Home

They are paging out for open shifts. "Anyone available to work this evening, any hours, we could use the help. Holiday Pay."

I am tempted. I could always use the pay, particuarly holiday pay, which is two and a half times base. Serious dough.

Its the last day of the year, and I have been an ironman this year. It seems appropriate that I close it out on the job.

But I don't call in. It is after all New Year's Eve. Sometimes you have to let someone else answer the call.

I stay home.

It is snowing outside, at least three inches so far of powdery white snow. Very beautiful outside. Occasionally I can hear a siren in the distance.

I eat a dinner of lobster ravioli with a marinara sauce I made myself.

In spite of myself I stay up waiting for the ball in Times Square to drop, signifying the start of a New Year.

I'll have to get up earlier than usual in the morning to shovel the driveway. And then I'll take a slow, and hopefully, safe drive to work.

Starting at 6:00 A.M. I'll be back on-line, covering the town.

Happy New Year Everyone!

Very Considerate

I'm working with another medic today. Nice guy who is going to PA school. He loves being a medic, but he has to look toward the future. He's been studying hard the last two years and is just about ready to start the clinical portion of his program.

Our first call is for a man down on the side of the road. Its a kid in his twenties sitting on the ground beside of a rental car. The police officer has him on a nonrebreather, and the kid is sucking it empty he is breathing so fast. He is grabbing his chest and babbling about how he can't breathe, call his lawyer, a car was chasing him, take him to the hospital get him out of here. We pick him up and get him in the back of the ambulance. He is going crazy. I have never seen anyone hyperventilate so hard. "My hands are cold, my hands are cold, do your jobs, take me to the hospital. You are not doing your jobs, take me to the hospital." We try to get him to slow down his breathing, but he is just completely going nuts. My partner gets out the Ativan. The guy sees the needle and says, "No, no, no. I'm against needles. I don't do needles. You can't do this. You're supposed to help me. I called for help, not needles. No, no, no. I refuse, I refuse."

I drive in. The guy babbles the whole way. In triage, he says, "I want my lawyer. I want my lawyer called. I've been kidnapped. I know my rights. Hippa. Hippa Violation. You're all going to lose your jobs. I'm not answering any questions."

He gets into it with the triage nurse. My partner takes the Ativan
syringe out of his pocket. He shakes his head. We should have just gone ahead and hit him with it.

All the way down the hallway, the kid is babbling. "You're losing your jobs. I know my rights. Call me lawyer, call my lawyer right now."

"What kind of car was chasing you?" I ask.

"What?"

"I was curious because there was a car following us on the way to the hospital."

"They couldn't follow. You were going lights and sirens."

"No we weren't. We went right, this car went right. We turned, it turned. I looped around, it looped around. Why were they chasing you?"

"It's not your business. Quit asking questions. Get my lawyer. Get him right now."

We get him in the room, and move him over on the sheet. All the while he is saying, "Don't touch me, don't touch me." He screams when we move him even though we don't touch him, moving him only with the sheet he is laying on and moving him gently. "I want my lawyer," he calls. "You've injured me. You've injured my back."

Some nurses and techs come running to the room. We just shake our heads.

"I want my lawyer!" the kid shouts. Then suddenly he gets up off the bed, then cluthes his chest and does a slowmotion swan dive to the floor. And lays there like he is out cold. The triage nurse has arrived and starts cussing him out, telling him to quit faking and get up.

We just walk down the hall.

His urine comes back positive for cocaine.

***

We get sent for an EDP (emotionally disturbed person). The cop meets us outside and says it is an old lady with Alzheimers. She took the trash out in her nightgown even though the trash doesn't get picked up today. This has happened before -- the woman wandering the neighborhood in her nightgown. Her husband came out to get her and she attacked him, scratching him quite viciously. She is now saying the neighbors attacked the house with snowballs and beat her husband up. The cop says the husband can't handle her anymore.

We go inside and find a sweet old woman sitting in her nightgown in an arm chair in the living room.

"I don't want to go to the hospital," she says.

"You brought this on. You brought this all on yourself," the husband says.

Another police office tries to usher the husband back into the kitchen.

"But they attacked our house," she says. "The neighbors."

"In your dreams," the husband shouts. "In your dreams!"

"Will my husband be coming to the hospital with me?" the woman asks me.

"No," he shouts again. "Take her out with the trash for all I care!"


In the ambulance, I ask her questions to test her memory. She is able to answer some, but not others.

She thinks today is Christmas. She knows her birthday. She says she thinks they have lived in their house for twenty years.

I ask her how old she was when she met her husband. She says she was twenty-five, but she doesn't remember where she met him.

They had a big wedding. They are Greek. Niether of them were good dancers.

She doesn't remember the names of her children. They are grown up and married.

She doesn't know what happened today or why she is in the ambulance.

"What qualities did your husband have that made you want to marry him?" I ask.

She thinks a moment, then smiles, remembering. "He is a kind man," she says. "Always very considerate. Courteous. He always treats me well."
***

We do a transfer -- a man paralyzed twenty-five years ago in a car accident -- now in a nursing home. He has a huge bedsore on his bottom. I recognize him as a man who used to live in an apartment who we were always picking up when he fell out of his wheelchairdown or when his colostomy bag burst.

***

Last call is for a woman with dementia and an elevated blood sugar.

***

Unless I pick up a shift in the next three days, I am done for the year.

Clean The Rig

Today has been one of those days where you do a call, come back sit down, start working on something and before you can ever get really started -- whether its a writing project, a meal, odrdering supplies, or laying down on the couch, as soon as you start, you get another call.

Here's what we did today. Nursing home chest pain/CHF. Motor vehicle. Fall at the senior center. Kid shot with a BB. Nursing home UTI. Psycogenic Shock -- girl fainted when family was talking about illeus's. Little kid who choked on ice cream. Woman vomiting with abdominal pain.

Twenty minutes to go. I've finished my paperwork, and am now out to clean the rig. I have switched ends of the week out in the suburbs, and the new medic on the other end of the week who will share my ambulance is a nice woman who is very neat and orderly, and the first day she was here, she cleaned out the refrigerator, which needed it. She really cleaned it out. Scrubbed it out. So I need to leave her a neat rig.

Slow Day

Three calls. Kind of a slow day.

Did the pull cord call at the apartment complex again. Still no one there.

Did a lady with "pink" blood coming out of her rectum. She was walking around with only slight discomfort when we got there. Stable vitals.

Last call -- a late call -- was a chest pain. Stable vitals. Good ECG. Some aspirin and a nitro.

That was it.

Went to the gymn on the way home, but it was closed.

Christmas

Christmas morning. I'm in at work. I enjoyed my three days off. It was nice to have a semblance of a life outside of work. I went Christmas shopping, got to the gymn twice, did some cleaning, paid bills, and played some on-line poker.

It was particuarly good to be in the gymn -- not that I worked out too hard, but I did work out hard for someone who hasn't been in the gymn as much as I should. I really am going to try to make an effort to get in there four times a week in the New Year, even if it is just for a short workout.

Last night I watched Scrooged, the Bill Murray version of a Christmas Carrol, where Murray is the bah humbug head of a big TV network. Bill Murray is a very funny actor, and Scrooged always chokes me up at the end, when the little mute kid speaks for the first time and says "God Bless us Everyone." Then they all start "Singing Put a Little Love in Your Heart" with Murray singing like his old Saturday Night Live lounge singer characater.

But sometimes I feel like I am a Scrooge. I am always working on Christmas. My brother invited me to go to New Jersey and have Christmas with him and his family this year. Of course I couldn't go -- I had to work.

What kind of a bah humbug am I? Working on Christmas all the time. But working in EMS on Christmas is different than working a regular job on Christmas. I have always been proud that when my name is written in the book, I can be counted on to be there. It is not like we can just close up shop on Christmas.

I read an interesting article -- "Will Words Fail Her?" -- about a young Chinese fiction writer, Yiyun Li, who wrote a great collection of short stories called A Thousand Years of Good Prayers. One of her teachers, James Alan McPherson, who was also a teacher of mine many years ago, was quoted in the article as saying in American fiction, we have lost the community voice. It is all about the self, but that community voice still exists in writers in Japan and China, writers like Li.

In this job over time you can lose yourself. You become a part of the community, the blanket of watchfulless over the cities and towns that you cover, and that becomes more important than who you are as an individual. People say it is bad to lose yourself in your job, and I don't disagree -- you need balance in your own life. But at the same time, I don't think it is neccessarily all bad.

In Scrooged, Murray's ex-boss, who comes back as the dead Jacob Marley, says his work, his life should have been that of mankind, not TV ratings. I think you can make the arguement that our work in EMS is the work of mankind. There is a certain privledge in looking out over the community, in being its protector, particularly on Christmas Day.

There is a fine line here, but if you find redemption in your work, that is no small thing.



***

In other thoughts, I rarely follow up with my patients. If they are in the ED when I come back with a new patient, I will stop in and see how thay are doing. Or I might ask a nurse or a doctor what was the deal with a certain recent patient from earlier in the day or maybe even the day before, but I am not one of these guys who is always going up to the floors to reintroduce myself to the patient as the paramedic who brought them in. Not that there is anything wrong with it. I did it a few times when I first started. Haven't for years.

A few weeks ago, we did a code save. It was my third code save this year. By "save" I am using the iffy terminology of a cardiac arrest patient brought to the ED with a blood pressure and still alive when we left the ED.

When it comes to cardiac arrests, unless they are talking to me when I leave the ER, I guess I just assume they die eventually. I was surprised once. I got called for a stroke. I found a man sitting on a neighbor's garbadge can, where he had been talking to them after driving up in his car, when he suddenly slumped over. We went lights and sirens to the hospital following the stoke protocol. I dug his ID out of his wallet and was shocked by the name. It was the same name as a man I had done in a cardiac arrest a year before. I'd gotten a pressure back, but never thought anything more of it. I just assumed he had died or was a vegetable in some nursing home. To make it an even better story, his massive stroke turned out to be a TIA and he was talking to me before we even reached the hospital. He was in fact the same guy. At the hospital I met his family and they said they had tried to get in contact with me, and had gone to the fire station to leave a message for me, but hadn't heard anything back. Niether had I.

With that story in mind, and because on this code, as I have written before, my two partners were a young man going through the EMT class and a 25 year plus EMT, both of whom it was their first code save, I thought it would be nice to find out how the lady was doing. She was after all breathing on her own on the way in. I had found out that a week later she was still alive in the ICU although I had no report on her condition.

I began to imagine her alive. I imagined us visiting her back in her home with her family and all her granchildren and great grandchildren around her. I thought how happy my partners would feel. For one it would be the crowning achievement of his career, for the other, an indelible moment that would guide him toward a long and rewarding lifetime in EMS.

I went in to see the hospital's EMS coordinator, and ask him if he could look up the three code saves I had this year, particularly the last one, to see how they made out. He said it would take some leg work, but he would be happy to do it for me.

I thanked him, then went out to the car, and opened up the newspaper and there she was on the obituary page -- our save -- rest in peace. I saw the coordinator later that day and thanked him for his offer, but told him not to bother looking up the others.

***

First call of the day is for severe bleeding. It turns out to be a burst abssess in a teenage male, who had injured his thigh and was going to have surgery to remove the undrained blood. At first I didn't know what it was. His friend was holding pressure on it, and had told me about spurting blood. We removed the pressure and then after a moment's delay this huge hunk of blood began to flow out of the large open wound. I covered it right back up and held pressure. He screamed. When I uncovered it again, I saw it was just pus. It was like pus from a boil, except it was at first, dark red, then pinky. The pus that flowed out was larger than a grapefruit. At the hospital, as I am giving my report to the nurse, who hasn't seen the patient or the wound yet, is chowing down on these little pastries. He hands me a creme-filled one. As soon as I am done with my report, I walk around the corner and drop it in the trash can.

***

We pick up a naked four hundred pound woman in a dirty apartment who fell and can't get up. We slide a board under her, lay her down on it, strap her in, then I take the head, and lift her up straight to her feet while my partners struggle to keep her from slipping down. She is righted. We get a refusal. Happy Holidays and wishes all around.

There aren't any stores open today and I haven't brought much in the way of food. But I admit I don't have much of an appetite right now.

***

At six they send an ambulance out from the city to pick me up and take me in to work another six hours of OT. They were paging out for people to come in for Christmas night and I volunteered yesterday if they couldn’t get anyone else, but they wrote me right into the schedule.

It’s pouring rain, but the temperature is in the high thirties so its just wet out. We do a transfer from the ER going back to a nursing home. Later we do a community an assist, helping a mentally disabled relative make it out to the car where his ride downstate waited. He had just frozen up and wouldn’t take any steps. We just picked him up and put him in the stair chair and carried him out of the house, through the rain and down several sets of stairs to the car waiting at the edge of the icy drive. The family all came out in the rain and thanked us. I saw a man palm a green bill and he started to make a gesture offering it to us, and while he was saying something like at least get yourself some hot coffee, I was saying, no, no, thank you anyway, we are highly compensated. It’s our job. Pleased to be of service. Happy Holidays.

***

It's getting time to head in. Another car is sent for a stabbing. A few minutes later we get sent for a man hit in the head by a gun. We pull up on the dark rain-drenched street to find several cops standing in the road with shotguns looking every which way. I hear a cop ask on his radio for a better location, then out of the fog we see a guy come staggering up to us. He is bleeding from the head. I see that we will have to c-spine him, so I have my partner set up the stretcher, while the cops are asking him questions. We get him into the ambulance. He is alert and trying to give the cops a description of the guys who jumped him. He says he doesn't think he got knocked out. He is wearing several heavy coats. We have him sitting on the board with a collar on while we lift his rain soaked leather jacket off, and then his tan hooded sweatshit. I ask him what else hurts and he says his side, his side. My partner sees it first. There is big hole in his side midaxillary down about the level of the costal margin. The hole is actually protruding out of the body several inches, and blood is coming from the wound. We are on our way to the trauma room just like that. The guy doesn't remember what happened other than two guys jumped him and they were fighting. He says he may have heard a gun shot. It looks more like a knife wound. It doesn't really matter to us. We are out at the hospital and into the trauma room. I only had time to strap him down, get his vitals, name, date of birth, social security number and address, quick medical history, and pop an IV lock in.

I show the wound to the doctor in the trauma room and blood starts spurting out.

I am glad we took his coats off-- all those layers.

I remember a story my teacher told me many years ago when I was in EMT class -- about a guy who had been hit in the head with a gun, and was walked into the ER, and placed in the waiting room. He passed out in his seat, and bled out and nobody noticed till he was dead. He had been stabbed, but nobody knew it.

***

After that call, I get dropped back at my suburban post where I will sleep for six hours, then go back on duty for another 12.

Merry Christmas Everyone!

Comfort

Last shift before three days off. I come to work feeling like it is my last day, like I am about ready to retire after twenty years. I fight back the nostaligia.

I am working with another medic today -- a woman, one of our best medics who has recently gone part-time and returned to her old job of selling retail. She says she is happy with her choice. She feels like she has a life again. Less stress, better attitude toward life. She tells me of two other medics who are leaving. One of our best male medics is leaving to take a construction job. A woman is leaving to train as a pharamcist. Another medic is going part-time to become a massage therapist.

On the positive side, an old EMT of ours is returning. A good guy we worked together for a year several years ago, he got fed up with the work, then bounced around from several different jobs, payroll clerk, mental health care worker, lab technician, then a security guard/EMT, who after seeing ambulance crews come into his company, got nostalgic for the streets and came back. Plus he'd just bought a house, and needed to make more money, so he is on the schedule quite a lot. I told him I would sign up to fill some of the open shifts with him.

I generally don't like working double medic. I like to be in charge all the time. When you work double medic, you alternate calls. But it is nice to spend a day visiting with people you don't often work with.

We do four calls. The first is for a new onset afib. The woman does a great job. It is a simple call requiring no more intervention that just an IV and 12 lead ECG, but she is very thorough and assuring to the patient, making him feel comfortable, explaining everything to him, making him feel that he is in good hands, which he is. He thanks us at the hospital.

Later we do a man whith cerebral palsy who cuts his head on a towell dispenser and gets a small lac, a fifteen year old with an anger problem, and a medic alarm that an old woman pushed by mistake, and then walked out of her bathroom to find two paramedics and four firefighters standing in her hallway. "Isn't that the gosh darndest thing?" she said. "Well, its good to know you're on the job, that you are there for an old lady." And she laughed. "Isn't that the gosh darndest thing?"

We all wished her happy holidays.

It was quiet for the rest of the shift.

Back at the base, the supervisor gave me a letter of commendation, a certificate, a key chain and a pin all commending my going to Mississippi. The medic I worked with today had also gone and she got the same thing. It was nice. The letter had a personal note on it from the director of special operations down in Mississippi. But when we looked at the signatures on the framable certificate, which included the company President, we saw they were printed on. Still it was nice. Not that I am planning on hanging it on my wall.

On the way out I talked to the medic who is leaving for a construction job. He said he was going to continue to work part-time, he said he just felt he needed a change, needed to start taking care of himself, needed something with a more secure future.

I am lucky becuase I have the suburban shift. I love being a medic, but there are days when I don't. More of those days occur when I work in the city. Those are the days when I am more likely to feel degraded. Over all though, I think that over the years I have reached a certain level of comfort, I passed over the burn out phase. I understand what the job is about, the good and the bad and I am realistic about it. For all its drawbacks, I think it beats most anything else.

Now I'm looking at three days off. I would go home and drink a few beers to celebrate, but I am too tired. I think I will watch a little TV, have a snack, then lay my tired head down.

Good Lives

Started the day off with a syncope -- the same old lady who passed out last Wednesday night, passed out again today. This time she was going to the hospital.

***

Took in a frequent flyer from a nursing home. Same thing as happened yesterday. The nursing home calls the commercial service for a transfer for a man with absent bowel sounds. It gets kicked back to us as unresponsive. Well, the man is unresponsive because since he had a stroke, he has been permanently unresponsive. The cops were annoyed again to go lights and sirens and find no one in the room with the patient. The nurse wanted to know why the police were even there. The man is a full code, which means when he dies, we will have to do CPR on him, even though he is basically a vegatable. He is a ward of the state and according to the nurse the state doesn't like to make anyone a DNR.

***

We had a sixty year old woman with back pain who had trouble getting out of bed. I thought about calling to get permission to give her some morphine, but held off. She was in pain, but not that severe. She ended up in the waiting room in a wheelchair.

***

A young woman ten weeks pregnant with a history of miscarriages, who started bleeding at the same time she was having a sharp pressing abdominal pain. She cried on the way in. She was leaking bright blood. We talked about her other miscarriages. She did have one child -- a miracle baby born at 23 weeks -- now a healthy four year old today.

***

A sixty year old woman with a history of angioedema felt her throat swelling, gave herself an epi injection and called 911. She was still having some trouble swallowing when we got there, but soon was better. She wouldn't leave until someone brought the dogs in -- they were old she said, and couldn't be left out. I offered to do it, even though I hate dogs. I opened up the back door, and said, here, pouchies, then I heard some chains rattling and the rustle of two big dogs approaching and then I saw they were German Shepards and I have had some terrible experiences with German Shepards in my life -- one taking a bite out of my butt when I was riding my bike as a five year old, and then another dog -- Stormy -- terrorizing me in the neighborhood when I was in junior high. But these dogs were nice, and gave me no trouble and came right in and approached their owner who gave them hugs and told them to be good, while she put some water in their dishes.

On the way in to the hospital, the woman told me she had just been diagnosed with cancer and was scheduled for surgery in January. She said she was going to have to put the dogs down. She said they were old and incontinent and there would be no one to take care of them when she was sick. I asked if she had family. She paused a moment and then said, it was just her. I said that was too bad. She said they had lived good lives. I said, I guessed maybe being put down wasn't the worst way to go. I said in this job, you came to feel good for people who died in their sleep. Then she said it was a pretty good way to go, to die in the arms of someone who loved you.

And then there was silence between us.

She cried quietly.

Like a Rose

Minor motor vehicle to start the day. But the woman was moaning like she was dying. She said she couldn't bend her knee, but I couldn't find any deformity. On the way to the hospital, her cellphone rang, and she answered it. I tried to imagine what the person on the other line was thinking, listening to her moan as she explained she was on the way to the hospital. "Ooooh, they talking me to the hospital, Oooohhh, I don't know if I'm gooing to make it. Oooooh..."

She ended up in the waiting room. I always feel like a villian with the whole waiting room watching as we lower our stretcher, they try to help this dying woman into a wheelchair as she moans and pseudofaints. But maybe they are thinking, "Suck it up, lady, and take a number like the rest of us."

***

An old woman falls and hits her side on the bathtub. Her ribs hurt, but she doesn't say much for awhile, but then they start hurting more so she tells her daughter who calls 911. When we get there the old woman does not want to go to the hospital, but she does admit to the pain. She is stable, but possibly has cracked or maybe just bruised a rib. Extricating her from the room is very difficult because the room is cluttered with furniture, as is the hallway and the living room, and for that matter the driveway was nearly impassable with the four parked cars and the poorly shoveled walk. Five family members are there. Besides the husband and daughter, there are three grown grandchildren. The grandmother says she can walk to the door, she's been walking since she fell so she can't walk now and she don't need any cane, thank you very much.

It is slow going, but with our help, she makes it out to the living room where her family members sit on the couches. "You going to take her out like that!" We try to explain we have blankets. "Look at her, she in pain!" I look at my partner. I say, "Maybe if we sit her here, and we move these two couches, we can get the stretcher in."

On the wall I notice a plaque that says, "Grandmother's Love is Like a Rose: Always Blooming, Always Caring, Always Sharing."

We get her seated, and then lift the couches, trying to make room for the stretcher. "Now I can't get out," the daughter says. She has gone into the bathroom for the grandmother's teeth, and we have placed the couch where it blocks the hallway.

So we move some more furniture. None of the family attempts to get up from the other couches. They are all sitting slouched back like the couches are quicksand. We get the grandmother on the stretcher. The daughter hands her grandmother her teeth, which she slurps into her mouth. My partner opens the door and tries to put the latch on the slider to keep it iopen, but it won't catch.

"That won't work," comes the chorus from the couch. "That won't work. It's broken. It never work!"

So we have to take her out the door, balancing the stretcher and trying to keep the door from closing on us. Then down the stairs, around the obstacle course of cars and ice patches. Then the family comes trooping out, and one by one, gives their grandmother a kiss and tells her that they love her. Then we put her in back and take her to the hospital.

***

We get another call at that same Doctor's office that calls all the time. Only this time, oddly the phone rang at our headquarters where a nurse from the doctor's office asked if this was the number to call for an ambulance transport to the hospital. I asked if it was an emergency, she said no, so I gave her the number of the comercial service, then I called our dispatcher and told him what had happened. Five minutes later the commercial service passed the call to our 911 dispatcher as a severe abdominal pain. He told them that it was not an emergency, they said, it EMDed as a high priority so they had to pass it. So we went and it was just an elderly woman who had been having diarrhea and vomiting and the doctor wanted her examined at the ER and possibly IV rehydrated. She was very stable, even got up and walked to the bathroom because she had to go again. We brought her in non-priority.

One Call

Nice slow day. Spent the day writing at the computer. Did some work on the lights and sirens policy for the region.

Only one call. Came in as a diabetic.

60-year old woman laying on the bed, semi-alert, but mumbling, out of it. I went right for the IV, while I directed my partner to get vitals, and put her some 02. I know going right for the IV is not by the book, (but it is an easy way to get two tasks done -- the IV and the blood sugar check). When it is a diabetic, it seems like the most efficient use of time. All the while of course, I am asking questions of the family.

I initially am thinking pure diabetic, but I am starting to have my doubts when I feel her forehead and it is warm, and when they tell me she takes pills not insulin.

Blood sugar comes up 158.

I do the quick stroke test and don't you know, she has right sided weakness.

The problem is she was last seen walking around this morning so we are well past the three hour window.

We load her up and take her in, providing supportive care. I have the young football player with me, and I have him hold the woman's hand and talk to her all the way in.

Day Off

Had the day off, and as people often find with vacations, the days off are more tiring than the days on. But at any rate, it was nice to not have to get into an ambulance, and hear the sirens and then go walking into some strange house carrying a heavy bag over your shoulder and a heart monitor in your hand, wondering what you will find, but feeling all along that you have been here before, sometimes too many times.

I didn't get to do many of the things I wanted, but I did get to sleep until I woke up, and I got to the gymn, and I was in bed by ten-thirty.

Nitro for Neck pain?

Started the day off with a hypoglycemic diabetic at a nursing home. It was a patient I have done many times before. She is always a tough stick, and while four staff members looked on and tried to hold her still I searched up and down her arms for a vein. I finally found one on her left forearm and slipped in a 24. A beautiful thing seeing the flash. I gave her an amp of D50 and she was back to normal.

What I like about EMS is the performance aspect. At times it like an athletic event. You are called upon to perform in public. You get a hit or you make an out. You get the job done or you don't. You can have a solid hitting streak, but the past never matters, you miss the IV, you've struck out. Its not like you have the Yankee stadium crowd looking on. Four nurses or nurses aides in a home, but getting a tough IV, well, it makes me feel the same as I did when I'd get a basehit in my Sunday softball league a fewe years ago, and all ten people in the stands and your teammates would cheer. The little things in life that make our days special.

***

We get called to the same doctor's office that has been calling us all the time of late. Man slips on the ice, hits his head, has neck and head pain, calls his doctor, they say, come on in. He goes there. They do an ECG which shows inverted T waves in nearly every lead. Keep in mind the man has no symptoms, but neck and head pain from his fall. They compare the ECG with his old one and decide to give him nitro and baby aspirin and call us. "Why did you give him nitro?" I ask.

"For neck pain with ecg changes," they say.

"Did I hear right that he slipped on the ice and hit his head?"

"Yes, that's why he came in. And we noticed the ECG changes."

"You did two sets of ECGs today and there were changes bewteen the two?"

"There were changes between the two, the new and the old."

The new and the old today or the new one today this year and the old one two years ago."

"Yes, that's right. The old one two years ago."

"Okay, got you."

We c-spine the man because he has cervical spinal tenderness. Out in the ambulance, I look at both ECGs. They are extremely similar. The man had longstanding inverted Ts.

The office never ceases to surprise me.

***

Last call is a four hundred pound woman at another doctor's office for an X-ray of her hip, he notices that she seems short of breath on exertion and calls us. She is short of breath on exertion. She has a lot of weight to move around.

***

I am off tomorrow, and am I looking forward to it. I need it. I almost snapped a couple times today, and that is not good. I just kept it inside, but it was brimming toward the surface. A day off will help.

Towel Rolls

Got to work this morning, switched into my rig, checked my gear, and then got into bed. Normally one of the best things ever is to wake up in the morning, wonder for a moment, then look around and realize, "Hey! I'm at work already! How cool is that!"

But this morning I had weird dreams that unsettled me.

My TV was on, but the picture was just this scene of winter. Nothing was going on, but winter. You could climb into the scene -- it was three dimensional, but still there wasn't anything there, except snow and fields and a barn, but nothing else. The barn wasn't even real. And it was cold.

And I dreamed I was in an ambulance, picking at some tarter between my teeth, when I scrapped off a big hunk, and then realized I had just pulled out one of my teeth.

And I dreamed I got an email from a fellow blogger who offered to split the cost of editor with me because I made so many small spelling and grammar mistakes and I really ought to proof read better before posting.

And I dreamed my ambulance was gone and I was wondering around in a building and my radio wasn't working, and I was worried somewhere there was a call, but I couldn't get to the ambulance because I was lost in this big building that was somehow connected to my base.

I dreamed some other unsettling stuff too that I have forgotten, but I know it was unpleasant.

Then as I actually lay in bed sleeping, in the background I heard the tones that they ring us with, and I woke up and picked up my radio, but it was off even though it was one. It just wasn't working. So I wandered up to the front of the building, and answered the phone which was the dispatcher calling us to tell us we had a call for severe abdominal pain.

I put on a hat because I had bad hair and we got in the ambulance, and had to walk across the cold snow drifts to a house where the man said his wife had bad abdominal pain and couldn't walk. We found her in the living room, and she was talking to a relative and seemed in no distress. Then she grabbed her side and let out a cry of pain that I wasn't buying. Because of the narrow hallways, we helped out to walk out to the back where I set the stretcher up. We drove it in BLS. Her vitals were fine. She was forty years old, and it turned out she had a UTI.

I bought a diet coke and some hot oatmeal at the hospital cafeteria.

***

Later we were sent for a fractured neck. A man fell a couple days ago. It was a low fall onto a carpet, but he had neck pain. After living with it for two days, he went to the doctor, who gave him an x-ray, which showed a fracture. He told him to get a CAT scan the next day. That’s where we picked him up. We found him sitting in the waiting room, clutching his x-rays. He said his neck hurt when he moved. As I was c-spining him very carefully, a nurse came out and said, "The doctor says no movement."

I looked at her blankly, then said, "That's why we are c-spining him." The doctor was too busy to come out and give me a report. I looked in the x-ray envelope for a written description, but there was nothing.

Once we got in the ambulance, I looked at the way we had c-spined him. We use these commercial head beds, composed of a long rectangular Styrofoam head base that sticks to the board and then two lightweight blocks that stick with Velcro on the rectangular base, then we apply first a Velcro tape over the forehead, then a heavy sticky duct-type tape over the forehead. They work fine when you are c-spining someone just to c-spine them, but when you are dealing with a broken neck, they seem pretty lame. Right then I took out some bath blankets and made up two towel rolls like we used to in the old days, and used them instead of the commercial head bed. He looked much more secure and I felt much better about the ride in. I think I will start using them again.

At triage the nurse took out the x-rays and held them up to the light. He had a partial fracture of C1. He was lucky to be alive.

***

Later we did a nursing home patient who was hypotensive, but had warm hand with good capillary refill, and was mentating fine.

Cold today with a storm coming tonight.

Tiring

We get called for an ETOH downtown. A forty-year old man laying in the lobby of a office building. He stumbled in looking for spare change, says the security guard. I recognize him right away. He’s the guy we found not breathing downtown, who I gave the narcan too, and when he didn’t respond, intubated, only to have him wake up and yank the tube, and then puke all over himself. I ask if he remembers me or the episode. He doesn’t. At least I’m glad his voice sounds normal. I was worried he damaged his vocal chords yanking the tube out. Today he has just been drinking vodka.

We do a psych who wants to go to the hospital for an evaluation. We pick her up at a shelter, and run her over to the hospital.

They send us downstate with a VA run.

We do a seizure, a patient who has regular seizures, who refuses.

It is cold today. I eat cerdo asada, yucca, and tostones with garlic oil over them. Very good on a cold day.

We do a lot of driving around from one post to the next and back. It is more tiring than doing calls.

We get called for an assault in the north end. A teenage girl has been out drinking with a guy who picked her up after school. When she refuses to have sex with him, he whacks her in the face with a gun. When we arrive she is hysterical, her face and lips swollen. She is spitting mucus and blood, screaming that she has asthma and can't breathe. It is hard to get her to sit still. I initially ask her if she has neck pain, and she says only on the side, then she gasps that she has asthma and can't breathe. I try to dance gingerly around her frequent spits. We get her on the stretcher and I listen to her lungs. She has some wheezing so I give her a breathing treatment. Once in the back of the ambulance, I check her from head to toe again, and now she is complaining of midline neck pain, so we cspine her on the stretcher, which just causes her more anxiety. She starts screaming that she is dying and don't let her die. Her vitals are all fine. My job is to just calm her and wipe her spit off her face. There is no need to go lights and sirens and the traffic is bad so it takes us forever. She keeps thrashing around. I try to tell her not to move her neck, but she does a fine job of dislodging the head supports. I hate calls like this. I like quiet manageable patients. "Why aren't we there yet!" she screams. "I'm dying! I'm dying! My face! My face!"

In the triage line at the hospital, the nurse comments on our cspine job. "Looks like you didn't do it very well."

"She's ETOH," my partner says.

An ER tech walks by. "Nice cspine job."

"Gang up on us now," he says.

Once she gets in the room, and her mother shows up, she calms down considerably. The hospital lets her get off the board, but keeps the collar on her.

They send us in one time. Today is the deadline for putting in vacaton requests for the next six months as well as bidding for open shits in January.

I have never had to formally put in for vacation before, but they have a new system and the worry is they are going to start getting hardline with us, so I put in for days that I had expected to be able to cover with shift swaps.

As far as the open shifts, I decide not to put in for any of them. I’ll just carry my pager and take openings as they occur only if I feel like working. January is going to be a break month for me. I need to get back in the gym and need to spend some time cleaning my house, and working more on my writing. I'm going to try to limit my overtime for awhile.

I can’t wait for Saturday when I am off.

A Great Present

We are sent to meet a car that has just crossed the northern border of our town for a "possible stroke in the car." At first I think what? How could anyone be driving if they are having a stroke, then it occurs to me that maybe the patient is a passenger.

We meet them at a hamburger restaurant, and looking in the car I can see two young adults, niether of whom look in distress. They both get out and the man leads the woman toward us. "I think she's having a stroke," he says.

She appears to be crying and breathing rapidly. "My hands are tingling," she says, "and I can't remember anything."

I have her squeeze my hands, lift her hands up, and then smile for me. She has none of the Cincinnati stroke symptoms. We get her in the back and take her in to the hospital. She has an anxiety history and a history of migranes. Her vitals are all fine and she seems to have no trouble remembering her demographic information. I encourage her to relax, which she does. We take a nice slow ride in.

At the hospital we wait in triage. Everytime someone comes in the ER door, there is a burst of cold wind that blows down the tunnel entrance and freezes us. I put on my gloves, and raise the collar of my work shirt. It is bitterly cold. At least we have a nice thick wool blanket on our patient. Another patient in line is chattering under just a bath blanket.

***

Difficulty breathing. 79-year old female. No chest pain. Dsypnea increases on extertion. Her lungs are a little decreased. Sats at 100% on 4 liters. We load her up, bundle her up good, wrap a towell around her head so she looks like Mother Theresa, then head out into the cold.

***

My monthly EMS regional meetings are today. The medic I'd asked to cover for me for a few hours has an emergency and is unable to help me out. I get permission to stop by the meeting in the ambulance and talk about my agenda items. While next week my suburban shift is switching from Thursday, Friday, Saturday to Sunday, Monday, Tuesday, I have arranged to get the second Tuesday of every month off so I can attend the meetings(in exchange for Tuesday I will have to work Saturday).

I see a old friend of mine at the meeting, who used to be a clinical coordinator at the hospital, but now works for the state. He has a Christmas present for me and it is awesome -- an autographed copy of Thom Dick's book: People Care: Career-Friendly Practices For Professional Caregivers with a personal inscription. My friend and Thom Dick are old friends and I almost got the chance to meet him a couple years ago when he was in town. My friend brought him by the station -- I had a copy of Street Talk for him to autograph, but then I had to go out on a call and missed him.

The inscription read : TO (me) "With best wishs for a continued long life of fullfillment in serving others, Always your friend, Thom."

A great, great present.

***

And only 2 calls in 16 hours.

Murphy

Today tickets for the World Baseball Classic went on sale. It is the first time national teams from all over the world, (the teams will include major leaguers), will play in a world championship tournament. At ten o'clock I bought tickets eight rows behind home plate for the opening round robin in Orlando, Florida that features teams from the Dominican Republic, Venezuela, Italy and Australia. I don't even know if I am going to go(the games are in March), but I figure I can sell the tickets if I can't go. The championship tickets didn't go on sale until one for three games in San Diego. I know I can't do both, but if you are even thinking about it, you have to buy the tickets. I think this event will be huge. Some joker on EBay is already selling tickets similar to the ones I bought for $999. I paid $330 for two tickets(6 games each ticket).

Went out and did a call for a child with asthma at a doctor's office. I think it was more pneumonia than asthma(she had a fever and decreased lung sounds on one side with a productive cough), but at any rate, we took the girl to the children's hospital in the city. On the way back I mention I need to get to the base by one to try to buy tickets.

My partner says, "Murphy's law says we'll get a call."

Came back, sat down at the computer. All set to click buy the moment the tickets went on sale for the championship games. I'm looking to get right on the field if possible. This could be awesome. USA with Roger Clemens and Barry Bonds, Japan, Dominican Republic with Pedro Martinez and David Ortiz and Manny Ramierez, Cuba. Historic games. Five minutes before one, the tones go off -- old guy with heart palpitations feeling nauseous. F---! Pardon me.

"Murphy's Law," my partner says.

Off we go lights and sirens. When we get there the guy says he is having heart palpitations and nausea. The 12 lead looks okay. He is a little hypertensive. The palpitations go away before we can record anything unusual on the monitor. We load him up. My partner asks if we should go lights and sirens. I am thinking lights and sirens would be nice timewise so I can get back and buy the tickets, but there is no need to go that way. Non-priority, I say.

I put in an IV and draw blood enroute. I draw up some phenergan to give him, but only when I am ready to inject it do I realize I used one of the new vanishing point syringes that are incompatible with our saline locks. The saline locks won't take a needle and with the vanishing points, you can't take the needle off, the needle "vanishes back into the syringe. I will have to spike a bag and attach it to the saline lock, and then inject the medication through a rubber port in the IV tubing, but we are already close to the hospital, and I haven't even patched the call in yet. I get up to make the call -- the radio is not in my reach from the bench seat, wait a long time for the hospital to come to the phone, give a brief report, but then we just now pulling in, so I never get time to spike the back and give the medicine.

Then just as we pull in to the hospital, he sits up and vomits over everything -- the blankets, the floor, my hand. A mess. He says he feels better. On the monitor I notice some unifocal PVCs -- about twenty in a two minute span. I ask him if he feels any palpitations, he says no. I record a strip for my report.

It takes us awhile to clean up. We don't get back to the barn until almost 3.

There are still tickets left, but they are in the upper deck. I buy them anyway.

Like I said, I don't know if I will be able to go to either set of games, but having the tickets gives me the option.

DNR DEAD

A fall at a nursing home with a probable broken nose.

As we are clearing a distant hospital we hear a call go out for a 97-year old female with severe respiratory distress and no blood pressure. A commercial ambulance is already enroute. We are too far away to respond. When we get closer to town, we hear the other unit go off on scene, then the PD are calling for us to back them up. When we arrive the patient is in the back of the rig. The medic tells me she is a DNR and she just now died. Have a nice trip into the hospital we say. There is nothing for them to do, but put a sheet over her head and drive on it, letting the hospital know with a simple patch. "Patient is DNR who just now died."

I have had that happen to me before. Nursing homes don't like the patients to expire on their beds, so they call us, even though they are DNRs. Some times I have made them call the doctor to see if he is sure he wants us to transport. Sometimes I have had to wait until the patient died. Sometimes they have insisted I take the patient, only to have what happened to the other crew, happen to me. You are the subject of some kidding when you roll through the ER doors and take your place in the triage line. "Your patient doesn't look very good." "Ah, dude, your patient's not breathing." Or better when the triage nurse asks "What have you got?" And you say, "A dead person." What?!

Sent to an MVA but no injuries.

Then a syncope where the old woman just went down at the kitchen sink. She looked grey and hadn't been eating. She'd didn’t want to go, but we were persistent. On the way in, while doing the IV, I put the vacutainer on the end of the catheter, and then got briefly distracted, and then the next thing I knew I felt warm liquid on my pants leg and saw the blood was flowing freely from the catheter. A bit of a mess, not to mention having IV blood stains on my left knee -- the mark of a rookie.

At the hospital I saw one of the ladies from the Spanish restaurant I eat at a lot. At first I couldn't place her, and then it came to me. We chatted a little in Spanish. I wish I got to talk more.

Last call is for Severe ABD pain in a 16 year old. The EMD slows us down to no lights and sirens, but the cop on scene, speeds us back up. The girl has a fever, but everything else is negative except for her occasional dramatic screams. Pulse is 64. BP 110/60. Ab soft. No vomiting or diarrhea. Had her period ten days ago. No trouble urinating. No blood in urine. She is able to walk out to the ambulance, over the snow banks without pain. We bring her in on a stretcher, and are sent from the Main ED to the walk-in section of the ER. They have us put her in the waiting room. As soon as we get her in a wheel chair, she shrieks, and closes her eyes. Her sister fans her. The triage nurse rolls her eyes.

Stroke

I spend the morning downloading more of the new AHA material.

There are three publications:

View the C2005 International Consensus on CPR and ECC Science with Treatment Recommendations

View the 2005 AHA Guidelines for CPR and ECC

Currents 2005 Highlights

***

First call is for a possible stroke. An old woman meets us at the door and says, "You need to take him to the hospital. He ain't right. He's slurring his words, and he had a stroke, and I can't take care of him like this. Something's wrong. Something's wrong with him."

As so often happens, I begin to get a sense of deja veu. As I walk up the stairs to the second floor, I know I have been in this house before. I remember the woman and her husband and how they were always fighting. She always wanted him to go to the hospital and he never wanted to go.

I find a man on the bed, watching cartoons. He is alert, but slurring his words slightly. He says something I can't really understand about the strangeness on the TV. I check his neuros out and they are good as he tells me he is fine and doesn't need to go to the hospital. I ask him if he has been drinking. He denies it.

"Why did your wife call us?" I ask.

"My wife?" he says, "She's my mother."

I apologize, and then say I remember coming here for her husband, and how they were always fighting about him going.

"I moved in when he was sick," he says, "Now she and I go at it."

He's a diabetic and I check his sugar. It's 46.

I give him some Dextrose, and his speech is much improved.

I try to tell the mother that the son is fine now. He just needs to eat more.

She will have none of it. "You got to take him to the hospital," his mother says. "I can't take care of him. It's hard. It's hard on me. He ain't right in the head. You got to take him out of here. I can't go on like this," she says. "Always looking after him. It's hard. It's hard."

The words echo through time.

"I have become my father," the man says.

***

Get back to the base and its that annual time of the year to try to get Red Sox tickets. I stay at the computer and battle the rest of Red Sox world as we all try to get through. I know a few tricks and by opening more and more windows, increase my odds 35 fold which is the number of windows I have open into what is called the Virtual Waiting Room. Rather than taking people on a first come first serve basis, everyone is dumped in a giant vat and are grabbed by random. Within ten minutes I get a chance for an early single game ticket and get two box seats to a May game against Texas between home and first base. But the real jewel the opening day Sox Pack -- a four game package, which is the only way to get an opening day ticket-- packaged with three less desirable games -- takes awhile. I go on a call and come back, and I am still in 37 waiting rooms. I open up a few more windows, then suddenly I am in, and the tickets are bought. I am going to opening day. Crappy seats deep in right field, seats I will not be able to fit into because they are so cramped, but at least I will be there -- in the Park on Opening Day.

***

We get called for a stroke at a local store. We find a man sitting in a chair, looking quite comfortable. It seems he has had a cold recently, went to the doctor on Thursday who gave him an anti-biotic, and then did an ECG, which revealed afib. The doctor started him on coumadin. He mentioned to his wife that he was feeling dizzy, she freaked. Called his MD, who told her to take him to the ER. She dialed 911. He has no neuro deficits, good vitals, not even feeling dizzy. We work him up, take him non-priority to the ER, where a neurologist and the man's heart doctor are there waiting, and they start interviewing him before we even have him off the stretcher. before the nurse is even over to get the report, the doctor is telling the man he will admit him for monitoring, even though he thinks this episode if benign.

I am guessing that this man is some kind of VIP to get such treatment. Anyone else had a similar episode and they could be in the ED all day.

***

We do a stroke at a nursing home, right sided paralysis, slurred speech, gaze to the left. Problem is no one knows the onset time.

***

Get called for a stroke again. Go to a nice house in the hill section of town where there is a Christmas party going on. Woman felt hot and fainted. We check her out. She doesn't want to go. They offer us food and drink and good cheer. We decline politely and head back to the base.

A Blanket

I stayed overnight at the barn because of the impending snowstorm. When I punched in at six, there was just a dusting on. Then it started down hard and heavy, and lasted about seven hours leaving about 8-10 inches.

First call was a commercial pass at a dialysis center for the patient passing out, so we went lights and sirens with two police cars also responding through the snowstorm. It turned out it was just a transfer. The guy's doctor told him to go to dialysis, and then have the ambulance take him to the ER when he was done where the doctor would meet him because he had him on a halter monitor and he wanted to check it out there. He had been falling some recently and falling asleep easily. No signs or symptoms today.

Next call also through the snowfall was for a chest pain. We had to walk to the house through knee deep snow drifts. My knees. I'm six eight. The woman had a history of anxiety, but also question of angina and pulmonary stenosis. When her doctor did a cardiac cath on her a year ago, it revealed no blockages. Her skin was warm and dry and she was walking about the house, so she walked right out through the snow and got into our ambulance. Her vitals and 12 lead were all fine.

On the way back, we got called for a 93-year old woman unresponsive with shallow breathing. Updated to respirations at six a minute, now irregular and gasping. I said it's going to be a code. When we got there instead of trying to haul the stretcher through the snow, we grabbed the equipment and went right in. We had to walk through a narrow hallway, through an open living room, then down some stairs to the basement, then down another corridor and into a small bedroom where a man and younger woman stood, and there on the bed was an old woman who from the door I could see was not breathing.

I'm thinking great, 93 years old not breathing. She is dead. Has the family even thought about what they want us to do? I say (I really do say) "Have you thought at all about what you would like us to do if she stops breathing or her heart stops and she dies." I feel for a pulse. There is none. "Like now. Would you like us to resuscitate her?"

The man seems understandably flustered by my question, and hesitates and then says something to the effect of well, yes, yes we do.

"It's a code," I tell my partner who has followed me down the narrow hallway and into the bedroom. "Let's get her on the floor." We pick her up and place her on the floor so there is room for one person at the head and room between the end of the bed and the dresser for someone to do compressions. I hand one partner the ambu bag, then the other partner -- an EMT student, the young ex-high school football player, who has been doing so well riding with us -- I tell to do compressions, (Let's do the new CPR, I say, 30 and 2) while I get the defib pads out, hook them up to the monitor, then slap them on. I have them stop for a moment, and I quickly see the woman is asystole.

I tell them to continue and not stop, while I get out my intubation kit. I also hand an oral airway to my partner, and tell him to take out her false teeth. The bottom teeth come out, but the top, he says are nailed in.

I take out a number 8 tube. I see the epiglottis, see the chords, have a little trouble getting the tube to go into the chords, as the lady's teeth stick up and there is not a lot of room between the blade, the teeth and the side's of her mouth. I reshape the tube, making it straighter and I am able to easily pass it. The bulb syringe test works. No sound in the belly. Equal and strong on the right and left. Vapor in the tube. I tie it up with the commercial holder. I hand it over to my partner and say, keep it in there. Squeeze the bag 8 times a minute.

Then, instead of dropping some epi down the tube like I always do, I delay and go for an IV. As I am pulling out my IV kit I remember I need to attach the capnography. I attach the capnography device between the tube and the bag and then into the machine. I glance at the reading. It says 35. I am shocked. 35 is normal. It is also an excellent prognosticator. On the other hand the lady looks dead and is asystole.

I get a 20 in the AC. I have them stop CPR. Still asystole, then I tell them to resume. I take out a milligram of epi and say, "All right, let's see if the epi can do it's job," and I slam the epi followed by an atropine, then a couple minutes later another epi.

I look up at the monitor and see a funky rhythm.

Shock or not shock. I hold off because it looks organized. I watch it evolve.

It's like there is a qrs complex, then some loopy ventricular like rolls, then a qrs.

I go so far as to hit the charge button, but I hold off.

That is definitely v-fib now, but there is also a rhythm trying to break in.

And there it is.

No question about it. Sinus tack.

"Check for pulses," I say.

"Strong radial pulse," my partner says. "Very rapid."

I look at the monitor. A Sinus tack at 132.

93 years old and we got here back -- at least temporarily. We package her up. I stay vigilant waiting for the epi to wear off, but she's hanging right in there. Good rhythm, good end tidal. Good BP.

We have a difficult extrication. We can't get the stretcher in the house. We have to strap her to the board, securing her head with head blocks. A police officer and I carry her down the hall stopping every ten seconds or so to ventilate her. The stair is a bitch. We have to pass her up nearly vertical. Her family waits in the living room. Suddenly they are yelling at us. "Put a sheet on her."' "You can't take her out like that." "Let me get a blanket." "Have some respect for her modesty."

I am doing my best to keep her from toppling off the board. I hadn't even thought about her exposed breasts. I was concerned with just getting her to the ambulance. They are yelling at me. It occurs to me then that they have no idea about her condition. I normally try to involve the family, and keep them updated, but due to the geography of the scene, I was isolated from them. I remember what I read in Thom Dick's book, People Care: Career-Friendly Practices for Professional Caregivers..

"People don't remember much about our medicine. But they do remember how we make them feel."-Thom Dick

We have no sheets handy. Our stretcher is outside in the snow. I set her down because I don't want to drop her and it's time for more ventilation.

"She'll be cold," a family member says.

I want to explain what I have just read in the new AHA guidelines about the benefits of hypothermia and how keeping her from getting too hot is good for her. "Her situation is very critical," I say. "We need to get her to the ambulance." I glance at the monitor. Still holding her own. "We'll get her covered up." I nod to the officer to pick her up again.

Normally, on a code I always pause, and have the family say something to the patient, even though she may not be able to hear. I do it for the family to let them at least have a chance to say goodbye because most of the time the patient is dead by the time they arrive. But I am not even thinking about that now. I'm just thinking about getting her out to the ambulance through the snow before she loses her pulse.

We back out the door, and down the icy steps, and out to where to the stretcher is set up. There we bag her again, and throw a blanket on her. In the back of the ambulance, we switch her to the main 02, and head to the hospital. Everything status quo. The EMT student is bagging. I compliment him on how well he has done on the call, but I tell him we can't expect the woman to ever walk out of the hospital. At her age and given the condition we found her in, it just isn't going to happen. He nods and says nothing.

A moment later the woman moves suddenly. It startles both of us. And then we see her chest heave again. And again. And to my amazement she is breathing on her own.

"But then again," I say. "I could be wrong."

At the hospital, her pressure is 130/60. Her heart rate is 104. Her respiratory rate is 10. The doctor congratulates us and I praise my crew. My regular partner has worked EMS as a volunteer for 20 years and this is his first save. The EMT student has just begun his career. I am still startled that we got back a 93 year old woman from asystole. She had to have stopped breathing just minutes before our arrival. I tried to use the new AHA guidelines. Good CPR, less ventilations. No drugs down the tube. Even unconsciously hypothermia. And while the AHA guidelines say our cardiac drugs have never been proven to help. I know she responded to the epi. I have seen it before. Epi IV has gotten me back many an arrested patient, or at least gotten them to the hospital alive.

But before I congratulate myself too much, after I have written the run form and dropped it off with the nurse, I glance at the patient's room and see two family members sitting in armless chairs by her side. Their eyes meet mine. They stare at me but give no expression. I feel like they are waiting for me to say something.

I approach, and bow my head slightly. They remain seated. "I am sorry about not covering her up," I say. I should have gotten a blanket."

"That's all right," the woman says. "Thank you."

"I wanted to get her out to the ambulance. I wasn't thinking."

"Thank you," she says. "Thank you for helping."

I bow my head slightly again, and then head back down the hall.

Lesson learned.

Christmas Shopping

Person in a car not responding parked by side of country road. Sounds like a possible diabetic. It is. Blood sugar 24. Gets an amp of D50. Wakes up. She's 12 weeks pregnant. She's been dropping her sugar almost daily. Has just come from her doctor's office where they discussed the problem. She doesn't want to go to the hospital. She is adament. She's been there several times in recent weeks. Her sugar is up to 169. She eats a few glucose tablets, then signs the refusal. We give her directions back to the route she'd wandered off of. She is late to work. Again.

Visiting nurse makes a visit. The patient complains of chills. She calls the patient's doctor who wants the patient seen at the ER. We get sent lights and sirens. The patient is up walking around. SAT 98% on room air. Good vitals, but she has a cough. Her lungs are a little decreased. We take her to her doctor's hospital, which is a twenty-five minute drive.

I have hot mashed potatoes and peas at the cafeteria, then head back to town.

I spend much of the afternoon Christmas shopping on the internet.

***

Speaking of Christmas shopping, I am reading this awesome book:

People Care: Career-Friendly Practices for Professional Caregivers

Thom Dick is the author of Street Talk, a book of essays that came out about the time I was in EMT school in 1989. It was extremely influential in instructing me in what it meant to be a caregiver. It encouraged me to see the patient as a person, to respect the people I work with, to take the time to be kind, and other important lessons that helped me become a better EMT.

A few years later I heard him speak at an EMS convention and he was fantastic. He got you fired up to go out there and hold old ladies' hands. He made you feel like the work you did, even the mundane parts, was special. I read his book often over the years and it always charged me up. Now I don't pretend to have always lived up to his standards. I know I haven't. But I do try.

His new book seems to be a expansion/complilation of his prior book and the talks he gives all over the country. It is enhanced by cartoons by Steve Berry, who does the I am Not an Ambulance Driver cartoon series.

"When you kneel in front of somebody's granpa who's sitting on his couch and denying his chest pain, you need to recognize the pain he says isn't there, detect the shortness of breath he hasn't mentioned and sense the fear that's absolutely dominating his conciousness. You need to appreciate the fact that his spouse, seated right there next to him, is scared to death she's never going to sleep with him again. And somehow, you need to make everything better in just a few minutes.

These are the dynamics of even the simplest emergency response. They presuppose the presence of gifts in us that not even the greatest teacher can impart -- gifts that unfortunately, come without instructions.

This book is an examination of those gifts and a collection of the instructions that didn't come with them. It's based on the collective experience and wisdom of dozens of professional paramedics and EMTs worlwide who learned to love the lifelong pursuit of helping others.

We hope it helps you to join their number."

- from back cover of book

"People don't remember much about our medicine. But they do remember how we make them feel."
-Thom Dick

"It's not enough to be the most competent EMT you can be. You need to be nice. And it's not enough to be nice. You need to be competent and nice."
-Thom Dick

Fainting Spell

Agreed to work 4 hours this morning because they had no one to cover the suburban shift because of the skill sessions. I had to get off at ten to be sure I could make it to the noon sesssion.

Only one call -- at a doctor's office where we are being called extremely frequently of late. A tall thin 21-year old female had a brief syncopal episode while paying her bill. She said she felt hot then passed out. She was all bundled up against the cold day. A thin, pale girl who probably doesn't eat much. She had no signs or symptoms when we got there and we took her in BLS. I think they were worried because she had fallen skiing a few days ago -- she was there because her knees were bruised -- and they were worried it was something serious. So they called us, and we drove her in while her boyfriend followed in his car.

Plastic Bag Over the Face Again

Started off the day with a stroke patient. 90-year old lady left sided paraylsis, left sided facial droop, slurred speech. Was undertreatment for a DVT. The cop got there and put the patient on a nonrebreather at 15 lpm. The attending nurse told him to turn it down to 4 liters, which is where we found it when we came in, just as the nurse was saying, "She's getting more lethargic." I almost said, it's because you've got a plastic bag over her head. Instead I just explained that the 02 needed to be at at least 10-12 to use the mask. She apologized and said she didn't know.

Then did a COPDer at a doctor's office. No acute distress.

Quiet day. I washed the ambulance, cleaned up the supply cabinet, did some phone errands, worked on some regional EMS policies.

At six we got sent out to check a woman who was found asleep in her car in the driveway of her house after being spotted driving erratically. She denied drinking, but had peed on herself and had poor balance. Her blood sugar was fine and she was totally alert with no neuro deficits. Her neighbor said this wasn't like her. She told me she peed herself because she had to go. She said her gait was due to new shoes. We took her in for evaluation.

Got a flu shot and a TB test at the fire station on the way back.

16 hours, 3 calls, back at six in the morning for a four hour day. I have to go to annual skill sessions.

Bathroom Break

Came in, checked my gear, went to bed. Got woken up with a call for the lady with leg pain. The EMD dispatch on the line with the caller says the patient is on the second floor. I am tempted to say, "Tell her to meet us at the curb."

We get there and find a 50 year old woman sitting on the bedspread of a kingsize bed on top of a bed pan. Her mother says she hasn't gotten out of bed for five days even though there is nothing wrong with her. She has a history of mental illness but has not been on any medications or seen any doctors for over a year. She refuses to get out of bed for us. When we approach, she becomes violent. We have to hold her down to check her blood sugar. Her mother has said she is a diabetic. Her sugar comes out normal.

We are on the second floor and stairwell is narrow. None of our attempts to persuade her to come to the hospital work. The cop starts writing a PEER(Police Evaluation Request) that gives us the power to take her against her will. None of us is looking forward to wrestling with her. I decide to just medicate her. While I am preparing my two syringes I joke that I should have a sedation kit that would include relaxation music like the sound of waves or light rain fall to put on the music player and incense to burn. When I am ready we hold her down and give her ativan and haldol, then sit back and wait.

I suddenly have a terrible stomach ache. I try to ignore it, but it only worsens. I have had stomach aches before on the job, but then I was always caught up in the call and managed to fight through it. But here I am standing waiting -- at least ten minutes for the drugs to take effect. I am about fifteen feet from the patient's bathroom. Finally I can't take it anymore. I ask the patient's mother if I may use the bathroom. (It is the first time I have ever had to use a patient's bathroom.) She says yes, and five minutes later I am feeling much better. We wait another five minutes, and then pick the woman up with minimal resistance, place her on the stair chair, carry her down to the stretcher, and she sleeps all the way to the hospital.

***

We do a fall with a head lac.

***

Get called to a doctor's office for rapid afib. The man has been feeling a little light-headed with chest tightness and palpitations. When I put him on the monitor his rate is 170. I give him cardizem and then hang a cardizem drip after the rate goes down into the 90's.

When I get back from the call I am reading the new ACLS guidelines for afib, and they are basically saying that medics should "seek expert consultation" instead of treating such a patient. This is a marked change from the 2000 guidelines. Here's the line: "Stable patients may await expert consultation as treatment has the potential for harm." You can argue over what "stable" is. Some might say, well they called 911 so they they can't be stable. They have chest tightness, etc. Someone else might say -- their BP is good, they are mentating and perfusing fine, they are stable. Whatever, the language is new and runs throughout the tachycardia section.

Management of Symptomatic Bradycardia and Tachycardia

While I will post about all the new changes, many are "anti-medic." I don't mean that in neccessarily a bad way because anything that is good for the patient, which I have to assume these guidelines are, must also be "pro-medic." What I mean is the guidelines seem to either restrict our practice or point out that much of what we do has no evidence proving it works and may in fact be harmful. From intubation to fluid rescusitation to drug administration, the emphasis seems to be on less medic intervention as opposed to more.

Naked

Cold, snowy, rainy day.

We started off with an MVA, which was a refusal, then just like yesterday as soon as we got back to the base, we were called back to the scene for the patient who, ticketed, now wanted to go to the hospital with a headache.

Did a seizure -- a young girl with a history of seizures who had stopped taking her medicine.

Then we did a repeat nursing home patient(3X for me in last month) with congestion, who said she felt the same as she always did and was walking around in the hallway when we got there. She asked us if she could have a cigarette.

Then we did a call for an old lady feeling woozy, whose neighbor called concerned about her. The neighbor said she had seen her yesterday raking her neighbor's yard instead of her own, and that when she came over today she seemed a little spacy and had been coughing up some blood.

The old lady I remembered from a call several years ago. We were called to her house because no one would answer the phone and she hadn't been seen for awhile. We pounded on the door. No answer. We finally broke in and walked quickly through the rooms of her old farmhouse looking for someone on the ground with a broken hip, stroked out, or maybe cold rigored and stiff. The cop and I walked right through the bedroom and into the large bathroom, then turned around and there she was sitting in a big velvet backed chair by her bed, completely naked, watching us without saying a word, off in her own world, a cup of hot tea beside her. She was in her eighties, but she had a chest that would have put Raquel Welch to shame. Tonight she was sitting in the same chair, except she had a bathrobe on and her skin was a little jaundiced, and she looked much older. She still had her tea and we let her finish drinking it before we carried her down in the stair chair.

***

A few minutes before time to leave we got a call for a man shoveling snow, who had collapsed suddenly. I thought for certain it would be a code, but no sooner had we tossed our coats on, then the hot line rang again and the dispatcher said, "Cancelled."

Annoyance Meter

Let me start off by saying, no one working in EMS should ever be annoyed by anything. The job is a privledge, we are there to help people in distress, as one of my teachers once said, it may not seem like an emergency to you, but it is always an emergency to the patient, etc. etc.

Now that I have gotten the PC stuff out of the way, I will admit that I do get annoyed (as anyone reading my posts can see). Not that I am proud of it. I'm not, but I still get annoyed.

What tricks my Annoyance Meter?

How about this?

"You do have oxygen? Don't You?"

or

"Let me put a jacket on him. He can't go out like that. It's cold out there."

or

"Don't lose his paperwork. The hospital will need it."

I know people are nervous and concerned for their loved ones and on my best days I just let it go. On my tired, cranky days, I say very slowly, "Yes, we have oxygen and we have blankets, and no we won't lose his paperwork. First we are going to undress his top so we can properly assess him, then we will put him a hospital top, then carefully bundle him against the cold. After I've listened to his lungs and thoroughly assessed his respiratory needs, I will do all I can as I always do to see that any difficulty he has is relieved as well as I am able. And the paperwork I need to review because it will help me determine my treatment and assist me in the medical report report I make to the physician at the hospital who will want to know my profesional assessment of your family members condition. It is all part of our job that we do everyday, giving oxygen as needed, keeping the patient comfortable and warm and providing a thorough and detailed history."

Most of the time, I keep it simpler. I look at them and say. "Yes, we have oxygen." or "We intend to bundle him up." Or "We need the paperwork to do our jobs."

Sometimes I just stare for a moment to let their words sink in to them, then I go back to doing my job.

Here's another one that torks me. I drive to the hospital and the family comes up to me and says, "You sure do take the long way."

I look at her and say, "We go all over the greater area. Everyone has their secret way from their home to their hospital. I go the way I know."

I've thought about saying. "Well, I thought about taking the shortest, quickest way, but then I thought, Naw, I'll go the long way."

Okay. Enough. I resolve today, even though I am tired and slightly cranky, to be above all the petty stuff. Today I banish my annoyance meter.

Stay tuned...

***

Call #1 Code Three Lights and Sirens Chest Pain at nursing home. First, a preface: many nursing homes nowdays have patients who are fully ambulatory, who seem to be in nursing homes for no reason other than there is no one to take care of them. We find a 70-year-old Spanish speaking gentleman standing in his room watching a tall long haired brunette beauty with big red lips, a low cut dress and major cleavage singing "No puedo controlo" (I can't control it)on the Spanish TV station. She is very hot. Caliente. The nurse says the man told an aide he had right-sided chest pain this morning, but when I talk to him, he denies any pain, says he is fine and does not want to go to the hospital. He will not take his eyes off the beauty on TV. I confer with the nurse and she agrees with me that the man seems to be fine. His skin is warm and dry. His vitals are 118/70, 64, 18. I suggest that maybe they can just call us back if anything develops. She is agreeable and we leave with a refusal. Simple enough. Haven't been called back yet.

Call #2 Minor motor vehicle. Guy refuses. The other car's passengers says no injuries. We clear. Just as we get back to the base we are sent back to the accident. The two people in the other car, including the driver who just got a ticket, are now claiming injuries. We go back. The driver has shoulder pain, her daughter neck pain. We c-spine the daughter and put the mother, who was ambulatory when we first arrived on scene, in the captain's chair. When the mother sees the daughter being put into the back of the ambulance, the woman, still holding the ticket the officer has written her, requests a collar too. She says she doesn't want the board, she just wants a neck collar. I calmly explain to her why she does not need a neck collar. We take her and her daughter to the hospital.

Annoyance Meter: Still reading zero.

Call #3 Take my first bite of steaming hot pizza. the tones go. 12 year old difficulty breathing. Lights and Sirens. Yeah, right, I think. Anxiety attack, no doubt. Get an update, keep coming, it sounds bad. The address is on the same street where there are some group homes. I'm thinking maybe some kid with cerebral palsy in a wheelchair, choked on plegm, is turning blue, and is going to be a code by the time we get there. We go charging in. It's an anxiety attack. "I got pnemonia, I've got pnemonia!" the boy shouts, clutching his chest.

"No, you don't, you got anxiety," his father says. "This happened two three times a week. The boy's was medication."

"But he's grabbing his chest," his mother says. "He's grabbing his chest."

"Listen, we've been through this. He's got anxiety. This is just like what happened in church. He got anxiety."

"But he's grabbing his chest."

"I want to go to the hospital," the boy says.

The kid is fine. warm and dry skin, lungs clear, sat is 100%. the kid was playing in the basement when suddenly he said he couldn't catch his breath. He's breathing fine watching his parents argue with each other. We end up with a refusal, the father saying he will take the boy down to the hospital if he continues to get upset.

Call #4 No sooner have we gotten back and I have gotten my plate of pizza, the tones go again. Difficulty breathing. Lights and sirens. We get half way there and we hear the cops go out and they say an ambulance is already there. It's not us. Somehow a commercial ambulance was dispatched. Whatever, we're canceled.

Get back, get some pizza.

Annoyance meter: Still hanging at zero because I am in a no annoyance, no whinning zone.

And I am rewarded by no late call. Who hoo!

Three Calls

Three calls today.

A 98 year old man growing weak.

A 47 year old man with jaundice and a failing liver.

A 78 year old man with colon cancer.

All three calls were BLS. All three went to the hospital because they were too sick and weak to be at home, at least according to their caregivers who seemed in denial about the progression of their diseases. He gets tired on exertion. He's too weak to eat. He's lost twenty pounds.

The old man looked like he'd been a twinkling Spencer Haywood type priest in his day.

The youngest man looked like Dean Martin with yellow skin.

The thin old man with colon cancer looked like an emaciated Snoop Doggy Dog.

None of them said a word in the ambulance. They hardly moved.

Something to Do

The last several days have been on the monotonous side. Same kind of calls over and over. Today we did two doctor's office calls. One for a man weak and dizzy who had the flu. The other for a man with some shortness of breath on exertion. He'd recently had surgery so his doctor sent him for x-rays and it turned out he had a PE so we brought him in to the ER. We did an old woman with Alzheimer's who said her neck hurt and then when we got to the hospital, she said she was fine and couldn't remember why we had brought her in. Did an MVA with neck and back pain.

Spent some time today reading through the AHA new guidelines. I've been jotting down some of the changes -- very interesting. I'll post more about them maybe tomorrow.

Also, you may have noticed I have started putting book ads on this site(Something to do while waiting for the big bad one). I am trying to post every autobiography or general non-fiction book about EMS and every fictional one I can find. I may add one or two instructional books, but only if they were real important to me. My apologies if I have left out anyone's book. I will add them as I come across them. At some point I may organize them better. I also may write a review of some of my favorites.