Really Bad

Woke up to snow this morning. Not happy about that. Even on Thanksgiving.

First call came in as a patient with a recent heart transplant, seizing and making funny noises. I thought for certain it would be a code. We found the man postictal, tackycardic at 120 and hypertensive 180/120. He's had the transplant just this month. His girlfriend said he had no history of seizures. He gradually started to come around till he was almost fully coherent. Then just after we took him out of the ambulance at the hospital, and had started wheeling him to the ER door, his girlfriend said, "What's happening to him?" He was back seizing, a violent full body seizure. It stopped just as we got him into his room. I haven't been back yet to see if they found out anything. I'm guessing maybe his CAT scan might show a bleed.

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Later we did rollover(skidded on ice, flipped over into a snowbank), but the patient is up and talking, denying any injury, see to be upset that he spilled his just purchased Starbucks coffee, than that he'd totalled his new SUV.

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Late in the day we get called for an 80-year old man unresponsive in an exclusive area of town. We wind our way through the house to find the man on the carpet, with cool, grey skin, but alert. He says he felt a stomach ache, then tried to get to the bathroom. His family says he then passed out. His pulse is 60. He says he has to go really bad. I ask my crew to bring the stretcher over, and with one partner, stand the man up to see how he does. He is still alert, though slightly wobbly. He is insistent on using the bathroom. It is just a few steps up. I have the sense that he is about to explode with diarrhea, so on my initiave, we help him into the bathroom. I get his pants down and sit him on the toilet.

Yes, that's what I did. Do'oh.

He says he is all right. I turn to see where the stretcher is. I see it is stuck in the kitchen blocked by a a kitchen island. I tell my partner to help our newest crew member maneuver the stretcher around it, then I turn back to the man, and he is out cold, still sitting on the toilet, urinating a fountain of pee onto the floor. I shout for help, and give him a sternal run to no avail. The stretcher is still in the kitchen, so my partner and I have to pick the man up and carry him into the kitchen. I am worried that he is coding as we carry him.

It takes him awhile, but he finally comes around. We want to take him to the closest hospital, but the family is insistent that we take him to their hospital, which is a bit further. The man's pressure is 83/50 and he is still complaining of belly pain, but I relent and agree to go there.

I dump a half liter of fluid in, and get his pressure up to 95/60, though he is still cool and clammy. He still has the pain. I don't feel any pulsing masses.

I'm not crazy about going to this one hospital because they tend to converge on you ER style -- they are not very busy -- and with so many people asking questions at the same time while others remark what took us so long, it is a little hard to maintain a coherent report. I had given an ETA of 5 and it was more like 10. Sorry. Here's the story (if you care to listen).

While I write up my paperwork, the entire family from the house is there in the ER hallway, rehashing the call. I hear everything from they wanted to go to the other hospital to they put him in the bathroom, they couldn't get the stretcher in. They are talking like this even though I am standing near them, writing a report against a counter. It's like I am invisible.

When I get back in the ambulance, I say to my partner, "So maybe I shouldn't have sat him down on the toilet."

What can I say?

You do what you do.