Smooth Operator

The nurse says its been a busy day. We are the third set of "ambulance drivers" she has had to call this morning. I let the ambulance driver remark pass.

The seventy-year old woman in the room looks frightened. She does not want to go to the hospital. The nurse says she has been pale, and her pressure is low. She is not herself.

"How are you?" I ask.

"Awright," she says, tentatively.

She has a Jamaican accent.

"Let me ask you one question. Are you a country girl or a town girl?"

"I am a Jamaican girl. I come from the town."

"Kingston?"

"That's right." She smiles now.

"I knew it," I say. There is a special twinkle to the town girls from Kingston."

The nurses aides, who are also Jamiacan, giggle.

I tell the woman my name and that we are going to be taking her to the hospital.

"Awright," she says. "I guess if you think so."

When I put her on the monitor, her heart is going at 160. I check the paperwork. She has no prior history of tachycardia.

"I'm going to fix you up now," I say. "I've got some medicine I am going to give you into your veins."

She watches as I mix, drawn up the Cardizem, then slowly push the Cardizem in the IV port.

Soon her heart rate is down to 70.

"How do you feel?"

"A bit better," she says.

"Good, good."

"Now hold still while I take a picture of your heart."

"A picture of my heart?"

"That's right. It looks good."


Later, I stop by to see her. Her daughter sits with her. Her daughter says, "My mother has been asking about you. She is much better. She said she like the tall man who take care of her, and hope you come by."

I smile back and approach the old woman. "How are you doing now?"

"Better," she says. "I'm doing fine now."

"I'm glad."

She blushes.

We do a pnemmonia, then a call for shortness of breath.

Our last call is a transfer. An eighty-seven year old woman is being discharged from the hospital folloing a bout of pnemonia.

"The ambulance drivers are here," the nurse announces as she leads us into the room. "Time for you to go home."

I introduce myself by name to the patient. "I will be your chauffer this afternoon, and this is my partner, Greg, who will be your escort, while I drive."

She is a tiny woman with a wrinkled face amd a funny cartoon voice. She looks like an eighty-seven year old Olive Oyle from Popeye.

"Are you going to take that out?" she says to the nurse, who flushes her G-tube. "I don't want it. Take it out."

"You have to talk to your doctor about that."

"Take it out."

"I can't. Your doctor wants it in."

She looks at us. "How about you. Do you know how to operate?"

"We do know how to operate," I say, "But that's not the kind of operating we do."

The nurse says to the patient, "Yeah, they think they're smooth operators."

"That's right." I sing, "We're smooth op-era-toors."

"Smooth oper-aaa-tooors," my partner chimes in.

"Take it out," she says. "I don't want the tubes anymore."

"They're going to take you to your daughter's house," the nurse says.

"No tubes," she says.

"We're going to put you on our stretcher," my partner says.

"Then, I'm going to give you a smooth ride to your daughter's," I say, "Because I'm a smooth oper-aa-toor."

"Smoooth Operaa-toor," my partner sings.

"You guys are all right," the nurse says, laughing.

At the house there are three generations at the house, a daughter, granddaughter, and two great granddaughters who are eating cherry popsciles. We can't get the stretcher into the bedroom. "I'll just pick her up and carry her in," I say.

"Are you sure? She's not as light as she looks," the daughter says.

But I pick her up easy and carry her into the bedroom. "Light as a ballerina," I say.

"How about that, grandma," the granddaughter says, "I bet you didn't think you'd have a man carrying you across the threshold and laying you into your bed."

The old woman laughs. "I knew he could operate. She smiles at me, eyes twinkling.


As we drive away, my partner says, "I'm going to be singing that song all day."

"What's that?"

"Smooth operator."

"Smoooth Oper-aa-toor," I sing.

"Smooth Oper-aa-toor," he sings.

"We're smooooth oper-aa-toors."


I used to hate being called an ambulance driver. Now I don't care. The job is the job. And I like doing it.

Besides smooth operators go with the flow.

Anthropophagi

an•thro•poph•a•gi -- Pronunciation: (an"thru-pof'u-jī", -gī").

***

We get called to an address and told to wait for the cops. There is a dead body in the house and there are dogs.

The cops ask us for masks. Evidently there is a stink.We only have three masks. I let the two officers and my partner have them. I have learned over the years how to breathe so the smell doesn't get to me.

The officer opens the door. A little white dog meets us. I notice a red stain on his cheek.

We start to walk through the house. I see a bigger larger dog dart quickly across my line of vision, then dissappear. The floor is covered with dog poops. They have been alone for several days at least.

The officer checks each room as we go. I am starting to recognize the house. "I've been here before," I say now. "There is a woman who lives here. Her bedroom is down this way."

Stepping over the poops, I lead the officer to the back bedroom where we find an extra from Raiders of the Lost Arc lying semi naked across the mattress. Her hair has been ripped out, her face eaten off. You basically see a skeleton face on a dead body. I can't bear to look. I remembered how pretty her eyes were.

I notate the time, then leave the room.

Later an officer holds a pole with a loop on the end, which he is hoping to put over the neck of the bigger dog who growls at him. They appear to be at a standoff. The officer is not the regular dog officer. He looks very nervous. Another officer tries to tempt the dog with a biscuit.

The dog isn’t interested in the biscuit.

***

Did a couple falls, including one at 9:30, so since she needed morphine, I ended up not getting out of work till past 11.

***

an•thro•poph•a•gi Pronunciation: (an"thru-pof'u-jī", -gī"), eaters of human flesh.
Random House Unabridged Dictionary, Copyright © 1997, by Random House

Lucky

We get called for a tractor-trailer rollover. Code Three. Lights and sirens.

About half way there we are slowed down to a non-emergency response and told it will be a refusal.

When we arrive we see that it is not a tractor-trailer rollover, but in fact the trailer container has rolled off the trailer. Then we see what it has rolled onto.

An SUV. It has crushed the driver compartment.

We are directed to the passengers -- two young women who stand on the side of the road holding each other up, starring at the car.

My first question is "What are tonight's winning lottery numbers?"

Niether are hurt. The driver was stopped at the light. She saw the trailer come slowly around the corner, then out of the corner of her eye, she saw the trailer container start to tip off and fall towards her. Instinctively, she leaned to the right.

Had she been talking on a cell phone or looking the other way, she would have been dead.

When her mother shows up, she issn't upset at all about the car. She makes certain her daughter is okay, then stares at the container on the car. "I've never seen anything like it," she says. "Can you imagine? Look at it, and she wasn't hurt."

"About those lottery numbers," I say again to the girl.

***

We took in the old guy from last Saturday who fell asleep at the movie. He tripped on the bed, lacerated his head and bruised his wrist. I asked him about his last stay at the hosptal. He said they did all kinds of tests, couldn't find anything wrong and finally sent him home, concluding he probably just fell asleep at the movies.

***

We also did another fall.

***

I was dead tired again. Luckily I caught two half hour naps.

DKA

Three calls today. A syncope, an MVA and a diabetic.

The syncope was at a house I have been to often, yet never recognize until I am inside and see the family. They know me by my name. I usually transport the wife, but sometimes the husband. They are nice people and they think highly of me, which makes me feel good about my job. Today while the daughter was getting dressed -- the husband was out on his daily walk, I sat in the back of the ambulance with an elderly neighbor who had come over to help. I asked her if she was coming with us. I said I just wanted to make sure we wouldn't be leaving with her in the back if she didn't want to come. "If you took me, so what. At my age I've learned, what the heck, you go with the flow." I'm learning the same.

The MVA was a good hit, a tracktor trailer into a van. The driver of the van ended up in the trauma room with bruised ribs.

The last call was for a forty year old man with difficulty breathing. The officer thought he had the flu, but he was breathing so quick and heavy, and it stunk. He was an insulin diabetic. I thought for certain his blood sugar would be through the roof. I thought he was in diabetic ketoacidosis, when your sugar goes through the roof and you become extremely acidotic and have to breathe rapidly to try to keep your blood gases in line. I had the stretcher brought in, and we got him out to the ambulance. I checked his sugar. Its going to be high, I announced. It came out 242. Not that high. I still dumped in fluid and kept him on a nonrebreather. He was nauseous and very restless.

We get to the hospital. They check his sugar -- its critically high.

So much for my glucometer.

At least it turned out to be what I thought it was.

License and Registration

Guy goes to the paint store, buys some white paint. Driving back to his mother's house in the north end of the city he is driving through a green light when bam. He gets slammed by a car being chased by the police. The other car rolls. A fire hydrant is hit. Water sprays everywhere. The guys in the rolled car get out and run down the street, the cops in foot pursuit. The other guy gets out of the car feels pain in his legs and lays down on the sidewalk.

When we get there, I see the guy on the sidewalk. His face and shirt are white with goop. I look inside the car. There is an exploded paint can. We board and collar him and take him to the hospital.

I check in with him later and he is all cleaned up. "Dude," I say, "I thought you were a white guy. I was thinking what are you doing in this part of town?"

Later we went to a nursing home for a lady who lost control of her motorized wheel chair and slammed her foot into her bed. The first thing I asked was for her licence and registration. My day to be the comedian. I'm going to have to draw blood to check your alcohol level, I said.

***
Busy day. Did eight calls.

A woman who got into a family argument, then wanted her blood pressure checked.

A woman given antibiotics two weeks ago for a stomach virus, not feeling well and with no appetite.

A child who dialed 911, not knowing what she was doing.

A crazy guy from a nursing home who was eating the fern trees by the nurses station and chewing on wallpaper and just babbling inanely.

Another crazy guy going from a crazy unit of a hospital to a hospital just for crazy people. After we pulled him out on the stretcher at the crazy hospital, we let him have a last cigarette before we took him in. He lay on our stretcher, staring up at the ramp leading to the locked doors, and sucked on his cigarette. Then he said, "Let's do it."

And we did a transfer, an old woman with cancer with a painful back and shoulder. I drove the long way to avoid the bumps.

You Got to Get Hep!

A man with a head cold, coughing up yellow phlegm, feeling weak. My BLS partner wanted to tech it, but I decided to tech it instead, just because he said he almost passed out. I got him in the back and we started to the hospital. I checked his pulse. It was 36. I put him on the monitor. He was in a second degree heart block. He said he had no heart history. I didn't do anything for him because he was maintaining a good blood pressure, but I pointed it out at the hospital. They ran a 12 lead and he was back in a regular rythmn. He said he was feeling better. They treated him for his cold.

We picked up a drunk. As we approached the corner we saw one man flagging us down with one hand, and holding up another man who looked unsteady with the other. We were on the other side of the street, and while we waited to do a U-turn, the man instead, dragged his buddy across the street to meet us. His buddy wore a Colorado Rockies hat and looked glassy eyed. He muttered that he was okay and didn't want to go anywhere, but his buddy insisted that we take him. "You got to get hep!" his buddy shouted at him. "You got to dry out. You got to go wit them. You got to go wit them now. And then I see you in a couple days. Right here! Right here! You go get some hep, then I see you right here!"

We took an old woman discharged from the hospital back to a convalescent home in a distant suburban town. I had a great bowl of clam chowder at a seafood market on the way back to town. That was clearly the highlight of my day. A hot thick chowda with lots of clams. I was sure glad I ordered the bowl and not just the cup because it was good chowda. Yes, sir.

I don't remember the other call. Not for the life of me.

Shopping

Eight hours in the city.

Slow day, an old woman with back pain, a young woman with numbness in her hands, and a discharge transfer.

It snowed about four inches last night, with another inch today through the motrning, then the storm ended well short of its projected eight to ten inches.

Rest of the day we hung out posted in a suburban town. I did some shopping, bought Turbo Tax at Staples, went to Blockbuster to see if they had OZ Season 4 in yet, went to an art store to buy some picture hangers, Marshall's to look for sweatpants, Barnes and Noble to read magazines, and a Chinese grocery to get frozen dumplings. We also stopped at Bally's so my partner could check out the place.

Not a bad day.

A Tremendous Dream

I'm on hold with the Red Sox ticket office, trying to get through to get some Yankee tickets they put on sale today. From conversing over the internet with other sox fans I am facing a long wait, but at least I am through the last hour of busy signals and all circuits are busy announcements. Fingers are crossed for several reasons.

***

Two calls so far.

Took in Big Mamma and Little daddy from yesterday. Seems they were not happy with the treatment they got at the hospital last night, little daddy's head still hurts and Big Mamma doesn't like to hear her baby cry. We took them to the kid's hospital, where they were put in the waiting room. Little Daddy immediately got down on the floor and starting playing with some toys.

The other call was for a woman in her mid forties with back pain. She had beautiful blue eyes, a slender woman who looked like at one time she was very pretty, but she was sleeping on a mattress in a house that smelled like urine. It looked like she had track marks on her arms. She had two dogs in the house and the cop asked her who was going to feed the dogs while she was away. No one, she said. I'm here alone. What about the guy who lives with you. I got rid off him, she said.

***

Check it. Four right field box to the Sox-Yankees in July. Only waited fifteen minutes once I got through.

***

Got two late calls.

A lady with pnemonia/CHF/COPD.

An old guy who was "unconcious" according to the nurse at the retirement community. It seems the old guy went down to the movie in the community's theatre room, sat in the back, was confused by the movie, and couldn't hear to well, drifted off to sleep, was "dreaming a tremendous dream" when he was awoken to his bafflement to see several people standing around him. It seems when the lights came on, he was "unconcious" sitting in his seat. The nurse said it took fifteen minutes to "revive him." He said he felt perfectly fine. His story seemed reasonable to me. She wanted him checked at the hospital for a possible stroke.

After working eleven days in a row, I am hoping to go to sleep soon, to dream a "Tremendous dream," then wake up feeling perfectly fine.

Just keep that nurse away from me.

My Sunshine/The Scream

Again, as soon as I get to work, there is a call. A syncope. Gorgeous modern house on the north side of town, with a beautiful view of the sun coming up over the meadow and woods.

***

Didn't do another call until almost one -- a three year-old who hit his head. The cops were questioning the mother when we got there, but I am sure it was an accident. The kid just banged his head. He didn't lose conciousness -- he just hurt when he moved his head. His mother had to be six two and weighing well over four hundred pounds -- she had a big belly hanging out under her tee-shirt and wore yellow fuzzy duck slippers. She was cuddling the little boy to her when I came in like he was a tiny baby doll. When we took him in the ambulance, she started singing to him as tears flowed down her cheeks. "You are my sunshine, my only sunshine (sob) you make me happy when times are grey (sob sob) You never know dear how much I love you, don't take my sunshine away. (sob) Sing it with me now little one... You are my sunshine...

Her voice was high and scratchy. I was worried if she fell forward, she was going to crush the little boy. He looked very scared, laying all bundled up on the backboard holding his teddy bear.

"Who does your monmmy love most in the world?"

"Me," he said, and smiled.

"Who's my daddy?" she said to him.

"Me," he said in a soft quiet voice.

"That's right," she said. "I will always be with you."


***


Nancy is an ER nurse in her forties. She always looks harried. She has a right to be. The ER nurses at the city hospitals are without a doubt the hardest working people I have ever seen, they are like an overflowing assembly line worker, who manages to stay at their post, even though the line is moving way too fast to control. Nancy walks around with one hand on her cheek and her mouth open, this look of astonishment and horror on her face. She reminds me of an early draft of Edward Munch's "The Scream" -- a draft never seen by the public. It is the screamer not quite ready to scream, but on his way. He only has the one hand on his cheek. But you know its only a matter of time before it gets there and the lasting scream happens. Just a matter of time.

Here's a link to the scream:

http://www.edvard-munch.com/gallery/anxiety/scream.htm


***

Ended up the day with an old woman dizzy and vomiting. Took her to City. Nancy wasn't happy. The ER was packed. I almost sang "You are My Sunshine" to cheer her up.

Praise Be

Come into work, and as soon as I walk in the door, we get called for a rollover. Lady in a SUV rolled completely off the road, went through a thicket of trees, landed on her side in someone's front yard. I get there and ask her if she's okay.

"Yes, I am, I had the lord with me."

"Any head or neck pain?"

"Nope, the lord was there."

"Back pain?"

"Nope."

"Did you get knocked out?"

"No, the lord was watching over me."

"Did you have your seat belt on?"

"The lord, praise be, he strapped me in."

"Are you sure you're okay?"

"The Lord made sure."

"You don't want to go to the hospital."

"No, I'm fine, praise be the lord."

"Okay." I get her to sign a refusal, and think about asking if she would like the Lord to sign as the witness.

My partner and I head back to the base. He remarks how lucky the lady was.

I tell him what the lady told me.

"What caused the accident?" he asks.

"I don't know. I think maybe the Lord nodded off for a moment in the passenger seat."

"He woke up in time though."

"Yeah, I guess you could say that."


***

The Lord or whoever gives me the rest of the day off. Nothing for eleven hours.

Praise be.

AP Story

Questions Surround N.C. Man Presumed Dead

Fri Feb 11, 2:54 PM ET U.S. National - AP


By ALLEN G. BREED, Associated Press Writer

INGLESIDE, N.C. - Larry Green stepped out of the darkness so suddenly that the car that hit him didn't even leave skid marks. The impact sent his shoes, socks and the unopened beer in his hand flying.

Green came to rest on U.S. 401 alongside a trash-strewn ditch, where he was examined by paramedics and declared dead.

Over the next 2 1/2 hours, the bloody body with a gaping head wound was zipped into a black vinyl bag, taken to the morgue and slid into a stainless-steel refrigerated drawer.

There was just one problem: Green was alive.

Two weeks after that shocking discovery, the 29-year-old Green clings to life in a hospital intensive care unit, paralyzed.

Anguished family members have listened in horror as officials described the many missed signs and miscues that led to the error. They and others in this rural tobacco community northeast of Raleigh are left to wonder how something like this could have happened — and whether it has happened before.

"Something ain't right with that," said T.J. Henderson, a high school classmate of Green's. "I thought they were supposed to try to give mouth to mouth or the shock at least till they got to the emergency room. That's where I thought you were pronounced dead at, not on the scene. ... Not on the street."

On the chilly night of Jan. 24, Green and a pair of friends showed up at the Ingleside Grocery about 8:45 p.m. to pick up a few tall-boy cans of Natural Ice to take back to his trailer down the road. Green never made it.

According to reports from state troopers and the Franklin County attorney's office, 36-year-old Tamuel Jackson did not have time to stop her car before it slammed into Green as he tried to cross the highway in front of his trailer.


Randy Kearney, an off-duty paramedic, was on the scene at 8:54 p.m. and found no pulse or sign of breathing. Blood had formed a foot-wide corona around Green's skull.

When county paramedics Paul Kilmer and Katherine Lamell arrived moments later, Kearney told them Green was dead, but asked Kilmer to double-check. Kilmer replied that his determination was "good enough for me," according to Kearney and two firefighters. Kilmer told officials he could not remember saying that, but doesn't deny it.

By the time paramedic Pamela Hayes arrived at 9 p.m., Green was covered by a white sheet.

Although the law does not require the medical examiner to go to accident scenes, Dr. J. B. Perdue showed up half an hour later and began examining the body, lifting and twisting Green's broken right leg, rolling him over and inserting a gloved finger into the gash in Green's head.

"That's more than I need to see!" Lamell shouted.

When Perdue opened Green's jacket, several firefighters holding a tarp to shield the body from onlookers noticed what appeared to be an in-and-out movement in Green's chest and abdomen.

"Doc, is he breathing?" the firefighters heard Kearney ask. Perdue told Kearney that it was just air escaping or moving around inside the body.

Paramedics put Green in a body bag and drove him to the morgue in nearby Louisburg. There, Perdue examined the body a second time. He took a blood sample, lifted Green's eyelids and sniffed around the man's mouth for alcohol.

Hayes, who had accompanied the body, thought she noticed twitching in Green's right eyelid. She asked Perdue if he was sure Green was really dead. Perdue responded that the twitching was a spasm, "like a frog leg jumping in a frying pan."

"I don't feel good about this," Hayes told colleagues, according to the county attorney's report. She asked Perdue again if he was sure Green was dead. He reassured her. The body bag was zipped back up, and Green was placed in the portable morgue unit, where the temperature is kept a few degrees above freezing.

Green probably would have remained in the stainless-steel container had state Trooper Tyrone Hunt not arrived around 11:20 p.m. and asked Perdue to help him determine the direction from which Green had been struck.

This time, Perdue observed slight movement. He could not find a pulse in Green's neck, thigh or wrist, even with a stethoscope. Perdue summoned paramedics and an electrocardiogram, which was able to pick up a faint heart rhythm.

Family members who have kept vigil at Green's bedside say his eyes flutter at times and he shows signs he recognizes those around him. It is unclear whether his paralysis is from the accident, or the handling of his body afterward.

Within days, Kearney, Kilmer, Hayes and Lamell were all suspended with pay. The state's Office of Emergency Medical Services suspended Kearney's and Kilmer's credentials, citing "a lack of competence to practice with a reasonable degree of skill and safety."

Kearney and Kilmer were fired; Hayes and Lamell were ordered to undergo remedial training before coming back to work. Kearney declined an Associated Press request for comment, and the others did not respond to messages.

Dr. John Butts, the state's chief medical examiner, said that Perdue did everything the law required of him and that there are no plans to censure the 34-year veteran.

"He went because he was informed that a man was dead as a result of violence or trauma," Butts said. "He did not come with a doctor's bag and a stethoscope. He came with a pencil and paper to get information."

Perdue told the AP: "I am not in any shape form or fashion responsible for pronouncement of death. ... Obviously, I'm in sympathy with the family. My heart goes out to them, and my prayers are that this person recovers."

The family has retained an attorney.

Elaine Hicks, who lives two trailers over from Green's, said she thinks people should focus on the miracle of Green's survival. In fact, she asked, who's to say the paramedics weren't right, and that Green did not come back from the dead?

"It could have been the Almighty," the 57-year-old woman said. "He has the last say so."

Asleep

I'm working the Tuesday overnight into Wednesday afternoon. I got here last night, butt tired. I didn't get a chance to nap on Tuesday. I got the narc keys from the day medic, switched into my ambulance, checked my gear, then went right back to the bunkroom and crashed.

12:30 the tones go off, and I am on my way to a racing heart call. Like I always say when I work the overnight, I'm never doing this again. I am too old. I stare out in a daze at the headlights illuminating the night road.

The call is BS. A woman with chest pain for two weeks, feels like a muscle pull. Nothing significant for a cardiac event. Still we take her in. Better safe than sorry.

As we go down the Avenue, my partner calls back, "Seven minutes out."

That's his reminder I need to patch to the hospital. I tell the patient, I'll be right back while I call the hospital. In our ambulance, the radio is in between the driver's section and the back. I sit in the captain's chair, pick up the mike and call the hospital. From where I sit, the patient cannot see me nor I the patient. I just see the back of the stretcher and the patient's head. I ask for a patch to the hospital. I hear the dispatcher say something that sounds like "Stand By."

The next thing I know we are pulling into the hospital, and I am still holding the radio. I look up and I'm on the main channel."Did they give me a med channel?" I ask my partner.

"I don't know, they said stand by."

I don't know what happened, whether they gave me a channel and said stand by or just said stand by. If they gave me a channel, I didn't go to it. They would have announced that the hospital was on, but I didn't hear it because I was still standing by on the main channel. The truth is, I think I fell asleep holding the mike.

I came back, got in bed, and didn't wake up till 7:15.

Thank you EMS Gods for a quiet night outside of that one call. I don't think I could have made it through the day if I was up all night.

I'm still on the tired side. I do need a few days off where I am doing nothing but resting. I wish I could lie on a beach somewhere hot.

***

Did one call later in the day.

Dispatch tells us the nurse says she thinks the patient is having a heart attack, but we shouldn't use lights and sirens. We use them anyway, then we get an update from the EMD dispatcher and they say no lights and sirens, it's a routine transport. We shut down. We get there, the nurse tells us the patient is having pain similar to when she had an MI. She is cold and clammy.

***

I came across this story about a guy called dead, who wasn't dead. Whenever I presume someone dead, I also worry about them waking up, even if they are cold and stiff. This is a story of someone who did.

http://news.yahoo.com/news?tmpl=story&u=/ap/20050211/ap_on_re_us/not_dead_yet_1

Old and Tired

Worked ten hours in the city today, and by the end I was beat down tired. Nothing out of the ordinary.

A thirty year old girl drug addict vomiting. She had just been released from the hospital for the same complaint. I drove and since she'd told me she'd just gotten out of the one hospital, I drove back there as it was only a couple blocks away. When I came around and opened the back doors up, my partner said, she wanted to to go to the other hospital. I just said, they have all your records of recent treatment here, and pulled the stretcher out. She didn't argue. They put her in the waiting room.

We did an old lady who the visiting nurse saw, called an ambulance for, then left without telling her or her son why? She said, she was okay, she just was having a hard time getting around.

We did a call for an 88 year old woman who the family said kept falling asleep all the time. She fell asleep on me in the back. I'd nudge her and she'd wake up and we'd continue our conversation. She was a cute old thing, on 02 all the time for her respiratory problems. My partner asked me what I thought was wrong with her. "She's old and tired," I said. "Her body just wants to sleep."

A regular dialysis transfer patient.

A round trip doctor's office visit for a guy from a nursing home who's ear was bleeding from a tumor.

I was lucky to get a half hour nap late in the afternoon in the back of the ambulance.

I went home and crashed.

Working too much.

SVT at 220

SVT

SVTS

Did four calls in the city, a maternity, a foster child who called the ambulance because she had a cold, and two SVTs.

An SVT is a supraventricular tackycardia -- a heart rate above 150 usually caused by a defect in the heart as opposed to someone's heart just racing because they ran a race. It's a great call from a medic's point of view because you can usually break it with one of the drugs you carry, and cure the patient -- at least for the time being right on the spot.

The first call was a guy living in a grungy apartment by himself in the north end. The call came in for chest pain. When we got there, the fire guys said his vitals were fine and he just wasn't feeling well. In my routine of late, I usually just look at the patient, feel their forehead and listen to their lungs before deciding how to get them to the ambulance -- walk or carry. I rarely feel the pulse unless the patient particuarly warrants it. I check it in the ambulance where I gennerally work the patient up. The guy's forehead was slightly diaphoretic, his lungs were clear, and the fire guys said his pulse was 80. I was going to see if the man could walk, but then he said the pain in his chest was like a pressure. That statement always buys a stair chair. But when I told my partner to get the stair chair, the patient said he didn't want to go to the hospital. I said, let me at least put you on the monitor and see what we see.

I popped him on it and whooa, he's banging away at 170. Nice and regular -- an SVT. There's the problem.

The drug of choice is adenosine, a short acting drug that stops the heart briefly and resets it. In the heart electricity travels from the SA node in the atrium, through the AV node, which is the gateway to the ventricles. The electricity, which causes the heart to contract, pauses briefly in the AV node to allow the atrium to contract first, pumping blood down into the ventricles, which then contract as the electricity comes through the AV node door. In an SVT, the AV node often acts more like a spinning revolving door then a straight one way door. The electricity whirls around causing the atrium and the ventricle to beat increadibly fast, thus causing the symptoms that cause the patient to call 911. The symptoms usually are just an uncomfortable feeling in the chest. Adenosine basically puts a stake in the revolving door, and just shuts down the AV node for a moment, hopefully allowing the heart to rest itself, restoring the natural one way flow of the electricity.

I got an IV in a vein in the man's AC -- the crook of the elbow, the prefered site to administer adenosine, and gave him six of Adenosine. Unfortunately, we just started getting our adenosine packaged in prefilled needleless syringes, so I gave the adenosine, then tried to follow it with a saline flush, but it took me too long to detach the prefilled syringe and hook up the line. My partner had the saline line shut off, so the adenosine didn't get the rocket boost it needs to get to the heart before its half-life ran out. I told the guy I had to give him another dose, and then he got all mad and started saying he wasn't going to have me experimenting on him. This preceeded a lengthy back and forth of me saying, you really need this, and him saying no you don't, and me saying yes you do, which ended up with me pushing the drug during a moment of his hesitation in countering my arguement, and it worked and he felt better. He still didn't want to go to the hospital, and we were there another twenty minutes trying to convince him. I had to call medical control and get it on the record that he didn't want to go. He said he would go to the VA the next day and I left him a copy of the before and after 12 leads, as well as a record of what I had done to show his doctor and he signed the refusal. Before we left he shook my hand and thanked me.

The very next call was for 21 year old with tachycardia. We found a fat 21 year old girl who had been out all night drinking. Again, the fire department gave me a set of vitals that were fine. I thought maybe the girl had the flu. When I asked her if she could walk to the hallway, she said, she was too tired to do that and that she had a history of SVT. I put her on the monitor and sure enough she's banging away at 228. I put a needle on the prefilled syringe, and loaded up another syringe with saline, stuck them both in the IV port and slammed them one after the other. She converted right away. She at least agreed to go to the hospital.

This link shows what an adenosine conversion looks like:

http://www.emedu.org/ecg/images/ans/2adeno_2a.jpg

You see the initial rapid rate, then the period of asystole or flat line, followed by some funky beats, then the regular rhythmn returns. The patient usually feels very uncomfortable during the brief interlude. The man got a headache. The girl, who had had adenosine several times before, didn't even realize I had given her the med. She just sort of gasped and said, "It just converted on its own." No, I just gave you the med, I said.

The other way to convert an SVT is with electicity -- shocking the patient at a lower level of electricity or joules than the shocking you see in the person in cardiac arrest -- at least for the initial dose. I have had some patients who have had both done, say they prefer the electricity to the uncomfortable feeling of the adenosine. I've seen both and would prefer the medicine.

The period of asystole usually is only a second or two, but I have seen it go as long as five or six seconds, which is more scary to the medic than the patient. I will try to post and old strip I have that shows a particuarly long conversion.

Now a Sinus Tack at 108

Post Adenosine

Old Strip

Adenosine Conversion

Steak Knives and Molecules

Just ordered my 10 year gift steak knives from the internet site. It was very cool. If I was only a five year employee I would have just gotten 6 knives. Instead I got 13 and they are Henkles Knives. Very fine quality. I browsed the gift levels from 5 to 40. The gifts get progressively ritzier. I am already eyeing the 15 year award. If I had to pick now it would be between the cusinart food proccesor/blender and the 3 piece luggage set.

Here's the description of my prize: C17. JA Henckels “Everedge” 13-piece serrated stainless steel knife set. Features natural color hardwood block, polypropylene handles and stamped, mirror-polished, stainless-steel, micro-serrated blades. Includes 8" chef’s, 5" tomato, 8" bread, 6" utility, 6" boning, 2 1/2" paring and six 5" steak knives.

Whoo-hoo!

***

Slow so far today. Just a patient with some pus filled abcesses and a lift assist from a regular caller, who occasionally slides out of his wheel chair, and his wife can't lift him back up. Took care of it, no problem.

***

Checked out a prisoner, did a seizure patient, and an asthmatic who a year or so ago I found on the floor not breathing and managed to rescusitate. One of our night medics had the same experience with him. The man has a problem with mucus plugs. He gets one caught. It blocks his airway, he passed out, hits the floor and bradys down. We get there ventilate him, and he starts breathing again. He was not having as nearly a hard time obviously. I gave him a couple of breathing treatments and some fluid to loosen him up.

***

On the way home, I turned the radio on. Saturday night is the worst time to listen to the radio because they have these creepy robot people on who talk about UFOs and other weird shit in this very intellectual self satisfied manner. Here's what they were saying.

The host asks, "What does it feel like to be ripped apart?"

Guest. "Well, it happens very quickly."

Announcer: "How long?"

Guest: "Four hours. First its the stars, then the planets, then molecules."

Announcer: "That quick? Molecules, huh?"

Guest: "Yes, once it starts the unniverse turns into an endless soup of mindless radioactivity. Just a lot of molecules."

Announcer: "Hmm, interesting."

Guest: "Oh course it's very theroetical."

Announcer: But then again, it reminds me, I heard just the other day, a news account, the ice caps, previously assumed to be stable, were found to be melting. The operative word, previoucly assumed."

Guest: "Yes, yes, exactly."

I turned the radio off. Freaks.

***

That night I have a dream about my steak knives floating in space like astronaunts, just my steak knifes and little molecules of the remains of life on earth.

Kicked

A guy slips on the ice and falls on his leg, snapping his ankle. He lies on the cold sidewalk unable to get up. A kind stranger lady lends him a blanket to stave off the chill, and calls 911 for him. The ambulance arrives. "You are in good hands," the kind lady says, taking back the blanket. The paramedic smiles at her comment, then slips himself on the ice, kicking the injured man's foot as he struggles to maintain his balance. The injured man screams in pain. There is an echo, as the paramedic's partner slips on the ice pulling the stretcher out. He ends up on the ground under the stretcher, swearing.

How to start the day.

At least the patient got 10 mg of morphine, enough to forget getting his broken ankle kicked. We are best buddies by the time we hit the triage desk.

***

Then it was back to the BS calls.

An employee "passes out." The doctor on the scene says, "I think she may be having a seizure." Her eye lids are twitching, I hold her hand over her face and let go, she keeps her hand in the air, she is making sounds in the back of her like someone getting ready to hack a looey, she starts speaking, babbling "Kuntakuntakunta." She rolls her eyes in the back of her head when I try to examine them. Her vitals are all fine. When we get her in the ambulance, she stops her fit, but will only speak in whispers. "I'm half deaf," I shout over and over, "Speak up! There is absolutely no reason for her to be whispering.

She asks "What happened?"

"You took off all your clothes and ran naked around the building," I say.

Not really.

***

An elderly man feels dizzy after standing up suddenly. The dizziness lasts 30 seconds. He feels fine. The nurse insists he go to the ER. His heart rate is only in the 40's, but he is on a beta blocker that is not inconsistent with a low heart rate. I ask her to look at his old records. His heart rate is nornmally in the 40's. We still go to the ER.

***

A doctor's office for chest pain. Patient had pain last night, feels fine today. She wants him to go to the ER to get evaluated. She calls for the ambulance. He is warm and dry, pain free. She gives him nothing, doesn't do an ECG, just calls us.

Stat

If forgot to mention yesterday when I came into work, the operations manager presented me with a plaque for ten years of service. I also got a gold pin, and I get a free gift from a catalog of gifts. I think I will take the set of steak knives.

I was actually sort of touched by the gesture.

Did four back to back calls to start the day, then nothing.

The first call was a legitamete COPD. I gave the man a breathing treatment and we went to the hospital on a priority. he also had a CHF history, and sometimes when you give a CHFer a breathing treatment, the next thing you know they are frothing with edema. Better flash at the hospital then in the ambulance. I asked him how he was doing-- he was sucking away on the treatment, then he takes the treatment out of his mouth and says, "You know, I was in the Navy and back in Europe, they exposed us, and there was some shit and I ain't been right, and that hypertension medicine they give me, fucked up my sex life, and that's the truth."

So I guess he was breathing better.

Then we did a 102 year old lady with dementia from a nursing home who was a DNR. They thought she was having chest pain beacuse she was grabbing at her chest. She didn't appear in any distress, and when I asked her if she had any pain, she said no. They still wanted her sent out. The ER wasn't happy. They are still backed up from yesterday.

A ninety-two year old lady who had diarrhea a week ago and who has felt dry since decided she needed to go to the ER and get hydrated because she felt she wasn't getting enough water to drink. She said, she called her doctor and he agreed she should go to the ER. The ER was not happy.

Then we went to an adult day care center. They told us we didn't need the stretcher, the man could walk. We brought the stretcher in anyway. They said the elderly man had a fever and seemed weak. They called his doctor, the doctor's office said the doctor was in the ER today and he could examine the patient down there. They said they called us because he had no other way for him to get there. They wrote a note to the ER staff saying the doctor was to see the man stat. The ER had a laugh over that one.

System in Chaos

Interesting day -- not so much from an exciting call perspective, but from a system anaylsis perspective:

First call was for a forty year old man who lived in an apartment by himself with no nursing care. He's been in a wheelchair since he was injured in a car accident as a teenager. He used to get around with a manual wheelchair, but then one day his shoulder fractured, so now he has an electric wheelchair. His body was covered with bed sores and blisters. His elbow from resting on his wheelchair was one open raw sore. He said he didn't eat well because he had trouble getting and cooking food. His hygine was bad.

We did two round trips one from a nursing home, one from a private home to doctor's offices, where we waited while the doctor examined the patient, then brought them home. Each patient was bedridden, severely retarded, and totally dependent and incapable of conversation other than babbling.

We did a minor MVA where both passengers claimed neck pain. We boarded and collared them, and they took up two beds in the ER.

We did a nursing home call where a paranoid patient from the pscych ward thought other patients were trying to kill him so he threatened to kill them in self defense. He had to stand up for himself. He didn't strike anyone, he just told them to leave him alone or he would kill them. The cops came and we ended up getting him to come peacefuly to the hospital for evaluation. The nursing home wrote a note to the hospital saying don't send the patient back until he is no longer a threat to others. So he's in the pscyh ward because he's paraniod. So because he starts acting paranoid, they have to send him to the hospital? At the hospital we put him in a wheelchair outside a room, and handed him his paperwork to hold. His nurse was in the trauma room so we just told another nurse who the patient was.

And we did an HIV unconcious patient who was having focol seizures, the family said she had a brain infection, she fell last night, and maybe did a speedball today. None of them bothered to come to the hospital.

We did another call that I cannot for the life of me remember. I think it was an old sick person.

Our last call was for a invalid who called us because his visiting nurse didn't come. He wanted us to cook him dinner, help him take his medicine and put him to bed. We did everything except cook his dinner, we just gave him a bannana.

We were late to all of our calls. The hospitals were as busy as I have ever seen them. They had no rooms, no beds, not enough staff. They were putting people in wheelchairs and lining them up in the halls. Someone on the radio said, it was the first time they has seen bunk beds in an ER.

In case you didn't know, the health care system is falling apart.

Stolen Ambulances

The news has been running a clip of an ambulance hurtling down a highway at 80 mph, then going out of control, spinning, then hitting a wall, then rolling several times. It was a stolen ambulance being chased by police and filmed by a news helicopter.

http://www.nbc4.tv/slideshow/4164977/detail.html?qs=;s=7;w=320

We are told not to leave the keys in the ignition. Where I work they have even gone so far as to install a system, where when you are on scene, you can take the keys out, but leave the engine running. Anyone who tries to drive it without putting the keys back in will cut the engine out.

Several years ago, a pscyh patient stole one an ambulance at one of the local hospitals. Every a year or so we get a page to look out for an ambulance somewhere in the state that has gone missing. The closest I came to having an ambulance stolen was when I went into a nursing home and came out to find two old coots sitting in the front seat playing with the siren.

***

Did three calls today, all Bls, an old fall, a drunk who fell asleep on a city bus, and the last one a psych. My relief meet me on scene, and we did a crew change right there, which was nice so I could home on time and sleep.

Snow Boy

Woke up early to shovel two inches of thick wet snow from the driveway. I thought today was going to be heart atatck from shoveling snow today, but instead it was MVA day. Did four MVAs and a nursing home fall. Nothing major.

The last call we did was a minor neck and back pain and the guy wanted to go to General Hospital, which was a lot farther than City. He was up and walking around when we got there. Simple call. Reared ended. he said he had neck and back pain. We board and collared him, put him in the ambulance, and took him to the hospital.

Most of the time I converse with my patients, but tonight, I just kept it brief, wrote my run form, then sat in the Captain's Chair and made notes in my notebook during the ride. He didn't mind. He was talking on his cell phone the whole way anyway.

***

Earlier we did another MVA, where the patient was an old Jamician woman. We had a nice guy named Winston working with us. He is a tech at one of the hospitals and decided to go to EMT class and rides with us occosionally. He has a very thick Jamaican accent as well. I initially started out talking to the lady. I always ask Jamaician women if they are country or city girls. Most are country and very proud of it. Country means they grew up in the Jamaician countryside rather than in the cities like Kingston before migrating to the US. They are all very proud of their heritage.

Sometimes they ask me how I knew they were Jamaican. Well, maybe its your accent. But I always say because Jamaican women are the most beautiful charming women in the world. They eat it up.

Anyway, the accident occured between crew changes so Winston showed up to switch,climbs in the back, and now she can't believe there is a Jamaican talking with her, and because I had already told her how I had gone to Jamaica and how much I loved it, she said, "What'd you do? Go down dere and bring'im back with you?"

"Yeah," I said, "I promised him the weather was great up here. No snow. Sun shinning every day."

They laughed, and then the two of them got talking about their roots and who they knew and then Winston told a very interesting story. In 1961 when he was 12, he hung out with the fisherman because they made a good living and always had some change for him. Many of his relatives were fisherman and they brought fish back for his mother to cook for them. On this day, his mother was cooking a big fish meal for them, when a man came in and whispered something about "the bay of pigs." They immediately finished their meal and ran down to the docks and got on their boat -- "The Snow Boy."

They never returned. All that was found was the captain's table floating in the water and from the burn marks on it, they could tell the boat had exploded. There had been no distress signal.

Winston lost 17 relatives on the boat. He said if not for the boat going down, his life would have been different. He would probably have become a fisherman.

Now he is working in an ER in the city.

***

Here's an interesting link on the Snow Boy.

www.jamaica-gleaner.com/gleaner/20040124/letters/letters1.html

And I found this passage from a news article:

"There was an unfortunate accident at sea that took place near the Pedro Cays when the boat 'Snow Boy' disappeared, and until this day no one really knows what happened to those unfortunate fishermen who were heading back to Kingston on that fateful day, and how many lives were lost. Don Drummond even recorded a song on the Beverley's Label about that incident."

I couldn't find anything else.

I'll have to try to find that song.

****

Did another MVA and a woman with the flu before finally getting out of here last night.

Red Head

One of our patients today was a sixty-nine year old red head from a doctor's office with a thick Southern accent, who looked fifty. I admit, I even thought she was kinda hot. She's had two husbands and was engaged to a third. She was very flirtatous. When I held out the aspirin for her, instead of opening her mough and letting me drop it in, she used her tongue to take them off my fingers. She didn't do it in an overtly flirtatous manner, but I think she enjoyed that it startled me slightly. When we did a twelve lead, and I asked her to use her right hand to cup her breast and lift it up so I could put the electrodes under it, she again startled me by, instead of using the gown to keep her breasts covered, she casually pushed the gown up so I could see her breast.

We met her fiance later. He was 81, but looked like he was sixty. Strong barrell chested, he about broke my hand when we shook. He was an old World War II pilot. They met at a Seniors dance.

***

Did three calls: Chest pain, motor vehicle, and a fall.

Meeting

Had the day off, except for a mandatory medic meeting. Punched in for two hours. We sat around trying to figure out what to do about all the non-emergency calls coming in as emergencies. Didn't come up with any answers.

Emergencies

Well, start of a new month. I just looked back over the last month. I did 120 calls. Not all of them emergencies.

***

My EMT teacher taught me that the emergency ends when you arrive and it really is true. We continue to be sent to emergencies only to arrive and find, there is no real emergency.

Sent for not breathing today at a doctor's office. Got there, patient was breathing. No emergency.

Did two calls at a nursing home, One for chest pain, one for difficulty breathing. The chest pain was nothing and the dsypnea was for desaturation. In other words, the pulse oximieter was getting crazy readings, but the patient was okay. Pilse oximeters monitor a patient's oxygen saturation in their blood. They are handy gadgets, but sometimes they don't read right. A good score is 95-100. A bad score is less than 90. If someone is reading 43, they shouldn't really be alert and pink in the face. They should be blue and having someone start CPR. This lady was talking. Her sat wasn't really 43. Machine error. A lot of unneccesary trips to the ER due to pulse oximiters.

The call list. Chest pain, dsypnea, lift assist, not breathing but really breathing, motor vehicle, and abdominal pain.