Friday, April 21, 2006

Ambulance Dude

Worked eight hours in the city with my preceptee and we did three calls: a man with HIV who walked out of the hospital two days earlier AMA, a woman from a psych facility who had "EKG" changes, and an out of town transfer.

I've done a lot of jobs in my life, but I've been doing this full-time for eleven years now. One of the benefits of doing a job awhile is the things that you know cold. Like the streets -- directions, how to get from one place to another. Yesterday twice we were sent great distances that involved either going all the way through two cities or taking the highway in a choice of diameter versus half a circumference. Both times I chose the half circumference of the highway and both times I think I made the wrong choice because it seemed to take forever to get there. I guess I might have felt the same way if I'd made the diameter choice. We just had a long way to go in each case. Oh, yeah, and I did make an explicable wrong turn at one point, getting off the highway too earlier. Fortunately I knew another way. Still, I was embarrassed.

The last call was to a nursing home in a distance town. The patient's wife, who was very meddling, making certain we did this and that, asked me which way we were planning to go. I said over the mountain. Like a person waiting to trap me, she said "X mountain?" which is the way someone who didn't really know how to go, would go. I said no "Y Mountain." The nursing home where we were going was in the town I grew up in and was the home where my mother died, so I knew the way -- all the right back roads. It is always strange driving an ambulance in the town I grew up in. On the way back I thought of going an alternate way just to see what the old neighborhood looked like, but I didn't. That would have freaked me out, imagining me as a five year old boy playing in the street, looking up to see an ambulance -- my future forty-two years later driving past.

The "EKG" call posed an interesting dilemna. An asymptomatic patient in a mental facility has an ECG done on a regular basis because one of the drugs she is on can cause ECG changes. The doctor does and ECG and sees inverted T waves and then gives the patient ASA and calls for an ambulance. She shows us the ECGs. 1) the t waves are not particularly inverted and 2) the ECG looks just like the one done two months earlier. Do you point this out to the MD? who I don't assume working in a mental health facility does too many 12 leads or do you just say okay and transfer? We just said okay and transfered. We go to a busy ER -- they are all busy these days.

While at the facility one of the patients called to me "Hey, Hey, Ambulance Dude? Ambulance Dude?" Or should I say, "Ambulance Doctor? Ambulance Doctor?"

"Ambulance Dude works," I said.

"You going to have all green lights, all green lights. All the way to the hospital. You don't need to use your red lights. I'm going to take care of that for you. You going to have all green lights. You going to keep her safe for me. I'll take care of the lights for you."

Now, I can't say, I didn't have a red light on the way to the hospital. But I do recall it as a smooth easy ride.

-Ambulance Dude