Crash/ A Cigarrette

I was in a crash today. I was in the back, helping my preceptee with an IV. I had just repositoned it to get a blood flow, and pulled out the needle, occluding the vein with my left hand while I reached for the saline lock, when all of a sudden we were decelerating and I started sliding, and I kept sliding and the next thing I knew I was in the net at the end of the bench. Our patient who we had c-spined after a fall resulting from a seizure and who was complaining of neck pain, slid some along with me until the harness caught him. Through it all I managed to keep his vein occluded and not spill a drop of blood. I did lose the lock and my preceptee had to draw up another one while we waited for another ambulance to come and take our patient. Fortunately no one was hurt. A car had pulled out in front of the ambulance and our partner did the best he could to stop, but made impact.

I love that net.

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We did a call for a psych today. The mental health team met us outside and said they had also called the police because the patient, a large woman had seemed anxious today and they had noticed a knife near her which wasn't there when they had talked to her a half an hour before. They said she was prone to fits of temper in which she would actually tear a door off its hinges. We waited for the cops.

Once they came and we walked up the three flights of outdoors stairs and then forced the door open because she would not come to it, we found a completely bare apartment. I am always surprised when I walk into what is a fairly common occurance -- a psychiatric patient living in an empty apartment. There was a kitchen table with no chair and in the living room, there was no furniture, except the single folding chair in which the woman sat facing the window sill, smoking a cigarette. She wore a dirty flowered robe and slippers. She was about two hundred and ninety pounds. When the officer started talking to her, she turned her head around slowly and said, "Don't you be talking to me in my house. I don't give a good god damned about any of you, so for all I care, you can all go ahead and kiss my ass. I ain't getting up, and I ain't going anywhere."

One at a time we tried talking to her, and she was just getting more agitated. When it was my turn, she turned full on me, and I could feel hot breath coming out of her flaring nostrils. I just let her rant, and whenever she stopped to get her breath, I'd start talking again in a real quiet, slow voice. It didn't get me far, but at least it wore her down some. I discussed with the cop the various game plans. He wanted us to get restraints. I offered chemical as an alternative, but suggested we just try to get her to walk first. They stood her up and she started yelling, but once they cuffed her she calmed down. We walked down the stairs with her, and she was yelling again at the top of her voice about what motherfuckers we were and how the world was corrupt. When we got her down on the stretcher, she said her wrists hurt. I started talking to her soft then, and got her to agree not to fight us if the cops took the cuffs off, and in return we would let her smoke a cigarette at the hospital. She agreed. The cops were a little dubious, but since my preceptee and I are both over six four and two twenty, they agreed. She was quiet the whole way in. We got her a cigarette, let her smoke it, then walked into the ER with her. While we were still in the ambulance, I had a vision of us pulling her out on the stretcher and letting her smoke while still on the stretcher, and a newspaper reporter taking a picture of us "ambulance attendents" standing around letting our patient have a cigarette, and what a storm of controversy it might cause. Since she said she would rather walk in, then ride, we had her step out of the back of the ambulance, and so she was standing when he gave her the cigarrette. People seeing a photo in a newspaper might not understand the power of a cigarette. It often works better than brute force, better than pepper spray, handcuffs, Haldolol and Ativan.

In the ER, the nurse told her she had to pee into a cup. "I'm going to need a bigger cup," she said. The nurse said it was to see if she was pregnant. "I ain't pregnant," she said. "We require this of all females," the nurse said. "You're wasting a cup on me."

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Did two other calls: a nursing home patient with pedal edema and a syncope with an elbow lac.

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I was picked today to be one of the medics trying out the new laptop computer run forms. I'll get trained in a few weeks.