Tuesday, July 6, 2010

Oopsy-Daisy!

It was well past midnight on a slow night on the west side of Oakland. Sometimes the city sleeps, but not for long. More like cat-naps. My partner and I were enjoying the fact that there was not much to do. We were killing the time by watching some nursing school lecture videos. I think it was one on blood chemistry. Really fascinating stuff, until the peace of the night was interrupted by a call.

The call was for a fall, with back pain. We showed up to the fourth floor of an apartment complex on the west side. This was the kind of place where all the hallways were exterior to the building. There was nothing but a wrought iron railing keeping you on the ledge. The light blue paint was chipping off the stucco in dinner plate sized flakes, which were scattered around the foundation. No one had bothered to pick them up.

This particular call was a “code 2” call, meaning the 911 dispatcher had determined that the fire department was not needed. This could be because of either the nature, severity, or priority of the call did not in their opinion warrant immediate attention, but still required a paramedic to check the patient out and possibly transport. In this instance, they made the right call. It was not a significant emergency.

“Hello? Paramedics!” I announced as I opened the door after knocking several times with no response.

“Don’t let the cat out!” a voice yelled back in a neurotic tone. I guess you have to have your priorities and for this guy, it is the cat.

I opened the door to find an apartment with all kinds of take-out food boxes everywhere. Chinese boxes. Pizza boxes. Fast food wrappers and bags. The urge to kick the two liter soda bottles as I waded through them was a little overwhelming, but I managed. I think this guy just went out, got food and brought it back and the boxes, bags, and bottles fell where they may once they had outlived their function.

We found our patient sitting in the cool blue light of his old 30-inch tube television. He was on an old shaggy couch in the middle of his apartment. He was a fuzzy headed nerd of a guy wearing dark rimmed glasses and an old Star Trek T-shirt. He was watching the TV and sitting stiff-legged in a very awkward position with a look of feigned distress on his face. He was easily 350 lbs if he was an ounce.

“Sir? Did you call 911?” I asked.

“Yes, I can’t move my legs”. His gaze was fixed on the television. Apparently not wanting to miss the next segment of Babylon 5.

“Hmmm…..Can you normally move them?” I asked further.

“Yes” not exactly a fountain of information.

“OK then, did you hurt your legs or fall down?” I asked even further.

“I fell down the stairs today and hurt my back."

“Those stairs out there?” I asked and he nodded in reply.

Oh great. I walked around behind him and held C-spine. This is when you hold a patient’s head steady so they don’t move it for fear of possibly severing their spine with a broken piece of vertebrae following a fall or trauma.

“Megan, let’s get some vitals” I asked my partner. “And turn the TV off and the lights on please”

“Sure”. She got to it.

“Awwww man, did you have to turn off the TV?” he whined.

“Sir, where does it hurt?” I asked ignoring the question about the TV.

“Everywhere”. He replied not making any eye contact with me. His tone was smug and almost teasing. Perhaps this was not his first rodeo.

“I can’t clear this guy, we are going to have to put him on a board” I told my partner. “He can’t decide what hurts, what doesn’t; can and can’t move limbs; his story is all messed up and he had a fall on the cement steps.”

“I’ll go get the equipment” she said.

This can be a tricky situation. Often times, someone technically fits into a protocol and has to be treated a certain way even though every bone in your body is telling you it is stupid to do so.

In the mean time I called dispatch and had the fire department sent out. They would be sleeping and I would be waking them up for this. I was pretty embarrassed to call them. I know this is BS. They will know it is BS. We will all know it is BS, but we will all have to follow guidelines and put him on a board and carry him down. For that, I needed more manpower.

My partner came back up with the equipment. I wasn’t sure how I was going to be able to do this by the book. He was very large and probably not too compliant. I could tell he was kind of excited about the idea of being strapped to a board, but had to keep up the charade of paralysis which meant we were not going to get any help.

I decided the best bet was to shove the board down from behind him on the couch. He was holding his legs straight out so if I could get his butt up, I might just be able to get him on the board elegantly without too much jarring. Megan had to straddle him and grab his belt to get his hips to move forward. With the collar on the board did indeed slide behind his stiff body and then I just pulled the couch out from under him. It was not easy and I definitely broke a sweat, but we got him to the floor flat on his back and that was the goal.

Just then I heard the familiar yelp of the fire engine’s air breaks out front. Megan finished up with the straps and the head bed and I went outside to meet the fire crew. They knew this guy and his games and were in no hurry to get up the stairs.

I met them just outside the door.

“Guys, I am so sorry, we had to C-spine him” I explained. “I did not want to wake you up, but I just can’t take the chance with him giving us all these inconsistent answers”.

“It’s cool Jon” the medic said. “We’ve been there before”. I had run several hairy calls with this particular crew. We trusted each other.

The fire medic walked in the room and began to question the patient to try and clear his C-spine. He didn’t get anywhere but frustrated and looked back to his Captain.

“Let’s get in here and get him downstairs” he said to his crew.

“See what I mean?” I asked him, looking to bolster my case.

“Yeah, let’s just get this over with. Four point work for you?” he asked the group.

We all made affirmative gestures and/or grunts and got into position.

“Where is the elevator in this building?” the Captain asked the patient.

“What elevator?” the patient asked.

“You have got to be kidding me” the Captain replied under his breath. A dark feeling was sinking in to all of us that we may have to carry this guy down four flights of stairs. Not cool. The Captain made a sweeping motion with is hand and the most junior firefighter jogged out of the room and down the hall. He came back confirming the bad news. There was no elevator.

So we picked the guy up. This would have to be done the old fashioned way.

The complication posed to us with this guy was he could not, or should I say, would not follow simple directions. A backboard can be uncomfortable. I have been strapped to a board many times in training and it is confining, hard on the back, and can make you feel out of control. But it does package you well for carrying and ultimately protects your spine from unnecessary twisting or movement, which is the purpose of the board. It gets more complicated when you are obese and your jiggling waves of fat over-exaggerate every movement made by your weight bearers. A slight tip to the left becomes a full-on list control issue with an extra hundred pounds of undulating adipose cycling behind it.

So given that little twist, we had decided to lift the patient using the four point method. Similar to the way pall-bearers carry a coffin. Two at each end with a person on each side helping to control list. This worked fine going down the hallway. It was tight, but with a little shuffling and sucking in of guts, we were able to make it to the stairwell.

This is where we took a pause and looked at the daunting task ahead.

The stairwell was wide enough for two people to walk comfortably next to each other, I would say three feet at the most. The puzzle was, how were we going to carry a six-foot four man down this series of square spirals down four flights given we could not utilize the inner parts of the stairwell for turns due to the support poles. The only answer was to take the corners wide.

This was not a good idea, but it was an idea.

In order to execute this move, it would require the patient is lifted to chest height and for periods of time suspended over open space until the corner was turned. This was not so bad on the side facing the apartments, but on the outside it literally meant nothing under him but our arms.

I looked over the edge to assess what was below and saw there was a jagged old wooden fence, a cement alley and trash cans. So if this guy falls, being strapped to a board, he pretty much dies. I reported my concerns back to the captain, who thought about it for a second and decided we needed to get him down so we would first try the tipping method. Anyone who had moved a couch through a doorway and had to execute a turn knows this one. As we tipped the patient up he began to flail his arms around yelling that he couldn’t breath. OK, this wouldn’t work. Back to plan A.

We planned it out pretty well. My partner ran ahead to prep the gurney for our arrival and to clear all the trash out of the stairwell. Feet first is the safest and easiest way. We put one guy in front to assist with step counts and catch any stumbling firefighters. We stuck with the four-point approach with one person on the side to try and stabilize him and provide emotional support. It was only four flights, that’s sixteen turns. Piece of cake. I had a lot of muscle with me. I wasn’t worried. I got on the front by the feet being one of the bigger guys and we began our descent.

So far so good. The patient was whining a bit, but no real problems. It was very challenging to keep the patient at chest height. My concentration was fixed on using good lifting form and not slipping on the stairs.

One flight down.

“Anyone need to rest?” The captain asked. Great question, looking out for his guys.

“Nope” we all said through gritted teeth. Sometimes it is just better to do it all at once.

Everything was going fine until we rounded the outer edge of the third floor. The feet had just gone over the edge and we were swinging the head around to make the turn when our patient began panicking. He was grabbing our arms, grabbing the wall, grabbing anything he could and was swinging his body around. This was not good, there was nowhere for us to go with him.

“Hey buddy, you need to relax for us, we’re almost there, we got you” the captain said in the most soothing tone he could muster.

“I’m gonna fall!” the patient yelled and began to lunge.

“Ahhhh” yelled one the firefighter on the head side. He let go and was grabbing his lower back. Something had twisted and suddenly we had three points of contact.

The patient sensed our momentary loss of control and completely panicked swinging his arms around and screaming. We were losing control fast and everyone was yelling. The patient was over open space and then the weirdest thing happened.

All at once, he just flipped upside down. I don’t understand from a physics standpoint exactly what happened, but here we were, clearly not in control of a patient, suspended three floors above certain death and we were grasping at anything to try and control the gyroscopic effect of him flipping over. I was hanging on the wall suspended by my stomach, feet off the ground holding my end with the other guy who was also leaning way over holding the back of the board. The lone guy at the head was doing everything he could to not let go. The captain had jumped in at the waist level and was using his feet to brace himself against the half-wall. Without him, it would have been over.

“OK, everyone on three…one, two, THREE!” the captain said.

And the patient came up and over the wall landing down on the stairs face down. Not hard enough to hurt him, but clearly enough to freak him out. Hell, we were all a little freaked out.

The captain went over to the guy who had hurt his back and me and the engine medic flipped the patient back onto his back. He had the true look of terror in his eyes. And then he suddenly calmed said the weirdest thing.

“I dropped my wallet”.

What the hell, we almost killed this guy and he was worried about his wallet? We sent the trainee down to find it amongst the garbage cans and the fence that surely would have split our portly patient into two good-sized chunks.

“This is crazy” the engine medic said to me and approached the patient with a “I’m going to fix this problem now” intensity to him.

“When did you fall?” he asked the patient with his authority voice on. It would be clear to anyone that he meant business and his questions were to be answered directly. It worked.

“At two o’clock.” Our plus-sized near-death survivor responded.

“A.M. or P.M.?” he asked further.

“P.M.” It had been over twelve hours, it was now three A.M.

“Then what happened?” he urged on.

“Then I went to get something to eat and came back home and watched TV until I called 911”. He stated.

“Can you move your hands and feet? Can you feel this? Any pain in your neck or back?” he was now getting very confrontational and hostile to the patient.

All the answers came back indicating there was no injury and the story supported someone who clearly had walked around for hours without any major problems. The medic ripped all the straps off.

“Get up”

“I can’t, I fell today, I hurt my back”

“Get the hell up, I am not going to ask you again” he was now standing over the patient in a threatening pose.

Get up he did, with a quickness. He showed no signs of any deficits or disability and was able to walk down the rest of the stairs under his own power pain free. Once at the bottom, the engine medic told me that he had been on many calls with this guy and he often would fake injuries or play games with them.

“That would have been nice to know at the beginning of the call” I thought to myself.

From the bottom of the stairs on, it was easy to load him into the ambulance and the ride into the ER was uneventful. The whole way he kept muttering that he was sorry and expressed that he did not want me to be mad at him. He was not actually hurt, he just needed an adjustment to his psych meds at the most.

The firefighter who hurt his back ended up being OK, though he again added another injury to an already weak back. He got a couple weeks off to recuperate and some physical therapy. I would be upset if he had a possible career-ending injury given the situation.

It took me a little time to decompress from this one.

While nothing really happened and the patient was safely delivered to the hospital in one piece, if we had dropped him, it would have pretty much been the end of my career.

What was the number to that truck driving school?

2 comments:

Lauren said...

Pretty cool that he was able to sign!

Keebler said...

You're certainly a more rational man than I... Had it been me, if he didn't need an ambulance when I got there, after all of that he'd certainly need one.

~Ron