We Get Paid

We were sent lights and sirens to a hospital 30 miles away in the middle of a driving rainstorm for a guy going from the small hospital to a bigger hospital to have a cardiac cath operation. We get there and the ER nurse tells us, "We canceled you right after we called. It's going to be a few more hours. We're waiting for the hospital to clear a bed so they can accept him."

Later in the day, we were sent for a fever at a nursing home in a suburban town. We were sent non-priority, then about fifteen minutes into the trip, we were upgraded to lights and sirens, and told the cops wanted us there on a priority. We asked if there were any symptom changes, and they responded, "it must be worse than they thought." When we got there there were no cops. There had never been cops. No one at the nursing home knew anything about an upgraded call. The guy, who had mild dementia, had a fever of 101, good vitals, and was pain free.

You can complain, or as my partner says, we get paid by the hour. I would shorten it to say, we get paid.

At least today the patients were lighter.

An old man with pnemonia, a fifteen year old stung by a bee with an allergic reaction, a man with dementia who fell out of his wheelchair, a psych transfer, and a woman who had a seizure.

Weight

Some days it seems all your patients are huge. Today was one of those days. They were big today -- no 400-500 pound monsters, but some big heavy people. Started off with a diaylsis patient. They reguarly send two crews for this guy. It was the first time I had done him, and I didn't think he needed two crews. He was big -- maybe 350, but my partner and I could have handled him without the help. I was a little annoyed they sent a basic unit to help us. I felt like saying why don't you have the basic crew do the transfer and we can help them while staying available.

Next we got sent completey across two towns to do another basic transfer. A big crabby lady at a nursing home who we had to take to the hospital for an MRI. At the MRI, she was complaining about how they told her she couldn't eat before the MRI and why was that? She said she didn't like to be denied food. They asked her a bunch of questions, including how much did she weigh. She said 260. My partner and I were shaking our heads. 300 easy, I thought.

We had a nursing home guy with a fever and he was easily 280 and he only had one leg.

We had to take a fifteen year old home from the hospital, and she was probably 250, and we had to carry her up the stairs into her house. Carry-ups are the worst.

No carrydown's today, but it seemed all day we were doing deadlifts lifting the stretcher from the low position to the high, then doing sheet pulls from one bed to the next.

Our day ended helping another crew do I carry up. I took all the weight on the bottom.

We also did a maternity, a lethargic nursing home patient with dementia, and were cancelled from a call where a two hundred pound ten year old, put a battery up his nose, but it fell out when his three hundred pound mom shook him.

A Day

How was my day? I don't know. It was a day. I went to work. I worked 12 hours. I did eight calls. Nothing really interesting. Let me try to recall:

1. Old man with increasing dementia. History of CVAs. Says he had chest pain briefly. His wife thinks he might have had a small seizure. He is not complaining of anything now.

2. Nursing home patient semi-responsive with fever, infected foot oozing putrid drainage.

3. Long distance transfer from VA to VA.

4. Fall, patient with MS rolled out of bed. We put him back in bed.

5. 25 year old vomiting.

6. Old lady with nosebleed that had stopped prior to our getting them. Refusal.

7. Motor vehicle with neck pain

8. Maybe we only did 7. I thought we did eight. If we did an eighth, it wasn't memorable.

***

I had another equipment incompatibility problem today. We were out of the small saline vials. I usually draw up saline out of a 250 bag, but the only needles that were long enough to get the fluid out, were not compatible with the saline locks. They had the retractable needles, which if you put in the saline locks, puncture the locks. I ended up having to give everyone an IV bag.

My other minor frustration for the day is I wanted to gets news about the hurricanse in the Gulf, but everyplace I went that had a TV -- hospital waiting rooms, nursing homes, etc, all had their TVs either on Jerry Springer or Soap Operas. I guess no one was interested in the storm of Biblical proportions.

One other tidbit from the day -- the morning paper had a story about the guy who was murdered the day before in the city. It went something like this: "Leroy Jones had just started to turn his life around and tomorrow was going to start a new job..."
Later in the strory his grandmother says, "He hung with the wrong crowd..."

It seems everytime someone is shot, they run the same story. They are always just turning their life around, always just starting a new job. Maybe that's why people don't work. Starting a new job has a death rate higher than cancer.

***

My throat is feeling a little scratchy. Tonight I took some of this "Airbourne" medicine which is supposed to be a cure-all for colds if you take it early. It had worked okay for me in the past. We'll see.

Toofwess Paramedic

Had a 9:00 A.M. dentist appointment this morning. Why on a Sunday? Because my teef fell out yesterday. When I was a boy I went over the handlebars of my bike and my adult front tooth came out through my gums before it had even decended, so I only had one adult front tooth. When I was 18 or so I got a bridge where they filed down two of my front teeth to stubs, then glued on a three tooth piece, where it remained for almost three decades. Until yesterday when I was eating Chinese for lunch. I bit into some chicken and that was that.

Now I'm missing my tree front teef.

People are already giving me spare change. At the hospital they wanted to put me in the drunk ward.

In another week or so I will be getting a root canal and then getting a temporary bridge.

What a pain.

Uh, hello.../Honey, I Love You

I come in at six and find the night crew is out on a call. A few minutes later they clear their scene with a refusal, but then are dispatched to a possible dead body/overdose at a local business. They ask me to respond in the second ambulance to meet them there in case it is a workable code.

I am almost there when they slow me down, telling me it is a 10-45 -- a presumption.

The address is a local transportation company that relies on contract workers. I find the night crew standing in the doorway of the hallway bathroom. I glance in. A large naked man is sitting on the toilet, bent forward, his head down by his knees. His body is mottled and rigorous. There is a syringe on the ground next to him. While we are standing there, his cell phone starts to ring.

You have the urge to pick it up and answer it.

We're thinking "What do you say?"

1. Uh, hello...
2. Fred's phone.
3. Hades.
4. Lucifer.
5. He's not available right now, he's ahhh... he's still being processed.
6. He's in the can.

We just let it ring.

Maybe it was his dealer.

Maybe it was his girlfriend.

***

A number of years ago there was a business where an angry employee came to work with an assault rifle and killed several of his co-workers and injured a number more. A medic, who was there, told me how as he walked through the room past all the cubicles, phones were ringing everywhere, and as he was presuming one man, he could hear the guy's wife on the answering machine, leaving a message saying, "Honey, are you okay? I've been watching the news. I just need to know you're all right. Honey, I love you, honey..."

***

One other call -- a ninety year old lady with dementia who vomited. Everything about her stable. As we start transporting a call comes in for difficulty breathing. It is passed to a city ambulance. As we cross the bridge near the hospital, we see a city ambulance headed north. A few minutes later the police update the call -- CPR now in progress. We are getting ready to leave the hospital as we see them bring in the patient. Forty year old male. They are still doing CPR.

For Another

A nursing home person with slightly altered mental status. History of a UTI. Routine transport.

An elderly man at a senior center passed out. Hot, diaphoretic, wakes up, vomits bile. Is alert as is his norm as a mentally disabled patient. Vitals, 12 lead -- all normal. he vomits some more at the hospital while we wait in triage.

Last call is at a nursing home for difficulty breathing. We find an Alzheimer's patient in a wheelchair, who has aspirated -- thrown up while being fed, and then swallowed the vomit into her lungs. We have just approached the patient when the nurses say, no they just spoke with the doctor and they are canceling the call. The patient is a DNR, and since her vitals are good and her SAT is 96%, they don't want her to go. "She looks like she needs to be suctioned," I say.

"We'll take care of it," the nurse says. "The doctor doesn't want her to go."

We leave, but we'll be back -- if not for that patient, then for another.

Patient Reunions

I have been having a correspondence with a woman who was badly injured in an automobile accident a number of years ago. She wrote to me yesterday about how a paramedic had visited her in the hospital and she thought he was upset because she did not remember him. She felt guilty that she did remember him or never learned his name even when he came to visit.

I wrote back that I did not think she should feel guilty. One, its
natural not to remember trauma -- I think it is part of the body's defense mechanisms to blank it out. Two, I think having to thank someone is wrong because we are after all just doing our job, and just because you help someone shouldn't neccessarily require them to owe you gratitude.

I know there are many medics who often go visit their patients in the hospital to check on them. Not being remembered is fairly common. I often stop back and see them during the course of the same day if they are still in the emergency room and I am bringing in another patient, I'll stop in and chat. But I have never gone up to the floors to check on them or tried to arrange a meeting once they have left the ER. Many of them I could be standing next to in a check out line and I wouldn't remember them and they probably wouldn't remember me.

One benefit of working frequently in one town is having repeat patients, but our relationships exist mostly only when I am called to help.

I think patients have a right to privacy, a right not to be reminded that they were once vulnerable and dependent on a stranger.

While I like to know what happened to a patient, I do not feel the need to go up to their hospital room and expect to recieve their thanks.

***

I have never had a Rescue 911 style picnic reunion with a patient. I have occasionally had patient's come up to my ambulance and say thank you for taking care of them, and I ask them how they are, but I often don't remember them. Many times I have had word sent to me, particuarly in the suburban town where I reguarly work, through people who work on the ambulance with me and know the patients socially, the patient's update and thanks for my efforts.

Over the years I have had some strange encounters with ex-patients:

1) A couple mornings a week (while on duty) I used to the Country Diner for french toast and bacon. Its the local hangout in town. Most of the crowd is old folks, retired people who take their time drinking their coffee. Going there I felt a part of the town like we were the good guys and everyone liked us and smiled good morning and have a nice day.

One morning I'm sitting there and see this old guy looking at me. He looks familiar, but I can't quite place him. I figure he has to have been one of my patients.

He finally comes over. "You remember me?"

"Yeah, yeah," I say, "How you doing?"

"You took me to the Hospital."

"Yeah, I remember," I say, although I don't. "Glad to see you're doing better."

"Better? Huh! I got a bill for three hundred dollars from you fucking people. Three hundred dollars for a back injury. I went to the doctor and he said there was nothing wrong with my back. They kept me there in the hospital eight god damned hours. And then they sent me home, I didn't have any god damned clothes. All I had was that johnny you put on me. I had to take a cab home, bare-assed. I don't know what kind of outfit you're running but hell if I'm giving you three hundred dollars so you can buy french toast and bacon every goddam morning."

Everyone in the place is watching him yell at us.

"Pip it down now, Edgar," Mary Beth, the regular waitress says. "Show some manners."

"I'm sorry, you were disappointed," I say.

"You aren't getting my money," he says. "This god damn town is going to hell in a hand basket," he says, as he walks out.

"Don't mind him," Mary Beth says, "He's an old pain in the ass."

It takes me awhile, but I finally remember him. He lived on the second floor of an apartment building. He was having a pain going into his back, and had been vomiting. I like to put my patients into a hospital johnny so I can access them better, palpating their abdomens, listening to lung sounds, putting on the ECG . When they get to the hospital, they are all set, and don't have to have their IV bag delicately weaved through their clothing as they are changed. I remember now getting him into the johnny. We usually always take their clothes along with us so they have soemthing to wear when they get discharged. We must have left his clothes there.

I have this image of him, standing his bare butt sticking out of his johnny as he stands on the street corner signaling a cab. The old bastard.

I stopped eating at the Country Diner after that.

2) An Encounter

3) One of the better reunions I had was when I was sent for an unresponsive man and found him sitting outside on a garbadge can, leaning against a garage. His friends said he drove over, was talking to them and just went unconcious. It seems like he is stroking out. He is completely flaccid on one side. I verify that he indeed did drive to that location and was fully functioning. I get him in the back, and we're off lights and sirens, I'm planning on calling in a stroke alert. I take the man's wallet out and look at his license. It is a name I recognize. I don't recognize many names, but this one stuns me because it is the name of a cardiac arrest I worked. I had found the man outside where he worked as a yard man, apneic, pulseless. I shocked him into aystole, then intubated him, and started pounding in the drugs. Halfway to the hospital I got a pulse and BP back, but no purposeful movement. I figured it was just the epinephrine that got him back, and that as soon as it wore off, he would go back to being dead. I've gotten BPs back on a lot of codes, but unless I get purposeful momement I pretty much write them off as dead. And as I have mentioned, I rarely follow up once they leave the ER.

Anyway, just then the guy starts coming around, opens his eyes, regains use of his left side and starts talking to me. He was just having a monster TIA. I ask him if he ever had a heart attack and he says yeah. I ask him where he used to work, and sure enough he is the guy. His family is in the ER when I bring my completed paperwork back to the room to drop it with the nurse, and I get in a conversation with them. They said they had tried to find me at one point to thank me, but didn't know who to call. They ended up leaving a message with the fire department who wasn't even involved with EMS in that town. Still it was nice meeting his family in the ER and being called his guardian angel.

4) Probably the worst reunion was when I had to do a nursing home transfer of a woman who I had tried to help, who was an asthma code. She wasn't breathing when I got to her address. Another crew was carring her across the yard. I got her back, but I had difficulty getting the tube at first, and although she lived, she suffered an anoxic brain injury. If I had gotten the tube on the first attempt, I think she might have done better. Seeing her in the nursing home was tough. She was alive, but no one was home. She had a trach and skin infections, and a foley catheter and a feeding tube. She was the only one I tried to see up on a floor when she was in the ICU, but the staff wouldn't let me up because the family didn't want visitors, although the staff did give me an update.

Maybe I should visit my patients more. Maybe it would give me more personal connection to all patients. The might be a good thing, but it might also make the job more difficult.

I think for the time being I am just going to keep trying to ask the patient's their names when I am with them, use mine and be as nice as possibile during the limited time we have together. Then the patients can go on with their lives and I can move on to the next patient.

***

Three calls so far today. A back pain due to sciatica, a nursing home abd pain, and a woman with neck pain who we c-spined after she wacked her head going up the stairs. She'd didn't want to go to the hospital, but she couldn't move her neck and it hurt when I touched it. I am interested to find out what her x-ray looks like. I'll check if I get back there today. Or if not, I'll try to follow up with the nurse.

Sojurn

Had the day off, but seems I was busier than when I am working.

I cleaned out the garage, and while doing it, noticed that my garage door opener was hanging precariously from the cieling, having lost the bolts on the right side of the bracket. I couldn't get the service company to come until tomorrow so I stacked boxes of books up to the base of the mechanical box to keep it square to the cieling.

I wrote a big check to a friend who is going to wrap the trim on my house -- I have vinyl siding, but the trim is wood and is rotting in some places and needs painting. He noticed my electric power box was falling off the house and said I need to call an electrician to get that taken care of right away.

Drinking cold water today I felt a chill in my front tooth, where I have I guess its called a bridge --three fake teeth cemented onto two real teeth that were whittled down to spikes so they could better hold the fake set. I've had them for about twenty years. They are feeling a little woobly. I will probably ignore it for awhile.

Got an electric and a gas bill. The electric was on the high side -- AC and the hot tub probably accounting for most of it. I did clean the hot tub out, and enjoyed a sojurn in there. It is my one luxury.

I finally got to Home Depot late in the day, and bought a flower pot to put in the big empty flower pot I have had on my front step landing for a couple years. I also bought some cedar mulch to put around the mailbox.

It will be good to be back at work tomorrow, earning money. I'm lucky I'll be in the suburban town for my regular shift. I had swapped out of it, but the guy I swapped with needed to book, so I got the two days back.

Like a Paramedic/Pink Flamingos

A half hour to go till our crew change. My partner wonders if he should ask if we can go in. Its a little touchy with the dispatchers sometimes, but it is time for us to head in.

Just then they call our number, and I am sure, the dispatcher will say, "bring it on in."

Instead, he gives us a call. Possible CVA.

On one hand I am pissed because the radio has been fairly quiet and there really should be other cars available to respond instead of us, but on the other hand, we are on the clock, we're getting paid, and most nights we get off on time, which is a huge change from how it used to be when I started over a decade ago. We were often held two hours or more. As long as you were in an ambulance and hadn't punched out yet, you were fair game.

We get there and find a seventy-five year old male cool, clammy and convulsing. He's an insulin dependent diabetic. Quick sugar test. Reads LO which is less than 20. Really LO. I put in an IV, give him an amp of D50. He opens his eyes, knows his name, skin no longer cool and clammy, but he's still a little confused. Recheck his sugar. It's 95. A little lower than I would have anticiapted, but not unreasonable. I give him another amp. Perks up more. His daughter asks if it is neccessary to go to the ER. She says she feels comfortable watching him. He drinks a glass of orange juice, eats a hamburger, still doesn't feel quite right. Has never had his sugar this low before.

We discuss reasons his sugar may have gone low. He may not have had lunch -- in fact from talking to him, he probably missed it. He was working about the house more than usual, and he gave himself some insulin right before dinner. All logical explanations.

We recheck his sugar. Its 120. That's too low for 2 amps of D50 and a hamburger and a glass of oranje juice.

Now all along, I have been thinking refusal, going so far as to explain that he needed to eat, be monitored, sugar checked before bed, MD consulted tomorrow, call us if anything unusual happens, etc. And as I mentioned the daughter is comfortable watching him, and doesn't want to go through the six hour ER wait.

And I am thinking, we might not get out so late after all. It'll be a refusal, we're near the office, I may well have time to go to Home Depot and do a little yard work (the neighborhood association President visited me a couple nights ago and politely asked if I was planning on doing any painting or landscaping. He said he heard I had busy scedule and maybe I needed the names of people to do the work for me).

But I am starting to get troubled by the inability to get his sugar up higher and his continuing statement that he doesn't feel right.

We call his doctor to consult with him. We don't get the regular doctor, and this guy doesn't know the patient, but he agrees maybe we should go to the hospital afterall.

In the ambulance, I recheck his sugar. It is now down to 83 and he is speaking a little slower.

Another amp of D50. Pulling into the parking lot, I recheck the sugar again. 240. Finally.

I give my report to the triage nurse, and later the room nurse, and shake the patient and his daughter's hands. They thank me for not leaving, for staying until he was all right. And I am thinking I am glad he wasn't a tough guy, I'm fine, I'm not going to the hospital type. Otherwise I might have gotten that refusal, and another ambulance would have been on the way before the night was over. Or I might have stayed and made him go when he didn't clear up completely. We won't know.

What caused his sugar to drop? Maybe the reasons cited above. Maybe something else? An insidious tumor? A breakdown in his body? Bottom line, he needed to go, and I'm glad he ended up there.

We punch out an hour and forty minutes late. That's okay because the call made me feel like a paramedic. The man complimented me on my medical knowledge and his daughter told me she thought I was in great shape. A little flattery goes a long way with me.

***

Seven calls total today. A wait and return transfer, a diaylsis transfer, a anxiety/chest pain, a fifteen year old kid acting out, who punched a wall and threatened staff at a group home, a woman who tripped on the sidewalk and the above diabetic.

On the diaylsis call, when brought the man back to his room, he asked if we could put him in his chair by the window so he could eat sitting up. We had to move the bed and some furniture, and attach the feet to his wheelchair. He was happy to be sitting there by the window looking out on the sunny day, instead of laying in his bed on top of several sheets he'd accumulated in the days transfers. Getting him comfortable and happy -- that also made me feel like a paramedic.

***

Off tomorrow after nine straight days.

Plan for the day -- work on the yard (which I rarely see in the daylight) so the neighbors don't get too upset.

Now where to buy pink flamingos?

Or Vice Versa

Called for seizures at a nursing home and found a woman having a partial seizure. She was alert and oriented, but the right side of her body was twitching. It had been going on for almost forty minutes. She said she'd been having these episodes lately, but they usually stopped after fifteen minutes. This one didn't stop, so she called a nurse. There was nothing in her records about having seizures. I gave a miligram of Ativan and stopped the seizures. She slept most of the way to the hospital.

One of my small pet peeves these days is how equipment doesn't all work together. In an effort to make our gear safer, we are using retracting syringes. The problem is Ativan is very viscous -- nearly impossible to draw up through a 25 gauge or even a 23 gauge needle. We used to take the little needle off the syringe and attach a 20 or an 18. Can't do it now. The retracting needles don't come off. Today I drew up the Ativan with a 5 cc syringe. Our Ativan comes 2 mg in 1 cc. So I had to draw up a 1/2 cc, which is a little more difficult with a 5 cc syringe than with the proper 1 cc syringe.

I had to change narcs at the pharmacy. They have a buzzer you have to ring to get them to come to the window to help you. Next to the buzzer is a sign that reads "One buzz will get you service, two or three might not." Well, I buzzed once, was ignored. Buzzed twice. No deal. Three times. No luck. These are all at five minute intervals. There are people in there. Maybe they all assume someone else is helping me. The fourth time finally does it. A cheery pharmacist helps me. While waiting I was thinking about vandalizing the note, writing something like "Or Vice Versa." But there is a hidden camera in the hallway down there, hidden in one of those casino style round domes that hang down from the cieling. They probably would have no sense of humor if they caught me on tape. I'm thinking about maybe writing a note, palming it with tape on it, and going down and leaning against the wall very casually and sticking it there.

***

Got called for an unresponsive at a nursing home and found a elderly Down's patient, who had passed out, and had no blood pressure or pulse for awhile, but then was now back at her norm, except her pulse was a little slow. While they are telling us this the patient is passing her bowells. She had according to the aide, who changed her diaper, a "humongous BM."

Our guess was she vagaled out while trying to go earlier.

***

Did two refusals -- a 13-year old with a bee-sting and a 16-year old with a small cut on her palm. We waited over forty minutes for the first patient's mom to show up. The second patient's mom I talked to on the phone and got a refusal that way. The girl was at work and was planning to continue working. The mom said she would come get her in a while.

That was the day.

The Way You Like the Call To Go

Last night just before I was set to get off, we got called for a diabetic. Go in the house, find the lady passed out in a car in the kitchen. Cold, clammy. Insulin dependent diabetic. Had been at the hospital earlier for a broken shoulder.

I pull out my IV kit and glucometer. I draw up a lock, put in an IV and check the sugar.

277.

I have to say I am surprised.

I check her BP 80/40. Feel her pulse, expecting it to be low. Its 80.

We get her in the stair chair and by the time we are down in the ambulance, she is alert, dryer, her BP steadily coming up to 110 then 134 then settling around 140/70.

I wish I had checked her pulse or gotten her on the monitor right away. I bet she vagaled and her pulse was probably low. I would have liked to have recorded it -- it would be good to show the hospital -- help them with the diagnosis.

Sometimes you get tunnel vision because 95% of the time your vision tunnels right in on the proper problem.

***

This morning we were sent for a lift assist. Lady with COPD needs help getting up. She admits to feeling weak. The cops have picked her up, but she has called her doctor and he wants her checked out at the hospital. She doesn't appear in too much distress and since the cops told us to just bring the stretcher in, that's all we have. We get her in the back, and since we are blocking both cop cars in the drive, I tell my partner, its okay to just go ahead, just drive slow. The idea being we won't hold the cops up and I can get my work done on the way.

My partner is a great partner, but he drives too fast like most people in the service who don't ride in back. I assess the patient, listen to lung sounds, put her on some 02, do vitals, get the IV, call the hospital because we are getting close all while trying to keep my balance. I finally get her on the monitor. She's in an afib about 120-130. It takes me a little while to see the strip clearly due to the bouncing. I figure it out, and then for a moment watch the rate get up to 150-160, then back down to the 130s. I'm thinking wow, she is borderline getting Cardizem, but here I am already at the hospital. Not that I would give it to her at this rate but almost. And then where would I be. Giving a drug in the hospital parking lot. Not the way you like the call to go.

***

Get a call (chest pain at a nursing home) with fifteen minutes to go in the shift, wakes me from a Sunday nap on the couch. I have that disoriented just got up feeling. I stumble to the ambulance, buttoning my shirt. Just then I see a car come careening into the parking lot. It is my relief! He jumps out of his car as I step out of the front passenger seat, leaving the door open for him. I hand him the narc keys. He takes off in the ambulance, while I am left to punch out on time. Whoo Hoo!

Now that's the way I like a call to go.

Homer Jones

We get sent for a premature baby difficulty breathing. Lights and sirens response.

No big deal, I think, it is usually nothing, although the last time I was dispatched to such a call it really was for a dead baby.

Funeral

We get the update we want to hear, "Baby breathing normally."

We arrive to find a twenty-three-day-old baby sleeping comfortably on his mother's knee. She tells us he was born seven weeks prematurely. For about a minute his head turned purple and he stopped breathing. The same thing happened to him yesterday. The mother tells us which hospital she wants to go to. She hands me the baby then goes upstairs to get some shoes. I hold the tiny baby in my hands. It is the size of a small football. I am standing holding it now in the front yard. The two police officers and I are making goo-goo eyes at it.

The grass in the yard is lush. There is just the tiniest hint of September in the air. "Okay," I say to one of the officers. "You go down about ten yards and do a button hook." To the other I say, "Go deep."

They look at me like I am crazy.

"Ready on two," I say.

"You're nuts."

"Did you hear the famous story about Homer Jones?" I ask, "The legendary Alabama wide reciever?"

They shake their heads.

"There was a big fire in one of the dormitories -- you maybe heard about it on the news. There was a mother and her baby trapped on the roof -- too high for the ladder trucks to reach. They had no way to get her down. Then someone came up with the answer -- the great Homer Jones. He had over eighty receptions including twelve touchdowns for the Crimson Tide. He never dropped a pass. So Homer lines up. The mother calls "Hike!" and drops back. Homer takes off. The mother lets loose with the pass -- a perfect spiral. Homer is running and running and it looks like he might not get to the baby, when he puts on a last burst of speed, then leaps, flies through the air, and with outstretched hands and fingertips, catches the baby as he bellyflops across the grass. The crowd goes wild. Hollaring and cheering. Homer jumps up and spikes the baby."

The mother has her shoes now and is stepping out the front door to join us.

"You're going to hand the baby back to the mother now," one officer says.

"Of course," I say.

"Real slow," the other says.

***

Three calls so far: nursing home patient with a skin tear, the baby above, and a three year old who ate a couple children's tylenol.

Names

A couple days ago I read an excellent article in the New York Times about how the health care system is often degrading to patients.

Here's an excerpt

The Importance of Names

After spending almost a year in an oncology ward being treated for leukemia, where she said she was spoiled by the nurses, Shawna Needham, 31, of Thomasville, N.C., had what she called a nightmare experience in a rehab unit.

"The nursing staff was inconsiderate and lazy; it would take them 15 to 30 minutes to answer, just to get help going to the bathroom," Ms. Needham said in an interview.

But she was afraid to complain to the hospital. "If I did that, that's the big time," she said, "and if they got into trouble and found out I complained, well, I didn't want anyone coming at night to slit my throat, put it that way."

Besides, she said, "I really had no idea who my nurses were; I knew none of their names."

Names matter enormously, patients say.

In Dr. Goffman's account of life in a mental institution in the 1950's, he describes the admission process as a stripping away of possessions, "perhaps the most significant of which is not physical at all, one's full name."

In modern medicine, patients more commonly become exasperated because they do not know the names of the doctors or other medical staff. At many clinics and hospitals, staff members come and go without introductions, patients say. Name tags are in lettering too small to read easily; the names embroidered in script on doctors' coats can get lost in folds.

In hundreds of focus groups conducted by Planetree, a nonprofit group based in Connecticut that helps hospitals become more responsive to patients needs, one of the most common complaints that patients had was that they could not tell who was on the care team or who was doing what, said Susan Frampton, president of Planetree.

"What we encourage hospital staff to do is introduce themselves, always, and patients should demand it," Dr. Frampton said.

James Edwards of Kinston, N.C., devised an especially effective technique. After being blinded and suffering severe injuries in a chemical plant explosion, Mr. Edwards spent about six months in a burn unit, where he got to know the medical staff by the sound of their voices.

Mr. Edwards was pleased with his care over all, but he became upset when hospital staff members entered his room without speaking to him.

After one doctor slipped into the room unannounced and tried to give him an injection, Mr. Edwards decided that he had had enough, said his father, James (Red) Edwards Sr., in an interview. His son posted a sign on the outside of his door. It read:

"ATTENTION:

1) Please announce yourself when you come into my room (let me know your name and why you are here).

2) Please let me know what you're going to do and how it will feel before you touch me for any reason.

Thanks - Jim and Red"

The hospital where he was treated, at the University of North Carolina in Chapel Hill, has included Mr. Edwards's sign in a training video for its staff.


You can read the full article at this link:

In the Hospital, a Degrading Shift From Person to Patient

***

I thought to myself on reading it, you know I often do a bad job introducing myself to patients. I more often tell them my name, then ask for theirs, and sometimes I neglect to do either. I resolved to try to change.

After my second patient today -- a man who fell and hurt his ribs, I found myself just getting to the hospital and having to ask him for his name. I did everything else, assess, vital, 02, IV, monitor, except I hadn't yet asked him his name.

I need to improve this.

***

Did four calls today -- a police standby (They were serving a warrant with the SWAT team), the man with the ribs, a lady with dementia and MRSA in her sputum, who tripped and ripped out her foley catheter, and a diabetic.

***

The diabetic, an elderly woman who lived alone, was out cold, blood sugar less than 20. I gave her an amp of D50, woke her up a little bit, introduced myself to her, then asked her again a few minutes later if she knew who I was. She didn't, so I gave her a little more D50, then introduced myself again. She knew this time, but only briefly, as we were finally getting her to agree to go to the hospital (An insulin dependent diabetic this was her first time having a sugar so low), she started acting confused again, so I rechecked her sugar and it had dropped again, so I gave her another half an amp, then asked who I was, and she had no idea, so I reintroduced myself, and this time it stuck. I don't know if introducing myself four times makes up for my neglect in the past, but I am going to keep working on it. And yes, I called her by her name repeatedly. I'm going to be working on that, too.

Working Hard?

After three twelve hour days in the city it was nice to start my shift off with a long nap. I actually slept till 9:30. I'm only allowed to sleep until eight, but I was out cold. The boss was here, and he was cool about it. "Working hard?" he asked when I stumbled to the front.

"Yeah, thank you," I said. I needed the rest.

***

Only one call so far. A syncope at a retirement community. Lady has been having blackouts. Her vitals were okay, but her hands were cool, and while she said she had never had an MI, the 12 lead looked like she'd had an old one. I wondered if maybe she doesn't have an occasional arrythmia.


***

I've spent most of the day at the computer writing.

Tonight, I've got to mow the lawn, and clean the house, and do the laundry. I've fallen a bit behind in the chores.

Drugs for Drug Users

230 lb guy slips in the shower, lands on his shoulder. When we get there he is in extreme pain and has an obviously deformed shoulder. It is either fractured, dislocated or both.

What do you do for pain?

Morphine.

Okay, now here's the catch. The location is a drug and alcohol rehab clinic, the patient is an ex-heroin user on methadone, who is there for cocaine/ETOH abuse.

I discuss the drug options with him. All I have is morphine. Does he have a problem with getting morphine seeing as he is going through rehab? And I tell him even if I give it to him, it may not touch him due to his past use. He's no doubt developed a certain tolerence.

He says he hurts bad. 10 out 10 on the pain scale. I can see that. I give him 5 milligrams, then another five milligrams.

10 of 10 goes down to an 8 of 10.

I call medical control for permission to give him another ten. I do it with some hesitation because I know when I tell them about his drug history they will probably deny me out of reflex.

Another 10 milligrams is a lot to ask for, but that's how much he needs. They say no. From the nurse's voice relaying the doctor's decision I feel they are saying "What are you crazy?"

At triage I show the nurse his deformed shoulder. "Just because he has a drug history, doesn't mean he shouldn't get pain relief," I say.

She smiles and says, "yes, dear." She and I are friends.

I talk to a doctor about it later. He says he is reluctant to give anyone 20 milligrams of morphine. But I argue that 10 is the standard weight based dose for someone of my patient's size just to start.

Another 10 is a lot, he says.

I argue that people are drastically undermedicated in ERs.

He doesn't disagree.

And I say because the patient has used opiates in the past he should get more medication, not less.

That could be true, the doctor says, but he says he would be relucatnt to give that much to someone he hasn't personally seen.

And I add just because I was only five minutes out doesn't mean the patient will he get meds in five minutes at the ER. It will be more like 40 minutes.

Well, that's not always true, the doctor says.

But as I am walking out -- this after I have brought another patient in -- this one for seizures, my patient with the messed up shoulder is just now an hour later getting more medicine. They give him 10 milligrams of morphine. Thank you.

I don't dispute a doctor's right to deny someone the extra morphine, but if we want to take people's pain away -- which is the goal -- we have to be more aggressive than we are.

I have been on a crusade to adequately medicate my patients. I considered it, but did not not let the patient's drug past affect me. Pain is pain.

***

I once had a patient who spilled boiling water on her arm. Entire arm one big painful raw blistering second degree burn. I gave her ten of morphine and called for orders for more. I was denied. When the doctor saw her as I was wheeling the patient in -- she was poor and black, the doctor said the ten probably didn't work because she was a drug addict. The doctor kept on walking down the hall. That really torqued me. She needed more pain relief right then.

Even if she was a drug addict, she was in obvious pain. Burns are very, very painful. And even if she was a drug seeking drug addict, if she poured boiling water on her arms to get a shot at getting high(unlikely and very stupid), then she deserves to get her prize.

What would you do to get morphine? I'd pour boiling water on my arm. Okay, I'll give it to you then.

Same with the guy, if somehow he concocted to break his shoulder so he could get a fix, well, he earned it. We set the bar high, and by golly, he jumped over it.

***

Eight calls today. A nursing home dsypnea, two hospital transfers, an MVA refusal, two psychs, a seizure and the shoulder injury.

Amber Alert

I failed my test. It was a three hour test. I was done in an hour. I knew half the questions and gave my best guess at the others and didn't sweat it. It serves me right for not studying. I'm not too upset because as I wrote before the only reason I took the test was I had paid for it a year ago, and would have to pay another $200 to take it again if I didn't do it this month. I lost interest in the program a year ago, although I still think it is something I may do at sometime. I will just have to study next time. I got a B on the first course with a month of part-time study. I was just hoping for a C on a week of quarter-time study. If I take it again, I will study seriously and shoot for an A.

***

Eight calls today.

Abd pain, maternity, transfer, lethargy, transfer, chest pain, fall from wheel chair with head lac, and muscle strain.


***


When we did the maternity, security had to let us in the door. They have this area now called an Amber Zone where all entry and exits go through double locked doors and are on camera to prevent anyone from nabbing one of the babies.

Later went to a dialysis center, and where we used to be able to hit an automatic button, today we had to speak to a guard over an intercom to get in one door, and then talk to a nurse though a glass window to get in the second door.

I imagined an Amber Alert going out.

"Missing a seventy-one year old female named Mattie with no teeth, a diaylsis shunt in her left arm, and one leg. Last seen accepting a caramel from an eighty year old man with a cane and a brown hat."

File Under

Today was a day about a poorly functioning EMS system. Here are the examples:

1) Sent for difficulty breathing. The fire department arrives thirty seconds before us and they all run into the house while we pull the stretcher. We get upstairs and there are three firemen all asking the patient different questions while one tries to take a blood pressure. I have a paramedic student with me, and we have a hard time getting in to the patient to even figure out what is going on, while the fire guys start giving us a disorganized stream of information. I feel like saying, "okay we are here, you guys can leave now. You're nice people, but you are in the way." One starts trying to put the patient on our monitor, another starts trying to put the man on oxygen, when it is not even clear he is having a hard time breathing. I end up just putting him on a stair chair and getting him down to the ambulance and in back where we can start the assessment from step one. It turns out the guy is in DTs and may have had a seizure. His girlfriend who called has dissappeared before I can really talk to her. It always happens when I go to this town, there are so many people on scene, you get thrown off, and miss your rhythm in just trying to get the patient out of the house. File Under: Why can't first responders leave when they are no longer needed?

2) We are sent to a mental health facility for an EDP(Emotionally Disturbed Person). We are led down a hall where outside the "Quiet Room" we find 17 staff members standing around, at least eight of them wearing blue latex gloves. (There are 17 -- I counted them twice.) The top guy explains to us that the patient is delusional, but he has agreed to come willingly, but he is concerned he might change his mind. I look at all the seventeen people. These are not big bruisers, but skinny academic looking men, a couple ladies in skirts. I can't imagine them piling on the guy and pummeling him if he tries to fight. We wait around until the paperwork is done, then go in the room, introduce ourselves, the guy gets up on the stretcher and comes peacefully. As we leave all 17 are still in the hall. The crazy guy looks at them like he can't figure out what they are all doing standing there watching him. "What they don't have any work to do?" he says as we go outside. File Under: Apparently not.

3) As I mentioned we have a paramedic student. Medic students ride with services for a limited amount of time -- 100 to 200 hours to gain experience to meet licensure standards. It is expected that they will get to do emergencies. We have already done one transfer when we are given another transfer -- a short trip from one hospital to a rehab hospital down the street. A basic car offers to do the transfer for us. Okay, the dispatcher says, then gives us another transfer to a farther town. I say since we have a student, can we do the shorter trip? The basic car then offers to do that one too after the short first one. Okay, the dispatcher says, and then gives us a third transfer. There are least twelve other cars on, including two who are about to clear from the hospital that we have just cleared from. We are the only car with a medic student. We do the transfer. File under: Why Have Paramedic Students Ride?

4)We are sent priority one to a "911 call" in a suburban town for an unknown. After a long ride, there is still no update on the nature. We get there and the PD tells us the woman has some kind of neurological problem and wants to go to a hospital 50 miles away where her specialist is. I am familiar with the woman. She has a chronic problem -- they have never been able to figure out why she has trouble walking and occasionaly with her speech. She says she has been having trouble for the last week and her local doctor wants her seen at the distant hospital. I explain that when you call 911, you have to go to the local hospital. Her sister explains that she did not call 911. She called the company and explained it was a chronic problem and she needed to go to the distant hospital. Somehow the call got transfered to the suburban town as an emergency and two police cars and an ambulance were sent lights and sirens to a patient who really didn't need an ambulance. We work back and forth with dispatch and get permission to take her to the distant hospital. File Under: Sucks to be our Paramedic Student today.

Did seven calls total: 2 Transfer transfers, one EDP transfer, one long distance (911) transfer, a man with DTs, a mild asthma, and a back strain.

I won't complain tomorrow. I hope.

Paradise City

Slept late, went to the gymn and had a power workout. I do my warm up to U2 -Beutiful Day and Walk On. Then I did squats, bench presses, shoulder presses and dead lifts with some abs mixed in to Guns and Roses. Here's my set.

Knocking on Heaven's Door
Live and Let Die
Paradise City
November Rain
Sweet Child of Mine

I used to lift to Neil Young and Crazy Horse (Powderfinger is the best lifting song), then Toots and the Maytals when I was into rapid circuit training (Pressure Drop was the best). But Guns and Roses is my favorite for heavy lifting.

Later I studied for my test on Tuesday, cleaned the house, and then went to a Jamaician picnic where one of the ER techs was the DJ. For $10 bucks I had all the jerk pork, stewed chicken, curry goat and rice and peas I could eat. I was going to mow the lawn, but it was too hot, then it was pouring rain.

I'm looking at six straight days of 12 plus hours ahead.

Hunter Thompson Style

Last night was my birthday so I celebrated by drinking nine Presidentes. I tried to drink a lot of water before I went to bed and took a couple tylenol. When the alarm went off, I was dragging. Since I rarely if ever drink the night before a working day, I was a little paranoid that I might still have alcohol on my breath. I gargled half a bottle of citrus-flavored Listerine, and sucked down a quarter of a bag of mentol lyptus Black Cherry cough drops. I also rehydrated myself with a liter of Normal Saline Hunter Thompson style. I was good to go.

Fortunately no calls for the first two hours, so I slept.

Another what I would call tedious day as a paramedic. Did five calls.

1) Depressed dehydrated housewife who was feeling dizzy. Repeat customer.
2) Woman feeling anxious about the heat, called 911 just so she knew someone was there who would help her if she couldn't cope.
3) Woman in a nursing home rehabbing a knee replacement had a vasovagal syncopal episode while working with the therapist.
4) Sent to a pschy call, but cancelled by PD before we got there.
5) Psych patient at a nursing home punched a wall and was gennerally misbehaving. Repeat customer. The service had even transported her once already within the last 24 hours. She'd just gotten back from the hospital.

***

So how do I feel to be a year older? I feel the same. I don't feel as old as I am. Still its a little depressing to watch the years mount.

My goals for the year?

1. Be a good person. (Speaks for itself)
2. Be a good paramedic. (Don't burnout)
3. Keep writing about what I do. (This blog and a novel)
4. Work alot (Stay financially solvent -- stay ahead of the game)
5. Work out alot. (Stay healthy)
6. Study Spanish (Habla todos los dias)
7. Work on my poker (Stay disciplined, no Tilting)

That's it.

A DOCTOR

It's been one of those nursing home/ doctor office days.

We are sent for severe GI bleeding. Woman with Alzheimers has a black tarry stool indicitive of some GI bleeding. She is oblivious to any problem.

Woman cuts her foot. Severe bleeding we are told by nursing home. Bleeding all stopped.

Woman with Alzheimer's has oxygen saturation in the 70's we are told. For us, she looks fine. Sat is 98%, good color, good vitals. No pain or dsypnea. No distress. I think instead of taking the woman to the hospital, we should take the pulse oximeter to the repair shop. This has become an all too often occurance.

Woman goes to her doctor's for a routine appointment. Says she had lower back pain and shortness of breath on exertion today. She has a history of anemia. She says she gets these symptoms whenever she becomes anemic. She gets blood transfusions once a month. It has been two months since she had her last one. The doctor says she has ECG changes, low blood pressure and may be having a dissecting Triple A. The woman is warm and dry, pain free, with no pulsing masses, good distal pulses, her new ECG looks just like her old one. The doctor says she must be rushed to the hospital and seen right away by a doctor. Her blood pressure is 120/80. I assure the doctor that her patient will be seen today by a DOCTOR.

Fecal Elimination

90 year old lady calls us because her blood pressuure machine reads 160/90 and she thinks that is too high. I have her call her doctor, who tells her to come to his office instead.

***

A woman falls at the bottom of the stairs, hears a crack in her ankle. She gets 10 of morphine and a pillow splint before we even move her. She has a comfortable ride to the hospital.

***

Another 90 year old lady tells her visiting nurse her heart feels irregular. We brought her to the hospital for the same thing several weeks ago. She wore a halter monitor that showed she has tachy-brady syndrome. The nurse is concerned that her blood pressure is only 90/60. I listen to it, very slowly. I get 140/90. You listen too quickly to an irregular rate and you will get a false reading. She goes back to the same hospital. She is in no distress.

***

It looks like one of our medics out here will be leaving in December. He works Sunday, Monday, Tuesday. While I have seniority over him, out here once you are in a shift, you are in a shift. Since I used to play softball every Sunday in the Summer, I chose to work the Thursday, Friday, Saturday shift, and have twice declined the beginning of the week shift. The problem with the end of the week shift is I have no weekend. I have to be at work Saturday morning at six so no late Friday nights, and my Saturday shift ends at ten, so I am too tired to go out, particuarly if I can boned with a late call. I'm looking forward to shifting.

***

Just finished studying "Fecal Elimination." About a year and a half ago, I was bored and heard about this program where a paramedic could get a nursing degree by taking exams. While I had no real desire to be a nurse, I thought it might be a good education and a good insurance policy in the event I hurt myself or overtime dried up. I banged out five courses in five months -- Gerentology, Life Span Development, Anatomy and Physiology, MicroBiology and Nursing 1 with three As and 2 Bs. I took the tests in a nearby town on a computer. They took less than 2 hours and I got my grade each time before leaving. I was all set to take Nursing 2 when I realized while I could probably pass the test, I really hadn't studied and what was the point in taking the course if I wasn't intent on learning.

Anyway, since I had already registered to take the exam, I had a year to take it, and my year ends in September and I have been too busy to pick up a book in that time, so today I picked up the book. I'm taking the test next Tuesday before work.

Here's what's on it: Nutrition, Elimination, Oxygenation, Fluid and Electrolyte Balance, Activity and Mobility, and Rest and Sleep.

Today I learned about enemas and colostomies.

After I take Nursing 2, I have to pay $800 if I want to enroll in the program. You have to be enrolled to take Nursing 3-7. Each test cost about $200. After completing those courses, you do a two day clinical, where you show them you can do IVs, foleys, put pills in paper cups, and then you have to take care of three patients, writing a nursing plan, and making certain you wash your hands all the time, while a grey faced nurse with a pointy hat makes notations on a clipboard. The practical only has a 60% pass rate and costs $1500 to take. I wouldn't want to fail that. I do much better on the writen than practicals.

Assuming you pass everything the first time(and depending on the prerequisites you need), the whole cost for me is about $6000 for the degree. It is good in 48 states.

The place is called Excelsior College.

Excelsior College

I'm not planning on enrolling for awhile -- not until I'm ready to bang out the rest of the courses, which could be awhile. I love being a paramedic, the overtime is unlimited, and I've got too many other things keeping me busy.

Tonight I study Urinary Elimination.

Diamond Rings

Had the day off. Still tired from my trip. Las Vegas was great, but when I compare it to my trip to the Dominican, I feel really bad. There I was helping people and seeing the world in a new way. In Las Vegas I was spending money right and left -- and aside from my poker tournaments which I paid for in advance ($75 each), I didn't gamble. But everybody had their hand out for tips. Waiters, bartenders, bellman, cab drivers. I carried a roll of ones, passing them out two at a time like a big shot. Beers on the Strip were $6 each. $8 in one of the restaurants. Downtown there were only $3.

I got to see what Las Vegas was all about. Rich people in limosines and old people riding around on Larks(motorized wheelchair scooters) with their 02 tanks in the back.

I went into a pawn shop -- filled with diamond rings, guitars, even fax machines -- they said people were always bringing them in, but never coming back for them.

Look at all those huge resort casinos -- Bellagio, Mandalay Bay, The Luxor, MGM Grand, the Venetian and the new Wynn -- all built on people's loses. Now I guess as long as you gamble for entertainment and lose what you can afford to, I guess it's okay.

Still I like what we built in the Dominican better.

Just Ducky

Back at work. Twelve hours in the city. Had a rider -- the ER nurse paramedic student who has riden with me before. We didn't do anything exciting. She handled all the calls. I hoped we would get her something really challenging, but no luck. She is riding with me again next Monday for twelve hours. Maybe that will be the day. I think we did seven calls -- the only transfer was an ALS transfer -- a woman whose pacemaker had stopped functioning, and who had a temporary pacemaker inserted at a small hospital. We transportered her to one of the bigger hospitals for placement of a permanent pacemaker. The call didn't involve much more than monitoring her.

Other calls were for a two year old whose diaper seemed filled with ketchup. The mother was concerned it was blood, but it just looked like tomato paste. Very strange. The girl was fine, pain free, normal, laughing girl. The Children's hospital put her in the waiting room.

We did a seven year old who hurt his back coming off the end of a slide. There was a motor vehicle accident with no injuries. A twenty-nine year old woman who had been drinking and had cirrohsis, drank and pulled some type of medical tube out of her side because she was tired of having a tube sticking out of her. A woman in a nursing home had surgical stitches removed and a day later felt pain.

***

I didn't mention it two weeks ago, but one of the long-time triage nurses retired at one of the hospitals. She gave me her address and I promised to stay in touch. It will be very strange not seeing her. On one hand life always goes on. Everyone is replaceable in EMS so much so that people might go out on disability and no one notice that they are gone. Still it is hard to imagine not seeing her. You'd ask her how she was and she'd always reply sarcastically "Just ducky."

I hope she enjoys her retirement. I told her her I thought she'd get bored and come back, but she said never.

Viva Las Vegas

I'm on the Strip in Las Vegas. I watch the volcano blow up in front of the Mirage, then outside Treasure Island, I watch a band of pirates attack a ship of female sailors with full cannons firing. I'm walking across the street when I hear a loud crash, then hear a police siren approaching. I hear a strange wobbling sound and look to see a car coming toward me on blown out tires, and realize the car is not stopping. It crashes into a car waiting at the light, then the driver leaps out and starts running, followed by the police officer who has leapt out of his car. The man turns the corner, slips, then the police officer is on him, and another officer appears. They have drawn guns. I can see a red laser light on the man's chest, then suddenly, he is jumping up, then I hear a dull firecracker sound, and see the man holding his arm, and then I am swept up in a crowd.

The whole time I am thinking, wow, I'm in the middle of a Cops episode. Police cars are screaming in from all directions. Pretty cool effects.

I look in the paper the next day to see if there are any accounts of the shooting, but I don't see anything.

A typical Las Vegas night.

***

Had a good time, but spent way too much money. I stayed downtown at an old casino called the Plaza. It was $25 a night for the room. I was there as part of a poker tournament. I didn't win, but I played okay. I went down when my AK suited lost to a pair of kings.

Ate at several all you can eat buffetts, which were good. Saw an awesome show called Ka. Spent a lot on cabs.

Drank Coronas.

***

One morning sitting in front of the hotel, I saw a familar ambulance company pull up, follwed by a Fire ambulance. There was a man sleeping on a bench. They roused him, and made him get up and stumble on, then they left.

On Vacation

No more posts until August 8.

Federal EMS

The following is a link to the National EMS Management Association's position paper on the current discussion reorganizing EMS on the federal level.

Position Paper

I don't know what will happen, but it will be a great day when EMS comes out of the giant shadows of police and fire to gain its rightful place as a third service.

Some days

100 years old, lives at home, feeling nauseous. Vitals were better than mine.

54 years old, feeling lightheaded, has been for two weeks, thinks it might be menopause. Has called her doctor several times for same problem. He thinks its menopause. Calls us because her doctor is at lunch. Vitals, except for a BP of 150/80, not quite as good as good as mine. She decided to have her son drive her to the doctor's office.

Woman in nursing home fell. Complains of shoulder pain. Has dementia. No deformities, full range of motion. They want her checked.

Lady hit in head by box at work. Has bump on head. No other complaint. Vitals as good as mine. They drove her from one building to nurse's office. Nurse had left for day, so she took shuttle back to her office. Friend told her she should call 911 to record event. She decided not to go to hospital.

Exciting job.

Some days.