Heroin

Home after seventeen hours. I am beat down. It wasn't even that busy. Four calls is all. Still, it's an accumulation of calls, of days.

Three more nursing home calls. A chest pain, a pnemonia and a man just not feeling well. The chest pain was the same lady I brought in a week ago. Same complaint. I asked what the hospital found out the last time. The nurse was unaware she had even been sent in. She found the discharge paperwork that basically said they couldn't find anything wrong. Same complaint today. She is tired with a heavy chest. She has Alzhiemers and keeps saying. I don't know why I feel so bad. I have a pacemaker.

The last guy felt bad for three days and wasn't eating or taking his meds. He was 79. What's wrong with him? my partner asked. I just wanted to say, he's old and tired.

The one non-nursing home call today was for a man found unresponsive by his wife. They updated us en route saying he had vomited, but was semi-responsive. The guy was on the kitchen floor. He could answer questions but seemed sluggish. He had hurt his shoulder a few weeks ago, had surgery and was on pain meds. I was guessing he'd taken too many meds and maybe washed them down with some liquor. I couldn't smell any liquor, but he seems just like a homeless man in his demeanor. What struck was here we were in this brand new home -- so new it hardly had any furniture in it, and instead of a paved walk, we'd had to pull the stretcher in over gravel -- and here was this guy with a well dressed wife, and he seemed in his faded jeans and grey tee-shirt and flushed face to be just a street man. He looks up at her and says, sorry. We got him up on the stretcher and we were starting out the door when suddenly the wife, who has gone into the bathroom, says, hold on a minute, and she comes out of the bathroom. Heroin.

She is beside herself, she is so angry. The officer asks her if this is something he regulary does. She says no -- he's been clean for almost sixteen years -- since before she met him. She's says he used to be an addict, he'd been upfront about his past to her, but he had been a good man in the time she had known him. He didn't even drink. She says she could kill him.

She comes to the hospital with us, riding in the front, She asks if he is okay. I tell her he'll be all right.

She just cries. She says he's been depressed. His son died recently, he's been out of work with his injury. He's had no money. They have a new home and can't afford to put anything in it.

He's beaten this before, I say, he can do it again. Don't be too hard on him.

I could just kill him, she says, but not as harsh this time.

After we leave them in an ER room, I come back later and glance in. She sits next to his bed, leaning against him, her head against his shoulder, his big arm around her. He brushes her hair. Niether of them speak.

The Fog

Unbelievable fog coming to work this morning. Thick. Headlights were no match for this fog. It was Biblical. It was so thick I was expecting to get sucked up in a vortex and come face to face with God who would say, "Young Man, What's on your mind?"

But it was just fog. The only way I got to work was I had traveled the same road so many times before I could navigate by feel. I knew the way.

Today has been a mirror image of yesterday. Three calls to start the day, then nothing so far in the afternoon.

All three calls were at nursing homes. A rectal bleed, an aspiration pnemonia, and another pnemonia.

Good calls for my preceptee. He is working on his routine. Assesment IV, 02, monitor.

Driving home it was dark and rainy, and misty.

Tomorrow

Quiet morning, turned into a busy afternoon. A nursing home patient bleeding from the penis, an elderly woman who fell and broke her hip, and a fifty year old woman with a history of colitis having severe abdominal pain.

Last call came in 15 minutes before crew change so I punched out an hour late.

I'd much rather have a slow morning and a busy afternoon, then the other around. I got some rest, did some writing, had lunch, then before I could get bored, we were out and working.

I didn't have my preceptee today because my shifts were already filled with members of the volunteer ambulance. The three calls weren't challenging, but it made me remember how intimated I was when I first started. Now, where there are still calls that rattle me, for the most part, I glide through so many of them. I have a routine that works for me. I'm comfortable in my job.

But how good a thing is that? Is it time to congratulate myself? Is it time to quit? Is it time to look in the mirror and ask myself who I am kidding? Is it time to get the books back out or take a class? Should I be looking over my shoulder? Or should I be looking ahead?

I don't know the answers.

I do know I did a good job today. But tomorrow I will have to prove myself all over again.

Suffering in the World

We’re called for chest pain at the court house. We question whether it is a case of "Jailitis." We find the patient sitting in the lobby on a bench surrounded by marshals and firefighters. It is a young man – twenty-five. My first reaction is he is a prisoner, but then I realize he is wearing street clothes. We hear the story. He was walking down the street when suddenly he felt an intense tearing sensation in his chest going into his back. He is a heart transplant patient. A firefighter hands me a paper with medical history on it. It is a typed report from a hospital saying the patient has a diagnosed Aortic dissection.

"Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta (the major artery from the heart). This condition may also involve abnormal widening or ballooning of the aorta (aneurysm)."

While the man looks okay, he also seems extremely tense. I would be too with that history. An aortic dissection rips open and the person bleeds out in a minute. One moment awake, the next dead.

I nod to my preceptor as I lower the stretcher. Let’s just get him on the stretcher and on the way to the hospital. His pressure is okay. When my preceptee says he is going to start a line, the man says he has no veins, the hospital has to use central lines so we shouldn't bother. We are already enroute to the hospital. I hand the CMED radio to my preceptee. He stutters some with the patch. The patient snaps at him when he says stomach pain. “It’s not stomach pain, it's chest pain, pain into my back.”

When I ask for the meds he’s on, he starts rattling off a list. I ask him to repeat one; he says the name again, but with thick frustration. He glances back to try to look ahead. “Are we at the hospital yet? How far is it?”

“Just up the road.”

When we finally approach the hospital, the man, seeing the ambulances out the side window, says urgently, “You just went past the ER!”

“No, listen, I know you are concerned, but we know where we’re going. It’s a one way drive.”

He apologizes.

“We’ll get you good care.”

In the ER, I tell the triage nurse the man has a possible AAA. "No! It's not possible, it’s been diagnosed,” he snaps. “I have it.”

“Okay,” I say. “We’re getting you a room now.”

He looks like he is about to snap as we wait for the triage nurse to give us a room assignment. His hand keeps tapping his leg. “Man, I can feel it pulsing!” he shouts.

**

My preceptee is discouraged that he gave a bad patch. He apologizes for doing poorly.

Doing poorly I say, you haven’t done poorly yet. And you will. Just wait, you’ll have a call from hell where everything will go wrong. You haven’t seen anything yet. Just be prepared.

While we are talking another medic tells us about the call she just had – a code. They couldn’t get the tube, they had to keep suctioning. Blood was billowing out of the man's mouth. The messiest call she had ever had she said. She even considered doing a crick -- cutting the man's throat to get an airway in. In the end, she was able to get a combi-tube in. Not a good call for a medic, much less a call a new preceptee would want.

**

Our calls are all routine. "Severe pain" is a man with knee pain and a month old rash on his legs. "Irregular ECG" at a health center is a woman with abdominal pain and cirrhosis of the liver. "Violent psych" is a seven year old is acting up at school.

**

We do a woman in a nursing home with abnormal lab values. She has an ETOH history with liver disease. She looks like a matron in her late fifties, maybe sixty who’s had too many martinis. I look at her age. She was born in 1963 -- four years later than me.

I’m proud of my preceptee when he realizes the woman has badly soiled herself he gets an aide to get her cleaned up before we take her out. He talks with the woman in calm, compassionate tone.

**

Later we do two heroin abusers -- a sixty year old Puerto Rican man who last used in the morning, then went to a detox center, but when they checked him in they found his sugar was over 600, so they called us to take him to the ER and a thirty year old man involved in a car accident in a bad neighborhood, who seemed a little odd to the cop. He was also an insulin dependent diabetic, although his blood sugar was low in the 40's. We ended up giving him one and a half amps of Dextrose. The younger man did not want to admit his heroin use. When we tried to roll up his sleeves to look for a vein, he resisted and said he had issues. We told him we didn't care, we just wanted to make him better. He had track marks, but not hard core ones like the older man. The older man talked freely about his addiction about how he fell in and out of it and back in again. He's spent 18 years in jail. Hald his family had been killed by drugs. He said when he got out of jail, he saw there was so much suffering in the world. Other people couldn't see it, he said, maybe because living on the outside they had gotten used to it, but it affected him. When it became too great, he was susceptible to the needle. But he wanted to get clean again. He wanted to live at least until he was seventy, he said. His father had lived into his nineties.

***

We never get back to the first hospital to find out about the young man with the dissection.

Routine

Worked eight hours today with my preceptee in the city. Started out with an unresponsive, but it just turned out to be an old woman not feeling well. He got his first IV no problem. The other calls were also pretty routine. A woman with chest pain that hurt when she moved her arm or touched her chest, another woman who wanted to kill herself, and an old man feeling weak. He was seen at the hospital last night for a urinary tract infection.

Tomorrow is twelve hours in the city. Maybe we'll get our first difficult call. It actually has been good, doing the slower common place calls. It gives him a chance to get used to doing the medic things such as checking blood sugar, doing 12 leads and IVs, giving breathing treatments.

I was also beat today. It seems I am more tired on my days following my days off.

Even though I was tired today, I was thinking how much I love the routine of this job, coming in to work, seeing the cars lined up in a row in the garage, the early crews checking out their gear, I punch in, get my car keys, narc keys, and radio. Spend a few moments chatting with people, then out to the car to go through the gear, get a few things in the supply cabinent, then go online. They post us. I get out my morning paper, open up a diet coke, and wait for them to call my number.

Every day is different.

How are you?

Today I started precepting a new medic. Nice guy with some decent BLS experience, but has been out of medic school for 18 months so we are going to start slow. The last guy I precepted was already a practicing medic in another state, so the precepting was more just watching him do calls. This medic is happy to be molded. We spent some time this morning practicing on the intubation manequin.

Not much action today. An old man with a fever, an old woman not taking her meds not acting her usual self and a prisoner who needed an evaluation.

But they were good calls for doing the basics.

1) Looking the first responder in the eye and asking for his report.
2) Introducing yourself to the patient by name and asking for theirs.
3) Looking them in the eye and feeling their forehead.
4) Getting the history (Asking the patient "How are you?")
5) Doing an assessment
6) Taking them to the hospital

***

I worked 16 hours, my preceptee was only with me for the first 12. Ten minutes before I get out, I get a call for chest pain at the Alzheimer's Place. Most of the time I go there, I ask the patients how they are, they say, Fine, how are you? Then the nurse says, but you were having chest pain, and they say, I was? I'm not kidding. Happens all the time. But this time the lady said she had pressure inher chest. She had a pacemaker so the 12 lead didn't tell me anything. IV 02 monitor, ASA and a couple ntg and transport.

Invisible

Woke to a snowstorm this morning. I had no idea it was going to snow. Very slippery coming in to work. Around nine we went out for an MVA on the town line. It was very minor. No injuries. The police officer suggested we let the driver of the damaged car warm up in our ambulance while he did the accident paper work. The man said he lived just up the road and we were volunteered to take him home. Well, then it turned out the accident actually happened across the town line so we had to wait for the other town to send an officer. He finally showed up and took a long time doing up the paperwork. In the meantime the passenger of the other car said his supervisor wanted him to get checked out at the hospital since the accident happened in a company vehicle. The officers debated whether they needed to call for the ambulance from the other town to come. It's in the other town, but we're an ambulance and we are already there, and its icy out so why not have us transport. The driver who wanted to get checked out said he'd just go with us and he could wait till the paperwork was done for the other guy, who I thought lived just up the road, on the way in fact to the hospital. Finally the paperwork is done, and the driver who wanted to get checked out walks back over to the ambulance (He's done doing his company paperwork with his supervisor)and I ask him again if he is okay and he says he just has a headache. Then once I get him on the stretcher, he says, oh yah, and my neck hurts now. So we c-spine him.

We start to the hospital, and well, the other guy lives a little further away than I thought. The passenger starts asking "are we there yet?" and I look out and we are on Main Street in the next town over. We are in fact farther away than when we started. Now at the same time the road is bumpy and icy and we are using the chains and the guy on the board is uncomfortable. "My head hurts," he says. "Are we there yet?"

I'm thinking "How did I get in this situation? I'm doing a call in another town and instead of transporting a patient to a hospital we're taking someone home while we have a patient on our stretcher who is now telling me his head is killing him.

Anyway, the one driver got home, we finally got to the hospital with the other guy who turned out to be okay. But what could have been a quick "no injuries, no paperwork" got very complex due to one tiny little good deed after the other.

***

Again accidents all over town, but none with injuries.

***

Late in the day we get called to an elderly housing for a patient unresponsive possible overdose. This is a different complex than the one we went to yesterday. This one has several buildings located around a single entrance drive. The resident all have outside entrances. Again the apartments are all the same. Kitchen living room and bedroom with bath off of it. These apartments are all dim with poor natural lighting.

The woman lies in bed, snoring. Her sister says she tried all day to call her with no luck, so she came over. She hands me the empty bottle of Ativan. Filled just a few days ago. 60 .5 mg tablets. Empty.

I give the woman a good sternal rub and she opens her eyes and mumbles. Her airway is patent, her vitals are good. We load her up and go. The sister says she has been despondent for weeks about her grandson, and has said she doesn't want to live. I never find out why happened to the grandson. I try to question the woman, but the best I get is mumbles. And I never find out when she took the pills or how many she really took. I did get the feeling that she did really want to die.

***

At the hospital I am walking through the ER when I see a black man maybe sixty standing naked in the middle of the bustle holding his catheter bag with fruit punch colored urine. The sight doesn't register on me until I am well past him. It was like he was invisible. Nobody was paying attention. I guess like a homeless man in Grand Central station, a naked man holding a foley in the middle of ER is not too out of the ordinary. When I walk back out of the EMS room to see if the man is still there or if he had just been a figment of my imagination, I find my partner escorting him back to his room.

Loneliness

No calls for 11 hours. My new Sunday shift is turning out to be a sleeper. I manage to keep myself busy with various projects, but am growing bored by late afternoon. At 5:30 we finally get a call. Elderly housing, elderly woman not feeling well.

There are many elderly housing complexes in this town. We go to this one all the time. It is a two story complex with five wings A-E. The residents enter through a main entrance. There is a common area with an aquarium that could use some algae scrapped from its sides, a cafeteria, a pool room, an area to sit and play cards. There are always a lot of people sitting out in the common area near the front door. They always want to know who we are coming for, who we are taking out.

The apartments open into the each wing's hallway. Behind every door is the same layout: a small open kitchen, a carpeted living room, one bedroom with a bath off of it. I feel like I have been in just about every unit in the place, some several times. I've been here for codes and strokes, and falls and MIs and COPD and more often, for not feeling well.

Tonight I stand there looking down at the 80 year-old woman sitting in her kitchen chair in no obvious distress, saying she just feels lousy. She says she's had diarrhea today and an ache in her shoulder and tingling in her fingers, and some nausea. I look at her apartment. It is cluttered with bills and mailings from medicare and insurance and drug companies, lottery tickets, mail order catalogs, newspapers, prescription bottles, a glucometer, crossword puzzles, a scrapbook. I ask if the woman has called her doctor, she says no one is there on the weekends. She needs to get her glasses and her book and newspaper and a coat before we leave. It all makes me very depressed. I know there are a lot of old folks who love living here who have active social groups, but there are others who live alone behind their doors, not just in this complex, but in apartments all across the world.

I've done this call so many times, old woman just not feeling well, doesn't want stay alone in her apartment, but doesn't really want to go to the hospital, what she really wants is just to have people there in her apartment, so she stalls. We finally go and she talks the whole way in. After we leave her off, she thanks us for being kind to her, and then turns her attention to the nurse, who cuts her short. "I'll be back in a moment." And then the nurse goes into the next room and helps the doctor with a patient who needs to be intubated. The woman alone at least has her book and her glasses and a bright room with a view of the ER where people bustle about.

Floating Jesus

Working 9:30-17:30 – a great shift for a Saturday. Can sleep until I wake up, and then lay in bed another fifteen minutes past then. Have a leisurely shower, breakfast, some internet surfing, a little poker (lost $6), then head in to work. Weekends in the city are great because there is no traffic. Half the stress of this job comes from the traffic.

Half my shift is over, and all I have done is two transfers – a dialysis patient and a psych. The rest of the time I’ve been typing away on my laptop.

The dialysis patient was fairly interesting. She seemed very teary and thanked us just about every fifteen seconds. I guessed that she was new to dialysis, and I was right. She is a diabetic, who had to have her legs amputated, and then suddenly her kidneys went, so she went from having control in her life to being in a nursing home, unable to adjust the heat – it was too hot in her room – and unable to shut out her roommates TV, as well as being at everyone else’s mercy.

She was a big woman – wide - and the dialysis center we went to, instead of using stretchers like most do, uses these geriatric chairs, where the patient sinks down in them. This center’s chairs don’t have removable sides, so we have to lift each patient up about a foot before we can transfer them over. This lady was hard to do, not just because of her weight, but because of her girth, she was sort of wedged on both sides. I was working with a strong male partner. I can’t imagine doing her with one of the weaker females. We’ll be picking her up and taking her back three times a week from now on.

**

Took a little nap in the back of the ambulance. I don’t sleep so much as stretch out. The nets are great for stretching. I lay flat on my back and reach my arms up over my head and grab on as high as I can on the net and just feel the stretch in my back muscles.

**

We help an out of region ambulance unload a heavy patient coming from a distant hospital to a nursing home in the city. She is too wide for their stretcher. I carry a picture of hers, a larged framed photophoto of a marble Jesus — his arms out -- suspended in space. She is upset because they don’t have the special bed she needs. For a few moments, she refuses to get off the stretcher, but we convince her that the nursing home’s bed, while not the one she wanted is more comfortable than the stretcher she is on. She relents.

**

We sit downtown in an empty parking lot. All the winter snow is melted. The wind whips up the sand. My partner says it reminds him on Iraq. I look up at the Capitol building on top of the hill to the south. The sky is pink and purple as the sun goes down.

Money

Another day off. The problem with days off is I spend money. I work, I make money. I take off, I spend.

In the last couple weeks I have bought an electric toothbrush, a microwave, and today, a high-end vacuum cleaner with all kinds of gizmos. I also bought a nice reading lamp for my bedroom, along with other assorted items like cleaning supplies, boxes of Cliff bars, energy efficient light bulbs, and new headphones for my MP3 player. Then I went to the health food store and spent $50 on all sorts of interesting things like frozen rice and chicken bowls, artichoke tortellini, frozen roasted corn, lime and chili nacho chips, and old-fashioned roasted peanuts. I did win about $40 playing on-line poker, but that hardly makes up for the loss of income from not working and all the expenditures which totaled nearly $400.

I got an email announcing a date change for the next Bolivia meeting along with the notation “Bring your checkbook.” They are doing a group airline ticket purchase. I had heard they might cancel the trip, but I guess not. The air fare is $900.

But also on the positive for the day, I slept until I woke up, I went to the gym, and I spent some time working on one of my EMS novels, including posting some new chapters at the following link: Diamond in The Rough.

4 Calls

Did an eight hour. 6:30-2:30. I don't like getting up so early on what I consider a day off, but I'm out by 2:30. The problem is eight hours still makes me tired, so instead of being tired working another four hours, I am just as tired, but sitting at home. I am going to try to take a short -- 30 minute nap -- and then hope to wake up refreshed and get some work done.

Did four calls. A G-tube transfer, a woman with a low H and H, a seizure that turned into a refusal, and an ETOH.

Rain

Poured rain all day. Rain and wind. I'm glad I wasn't working. Slept till almost noon. Never made it to the gymn. I did get in the mail today a book about Staying in Shape Past Forty. I'm still in good shape, but nothing like I was a year ago.

Going in at 6:30 tomorrow.

More MVAs

More motor vehicles today except this time they all wanted to go to the hospital. Also did an old woman not feeling and a young man who drank bleach, then changed his mind and spit it out before it did any damage.

I am off tomorrow.

I don't think I'll pick up a shift.

I'm kind of beat.

No Injuries

Cold and icy. Lots of minor car wrecks all over town. We are sent out to two of them, but find no injuries when we get there.

Sunday Morning Church Service Syncope

One call in 12 hours. A Sunday morning Church Service syncope. The woman says she was briefly overcome, but is now fine, thank the Lord.

Since I am now working Sundays I asked the Sunday morning volunteer crew -- two people who have been working every Sunday morning in town for twenty years what percentage of their calls are church service syncopes. 40% they said.

There are a lot of churches in this town.

Carolina

I'm working on the computer when we get the call. I am in fact in the middle of downloading a program. Bad timing. There is no way I can wait for the download to finish. I decide to just minimize the window amd leave it at that.

Only when we are on the way to the call do I start to worry. This isn't a typical day at the barn where when we go out no one is there. Today there is a class going on. During break up to twenty people will wander into the front room. Some will sit down at the computer. I realize I have forgotten to log out of my email. I start to imagine people reading my email. Worse sending out emails under my name, then changing my passwords, depleting all my accounts. Damn, I think. I hope this call doesn't take long.

20 year old female with severe abdominal pain. History of gallstones. She is a large girl with big doe eyes. She is crying. She says she is scheduled for surgery later this week in Carolina where she lives. She says she ran out of her pain meds two weeks ago because she hasn't been able to refill them.

She is in the upstairs bedroom. I figure she is about twohundred and twenty pounds. I am working with two partners who are not quite up to carrying half that load. I tell her the stretcher is set up at the base of the stairs. She stands reluctantly and then bends over holding her abdomen. The first responder on scene puts a hand on her arm and then eyes me. Her look says, "Are you sure you want her to walk? Can't you carry her?" I raise my eyebrows to the first responder in a look that says, "She is two hundred and twenty pounds and there is nothing wrong with her legs."

She makes it down the stairs just fine. We get her out of her baggy NFL football jacket and sit her down on the stretcher, and then wrap her up in a wool blanket. We get her out to the ambulance, and I tell my partner to head to the hospital on a nonpriority.

I take vitals and check her from head to toe. 130/80. Pulse of 80. Her pain is in the upper to upper right area of the abdomen. She says she has thrown up six times. Her pain is 10 out of 10.

I ask her if she has ever had to go to the hospital by ambulance before for this. She says yes, six times. I ask her what they have done for her. She says well, down in Carolina, they give her an IV and fluids and drugs for the pain through the IV. I think well I can't let Carolina show us up.

I wrap a tourniquet around her arm, and go for an IV. Her veins feel hard for a 20 year old's. Hard in the sense that they are sclerosed. I miss. Feeling Carolina's crowd doing the wave, I check the other arm. Sure there is a huge AC. No doubt the vein Carolina used. I slam a 16 in. And take four tubes of blood. Take that Carolina.

We are not that far from the hospital. Maybe ten minutes. As I sit there cleaning up the IV wrappers, I see her big doe eyes looking at me. She turns her head and batts her eyes. They seem to be pleading with me.

"What was it again they did for you in Carolina?" I ask.

"They gave me drugs through the IV."

"What did they give you?"

"I don't know. Something for the pain."

She stares at me. She looks so pathetic.

My mind is on many things. I'm thinking about about the class sending out emails under my name. I'm thinking about Carolina medics dancing around holding their fingers in the air, chanting "We're number one! We're number one!" I'm thinking about how long it will take her to get pain medicine in the hospital. I'm thinking about how if I give her medicine, I will have to call for medical control now, and then afterwards, I will have to track down the doctor to get his signature, and then walk across the street to the other building and then down the stairs to the basement to the pharmacy where I will turn in my used set, and pick up a new kit, and fill out all the paperwork, all the while they are sending out emails under my name and stealing all my passwords, spending all my money.

I move seats to reach the CMED radio. I ask for a patch, and at the last moment, request medical control.

I just can't stand to look at those pleading eyes.

I get permission for 5 mg of Morphine. Not a huge dose, but enough to start to take the edge off. I get the narcs out of the locked cabinet, and then sit down beside her.

"All right, I've got some pain medicine for you."

I see a slight, appreciative smile- an I'm not such a bad guy after all smile.

And I am thinking of my own state's cheerleaders, chanting "Go State! Go State!"

I give her the medicine and throw in some phenergan for her nausea for good measure.

We get her in her room in the ER, and she seems sedated now. I ask her about her pain, and she slowly says its down to a six. Since she is talking in slow motion, I consider the mission a success.

On my way out the triage nurse calls me over. "She's a regular here," he says. "She's got that bullshit story. She's going to have the operation in a couple days in another state. Her prescription ran out. Etc. Etc."

"She seemed in pain," I say.

He just looks at me, shaking his head like I am the biggest sucker.

"Are you saying she's drug seeking?"

"I'm just saying she's a regular and she's always just about ready to have surgery."

Oh well.

I do all the paperwork, walk across the street, change the narcs, and on the ride back to the base, I'm thinking maybe I should call up Carolina and commiserate. Got you, too, witht that tall tale, huh, old partner.

At least my email seems none the worse for being left open. As far as I know.

***

We do a two year old with asthma and a fever in respiratory distress.

A ninety-seven year old with pnemonia and a fever in respiratory distress.

***

It is a rainy foggy day.

***

It's pouring rain and we get called for anxiety. 40 year old female sits in her kitchen holding her chest saying it feels heavy. We ask if she has been under stress and she says, "You don't want to know."

But she has never felt a pressure like this before and she says it feels like someone sitting on her chest. Her skin is warm and dry. BP 150/90. P- 108. Sat 100% on room air.

No prior history, though given her race and weight, she looks like she might have hypertension and high cholestrol.

Out in the ambulance, I put her on the monitor. Doesn't look too bad at first glance.

I do a 12 lead.

Looks a little suspicious.

I give ASA and NTG, which brings no relief. Her pressure holds steady. I call the hospital, and let them know I have a chest pain with a borderline ECG, possible ST elevation in lateral leads.

I do another 12-Lead.

Looks nasty. Particuarly in V-4 -V6. Such a change in ten minutes. In addition to the lateral there is fresh change inferiorly with an ominous cove shaping of the ST.

At the hospital I tell the triage nurse I believe my patient is having an MI. They have a room ready for us. The woman is in the cath lab before I leave the hospital.

Any Difference

Call comes in for a stroke. We find the woman in her wheelchair attended by her husband and a friend. She is thin frail woman who is alert, but seems to be in pain. The husband says he has had trouble waking her up in the morning, and that she can't sit up straight in the wheelchair, that she stiffens up. Her grips are equal, no slurred speech, but it is hard to understand her because her teeth are gritted together.

Her pressure is 84/40(at least that's what I hear it at), but her hands are warm and she has a history of low blood pressure. She is shaking imperceptibly, but enough that it is hard to get a decent ECG tracing. I listen to her heart and count the beats at 120. I can't get a SAT either, but she doesn't seem in any respiratory distress. She has a history of IDDM, peritoneal diaylsis, and silent MI. She has no IV access, and anything I do causes her pain. Her pain is in her back, in her shoulder, in her feet.

She seems stable enough so we go on a non-priority. I put her on a canuala. The husband, who has not been much help in detailing her history both what happened this morning and her general history follows in his car. When we get to the hospital, he comes in with us. The nurse asks what this is, and as I start to explain, she turns to the husband and starts questioning him. He starts talking and before thirty seconds have passed he has her off on all kinds of tangents, and she is rattling off questions about seizures and strokes and triple As. After saying excuse me a couple times, I finally get her attention enough to have her look at me as I say, "Would you like me to give you a report?" The nurse, who is normally one of the better ones at this hospital, comes to her senses and listens to my story. Bottom line -- the woman has chronic pain and takes diladid at night, which the husband neglected to tell me and I only found out about after much questioning. It seems her pain is chronic, and since there was no pain meds on the list I got from the prescription bottles the husband gave me, I asked her what she took for pain, and she said dilaudid.

It was just a frustrating call. A family that couldn't tell me what was what. A patient who was bothered by everything, and a long bumpy ride to the hospital.

When I was a new medic I could see freaking out due to the husband's story, her blood pressure, my poor ECG strip and no SAT registering. I could be thinking anything from AAA to another MI to just play dying.

And if she was dying, she wasn't dying in the next couple hours or in any amount of time that going lights and sirens would have made any difference in.

***

We do a diabetic with a blood sugar of 34. He wakes right up with D50. It seems the pharmacy gave him a glypizide prescription at twice the normal dose.

***

An old woman has a syncopal episode and we take her in.

While we are doing our calls the commercial service comes in to town three times for other emergencies.

***

In the afternoon we get called for a cardiac arrest at a nursing home, but then are cancelled and told it was a mistake. I'm guessing they realized the patient was a DNR.

***

I'm going out to wash the dirt off the ambulance, and hope that we don't get anymore calls in the next fifty minutes.

Wide

"She's not going to fit on that stretcher," the nurse says. "Where are the other two people?"

"We'll check her out first," I say, "Because this is all we have."

"Suit yourself."

As we continue down the hall, the other nurses and aides look at us -- the two of us and our meager stretcher -- and shake their heads.

"She's over 400 pounds," a nurse says.

I point to the little decal on the stretcher. "This baby's rated for 500 pounds," I say.

"It's not wide enough."

We go in the room. I recognize her. I've done her before. The retired dietician. She might be 400 pounds, but the nurse is right about her width. She's not twice as long as she is wide. No way is she fitting on our stretcher.

She looks up from her bowl of cheerios. "Can you give me a minute to finish eating," she says. (I didn't put a question mark after her statement because there was no question. She was going to finish eating.)

I explain we aren't taking her just this moment because we don't have the big stretcher.

"I must have the big stretcher," she says.

"Yes," I say.

I back out of the room, and go down to the nurse's station and ask to borrow the phone. I call dispatch and request the big stretcher. They say there was nothing in the notes about it. The nursing staff tells me they asked for it. After I hang up, I talk to the secretary who called for it. She says all they wanted to know was how much she weighed and how tall she was. They said she didn't need the big stretcher. I say next time tell them how wide. Make a point of it. Don't take no for an answer.

We wait around for the big ambulance to come, then we help load her, then follow the other ambulance to the hospital, and wait around there while she is examined on the stretcher, and then we follow them back to the nursing home, and help unload her. Total call time 4 hours.

***

We spend the next hour covering a suburban town until their ambulance returns to town.

***

End the day with a nursing home patient with a funny hand sensation for three days and person who slipped AT WORK and hurt her back and can't remember whether or not she was knocked out. We have to wait around for awhile at the hospital while they find a bed, the patient wants to know how much longer it will be. She says she hurt her foot last week at work and was in the ER so long, she just got up and walked out.

***

A number of years ago, one of our ambulances was involved in an MVA and the attendent in the back, went flying forward and banged his head and nearly had his ear cut off. Shortly after, they started putting nets in the back of the ambulance at the end of the bench seat. They are sort of a pain when you are getting in the side of the ambulance, or particuarly if you want to toss the monitor which may be on the shelf or on the floor of the side up onto the stretcher. You have to lean in farther to get around the net. Anyway, yesterday I am standing up to get over to the cmed radio. My partner slammed on the breaks and I went flying forward -- right into the net. It absorbed me like an Ozzie Smith baseball glove snaring a fastball. But instead of being out, I was safe.

***
On bit of good news from today. I saw the hospital's EMS coordinator who just came back from the state EMS Medical Committee meeting and he says they approved the Termination guidelines with my "injury incompatible with life" language added. Now if we come upon a freshly deceased patient with "injury incompatible with life" we don't have to start working them prior to calling medical control for permission to stop. "Injury incompatible with life" could include severly displaced brain matter, complete exsanguination or splat injury from 50 story fall. Previously the draft only said decapitation, body transection, incineration to go along with the old dead of rigor with lividity or decomposition.

Foggy Rainy Night

A thirteen year old flies off a snow bump on a backyard hill spins off his saucer and lands on his leg. It hurts when he moves his knee or ankle, but the pain is located in the mid-tibia. There is no deformity, just a little discoloration. We get him in a position of comfort and carry him across the yard on a board. His father rides in the back of the ambulance with us. The boy says his pain is 7 on a 1-10 scale, but he doesn’t seem in that bad pain. I talk over the options with his father, who says he doesn’t think the boy is quite there yet as far as needing morphine.

We are sent to the lockup for a female patient with sickle cell anemia, who is complaining of pain. The guard says, “another patient with a case of jailitis.” The woman tells me she has an IV port under her skin. She is crying, but doesn’t seem in that great pain, although I know sickle cell can cause excruciating pain and is a true crisis. She tells me she takes 30 mg pills of morphine, along with percocet, oxycodone and vicodin. I carry a total of 40 milligrams of morphine and I think maybe, just maybe if I unloaded all of it into her, it might get past her tolerance and give her a slight ease. Plus I would have to call for permission and I don’t think any doctor is going to let me give 40 milligrams of morphine on one patient without laying his own eyes on her, particularly a patient in police custody. I explain all of this to her and ask her to be patient, I promise her that they will take her condition and pain seriously at the hospital.

They say kids often have their pain underestimated by health care providers and sickle cell patients are rarely treated with enough medication. I have a vague feeling of dissatisfaction like I let them down.

We do a hospital return from a nursing home and are sent for a man passed out behind the wheel of a green car, but when we get to the address we can’t find a man slumped behind the wheel of any car, much less a green one. We clear unfounded.

Diabetic in an elderly high-rise. We find him sitting in an armchair in a neighbor’s apartment. He is an elderly black man, she is an elderly Hispanic woman. The woman says he is her best friend. He can tell me his name and shakes my hand, but he is a little slow to answer some questions. He's not right, she says, he's not my John. I check his sugar. It’s 34. I give him an amp of D50, and he is back to his old self. He admits he didn’t have lunch. The woman says again he is her best friend, he looks after her ever since she broke her leg in three places. He says she is his best friend. He visits her everyday. She asks us if he is going be okay? He doesn’t want to go to the hospital. We get his list of meds. He asks us to come downstairs to his place where he’ll show the other medicine he takes, raising an eyebrow. We tell her he’s okay, but we take a pass on meeting his other friend Jack.

Foggy, rainy night.

Confused Can of Worms

Went to the EMS regional meetings today. While these meetings are very good and often productive, today we dealt with some issues that were just bang your head against the table difficult.

First off at the education meeting, we had a nice guy from the state there to explain what services would have to do to meet the new federal NIMS mandates:

Here's a blurb from a state memo about NIMS:

"The National Incident Management System (NIMS) has been developed in accordance with Homeland Security Presidential Directive – 5 (HSPD-5). It provides for a flexible framework that facilitates government and private entities at all levels working together to manage domestic incidents. This flexibility applies to all levels of any incident. NIMS provides for a set of standardized organizational structures, as well as requirements for processes, procedures and systems designed to improve interoperability. It employs two levels of incident management structures: The Incident Command System, and the Unified Command concept, a method of coordinating a multi-agency response by combining the leadership of responding agencies into a cooperative incident command structure."

Here are some of my notes from today's meeting:

"NRP...Playbook...will be shredded, didn't work...Presidential directive #8, Presidential Directive #5..work to local level...series of documents, many documents. Ex documents, feds didn't know where the issues were, issuing new documents..new one is five pages longer...NIMS compliant...ICS 100, ICS 200, duplicative, half of it is just a review of ICS 100, let's get to the meat and potatoes, but that's fallen through the cracks ...resource typing assets, they have a list of 520 assessts including bulldozers, gotten a million inquires so they are redoing the asset list...questions, revising...IS 700 compliant...ICS 100 will be required for all street level providers, ICS 200 for all supervisors, including anyone who might be in charge of anyone, so a Paramedic in charge of an EMT or even an EMT in charge of an EMT has to take ICS 200. ICS 300 will be a requirement in FY 07. ..But things change and there could be additions...developed work groups composed of multidisciplinary under contract to homeland security...developed a traing maitrix, but the federal matrix is different...things could change and there could be additions....I envision this taking years to get done and there will be changes..similar to NIMS but for NRP..."

Now here are some comments from the committee:

"Is that going to happen? No?"

"Who is paying for this?"

"If they want the president of the hospital to take 12 hours of classes on this, they are crazy."

"I go to those meetings and walk out more confused than when I go in."

"Like sitting in a corner talking to yourself."

"My head hurts, my head really hurts."

Here's what I understand: The federal government wants everyone even marginally involved with any kind of response to be trained to know what to do in emergencies. Their initial plan was a disaster as proven by Katrina and Rita. As a street medic I will be required to take at least 2 three hour courses to start, amd most likely 12 hours of classes. My service will be responsible for me taking them. If I don't they won't get federal grant money, which they already don't get, and because they are a commercial service they miss out on all the tons of money given to police and fire. That aside, the federal government plan which is not completed is subject to change and will in fact change.

And I will say this: While people have been going to countless meetings to develop this plan or that plan, since 911, I have not taken one class nor recieved any new training that has had anything do with disaster preparedness, weapons of mass destruction, biological warfare or anything like that. Not one class. And I am most likely to be one of the first one scene because I work all the time, and am in an ambulance which is like the first response sent.

***

Other issues we discussed at the next meeting -- the medical meeting: Quality assurance for intubation attempts, lights and sirens responses, the new ACLS guidelines, critical care transport protocols, cessation of resusication and use of the CMED radios to coordinate mass casualty incidents. Every single one resulted in extremely complicated set of problems. Or as the chairman of the medical commitee said, "Clearly this is a bigger can of worms than I had anticipated."

But it is a good committee and we do get things done. Many of the problems, at least in this state are caused by lack of county government which has spawned a nearly unmanageable array of services, responders, communications centers, etc.

If you were to start over you would clearly blow up the system we have, but you can't blow it up and start over.

So we try to patch work things.

I don't think we will be able to fix the federal response plan, but some of these other issues, we may be able to at least problem solve our way into making something workable.

***

I'm back in the street tomorrow.

Dark Days of Winter

Tomorrow I will have some EMS content. I have my monthly regional EMS meetings. I think next week I will get back to working hard again. In one way, its nice to be off, but I confess it takes some getting used to having time off. While I had a fairly productive day today, at the end of it, I feel a little hollow like I didn't make all the use of my time I could have. I think the fact that is so dark and cold out also adds to it. Maybe January isn't the best time to be cutting back. I have a lot of expenses coming up. Plus the mail brought bills. The one that torqued me the most was Bank of America suddenly deciding to charge a $10 a month maintenence fee on my savings account starting in February unless I keep $2500 in it. How can anyone afford a savings account with those conditions? I'm lucky I opened and read the letter. Maybe I should be pounding out the hours now so I can ease off in summer.

Dark days of winter. For the first time in months my back has been sore for a couple days in a row. I can trace it to doing heavysquats in the gymn. Its my favorite exercise, but I worry it will compress the discs in my back, and my back will never feel right again. Age.

I'm doing laundry now, drinking a beer, and playing online poker. I'm glad I don't have to work tomorrow, but I miss that feeling at the end of the day like I made full use of my time. When you are working and doing a job you love your days are full, but maybe on the other hand, when you work and do a job you love, you are missing out on something else.

If it was baseball season I could be listening to the Red Sox now. College basketball does nothing for me.

OJ

Baby unresponsive, short of breath. Section of town where we often get BS. I'm thinking if the baby is unresponsive I will do my patented baby pinch, the baby will cry and all will be right with the world. The cops tell us to keep coming code 3. When I walk up the stairs I hear the cop mention something about a heart operation. The two month old is in her big mother's arms and is attached to a heart monitor and a feeding tube. They have my attention. The baby is in severe respiratory distress, but it is at least alert. My partner takes the baby from the mother just as the phone rings. It is the baby's cardiologist. I hear her telling him what happened and asking if the baby should go to the hospital. We clock the baby's resps at 88 with nasal flaring and deep retractions. The mother who seems amazingly calm is chatting away with the doctor. I ask for the phone. I introduce myself to the doctor and say the baby needs to go now. And I do what I used to call an OJ Simpson before OJ got known for other things. I grab the baby and run for the hospital before it tires completely out. The baby's heart rate is over 200. It's SAT is 80, but with oxygen I get it up to 90. The mother tells me the baby has pulmonary atresiaand ventricular septal defect. At the hospital they bring in the requisite number of physicians to fuss over the baby, who no doubt has a long hard road ahead of it.

Only other call was for an Alzheimer's patient with nausea.

My relief came in a few minutes early just when a call came in for an unresponsive found by neighbor. He took the main ambulance and I followed in the second ambulance in case it was a code. It was a presumption so I headed back and am out of here.

No shifts till Friday unless I pick some up, which I no doubt will.

Good as New

I would like to say that I came into work today refreshed from two days off, and tackled the job with vim and vigor, but it would not be true.

I switched the gear into my ambulance, which was immaculate inside, but coated with brown dirt all over the outside. Instead of washing it, I went and lay down for twenty minutes, then got a call. An old woman in a group home slipped and hit her knee. She kept muttering I broke my leg I broke my leg, so they called us, but she didn't break her leg. We stood her up, said your leg is good as new. She nodded, seemed pleased, and then puttered away chanting good as new, good as new.

We came back to the bay, and I took a long look at the dirty ambulance and decided I needed to wash it right then. It was that dirty.

Later we did a call for a man who was tired and then one for a woman feeling weak. I never found out what was wrong with the man -- I think it was new onset of afib, but I found out about the woman, which was an unusual story. I have taken her in often in the past -- she is very needy and in poor health. She said she hurt all over and had not been feeling well for two weeks. Her assessment was unremarkable. Lungs were slightly decreased. Her SAT was 94-95 on room air. Dsypnea only on exertion. At the hospital, a doctor put in an order for a CAT scan of the patient in one room, but he wrote down the wrong room number so she got the scan. It showed she had multiple bilateral PEs. Pretty amazing.

Later did a seizure call. Seizure history, takes dilantin, but didn't take it today, had a seizure.

My relief is in and I am off to the hospital's Holiday party.

I can't stay out too late because I am back tomorrow and I really would like to go at the job with vigor. Actually I would like to lay on the couch all afternoon and watch the football games.

The Job (A) and (B)

Resisted the siren call of the pager with its constant buzzing announcing open shifts.

Today other than a short errand this morning, I did not leave the house. I spent just about the whole day writing -- or rather going through the first year of this blog -- trying to edit it to see if it is worth turning into a book. I had two reactions.

A). It was mind numbing reading over the entries about bad dispatching, stupid nursing homes, idiotic calls, and all the other daily bitches of the job. I think I just need to face it. The job is what it is and all that crap comes with it. I should expect it. All jobs have their routine BS and drawbacks you have to put up with. I shouldn't let it get to me as much as it does.

B) The real gems in here -- the interesting parts, what makes the job worthwhile are the people you encounter, the situations. Being a paramedic is a privledge. What I have seen in the last year -- in any year as a medic -- is really remarkable. For all we paramedics bitch about the dumb and ridiculous, we also have a front row seat to life, to heartache, joy and to miracles.

That's the part I want to write about, the part I want to record.

Middle Eastern Music

Slept until nine-thirty, got up refreshed, was getting ready to go to the gymn when the phone rang and the company supervisor said "Where are you? I have you on the schedule."

I thought I was off. But it turns out the first week in January is still part of the last six months of the 2005 schedule block because the week started on December 31. I had been written in for Mondays, Tuesdays and Wednesdays in the city 9:30-9:30 in that schedule block. My suburban shifts got switched two weeks ago, so I was taken off the Monday and Tuesday city shifts because I was now working in the suburbs on those days, but I was left on Wednesday. Anyway... I got uniformed up and went in.

Busy day.

Started off with a VA transfer -- nice forty minute out of town trip. Came back and hardly got a break the rest of the day.

We got sent for a MVA near the golf course. On the long icy entrance road we found a rollover, but no patient. While rollovers with no patients are common in the north end of the city -- they are usually stolen cars -- what was unusual about this was the car stereo was blasting middle eastern music, and witnesses say they saw a man with a turban fleeing across the snowcovered golf course. So why was he running? It couldn't have been a stolen car because I wouldn't think a car thief would bring his own music. Who was he? Why was he running?

We did a short fat little ten year old girl with huge pig tails, who had a fever at school. When I first saw her lying on the cot in the nurse's office, I thought she was eighteen, but then she stood up and was barely four feet tall. We had trouble lifting her up on the stretcher. By trouble I mean she was a lot heavier than I anticipated when I went to lift the stretcher up. At the children's hospital, she stepped on the scale and weighed 85 kilos. That's 187 pounds.

Later we did a tiny seven year old with a stomach ache, and a drunken eighty-year old Jamaican, who called from a pay phone. He sang all the way to the hospital. The nurse at triage crumpled up the registration slip I handed her. "Just put him in a wheelchair and set him in front of a TV," she said. "He'll get bored in a couple hours and leave."

We did a woman with chest pain from a doctor's office. Her twelve lead was insignificant, but she had a lot of risk factors so the doctor wanted her to get the full rule out workup.

We did an old woman with abdominal pain and severe nausea with a history of bowell adhesions. Her BP was 220/110 with a heart rate of 120. She didn't want me to try an IV. "Let them do it at the hospital," she said. "You'll never get it. I have terrible veins. You'll just hurt me. You just want to practice. I've never met an EMT who could get it. They have to call the special team at the hospital."

I love a challenge.

She did have spidery veins. I got in a 22. If I had been a real stud I would have drawn blood as well, but I knew there was no way I was going to get blood out of it, so rather than trying and failing, I just attached the lock. She told me I deserved a raise and a gold star. I've been challenged before, I told her. What I didn't tell her is I have lost some of those challenges. I could just imagine what she would have said had I missed. "I told you..., but you just wanted to practice on me. You hurt me..."

I gave her some IV phenergan for her nausea.

Tomorrow I am off.

I hope.

The Drive

I stayed over last night at the ambulance barn so I wouldn’t have to brave the storm, getting up early to shovel the drive, then drive twenty minutes along ice filled roads. I hate driving my car in winter storms. I’ll drive anyone else’s car, I just don’t want to skid out and smash my car. Every winter I have one or two episodes where I lose control for a brief moment and am lucky there is no one there to hit or someone else will lose control and just miss me.

A couple days ago I was driving along in the evening. It had been snowing maybe a half and hour. I was going down a hill when I started to slide. I was going like two miles an hour, but I could not stop the car. I kept getting closer and closer to the car in front of me. I tried taking my foot off the brake, then tapping it. Nothing was working. I finally managed to steer the car up onto a sidewalk, and only there did I find traction to finally stop. I looked down the hill and saw two other cars had wiped out and smashed up. It’s just not worth the risk for me to drive when I can avoid it.

I slept okay – not as well as if I had been in my own bed, but at least I didn’t have to get up early and shovel the drive.

All told there was about eight or ten inches. The morning was quiet. I was more tired than usual because I am trying to quit Diet cola cold turkey. In recent weeks I have been getting this acidy taste in my throat. The only thing I can think of that is causing it is my increasing reliance on Diet cola to keep me going. I am drinking it steady from six in the morning to two in the afternoon. This web site I went to said carbonated soda and caffineted drinks are leading causes of acid reflux. I want that taste in my throat to go away so I will quit my Diet cokes.

Did three calls. I felt like I was doing them in slow motion. A lady with Alzheimer’s and hematuria (blood in the urine) – while were driving to the hospital I couldn’t for the life of me remember what the medical term for blood in the urine was. I knew I could get it in multiple-choice situation; it just wouldn’t come to me. Finally at triage out of the blue it popped into my head . Hematuria. Of course.

We did a chest pain at a retirement community and a fall at elderly housing. Like I said I was in a slow motion daze. It wasn’t like I wasn’t proficient, I just moved like I was in no hurry at all, like I done it a thousand times and there wasn’t anything to be concerned with. I think the patient’s found it very comforting. Now how I would have handled a real emergency, I don’t know.

Three more hours to go.

I am glad I am off tomorrow. I need some serious day off do nothing at all time, not day off run around all over the place time.

And I still have to shovel my drive when I get home tonight.

In the Rain

Thought I was working in the city today then I got a call at six-thirty this morning saying I was supposed to be out in the suburbs. I had thought I had done a shift swap. Anyway, I was happy to do 12 hours in the suburbs as oppossed to eight in the city.

Did three calls. A nursing home pass from the commercial service for a man who'd fallen down, but hadn't hurt himself. He said he hadn't slept well last night and was tired. The call came in as altered mental status, but he was pretty with it.

We got a call for difficuty breathing at one of the expensive condos up on the mountain. A woman with Alzheimer's had a nasty respiratory infection. I felt bad for her husband. It was raining and he was following in the car. The road was really bumpy, and I couldn't hear the blood pressure so I asked my partner to pull to the side for a moment. He pulls over, and I don't realize it, but the husband pulls over, gets out, walks through the rain and is just about to knock on our back door, when I get the pressure and tell my partner it's okay to continue on. It is only then I glance out the back window and see the poor guy walking back to his car in the pouring rain. My partner said he had been following closely and running red lights to stay up with us even though we weren't going lights and sirens.

Last call was for a lady with chest pain that seemed to occasionally shoot through her body. Her vitals and 12 lead were all good.

A big storm is coming tonight.

Call Nine-One-One

Ruby has been taking care of old Mrs. Johnson for seven years. This afternoon she finds Mrs. Johnson has been a little too quiet, even for a 93-year old. She won't wake up. Her skin is cool, and she doens't respond to the the throat rub that the doctor taught her to do. So Ruby calls Hattie the neighbor and asks her to come over and see what she thinks. Hattie comes over and examines Mrs. Johnson. When Ruby asks Hattie what she thinks, Hattie has a response for her. "I told her to call Nine-One-One!" Hattie tells me.

This conversation takes place after we have ceased our rescusitation efforts.

When we arrived we found the police doing CPR on the bed. With each compression Mrs. Johnson was swallowed up by the soft bed, seeming to almost dissappear from sight, then spring up on the rebound, then disappear again. We got her on the floor. She was asystole. While her extremities were cool, her jaw was still limber. I intubated her and we got an initial capnography of 11, but that slowly dropped. No response from the IV epi or atropine. I called her as soon as we hit the 20 minute mark.

Afterwards Ruby told me Mrs. Johnson was praying in French last night. She had recently been diagnosed with cancer.

***

Three other calls. A nursing home patient with abdominal pain, a Down's patient in a group home who choked on a piece of cucumber(her aide successfully performed the Heimlich maneuver, and an old man with open sores on his neck, who refused treatment and transport against our advice, but agreed to call his doctor in the morning.

A Year on the Streets

Well, here we are on January 1, 2006. When I started this blog "A Year on the Street" it was my intention to only record "a year" of being a medic, so it is with some trepidation that I am writing today. It is has been a lot of work writing each day, but it has yielded rewards for me. The discipline is no doubt good. But the best benefit has been the ability to see my day clearer. Sometimes I have no idea what I will write about. Some entries are tedious. But other times when I write, something from the day that I paid little attention to comes into focus. Moments that I might have otherwise missed are saved and recorded.

People do EMS for many reasons: to help people, for the excitment, for the challenge of medicine... For me one of the big reasons is for the view into people -- people at their best and worst. I am happiest when I can capture one of these moments. I don't do it everyday, but by the sheer act of writing, sometimes these nuggets fall onto my paper.

Some of you know I have another blog, Street Watch: Notes of a Paramedic,which I write maybe once or twice a week. I draw much of the material from this blog. I take out the better stories and rewrite them or I elaborate on some issue that comes up. It was my intention to return to just doing that blog. But I think I will try to keep both going -- at least for awhile longer. This will remain the rough cut.

I probably won't work as much this year as last so there will be fewer entries.

Thank you for reading. Knowing that everyday someone clicks this link gives me the impetus to sit down and try to make certain there is something new to read.