Victor lacked Troy’s brilliance, but he did his best for each patient in his workmanlike manner. While at times he could be rash and hot-headed in his emotions, in his work he was thorough and bullheaded when he had to be. He didn’t take short cuts. A minor motor vehicle with a case of “oh, my lawyer hurts,” another medic might take the patient’s blood pressure by “The Seer” method. Without laying hands on the patient, the medic would study the patient a moment, and then write down on the run form, “Blood pressure 120/80, pulse –80, respirations 18.” Victor took everyone’s blood pressure. He listened to their lung sounds. He gave them all a full physical assessment. You were old or sick and you lived on the second floor, Victor insisted you were carried down the stairs in a stair chair. No buts. Victor used a Kendrick extrication device on most of his motor vehicle patients. The device was strapped on them while they still sat in the car. It was like a suit that completely immobilized their neck and back. If you were going to immobilize them, do it right. If they were standing when he arrived, he did standing long board takedowns.
People made fun of his by-the book method, but they respected him nonetheless. He wasn’t doing it because he necessarily thought they were hurt. He was doing it because that’s the way he practiced his medicine. His routine, his rigidity of method gave him strength. You couldn’t argue with that.
“When I was little boy and my grandmother was still alive, she had congestive heart failure,” he told me. “Her legs would get very swollen with edema. It was very painful for her to walk. She was a heavy woman. She liked to eat and cook. She believed food was love. She never let us go hungry when we came to visit, and when she moved in with us, she would sit in the kitchen and help my mother and sister cook or just talk with them while they did because she could not stand for long periods of time. One day the visiting nurse came and told her she needed to go to the emergency room. Her feet and legs were swollen. The ambulance came, and I will never forget the paramedic and his partner -- they made her walk. They said she was too heavy for their chair, and if she was able to stand, they would help her down the stairs. She was big, but she wasn’t too big for their chair. They just were lazy.
“She made it. But she cried all the way. They were very impatient with her, saying ‘Vamos, vamos, senora,’ when she paused to rest. You can be sure if she was a rich white lady living in West Hartford, they would have carried her because there they would have gotten a complaint if they didn’t. Here with the poor Spanish lady, whose eyes were there to see?
“My job is to help the patient, no matter what. Who am I not to take them seriously if they say they are hurt or sick?”
Victor seemed to always get into altercations with staff at the nursing homes and the triage nurses at the hospital. He was one of the few paramedics I’d seen who dared confront physicians if he felt the patient wasn’t getting the attention they needed. Most people who knew him accepted that as who he was and let it slide if he grated on them. He had the ability to cuss and swear at someone, and then the next time he saw them to smile and ask how their wife and kids were as if there had never been any problem between them.
One afternoon we got called priority one for a thirty-three year old man with chest pain at the Bellevue Square public housing complex. My reaction was it was going to be another bullshit call -- maybe a guy whose chest hurt because he’s coughing up yellow phlegm.
We found the man sitting in his apartment watching a big screen TV movie Dead Presidents. You could smell marijuana coming from another room. The man wore a Michael Jordon basketball jersey and had a beeper on his belt. He rubbed his chest with his muscled arms and said, “I just got this pain here.”
Victor had me check his pressure and pulse while he questioned the man. I reported his pressure was good 130/80, pulse 76, respirations 20, lungs clear. The man told Victor the pain had come on while at rest. He hadn’t felt short of breath. Yes, it hurt more if he moved. No, he hadn’t had a cold or been coughing up anything. No, he hadn’t done any heavy weight lifting -- nothing out of the ordinary. I had him pegged as a candidate for the waiting room.
“What exactly does the pain feel like?” Victor asked.
“It feels like someone is sitting on my chest.”
We exchanged glances. That wasn’t a good thing to say. Still the man was only thirty-three and looked perfectly healthy.
At the time we just carried the Lifepack 10, which was a three lead monitor that was good for getting a heart rhythm, but not for the more comprehensive 12-Lead electrocardiograph of the heart done by the most sophisticated machines at the hospital. I attached the leads on the right and left arm, and left leg, and ran a strip showing each of the three leads views of the heart, which I then handed to Victor.
He nodded. From the rudimentary EKG – it looked perfectly normal.
“Let’s do the modified chest leads,” Victor said.
It was a trick he had learned from his reading, one that only a few other medics, including Troy had picked up on. By moving the red left leg lead and placing in the same positions on the chest that standard chest leads were placed when doing a 12-lead, and then viewing those leads in Lead III on the monitor, you could closely replicate a 12-lead ECG. The point of this was it gave the paramedic a view of the anterior side of the heart, which was not seen by the basic three lead which saw the inferior and part of the lateral side.
As I moved the lead to the 4th position, I saw an anomaly. There was what we call a huge ST elevation, a tombstone pattern -- indicative of a massive heart attack.
Victor rechecked my placement, and then ran the 3rd and 5th leads himself. “Get the stair chair,” he said.
“I can walk,” the man said, but Victor, who’d already given him aspirin and put an IV in his arm, would not allow it.
We humped his two hundred twenty pounds down four flights of concrete stairs, and out to the ambulance where Victor ordered me to drive on a one.
He patched to the hospital requesting medic control -- to speak with a physician -- instead of just telling the triage nurse what we were coming in with. You requested a physician for consultation or for orders to give certain drugs such as morphine for which we did not have standing orders.
“I have a thirty-three year old, no previous medical history, experiencing substernal chest pressure. 5 on a 1-10 scale. He says he feels like someone is sitting on his chest. It came on at rest, increases slightly on movement. He’s alert and oriented, skin warm and dry, lungs clear. Vitals 130/80, pulse 76, respirations 18. Sating at 100%. I do have him on a cannula, have given aspirin, and two nitro, but with no relief. My major concern is his modified 9-lead shows massive ST-elevation across the anterior leads. Looks like a cath lab candidate to me. I’m six minutes out. I’d like permission to get him started with 2 mgs of Morphine IV, followed by another 2 in five minutes if his pain persists and his pressure holds. Any questions?”
“How old did you say he was?”
“Thirty-three. That’s 3-3.”
“33. Yeah, hold off on the morphine and hold the nitro as well.”
“Could you repeat please?”
There was no response.
“461, please repeat.”
A nurse came on. “The doctor says hold off on the drugs till we can evaluate the patient.”
“Hold off. He’s got massive ST elevation. Tombstone! He’s having an MI. He’s infracting! Hello? Hello?”
He slammed the phone down.
When we reached the triage desk, there was no one there. “Screw it,” Victor said, “They must be in the cardiac room.”
We started in that direction, but just then the triage nurse came out of another room. “Hold it. I need to triage you.”
“This is the C-MED call.”
“What’s your patient’s name?”
Victor showed her the strip. “Mr. I’m having an MI right now,” he said. “Mr. Get Me to the Cath Lab on Time.”
She looked at the strip. “What lead is that?”
“McL4. It’s a modified chest lead comparable to V4. Can we go to the cardiac room?”
“Hold on.” She spoke into the mike. “Dr. Bertell to triage.”
The doctor whom I did not recognize, was in his early thirties, a neatly groomed, bow-tied young man, who was new at the hospital.
He looked at the patient and you could tell he wasn’t impressed.
Victor handed him the strip.
“Its likely early repolarization,” the doctor said. “It’s common in young African American males. Look at your patient. Does he look like he’s having an MI?” He said to the patient. “You lift weights?”
The patient nodded. “But this doesn’t feel like that kind of pain.”
“Thirty-three, healthy looking, good vitals, early repol. Don’t rely on your monitor.”
He started away.
“Come back here and look at this,” Victor said. “Do your own 12-lead, but this man needs attention.”
The doctor turned around and put his finger right in Victor face. “Listen. There are lots of sick patients here who need my attention. The triage nurse will assign you a room. Now here’s some advice for you. Go spark out at some other hospital. Not this one.”
“Spark out? What are you an idiot?” He turned to the triage nurse who was standing on the sidelines with me. “Get Dr. Bond. Get this guy a 12-lead and get him to the cath lab before young Dr. Kildaire here gets his state license revoked for malpractice.”
I tried to step in between Victor and the doctor, but they were shouting at each other so loudly now, the nurse had to call for security.
“Oh, my god,” the nurse said.
Our patient was seizing, his head turning purple.
“Victor,” I said.
Victor broke free from the grasp of the security guard. I could see the squiggly lines on the monitor. Our patient was in ventricular fibrillation.
Victor pulled the paddles off the monitor, and pressed them against the man’s chest. “Clear!”
He zapped the man, who sat up quickly grabbing at his chest. “What the fuck.”
“Dr. Bond,” Victor said, recognizing the head ED doctor, who’d been drawn by the attention. “He just went into v-fib. He’s back in a sinus but he’s still got massive ST elevation.”
“You have access?”
“Two lines.”
“Let’s get him some lidocaine and get him up to the cath lab now.”
He grabbed the stretcher and started pulling it. The other doctor stood there like he’d been hit by a stun gun.
“Was I out of line?” Victor asked me in the EMS room, as he wrote the call up. “The guy almost killed my patient.”
“You’re not out of line, but you might want to think twice before going at a doctor that way. We all screw up, but they know a hell of a lot more than we do. You don’t want them to become your enemy because they can make your life miserable. Right or wrong. Shit runs downhill. They have the juice. We don’t.”
“He can’t take criticism, fuck him, just don’t kill my patient.” He stalked off.
I worried about Victor’s temperament. His quick fuse was going to lead him to trouble. He might forget an incident as soon as he calmed down, but other people wouldn’t, people who didn’t know him. To them he probably seemed like a macho hothead, when in truth he was a thoughtful and considerate guy.
I kept waiting for the call to come to report to a supervisor, but even after we’d turned in our run envelope at the end of the day, no one said a thing. The next day I was at the hospital when a nurse called me. “Hey, you remember that guy from yesterday who coded in the ED? They took him upstairs and cathed him. He had a hundred percent blockage of the LAD – the widowmaker. The angioplasty went great and he’s doing fine. Tell Victor that was a great pickup. You guys saved his life.”
