At night I empty my pockets on the dresser. Once a week I clean the dresser top off. Crumpled gloves. ECG strips. Narcotics slips. Med lists scribbled on a notepad. An empty drug or saline vial. Four ECG electrodes stuck together.
The call is for the man who can't be woken up, cold to the touch.
He's on the living room floor, lying on his left side, his head resting on his hand in a sort of horizontal Rodin "The Thinker" statue pose, his head being supported by an invisible pillow, his neck rigored. It turns out he was found on the couch, and then was put down on the floor.
The officer tells me no one had seen him since last night when he had complained of chest pains. He was just visiting the house. Actually the truth was his wife had just booted him out of his.
While my partner gets the patient's name and date of birth from the officer, I lay the monitor by the dead man's side and unwind the leads. I open up a fresh pack of electrodes and attach them to the leads. I put one on each exposed ankle, one on each wrist. I turn on the machine and stare at three long flat lines. I print out a six second strip. Then on another piece of paper, I write my name, license number and date of birth, along with the time of presumption. The officer will need the information for his report. I shut the monitor off, and then carefully peel the electrodes off. First the right ankle, and then the left. I attach each electrode to the next so at the end I have four electrodes stuck together. I put them in my pocket, and then I roll up the lead wires and put them back in the monitor pouch. On my way out the door, I hand the officer the piece of paper with the presumption information.
The electrodes stay in my pocket all day until I discover them at night when I empty my pockets. A couple days later, I clean the dresser top off and the electrodes go out in the trash.
Monday, November 26, 2007
Monday, November 12, 2007
Searching for Serenity
I seek a state of grace. I want to do every call the way it should be done. I’m not talking about the medical aspect, although I try to do everything right. It is in my case or maybe in anyone’s case, not possible. I do the best I can. What I am talking about it the attitude aspect. I want to have the right attitude – toward the patients, toward the job, toward the work, toward the profession.
I think sometimes to do that I need to retire from the discussion – from the talk about the patients, the talk about other medics and EMTs, other ambulance companies, hospitals, nursing homes. Did you hear? These jokers…Can you believe? And they call themselves. This f-ing guy? Blah, blah, blah…
I have always admired the older quiet medics, who come to work, do their job, sit quietly while they write their reports, never engage in the chit chat of the moment, just go back out and do the job, provide good care, are nice to everyone, and then go home.
EMS, by a strange set of events happened to become my profession, my work, and a large focus of my life. I like that when the day is over, my work is largely over. I don’t have reports due or projects. But I am on committees, I do write about it, and for better or worse, it is a big part of who I am (And I work so many hours). I get caught up in it and everything it sometimes entails.
I get fired up too easily when I think about all the things that aren’t perfect about EMS or the people in it. I’m not even going to list one for fear of raising my blood pressure or going down a path I don’t want to. And while I admire people who tackle problems and fix them, who want to be a part of the solution, sometimes I just want to cleanse myself of all of it. I don’t want to judge, I don’t want to have a bad opinion. I just want to go through my day quietly, trying to be a good man by my own standards, and not judging anyone or saying a word, until I can achieve that state.
Now I’m not going to stop going to meetings or unfortunately, gossiping in the EMS room or at crew change or even writing in this blog. It is just a small wish that I could just be good at all the small things. Maybe what I do need is a vow of silence for awhile. A vow that I will not speak ill of anyone or anything just to hear the sound of my own voice. I want serenity.
***
I had a stressful day on Saturday, including two “medical alerts” – an unresponsive with a difficult carry down and a bad COPDer from a nursing home -- and then a cardiac arrest at the end of the shift. The cardiac arrest was also at a nursing home. It came in as an unconscious. On the way we were updated that universal precautions were in effect for the patient. A nurse’s aide, fully gowned, met us in the hallway and started putting gowns and face masks on us. I asked why? What was the condition? but all she would say was the nurse would tell us. So she put long yellow gowns on us, and face masks and still wouldn’t even tell me what the patient condition was. Then she pointed to the room and we walked in, and wouldn’t you know, they were doing CPR on a naked man laying on the floor with a full colostomy bag that looked like it was about to burst. Three minutes we had been standing in the hall, getting the gowns on and trying to get a story. I guess they had gowned us because he had respiratory MRSA. It was my partner’s first code. We got the patient from asystole into a PEA and had to transport, but they called him dead at the hospital. All told, counting scene and transport, we did CPR for 45 minutes to no avail. When we arrived at the hospital, my partner didn’t know how to turn the siren off, plus the parking lot was filled up, so we were parked on an angle with the siren going full tilt, until I could finally get her to hit the right switch. We jumped out still wearing our yellow gowns and masks and the initial people who had come over to help suddenly disappeared. Once we got inside, the hospital sort of chuckled at our torn infection suits. Some places take respiratory MRSA more serious than others. If everyone else is wearing a gown, and they are dressing me in one, I let them put it on me. If they didn’t have gowns, I probably wouldn’t have thought to put on one. Can’t hurt, I guess. Particularly if I am the one who has to intubate.
It took a long time to cleanup and restock. I punched out late, drove home, slept for a few hours, and then got up at five and headed back to work.
It was a much better day. After checking my gear, I got to sleep for a couple hours, and then did a couple routine calls. I had a hearty lunch – thick clam chowder with fresh nine grain bread -- watched some football, and then decided since it was such a nice day, I would ride my bike around the industrial circle for awhile. I just got the bike back from the shop the day before and hadn’t ridden for a week. For the last year I have been doing my triathlon training and really enjoy the solitude of biking. I put my radio in my pocket and just pedal around the .7 mile loop. Being a Sunday I can do a figure 8 and go down another road and around the town garage since there is no traffic there on Sunday. It makes a more pleasant mile long course. I had just done four easy miles and was thinking, this is great – what a day, what a life – I feel great -- today I am going to go for a record. I’m going to do 16 miles, when the tone went off.
I recognized the address. Georgia again. Our most frequent flyer and subject of my last post.
We drove to her apartment complex non-priority. The complaint – same as always – pain. Now as I wrote in my previous post, I was feeling a little guilty that I had not picked up on her fractured shoulder head that last time, so despite the fact that I could still be riding my bike through the leaves on this maybe last pleasant Sunday of autumn, I resolved that I would be nice to her – extra nice.
How are you Georgia? I asked as I went into her apartment. How’s the shoulder?
It hurt that’s why I called.
How come your arm isn’t in a sling?
I got tired of wearing it. Get my cane and my coat.
Did the hospital give you pain medicine?
Yes, but my arthritis patch is done and I don’t have any refills, so they are going to have to give me a new patch.
Back to Hospital A?
No, I ain’t going there. Take me to Hospital B.
But Hospital A is the hospital we always take you too – they are the ones who have been treating you?
I don’t like the way they treat me. Take me to Hospital B.
Reminding myself that I am going to try to be nice to everyone regardless, I don’t argue, even though my girlfriend is working at Hospital A, which is also the closest hospital. Hospital B is on the far side of the other town.
Whatever you want, Georgia, I say.
I help her onto the stretcher and fluff her pillow and am pleasant to her all the way in.
At the hospital, they put her in the hallway. I wish her well.
When we get back to the base, I slide my radio into my pocket, get back on my bike and ride my slow loop, feeling the breeze in my face, the clear air in my lungs, taking in all the color -- the red, yellow and orange -- before the sun sets behind the trees.
I think sometimes to do that I need to retire from the discussion – from the talk about the patients, the talk about other medics and EMTs, other ambulance companies, hospitals, nursing homes. Did you hear? These jokers…Can you believe? And they call themselves. This f-ing guy? Blah, blah, blah…
I have always admired the older quiet medics, who come to work, do their job, sit quietly while they write their reports, never engage in the chit chat of the moment, just go back out and do the job, provide good care, are nice to everyone, and then go home.
EMS, by a strange set of events happened to become my profession, my work, and a large focus of my life. I like that when the day is over, my work is largely over. I don’t have reports due or projects. But I am on committees, I do write about it, and for better or worse, it is a big part of who I am (And I work so many hours). I get caught up in it and everything it sometimes entails.
I get fired up too easily when I think about all the things that aren’t perfect about EMS or the people in it. I’m not even going to list one for fear of raising my blood pressure or going down a path I don’t want to. And while I admire people who tackle problems and fix them, who want to be a part of the solution, sometimes I just want to cleanse myself of all of it. I don’t want to judge, I don’t want to have a bad opinion. I just want to go through my day quietly, trying to be a good man by my own standards, and not judging anyone or saying a word, until I can achieve that state.
Now I’m not going to stop going to meetings or unfortunately, gossiping in the EMS room or at crew change or even writing in this blog. It is just a small wish that I could just be good at all the small things. Maybe what I do need is a vow of silence for awhile. A vow that I will not speak ill of anyone or anything just to hear the sound of my own voice. I want serenity.
***
I had a stressful day on Saturday, including two “medical alerts” – an unresponsive with a difficult carry down and a bad COPDer from a nursing home -- and then a cardiac arrest at the end of the shift. The cardiac arrest was also at a nursing home. It came in as an unconscious. On the way we were updated that universal precautions were in effect for the patient. A nurse’s aide, fully gowned, met us in the hallway and started putting gowns and face masks on us. I asked why? What was the condition? but all she would say was the nurse would tell us. So she put long yellow gowns on us, and face masks and still wouldn’t even tell me what the patient condition was. Then she pointed to the room and we walked in, and wouldn’t you know, they were doing CPR on a naked man laying on the floor with a full colostomy bag that looked like it was about to burst. Three minutes we had been standing in the hall, getting the gowns on and trying to get a story. I guess they had gowned us because he had respiratory MRSA. It was my partner’s first code. We got the patient from asystole into a PEA and had to transport, but they called him dead at the hospital. All told, counting scene and transport, we did CPR for 45 minutes to no avail. When we arrived at the hospital, my partner didn’t know how to turn the siren off, plus the parking lot was filled up, so we were parked on an angle with the siren going full tilt, until I could finally get her to hit the right switch. We jumped out still wearing our yellow gowns and masks and the initial people who had come over to help suddenly disappeared. Once we got inside, the hospital sort of chuckled at our torn infection suits. Some places take respiratory MRSA more serious than others. If everyone else is wearing a gown, and they are dressing me in one, I let them put it on me. If they didn’t have gowns, I probably wouldn’t have thought to put on one. Can’t hurt, I guess. Particularly if I am the one who has to intubate.
It took a long time to cleanup and restock. I punched out late, drove home, slept for a few hours, and then got up at five and headed back to work.
It was a much better day. After checking my gear, I got to sleep for a couple hours, and then did a couple routine calls. I had a hearty lunch – thick clam chowder with fresh nine grain bread -- watched some football, and then decided since it was such a nice day, I would ride my bike around the industrial circle for awhile. I just got the bike back from the shop the day before and hadn’t ridden for a week. For the last year I have been doing my triathlon training and really enjoy the solitude of biking. I put my radio in my pocket and just pedal around the .7 mile loop. Being a Sunday I can do a figure 8 and go down another road and around the town garage since there is no traffic there on Sunday. It makes a more pleasant mile long course. I had just done four easy miles and was thinking, this is great – what a day, what a life – I feel great -- today I am going to go for a record. I’m going to do 16 miles, when the tone went off.
I recognized the address. Georgia again. Our most frequent flyer and subject of my last post.
We drove to her apartment complex non-priority. The complaint – same as always – pain. Now as I wrote in my previous post, I was feeling a little guilty that I had not picked up on her fractured shoulder head that last time, so despite the fact that I could still be riding my bike through the leaves on this maybe last pleasant Sunday of autumn, I resolved that I would be nice to her – extra nice.
How are you Georgia? I asked as I went into her apartment. How’s the shoulder?
It hurt that’s why I called.
How come your arm isn’t in a sling?
I got tired of wearing it. Get my cane and my coat.
Did the hospital give you pain medicine?
Yes, but my arthritis patch is done and I don’t have any refills, so they are going to have to give me a new patch.
Back to Hospital A?
No, I ain’t going there. Take me to Hospital B.
But Hospital A is the hospital we always take you too – they are the ones who have been treating you?
I don’t like the way they treat me. Take me to Hospital B.
Reminding myself that I am going to try to be nice to everyone regardless, I don’t argue, even though my girlfriend is working at Hospital A, which is also the closest hospital. Hospital B is on the far side of the other town.
Whatever you want, Georgia, I say.
I help her onto the stretcher and fluff her pillow and am pleasant to her all the way in.
At the hospital, they put her in the hallway. I wish her well.
When we get back to the base, I slide my radio into my pocket, get back on my bike and ride my slow loop, feeling the breeze in my face, the clear air in my lungs, taking in all the color -- the red, yellow and orange -- before the sun sets behind the trees.
Tuesday, November 06, 2007
Georgia
Georgia Johnson has been our most frequent flyer for the last year. Georgia calls five or six times a month with a complaint of being tired and hurting all over. She never calls her doctor, just 911. She is a big woman who walks with a cane and lives in elderly housing. The entrance to apartment is such that we can never fit the stretcher in, but she always says she can walk out, so we set the stretcher up right outside the door and help her walk out. She has gout and arthritis and is on several pain killers, including a fentnyl patch. Her pain has been bad enough that I have given her morphine before on a couple occasions – maybe twice out of thirty or more transports -- but lately I do little more than take her vitals, and pop her on the heart monitor quick because she always mentions chest pain in her litany of places that hurt before she ends up qualifying it as “My body hurts all over.”
I took her in on Friday, and the triage nurse had us lower our stretcher and move her over to a wheelchair, and then wheel her out to the waiting room. I took her in again on Sunday. She seemed in a good amount of pain, more than usual. Her right shoulder hurt and her right wrist, and her chest, and her back, and her legs, and “my body hurts all over.” As I said, she was grimacing more than usual, and when I asked her the pain scale, she said, “It hurts real bad.” She had a couple tears in her eyes as she spoke, which was not unusual. I asked her what they had done for her at the hospital on Friday and she said, “Nothing. They didn’t tell me anything, just gave me more pills that don’t work.”
I was going to give her some morphine, but when I put the tourniquet around her arm to start the IV, she told me to only put the IV in her hand. She had a nice vein in her AC, but the hand veins were just little spidery things. “I’d rather put it up here,” I said, pointing to the big vein.
“No, that’ll hurt too much. Why don’t you just wait till we get to the hospital?”
“Okay, fine,” I said, thinking you’re the one in pain, not me. Your problem, not mine. I offered to help. You just suck it up. I’m tired of picking you up anyway.
The triage nurse had us put her in a bed. The nurse for the room looked at her and said, “What is she doing back here? She’s here all the time. She needs to be a social service case.”
“I know,” I said sympathizing. “She’s our most frequent flyer.”
Yesterday, while bringing another patient in, I saw Georgia sitting in a wheelchair in the hallway of the overcrowded ED. After I’d moved my patient into his room, I went back and talked to her.
“How are you doing, Georgia?”
“Okay, I guess.”
“Are you still here from yesterday or did they bring you in again today?”
“From yesterday still,” she said.
I noticed then her arm was in a sling. “What’s up with your arm?”
“I got a fractured shoulder,” she said.
“When did that happen? Did you fall?”
“I don’t know. They took an X-ray and said my shoulder broke and then give me some more pills.”
Fractured shoulder. No wonder she was in more pain than normal. I just assumed…
I took her in on Friday, and the triage nurse had us lower our stretcher and move her over to a wheelchair, and then wheel her out to the waiting room. I took her in again on Sunday. She seemed in a good amount of pain, more than usual. Her right shoulder hurt and her right wrist, and her chest, and her back, and her legs, and “my body hurts all over.” As I said, she was grimacing more than usual, and when I asked her the pain scale, she said, “It hurts real bad.” She had a couple tears in her eyes as she spoke, which was not unusual. I asked her what they had done for her at the hospital on Friday and she said, “Nothing. They didn’t tell me anything, just gave me more pills that don’t work.”
I was going to give her some morphine, but when I put the tourniquet around her arm to start the IV, she told me to only put the IV in her hand. She had a nice vein in her AC, but the hand veins were just little spidery things. “I’d rather put it up here,” I said, pointing to the big vein.
“No, that’ll hurt too much. Why don’t you just wait till we get to the hospital?”
“Okay, fine,” I said, thinking you’re the one in pain, not me. Your problem, not mine. I offered to help. You just suck it up. I’m tired of picking you up anyway.
The triage nurse had us put her in a bed. The nurse for the room looked at her and said, “What is she doing back here? She’s here all the time. She needs to be a social service case.”
“I know,” I said sympathizing. “She’s our most frequent flyer.”
Yesterday, while bringing another patient in, I saw Georgia sitting in a wheelchair in the hallway of the overcrowded ED. After I’d moved my patient into his room, I went back and talked to her.
“How are you doing, Georgia?”
“Okay, I guess.”
“Are you still here from yesterday or did they bring you in again today?”
“From yesterday still,” she said.
I noticed then her arm was in a sling. “What’s up with your arm?”
“I got a fractured shoulder,” she said.
“When did that happen? Did you fall?”
“I don’t know. They took an X-ray and said my shoulder broke and then give me some more pills.”
Fractured shoulder. No wonder she was in more pain than normal. I just assumed…
Saturday, November 03, 2007
Rant and Rude Business
I have been thinking about all this rant business, and promised some thoughts on it. I was on the phone the other day trying to get an issue resolved with a telephone person and I was frustrated and trying to get her to understand my dilemma and how it wasn't my problem, but their problem. I raised my voice a couple times. She remained unfailingly polite, even though she probably wanted to hang up on me or tell me to stop yelling. Maybe she is just used to people yelling at her in her job or maybe if she was rude back to me, she would be fired because after all it is a taped line. You know the "someone may be listening in" message you always get.
I have also over the years been to doctors' offices and dentists' offices and always found the people polite and friendly, even if they looked like they were having a bad day. I was a customer and they tried to always at least smile, even if they were making me wait or screwing up my bill. No doubt if they had been rude to me, I would have gone looking for another doctor.
Which brings us to EMS and I will include the ED in this. I have never seen more rude behaviour toward patients or people anywhere. Sure most of the time most of us are polite, but a lot of the time, some of us at least can be real jerks to patients and other people like nursing home staff. Don't you dare vomit in my truck. Your legs aren't hurt, you can walk. You're just going to have to wait, there are sicker people than you. A nonreabreather at 2 liters, what you trying to do, suffacate them? Etc.
Giving someone a good telling off seems to be an admirable thing in EMS.
So why are we rude and why do we rant about the people- the patients -- who are such a bother to us?
A part of it, I think is a sense of moral superiority. We are doing this job for crappy pay because we supposedly love it and we are lifesavers, so don't waste our time if your life doesn't need saving.
Another part is we at the caregiver level in emergency medicine aren't paid based on customer satisfaction level at least in the immediate sense. If we saw more pay at the end of the day based on customer surveys, you can bet we would be nicer.
Another part is we have a monopoly. The patient can't chose who responds. They are stuck with us. Company A is rude to them, the next time they call 911, they can't ask for company B. They get company A. EDs at least -- they can go across town and they often do, where unfortunately they get the same the hell with you treatment because there are more sick people than hospitals can handle so they don't have to worry about offending people. Business is too good.
The final part is we very rarely get fired for being rude. You have to be pretty out of control to lose your job in EMS for being rude. You make a racial or religious slur, you will be fired. Aside from that, the only people I have ever heard of being fired for being rude to patients are ones who ended up physically assaulting the patient -- punching them or trying to smother them with a pillow.
So what of all this rant and rude business -- I tend to rant more than I am rude, but I find neither attractive. I will try not to do it if I can help it. I am in this work of my own choosing, so there must be enough rewards in it. Most days there are.
***
I was just talking about this issue with an EMT friend and he said something really funny. In our ambulances we have black boxes that beep when we drive too fast, take a corner too hard, backup without a spotter or don't wear a seat belt, all the while recording the violation to computer for review and score at the end of the month. He said he was waiting for the day they put black boxes on us. They would beep whenever you swore or raised your voice or were rude.
I have also over the years been to doctors' offices and dentists' offices and always found the people polite and friendly, even if they looked like they were having a bad day. I was a customer and they tried to always at least smile, even if they were making me wait or screwing up my bill. No doubt if they had been rude to me, I would have gone looking for another doctor.
Which brings us to EMS and I will include the ED in this. I have never seen more rude behaviour toward patients or people anywhere. Sure most of the time most of us are polite, but a lot of the time, some of us at least can be real jerks to patients and other people like nursing home staff. Don't you dare vomit in my truck. Your legs aren't hurt, you can walk. You're just going to have to wait, there are sicker people than you. A nonreabreather at 2 liters, what you trying to do, suffacate them? Etc.
Giving someone a good telling off seems to be an admirable thing in EMS.
So why are we rude and why do we rant about the people- the patients -- who are such a bother to us?
A part of it, I think is a sense of moral superiority. We are doing this job for crappy pay because we supposedly love it and we are lifesavers, so don't waste our time if your life doesn't need saving.
Another part is we at the caregiver level in emergency medicine aren't paid based on customer satisfaction level at least in the immediate sense. If we saw more pay at the end of the day based on customer surveys, you can bet we would be nicer.
Another part is we have a monopoly. The patient can't chose who responds. They are stuck with us. Company A is rude to them, the next time they call 911, they can't ask for company B. They get company A. EDs at least -- they can go across town and they often do, where unfortunately they get the same the hell with you treatment because there are more sick people than hospitals can handle so they don't have to worry about offending people. Business is too good.
The final part is we very rarely get fired for being rude. You have to be pretty out of control to lose your job in EMS for being rude. You make a racial or religious slur, you will be fired. Aside from that, the only people I have ever heard of being fired for being rude to patients are ones who ended up physically assaulting the patient -- punching them or trying to smother them with a pillow.
So what of all this rant and rude business -- I tend to rant more than I am rude, but I find neither attractive. I will try not to do it if I can help it. I am in this work of my own choosing, so there must be enough rewards in it. Most days there are.
***
I was just talking about this issue with an EMT friend and he said something really funny. In our ambulances we have black boxes that beep when we drive too fast, take a corner too hard, backup without a spotter or don't wear a seat belt, all the while recording the violation to computer for review and score at the end of the month. He said he was waiting for the day they put black boxes on us. They would beep whenever you swore or raised your voice or were rude.
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