A Cigarette

The mental health team meets us outside. "We should wait for the police," the clinician says. "She's a big woman. When we went back up there she had a knife near her that wasn't there the first time we were up with her. She's very anxious today. When she's off her meds, she can be volatile. I've seen her tear a door off its hinges."

"Okay," I say. "We'll wait for the PD."

When the first officer arrives, she repeats the story to him. He calls for backup.

Once backup arrives, we walk up the three flights of outdoors stairs and then force the door open because she will not come to it. Inside we find a completely bare apartment. I am always surprised when I walk into what is actually a fairly common occurrence -- a psychiatric patient living in an empty apartment. In the kitchen there is a bare table with no chair and in the living room, there is no furniture, except the single folding chair in which the woman sits facing the window sill, smoking a cigarette. She wears a dirty flowered robe and slippers. She is about two hundred and ninety pounds and built solid like a rhinoceros. When the officer starts talking to her, she turns her head around slowly and says, "Don't you be talking to me in my house. I don't give a good god damned about any of you, so for all I care, you can all go ahead and kiss my ass. I ain't getting up, and I ain't going anywhere." She goes back to looking out the window and slowly smoking her cigarette

One at a time we try to talk to her, but she just gets more agitated. When it is my turn, I say in a soft monotone, "We're just to give you a nice easy ride down to the hospital where you can get something to eat and talk with a doctor and nice nurse about all that's going on." She turns full on me, and even though I am several feet away, I can feel hot breath coming out of her flaring nostrils. I just let her rant, and whenever she stops to catch her breath, I start talking again in a real quiet, slow voice. It doesn't get me far, but at least it wears her down some.

Our efforts to talk her into going having failed, the lead cop and I discuss various game plans. He wants us to get restraints. I offer chemical as an alternative, but suggest we just try to get her to walk first. They stand her up and she starts yelling, but once they cuff her she calms down. We walk down the stairs with her, and she yells again at the top of her voice about what motherfuckers we are and how the world is corrupt. "You think you can just go in and take a woman out of her house, you all a bunch of god damned honkey ass motherfuckers! I have my mind set to take you all out, and I will leave nothing, nothing in my wake. Do you hear me? I said do you hear me! Make no mistake. You all can kiss my black ass cause I'm going to take you all down, treating a poor black woman like this. You should be ashamed of your punk asses, motherfuckers!"

When we get her down on the stretcher, she says, "My wrists hurt." I start talking soft to her again, "I'm sorry they hurt. I'll ask the officers to take them off if you agree to not fight us.” I nod to my preceptee who is probably about six-four and close to three hundred pounds himself. "The two of us will ride in the back with you. We'll just take a nice easy ride to the hospital, where you can talk to a doctor. You don't even have to say anything to us." She seems to be listening. "And we'll let you have a cigarette outside the hospital before we go in if don't fight us."

"Okay," she says.

The cops seem a little dubious. "You're going to have to ride with her." I nod at my partner. "We can handle her." They look at the two of us, and they have to admit, she's big, but the two of us are not likely to be easily handled even by an enraged rhino, and I do have the Haldol and Ativan at the ready. "It's your choice."

"She'll be good," I say. "We'll let her have a smoke."

"You best not be tricking me," the woman says.

"We'll get you a smoke."

They uncuff her and she is quiet on the way in. She even lets us take her pulse and blood pressure. While we are still in the ambulance, I have a vision of us pulling her out on the stretcher and letting her smoke while still on the stretcher, and a newspaper reporter taking a picture of us "ambulance attendants" standing around letting our patient have a cigarette, and what a storm of controversy it might cause. When we get to the hospital, I ask her is she wants to walk in or go in on the stretcher. "I'll walk," she says. We're supposed to keep everyone on the stretcher and while there is no policy about not letting them smoke, I think that is only because no probably imagined crews would let their patients smoke.

We have her step out of the back of the ambulance, and so she is standing when he give her the cigarette. If a photographer were there, it wouldn't be apparent that she is our patient. She looks like your typical weary two hundred and ninety pound late fifty year old lady in a dirty flowered robe and slippers, smoking a cigarette on a cold grey day. And that's good, because if she were on the stretcher people seeing a photo in a newspaper might not understand the power of a cigarette. It often works better than brute force, better than pepper spray, handcuffs, Haldol and Ativan. It's a simple acknowledgement that a person is having a tough day and needs a break, a chance to have a smoke and collect yourself before heading on into another tough day.

In the ER, she says she has to use the bathroom. The nurse tells her she has to pee into a cup.

"I'm going to need a bigger cup," she says. "And why can't I just go in the bathroom?"

The nurse says all females have to pee into a cup to see if they are pregnant.

"I ain't pregnant," she says.

"We require this of all females," the nurse said.

"You're wasting a cup on me."

Still she takes the cup and shaking her head, waddles over toward the bathroom.

Crash

I'm in the back, helping my preceptee with an IV. I repositon the catheter to get a blood flow, and then pull out the needle, occluding the vein with my left hand while I reach for the saline lock. All of a sudden we are decelerating and I start sliding to my right, and I keep sliding. Our patient who is c-spined after a fall resulting from a seizure and who is complaining of neck pain, slids along with me. Then his harness catches and whoa! I am deep in the net at the end of the bench and we are stopped. I look out the side window and see a car in front of our bumper. We've been in a crash. Fortunately, no one is hurt. Amazingly to me I still have his vein occluded and not a drop of blood has spilled, although I think I have permanently indented my fingers into the man's arm. I have lost the lock and my preceptee has to draw up another one while we wait for another ambulance to come and take our patient.

I feel lucky, particularly when I read the dailyAmbulance Crash Log.

I also love that net.

Complete Draft Now On-Line

The complete draft of the novel is now up and will stay up until at least March 15. At that time I will reread it myself and no doubt do major revisions. I do not plan at this time on posting the next draft in its entirety. My hope is that draft will be publishable in book form. For those who have been reading the novel, I discovered a missing chapter, which has been added back as "Chapter 15 and a half."

To read the novel, click the link below:

Diamond in the Rough

Snow

The snow is coming down in near white out conditions. At one point we lose the road the snow bank kicking up snow that completely obliterates our view through the windshield. We arrive at a townhouse apartment complex where we have been called for an unresponsive diabetic. Carrying our blue house bag, heart monitor, and 02 tank, we wade through drifts up to our waist to get to the door.

An old Jamaican woman meets us at the door in her bathrobe and says her sister is upstairs on the bed. We have been to this house many times before. The sister is in her eighties. She is supine across the bed, snoring, her skin cool and clammy. We check her sugar. Our glucometer reads "LO" which means less than 20. I get a line and push in an amp of D50. She opens her eyes to a sternal rub now, but is still mostly out of it. I give her another half an amp and she now has her eyes fully open and looks around at us quizzically. "What hap'en?" she asks.

"Your sugar was low," I say. "Less than 20."

"No, my sugar is high," she says, "I write it right down dere in de book."

"No, it was less than twenty."

"No, it isn't low. Me write it down in de book before me go to bed."

"You sugar went down. You must not have eaten."

She listens seemingly intently to what I say. I think I am getting through, but then she says again, "My sugar high. I write it down in de book."

Finally her sister says, "Dis is anothder day now dear."

We finally got her straightened out and have her sitting at the kitchen table eating a big Jamaican meal of stew chicken and rice and peas.

"What do you think of the snow storm?" I ask.

She looks at me with one eye cocked, uncertain what I am saying.

"Look outside," I say.

My partner opens the door for her to see.

It is a winter wonderland outside, nothing but white powder.

Her eyes widen. Her mouth opens, but no words come out. She looks like a little five-year old Jamaican girl seeing snow for the first time.

You Never Know

We’re called for chest pain at the court house. We question whether it is a case of "Jailitis." We find the patient sitting in the lobby on a bench surrounded by marshals and firefighters. It is a young man – twenty-five. My first reaction is he is a prisoner, but then I realize he is wearing street clothes. We hear the story. He was walking down the street when suddenly he felt an intense tearing sensation in his chest going into his back. He is a heart transplant patient. A firefighter hands me a paper with medical history on it. It is a typed report from a hospital saying the patient has a diagnosed Aortic dissection.

"Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta (the major artery from the heart). This condition may also involve abnormal widening or ballooning of the aorta (aneurysm)."

While the man looks okay, he also seems extremely tense. I would be too with that history. An aortic dissection rips open and the person bleeds out in a minute. One moment awake, the next dead.

I nod to my preceptor as I lower the stretcher. Let’s just get him on the stretcher and on the way to the hospital. His pressure is okay. When my preceptee says he is going to start a line, the man says he has no veins, the hospital has to use central lines so we shouldn't bother. We are already enroute to the hospital. I hand the CMED radio to my preceptee. He stutters some with the patch. The patient snaps at him when he says stomach pain. “It’s not stomach pain, it's chest pain, pain into my back.”

When I ask for the meds he’s on, he starts rattling off a list. I ask him to repeat one; he says the name again, but with thick frustration. He glances back to try to look ahead. “Are we at the hospital yet? How far is it?”

“Just up the road.”

When we finally approach the hospital, the man, seeing the ambulances out the side window, says urgently, “You just went past the ER!”

“No, listen, I know you are concerned, but we know where we’re going. It’s a one way drive.”

He apologizes.

“We’ll get you good care.”

In the ER, I tell the triage nurse the man has a possible AAA. "No! It's not possible, it’s been diagnosed,” he snaps. “I have it.”

“Okay,” I say. “We’re getting you a room now.”

He looks like he is about to snap as we wait for the triage nurse to give us a room assignment. His hand keeps tapping his leg. “Man, I can feel it pulsing!” he shouts.

***

Later I see the nurse who was taking care of the man. I ask how he made out, curious whether or not he was rushed to surgery. I imagine his AAA rupturing in the elevator and him bleeding out before the doors can open. The nurse says he was very squirelly with the doctors. They called the other hospital in town and found out he had been there the night before. They felt he was drug seeking. He ended up walking out of the ED and taking a cab to a third hospital.