Vent

Had a really bad sleep. I dreamed I was working for a rich man on a special assignment. I had been highly recommended to him, and for the most part he was pleased with my work, and wanted me to sign on for a longer term. I told him I wanted to go back to my job as a paramedic. He scoffed and asked me how much money I made working for the rotary( he meant the volunteer ambulance and I think he thought I made nothing). He said if that's how I felt, he wanted nothing more to do with me.

Work was busy.

We took care of a 82 year old priest who fell and badly bruised his knee. He said the pain was excruciting, but he he said he had major hallucinations when he took morphine. He said the lst time he had it, he wanted to fight the whole rectory.

We were called and then cancelled on a motor vehicle.

We went to the house of an 82 year old woman where we found her in bed with back pain. She was a pack rat. Every room piled high with junk. The house stunk. Insulation hang out of the cieling. She had some Alzheimers. It made me want to go home and bag up eveything I owned except for the bare essentials and cart it all to the dump.

Went to the nursing home for the dsypnea. Found a patient with fish out of water lying on its side, last gasping breathing. The nursing home couldn't get a SAT, they said her pressure was 80/50. She also had a bloodsugar of 55, then they gave her orange juice and took her sugar again and it was 50. She could still talk, but they said she was hallucinating, talking about not being able to hold on much longer. Her belly was all distended. She had everything in the world wrong with her -- IDDM, HTN, COPN, CAD, asthma, pnemonia, renal failure, CHF, etc. She was a full code. Out in the ambulance, our pressure was 70/?, no sat, no palpable pulse. I had her on a nonrebreather as she was still talking some. I missed my first IV, then got the second. I pushed an amp of D50, after having givin her some glucagon, after not getting the first IV as the blood sugar I had gotten was 39. It was too small of a line to run any meaningful fluid through. I called ahead to the hospital and told them I had a hypotensive, hypoglycemic, now hypoventilating patient. They got a pressure of 32/20. She took 3 amps of D50 and just barely got her sugar over 100. She also got at least three liters of fluid. Then she coded, but they got her back with some epi. She had blood in her stools, a low H and H, a sky high potassium, and other screwy labs. She was unresponsive and on a vent.

84 year old female had a syncopal episode but didn't want to go to the hospital despite our insistence.

A 74 year old female not feeling well. I had picked her up earlier in the week. She was belching. Same symptoms she had then. I asked her what the doctors had told her. She had had silent MI and had two stents placed. She just got out of the hospital. On the 12 lead, she had inverted ts in the septal leads which I know she didn't have earlier in the week.

Ten minutes before crew change, we get a call for chest pain. My relief is nowhere in sight. Sucks to be me. We get updated that it is a twenty year old male. I think it is bullshit, but then we get to the house I can see a hospital bed in the back bedroom. The patient is a quad on a ventilator. He had a fever and dark urine in his foley bag. As I get the medical history, I ask how he became a quad. Spinal injury, the mother says. I ask how again. Gunshot to the neck. I know the patient. I took care of him, I say. The mother says nothing. Today we are in a small apartment. Then, almost two years ago, the scene was a nice big house. We were called for a shooting to the head, updated as shooting to the neck. We pulled into the driveway and saw two teenagers wailing. Inside we expected a messy scene, but there was little blood. Kid lying on the carpet in the living room, not breathing. He still had a pulse. I intubated him, and we raced him to the hospital. I guess they were playing Russian Roulette. He missed the major vessels, missed any bones. Severed his spinal chord. We bag him en route to the hospital. He is wearing a skull cap, and watches me as I breathe for him. He mouths that he is cold. I pull the blankets up over him, and tuck them in. He says nothing else, but I find him watching me. I wonder what he is thinking. Going to the hospital again. Not feeling well, even if he gets better, he is still going to be a quad. Always will be on the ventilator or always have to have someone breathing for him. At the hospital, the mother signs the back of the run form, and then thanks me when I say good luck.

I don't punch out until an hour and a half past crew change. Back at work at six in the morning.