Tuesday, August 23, 2005

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?