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.