mean? Is she a Do Not Intubate.”
“It means do everything except rescusitate her if she is cold and stiff. The family is very involved. They want aggressive care.”
“So I can intubate her?”
“Absolutely. The family will meet you at the hospital.”
Out in the ambulance while she is still breathing I intubate her. Inside they had a BP of 50/20. We can't hear an BP or feel a pulse. She is now in full respiratory arrest. On the monitor she is in a bradycardia in the 40's.
Her capnography is 20, then slowly goes down to 14. We should be doing compressions, but she is a DNR.
I find myself in a little bit of a dilemma. I intubated her when she still technically intubatable, but now that she needs resuscitation do I stop bagging her? I decide to call medical control for permission to cease, which they give me. I detach the ambu-bag. "I guess that's it," I say. Her rhythm is still in the 40's. She has no pulse or detectable BP. I stare at her. My partner throws a sheet over her. But then it suddenly looks like she is moving imperceptibly or is it just the shaking of the idling ambulance? I pull the sheet back. This is very confusing to me. She is a pulseless, apneic DNR. Her pupils are fixed and dilated. But her rhythm holds steady and her capnography actually rises. Maybe if I had a Doppler it would show she had a BP, and maybe even though I can't see it she may be breathing imperceptibly. I doubt she is -- I don't see any signs of it, but how can she be generating a capnography of 14. I would think anyone with a capnography of 14 has to have some kind of perfusion going on. Admittedly I could use a course in capnography because I am still new to it and have a lot of questions. But what should I do right now? I am uncomfortable putting a sheet over the head of someone who may not be completely dead. I don't know whether to start bagging again or what. If she wasn't a DNR, I'd be doing CPR. I look at the monitor hoping for the patient to brady down, but she stays strong and steady at 40.I am tempted to tell my partner, “Drive really really slowly.” I call the hospital back and say, "About that presumption..." I tell them I am uncomfortable putting a sheet over her just yet, and will continue to bag her, but withhold compressions. Just then she starts to brady down, and by the time I am at the hospital, about twenty minutes after I intubated her, she is almost completely flat line.
I have stopped bagging her again. The doctor calls her dead and that's that.
***
The doctor later tells me that he has just read her recent discharge notes from several days ago. She was supposed to be a DNI/DNR. He says I had to go on what they told me.
You can’t come up with enough scenarios sometimes.
Tuesday, February 21, 2006
A Cigarette
The mental health team meets us outside. "We should wait for the police," the clinician says. "She's a big woman. When we went back up there she had a knife near her that wasn't there the first time we were up with her. She's very anxious today. When she's off her meds, she can be volatile. I've seen her tear a door off its hinges."
"Okay," I say. "We'll wait for the PD."
When the first officer arrives, she repeats the story to him. He calls for backup.
Once backup arrives, we walk up the three flights of outdoors stairs and then force the door open because she will not come to it. Inside we find a completely bare apartment. I am always surprised when I walk into what is actually a fairly common occurrence -- a psychiatric patient living in an empty apartment. In the kitchen there is a bare table with no chair and in the living room, there is no furniture, except the single folding chair in which the woman sits facing the window sill, smoking a cigarette. She wears a dirty flowered robe and slippers. She is about two hundred and ninety pounds and built solid like a rhinoceros. When the officer starts talking to her, she turns her head around slowly and says, "Don't you be talking to me in my house. I don't give a good god damned about any of you, so for all I care, you can all go ahead and kiss my ass. I ain't getting up, and I ain't going anywhere." She goes back to looking out the window and slowly smoking her cigarette
One at a time we try to talk to her, but she just gets more agitated. When it is my turn, I say in a soft monotone, "We're just to give you a nice easy ride down to the hospital where you can get something to eat and talk with a doctor and nice nurse about all that's going on." She turns full on me, and even though I am several feet away, I can feel hot breath coming out of her flaring nostrils. I just let her rant, and whenever she stops to catch her breath, I start talking again in a real quiet, slow voice. It doesn't get me far, but at least it wears her down some.
Our efforts to talk her into going having failed, the lead cop and I discuss various game plans. He wants us to get restraints. I offer chemical as an alternative, but suggest we just try to get her to walk first. They stand her up and she starts yelling, but once they cuff her she calms down. We walk down the stairs with her, and she yells again at the top of her voice about what motherfuckers we are and how the world is corrupt. "You think you can just go in and take a woman out of her house, you all a bunch of god damned honkey ass motherfuckers! I have my mind set to take you all out, and I will leave nothing, nothing in my wake. Do you hear me? I said do you hear me! Make no mistake. You all can kiss my black ass cause I'm going to take you all down, treating a poor black woman like this. You should be ashamed of your punk asses, motherfuckers!"
When we get her down on the stretcher, she says, "My wrists hurt." I start talking soft to her again, "I'm sorry they hurt. I'll ask the officers to take them off if you agree to not fight us.” I nod to my preceptee who is probably about six-four and close to three hundred pounds himself. "The two of us will ride in the back with you. We'll just take a nice easy ride to the hospital, where you can talk to a doctor. You don't even have to say anything to us." She seems to be listening. "And we'll let you have a cigarette outside the hospital before we go in if don't fight us."
"Okay," she says.
The cops seem a little dubious. "You're going to have to ride with her." I nod at my partner. "We can handle her." They look at the two of us, and they have to admit, she's big, but the two of us are not likely to be easily handled even by an enraged rhino, and I do have the Haldol and Ativan at the ready. "It's your choice."
"She'll be good," I say. "We'll let her have a smoke."
"You best not be tricking me," the woman says.
"We'll get you a smoke."
They uncuff her and she is quiet on the way in. She even lets us take her pulse and blood pressure. While we are still in the ambulance, I have a vision of us pulling her out on the stretcher and letting her smoke while still on the stretcher, and a newspaper reporter taking a picture of us "ambulance attendants" standing around letting our patient have a cigarette, and what a storm of controversy it might cause. When we get to the hospital, I ask her is she wants to walk in or go in on the stretcher. "I'll walk," she says. We're supposed to keep everyone on the stretcher and while there is no policy about not letting them smoke, I think that is only because no probably imagined crews would let their patients smoke.
We have her step out of the back of the ambulance, and so she is standing when he give her the cigarette. If a photographer were there, it wouldn't be apparent that she is our patient. She looks like your typical weary two hundred and ninety pound late fifty year old lady in a dirty flowered robe and slippers, smoking a cigarette on a cold grey day. And that's good, because if she were on the stretcher people seeing a photo in a newspaper might not understand the power of a cigarette. It often works better than brute force, better than pepper spray, handcuffs, Haldol and Ativan. It's a simple acknowledgement that a person is having a tough day and needs a break, a chance to have a smoke and collect yourself before heading on into another tough day.
In the ER, she says she has to use the bathroom. The nurse tells her she has to pee into a cup.
"I'm going to need a bigger cup," she says. "And why can't I just go in the bathroom?"
The nurse says all females have to pee into a cup to see if they are pregnant.
"I ain't pregnant," she says.
"We require this of all females," the nurse said.
"You're wasting a cup on me."
Still she takes the cup and shaking her head, waddles over toward the bathroom.
"Okay," I say. "We'll wait for the PD."
When the first officer arrives, she repeats the story to him. He calls for backup.
Once backup arrives, we walk up the three flights of outdoors stairs and then force the door open because she will not come to it. Inside we find a completely bare apartment. I am always surprised when I walk into what is actually a fairly common occurrence -- a psychiatric patient living in an empty apartment. In the kitchen there is a bare table with no chair and in the living room, there is no furniture, except the single folding chair in which the woman sits facing the window sill, smoking a cigarette. She wears a dirty flowered robe and slippers. She is about two hundred and ninety pounds and built solid like a rhinoceros. When the officer starts talking to her, she turns her head around slowly and says, "Don't you be talking to me in my house. I don't give a good god damned about any of you, so for all I care, you can all go ahead and kiss my ass. I ain't getting up, and I ain't going anywhere." She goes back to looking out the window and slowly smoking her cigarette
One at a time we try to talk to her, but she just gets more agitated. When it is my turn, I say in a soft monotone, "We're just to give you a nice easy ride down to the hospital where you can get something to eat and talk with a doctor and nice nurse about all that's going on." She turns full on me, and even though I am several feet away, I can feel hot breath coming out of her flaring nostrils. I just let her rant, and whenever she stops to catch her breath, I start talking again in a real quiet, slow voice. It doesn't get me far, but at least it wears her down some.
Our efforts to talk her into going having failed, the lead cop and I discuss various game plans. He wants us to get restraints. I offer chemical as an alternative, but suggest we just try to get her to walk first. They stand her up and she starts yelling, but once they cuff her she calms down. We walk down the stairs with her, and she yells again at the top of her voice about what motherfuckers we are and how the world is corrupt. "You think you can just go in and take a woman out of her house, you all a bunch of god damned honkey ass motherfuckers! I have my mind set to take you all out, and I will leave nothing, nothing in my wake. Do you hear me? I said do you hear me! Make no mistake. You all can kiss my black ass cause I'm going to take you all down, treating a poor black woman like this. You should be ashamed of your punk asses, motherfuckers!"
When we get her down on the stretcher, she says, "My wrists hurt." I start talking soft to her again, "I'm sorry they hurt. I'll ask the officers to take them off if you agree to not fight us.” I nod to my preceptee who is probably about six-four and close to three hundred pounds himself. "The two of us will ride in the back with you. We'll just take a nice easy ride to the hospital, where you can talk to a doctor. You don't even have to say anything to us." She seems to be listening. "And we'll let you have a cigarette outside the hospital before we go in if don't fight us."
"Okay," she says.
The cops seem a little dubious. "You're going to have to ride with her." I nod at my partner. "We can handle her." They look at the two of us, and they have to admit, she's big, but the two of us are not likely to be easily handled even by an enraged rhino, and I do have the Haldol and Ativan at the ready. "It's your choice."
"She'll be good," I say. "We'll let her have a smoke."
"You best not be tricking me," the woman says.
"We'll get you a smoke."
They uncuff her and she is quiet on the way in. She even lets us take her pulse and blood pressure. While we are still in the ambulance, I have a vision of us pulling her out on the stretcher and letting her smoke while still on the stretcher, and a newspaper reporter taking a picture of us "ambulance attendants" standing around letting our patient have a cigarette, and what a storm of controversy it might cause. When we get to the hospital, I ask her is she wants to walk in or go in on the stretcher. "I'll walk," she says. We're supposed to keep everyone on the stretcher and while there is no policy about not letting them smoke, I think that is only because no probably imagined crews would let their patients smoke.
We have her step out of the back of the ambulance, and so she is standing when he give her the cigarette. If a photographer were there, it wouldn't be apparent that she is our patient. She looks like your typical weary two hundred and ninety pound late fifty year old lady in a dirty flowered robe and slippers, smoking a cigarette on a cold grey day. And that's good, because if she were on the stretcher people seeing a photo in a newspaper might not understand the power of a cigarette. It often works better than brute force, better than pepper spray, handcuffs, Haldol and Ativan. It's a simple acknowledgement that a person is having a tough day and needs a break, a chance to have a smoke and collect yourself before heading on into another tough day.
In the ER, she says she has to use the bathroom. The nurse tells her she has to pee into a cup.
"I'm going to need a bigger cup," she says. "And why can't I just go in the bathroom?"
The nurse says all females have to pee into a cup to see if they are pregnant.
"I ain't pregnant," she says.
"We require this of all females," the nurse said.
"You're wasting a cup on me."
Still she takes the cup and shaking her head, waddles over toward the bathroom.
Sunday, February 19, 2006
Crash
I'm in the back, helping my preceptee with an IV. I repositon the catheter to get a blood flow, and then pull out the needle, occluding the vein with my left hand while I reach for the saline lock. All of a sudden we are decelerating and I start sliding to my right, and I keep sliding. Our patient who is c-spined after a fall resulting from a seizure and who is complaining of neck pain, slids along with me. Then his harness catches and whoa! I am deep in the net at the end of the bench and we are stopped. I look out the side window and see a car in front of our bumper. We've been in a crash. Fortunately, no one is hurt. Amazingly to me I still have his vein occluded and not a drop of blood has spilled, although I think I have permanently indented my fingers into the man's arm. I have lost the lock and my preceptee has to draw up another one while we wait for another ambulance to come and take our patient.
I feel lucky, particularly when I read the dailyAmbulance Crash Log.
I also love that net.
I feel lucky, particularly when I read the dailyAmbulance Crash Log.
I also love that net.
Tuesday, February 14, 2006
Complete Draft Now On-Line
The complete draft of the novel is now up and will stay up until at least March 15. At that time I will reread it myself and no doubt do major revisions. I do not plan at this time on posting the next draft in its entirety. My hope is that draft will be publishable in book form. For those who have been reading the novel, I discovered a missing chapter, which has been added back as "Chapter 15 and a half."
To read the novel, click the link below:
Diamond in the Rough
To read the novel, click the link below:
Diamond in the Rough
Monday, February 13, 2006
Snow
The snow is coming down in near white out conditions. At one point we lose the road the snow bank kicking up snow that completely obliterates our view through the windshield. We arrive at a townhouse apartment complex where we have been called for an unresponsive diabetic. Carrying our blue house bag, heart monitor, and 02 tank, we wade through drifts up to our waist to get to the door.
An old Jamaican woman meets us at the door in her bathrobe and says her sister is upstairs on the bed. We have been to this house many times before. The sister is in her eighties. She is supine across the bed, snoring, her skin cool and clammy. We check her sugar. Our glucometer reads "LO" which means less than 20. I get a line and push in an amp of D50. She opens her eyes to a sternal rub now, but is still mostly out of it. I give her another half an amp and she now has her eyes fully open and looks around at us quizzically. "What hap'en?" she asks.
"Your sugar was low," I say. "Less than 20."
"No, my sugar is high," she says, "I write it right down dere in de book."
"No, it was less than twenty."
"No, it isn't low. Me write it down in de book before me go to bed."
"You sugar went down. You must not have eaten."
She listens seemingly intently to what I say. I think I am getting through, but then she says again, "My sugar high. I write it down in de book."
Finally her sister says, "Dis is anothder day now dear."
We finally got her straightened out and have her sitting at the kitchen table eating a big Jamaican meal of stew chicken and rice and peas.
"What do you think of the snow storm?" I ask.
She looks at me with one eye cocked, uncertain what I am saying.
"Look outside," I say.
My partner opens the door for her to see.
It is a winter wonderland outside, nothing but white powder.
Her eyes widen. Her mouth opens, but no words come out. She looks like a little five-year old Jamaican girl seeing snow for the first time.
An old Jamaican woman meets us at the door in her bathrobe and says her sister is upstairs on the bed. We have been to this house many times before. The sister is in her eighties. She is supine across the bed, snoring, her skin cool and clammy. We check her sugar. Our glucometer reads "LO" which means less than 20. I get a line and push in an amp of D50. She opens her eyes to a sternal rub now, but is still mostly out of it. I give her another half an amp and she now has her eyes fully open and looks around at us quizzically. "What hap'en?" she asks.
"Your sugar was low," I say. "Less than 20."
"No, my sugar is high," she says, "I write it right down dere in de book."
"No, it was less than twenty."
"No, it isn't low. Me write it down in de book before me go to bed."
"You sugar went down. You must not have eaten."
She listens seemingly intently to what I say. I think I am getting through, but then she says again, "My sugar high. I write it down in de book."
Finally her sister says, "Dis is anothder day now dear."
We finally got her straightened out and have her sitting at the kitchen table eating a big Jamaican meal of stew chicken and rice and peas.
"What do you think of the snow storm?" I ask.
She looks at me with one eye cocked, uncertain what I am saying.
"Look outside," I say.
My partner opens the door for her to see.
It is a winter wonderland outside, nothing but white powder.
Her eyes widen. Her mouth opens, but no words come out. She looks like a little five-year old Jamaican girl seeing snow for the first time.
Monday, February 06, 2006
You Never Know
We’re called for chest pain at the court house. We question whether it is a case of "Jailitis." We find the patient sitting in the lobby on a bench surrounded by marshals and firefighters. It is a young man – twenty-five. My first reaction is he is a prisoner, but then I realize he is wearing street clothes. We hear the story. He was walking down the street when suddenly he felt an intense tearing sensation in his chest going into his back. He is a heart transplant patient. A firefighter hands me a paper with medical history on it. It is a typed report from a hospital saying the patient has a diagnosed Aortic dissection.
"Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta (the major artery from the heart). This condition may also involve abnormal widening or ballooning of the aorta (aneurysm)."
While the man looks okay, he also seems extremely tense. I would be too with that history. An aortic dissection rips open and the person bleeds out in a minute. One moment awake, the next dead.
I nod to my preceptor as I lower the stretcher. Let’s just get him on the stretcher and on the way to the hospital. His pressure is okay. When my preceptee says he is going to start a line, the man says he has no veins, the hospital has to use central lines so we shouldn't bother. We are already enroute to the hospital. I hand the CMED radio to my preceptee. He stutters some with the patch. The patient snaps at him when he says stomach pain. “It’s not stomach pain, it's chest pain, pain into my back.”
When I ask for the meds he’s on, he starts rattling off a list. I ask him to repeat one; he says the name again, but with thick frustration. He glances back to try to look ahead. “Are we at the hospital yet? How far is it?”
“Just up the road.”
When we finally approach the hospital, the man, seeing the ambulances out the side window, says urgently, “You just went past the ER!”
“No, listen, I know you are concerned, but we know where we’re going. It’s a one way drive.”
He apologizes.
“We’ll get you good care.”
In the ER, I tell the triage nurse the man has a possible AAA. "No! It's not possible, it’s been diagnosed,” he snaps. “I have it.”
“Okay,” I say. “We’re getting you a room now.”
He looks like he is about to snap as we wait for the triage nurse to give us a room assignment. His hand keeps tapping his leg. “Man, I can feel it pulsing!” he shouts.
***
Later I see the nurse who was taking care of the man. I ask how he made out, curious whether or not he was rushed to surgery. I imagine his AAA rupturing in the elevator and him bleeding out before the doors can open. The nurse says he was very squirelly with the doctors. They called the other hospital in town and found out he had been there the night before. They felt he was drug seeking. He ended up walking out of the ED and taking a cab to a third hospital.
"Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta (the major artery from the heart). This condition may also involve abnormal widening or ballooning of the aorta (aneurysm)."
While the man looks okay, he also seems extremely tense. I would be too with that history. An aortic dissection rips open and the person bleeds out in a minute. One moment awake, the next dead.
I nod to my preceptor as I lower the stretcher. Let’s just get him on the stretcher and on the way to the hospital. His pressure is okay. When my preceptee says he is going to start a line, the man says he has no veins, the hospital has to use central lines so we shouldn't bother. We are already enroute to the hospital. I hand the CMED radio to my preceptee. He stutters some with the patch. The patient snaps at him when he says stomach pain. “It’s not stomach pain, it's chest pain, pain into my back.”
When I ask for the meds he’s on, he starts rattling off a list. I ask him to repeat one; he says the name again, but with thick frustration. He glances back to try to look ahead. “Are we at the hospital yet? How far is it?”
“Just up the road.”
When we finally approach the hospital, the man, seeing the ambulances out the side window, says urgently, “You just went past the ER!”
“No, listen, I know you are concerned, but we know where we’re going. It’s a one way drive.”
He apologizes.
“We’ll get you good care.”
In the ER, I tell the triage nurse the man has a possible AAA. "No! It's not possible, it’s been diagnosed,” he snaps. “I have it.”
“Okay,” I say. “We’re getting you a room now.”
He looks like he is about to snap as we wait for the triage nurse to give us a room assignment. His hand keeps tapping his leg. “Man, I can feel it pulsing!” he shouts.
***
Later I see the nurse who was taking care of the man. I ask how he made out, curious whether or not he was rushed to surgery. I imagine his AAA rupturing in the elevator and him bleeding out before the doors can open. The nurse says he was very squirelly with the doctors. They called the other hospital in town and found out he had been there the night before. They felt he was drug seeking. He ended up walking out of the ED and taking a cab to a third hospital.
Friday, February 03, 2006
Thursday, February 02, 2006
Suffering in the World
We are sent to a detox center for a diabetic. We find a sixty-year old Puerto Rican with a blood sugar over 600, although he has no complaint. He has come to the center to kick his heroin habit. But first now he will have to go to the ER to get his sugar under control. “I did three bags of heroin this morning,” he admits, “then I flushed the rest of the bundle down the toilet, and came here.” He is a man with deep eyes. He speaks quietly. “I spent eighteen years in prison,” he says. “When I came out, I saw there was so much suffering in the world. People on the outside are used to it, and they don’t see it, but I saw it. That’s how I got started. I’ve been on and off of it for most of my life.” He tells us how he lost two brothers to heroin and a sister and two cousins to crack cocaine. “My father died at ninety last week. He was all I had left. I was lost without him. It was a setback for me, but I looked at myself this morning and knew I wouldn’t see seventy if I didn’t get a hold of myself. I knew it was time for me to come in.”
At the scene of a motor vehicle accident, a wife yells at her husband who has driven his new Toyota into a parked car. He called her and gave her the address so she could bring his insurance card. The address isn’t in the best part of town. After she leaves, he waits with the cop for the tow truck to come. The cop thinks something isn’t quite right with him, and asks if he is a diabetic. He is, he says, so the officer calls us to check him. He looks to be in late thirties. He wears blue jeans and a college athletic sweat shirt. His sugar is 43 a little on the low side. His answers to questions are slow. He can’t remember if he ate or how the accident happened. When I go to roll up his sleeve to look for a vein, he at first refuses. “I have issues,” he says. “We don’t care about that,” I say. He has track marks on his arms. I put in an IV and give him some sugar that clears his mind up. He looks at the front bumper of his car which is all mashed in. Driving along and he veers off the road. I wonder what he’s thinking now. Maybe I should have stayed home. Maybe I should have had a sandwich before I shot up. I wonder up the road what lays ahead for him. I don’t think he has thought about that yet.
A wife comes home from work and finds her fifty-year old husband on the kitchen floor, semi-responsive with vomit on his face, chest and the linonleum. His skin is cool. She calls 911. He recently had shoulder surgery and is on blood thinners for clots in his legs. She has no idea what has happened or how long he has been there. When we arrive, we find he can answer questions. He is not hurt, his grips are equal, there is no facial droop, but his speech is slow. He looks at his wife and says “Sorry.” I ask what meds he is on. I’m thinking maybe he has taken too many and maybe drank, although I can smell no liquor on his breath. He seems familiar to me; not his face, but his whole manner as we pick him up. We are in this new freshly built home, a large sparse home with hardly any furniture, but he seems just like a homeless man in his demeanor. Here is this guy with a well dressed wife, and he seems in his faded jeans and grey tee-shirt and flushed face to be just a street man. He looks up at her and again says, sorry. We get him up on the stretcher and as we start out the door suddenly I hear the wife say, “Hold on a minute.” She has found something in the bathroom. Heroin.
She is beside herself, she is so angry. The officer asks her if this is something he regularly does.
“No, He’s been clean for almost sixteen years -- since before I met him. He’s been very upfront about his past with me, but I’ve never seen it. He doesn’t even drink. I can’t believe he did this. I could kill him.”
“It’s the most addictive drug in the world,” the officer says. “No one ever completely beats it.
“I just can’t believe this. I’m in shock.”
She comes to the hospital with us, riding in the front. “Is he okay?” she asks.
“He’s stable,” I say. “He’ll be all right.”
She cries. “He’s been so depressed,” she says. “He lost his grown son two weeks ago. He’s been out of work with his injury. He's had no money. We have a new home and with him not working, we can't afford to put anything in it.”
“He's beaten this before,” I say, “He can do it again. Don't be too hard on him. It sounds like he’s had a rough go.”
“I could just kill him,” she says, but not as harsh this time.
After we leave them in an ER room, I come back later and glance in. She sits next to his bed, leaning against him, her head against his shoulder, his big arm around her. He brushes her hair. Niether of them speak.
At the scene of a motor vehicle accident, a wife yells at her husband who has driven his new Toyota into a parked car. He called her and gave her the address so she could bring his insurance card. The address isn’t in the best part of town. After she leaves, he waits with the cop for the tow truck to come. The cop thinks something isn’t quite right with him, and asks if he is a diabetic. He is, he says, so the officer calls us to check him. He looks to be in late thirties. He wears blue jeans and a college athletic sweat shirt. His sugar is 43 a little on the low side. His answers to questions are slow. He can’t remember if he ate or how the accident happened. When I go to roll up his sleeve to look for a vein, he at first refuses. “I have issues,” he says. “We don’t care about that,” I say. He has track marks on his arms. I put in an IV and give him some sugar that clears his mind up. He looks at the front bumper of his car which is all mashed in. Driving along and he veers off the road. I wonder what he’s thinking now. Maybe I should have stayed home. Maybe I should have had a sandwich before I shot up. I wonder up the road what lays ahead for him. I don’t think he has thought about that yet.
A wife comes home from work and finds her fifty-year old husband on the kitchen floor, semi-responsive with vomit on his face, chest and the linonleum. His skin is cool. She calls 911. He recently had shoulder surgery and is on blood thinners for clots in his legs. She has no idea what has happened or how long he has been there. When we arrive, we find he can answer questions. He is not hurt, his grips are equal, there is no facial droop, but his speech is slow. He looks at his wife and says “Sorry.” I ask what meds he is on. I’m thinking maybe he has taken too many and maybe drank, although I can smell no liquor on his breath. He seems familiar to me; not his face, but his whole manner as we pick him up. We are in this new freshly built home, a large sparse home with hardly any furniture, but he seems just like a homeless man in his demeanor. Here is this guy with a well dressed wife, and he seems in his faded jeans and grey tee-shirt and flushed face to be just a street man. He looks up at her and again says, sorry. We get him up on the stretcher and as we start out the door suddenly I hear the wife say, “Hold on a minute.” She has found something in the bathroom. Heroin.
She is beside herself, she is so angry. The officer asks her if this is something he regularly does.
“No, He’s been clean for almost sixteen years -- since before I met him. He’s been very upfront about his past with me, but I’ve never seen it. He doesn’t even drink. I can’t believe he did this. I could kill him.”
“It’s the most addictive drug in the world,” the officer says. “No one ever completely beats it.
“I just can’t believe this. I’m in shock.”
She comes to the hospital with us, riding in the front. “Is he okay?” she asks.
“He’s stable,” I say. “He’ll be all right.”
She cries. “He’s been so depressed,” she says. “He lost his grown son two weeks ago. He’s been out of work with his injury. He's had no money. We have a new home and with him not working, we can't afford to put anything in it.”
“He's beaten this before,” I say, “He can do it again. Don't be too hard on him. It sounds like he’s had a rough go.”
“I could just kill him,” she says, but not as harsh this time.
After we leave them in an ER room, I come back later and glance in. She sits next to his bed, leaning against him, her head against his shoulder, his big arm around her. He brushes her hair. Niether of them speak.
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