Ten More Chapters

I've added ten more chapters to Diamond in the Rough. Up to thirty now.

Diamond in the Rough

Suffering in the World

We are sent to a detox center for a diabetic. We find a sixty-year old Puerto Rican with a blood sugar over 600, although he has no complaint. He has come to the center to kick his heroin habit. But first now he will have to go to the ER to get his sugar under control. “I did three bags of heroin this morning,” he admits, “then I flushed the rest of the bundle down the toilet, and came here.” He is a man with deep eyes. He speaks quietly. “I spent eighteen years in prison,” he says. “When I came out, I saw there was so much suffering in the world. People on the outside are used to it, and they don’t see it, but I saw it. That’s how I got started. I’ve been on and off of it for most of my life.” He tells us how he lost two brothers to heroin and a sister and two cousins to crack cocaine. “My father died at ninety last week. He was all I had left. I was lost without him. It was a setback for me, but I looked at myself this morning and knew I wouldn’t see seventy if I didn’t get a hold of myself. I knew it was time for me to come in.”

At the scene of a motor vehicle accident, a wife yells at her husband who has driven his new Toyota into a parked car. He called her and gave her the address so she could bring his insurance card. The address isn’t in the best part of town. After she leaves, he waits with the cop for the tow truck to come. The cop thinks something isn’t quite right with him, and asks if he is a diabetic. He is, he says, so the officer calls us to check him. He looks to be in late thirties. He wears blue jeans and a college athletic sweat shirt. His sugar is 43 a little on the low side. His answers to questions are slow. He can’t remember if he ate or how the accident happened. When I go to roll up his sleeve to look for a vein, he at first refuses. “I have issues,” he says. “We don’t care about that,” I say. He has track marks on his arms. I put in an IV and give him some sugar that clears his mind up. He looks at the front bumper of his car which is all mashed in. Driving along and he veers off the road. I wonder what he’s thinking now. Maybe I should have stayed home. Maybe I should have had a sandwich before I shot up. I wonder up the road what lays ahead for him. I don’t think he has thought about that yet.

A wife comes home from work and finds her fifty-year old husband on the kitchen floor, semi-responsive with vomit on his face, chest and the linonleum. His skin is cool. She calls 911. He recently had shoulder surgery and is on blood thinners for clots in his legs. She has no idea what has happened or how long he has been there. When we arrive, we find he can answer questions. He is not hurt, his grips are equal, there is no facial droop, but his speech is slow. He looks at his wife and says “Sorry.” I ask what meds he is on. I’m thinking maybe he has taken too many and maybe drank, although I can smell no liquor on his breath. He seems familiar to me; not his face, but his whole manner as we pick him up. We are in this new freshly built home, a large sparse home with hardly any furniture, but he seems just like a homeless man in his demeanor. Here is this guy with a well dressed wife, and he seems in his faded jeans and grey tee-shirt and flushed face to be just a street man. He looks up at her and again says, sorry. We get him up on the stretcher and as we start out the door suddenly I hear the wife say, “Hold on a minute.” She has found something in the bathroom. Heroin.

She is beside herself, she is so angry. The officer asks her if this is something he regularly does.

“No, He’s been clean for almost sixteen years -- since before I met him. He’s been very upfront about his past with me, but I’ve never seen it. He doesn’t even drink. I can’t believe he did this. I could kill him.”

“It’s the most addictive drug in the world,” the officer says. “No one ever completely beats it.

“I just can’t believe this. I’m in shock.”

She comes to the hospital with us, riding in the front. “Is he okay?” she asks.

“He’s stable,” I say. “He’ll be all right.”

She cries. “He’s been so depressed,” she says. “He lost his grown son two weeks ago. He’s been out of work with his injury. He's had no money. We have a new home and with him not working, we can't afford to put anything in it.”

“He's beaten this before,” I say, “He can do it again. Don't be too hard on him. It sounds like he’s had a rough go.”

“I could just kill him,” she says, but not as harsh this time.

After we leave them in an ER room, I come back later and glance in. She sits next to his bed, leaning against him, her head against his shoulder, his big arm around her. He brushes her hair. Niether of them speak.

Grand Central Station

I walk through the ER. There are beds in the hallway. I step aside as a tech pushes a portable X-Ray machine past. I call a greeting to a nurse who steps out of a room carrying an IV tray. In another room a doctor intubates an extremely large patient. The intercom pages a cleaning crew to the trauma room. A nurse answers the CMED radio. One of crews is coming in with a heroin overdose. Ahead of me a black man maybe sixty stands naked in the middle of the bustle, a foley catheter in his penis. In his hand he holds a catheter bag filled with fruit punch colored urine. Another ambulance crew comes down the hall, one EMT pulls the stretcher, while another rides the rails doing CPR on the patient's chest, while the medic at the head ventilates the man through an ambu-bag and ET tube. A nurse's aide sits outside a room reading a book, guarding the door where inside, a man restrained to a bed utters a string of obscenities. I go into the EMS and sit down to write my run report. I sit there for a moment. I get up go look down the hall. I see my partner gently escorting the naked man back to his room.

Diamond in the Rough (More Chapters)

I have now posted the first 20 chapters (out of 50) for Diamond in the Rough at the following link.

Diamond in the Rough

I have also attached the following preface:

"This novel is based on a true incident, and grew out of a challenge I gave myself to find out why someone did what they did, and to try to write a story that might explain how someone would come to do such a deed. However, this is a work of fiction and while inspired by a true story, it does not depict nor is is based on any real persons. All of the characters are entirely fictional. Any resemblence to real people is entirely coincidental.

I do have a strong concern about the book, and that is, unless written carefully, it may reflect badly on EMS as a profession. There are characters in this book (particuarly Fred) who do things that I do not obviously endorse. My main character (the narrator), who I hope will be viewed as ultimately symphathetic, will do things that are clearly unacceptable. Because the lead characters are certainly not role models, I am hoping that I will be able to find ways, either through the character's self-realization or by adding a more positive character or two, to at least show how EMS should be.

I also want to caution readers that some of the content is sexually explicit and should not be read by those who are offended by such writing.

I plan to post the entire book on this site, but then only keep it up for a short period of time (perhaps two weeks or a month). I hope to have it all posted by the end of March if not sooner. I expect that I will do at least one additional rewrite after finishing this draft.

Thank you all for reading."

I welcome comments.

ECG Changes

It's pouring rain and we get called for anxiety. 40 year old female sits in her kitchen holding her chest saying it feels heavy. We ask if she has been under stress and she says, "You don't want to know."

But she has never felt a pressure like this before and she says it feels like someone sitting on her chest. Her skin is warm and dry. BP 150/90. P- 108. Sat 100% on room air.

No prior history, though given her race and weight, she looks like she might have hypertension and high cholestrol.

Out in the ambulance, I put her on the monitor. Doesn't look too bad at first glance. Of course I am just looking at the inferior leads.

This could just be stress I tell her, but we are going to treat you like its your heart. We're required too.

I do a 12 lead.

Looks a little suspicious. V-6 is troubling. V-5 just a touch. The inferior leads look ever so slightly up. Maybe it is just a variant for her.

I give ASA and NTG, which brings no relief. Her pressure holds steady. I call the hospital, and let them know I have a chest pain with a borderline ECG, possible ST elevation in lateral leads.

I do another 12-Lead. The patient asks how it is. She sees something in my face as I stare at it.

Holy. Looks nasty. Particuarly in V-4 -V6. Such a change in ten minutes. In addition to the lateral there is fresh change inferiorly with an ominous cove shaping of the ST.

At the hospital I tell the triage nurse I believe my patient is having an MI. She says they are getting a room ready for us. I ask who the doctor is. She tells me it is a new physician and points in her direction. Sitting next to her I see one of hospital's best physicians, who is very EMS oriented. After I give a report to the nurse and get the patient on the bed, I go over to the doctor I know and show him the strips. He asks what room and I tell him. He immediately shows the strips to the new physician. He tells her the process for calling the cath lab.

I write my report and as I am bringing it back to the room, they are already wheeling the patient out, headed to the cath lab.

Nice turn around.