Elderly man. Alzheimers. DNR. No history of seizures. Had a witnessed seizure at the nursing home. Started with his eyes twitching, progressed to a full gran mal. Now the patient who is normally verbal, isn't saying anything, and has snoring respirations. His pressure is 200/110. I stick an oral airway in after a slight gag, the patient takes it fine and the snoring stops. We start to the hospital no-lights, no siren. I put in an IV. As I'm patching to the hospital, I notice the patient's eyelids are starting to twitch. I get out the Ativan. Like a speeding freight train that you hear coming that you feel the ground shake before it roars into view, so comes this seizure till it is full and upon him, and violent. The stretcher itself is rattling with the force of energy seizing in the man. I draw the Ativan up, but wait a little to see if it will subside on its own, but it is just too violent and I have to try to kill it before it blows this man apart, before the alien force inside him comes out and gets me. I give him one milligram and wait a minute and then give him a second milligram. But he is still seizing to beat the band, so after a few more minutes I draw up another dose, but then the shaking slowly slows inside him until he is still. The monitor shows his heart beating. I can see his chest rise. His body looks really, really tired. In his eyes, it doesn't look like he is even there anymore.
At the hospital, I notice his left arm turning in. Posturing. I overhear the doctor telling his daughter the prognosis is grim. She says she just wants him to be comfortable. I walk by the lighted X-ray viewer on the wall and see a scan of a brain with a large white patch in the middle of it.
***
We're called for an unconscious student at the high school. When we arrive at the classroom, I see a nurse with an ambu-bag in hand, kneeling by a young man who is prone on the floor, jerking asynchronously, arching his back, and slamming his arms against the floor. "He's been seizing for seven minutes," the nurse says. I nod and reach over and touch the student and say "Okay, time to stop." I help him to a sitting position and he ceases his activity. I help him to his feet and over to the stretcher, where my crew buckles him in. He is of course, alert and oriented. His pressure is 120/70. One of his fellow students brings him his jacket from his locker along with a New York Jets cap. On the way to the hospital "DeShawn" tells us his mother is out of the country and he doesn't like his step-father. The young EMT working with me tells the boy at least he probably won't have to go to school tomorrow. I see the student smile.
***
Unconscious elderly man found in a fetal position in his home by a coworker who went to check on him because he didn't show up at work. The officer tells us not to bother with the stretcher. When I enter the house I see why. There is clutter and junk piled to the celling. This is the home of a pack rat. The officer says he is in the living room, but to get to him, I have to snake my way through the clutter in the kitchen. The hallway is completely blocked. I find him amid a fallen pile of magazines. The coworker is as shocked as we are by the surrounding says she has never seen him like this. He is a vibrant man who every year wins sales awards at their office. He looks like a malnourished homeless man. I see a few liquor bottles around -- wine, vodka -- but there is no evidence of recent drinking. And no signs of physical trauma. His eyes don't focus. His grips are equal and there is no facial droop. No arm drift. Could he be a hidden drunk? He certainly manages to hide his clutter habit from his coworker. He struggles to tell me his date of birth. He says he drank last night. But I don't smell liquor on his breath. I wonder if he is also having a head bleed. His blood pressure is 180/110. I pick him up in my arms and carry him carefully through the narrow passages. He seems frightened like a small deer.
***
I take the next day off and take the kids to the Big E -- The Eastern State's Exposition -- New England's big fair. It's a beautiful day so nice I don't even mind the twenty dollar bills flying out of my wallet every time I turn around. Bumper cars. The Fun House. Smoked Turkey Legs. A midget roller coaster. Mini Doughnuts with cinnamon powder. The water gun races to see who pops the balloon first. Fresh squeezed lemonade. The barkers selling kitchen cleanup supplies. Miracle mops and knifes that never dull. I win a Yosemite Sam doll when the man fails to guess my age within two years. Throw the rings at the bottles to try to win an I-pod. More bumper cars. Watch chicks hatch from their eggs. See the sheep, cows and horses. The Haunted House. Knock over the milk cartons. Ride the Ferris Wheel as the sun sets. The Petting Zoo where you can feed the billy goats and a Camel.
And then I think I see him. A young man in a New York Jets hat. I think that little shit. I push through the crowd. I call his name "Hey DeShawn!" The young man turns, but it's not my patient from the previous day -- the boy who faked the seizure to get out of school. It's someone else.
But then I think, hell even if it was him. Can I blame him?
Everybody ought to enjoy a fair in their lives. As often as they can.
Eat the mini doughnuts.
