Monday, September 19, 2005

Day Three - "Dooh!"/EGO

I sleep through the night. In the morning I have a breakfast of sausage, grits, biscuit and fruit.

I work with a nice 27-year-old guy from Oregon who would like to go to medical school. He has been in Mississippi going on three weeks so he is familiar with the roads.

Right off the back we are sent for a chest pain at one of the red Cross Disaster relief centers. I have told him I am a good map person, but we shoot by the road because there are no street signs. I have to gauge by the map and what appear to be roads and I misgauge. We swing around, and the delay is only a minute or two.

The Red Cross center is in an industrial park. As we approach the road is crammed on both sides with cars for a great distance. People walk along the sides of the road as if they are walking to a sporting event. There is a huge line outside the gate, mothers carrying babies, trailed by children of varying sizes, old people holding each other up. A guard lets us in the gate and directs us toward a big open tent. Another man points us toward a table where three woman sit, none of them looking particularly well. I ask who is sick and I am directed to two of the woman, who are both pale and diaphoretic. Their stories are similar. Both have had bypasses, one has two stents, both have been taking nitro. Both refuse to go to the hospital. The heat is over 100 degrees and sopping humid. Its just a little chest pain,” one says. “I’m feeling quite better now that I am in the shade. I appreciate your wanting to help, but I’ll be fine. I don’t want to make any trouble.”

I plead with both of them to go to the hospital, but the closest I get is calling their physician. The line is busy, the woman says, though I wonder if she has not dialed her own cell phone number. While I am talking to one of the other women, the other woman says. “Doctor, I’m feeling fine really. I had a little chest pain, but its over, what you want me to come to your office, after I’ve got my check, well, twist my arm, okay. Bye.” I have turned now and am asking if I may talk to him, but she shrugs and says “Sorry. I hung up. We both are going to see him later when we’re done here. Thank you for being so nice and caring about us.”

Just then, a large man profusely sweating man is being lead over by two others. He is only 37, but he has a history of an MI. he too has been gobbling nitro. “You can check me out,” he says, “But I ain’t leaving until I get my check. I waited sixteen hours yesterday. I’m not leaving.”

Nothing works, I make every appeal possible. Think of your family, think of the future. I don’t want to come back and have to pound on your chest. No go. He isn’t leaving. After giving them all aspirin (and doing 12 leads) we end up with three refusals, and a probably empty promises that they will call if they start to feel worse. The nurse has asked us if we can post a unit at the center. My partner tells me there are relief centers like this all over town with lines as long. I tell dispatch I think we will be sent back here and they have me talk to a supervisor who says he will look into it. I think you could easily lay out fifty cots and start running Ivs on all of them. Walking out there are people leaning against each other, holding each other up. The sun and humidity are brutal.

They send us to a new location, but for the rest of the day we hear other ambulances dispatched back to the center – for chest pain, for dehydration, for asthma.

We are dispatched to another Red Cross center. This line is just as long. This one has an army medical team assigned. We are the second of three ambulances –all arriving lights and sirens for unknowns within ten minutes of each other. An army medic gives us a quick briefing. We have lots of dehydration. We’re in there starting lines. Just go in and help us triage, take the worst ones, and send another ambulance in. It’s getting out of control. The scene is surreal, people in fatigues, crowds of people, a helicopter sweeps low overhead. We go in, and a woman in fatigues says, "We have a baby who isn’t responding. She’s been in line since six thirty this morning. I put an ice pack on her and she doesn’t flinch." I see the baby, and snatch it from the mother. I give it a little pinch and it doesn’t respond. “Let’s go,’ I say. It is too crowded and chaotic in there to do a full assessment. One ambulance crew is loading a large sweating man on their stretcher, the third ambulance is just wheeling their stretcher in now. I’ll let them triage, I’m taking the kid. We race out to the ambulance and I have my partner hang a buretrol, then get in the front and drive. I strap a tourniquet around the kid, but I see no veins. I hold a 24 in my hand, but I don’t have faith to stick. I get out the glucometer, and poke the kid’s ear. Oh, to hear the noise. She wakes up and starts crying like a banshee. Now kids freak me out, and I always want to be safe rather than sorry, but I am regretting that I did not do my patented grab a piece of their skin near their belly pinch and twist hard when I first held her. I was freaked out by their setting. This is just a kid who was tired and sleeping soundly, and who really isn’t very sick. It is certainly no longer an unconscious child. I feel silly at the hospital explaining that I think the kid in fact is really okay. Now that we are in the air-conditioned hospital, and the baby is safely in his mother’s arm, the baby stops crying and seems quite normal. Baby and mother are sent to the waiting room.

Our next call is for an MVA. We arrive to find a woman lying in the middle of the road. The fire department is already there and they have put a collar on her. She is alert, and seems okay. When her air bag went off, the she got out of the car, but then lay down in the road because she thought that was the thing to do. I get the stretcher and wheel it over. I look for the release to lower it, but I can’t find it. I nod to a cop on scene and ask him to take the head end, while I pull the foot release and we lower it down. We get the woman c-spined, and over onto the stretcher. I am at the head end now, and a firefighter is at the foot end. Ready to go up I say. He pulls the release and I lift up, but the wheels don’t drop. “You have to pull the release," he says. I look at my end and there is a release there too. We both pull our releases and the wheels finally drop. My partner has to show me how to put the stretcher in the ambulance. The head end has to go into a load position, then a latch is pulled, then the foot end, pulls a lever and the stretcher is pushed in. Boy do I feel stupid. I have never seen a stretcher like this before. The worst part is my partner asked me in the morning if I never how their stretcher worked. My internal answer of “Daah!” in the morning turned into "Dooh!" when I had to work the stretcher. You learn something new everyday.

Next we are sent to another hospital to pick up a man who has been having increased confusion and falls for a week. They did a CAT scan and it showed he has a subdural hematoma. One of his pupils has just blown. He needs to be transported to a distant hospital where they have a neuro ICU. He is a 73 year old with a thick Mississippi accent wearing a white tank top tee shirt. Between his accent and his confusion, I have a hard time carrying on a conversation as we race along the highway.

On the way back, we stop at a highway rest stop to get a hamburger. Gas is a little expensive down there.

We're posted in the outskirts off the highway. A guy approaches us and asks us if we have any glucometer strips. He is a nurse with a team who's job it is to check on the welfare of other nurses working in the disaster area, and they have a diabetic nurse in the hotel there who isn't feeling well. They have glucometers but no strips. His glucometer isn't compatabile with ours so he ends up asking if we wouldn't ind going in and checking on the nurse with him. We bring all our gear, including the glucometer and the heart monitor. There is another nurse in the hotel room with the nurse who isn't feeling well and she is somewhat offended by our presence. I go to take vitals and she says she has already done that. She tells us she has fully assessed her, she is a nurse and all she needs is the woman's blood sugar checked. My partner and I both have the impulse to slam her, but we don't. I think we handle her with respect, while still doing what we need to do. There is no sense in getting into pissing fights when the goal is to just help people. The ill nurse refuses transport. I have the offended nurse sign the refusal as a witness. She puts a lot of letters after her name.

We go to a waffle house to use the rest room, and end us in a conversation with a retired army chaplin and his wife. The chaplin, who wears an oxygen cannula has come down from Michigan on his home to help counsel people. he starts telling us about World War II, while his wife sits there patiently. We hear about the time the Germans came over the hill at them. We shake his hand, compliment him on his life and his heart for coming down to help people, then make our exit.

I start to think about the issue of EGO and what motivates us to "do good." Why am I in Mississippi? Is it because I am "good person" or is it because I want to be able to tell people I went to Mississippi so they will gather around and hear my stories? Am I pure of heart or does my heart have other motives? And does it really matter what your motives are if you are doing the work? I always want stories. I like to be able to say "There I was!" When I was a kid one of my favorite cartoons was Commander McBrag. His catch line was "There I was tiger in front of me, lion to the left, a band of savages attaching from the rear, an alligator filled swamp on my left."

At the camp one night there was a big debate over people who come for the wrong reasons. One person said they came because they wanted to help people, not because they wanted to say they were there. I don't think the reasons you do what you are ever so clear cut. One one hand we can puff out our chests and say we are here helping the victims of the hurricane out of the goodness of our hearts, which we are, but at the same time we are not volunteering in the strictest sense. We are getting paid to be here. Few of us asked what we would be paid or how we would be paid when we volunteered to go. I would have gone for nothing (as when I went to the Dominican I paid my way). But even if I wasn't being paid, it wouldn't be for nothing, because I would be getting experience in return, and experience to me is as valuable as money. I also go because it makes me feel better about myself. Would I go if it made me feel worse? There is some hardship in leaving your life at home for a week and sleeping on a cot in a room full of snoring people, but it is only a week.

The people who impress me the most down here are not the people from FEMA or the Red Cross or the ambulance or the utility workers, it is the common people -- individuals or small groups who have collected supplies from their neighborhoods, loaded up trucks and come down and passed the stuff out -- food, water, clothing, even money. No bureacracy, no processesing or paperwork, just getting the work done. There is a purity there that I admire.

Our company has a plan where you can donate some of your unused paid time off to fellow employees who are sick or suffering hardships. I have never done it. Maybe I should. I definately should. I should do it and not tell anyone, except whoever I need to tell in order to do it.

I admire anoynmous donors.

It is sort of like the old saying If a tree falls in the forest and no one hears it, does it make any noise? Of course it makes noise.

I read an article in USA Today about the guy who founded Domino's Pizza, then sold it for $1 billion. The guy gave up his yachts, his mansions, his rich life, and has very quietly been living a simple life, and giving all his money away to charitable causes, and giving it away without fanfare.

What would most churchgoers do when faced with this decision? Every week, you put a twenty dollar bill in the collection plate as all your fellow church goers look on. You have the choice now, of giving God or whoever $20 on the sly, which he will match also on the sly with the only sticking point being when the plate is passed to you, you have to pass it to the next person without putting any money in. So the church is getting $40 instead of $20 because of your choice, but all your neighbors now think you are a cheapshake, but you can't tell them why you don't put anything in. What do you do? It should be an easy choice.

I'm working on trying to be the best paramedic I can this week, and aside from screwing up with the stretcher, I feel I'm doing okay. I am besing excellent at using my name and the patient's name. I am also slowing down my talk, which I think is a good idea. Years ago I was a telephone soliciter for a national company, and when I would come to work each day, I'd get a new list of numbers to call. Some days I called people in big Northern cities like Pittsburg, others, I'd call customers in small towns in the South. I learned that what worked in one place, didn't always work in the other. In Pittsburg I used my best rapid fire TV/used car salesman voice "LetmetellyouDaisyHaveIgotaDEALforYOU. IamofferingyouTWOthat's rightTWOTWOsilkpillowsforthepriceofONLYONE. If I used that voice in the the small Southern towns they would hang up on me. I had to slow it down. "Well, hello...there..Daisy...How are you...this fine morning...Let me tell you why I am calling."

In addition to tyring to talk slower, I am asking myself in each situation, what does this person need from me. How can I leave them better than when I found them? The old chaplin in the Waffle House. We listened to his story about the Germans that he has told a thousand times, we complimented him and his wife. We tried to show that we valued him and appreciated him, then we left before he could tell us another story.

Dinner is over before we get back, but they have set aside meals for the later crews. Tonight there is pork and it is good.

I have no trouble falling asleep.