I’ve been fighting a respiratory infection for the last week. Every now and then I have a coughing fit that brings up lingering mucus from my chest. I have some medicine I can take to keep the cough under control if it gets too bad -- when my cough is so rough patients offer me their spot on the stretcher. I am actually feeling much better today. I even went running this morning before work -- just a short 2.4 mile neighborhood run to get my legs and air back.
Normally, the first thing I do once we put ourselves on-line with dispatch is get a large Diet Coke on ice at one of the local 7-11s. I could get a bottle from the vending machine in the crew room, but something about the Diet Coke on ice makes it taste so much better and helps relax me and tells me everything is all right with the world. I imagine it is how an alcoholic must feel when they pour their first drink of the day. I just sip that Diet Coke slow throughout the morning. If I have my cold, that’s when I pop the cough pill or a decongestant if I need one. Some mornings I don't get my Coke until after a call or two, and today, I go four deep before I finally get it. It has been busy.
I’m seven calls in already and this is the first chance I’ve had to get my netbook out and start recording. I started the day off with an unknown that turned out to be a guy who turned his ankle getting into a police car a couple days ago (I didn't ask about that story) and said it was swollen now and hurting him. He met us on the stoop outside his apartment building. My partner started to pull the stretcher, but the man said he was fine and would walk over to where we had the ambulance parked. When we got to the back of the ambulance, I offered to pull the stretcher again so he wouldn't have to climb in the back. But again, he said he was fine. I told him to watch his head as he climbed in. Once in the back, he at least agreed to lie down on the clean sheet we spread out the stretcher and be strapped in. At the hospital, the triage nurse told us to put him in a wheelchair and take him out to the waiting area. All of a sudden he made a big deal about how his leg was killing him and why couldn’t he have a room instead of having to sit in the waiting room? He walked out to the ambulance, my partner told the nurse as the man went through his theatre. She just shook her head at him and said "Waiting room."
As soon as we got back in the ambulance, we were dispatched for a stroke at a group home. Patient found that morning leaning to her right. Last time that happened the hospital diagnosed her with depression. She was depressed so she leaned to her right, instead of sitting up straight. She had no facial droop, clear speech, equal grips and no pronator drift. But she was leaning to her right. "Are you depressed?" I asked. "Yes," she said. She looked like someone leaning to her right because she was depressed rather than someone leaning to the right because they were stroking out. She was on a lot of heavy duty psych meds and lived in a small spare room with not much light in the home. If that was me, I'd probably lean to the right, too.
No sooner had we cleared that call then it was off to a surburbantown for a headache. Girl with severe left-sided head pain and an aversion to the light. She said she had two prior episodes recently with negative cat scans. BP was 120/60. Pulse 60. She wouldn’t open her eyes to let me look at her pupils. “”What do you think it is?” she asked. “A migraine,” I said.
There is a new ED at one of the hospitals and while it is an awesome ED, it is hard to get to the cafeteria now and for some reason my security badge isn’t working so if I go, I often have a hard time getting back to the ED. I have to wait for someone to come along and swipe me in. So instead of getting my Coke, I went back on-line figuring I could get my Coke at a 7-11 or fast food restaurant before we got another call. Wrong.
Man down behind the motel. Unknown. On the way there, I have a coughing fit and try to resolve it with a stick of gum, lacking any beverage to wet my throat. It is getting very hot and muggy out, which does not help. One moment, I am fine, the next I can’t breathe, but I manage to get it under control before we arrive.
The patient is intoxicated -- crawling on the ground looking for his glasses. He says he just got locked out of his room. I can smell the alcohol on his breath. We pick him up and put him on the stretcher. He takes a half-hearted swing at my partner, and when I tell him to cut it out, he takes a swing at me, which I easily deflect. He calls the police officer some names and says he still wants his glasses. The officer says he has looked for them and can’t find them so he is out of luck. As we load him into the back, he looks at me and spits. The spit doesn’t reach me, but I caution him.
“Please don’t spit at me,” I say. “I’m just a working man.”
I am getting the glucometer out to try to check his sugar when the cop opens the back door and says, "You’re in luck, I found your glasses." He hands them to me. I consider leaving them by the patient’s feet, but instead hand them to the patient. I'm willing to let bygones be bygones. If I treat him well, maybe he will reciprocate. He puts the glasses on, looks at me, and then launches another goober in my direction. Now just because I was willing to offer an olive branch, doesn't mean I have left my guard down. And I have been in EMS a long time, and like most who have been in EMS a long time, I have acquired a Matrix-like ability to evade bodily fluids, including spit. I do my best Keenau Reeves impression and for a brief second find my eyeball a bare millimeter from the spit gob. But I slowmo evade it. It falls back to earth, landing on my computer screen.
“Again, not cool,” I say.
He spits again, but this time the glob lands back on his face. “Looks like you misfired,” I say.
I get a towel and with a straightarm wipe it off his face, and say, “I would appreciate it if you would stop. Nobody likes having spit on their face.”
He looks at me blankly and then I see him start to work on getting another mouthful of spit.
It is stuffy in the back of the ambulance and the switch for the AC is on the patient’s side of the ambulance. To hit it on, I will have to come again into his range. He senses my intention and spits again. I deflect it with the towel.
Suddenly, just then, a coughing fit comes on me. It begins with three asthma like gasps to get some air in, and then, four staccato, deep rattling coughs. If this blog had sound, imagine an old homeless man with a long greasy beard coughing up a deep aqualung wad of phlegm. That's what it sounds like. I can feel the mucus detaching itself from my lungs and shooting up in my throat. Now, let me just say here that I try to always be a gentlemen and subscribe to the highest ethical standards of professional conduct. As I cough, the patient suddenly looks quite uneasy. I would never spit on a human even in retaliation. I don't understand how a human could spit on another. But I suspect his view of human nature is different than mine. If he is capable of spitting on another human being, maybe he thinks I am capable of spitting on him. He doesn’t know me. He doesn’t know how I roll.
With a terrible sound, I hawk the mucus up into my mouth to keep from choking on it. The man is now clearly frightened by this display. I wonder if he is thinking about the positional advantage I have over him. I wonder if he is thinking just how nasty that mucus is in my mouth. In normal polite circumstances, I might force myself to quickly reswallowthe mucus. Instead I find myself raising the towel to my mouth and depositing my phlegm into it. “Forgive me,” I say,” “I’ve got this lingering respiratory infection. I 've been coughing up some serious phlegm. Green, yellow, very purulent.” Here I am exaggerating. It is clear mucus, but instead of showing it to him, I lie about its qualities.
He doesn’t take his eyes off me, but he doesn’t try to spit again the rest of the way. I wonder if this is how nuclear deterrence with Russia worked for so many years.
After the call, I make certain to wash my hands and carefully clean off the computer. I also borrow my partner’s badge so I can go down to the café and finally get my Diet Coke on ice.
The Diet Coke (with Lime) tastes good, and I sip it slow as we head off to a doctor’s office for a seizure. We find the man on the floor of an exam room. The doctor says the patient had four gran mal seizures without waking up. The patient has his eyes open looking at the ceiling. The man has the end of an OPA sticking three quarters out of his mouth that he is holding with his teeth. I pick one of his arms up and can feel he has good control over it. I question the doctor about what was observed, and then put the patient on the stretcher and transport. I work him up like he had a real seizure, check his sugar put him on the monitor. The transport is uneventful I tell the nurse at the hospital, no incontinence, no tongue biting. Seizure described as tonic-clonic full body lasting 30 seconds, repeated every three minutes until our arrival. I tell her I caught him watching me out of the corner of his eye when I got ready to do the IV. Then it’s off for another unknown which turns out to be a 24 year-old who tried to kill herself by slashing her wrists. Never mind that she failed to break the skin. She is upset because her boyfriend broke up with her. I feel bad for her. She has a big tattoo on her arm that says "Enrique" with a big heart around it. I hope Enrique is her son (if she has one) and not her boyfriend. She goes in the psych wing in the room next to the spitter who is now sound asleep, snoring.
We do a dialysis transfer and then stage for a psych, awaiting PD. The cops are very busy today also, but eventually an officer arrives and we and the firefighters follow him into the house where a woman says she wants her thirteen-year-old son brought to the hospital. She doesn’t want him in the house anymore because he doesn’t pay her any mind. It takes awhile to figure it out, but that is just it. She just doesn’t want him in the house because he doesn’t do what she asks. He isn’t out-of-control. He is not suicidal. She just doesn’t want him in the house. Meanwhile he is in his bedroom playing with his PSP and listening to music on his IPOD, turned up so loud I can hear the beat. Maybe the hospital can talk some sense into him, she says. The officer asks her if she has tried to discipline him. "I can do that?" she says. "Yes, you can." "Well, good, then, you can go. As soon as you leave I’m going to whoop his little behind." "Just don’t leave any bruises or marks," the officer says. "Show some judgment." "Oh, I will," she says. "He's going to feel my judgement all right." While the officer (aka social worker) further clarifies what as a parent she can and cannot do, we clear, no patient.
Then it is off to a doctor’s office for a man with chest pain for two days, skin warm and dry, normal 12-lead. I give him some ASA and then apply a tourniquet for the IV. “I have bad veins,” the man says. “That’s okay,” I say, “if I see one, I’ll try for it. I’m pretty good at it.” "Why don’t you wait until the hospital,” he says. This is a situation I encounter fairly often. Most of the time, I sink the IV and the patient says, “Wow, you’re great.” I love it when that happens. This time I try a 24 in the wrist and while I get a small flash, the line blows up when I push the flush. The man looks at me and shakes his head. I can tell he just wants to be at the hospital and out of my ambulance. I don't press the IV issue. I put a 4 X 4 on my miss, and then pick up my computer and start typing out my PCR. You can’t be a hero everyday.
