Milk it does a body good

It was a pleasant day on the east side of Oakland. The sun was shining, the birds were chirping. All of the gang-bangers and drug dealers were still asleep. All was well. I was working with one of my best paramedic friends on the ambulance, Joe. Joe is a tall and lanky guy with a crooked smile who lives for intelligent humor. He and I have very similar backgrounds, though raised on opposite coasts. It always amazes me how two people can be raised three thousand miles apart and still have unbelievably similar experiences. It was Joe’s tech, meaning that he would be the one to do the patient care and I was driving.

The call came in for a particularly run down area of Oakland by the Coliseum. This neighborhood was one of those that had been forgotten. A large overpass was built several years ago creating a monstrosity that overshadowed the rows of tiny bungalow houses. The elevated road made it so that you could not even access it from the main roads, further isolating the neighborhood. Good for those that want to be able to go about their illegal dealings without the hassles of the police and general public, not so good for the average citizens who make up the bulk of the people.

The call was for accidental poisoning/overdose. This is a generic complaint that could mean anything from taking three aspirin when you were supposed to take two all the way to drinking bleach or a heroin overdose. Who knows. We pulled up to the multi-unit house, which was actually in pretty good shape given the neighborhood. The street was littered with trash and beer bottles. The ever-present faint smell of urine, the trademark of these neighborhoods, provided a quick shock to the senses as we exited the ambulance. Nothing new here.

The fire department had beat us to the call, but were just unpacking their medical gear from the engine so we walked in behind them.

“Fire department!” The captain announced as he knocked on the slightly ajar door causing it to swing open a little more.

“In here! In here!” replied our soon-to-be patient.

We entered the house. We navigated around the scattered laundry of unknown cleanliness that littered the floor. The art on the walls was modern African tribal art. The house reeked of marijuana and a haze hung in the air. We were going to get a contact high if we spent too much time here. In the back of the house in the kitchen, we found a forty-something woman wearing a bad wig, a leopard print tank top and Apple Bottom jeans that were easily two sizes too small for her obese frame. She was in the middle of her kitchen talking on the phone standing barefoot in approximately a half an inch of milk, much of it curdled. She was loudly gabbing away on the phone apparently unaware of the partially digested, lumpy dairy product that now covered her linoleum floor. Her brightly painted toenails and dark brown toes stood out in stark contrast to the white milk. In her other hand she was holding a mostly empty gallon jug of milk that she was waving around to punctuate here sentences. The milk sloshed and hit hard against the sides of the plastic container making an unusual sound. Not the weirdest thing we have ever walked in on, but definitely up there.

“Ma’am, we need you to hang up the phone” the captain said.

“Just a second” she said with a defiant finger up and a wild-eyed look that warned us to not come any closer.

“Ma’am, please, tell them you will call them back,” the captain persisted.

“OK, Ima have ta call you back, this RUDE MAN in MY kitchen needs to talk to me” she told the caller in a passive aggressive move. She hit the “end” button with much more force than was necessary and looked at us with a look that said “…..AND?”

“Ma’am, did you call 9-1-1?”

“Well, there’s no one else here is there?” she snapped back.

“No there isn’t ma’am.” The captain said calmly, rethinking his approach. “Do you have a medical emergency?”

“Yeah, I threw up all this milk and I can’t stop throwing up” she quickly raised the gallon jug to her lips and chugged what was left which quickly came back up and added to the sea of smelly milk she was standing in.

“Maybe you should stop drinking it if it is making you vomit” he said.

“But I have to, I was poisoned” she said as if we were idiots.

Red flag. OK, this had potential to be a little more than we thought at first glance.

“Please sit down on the couch over here” Joe directed.

She complied, bringing the phone and the now empty milk jug with her.

We started immediately checking her vital signs. She looked fine overall, but her eyes were dilated and very bloodshot and she was talking very quickly. We needed to gather some information before moving on.

“My partner here is going to take your vital signs and we need you to answer a couple of quick questions. What leads you to believe you have been poisoned? Did you take something?” Joe asked.

“OK, so here it is. Today is my birthday.” She started her story. “So I decided that today I am going to stay home and smoke a whole lot of weed”. OK, that wasn’t so strange, plenty of people take their birthdays off to kill brain cells.

“How much weed are we talking about?” Joe asked.

“All of it” she answered. “That whole baggy was full.”

If this was true, this would explain a lot as far as her actions were concerned. She was high as a kite. That would be a lot of marijuana for one person to smoke in one sitting. I couldn’t believe her lungs would tolerate such an onslaught, but the body is a resilient thing.

“So what’s with the milk?” Joe dug deeper.

“I was afraid I was poisoned and I know that you should drink milk if you are poisoned” she said.

“But you didn’t actually ingest anything you smoked it!” One of the firefighters interjected, obviously irritated at this point.

“You know what guys, you can clear, we can handle this” Joe said to the firefighters. They happily left in a hurry shaking their heads in disbelief as they went.

We continued our assessment and found nothing unusual with the patient. All vital signs were normal and the longer we sat with her, the more she seemed to be relaxing and becoming lucid.

“Do you want to go to the hospital?” Joe finally asked, after all, taking people to the hospital is what we do.

“No no no, I just wanted to get checked out. If I’m OK I’d rather stay home”.

We agreed, she was not technically mentally altered, just really high. She was still able to make decisions for herself and certainly was hemo-dynamically stable. We tried a few more times to get her to go, probably not as aggressively as we should have, but nonetheless, in a few minutes I was running back to the rig to get the “Against Medical Advice” paperwork for her to sign. This would release us from any legal liability.

“Now you have someone you can call who can come over and stay with you for a while until you fully sober up, right?” Joe asked.

“Oh yeah, I can call my cousin, she’ll come right over.” She said.

She made the phone call, the cousin was on the way, and she signed our paperwork. That little voice in our head was saying this was not a good idea, but I think the selfish motives of being rid of this patient and the promise of a good cup of coffee were too alluring to pass up.

Approximately fifteen minutes had passed since we had cleared that last call. We were happy to be moving on. We had received a new post that was not too far from where the call was.

“Five one two, five one two, copy code three” the radio said. It was us.

“Five one two, go ahead” Joe said, he was driving now.

The dispatcher gave us the exact address and the same basic demographics as the lady we just had, but added a nice little tag on the end: “CPR in progress”

All of the color drained out of Joe’s face. I actually felt a cardiovascular response similar to the one you feel when you get news a relative just died or find out your lover is cheating on you. I could feel a slimy sweat forming on my brow.

“Dude, we just signed her out” Joe said in a tone that spoke half disbelief and half resignation. He flipped on the lights and siren and floored the gas.

“I know.” I said reaching for some way to make this messed up situation better. “Do you still have the number to that truck driving school?” I asked, quoting the famous line from “Top Gun” when they were getting chewed out for buzzing the tower and were pretty sure they were going to get fired.

“We are so fired” Joe said.

“Just get there. Fast.” I said.

We could not have been in a worse area to drive fast. This was an overly-crowded street with rows of shops. There were hundreds of people out walking up and down the sidewalks and in and out of the various markets and shops. To make matters worse, traffic was basically at a standstill due to people slowing to allow jaywalkers to jump from one side to the other. Many others were trolling for a good parking spot.

Joe was laying on the horn and the siren, I was half out the window waving people to the side. They seemed to not even notice the big white and red van behind them with the flashing red lights and impossibly loud siren. Sometimes I wonder about people. Finally we threaded our way through the busy area, not without several close calls.

We pulled up at the same time as the fire department and the police. The police come out any time there is a death and this was a CPR in progress call so they came. We jumped out of the ambulance eager to find out what the heck happened when the lady came walking out with her hands over her head waving us back.

“AHHHHHH…..I’m just playin’ with yall!” she laughed.

“Ma’am, we got a call of CPR in progress, what’s going on?” The fire captain asked.

“Nobody, dyin’ here” she said with a laugh. “I’m just messin’ with you”.

I could see the rage building up in the firefighter, but he maintained good customer service.

“So you have no medical complaint?” he asked.

“Nah, I’m just playin’” she responded.

“I’ve got this” I stepped in. I didn’t want her to get punched regardless of how much she deserved it. The fire crew cleared.

I called the police officer over. “Ma’am, I’d like you to meet my friend here.” I said in my most authoritative tone I could muster. “He would like nothing better than to cuff and stuff you and take you in. Calling 9-1-1 for a joke is a crime. You have wasted all of these city and county resources that could have helped you. So you now have two choices the way I see it, go with us, or go with your new police friend.”

“Well I aint going to no hospital” she said.

“Perfect” I responded “hook her up” I said to the cop.

“No no no no I’ll go to the hospital” she recanted. “I don’t need to go to no jail on my birthday. I am short of breath, my chest hurts” she knew what to say.

We took her to the hospital so she could be monitored while detoxing from her excessive marijuana smoking. I would have liked to have seen her arrested not only for wasting our time and resources, but also for endangering the community and practically giving Joe and I a heart attack.

After we cleared from the hospital we popped over to a local bakery and picked up a small cake and brought it to the fire house. We felt bad for signing her out in the first place and wanted to make amends. We went in and had coffee and cake with the firefighters and laughed about the call. Everyone had cooled down by now and it was comical in retro-spect. I think the thought of us driving code 3 with our hair on fire entertained the guys.

In the end, I think we probably did the right thing not sending her off to jail. She wasn't a criminal, just really stoned. If only we had done the right thing the first time and not signed her out, we could have saved everyone a lot of stress. But that is really the way EMS goes. You start out with a base amount of knowledge and you learn day by day, making mistakes as you go along. Some of them more entertaining than others. But in the end, you never stop learning and refining your judgment. And to this day, whenever I see a plastic gallon milk container, I think of our crazy old patient in the crooked wig standing toe deep in milk waving it around.

copyright 2010 Jon Kuppinger