Thursday, October 7, 2010

Field Save

It was an unusually warm Monday for being before noon. Normally in downtown Oakland, the sun doesn’t burn off the fog until around noon or so. On this day, the grey blanket that serves as our own built in air conditioner had made an early departure. The temperature was already up over eighty degrees at eight AM.

My “black cloud” was in full effect. In the last few shifts I had run several code three returns, meaning that the patient was in such poor condition that they required lights and sirens on the return to the hospital. This kind of thing runs in cycles and when it is on, we call it the black cloud. A sort of tribute to the cloud that followed the Pink Panther around. When things are light we call it the white cloud. Silly superstitions, but they can get in your head and mess you up if you let them in.

My partner this day, Sarah, was an entertaining one. She and I shared a similar taste in music and we were jamming out to Frank Zappa’s “Joe’s Garage” in the parking lot of Summit Medical Center when the call came in.

“Five One Two, Five Twelve, can you clear the hospital for a code three?” The dispatcher asked.

My partner raised an eyebrow at me with the inquisitive look that asked “what do you want me to say?”

I nodded.

“Sure, what do you have?” my partner Sara responded over the radio.

“Sixty-four year old male, shortness of breath.” And they followed with the address.

“Ten-eight.” She said, meaning we were on the way.

We pulled into to the well-worn neighborhood to find the fire engine parked in front of an old, small Victorian house with a huge staircase leading up to the front door. The fire engineer was leaning up against the engine fiddling with some gadget and waved to us as we pulled up. He looked very relaxed so our guard went down a notch.

“Hey guys” he said over the chugging of the idling diesels. “Looks like an SOB” (meaning shortness of breath.) “What do you think of this weather?” he added with his face up to the sun and arms stretched out as if to measure the air.

“Friggin’ beautiful!” I responded. “Finally summer arrives in Oakland”. Now we were in casual mode and it was all smiles and jokes. How bad could it be if our sunglass bespectacled member of Oakland’s Bravest was so relaxed?

The house was a typical Victorian in that it was narrow and built straight up with fantastic, yet neglected appointments and detail giving it more of a haunted house vibe than the intended charming San Francisco row house look. I estimated this house was probably over one hundred years old and nobody had cared for it in the last thirty to forty years. The Pepto Bismol colored pink paint, which is not unusual for these older Victorians, was missing and in areas exposing rotted boards. This Victorian was sitting on top of it’s garage, as so many of them do, making the front door a good fifteen feet off the ground.

I walked up the red painted steps leading up to the front door. The thick red paint was chipped showing the century old cement underneath. The steps were littered with old dead potted plants, old kitchen appliances and beer cans. Trip hazards galore. The handrail was wooden and worn. Sections of it were missing, others were replaced with what looked like broomstick handles.

The door had so much rot and pet damage that I was surprised it could actually even keep the wind out let alone unwanted strangers and stray animals.

The front door was already open and in the darkness of the house in contrast to the direct sunlight of outside, all I could see was the “OAKLAND FIRE” emblazoned on the firefighters’ backs in stark white block lettering. It almost looked like the letters were floating and bobbing on their own in the darkness. The smell of dirt and old tobacco was there to greet me as I approached the door.

I popped my head into the front room.

When my eyes adjusted to the darkness I realized this place was filthy, and not the kind you could fix. Everything inside was so covered with dirt, smoke damage and dust that it all had settled into a dark brown grayish color. There were already way too many people in this dingy room. There was the patient, myself, three very large firefighters and another older black man sitting so quietly in the corner it startled me when he moved. His dingy clothing and unkempt skin and hair made him blend in with everything else in there that was dark brown and grey. I wondered how many years he had sat in that exact chair watching the world go by, day by day in the darkness.

“What do we have?” I asked the fire medic trying to get a look at the patient. I could tell someone was sitting there, but all I could make out was the glare off his glasses and the huffing and puffing of someone in respiratory distress.

“Shortness of breath, might want to grab a stair chair, he’s not gonna walk for us” the fire medic responded.

I walked back out to the porch and yelled down to Sarah to grab the stair chair. She was just setting up the gurney at the bottom of the stairs anticipating the patient coming out.

“Got it” she yelled back as she headed to the back of the ambulance to fetch the dreaded stair chair.

The stair chair is a device that looks like it was invented in the dark ages and probably is more responsible for paramedic workmen’s compensation claims than any other device we have. It is a collapsible aluminum framed wheelchair of sorts with extendable handles and straps. The idea is that the patient can sit in the chair and you get on either side and carry the chair similar to how Egyptian slaves carried their queen. You can opt to roll it on the ground (as it was designed to be used) and guide it along stooped over if you desire a debilitating back injury, but most go for carrying, that way you can use your arms and legs for most of the heavy lifting, not your back. This thing is a paramedic killer.

I stuck my head back in the house and got my first real look at the patient through the wall of well-muscled firefighters, who seemed to be watching the patient. Our patient was indeed clearly struggling to catch his breath and “tripoding” with both hands on his knees. He was breathing at least fifty times a minute. He was too dark black and the room was too dark to see the quality of his skin tone, but I could see what little light there was reflecting off the sweat on his face and neck. His oversized glasses were fogging up from his exhalations escaping through the top of his mask. I could see frothy foam coming out of his mouth around the oxygen mask indicating to me that he may be drowning in his own fluids.

I glanced over at the cardiac monitor and it made me jump a bit.

“Guys, he’s in SVT at 220 bpm!” I said.

“Oh boy… somebody spike me a line” the medic said shifting his attention to me. “I was planning on taking this on the road as soon as you guys arrived” he said in an apologetic tone.

“Got it” the extra firefighter who was previously just standing there said and got to work on getting an IV line flooded.

“I’ll get the drugs” I said. “meanwhile, this guy is going to need CPAP”

“You think so?” he asked.

“Yeah, I think so.” I said.

The patient suddenly slumped and the monitor went completely unorganized.

“He coded” the medic said. The guy in the corner didn’t react.

Just then Sara stepped in and saw us lowering him to the floor.

“I’ve got CPR” she said and jockeyed for position at the old man’s now bare chest. She began chest compressions immediately. I went over to the gear and grabbed a BVM and tossed it to the fire medic.

“Get him on the pads, we need to shock him now” I said tossing the pads to the lieutenant who was staring intently at his clipboard. “Can’t we get anymore light in here?”

“There’s a light over there.” The silent grey man from the corner spoke up in a gravely drawl that gave me the creeps. “You can cut it on over by the door.” How much do you have to drink and smoke to get that voice?

“Do we have that line yet?” I asked the medic? I was feeling like I was clearly in charge now and everyone was willing to just take orders.

“I can’t get it” he said. There were a number of needles in the guy, none of them flowing.

“Don’t worry about it, clear the patient, charging” The defibrillator began it’s rising siren that signifies the capacitors are charging up. Then the tone changed to one that sounded like the European cop cars. It was time to shock.

“Clear! Shocking now!” I yelled.

The patient jerked, and everyone jumped back into action.

Sarah was doing compressions, the medic was still trying to get a line and I was prepping the meds and watching the monitor. The captain was questioning the man in the corner, who though he new the recently deceased, didn’t seem to know much about his medical conditions.

“Yall’ve been here before, same kinda thing I think” he said in his rotten zombie voice to the lieutenant.

“Hold CPR, I’m going to check the rhythm” I said.

The monitor showed a nice tight rhythm. It was a bit slow, but still very promising.

“Check for a pulse” I asked the medic.

“Yup, he’s got one. Weak, but it’s there.”

“Breathing on his own?” I asked.

“I need suction” Sarah said.

The lieutenant handed her the suction device and she sucked about 50cc of water and who knows what else out of his mouth and throat before resuming assisting with ventilations.

“LT, we need to get this show on the road” I said to the lieutenant.

He stepped out to the steps and whistled to his engineer who popped his head around the corner of the fire engine.

“Get the backboard up here, we’re heading out.”

The engineer was at the door quickly with the board and in a matter of seconds we had the patient strapped to it and ready to go.

“I’ll run ahead and prep the gurney” Sara said as she squeezed by everyone and headed down the stairs.

We lifted the man, four of us, two at each end and began to walk with him out the front door.

“Coming out feet first!” the captain yelled.

We descended the steps and strapped the patient to the gurney, all the while continuing to assist with respirations. I could see his chest rising and falling. This was a good sign.

We had developed a group of neighborhood people on the sidewalk watching. Ghetto paparazzi, as I call them, were recording the whole event on their cell phones. This was status quo these days in Oakland. All police and fire actions were recorded by the citizens just hoping that we did something wrong or illegal. The news channels pay well for that kind of footage if something is done wrong. Sometimes they will even provoke and critique us to try and get a reaction they can film.

Once in the ambulance we headed off to the hospital code 3. The fire medic was in the seat just over the head of the patient helping him breath. I was down at the body. I established IV access and was just hanging the line when the patient regained consciousness.

It was slow at first, but he came around pretty quickly.

“Good morning sunshine!” The fire medic said looking down into the patient’s face from the top.

“What happened?” he asked very confused as to where he was.

“You died sir, but now you are back. “ the fire medic said.

“Oh, not again.” He said.

“Again?” the fire medic asked?

“Yeah, I died and you guys shocked me back about a year ago.” He said nonchalantly. He wasn’t thanking us, just stating the facts.

“Well, happy we could be here for you” I said as I checked his lung and heart sounds. His heart sounded fine, but his lungs were junky, like someone crumpling up cellophane.

“Let’s get him on CPAP” I suggested to the fire medic who was taking care of the respirations side of things.

“Is he filling up again?” he asked.

“He’s almost full.”

The CPAP creates positive pressure in the lungs to force the water back across the alveolar barrier and into the blood stream. This creates great relief for the patient, but is not without it’s drawbacks. Most patients hate it because it feels like they are being force-fed oxygen (which is pretty much what is going on) and they end up feeling claustrophobic.

After we arrived at the hospital and I gave my turn over to the ER doctor, I got to writing my report. This would be a long one. A lot happened in that short ten minutes we were with the patient. After my report was done, I stopped by to see the patient and he was sitting up in bed and talking.

“Hey, Mr. Paramedic!” he said, still a bit rough sounding, but amazingly alert and spry for having just died less than an hour ago. In the good light I could now clearly see the man I had been working so hard to save. He was about seventy years old with a shock of receded grey hair. His skin was leathery from too much sun exposure and he had a barrel chest with spindly arms and legs. Tell tale signs of a chronic COPD patient. He was breathing comfortably now and all his vital signs had normalized.

“How are you doing sir?” I asked.

“Oh you know, I’ve seen better days.” He said in a southern drawl. “Probably gonna see a few more thanks to you guys.”

“Ah, don’t worry about it. Just doing our job.” I said. “Although it is nice to meet you now that you are alive.” I joked.

“Sit down here, let’s visit a while.” He said.

We sat and talked for about a half an hour, periodically interrupted by nurses and interns. Everyone wanted to see the guy who coded and was now right as rain. I learned that he was from Mississippi and he learned that I was from New York. He worked forty years at the Port of Oakland off-loading ships and I was in the Navy. He had been married for fifty years before she died a few years back. I showed him pictures of my wife and kids. We talked.

Eventually, Sarah poked her head into the room “Hey, they need us to clear for the next call” she said. “Oh hi!” She just realized how well he was doing.

“Hello there young lady”.

“Sir, this is the woman who was pumping on your heart” I told him.

“Oh, pretty girl like that, surprised she didn’t steal my heart.” He flirted.

“Yeah, I have my strengths” she said fluffing imaginary curls.

He even signed my paperwork for the transport. That is a first. I have never done CPR on someone and then had them sign for themselves at the end of the call. Usually a crying family member or the receiving RN signs the paperwork. Usually the patient has passed at that point.

We cleared the hospital and headed out for the next call without knowing what it was going to be. Trucking down the pothole-ridden roads of Oakland, sirens blaring, lights flashing, with Frank Zappa back on the stereo we closed the chapter on this one and rode off into the unknown.

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