The call is for a man on the ground, not injured just needs help getting up. Been there all night. The front door should be open. The stink hits us when we go in. There he is lying on the floor in a nearly empty house, shit on the rug, shit crusted on his underwear. The stink isn’t just from the recent shit. It’s from the filth of the house – a house that hasn’t seen a cleaning in some time. The man’s name is Joe and he is Veteran of World War II. We’re glad he says his knees hurt because it gives us a good excuse to take him to the hospital. He says his son checks on him every now and then. His legs are red and painful to the touch. There is a yellow green fungus growing on his arms. My preceptee gets a bucket of soap and water, and we cut off his underwear and scrub him off some before rolling him on a board and then lifting him up onto our clean sheets. We roll him off the board, and put a Johnny on him, and lay a fresh bath blanket over him. My preceptee tries to secure the straps while we are still in the house, but I say, “Outside.” I have smelt worse, but it is early in the morning, and my cough is on the verge of becoming a puke.
He is a nice guy and we chat on the way in. On good days he can walk he says, others he uses a wheelchair. He hasn’t been out of the house for awhile. He doesn’t know his son’s number. He thinks it might be on the record at the hospital.
Later in the day we get called for another assist. An eighty-eight year old woman living alone fell and needs help getting up. She’s not hurt. The key is in the shed in the back. When I go into the shed, it is like walking into the 1930’s. There is a old wooden Flexible Flyer sled with rusted runners and a scythe leaning against the wall, and some kind of old combustion engine. Not much else. I can’t find the key, but when I come out I see another smaller shed attached to the house and I try that one. There’s the key.
The house is well kept, but it is like it is frozen in the 1950’s. There is one of those old enormous radios, a TV in a cabinet, and instead of a computer on a desk, there is an old Royal typewriter. Wood floors, old farmhouse type furniture, a metal rabbit holding a door open, an old, weathered edition of the Encyclopedia Britannica in the bookcase.
We find her upstairs, sitting on the floor. She has been there since last night and hasn’t eaten. She didn’t want to bother anyone, but she was getting hungry and she just couldn’t get up. On the wall is a photo of a man in a World War II pilot’s garb, and a picture of him in dress uniform and his bride arm and arm, smiling. I see the resemblance to the woman. His buddies would have envied him marrying a girl who looked like her.
We help her up, and she is a little wobbly, but can stay on her feet. We help her downstairs and fix her some macaroni and cheese and a glass of orange juice. She raised five children in the house she says, and had a sister living there too. Her husband died over forty years ago. Someone from the family calls her everyday, but when we ask if we can call her daughter, she says, heavens no; she doesn’t want to be a bother. In the midst of all the old photos I see one that looks new. It is one of those Photoshop jobs – A generic cover of Rolling Stone with a young teenager on the cover holding a guitar. It says “Artist of the Year.” She says her grandchildren come and see her all the time. Talking with her she has a little bit of dementia – she is after all eighty-eight.
Afterwards we talk about her, and how comfortable or not we were leaving her alone. I say at least her house was clean, there was food in the kitchen, and it seems her family looks after her. Better to be alone in your own house than sitting in some nursing home hallway next to people in wheelchairs with their heads bent, mouths open, drooling.
Wednesday, August 30, 2006
Sunday, August 27, 2006
Beam Away
We’re on the third floor of an apartment building whose elevator doesn’t work. In the tiny efficiency apartment, layered with dirt, an old skinny man with dreadlocks says he didn’t call us, and why are we bothering him. The man’s body reminds me of a Biafrin child’s it is so emaciated. We’re here because a man who follows him as part of a church outreach group has decided he is just too sick to stay by himself.
“You got to go,” the thick-necked man says. “You can’t stay here. You got to go and get cleaned up and get checked out. We leave you alone, you’re going to die.”
“Give me my peace,” the frail man says.
The room is piled with papers, opened bill envelopes, a stack of several cases of Ramen, some half-full bottles of cranberry juice. I see a paperback copy of a book called “Ellison’s Key’s to Success” on the windowsill. On the bed is a library edition of Ellison’s How to make your first Million.” On the wall I see a taped photograph of a healthy man in a purple velvet shirt standing with two smiling younger men wearing earrings.
“You really should go in to the hospital and get checked out,” my partner, a precepting medic says. “You look like you have some gangrene on your feet. That needs to be taken care off.”
“You got to take him,” the man in the doorway says.
“We can’t take him against his will,” my partner says, “But I think he’ll agree with us all that the hospital is the best idea. They can cook him a warm meal, a change of pace from noodles, and get a nurse and a doctor to look you over. How about it?”
“I ain’t got no clean pants,” our patient says.
“Here’s some here,” my partner says. “They look like they’ll do. Let me give you a hand with them.”
The man is still reluctant to go, but my partner who is very patient, keeps at it, and slowly starts to move him along to getting his things in order.
The man in the doorway says to us, “What you all need is a beamer. Something you could just press and beam him to the hospital so you wouldn’t have to mess with all this getting him up, getting him dressed, carrying him down the stairs, everybody watching, just a beamer to beam him right to the hospital.”
“Well, that would sort of put us out of work now, wouldn’t it?” my partner says.
“No, no man,” the guy says. “You’d still need someone to come out and check him out and make certain he needs to be beamed, and that he gets beamed to the right place. You couldn’t put that beamer in the hand of any old fool. You’d need training like you people got. Couldn’t have him being beamed to the wrong doctor or into the wrong century for that matter. You’d still need the paramedics to come out and do their job. All I’m saying is it would make it easier on you and the patients – the getting to the hospital part, that’s all.”
“If you put it, that way, I guess it would be okay,” my partner says, as he gently slips the man’s pants over his blackened feet.
Later, as we carry the man down the stairs in our chair, barely feeling any weight at all, but watching his pained face as he looks at the water-stained stairwell of his apartment building like maybe it is the last time he will be seeing it, I think about the future, about the days when we might have beamers in our jump kits. I imagine myself waving a beamer like a magic wand. Maybe with enough practice, instead of just being able to beam people to the hospital, we’ll be able to treat them right there. Beam their ills and pains away. Beam fresh paint on the walls. Beam the Ramen into roast beef, the cranberry juice into wine. Beam away their hard luck. Beam them back to a happier time.
“You got to go,” the thick-necked man says. “You can’t stay here. You got to go and get cleaned up and get checked out. We leave you alone, you’re going to die.”
“Give me my peace,” the frail man says.
The room is piled with papers, opened bill envelopes, a stack of several cases of Ramen, some half-full bottles of cranberry juice. I see a paperback copy of a book called “Ellison’s Key’s to Success” on the windowsill. On the bed is a library edition of Ellison’s How to make your first Million.” On the wall I see a taped photograph of a healthy man in a purple velvet shirt standing with two smiling younger men wearing earrings.
“You really should go in to the hospital and get checked out,” my partner, a precepting medic says. “You look like you have some gangrene on your feet. That needs to be taken care off.”
“You got to take him,” the man in the doorway says.
“We can’t take him against his will,” my partner says, “But I think he’ll agree with us all that the hospital is the best idea. They can cook him a warm meal, a change of pace from noodles, and get a nurse and a doctor to look you over. How about it?”
“I ain’t got no clean pants,” our patient says.
“Here’s some here,” my partner says. “They look like they’ll do. Let me give you a hand with them.”
The man is still reluctant to go, but my partner who is very patient, keeps at it, and slowly starts to move him along to getting his things in order.
The man in the doorway says to us, “What you all need is a beamer. Something you could just press and beam him to the hospital so you wouldn’t have to mess with all this getting him up, getting him dressed, carrying him down the stairs, everybody watching, just a beamer to beam him right to the hospital.”
“Well, that would sort of put us out of work now, wouldn’t it?” my partner says.
“No, no man,” the guy says. “You’d still need someone to come out and check him out and make certain he needs to be beamed, and that he gets beamed to the right place. You couldn’t put that beamer in the hand of any old fool. You’d need training like you people got. Couldn’t have him being beamed to the wrong doctor or into the wrong century for that matter. You’d still need the paramedics to come out and do their job. All I’m saying is it would make it easier on you and the patients – the getting to the hospital part, that’s all.”
“If you put it, that way, I guess it would be okay,” my partner says, as he gently slips the man’s pants over his blackened feet.
Later, as we carry the man down the stairs in our chair, barely feeling any weight at all, but watching his pained face as he looks at the water-stained stairwell of his apartment building like maybe it is the last time he will be seeing it, I think about the future, about the days when we might have beamers in our jump kits. I imagine myself waving a beamer like a magic wand. Maybe with enough practice, instead of just being able to beam people to the hospital, we’ll be able to treat them right there. Beam their ills and pains away. Beam fresh paint on the walls. Beam the Ramen into roast beef, the cranberry juice into wine. Beam away their hard luck. Beam them back to a happier time.
Wednesday, August 23, 2006
Mortal Men (Chapters 4-6)
I'm taking a few days off. In the meantime I am posting chapters 4-6 of my novel Mortal Men, which I am close to finishing. The first three chapters are posted at:
Chapters 1-3
As I mentioned before I probably won't post the entire novel, but will post at least half in the next month or so.
(Disclaimer -- This is a work of fiction. Any resemblence to real people is purely coincidental).
Chapter 4
“456, Chest pain 85 Vine, on a one. 454, Rollover Whitehead Highway. Person ejected.”
Troy and I were on the second floor of Saint Francis Hospital waiting in the hallway while a nursing home patient we’d brought in from Mediplex of Greater Hartford had an x-ray on his hip. Troy’s first day back at work from his hunting trip and here he was working with me again, and all they’d given us were basic transfers.
“We should be out there,” Troy said.
“Why don’t you turn the radio off?”
“I’ve humped more basic transfers today than I’ve humped in the last three years. The least they could do is give us time to get a meal. Fucking Seurat brothers, the both of them. They’re probably sitting back in the office cackling every time dispatch calls our number. Thinking about how good they’re boning me. ‘482, CB-6, going to Glastonbury Health Care.’ ‘482, Pickup up Steady at Saint Fran Dialysis, then grab Edith next.’ ‘482, Alexandria Manor going to the Cancer Center, wait and return.’ I can’t take it.”
I’d worked enough to know when a dispatcher had it in for you, or when they were told to stick to you, and clearly that was the order of the day for us. “The more you complain, the more you let them see they’re getting to you, the more they are going to mess with you.”
“There’re messing with me plenty. Don’s already asked Linda and her kids out on his boat. I saw that coming a mile away.”
“Is there a problem with that?”
“Linda is free to do what she wants. Her kids love his boat.”
“You two were never a couple?”
“We were just partners. We had fun. We understood each other.”
Sanchez had told me when Troy and Linda worked together, they often drove down behind the college at night and parked in the empty lot by the river. People knew enough to leave them alone.
“471, shooting to the head, Park and Zion. On a one.”
Troy swore. I noticed his hands were shaking. He looked pale.
“You all right?”
“Give me fifty cents,” he said.
I dug into my pocket and gave it to him.
He came back with a Baby Ruth bar.
“It’s not right,” he said. “Paramedics doing basic transfers.”
“I’ll do anything they tell me to do,” I said, “as long as they sign my paycheck at the end of the week.”
“If it was about money, I wouldn’t be here.” He unwrapped his candy bar and took a big bite. “All I ask is a chance to use my skills.”
“Careful what you wish for.”
“I wish no harm on anyone,” he said. “But if harm shows up, call my number. I am the cavalry.”
Chapter Five
As much as I didn’t care for Troy, I had never seen a medic with more confidence, more presence, when he walked on a scene. When he arrived, you had the sense the emergency was over, that the calvary had indeed arrived.
We’d cleared a transfer at Britainy Farms and were headed on New Britain Avenue toward Avery Heights for a dialysis run when dispatch called. “482, disregard that transfer. I need you to back up 463 on Overbrook. Their radio’s breaking up, but it sounds like they need help.”
“Overlook,” I repeated. “What’s the nature?”
“Came in as a child with abdominal pain.”
Overbrook was in the Charter Oak public housing complex just a few blocks away from our location. Two story brick buildings built during World War II were laid out around several oval roads. The buildings looked in disrepair, the grass was burned. Shirtless children shouted and waved at us as we approached. Ahead we saw a parked police car and 463, its lights on and back door open.
The stretcher was outside the building in low position with the straps undone and the sheet spread out.
“They upstairs,” a young boy said. “Davey’s sister sick. She got the shakes.”
I followed Troy up the narrow staircase to the second floor. He took the steps three at a time, easy as walking.
We entered the apartment that smelled of rancid hamburger.
“Let them do their jobs!” I heard someone bark.
A man and woman were yelling at a police officer in the room at the end of the hall.
“Just take her to the hospital!” the man shouted.
“Calm down or I’m going to have to arrest you,” the officer said.
“That’s my daughter!” the man said.
“She’s sick! Lord, she’s sick!” the woman cried.
We pushed into the room. “Coming through,” Troy said.
A young woman lay on the bed convulsing, arms and legs jerking together. She had an oxygen mask on her face. She had to be two hundred twenty pounds. On the wall was a shelf of teddy bears and a poster from Disney’s Beauty and the Beast.
Andrew Melnick, a short, skinny paramedic, just twenty years old, was trying to tape an IV down on the woman’s jerking arm. Blood backed up in the IV line. Melnick’s hands shook.
“What do you have?” Troy asked.
“Lord help my baby!” The woman, now by the foot of the bed, cried.
“Take her to the hospital!” the man shouted. His breath reeked of alcohol. The police officer pushed him back. “Calm down or you’re out of the room.”
“Everyone quiet!” Troy said.
“She said she had belly pain,” Andrew said. “Then all of a sudden she started seizing. I just got a line and gave her five of Valium, but it’s not working.”
“Did you get a pressure before she started?”
“230/130.”
“Is she pregnant?”
“Pregnant? My daughter not pregnant,” the man said.
“She’s a good girl!” the mother shouted. “A church girl!”
“Take her to the hospital before she dies!”
“That’s it, you’re out of here.” The officer grabbed the man by the arm.
The IV line came loose. Blood squirted in the air.
“Lee hold her shoulder,” Troy said. “Get some tape on that. Andrew get me an 18.”
He knelt on the woman’s forearm to hold it steady and took the IV catheter Andrew handed him. “She’s got to be eclamptic.”
“But she said there was no chance.”
“Look at her pants. That’s not pee, she broke her water.”
Her sweat pants were soaked at the crotch. The smell wasn’t urine.
Troy had the IV in. “Give me some mag.”
Andrew fumbled with the one cc syringe as he tried to stick the needle into the small vial of magnesium I had handed him from the med kit. He pulled the plunger back. The drug drained into the chamber.
“Easy, my friend,” Troy said. “Get it in there and push it slow.”
Andrew again had trouble as he tried to stick the needle through the rubber port on the IV line.
“Easy,” Troy said. “That’s it. Now push slow.”
I felt a tension easing in the girl’s arms. The seizure stopped.
“Get your airway kit out,” Troy said.
The woman lay still. Her chest wasn’t moving. She wasn’t breathing.
“Bag her,” Troy said. He tossed me the ambu-bag as Andrew unzipped his airway kit and fumbled to get out the laryngoscope.
I applied the mask over her face, holding a tight seal around her mouth and bending her head back to keep her airway open as I squeezed the bag.
“How my daughter doing in there?” the man shouted.
The cop barred the doorway.
“Just fine,” Troy said to the man. “I’m shutting the door.” To us, “She still has a good pulse. Tube her.”
Andrew nudged me to the side and stuck the scope in her mouth and swept her tongue to the side, peering in looking for her vocal chords.
“She’s bradying down,” Troy said, “Get that tube in.”
“I can’t see the chords.”
Troy reached up and pressed on the front of the woman’s neck.
“I think I’m in,” Andrew said.
“You’re not,” Troy said. “I didn’t feel it pass.”
“Heart rate’s thirty,” I said.
“No, I’m in.”
“Pull it out,” Troy said.
Andrew attached the ambu bag to the end of the tube. Gave one squeeze. The bag didn’t reopen. I saw the belly rise. He pulled the bag off. Vomit surged out of the tube.
“Listen to me next time,” Troy said. “No, leave the tube there. Go in above it. Don’t go in so deep this time. She’s anterior.”
Troy handed him another tube. He went back in. More puke came out of the other tube.
Andrew’s partner turned his head. I could hear him vomit.
“Rate’s fifteen.”
Troy pressed his fingers against the neck again, just below the Adam’s apple. “That’s it. I felt it pass.”
Andrew attached the bag. This time you could see vapor in the tube. Good chest rise. Troy listened with his stethoscope while Andrew bagged. “Nothing in the belly. Good on the left. Nothing on the right. Pull back a little. That’s good. Solid placement. Tie it off. Yank the other tube.”
“Rate’s coming up,” I said.
But Troy wasn’t looking at the monitor. “We’ve got company.”
“What?”
Troy had pulled the woman’s sweat pants down. There between her legs was a bloody motionless baby.
“Throw me a blanket.”
I handed him a towel that was by the bedside.
Troy lifted the child and rubbed it with the towel. He brought the baby up to his mouth and gave it two breaths. He moved his fingers up and down on its chest. In between breaths, he told Andrew how to set up a magnesium drip, while Andrew’s partner bagged the woman through the tube.
“Drip set,” Troy said, “Hang it from the wall hanger. Lee get her on the board and strapped tight.” He gave the baby two more breaths. “Andrew get the infant ambu out, then get the OB kit and let’s get the chord cut.”
It was hot in that room, and I was sweating too, lifting and turning the woman to get the board under her and the straps around her fat. I was so busy I didn’t have time to stop and admire Troy, the calm he displayed. He kept us focused. At his direction I unhooked the woman from the monitor, and applied patches to the baby, who they laid on the short board on the dresser. Its color wasn’t quite as mottled. Troy had a tube in the baby’s mouth, and coached Andrew inserting a small catheter into the umbilical vein.
“Nice job,” he said to Andrew. “A little epi, a little atropine, and maybe things will be all right. You know the dose?”
“I have a field guide.” He reached for his side pocket.
“.01 per kilogram for the epi. .02 for the atropine,” Troy said. “Let’s make it .35 ccs for the epi and 1 cc for the atropine.”
The baby’s rate came up to 140. Troy stopped the compressions. Its color was close to pink now. “Attention all,” Troy announced. “In case you haven’t noticed. It’s a boy.”
When we got to the ED, they had a team from labor and delivery down there with an incubator. The baby weighed five pounds, but the doctor said he appeared to have good reflexes. The mother was stable too. Her pressure was down close to normal. She was breathing well enough on her own that they were able take the tube out of her windpipe.
“Excellent work,” Doctor Eckstein said to Troy. “You guys did a hell of job. Strong work. Strong work.”
She seemed to lighten up around Troy.
“Andrew was the man,” Troy said. “This was your first delivery, isn’t it?”
“Well, yeah. If you could call that a delivery.”
“I foresee a great future for you.”
“I don’t know,” Andrew said. “I was sort of losing it there.”
Troy slapped him on the back. “You hung in there. You were a stud. They should name the kid Andrew in your honor.”
Watching Troy walk down the hall, seeing the way the others looked at him -- two nurses in the station, Melnick, Dr. Eckstein who’d come out of the room behind him, even the cleaning lady looked up from her mop as he passed -- I couldn’t help but feel his aura. He commanded his stage.
Chapter 6
David Nestor was one of the city’s original paramedics. Now at forty-eight, he weighed over three hundred pounds. He’d been taken off the road due to his arthritic hips and cardiac problems, not helped by his three pack a day cigarette habit. Others said the hospital had quietly yanked his medical control to practice because he had been unable to adapt to changing protocols and techniques. His job now was to read through the previous day’s run forms, sort them by number, and make certain all the signatures and insurance numbers were in place before the forms were sent on to the billing department. He often came to work unshaven. His uniform no longer fit. His prodigious gut hung over his belt. He looked like a broken tusked walrus. Instead of sitting at the desk in the back office, he sat on two chairs at a table in the crew room where he liked to hold court.
“Melnick, how can you wear that medic patch on your sleeve?” Nestor said. “I’m looking at this form. You write this guy had rales and you didn’t give him lasix? Didn’t they teach you anything in school?”
“I thought he might have pneumonia.”
“You can’t tell the difference? Didn’t they teach you assessment?”
“Yeah, but you need an x-ray.”
“An X-ray? Bullshit. All a medic needs is a good head on his shoulders and a twenty-dollar stethoscope. A medic doesn’t need an x-ray to see the patient’s in failure. Just reading the form, it’s clear he’s in failure. He’s got JVD, no fever, pedal edema, rales, Bp’s up, he’s tachycardic, Sat’s in the low 90’s despite your non-rebreather.”
“He’s got a pneumonia history. He wasn’t that bad, I didn’t want to take a chance and dehydrate him.”
“Are you a paramedic? You gave him nitro, go ahead and give the lasix. He’s on 60 a day, give him 120 and hand him a urinal. Case closed.”
He turned to see what everyone else in the room was looking at.
Troy stood in the doorway with that demon gleam in his eye. “Nestor, you worthless slug,” he said.
Nestor narrowed his eyes suspiciously like he wasn’t sure whether Troy was serious or just toying with him.
“Nestor, I wouldn’t let you get within ten feet of me with a placebo.”
One moment the EMTs in the crew room had been checking their equipment and strapping on their bulletproof vests. The next they were silent, watching, waiting.
Nestor looked confused and irritated.
“You old paramedics don’t know half what the newest medic coming out of school today knows,” Troy continued. “There’s a new breed on the street. Fifty dollars says Melnick knows all his pediatric doses off the top of his head, and that you would only know them by pulling out your field guide unsticking its pages and putting on your bifocals.”
“Listen to you,” Nestor said. “Go take your medication.”
“That’s right. It would do you some good to take some lessons from a real paramedic, not some washed up old dinosaur that’s killed more people than Son of Sam.”
“You wouldn’t know a medic if you saw one,” Nestor said. “When I first worked the city medics were special -- they were giants of the street. You had to earn the patch. Now days all you need is a pulse and you get hired. Medics are a dime a dozen, but they’re not worth the paper their card is printed on. Shake and Bake medics. Chia Pet medics. No wonder no one respects us anymore.”
“You make a good case for the giant part. The size certainly attests that they were exceedingly large, but like the stegosaurus they had tiny brains and made large shits wherever they went. When’s the last time you took a bath?”
“Psycho,” Nestor mumbled. He looked down at his run forms.
The EMTs in the room smiled like jackals and grinned at Troy, like they’d just crowned him lion king. I felt nauseous. Nestor was red-faced.
“Atropine .02 milligrams per kilogram,” Melnick said. “Epi...”
“Shut up Melnick,” Troy said.
I went out to the car. Troy might have been a phenomenal paramedic, but he grated me the wrong way. We all traveled our own roads and took our own hard lessons. I guessed his were yet ahead of him.
“482, You available to sign on yet?”
“Just about,” I answered. “Give us a couple minutes. Troy’s in a meeting.”
“Tell me once he’s finished his paperwork, I need you to sign on and cover Newington.”
“Understood,” I said.
I went back into the crew room. “Have you seen Troy?” I asked Nestor.
He shook his head without looking up from his run forms. “I’m not his keeper.”
I looked in the bathroom, but no one was there. I glanced in the supply room. I saw no one. Then I did a quick double take. Troy lay on the floor in the corner of the room, half hidden by several stacked crates of IV fluids. He wasn’t moving. When I approached I saw his eyes were glassy. His skin was gray and beaded with sweat. I shook his shoulder. “Are you all right?”
He was unconscious, his skin cool to the touch.
I turned for help just as a tall broad-shouldered medic came in the door. He was about Troy’s age, blonde and fair-complected, wearing a Boston Red Sox hat. He went right for Troy. “Yo, bro!” He rubbed his knuckles into Troy’s sternum.
Still no response.
“Don’t worry,” he said to me. “He does this all the time. It’s his sugar. Now go close the door.”
I knew Troy was a diabetic. I’d seen him checking his sugar with his pocket glucometer, pricking his finger to produce a drop of blood for the test strip, but certainly I hadn’t expected to see Troy Johnson like this. The medic talked gently to Troy as he put a tourniquet around his arm. “Sometimes he resists, so you have to be careful. He’s being good today.” He took an alcohol wipe and rubbed it over a large vein in the crook of Troy’s arm. He stuck a needle in. I saw the blood flash back. “Get me some D50 from the shelf.”
I handed him the blue box. He took out a large bristo jet and a glass ampule of Dextrose, screwed them together, and then stuck the Bristo jet needle in the rubber port of the IV line. He pushed the ampule deeper into the jet, pushing the sugar water into Troy’s vein.
Troy’s eyes were still closed, but his skin was less diaphoretic.
“Shit,” he said, groggily. He looked up at us. “Gimme a four by four."
“You know you have to eat,” the medic said.
“I got a headache. Don’t push it so fast, you know that.” Troy grabbed the four by four I offered, placed it against the IV site, then ripped the line out of his arm, and bent his elbow. “That hurts.” He got to his feet. “What’d you use? A sixteen?” He walked out of the closet and went into the bathroom across the hall.
“Nothing better than a grateful friend,” the medic said. “I’m Pat Brothers.”
“Lee Jones.” We shook.
“I’ve heard about you. I guess no one gave you the spiel on Troy. I’ve been on vacation or I would have.”
“I’ve got part of it. Not this part.”
“He’s a brittle diabetic, and you’ve got to watch him constantly. As long as his sugar stays above 70, he’s got your back. It dips below; you have to have his. Are you any good at IVs?”
“I’m not IV certified.”
“That’s all right. I’ll teach you.
“This happens frequently?”
“Yes, it does, though it runs in spurts. He can be fine for months, and then it’ll happen every day for a week. The company knows he has a problem, but not to the degree it happens. There isn’t a medic here that hasn’t had to sit on him once or twice or five times to get some sugar in him. If you’re going to work with him, you’re going to have to learn how to do IVs.”
I could have answered that I wasn’t an IV tech, but from looking at the light blue of the EMT rocker on my shoulder he already knew that. I saw how things were, and I’ve done worse deeds than look out for a co-worker.
Pat grabbed two EMTs out of the break room, and despite their protests, had them roll up their sleeves. He gave me a quick course. I stuck each of them twice, and Pat three times, getting veins in the crook of the elbow, the forearm, wrist and hand. “Excellent, you’re a natural,” he said. “You’re all set.”
Troy came out of the bathroom ten minutes later, looking hung over, his hair out of place. He put on his Yankees cap and walked right past Nestor like nothing had happened between them.
“A pity the young are so frail,” Nestor said.
I thought Troy would go home for the day, but he sat in the ambulance, and we went out on the road. He said nothing about the incident.
“You’ll learn to see it coming on,” Pat said to me that day. “He starts doing crazy things. Make him eat. Don’t take anything he says personally. He just needs a little sweetening from time to time.”
Chapters 1-3
As I mentioned before I probably won't post the entire novel, but will post at least half in the next month or so.
(Disclaimer -- This is a work of fiction. Any resemblence to real people is purely coincidental).
Chapter 4
“456, Chest pain 85 Vine, on a one. 454, Rollover Whitehead Highway. Person ejected.”
Troy and I were on the second floor of Saint Francis Hospital waiting in the hallway while a nursing home patient we’d brought in from Mediplex of Greater Hartford had an x-ray on his hip. Troy’s first day back at work from his hunting trip and here he was working with me again, and all they’d given us were basic transfers.
“We should be out there,” Troy said.
“Why don’t you turn the radio off?”
“I’ve humped more basic transfers today than I’ve humped in the last three years. The least they could do is give us time to get a meal. Fucking Seurat brothers, the both of them. They’re probably sitting back in the office cackling every time dispatch calls our number. Thinking about how good they’re boning me. ‘482, CB-6, going to Glastonbury Health Care.’ ‘482, Pickup up Steady at Saint Fran Dialysis, then grab Edith next.’ ‘482, Alexandria Manor going to the Cancer Center, wait and return.’ I can’t take it.”
I’d worked enough to know when a dispatcher had it in for you, or when they were told to stick to you, and clearly that was the order of the day for us. “The more you complain, the more you let them see they’re getting to you, the more they are going to mess with you.”
“There’re messing with me plenty. Don’s already asked Linda and her kids out on his boat. I saw that coming a mile away.”
“Is there a problem with that?”
“Linda is free to do what she wants. Her kids love his boat.”
“You two were never a couple?”
“We were just partners. We had fun. We understood each other.”
Sanchez had told me when Troy and Linda worked together, they often drove down behind the college at night and parked in the empty lot by the river. People knew enough to leave them alone.
“471, shooting to the head, Park and Zion. On a one.”
Troy swore. I noticed his hands were shaking. He looked pale.
“You all right?”
“Give me fifty cents,” he said.
I dug into my pocket and gave it to him.
He came back with a Baby Ruth bar.
“It’s not right,” he said. “Paramedics doing basic transfers.”
“I’ll do anything they tell me to do,” I said, “as long as they sign my paycheck at the end of the week.”
“If it was about money, I wouldn’t be here.” He unwrapped his candy bar and took a big bite. “All I ask is a chance to use my skills.”
“Careful what you wish for.”
“I wish no harm on anyone,” he said. “But if harm shows up, call my number. I am the cavalry.”
Chapter Five
As much as I didn’t care for Troy, I had never seen a medic with more confidence, more presence, when he walked on a scene. When he arrived, you had the sense the emergency was over, that the calvary had indeed arrived.
We’d cleared a transfer at Britainy Farms and were headed on New Britain Avenue toward Avery Heights for a dialysis run when dispatch called. “482, disregard that transfer. I need you to back up 463 on Overbrook. Their radio’s breaking up, but it sounds like they need help.”
“Overlook,” I repeated. “What’s the nature?”
“Came in as a child with abdominal pain.”
Overbrook was in the Charter Oak public housing complex just a few blocks away from our location. Two story brick buildings built during World War II were laid out around several oval roads. The buildings looked in disrepair, the grass was burned. Shirtless children shouted and waved at us as we approached. Ahead we saw a parked police car and 463, its lights on and back door open.
The stretcher was outside the building in low position with the straps undone and the sheet spread out.
“They upstairs,” a young boy said. “Davey’s sister sick. She got the shakes.”
I followed Troy up the narrow staircase to the second floor. He took the steps three at a time, easy as walking.
We entered the apartment that smelled of rancid hamburger.
“Let them do their jobs!” I heard someone bark.
A man and woman were yelling at a police officer in the room at the end of the hall.
“Just take her to the hospital!” the man shouted.
“Calm down or I’m going to have to arrest you,” the officer said.
“That’s my daughter!” the man said.
“She’s sick! Lord, she’s sick!” the woman cried.
We pushed into the room. “Coming through,” Troy said.
A young woman lay on the bed convulsing, arms and legs jerking together. She had an oxygen mask on her face. She had to be two hundred twenty pounds. On the wall was a shelf of teddy bears and a poster from Disney’s Beauty and the Beast.
Andrew Melnick, a short, skinny paramedic, just twenty years old, was trying to tape an IV down on the woman’s jerking arm. Blood backed up in the IV line. Melnick’s hands shook.
“What do you have?” Troy asked.
“Lord help my baby!” The woman, now by the foot of the bed, cried.
“Take her to the hospital!” the man shouted. His breath reeked of alcohol. The police officer pushed him back. “Calm down or you’re out of the room.”
“Everyone quiet!” Troy said.
“She said she had belly pain,” Andrew said. “Then all of a sudden she started seizing. I just got a line and gave her five of Valium, but it’s not working.”
“Did you get a pressure before she started?”
“230/130.”
“Is she pregnant?”
“Pregnant? My daughter not pregnant,” the man said.
“She’s a good girl!” the mother shouted. “A church girl!”
“Take her to the hospital before she dies!”
“That’s it, you’re out of here.” The officer grabbed the man by the arm.
The IV line came loose. Blood squirted in the air.
“Lee hold her shoulder,” Troy said. “Get some tape on that. Andrew get me an 18.”
He knelt on the woman’s forearm to hold it steady and took the IV catheter Andrew handed him. “She’s got to be eclamptic.”
“But she said there was no chance.”
“Look at her pants. That’s not pee, she broke her water.”
Her sweat pants were soaked at the crotch. The smell wasn’t urine.
Troy had the IV in. “Give me some mag.”
Andrew fumbled with the one cc syringe as he tried to stick the needle into the small vial of magnesium I had handed him from the med kit. He pulled the plunger back. The drug drained into the chamber.
“Easy, my friend,” Troy said. “Get it in there and push it slow.”
Andrew again had trouble as he tried to stick the needle through the rubber port on the IV line.
“Easy,” Troy said. “That’s it. Now push slow.”
I felt a tension easing in the girl’s arms. The seizure stopped.
“Get your airway kit out,” Troy said.
The woman lay still. Her chest wasn’t moving. She wasn’t breathing.
“Bag her,” Troy said. He tossed me the ambu-bag as Andrew unzipped his airway kit and fumbled to get out the laryngoscope.
I applied the mask over her face, holding a tight seal around her mouth and bending her head back to keep her airway open as I squeezed the bag.
“How my daughter doing in there?” the man shouted.
The cop barred the doorway.
“Just fine,” Troy said to the man. “I’m shutting the door.” To us, “She still has a good pulse. Tube her.”
Andrew nudged me to the side and stuck the scope in her mouth and swept her tongue to the side, peering in looking for her vocal chords.
“She’s bradying down,” Troy said, “Get that tube in.”
“I can’t see the chords.”
Troy reached up and pressed on the front of the woman’s neck.
“I think I’m in,” Andrew said.
“You’re not,” Troy said. “I didn’t feel it pass.”
“Heart rate’s thirty,” I said.
“No, I’m in.”
“Pull it out,” Troy said.
Andrew attached the ambu bag to the end of the tube. Gave one squeeze. The bag didn’t reopen. I saw the belly rise. He pulled the bag off. Vomit surged out of the tube.
“Listen to me next time,” Troy said. “No, leave the tube there. Go in above it. Don’t go in so deep this time. She’s anterior.”
Troy handed him another tube. He went back in. More puke came out of the other tube.
Andrew’s partner turned his head. I could hear him vomit.
“Rate’s fifteen.”
Troy pressed his fingers against the neck again, just below the Adam’s apple. “That’s it. I felt it pass.”
Andrew attached the bag. This time you could see vapor in the tube. Good chest rise. Troy listened with his stethoscope while Andrew bagged. “Nothing in the belly. Good on the left. Nothing on the right. Pull back a little. That’s good. Solid placement. Tie it off. Yank the other tube.”
“Rate’s coming up,” I said.
But Troy wasn’t looking at the monitor. “We’ve got company.”
“What?”
Troy had pulled the woman’s sweat pants down. There between her legs was a bloody motionless baby.
“Throw me a blanket.”
I handed him a towel that was by the bedside.
Troy lifted the child and rubbed it with the towel. He brought the baby up to his mouth and gave it two breaths. He moved his fingers up and down on its chest. In between breaths, he told Andrew how to set up a magnesium drip, while Andrew’s partner bagged the woman through the tube.
“Drip set,” Troy said, “Hang it from the wall hanger. Lee get her on the board and strapped tight.” He gave the baby two more breaths. “Andrew get the infant ambu out, then get the OB kit and let’s get the chord cut.”
It was hot in that room, and I was sweating too, lifting and turning the woman to get the board under her and the straps around her fat. I was so busy I didn’t have time to stop and admire Troy, the calm he displayed. He kept us focused. At his direction I unhooked the woman from the monitor, and applied patches to the baby, who they laid on the short board on the dresser. Its color wasn’t quite as mottled. Troy had a tube in the baby’s mouth, and coached Andrew inserting a small catheter into the umbilical vein.
“Nice job,” he said to Andrew. “A little epi, a little atropine, and maybe things will be all right. You know the dose?”
“I have a field guide.” He reached for his side pocket.
“.01 per kilogram for the epi. .02 for the atropine,” Troy said. “Let’s make it .35 ccs for the epi and 1 cc for the atropine.”
The baby’s rate came up to 140. Troy stopped the compressions. Its color was close to pink now. “Attention all,” Troy announced. “In case you haven’t noticed. It’s a boy.”
When we got to the ED, they had a team from labor and delivery down there with an incubator. The baby weighed five pounds, but the doctor said he appeared to have good reflexes. The mother was stable too. Her pressure was down close to normal. She was breathing well enough on her own that they were able take the tube out of her windpipe.
“Excellent work,” Doctor Eckstein said to Troy. “You guys did a hell of job. Strong work. Strong work.”
She seemed to lighten up around Troy.
“Andrew was the man,” Troy said. “This was your first delivery, isn’t it?”
“Well, yeah. If you could call that a delivery.”
“I foresee a great future for you.”
“I don’t know,” Andrew said. “I was sort of losing it there.”
Troy slapped him on the back. “You hung in there. You were a stud. They should name the kid Andrew in your honor.”
Watching Troy walk down the hall, seeing the way the others looked at him -- two nurses in the station, Melnick, Dr. Eckstein who’d come out of the room behind him, even the cleaning lady looked up from her mop as he passed -- I couldn’t help but feel his aura. He commanded his stage.
Chapter 6
David Nestor was one of the city’s original paramedics. Now at forty-eight, he weighed over three hundred pounds. He’d been taken off the road due to his arthritic hips and cardiac problems, not helped by his three pack a day cigarette habit. Others said the hospital had quietly yanked his medical control to practice because he had been unable to adapt to changing protocols and techniques. His job now was to read through the previous day’s run forms, sort them by number, and make certain all the signatures and insurance numbers were in place before the forms were sent on to the billing department. He often came to work unshaven. His uniform no longer fit. His prodigious gut hung over his belt. He looked like a broken tusked walrus. Instead of sitting at the desk in the back office, he sat on two chairs at a table in the crew room where he liked to hold court.
“Melnick, how can you wear that medic patch on your sleeve?” Nestor said. “I’m looking at this form. You write this guy had rales and you didn’t give him lasix? Didn’t they teach you anything in school?”
“I thought he might have pneumonia.”
“You can’t tell the difference? Didn’t they teach you assessment?”
“Yeah, but you need an x-ray.”
“An X-ray? Bullshit. All a medic needs is a good head on his shoulders and a twenty-dollar stethoscope. A medic doesn’t need an x-ray to see the patient’s in failure. Just reading the form, it’s clear he’s in failure. He’s got JVD, no fever, pedal edema, rales, Bp’s up, he’s tachycardic, Sat’s in the low 90’s despite your non-rebreather.”
“He’s got a pneumonia history. He wasn’t that bad, I didn’t want to take a chance and dehydrate him.”
“Are you a paramedic? You gave him nitro, go ahead and give the lasix. He’s on 60 a day, give him 120 and hand him a urinal. Case closed.”
He turned to see what everyone else in the room was looking at.
Troy stood in the doorway with that demon gleam in his eye. “Nestor, you worthless slug,” he said.
Nestor narrowed his eyes suspiciously like he wasn’t sure whether Troy was serious or just toying with him.
“Nestor, I wouldn’t let you get within ten feet of me with a placebo.”
One moment the EMTs in the crew room had been checking their equipment and strapping on their bulletproof vests. The next they were silent, watching, waiting.
Nestor looked confused and irritated.
“You old paramedics don’t know half what the newest medic coming out of school today knows,” Troy continued. “There’s a new breed on the street. Fifty dollars says Melnick knows all his pediatric doses off the top of his head, and that you would only know them by pulling out your field guide unsticking its pages and putting on your bifocals.”
“Listen to you,” Nestor said. “Go take your medication.”
“That’s right. It would do you some good to take some lessons from a real paramedic, not some washed up old dinosaur that’s killed more people than Son of Sam.”
“You wouldn’t know a medic if you saw one,” Nestor said. “When I first worked the city medics were special -- they were giants of the street. You had to earn the patch. Now days all you need is a pulse and you get hired. Medics are a dime a dozen, but they’re not worth the paper their card is printed on. Shake and Bake medics. Chia Pet medics. No wonder no one respects us anymore.”
“You make a good case for the giant part. The size certainly attests that they were exceedingly large, but like the stegosaurus they had tiny brains and made large shits wherever they went. When’s the last time you took a bath?”
“Psycho,” Nestor mumbled. He looked down at his run forms.
The EMTs in the room smiled like jackals and grinned at Troy, like they’d just crowned him lion king. I felt nauseous. Nestor was red-faced.
“Atropine .02 milligrams per kilogram,” Melnick said. “Epi...”
“Shut up Melnick,” Troy said.
I went out to the car. Troy might have been a phenomenal paramedic, but he grated me the wrong way. We all traveled our own roads and took our own hard lessons. I guessed his were yet ahead of him.
“482, You available to sign on yet?”
“Just about,” I answered. “Give us a couple minutes. Troy’s in a meeting.”
“Tell me once he’s finished his paperwork, I need you to sign on and cover Newington.”
“Understood,” I said.
I went back into the crew room. “Have you seen Troy?” I asked Nestor.
He shook his head without looking up from his run forms. “I’m not his keeper.”
I looked in the bathroom, but no one was there. I glanced in the supply room. I saw no one. Then I did a quick double take. Troy lay on the floor in the corner of the room, half hidden by several stacked crates of IV fluids. He wasn’t moving. When I approached I saw his eyes were glassy. His skin was gray and beaded with sweat. I shook his shoulder. “Are you all right?”
He was unconscious, his skin cool to the touch.
I turned for help just as a tall broad-shouldered medic came in the door. He was about Troy’s age, blonde and fair-complected, wearing a Boston Red Sox hat. He went right for Troy. “Yo, bro!” He rubbed his knuckles into Troy’s sternum.
Still no response.
“Don’t worry,” he said to me. “He does this all the time. It’s his sugar. Now go close the door.”
I knew Troy was a diabetic. I’d seen him checking his sugar with his pocket glucometer, pricking his finger to produce a drop of blood for the test strip, but certainly I hadn’t expected to see Troy Johnson like this. The medic talked gently to Troy as he put a tourniquet around his arm. “Sometimes he resists, so you have to be careful. He’s being good today.” He took an alcohol wipe and rubbed it over a large vein in the crook of Troy’s arm. He stuck a needle in. I saw the blood flash back. “Get me some D50 from the shelf.”
I handed him the blue box. He took out a large bristo jet and a glass ampule of Dextrose, screwed them together, and then stuck the Bristo jet needle in the rubber port of the IV line. He pushed the ampule deeper into the jet, pushing the sugar water into Troy’s vein.
Troy’s eyes were still closed, but his skin was less diaphoretic.
“Shit,” he said, groggily. He looked up at us. “Gimme a four by four."
“You know you have to eat,” the medic said.
“I got a headache. Don’t push it so fast, you know that.” Troy grabbed the four by four I offered, placed it against the IV site, then ripped the line out of his arm, and bent his elbow. “That hurts.” He got to his feet. “What’d you use? A sixteen?” He walked out of the closet and went into the bathroom across the hall.
“Nothing better than a grateful friend,” the medic said. “I’m Pat Brothers.”
“Lee Jones.” We shook.
“I’ve heard about you. I guess no one gave you the spiel on Troy. I’ve been on vacation or I would have.”
“I’ve got part of it. Not this part.”
“He’s a brittle diabetic, and you’ve got to watch him constantly. As long as his sugar stays above 70, he’s got your back. It dips below; you have to have his. Are you any good at IVs?”
“I’m not IV certified.”
“That’s all right. I’ll teach you.
“This happens frequently?”
“Yes, it does, though it runs in spurts. He can be fine for months, and then it’ll happen every day for a week. The company knows he has a problem, but not to the degree it happens. There isn’t a medic here that hasn’t had to sit on him once or twice or five times to get some sugar in him. If you’re going to work with him, you’re going to have to learn how to do IVs.”
I could have answered that I wasn’t an IV tech, but from looking at the light blue of the EMT rocker on my shoulder he already knew that. I saw how things were, and I’ve done worse deeds than look out for a co-worker.
Pat grabbed two EMTs out of the break room, and despite their protests, had them roll up their sleeves. He gave me a quick course. I stuck each of them twice, and Pat three times, getting veins in the crook of the elbow, the forearm, wrist and hand. “Excellent, you’re a natural,” he said. “You’re all set.”
Troy came out of the bathroom ten minutes later, looking hung over, his hair out of place. He put on his Yankees cap and walked right past Nestor like nothing had happened between them.
“A pity the young are so frail,” Nestor said.
I thought Troy would go home for the day, but he sat in the ambulance, and we went out on the road. He said nothing about the incident.
“You’ll learn to see it coming on,” Pat said to me that day. “He starts doing crazy things. Make him eat. Don’t take anything he says personally. He just needs a little sweetening from time to time.”
Sunday, August 20, 2006
The Line
You’re a paramedic. You’re on your knees. A naked obese patient lies in front of you, their flaccid head in your hands as you try to position their mouth open. Watery vomit flows from between their lips. The monitor shows flat line. Every time your partner does compressions, more warm vomit spews onto your hands. The room is crowded with first responders looking to you to be in charge. You go in with your laryngoscope, but you can’t make sense out of anything you see. The tongue is massive. There is no neck. The airway is filled with brown watery secretions, and you don’t see the chords anywhere. You suction. You try not to puke yourself, and you think how just five, six minutes ago, you were sitting peacefully in your ambulance, reading a magazine, talking to your partner, eating a hamburger and fries and listening to Lynyrd Skynyrd on the radio, thinking how great is this job.
We’ve all been there.
Yesterday I was sitting in my area, sipping my Diet Coke and reading an interesting book about an EMT in London when I heard another ambulance sent for a “person on the floor.” Sometime later they call our number and say for us to head to the same address to back up that car on a code.
I like being in charge, but I will confess I am much more relaxed going to a code when I am backing up another car then when I am the first one in. When I am first in, I think, I hope it’s an easy tube, I hope there isn’t a lot of vomit and puke and shit to deal with, I hope it all goes smoothly. When I am backing up another medic, it’s like, hey, how can I help you. If there is shit, you’re kneeling in it not me. If the tube is hard, well, you have to deal with it first. I’m just there for support.
The address is clear on the far side of town, so it takes us awhile to get there. There is a fire engine outside. I have my partner check just to make certain it is another medic on scene and not a basic car. I didn’t want to go in without any equipment and have them look at me like where’s your stuff, you’re the medic. Dispatcher replies it is a medic unit.
It is an apartment building. I can hear the commotion behind the door, which is unlocked. And there it is obese no necked man on the floor. Vomit, shit, and the medic right where I have been, kneeling at the head, trying to get the tube, and calling for more suction. The patient is asystole.
“How can I help you?” I say.
He asks for some crick pressure.
I kneel by the head, carefully avoiding the secretions and try to apply some pressure on the neck to help bring the chords down into view. It doesn’t help. I take the tube from him and have him use his own hand to manipulate the neck to see if he can find the chords, and then I’ll put my hand there. But the mouth is filling with fluid, and he has to reach for the suction. I suggest he try a bougie, and while he gets that, I bag the patient with the aid of a firefighter. The medic tries to bougie, but it goes all the way down. He tries again to tube, but is clearly frustrated. I admit thinking glad you were here first, and not me.
There is a point of frustration. You can’t get the tube, you can’t get the mouth suctioned, poor IV access, and you just know the person is slipping across that line from which they cannot come back. You feel so helpless and frustrated. I think it is particularly hard for him because he is a new medic – one of our most promising ones – it’s not a situation any medic wants to be in.
I say, “Let me try.” And he gives me the laryngoscope while he goes to look for an IV.
I go in, and it’s like, I can’t see anything. “I need suction.” The mouth is full of blood and brown water. I suction away and look around and can’t see anything that looks like anything. I try the bougie, but it slides all the way down. I slip the tube over it, but it’s no good. I yank it, and then there I am, at the airway of the obese, no necked, vomiting person and I can’t get the tube, and its like I am back to square one – all my prowess out the window – all my I’m a veteran medic I always get the tube pride slipping away -- and I’m thinking I wish I was back reading my book and sipping my Diet Coke.
Then I look at the laryngoscope and realize it is a Mac 4, not the shorter Mac 3 I always use, and I remember how when I was new, I often went too deep with the Mac 4, and that was why I switched to the 3. The person with no neck often has chords very anterior, and a Mac 4 isn’t always the best choice. So I switch blades, and I ask for a pillow, which I put under the patient’s head, and get him in the sniffing position, and I go in again, and I look for my landmarks and I see the epiglottis, and I lift up and out, and then amid the red and brown I see the bottom of the chords. I pass the tube, blow up the balloon, and yank the stylet. Nothing in the belly, equal breath sounds on both sides. I put on the capnography, but the machine says line blocked. I get a fresh capnography filter, but then the old one is stuck on the top of the ET, the top connection of which pulls out. So I just open up a fresh tube, pull off the tip and stick it on top of the tube in the man’s throat, and then attack the new capnography filter. With the first bag is a beautiful wave form.
I look at the number. It is 52!
Someone who has been asystole this long – we’re talking at least twenty minutes – considering his neighbor found him not breathing – you would expect to see the number around 4 or 5. 18 to 15 would be excellent. 52 is so high I don’t know what it means.
The patient is still asystole. The medic now has an IV in the patient’s left arm and is starting the epi and atropine. I have the firefighters take over CPR and counsel them in the new CPR, push hard, push fast, push deep. I have the monitor set up so they can see the wave form they are making with their compressions. I have them switch every two minutes. And they are pounding the compressions. Excellent CPR. Likewise, I have one of them be certain and bag only eight times a minute, and just a quick small tidal volume. We use the monitor to guide them. One of the EMT’s is getting the patient ready for transport, but I suggest that since he has been asystole this long, we just do 20 minutes and out. We all agree. Lives alone, lengthy medical history, unknown down time, if twenty minutes of ACLS doesn’t bring him back, transport is futile.
He is still asystole after the first two epis and atropines. Still I am puzzled by the high ETCO2 number. The research says the higher the initial ETCO2, the better chance to resuscitation, but he is so high he is past the good high level, into the bad high level. I can’t understand it.
A firefighter asked if it looks like we will need the police, who take care of the dead bodies. I say, yeah, go ahead and start them. It doesn’t look like he is going to come around. And then I see the CO2 go even higher. Its 70, then 80. We stop CPR. There looks like the beginning of a rhythm there. There is a rhythm.
“Check for pulses.”
“I’ve got a pulse.”
The rhythm is clear now. We do a blood pressure 190/ 110. I’ll take it.
Back from the dead.
Every time I gets pulses back, I think, you know, it really is sort of amazing. Everyone has that look of wonder about them. The fire fighters are smiling and nodding to each other. I think of all the parts of the code, the people who have the deepest connection with the patient are not the medics who get the tube and give the drugs; it’s the compressors, because they are the ones whose hands come closest to the patient’s hearts. Their bodies lean into the patient, they drive their strength down into the chest and then as they lift up, the patient’s heart recoils as blood rushes into it. The compressor pushes down again as their sweat falls down onto the patient’s skin. Yeah, they are the ones who are closest to the line between the living and the parted. I rarely do CPR, but I remember how in a recent code I took over CPR briefly to demonstrate how to really pound, and I drove myself into the patient, and I pounded hard, and then all of a sudden we had the patient back, and I felt like I had accomplished magic -- a feat of both wizardry and will. I think the firefighters were feeling that. You go to work, you grind through the tediousness of the day, and then briefly, you have a moment where your hands have helped return life to the dead. And you think, wow, what I have I just done? It’s a feeling that verges on holiness.
So we package him up, get him out to the ambulance. As we go through the lobby, the cops are coming in. They look confused. They were sent for a body. "We got him back," we say. They nod -- good news for them too. I drive – in the back is the original crew and one firefighter. I go easy, no lights or siren. At the hospital, he is satting at 100%. Pressure of 150/70. Pulse 72. Normal sinus on the monitor. ETCO2 -45. The doctor tells us good work.
Whether he makes it out of the hospital and makes it out without neurological damage remains to be seen. He was down quite awhile, but you never know. I talk to the doctor later, and he says the patient has a history of hypercapnia – too much carbon dioxide in the blood, which explains his high ETCO2 readings. He probably stopped breathing due to a hypercapnic breathing event as opposed to a heart problem. That may be why once we got his heart beating, it was able to sustain him.
I have been doing this a long time now, and while there are still calls that rattle me, the truth is, you do learn over the years, you get better at your job, you’re calmer, you have the experience to stop and say, okay, why am I not getting this tube? what can I do differently? Your past patients give your future patients the gift of your experience with them. I still have some patients who I want to pay back, who I want to be a better paramedic to in their future reincarnations – a premature baby, a woman in asthmatic arrest, a child struck by a car. I know every medic has the calls they need to do over, to do better to show what they have learned, to pay the past back.
Give us our chance to save them. Let our hands do in the future what they could not always in the past. Touch us when we reach toward their stilled hearts.
***
We’ve all been there.
Yesterday I was sitting in my area, sipping my Diet Coke and reading an interesting book about an EMT in London when I heard another ambulance sent for a “person on the floor.” Sometime later they call our number and say for us to head to the same address to back up that car on a code.
I like being in charge, but I will confess I am much more relaxed going to a code when I am backing up another car then when I am the first one in. When I am first in, I think, I hope it’s an easy tube, I hope there isn’t a lot of vomit and puke and shit to deal with, I hope it all goes smoothly. When I am backing up another medic, it’s like, hey, how can I help you. If there is shit, you’re kneeling in it not me. If the tube is hard, well, you have to deal with it first. I’m just there for support.
The address is clear on the far side of town, so it takes us awhile to get there. There is a fire engine outside. I have my partner check just to make certain it is another medic on scene and not a basic car. I didn’t want to go in without any equipment and have them look at me like where’s your stuff, you’re the medic. Dispatcher replies it is a medic unit.
It is an apartment building. I can hear the commotion behind the door, which is unlocked. And there it is obese no necked man on the floor. Vomit, shit, and the medic right where I have been, kneeling at the head, trying to get the tube, and calling for more suction. The patient is asystole.
“How can I help you?” I say.
He asks for some crick pressure.
I kneel by the head, carefully avoiding the secretions and try to apply some pressure on the neck to help bring the chords down into view. It doesn’t help. I take the tube from him and have him use his own hand to manipulate the neck to see if he can find the chords, and then I’ll put my hand there. But the mouth is filling with fluid, and he has to reach for the suction. I suggest he try a bougie, and while he gets that, I bag the patient with the aid of a firefighter. The medic tries to bougie, but it goes all the way down. He tries again to tube, but is clearly frustrated. I admit thinking glad you were here first, and not me.
There is a point of frustration. You can’t get the tube, you can’t get the mouth suctioned, poor IV access, and you just know the person is slipping across that line from which they cannot come back. You feel so helpless and frustrated. I think it is particularly hard for him because he is a new medic – one of our most promising ones – it’s not a situation any medic wants to be in.
I say, “Let me try.” And he gives me the laryngoscope while he goes to look for an IV.
I go in, and it’s like, I can’t see anything. “I need suction.” The mouth is full of blood and brown water. I suction away and look around and can’t see anything that looks like anything. I try the bougie, but it slides all the way down. I slip the tube over it, but it’s no good. I yank it, and then there I am, at the airway of the obese, no necked, vomiting person and I can’t get the tube, and its like I am back to square one – all my prowess out the window – all my I’m a veteran medic I always get the tube pride slipping away -- and I’m thinking I wish I was back reading my book and sipping my Diet Coke.
Then I look at the laryngoscope and realize it is a Mac 4, not the shorter Mac 3 I always use, and I remember how when I was new, I often went too deep with the Mac 4, and that was why I switched to the 3. The person with no neck often has chords very anterior, and a Mac 4 isn’t always the best choice. So I switch blades, and I ask for a pillow, which I put under the patient’s head, and get him in the sniffing position, and I go in again, and I look for my landmarks and I see the epiglottis, and I lift up and out, and then amid the red and brown I see the bottom of the chords. I pass the tube, blow up the balloon, and yank the stylet. Nothing in the belly, equal breath sounds on both sides. I put on the capnography, but the machine says line blocked. I get a fresh capnography filter, but then the old one is stuck on the top of the ET, the top connection of which pulls out. So I just open up a fresh tube, pull off the tip and stick it on top of the tube in the man’s throat, and then attack the new capnography filter. With the first bag is a beautiful wave form.
I look at the number. It is 52!
Someone who has been asystole this long – we’re talking at least twenty minutes – considering his neighbor found him not breathing – you would expect to see the number around 4 or 5. 18 to 15 would be excellent. 52 is so high I don’t know what it means.
The patient is still asystole. The medic now has an IV in the patient’s left arm and is starting the epi and atropine. I have the firefighters take over CPR and counsel them in the new CPR, push hard, push fast, push deep. I have the monitor set up so they can see the wave form they are making with their compressions. I have them switch every two minutes. And they are pounding the compressions. Excellent CPR. Likewise, I have one of them be certain and bag only eight times a minute, and just a quick small tidal volume. We use the monitor to guide them. One of the EMT’s is getting the patient ready for transport, but I suggest that since he has been asystole this long, we just do 20 minutes and out. We all agree. Lives alone, lengthy medical history, unknown down time, if twenty minutes of ACLS doesn’t bring him back, transport is futile.
He is still asystole after the first two epis and atropines. Still I am puzzled by the high ETCO2 number. The research says the higher the initial ETCO2, the better chance to resuscitation, but he is so high he is past the good high level, into the bad high level. I can’t understand it.
A firefighter asked if it looks like we will need the police, who take care of the dead bodies. I say, yeah, go ahead and start them. It doesn’t look like he is going to come around. And then I see the CO2 go even higher. Its 70, then 80. We stop CPR. There looks like the beginning of a rhythm there. There is a rhythm.
“Check for pulses.”
“I’ve got a pulse.”
The rhythm is clear now. We do a blood pressure 190/ 110. I’ll take it.
Back from the dead.
Every time I gets pulses back, I think, you know, it really is sort of amazing. Everyone has that look of wonder about them. The fire fighters are smiling and nodding to each other. I think of all the parts of the code, the people who have the deepest connection with the patient are not the medics who get the tube and give the drugs; it’s the compressors, because they are the ones whose hands come closest to the patient’s hearts. Their bodies lean into the patient, they drive their strength down into the chest and then as they lift up, the patient’s heart recoils as blood rushes into it. The compressor pushes down again as their sweat falls down onto the patient’s skin. Yeah, they are the ones who are closest to the line between the living and the parted. I rarely do CPR, but I remember how in a recent code I took over CPR briefly to demonstrate how to really pound, and I drove myself into the patient, and I pounded hard, and then all of a sudden we had the patient back, and I felt like I had accomplished magic -- a feat of both wizardry and will. I think the firefighters were feeling that. You go to work, you grind through the tediousness of the day, and then briefly, you have a moment where your hands have helped return life to the dead. And you think, wow, what I have I just done? It’s a feeling that verges on holiness.
So we package him up, get him out to the ambulance. As we go through the lobby, the cops are coming in. They look confused. They were sent for a body. "We got him back," we say. They nod -- good news for them too. I drive – in the back is the original crew and one firefighter. I go easy, no lights or siren. At the hospital, he is satting at 100%. Pressure of 150/70. Pulse 72. Normal sinus on the monitor. ETCO2 -45. The doctor tells us good work.
Whether he makes it out of the hospital and makes it out without neurological damage remains to be seen. He was down quite awhile, but you never know. I talk to the doctor later, and he says the patient has a history of hypercapnia – too much carbon dioxide in the blood, which explains his high ETCO2 readings. He probably stopped breathing due to a hypercapnic breathing event as opposed to a heart problem. That may be why once we got his heart beating, it was able to sustain him.
I have been doing this a long time now, and while there are still calls that rattle me, the truth is, you do learn over the years, you get better at your job, you’re calmer, you have the experience to stop and say, okay, why am I not getting this tube? what can I do differently? Your past patients give your future patients the gift of your experience with them. I still have some patients who I want to pay back, who I want to be a better paramedic to in their future reincarnations – a premature baby, a woman in asthmatic arrest, a child struck by a car. I know every medic has the calls they need to do over, to do better to show what they have learned, to pay the past back.
Give us our chance to save them. Let our hands do in the future what they could not always in the past. Touch us when we reach toward their stilled hearts.
***
Thursday, August 17, 2006
American Summer
It’s been over ten years I’ve been working in the city. Driving around in the ambulance, you can see the changes. None of the book stores I used to stop at are still in business. The barbeque place in the north end where they sold cornbread muffins for twenty-five cents is gone. The Lion’s Den – the Jamaican vegetarian restaurant -- where you could smell the marijuana smoke coming from the backroom when you went in to buy soy patties – burned to the ground and was demolished. One of the city hospitals closed. The nursing homes all have new names. People still shoot each other and do heroin and call the ambulance for dumb things. There are still a lot of drunks, but none of the old ones are left. We don’t respond in the south end anymore – another company does. The fire department is a first responder now instead of the police who rarely ever came in the first place. Instead of navy blue uniforms we wear light blue shirts. There are more medics on the road these days where before there were just a few of us. We never did transfers unless they were ALS; now transfers are a regular part of the day. I’m as apt to be doing a dialysis run as I am responding to a motor vehicle.
I ‘m working with a guy who has been around almost as long as me, and we are talking about how some girls who were pretty when we started are now on the heavy side, how some medics who were sparks are now burnt out, how some new stuff is good – like all the overtime -- and some is bad – like how the out-of-town dispatchers don’t know the streets. We talk about how you can never rely on anything to stay the same. All you can do is try to do your job and treat your patients decently. The seasons come, the seasons go.
The afternoon is slow. We are posted in an area near the edge of town. Instead of posting on the specific street corner that represents the area we are covering, we are about a quarter of a mile away at the maintenance entrance of a park, right next to a small pond. It is a beautiful August day – blue sky, a slight cooling breeze. We shut the engine off. I open the door and stretch my legs out. My partner goes over and sits on a bench. We are the only ones there. Five minutes later we get a page. Effective immediately per the PD we are to move to the assigned area. We look around and don’t see anyone. I look at the maintenance building, at the windows to see if anyone on a phone is looking out at us. Someone obviously complained to the police about us being in the park.
We get in the ambulance and drive up the road to the posting location and park on the asphalt in the sun. The AC is running, but we are in an old car and the engine is really loud. I try to do the crossword puzzle in the morning paper, but it’s late in the week and as you get toward Friday, it gets much harder. I don’t make much progress.
We go on a couple calls. On a motor vehicle, as we arrive lights and sirens, the cops give us the cut sign. They say they canceled us – it just never made it through the dispatchers. Then we get the dispatch. We’re canceled.
Dispatch sends us over to Main Street for an ETOH. The man who called leans out from a third floor window under a flag of Puerto Rico and points across the street to the baseball field and says, “He’s over there under the tree. He drinks too much. You need to take him to detox.”
We get back in the ambulance and drive over to the field, get out walk along the tree-lined fence, until we come to the entrance, and then walk over to where we see a man in a Yankees tee-shirt sitting with three forty ounce beers. He’s a got a big grin on his face. He’s just cracked open the first one and has two full ones sticking out of a paper bag.
“What’s up?” I ask.
“Drinking beer in the park,” he says.
“You know why we’re here?”
“Cause I’m not supposed to drink in the park?”
“No, that’s not our business. We’re here to see if you’re okay, if you’d like to go to the hospital. Do you need detox?”
“No, I just want to drink my beer. Did my uncle call you?”
“Is he the guy in the third floor window?”
“Yeah. He kicked me out of his apartment. He drinks more beer than I do.”
“Well, just because he wants you to go to detox, we can’t take you against you will, but you realize, if you pass out, we can come and take you.”
“I understand.” He smiles. He sees we are no danger to him.
I’m looking around at the lush green field, the beautiful August day, the beer which is cold right from the store. I look at my partner and I know he’s thinking the same thing I am. “If we weren’t on the clock,” I say, “We’d love to join you. You have a good afternoon. Don’t outdo yourself, and if you ever aren’t feeling well and need to go to the hospital or want detox, just give us a call. And if you do pass out and your uncle calls, we’ll have to take you in. Understand?”
He smiles again, and extends his hand. “You guys are alright,” he says. “It’s a deal.”
We walk back to the ambulance, get in, and then drive back to the apartment building where we call up to the guy in the window. “We can’t take him,” I say. “It’s America. He’s alert and oriented. He’s got rights.”
The man, who we can see has a long-necked bottle of beer of his own in his hand, shrugs and thanks us for trying.
“He passes out, you call us back, and then we’ll come and get him.”
He waves, and sticks his head back inside.
I don’t know about my partner, but when I get home I have a few cold ones myself and sit out in my back yard and enjoy the summer evening.
Time passes. Sometimes you need to stop and enjoy the seasons.
I ‘m working with a guy who has been around almost as long as me, and we are talking about how some girls who were pretty when we started are now on the heavy side, how some medics who were sparks are now burnt out, how some new stuff is good – like all the overtime -- and some is bad – like how the out-of-town dispatchers don’t know the streets. We talk about how you can never rely on anything to stay the same. All you can do is try to do your job and treat your patients decently. The seasons come, the seasons go.
The afternoon is slow. We are posted in an area near the edge of town. Instead of posting on the specific street corner that represents the area we are covering, we are about a quarter of a mile away at the maintenance entrance of a park, right next to a small pond. It is a beautiful August day – blue sky, a slight cooling breeze. We shut the engine off. I open the door and stretch my legs out. My partner goes over and sits on a bench. We are the only ones there. Five minutes later we get a page. Effective immediately per the PD we are to move to the assigned area. We look around and don’t see anyone. I look at the maintenance building, at the windows to see if anyone on a phone is looking out at us. Someone obviously complained to the police about us being in the park.
We get in the ambulance and drive up the road to the posting location and park on the asphalt in the sun. The AC is running, but we are in an old car and the engine is really loud. I try to do the crossword puzzle in the morning paper, but it’s late in the week and as you get toward Friday, it gets much harder. I don’t make much progress.
We go on a couple calls. On a motor vehicle, as we arrive lights and sirens, the cops give us the cut sign. They say they canceled us – it just never made it through the dispatchers. Then we get the dispatch. We’re canceled.
Dispatch sends us over to Main Street for an ETOH. The man who called leans out from a third floor window under a flag of Puerto Rico and points across the street to the baseball field and says, “He’s over there under the tree. He drinks too much. You need to take him to detox.”
We get back in the ambulance and drive over to the field, get out walk along the tree-lined fence, until we come to the entrance, and then walk over to where we see a man in a Yankees tee-shirt sitting with three forty ounce beers. He’s a got a big grin on his face. He’s just cracked open the first one and has two full ones sticking out of a paper bag.
“What’s up?” I ask.
“Drinking beer in the park,” he says.
“You know why we’re here?”
“Cause I’m not supposed to drink in the park?”
“No, that’s not our business. We’re here to see if you’re okay, if you’d like to go to the hospital. Do you need detox?”
“No, I just want to drink my beer. Did my uncle call you?”
“Is he the guy in the third floor window?”
“Yeah. He kicked me out of his apartment. He drinks more beer than I do.”
“Well, just because he wants you to go to detox, we can’t take you against you will, but you realize, if you pass out, we can come and take you.”
“I understand.” He smiles. He sees we are no danger to him.
I’m looking around at the lush green field, the beautiful August day, the beer which is cold right from the store. I look at my partner and I know he’s thinking the same thing I am. “If we weren’t on the clock,” I say, “We’d love to join you. You have a good afternoon. Don’t outdo yourself, and if you ever aren’t feeling well and need to go to the hospital or want detox, just give us a call. And if you do pass out and your uncle calls, we’ll have to take you in. Understand?”
He smiles again, and extends his hand. “You guys are alright,” he says. “It’s a deal.”
We walk back to the ambulance, get in, and then drive back to the apartment building where we call up to the guy in the window. “We can’t take him,” I say. “It’s America. He’s alert and oriented. He’s got rights.”
The man, who we can see has a long-necked bottle of beer of his own in his hand, shrugs and thanks us for trying.
“He passes out, you call us back, and then we’ll come and get him.”
He waves, and sticks his head back inside.
I don’t know about my partner, but when I get home I have a few cold ones myself and sit out in my back yard and enjoy the summer evening.
Time passes. Sometimes you need to stop and enjoy the seasons.
Tuesday, August 15, 2006
Thoughts on Blogging
Hello Everyone. I hope you are all having great summers. I am writing this entry today because I lack the energy to write well about a funny call I did recently.
I have been working quite a lot -- 84 hours in seven days this past week --and am finding it hard to keep up the quality of this blog and my daily blog at Paramedic: A Year on the Streets. I am not yet ready to give up. I am hoping this is just a lull and I will catch a second wind. It has been almost two years since I have been blogging here, and 20 months at the daily blog. During that time I have noticed some of the bloggers that I have been following have disappeared off the internet. I don't know if they got burned out, or had complaints or if they left the field.
I like blogging in that it captures my day and events I might forget about or not remember as clearly. But to do that well I need to be able to see freshly every day. A problem that I think comes with working so much is I tend to just want to get through to the next call to the end of the day, and to the next day and to pay day when I spend probably too much time looking at my check.
When I started as a medic I told myself I would never let myself get to the point where I needed to work overtime to get by. Well, so much for the that. It's what a house and a divorce and a will to see the world before you croak will do to you.
I have been spending a lot of my time lately on my Capnography blog at Capnography for Paramedics. What started out as just a place to put the information I had found on my own has become a near obsession. My physiology background is shamefully weak so I have been struggling to get a handle on everything and then put it into simple language. I agreed to teach a class on Capnography this coming September when I knew very little about Capnography, but knew if I agreed to teach the class I would have to become an expert. I have enjoyed learning. Everyday I hope to get a new capnography strip or story or read about a new study. I am working hard on my powerpoint presentation.
I have also been working more on one of my novels that I excerpted recently. I will probably post more chapters soon. Unfortunately it has taken a back seat to the capnography which is under deadline.
Recently the ambulance service where I work as the contract medic opened its EMS Commander position. I thought about applying. The pay isn't what I make in overtime, but it was decent for a salaried job. And it was a way off the street in the daily grind sense. It was a job I could do when I am older or if I get hurt. I have lots of ideas about how to make the EMS system better, and it would have been fun to have a playground to try them out on.
But I didn't apply. Mainly because I love being a paramedic, and in the new job I don't know how much I would have been able to work -- maybe only in a supplemental way. And I would have had to have quit the company I work for now due to conflict of interest provisions. Also, not being able to work overtime I would see a decline in income. And you can't overrate the ability to have the time be your own when you are not responding to calls. I mean right now I'm at work, I'm on the clock and I'm sitting here working on my blog. How good is that!
Maybe some time down the line I'll be ready for a step off the street, but now I want to stay here.
Thanks for reading my blog and I hope I will try to get to that funny story soon.
I have been working quite a lot -- 84 hours in seven days this past week --and am finding it hard to keep up the quality of this blog and my daily blog at Paramedic: A Year on the Streets. I am not yet ready to give up. I am hoping this is just a lull and I will catch a second wind. It has been almost two years since I have been blogging here, and 20 months at the daily blog. During that time I have noticed some of the bloggers that I have been following have disappeared off the internet. I don't know if they got burned out, or had complaints or if they left the field.
I like blogging in that it captures my day and events I might forget about or not remember as clearly. But to do that well I need to be able to see freshly every day. A problem that I think comes with working so much is I tend to just want to get through to the next call to the end of the day, and to the next day and to pay day when I spend probably too much time looking at my check.
When I started as a medic I told myself I would never let myself get to the point where I needed to work overtime to get by. Well, so much for the that. It's what a house and a divorce and a will to see the world before you croak will do to you.
I have been spending a lot of my time lately on my Capnography blog at Capnography for Paramedics. What started out as just a place to put the information I had found on my own has become a near obsession. My physiology background is shamefully weak so I have been struggling to get a handle on everything and then put it into simple language. I agreed to teach a class on Capnography this coming September when I knew very little about Capnography, but knew if I agreed to teach the class I would have to become an expert. I have enjoyed learning. Everyday I hope to get a new capnography strip or story or read about a new study. I am working hard on my powerpoint presentation.
I have also been working more on one of my novels that I excerpted recently. I will probably post more chapters soon. Unfortunately it has taken a back seat to the capnography which is under deadline.
Recently the ambulance service where I work as the contract medic opened its EMS Commander position. I thought about applying. The pay isn't what I make in overtime, but it was decent for a salaried job. And it was a way off the street in the daily grind sense. It was a job I could do when I am older or if I get hurt. I have lots of ideas about how to make the EMS system better, and it would have been fun to have a playground to try them out on.
But I didn't apply. Mainly because I love being a paramedic, and in the new job I don't know how much I would have been able to work -- maybe only in a supplemental way. And I would have had to have quit the company I work for now due to conflict of interest provisions. Also, not being able to work overtime I would see a decline in income. And you can't overrate the ability to have the time be your own when you are not responding to calls. I mean right now I'm at work, I'm on the clock and I'm sitting here working on my blog. How good is that!
Maybe some time down the line I'll be ready for a step off the street, but now I want to stay here.
Thanks for reading my blog and I hope I will try to get to that funny story soon.
Monday, August 07, 2006
Podcast
I want to apologize for a slowing number of EMS scene call posts in the recent past. I have been very busy working on several projects in addition to working mega hours. I think I am so tired that I am losing my fresh look at each scene and the energy to write about it fully. Maybe I am working too much. I hope that I will soon regain my energy or have some calls that will spark my muse. In the meantime, I am going to highlight some alternative EMS sites that people may want to check out.
Today, I'm recommending The Medic Cast -- an EMS podcast done by a Maryland paramedic named Jamie Davis. When I first heard the term podcast, I thought you needed an IPOD to be able to listen, but I soon found out all you need is a computer. Jamie puts out a biweekly show of 20-30 minutes covering a variety of EMS topics, trends and treatments. His accompanying web page also has interesting and relevant links. I often put the show on and listen while working on my projects. I highly recommend you give his podcasts a try.
Here's the link:
The Medic Cast
Today, I'm recommending The Medic Cast -- an EMS podcast done by a Maryland paramedic named Jamie Davis. When I first heard the term podcast, I thought you needed an IPOD to be able to listen, but I soon found out all you need is a computer. Jamie puts out a biweekly show of 20-30 minutes covering a variety of EMS topics, trends and treatments. His accompanying web page also has interesting and relevant links. I often put the show on and listen while working on my projects. I highly recommend you give his podcasts a try.
Here's the link:
The Medic Cast
Sunday, August 06, 2006
New Frontier
They said she was vomiting and nauseous and having seizures. I asked what the seizures looked like and the patient’s friend who had witnessed them, said the patient shook all over with her arms and legs out. It didn’t sound like a seizure. She said they had done all kinds of tests, but hadn’t been able to diagnose anything. In the ambulance, I was putting in an IV when all of a sudden her head goes to the left, her arms and legs go out straight and she starts shaking. I am not impressed. “Knock it off,” I say. She stops. She is fully coherent. There is no postictal state. She didn’t pee herself or bite her tongue. She demonstrated complete control of her muscles in the way she was flapping. “What were you thinking about what just now?” I ask. “I wasn’t thinking about anything,” she says. “Why were you shaking?” “I don’t know.” “Is that what happened to you before when you had your seizures?” “Yes,” she says.
I have seen many seizures over the years and many fake seizures. I remember when I was a new medic and how this girl had arched her back and started shaking and foaming at the mouth, and how I told them breathlessly at the hospital triage how she had seized. The nurse looked at me like I was an idiot and told me to take her to the waiting room. She was a regular – always looking to fool new medics and new doctors into giving her valium, which is what we gave in those days. Some people fake seizures for drugs, others for attention, others I don’t know why.
I get an idea then. I reach into my backpack and take out my small digital camera. I use it at traffic accident scenes to take a picture to show mechanism of injury at the hospital. The trauma team loves seeing the pictures. The camera is so small it fits right into my pocket. Often I don’t even know I am carrying it. There is a motion picture feature on it. I think if she has another one of her fits, I can record it to show the doctors. Maybe then they won’t need to do any more expensive tests.
But then I think, hold on. There might be some patient privacy rights going on here. I am almost certain there is a rule about filming patients. Probably even if filming their seizure might be of great benefit to the doctor’s. I put the camera away.
The next day I get called for a woman with vaginal bleeding. There is blood all over the floor, in the bathroom, in the bedroom. I see some big clumps that look like maybe they might hold a tiny fetus. I need to focus my attention on the patient and not the clumps. She says all her periods have been regular and there is no way she is pregnant. I’m thinking miscarriage. I have my camera in my pocket. I could snap a few quick shots of the gore – to show them at the hospital. It would tell a better story than my just saying, it was really bloody there. Still, this is new territory and I am not really certain I want to be on the end of “Report at once to the Supervisor” pages.
I seem to remember getting some type of memo about digital cameras, but I can’t remember exactly what was in it. I know it was don’t do the obvious wrong stuff, but I don’t know if it covered the grey areas. I don’t want to chance it.
It is new territory, maybe territory that needs some addressing. There surely is a possibility for abuse, but also a possibility for some good. Cops videotape all their encounters on traffic stops. I’ve heard talk of cameras being put in the back of ambulances. How will this all shake out in the future? I wonder.
I have seen many seizures over the years and many fake seizures. I remember when I was a new medic and how this girl had arched her back and started shaking and foaming at the mouth, and how I told them breathlessly at the hospital triage how she had seized. The nurse looked at me like I was an idiot and told me to take her to the waiting room. She was a regular – always looking to fool new medics and new doctors into giving her valium, which is what we gave in those days. Some people fake seizures for drugs, others for attention, others I don’t know why.
I get an idea then. I reach into my backpack and take out my small digital camera. I use it at traffic accident scenes to take a picture to show mechanism of injury at the hospital. The trauma team loves seeing the pictures. The camera is so small it fits right into my pocket. Often I don’t even know I am carrying it. There is a motion picture feature on it. I think if she has another one of her fits, I can record it to show the doctors. Maybe then they won’t need to do any more expensive tests.
But then I think, hold on. There might be some patient privacy rights going on here. I am almost certain there is a rule about filming patients. Probably even if filming their seizure might be of great benefit to the doctor’s. I put the camera away.
The next day I get called for a woman with vaginal bleeding. There is blood all over the floor, in the bathroom, in the bedroom. I see some big clumps that look like maybe they might hold a tiny fetus. I need to focus my attention on the patient and not the clumps. She says all her periods have been regular and there is no way she is pregnant. I’m thinking miscarriage. I have my camera in my pocket. I could snap a few quick shots of the gore – to show them at the hospital. It would tell a better story than my just saying, it was really bloody there. Still, this is new territory and I am not really certain I want to be on the end of “Report at once to the Supervisor” pages.
I seem to remember getting some type of memo about digital cameras, but I can’t remember exactly what was in it. I know it was don’t do the obvious wrong stuff, but I don’t know if it covered the grey areas. I don’t want to chance it.
It is new territory, maybe territory that needs some addressing. There surely is a possibility for abuse, but also a possibility for some good. Cops videotape all their encounters on traffic stops. I’ve heard talk of cameras being put in the back of ambulances. How will this all shake out in the future? I wonder.
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