tag:blogger.com,1999:blog-33349253217776511512024-02-20T15:40:41.966-08:00Scenes from the AmbulanceA blog about life on the ambulance in Oakland CAJon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.comBlogger18125tag:blogger.com,1999:blog-3334925321777651151.post-41293153042678606362011-11-22T01:25:00.002-08:002011-11-22T01:34:14.263-08:00The Thin Ice of My LifeIt was an early weekday morning in Oakland and we had been experiencing some of the most unusual weather patterns on recent record. One moment, the sun would be out without a cloud in the sky. Status Californius. Then without warning, a foreboding silver and black cloud would pull a drive by, dumping buckets of wind-driven rain as the unsuspecting population ducks for cover. As quickly as it came, it was over. The glorious sun returned as the howling wind died down leaving behind a sodden if not bewildered city. The cycle repeated without warning nor prejudice. The commuters were caught up as reluctant pawns in the series of meteorological tempests that had a grip on the East Bay. <br /><br />The final knot in the knurled up ball of muck that morning commute had become came fast and furiously in the form of hail. Ice fell from the sky in various sizes from those rivaling golf balls down to minute pebbles. The roadway was coated and in California, nobody adjusts driving speed for anything, least of all weather; an accident was imminent. <br /><br />The call was for a part of the freeway where one freeway splits up into two others. The lanes peel off to the left and right with signage to direct. There are several choices and often times people make either last minute decisions to change lanes, or more likely realize they are on the wrong path and abruptly adjust. The latter was the suspected cause of the call we were going on.<br /><br />“Five-oh-Six, Five-oh-Six copy code three.” The dispatcher said in a calm voice devoid of emotion.<br /><br />“Five-oh-Six.”<br /><br />“Five-oh-Six, I have a code three for you. It’s for the MVA, unknown injuries, bus involved, possible MCI, I’ll start an advisory. Please advise additional units upon arrival.” And we were given the location.<br /><br />“Five-oh-Six, we copy the call. Ten-Eight.”<br /><br />We were rolling code three down the shoulder of the freeway. The crunching of the tires against the new-fallen ice cubes made for a unique experience. It was loud enough in the cab that it was difficult to talk over when added to the siren. We were only about a half-mile from the reported location of the call and traffic was already backed up in a disjointed, slow-moving queue. All of the motorists jockeying for position made the lines of traffic bob and weave like rows of snakes in the throws of death. The shoulder was our only refuge, but we had to take it slow given the severity of the ice storm we were in and the suspicion that a driver would get frustrated and pull into our path on the wide-open shoulder. It was a gamble, but our only option. <br /><br />The hail suddenly stopped as if a water faucet had been turned off and the sun again came out, keeping the daily promise of California sunshine alive. The sun was riding very low on the horizon and was illuminating all of the ice, now covering the freeway, sending blinding glares in all directions.<br /><br />“Oh man, this is going to cause some serious accidents.” My partner said to me.<br /><br />“Town biz for sure. Good thing traffic is pretty much stopped. Hard to get into an accident at five miles an hour.”<br /><br />“Oh, they can figure out a way.” My partner joked.<br /><br />We got up to the accident at the head of the line of cars and it was a simple fender bender already moving over to the side with CHP on scene. There was no bus in site. I rolled down my window and my partner crept the ambulance up to the officer directing traffic and moving along the rubber-neckers.<br /><br />“What do you got?” I asked the CHP officer, yelling over the traffic crunching the ice balls on the freeway.<br /><br />“Non-injury. Should be cleaned up in five.”<br /><br />“Where’s the bus?”<br /><br />His eyebrows raised a bit and a smile crept across his face. “Oh, you are on that call.” He said with a knowing nod as he chewed his gum. I remember his teeth looking a brilliant white illuminated by the argent glare of the sun off of the hail. I could see myself squinting in the reflection of his mirrored aviator sunglasses. He pointed down the freeway and against the extreme glare of the sun on all the ice I could see a dark blue bus on the side of the road with a few other cars haphazardly positioned on the freeway. I could hear the fire engine about five hundred yards behind us laying on the horn to get the commuters to just give them an inch so they can get by. There were a couple CHP cruisers on scene and they were running around a bit. This would be some action. “Enjoy!” he said slamming his clipboard shut and turning back to his task.<br /><br />“Great.”<br /><br />I was worried. Traffic was picking up from zero to sixty just past the minor accident once everyone got an eyeful of nothing. They were accelerating like horses out of a race gate without knowledge of what they were driving into.<br /><br />As I got closer I realized that the accident was spread out, maybe even more than one accident. There was a pair of cars against the center K-rail that looked like maybe just a minor fender-bender. The occupants had self-extricated and made their way over to the shoulder on foot and appeared to be exchanging documents. Traffic was zipping by and cars were obviously having trouble navigating the slick road as they fishtailed around. There were two other cars and a dark blue bus on the far right shoulder. Five lanes total so there was plenty of room for cars to zip through and CHP had not been able to control traffic. This would be a confusing call to triage. <br /><br />It didn’t look like there was anyone in the cars so I went over to the bus. As I approached it, I noted the bars on the windows. This was a prison transport bus! I popped my head in and saw there were several officers inside taking inventory on the prisoners and triaging their complaints. Of course everyone had a complaint but a couple were legitimate. The officer approached me.<br /><br />“We have two head bleeds, a broken hand, a skinned knee and a broken forearm. Everyone else is neck and back pain.” He said mocking fake neck pain.<br /><br />I thought this seemed like a lot of injuries for a crash like this with minimum mechanism until I noticed they were all handcuffed. They had no way to break their fall into the seats and railings in front of them. “How horrible would that be?” I thought. It was time to report what we had and call for more resources. I ran back to the ambulance to get my partner.<br /><br />“Call an MCI and get a sup here. Tell them we need at least three more ambulances and when you are done get in there with some BLS supplies. Mostly minor traumas. They are all prisoners so we’ll need restraints.”<br /><br />Just as I turned around the fire engine was pulling up. I gave report to the captain and he directed his guys what to do to help out with triage and bandaging everyone up and preparing for transport.<br /><br />I looked down the freeway to the other smaller accident and noticed it was cleared. The CHP officer had opened the lanes and it looked like the start of a drag race. Everyone was accelerating towards us. The freeway surface was still covered with millions of little ice cubes and the sun was still refracting the light in every which way possible. This was going to be a disaster. The first few cars zipped by hardly even noticing we were there. Then the rubber-necking started. Car after car of drivers craning their necks towards us to see what we were doing on the shoulder only looking forward again at the last second and narrowly avoiding the unsuspected stalled cars in the number one lane. <br /><br />As luck would have it eventually somebody plowed hard into one of the cars. The sound of the locked up tires grinding the ice on the cement was unnerving. The point of impact was parallel to where the fire captain and I were standing so we had front row seats to a show we did not want to be at. The small, silver sedan hit the stalled cars so hard her rear wheels lifted off the ground. I could feel the vibration through the pavement and the crash itself was deafening. There was an immediate stress reaction that made my heart sink and took my breath away. Very similar to the feeling when you get dumped by a girlfriend or get some equally bad news. <br /><br />“Holy shit!” said the captain.<br /><br />I instinctively turned to avoid the debris from the crash. Some did come our way, but nothing that was too threatening and nobody got hurt.<br /><br />“Call for another unit” I said to the captain and he did immediately. “And more CHP, we need this mess shut down before someone gets killed.”<br /><br />My partner returned from the bus to give me a count and progress report on what the firefighters were doing. The three of us were staring at the car that had just stacked up behind the already stalled car. We could tell there was a small person in the driver’s seat. Probably a woman judging from the small size. It was very hard to see with all the glare. She was franticly moving around in the front seat. We were pretty sure she was going to get out of the car. The last thing we wanted her to do. We were yelling to her and waving our arms around to get her attention but she seemed very focused and not interested in our input one bit. <br /><br />Her door opened on the opposite side of us as we were looking at her across five lanes of aggressively moving traffic. We saw her feet below the car silhouetted against the glaring background and her head appear above the car. She was going to make a run for it. This could not end well. Now some of the cops had joined in yelling to her to stay in the car, but she either could not understand us or was not listening. She moved to the back door and opened it up. <br /><br />“What is she doing?” asked the captain, more to himself than any of us.<br /><br />“Maybe she needs to get her phone or her briefcase or something” my partner suggested. <br /><br />“What can be so important?” I asked.<br /><br />“Maybe she got her bell rung and she is altered?” my partner added. This was certainly possible.<br /><br />We speculated only for a moment later, for the answer came and it was not the one we were looking for. <br /><br />Two little toddler feet were added to the adult feet already seen under the car. I felt like someone had just punched me in the gut. “NO!” I said instinctively. I thought I was going to pass out for a second. She was going to put a little kid into this traffic and we were going to witness a horrible, traumatic death of a child just feet in front of us.<br /><br />The chorus of emergency workers trying to make her reconsider her suicide run was growing louder. She lifted the child up, or at least the feet disappeared and she came around the back of the car. We now had our first look at her. She was a small Asian woman. Perhaps five feet tall, maybe ninety pounds if she was lucky. She was in professional dress and her eyes were ablaze with fear and determination. She was clutching the small child to her chest under some kind of blanket. We could not see the child’s face or head, but the little legs were sticking out below the blanket. Without checking the traffic she just hunkered down and ran full speed across five lanes towards us like a macabre live action version of “Frogger” but without any judgment or timing. I had played that game enough times as a child to know that if you play it like that, the frog always dies.<br /><br />I couldn’t look, but I had to. Our eyes were riveted to see how this would play out. <br /><br />The scene was reminiscent of Vietnam era movies when you see the mother tucking and running with a child at her bosom against a backdrop of napalm exploding. She ran into the traffic and somehow managed to thread the deadly needle ending up on the shoulder next to us in fetal position. She would not let go of the child and was sobbing uncontrollably. There was no way to assess her for injuries as she not only did not speak English, but was not allowing us to touch or assess her in any way. We decided to give her a moment to calm down.<br /><br />I left a firefighter with her and headed back to the bus. The other ambulances and cops were now arriving and we had all the help we needed. The freeway was shut down and tow trucks came to move the wreckage to the shoulder. The rest of the call went like clockwork, but was a challenge because we were spent from adrenalin overload. My EMT and the firefighters were able to quickly triage and bandage up all the prisoners and transport everyone who wanted to be seen. The woman eventually was able to calm down enough to let go of the child and let us assess them both. No injuries, just shaken up. We still transported them to the hospital since the mechanism of the crash was so brutal. <br /><br />This call took a long time to get out of my head. There were so many things that could have gone wrong and they all ran through my mind and haunted me regardless of the fact that they did not materialize. There were a dozen scenarios, all of them much worse than the actual outcome that could have easily come to pass on that brilliant morning in Oakland. Sometimes, at the psychological level, the suggestion of what could happen is worse than reality. <br /><br />copywright 2011 Jon KuppingerJon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com0tag:blogger.com,1999:blog-3334925321777651151.post-17236711861903084912011-08-16T21:55:00.000-07:002011-08-16T21:58:47.680-07:00OG and some unusual mathIt was a soggy, rainy day on the east side of Oakland in the killing fields; a square that is bordered by Seminary to the north, 106th Ave. to the south, MacArthur Blvd. to the east and 880 to the west. Most of the shooting, stabbing and other various gang activities that Oakland is famous for take place in this neatly packaged little slice of hell.
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<br />I was picking up an overtime weekend shift to try and compensate for some lost time I had due to an injury in my rotator cuff and my lower back. Minor setbacks like that can really cripple you financially. I was working with a new guy. We had been talking about how he had never had anything really bad yet like a shooting or stabbing, which is not a great idea. In general, I’m not superstitious, but everybody knows not to talk about something unless you want it to happen. One of the first rules. You never mention that it is “slow” or “quiet” either, unless you are looking to get run. Of course, on this day, we were stupid enough to talk about my partner’s lack of “good” calls.
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<br />We heard a number of calls drop in succession on a hot corner notorious for gang activity. There were a total of four all within a block of each other. We were assigned as first unit in on a GSW (gun shot wound) with a non-secure scene. My partner hit the lights, the siren and the gas and we cut through the town.
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<br />As we were approaching the scene, we were trying to be cognizant of the fact that there were no fewer than four calls all on the same block. All kinds of fire trucks, police cars and ambulances were all triangulating in on this one block at a high rate of speed. That can be very dangerous to all the responders, so we took it on alert. The pouring rain cut down on visibility further complicating the response.
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<br />Two of the calls on this block were for GSWs, most likely related to each other being that close in proximity. One was for a MVA (motor vehicle accident). The fourth seemed to be a medical that was unrelated. Certainly possible given the level of poverty and lack of even basic health care this area is famous for. Some people will go a lifetime without any preventative care with astronomical hypertension and untreated cardiac conditions. Walking, ticking, time bombs just waiting for their fifties to creep up on them. A few blocks out we heard a second unit attached to our call and dispatched to our location. So now we had five ambulances, four fire engines, countless cops and who knows what other resources coming. Add to that a couple dozen looky-lous and you have a recipe for disaster.
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<br />Since we were first to arrive (besides the police of course) the bystanders were easily as confused as we were as to where we were supposed to be at. We saw a BLS rig from another transporting agency a block from us with several police cars. It looked like they were on the ground working someone up. As we passed the first scene the bystanders were obviously very agitated we were not stopping for their patient. The jumped up and down and yelled waving their hands over their head. Some of them held up their iPhones to film us. A cop jumped out into the street pointing back to the first clump of people on the sidewalk indicating that was going to be our call. Apparently he and the BLS crew had his corner of the block handled and we were needed back a couple houses.
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<br />I called in again to dispatch asking if the scene was secure. The answer came in an OPD officer shining a flashlight at us and directing us through the crowd to a small run down house with way too many people in front if it pointing down their driveway.
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<br />“I guess the scene is secure and this is our guy.” I said to my partner.
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<br />“Five fifty-nine we are on scene, waved in by PD.” My partner said into the radio.
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<br />“Well, ask and you shall receive, here’s your shooting you were looking for.” I said to my partner.
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<br />I was putting my gloves on waiting for the ambulance to come to a stop. I wanted to be ready to jump out and get to work immediately. These kinds of scenes can be very sketchy and the quicker you get the victim packaged up and out of there the better. There were police and firefighters swarming all over the place with about fifty concerned citizens mucking up the progress. Everyone wanted to tell somebody their version of what they saw or more likely didn’t see.
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<br />Once the rig stopped I said to my partner, “I’ll get the board and C-spine, you get the gurney ready and get it as close as you can.”
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<br />I ran around to the back of the ambulance and the fire engine was just pulling up. The Lieutenant stepped out talking into his mike on his shoulder and the medic approached me.
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<br />“Know anything yet?” he asked me.
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<br />“The cops said he’s out back.” I said handing him some of the gear.
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<br />I particularly liked this fire medic. He has always been competent, supportive and an all-around nice guy on previous calls. I was happy it was him.
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<br />We walked down the crowded driveway into the back yard. There was a pit bull on a chain that could almost, but no quite reach us. He was testing the strength of the chain and barking like he would certainly eat us given the chance. I didn’t want to find out.
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<br />“Hey puppy!” The medic said, acting as if he were going to approach the dog and then backing off saying “just kidding”.
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<br />There was a bald, plain-clothes cop in the alleyway in dark sunglasses with a badge on a chain dangling over his hastily donned bulletproof vest. He was holding an assault rifle at the ready and his attention was darting around ready for any combat that came his way. He had a handgun in a holster attached to his belt on his jeans. He was waving to us to move along and make it snappy. There were at least three iPhones tracking us from the windows and porches as we walked back along the narrow driveway to the one car garage behind the little shack of a house.
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<br />Everyone films everything in the hood.
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<br />Our patient was around the side of the small, detached garage lying on his side cradling his ribs with his arms and rocking back and forth in pain. There was a rusted and slightly physically compromised chain-link fence on two sides of him defining the property line. He had tight cornrows in his hair, looked to be about forty years old with a number of scars on his face. He was wearing a thick, light brown leather jacket over a nice dress shirt that might have been silk. He wore expensive designer jeans, and classic Air Jordans, laced up so he could run. This is the uniform of the older gangsters in the hood. All the kids now wear long white T-shirt, saggy pants, and unlaced hi-tops that make them walk in a funny waddle. Their pants sag well below their crotch so they wear brightly colored or patterned boxer shorts to contrast the simple colors they wear on the outside. In the summer, lose the shirt. In the winter, add a bulky black bubble jacket that may or may not be hiding a sawed-off shotgun or a strap in their waistband. It is for them to know and you to ponder. They sport long extension braids with an oversized, precariously perched baseball cap that has perversely converted the colors of the local sports team’s logo to fit the colors of their gang, car or otherwise and wear gold or platinum removable “grills” in their mouth. The OGs have their own “classier” uniforms and wear their hair cropped much closer and wear gold, not platinum or silver. The OGs have real gold teeth, not these fake “grills” the posers wear. My guy was an OG.
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<br />We stood over him for a second trying to figure out what the problem was. There was no blood. He appeared to have either ran in this backyard and found himself trapped or jumped over the fence from the yard behind him and ran out of steam. Either way, it wasn’t clear exactly what was wrong with him.
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<br />“What happened man?” I asked him.
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<br />“I got shot” he said through clinched teeth.
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<br />“Where?” I asked him.
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<br />“In the chest” he gasped.
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<br />“OK, we are going to have to take all your clothes off” I started to tug on his jacket and he reacted violently pulling away.
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<br />“Man, what you trying to do? That hurts!” he barked at us. He had anger in his eyes.
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<br />I could smell the combination of leather and the unique tangy odor of adrenalin driven sweat that cut through the musty smell of garbage cans and wet weeds he was lying in.
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<br />“I can either take your jacket off or cut it off. Your choice, but it’s coming off.” I told him with authority.
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<br />We were running out of time. A critical trauma like this hast to be packaged up and on the road to the hospital in less than ten minutes from arrival. I usually shoot for six. It’s the patient’s best fighting chance of survival to keep it brief on scene.
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<br />He quickly sat up and held his arms out like a kid does when it is time to take a jacket off and they want mom or dad’s help. So much for keeping him immobilized in the position found. We pulled the jacket off and there was the blood. The whole upper left side of his dress shirt and wife-beater T-shirt were soaked in bright red blood. I quickly cut the shirt off with my shears and asked him to hold his arms up so I could see under his arms.
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<br />There were a total of five holes in his chest. Two were under the armpit area. One was exactly over where you would point if I asked you where your heart was. He was breathing in short breaths so my concern was up that a lung might be punctured. I couldn’t believe he was alive much less talking to us.
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<br />I could hear sirens all around us. This wasn’t over yet.
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<br />“OK, I’m gonna need you to lay down on this board.” I told him. He did.
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<br />As soon as we got him on the board I took his shoes and pants off to look for more holes. He didn’t have any more.
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<br />Then the heavens opened up. The rain came fast and furious in sheets. It was time to hustle and get the patient out of the back yard and into the cover of the ambulance. I was wearing rain slicker pants so my bottom half was OK, but from the waist up was getting soaked. I thought it must be worse for the patient who is now naked and on a board getting pelted with rain.
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<br />Once in the ambulance we got to work quickly. I got a baseline set of vital signs which were amazingly normal. He said it was getting hard to breathe and was starting to really complain of pain in the chest. I listened to his lungs. They were equal, with good tidal volume and air movement, but he still winced in every inspiration. The holes in his chest were oozing, but not aggressively bleeding and there was no obvious signs of a sucking chest wound. I covered the wounds with occlusive dressings, and prepared the decompression kit just in case the situation worsened.
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<br />On the way, I tried to make conversation with the patient just to keep him conscious. He was not very forthcoming and knew he was potentially in a lot of trouble so the less he says the better. I don’t make a habit of asking about the details of crimes or even wanting to know as it affects my ability to provide unbiased care. I was able to get out of him that he had no pre-existing medical conditions, took no medications and had no allergies to medications that he knew of.
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<br />We came into the hospital hot. His vitals were still holding well and his bleeding was well under control, but still, this was a guy who took several rounds to the chest in the area of his heart. If things were good right now, chances are they wouldn’t stay that way too long.
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<br />After I turned over to the trauma team and the students and residents swarmed him like yellow jackets on a spilled soda, I asked one of the nurses if the other guy came it yet.
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<br />“What other guy?” she asked.
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<br />“There was another gunshot patient on scene” I said.
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<br />Another crew came in fast and furious. They were performing CPR on the go as they hustled in to the ER leaving a trail of watered down blood behind them as it was still torrentially raining out. They were bagging the patient and someone was holding pressure just below the armpit on what I assumed was a wound.
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<br />“Is this the guy from the car?” I asked.
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<br />“Yeah. One shot axillary. Witnesses say your guy was the driver”
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<br />Through talking with the other crew, I was able to put it all together. Suddenly it all made sense. My guy was driving, the shooter was in a passing car that pulled up to the driver’s side and opened up on them striking my guy four or five times and hitting the passenger once. This caused the car to crash into another car, creating further injuries to the other vehicle’s occupants and rendering the OG’s car inoperable. The OG bailed out of the car and jumped a few fences between backyards until he either ran out of steam or felt he was a safe enough distance to call out for help.
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<br />I talked with the ER doctor later and got the rundown on the injuries. The OG would be going home later that day. The other guy would be going to the morgue. The cops said there were no outstanding warrants and my guy was not on parole so given that he is not talking, he will be free to walk.
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<br />But the inequality of the equation, and what kind of freaked me out is the following. My guy had several holes in his chest. They were all at the perfect trajectory, speed and caliber that they were able to bounce off of ribs. On first inspection, clearly any could have killed him. The other guy only had a lone hole but it was in just the right exact position to slip between two ribs and hit a major vessel (the aorta most likely but any major vessel would do) an cause him to bleed out internally in seconds. Just dumb luck. But the trauma game is a matter of millimeters and a lot of dumb luck.
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<br />On my next run to the hospital I stopped into OG’s room. He was all smiles and had a friend visiting him. A youngster in a long white T-shirt, braids, sideways red hat, baggy jeans and unlaced hi-tops. Associate is probably a better word. There was a large bandage over his whole upper left chest, but other than that he looked to be in very good health.
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<br />“Well there’s the luckiest guy in the world” I said as I walked in startling him and his guest.
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<br />“Hey!” he said “This is Jon, the paramedic that picked me out there when they shot me” he introduced me to his friend. His friend gave me the nod, no words.
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<br />“I hear you are getting out of here soon” I said.
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<br />“That’s what the doc says. Nothing major hit, just flesh wounds.”
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<br />“Hmmmm, that’s great.” I said. “So here is what you have to do.”
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<br />“Yeah?” I had his attention.
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<br />“As soon as you get out of here, you need to go straight to the minimart at the bottom of the hill.”
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<br />“Why?” he asked.
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<br />“Because you need to buy a lottery ticket tonight, you are the luckiest son of a bitch in the world.”
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<br />“Awww man, you know it. I think I used up all my luck though. Aint no thing. I’ve been shot before.”
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<br />“ I still think you should get yourself a ticket.” I persisted.
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<br />“Alright then, I’ll do that.”
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<br />“Oh, and buddy, if you win, I get half!”
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<br />We both laughed and I headed back out to prepare for the next call.
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<br />Jon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com0tag:blogger.com,1999:blog-3334925321777651151.post-46829532734397248482011-01-10T10:16:00.000-08:002011-01-10T10:17:51.292-08:00Party BoyIt was a miserable rainy morning on the east side of Oakland. The run down neighborhoods and their unfortunate residents seem to look more desperate when they are soaking wet and put against a background of brooding, rain laden clouds. It was very close to Christmas and this time of year and a few of the bungalow style homes had some cheap lights strung haphazardly to combat the annual blahs that plague California in the rainy season. <br /><br />You can ask anyone in the emergency business, this time of year our calls take on a different light. I don’t know if there is any documentation to back this up or if it is just superstition because we are more sensitive around Christmas. Perhaps it is just how shocking it is to see some of the scenes we walk in on against the familiar backdrop of red and green holiday decorations that for the first half of our lives invoked cheer, magic, and wonderment. <br /><br />For our patients, and really everyone in general, there are indeed more stresses this time of year. There are many unwanted family interactions ending in violence and sometimes even death. Depression is common even among people who do not normally exhibit psychological problems throughout the year; and for those who are normally clinically depressed, it can be more profound in the face of the expectation they must be happy. People also tend to eat much more than they normally would; gorging ones self can compound any of the pre-existing medical complications they already have. Anyone who has ever tried to be on a diet during this time of year knows the pressures to make poor food choices are crushing at best.<br /><br />There is one other seasonal factor that is responsible for bringing Party Boy, the subject of this story, into my life. Typically around the holidays, people tend to overindulge in the intoxicant of their choice, be it alcohol, narcotics, or whatever else they can get their hands on.<br /><br />The call came in for a residence that was on one of those strange little streets that keep starting and stopping depending on which block you were on. You would hit the dead end, but then go around a block and pick it up again. Of course the map book does not reflect these little idiosyncracies. This made us a little later to the call than we like to be, but still well within our allotted time.<br /><br />The house was a multi-unit, single story house and the address we were looking for was in the back of the building. The door was open and we were met by one of the firefighters walking out. <br /><br />“You guys might want to bring some extra sheets and towels, he’s all covered in vomit and blood” she said punctuating with a look of exaggerated disgust.<br /><br />“What’s the deal?” I asked. We still didn’t know. The call was for “unknown medical” which could be anything from a hangnail to dead.<br /><br />“We don’t know yet, he’s spitting up blood and has vomit all over him.” She said.<br /><br />“Great”. I said not meaning it at all. <br /><br />“I’ll get the blankets and tarp” my partner said, “you can go ahead and see what we have”. She was telling me not to worry about the equipment, she would get it for us. Partners who are helpful in this way are like gold.<br /><br />I walked down the walk with the firefighter and she and I made small talk. She had been in the house and knew what she was about to walk back into. I didn’t but had a pretty good idea. We wanted the next twenty feet to at least be somewhat pleasant. <br /><br />I stepped up the steps and knocked as I usually do on the doorframe even though the door was open to announce my entrance.<br /><br />The apartment was shockingly neat and tidy on the inside betraying the shabby exterior. Recently refinished hardwood floors. Modern colored paint on the walls with white crown molding. The kitchen looked like it had been updated recently. Not at all what I expected from the outside. There was a thirty-something young lady sitting on the couch in an oversized white T-shirt pulled over her black legging covered legs. Her knees were drawn up to her chest under the shirt and she looked as if she had been crying. She had long dyed black hair and acne and piercings on her face. Her look screamed “I just woke up!” She just pointed to the bedroom off to the side.<br /><br />As I entered the bedroom, I couldn’t see exactly what was going on but could hear guttural and inhuman noises coming out of the room as if someone had captured some prehistoric animal. The firefighters were shifting their weight back and forth like they were trying to trap the animal. <br /><br />It was then I first saw Party Boy.<br /><br />Party Boy was about thirty years old, Caucasian, short black hair, dark eyes, and shaved hairless. Everywhere. He was completely naked, very thin, covered in random tattoos, vomit, and had blood streaked all down the front of his chest from his obviously broken nose and busted lip. He had a wild, wide-eyed stare that matched the bizarre noises coming out of his mouth. His head twitched back and forth over-reacting to every noise, but with a thousand yard stare that seemingly looked through walls. He was fully sexually aroused and was attempting to manually pleasure himself while using his free hand to ward off the would be captors. His mouth was hanging open except when he closed it to gather bloody saliva which he spit at the firefighters. They did their best to dodge the flying blood globules. I felt like they were doing a great job, nothing I needed to get involved in, so I backed out of the room and approached the young lady.<br /><br />“Who is he to you?” I asked her.<br /><br />“She’s the girlfriend” the clipboard wielding lieutenant responded for her. “But she doesn’t seem to know much about him at all.”<br /><br />“EX-girlfriend!” she corrected with emphasis on the “ex”. “As of right now, phhssssssstt” she said drawing her hand across her throat in the universal symbol for cutting. I felt like I was in the movie Scarface.<br /><br />“Oh excuse me” the lieutenant said feigning respect “The EX-girlfriend says our guy in there has an addiction to GHB and took too much of it.” He said with mock emphasis on the “ex” and an additional eye roll.<br /><br />GHB is a powerful illegal drug that works as an intoxicant as well as an amnesiac. It’s used mostly as either in small doses as a performance enhancement drug for athletes or in larger doses as a date rape drug. Some more adventurous types take it themselves to get ultra-high.<br /><br />“Do you know anything else about him?” I asked the freshly available ex-girlfriend over the crashing of what sounded like a lamp hitting the floor in the bedroom. <br /><br />“You know what?” she said springing to action and jumping off the couch with a sudden burst of happy energy. “I have the number to the perfect person to ask about him” she ran to the kitchen where she rummaged around in a drawer before producing a small telephone number book. She thumbed through the book, mumbling names to herself as she passed through them alphabetically before exclaiming in success “Here it is!” She held out the book and pointed to a name and number “She will tell you all you need to know about him” she said with a smile, proud of herself for setting up this little piece of drama.<br /><br />“Is this a family member?” I asked.<br /><br />“Nope, this is the bitch who was his girlfriend before me. She would looooove a call from you guys. She can have him back, I’m done with him. Her problem now I guess” She said with finality and a smirk that seemed to indicate that her role in this was over.<br /><br />“So this is the number to the EX-EX-girlfriend?” the lieutenant teased pointing to the number.<br /><br />“Yeah, something like that” she said with an icy look.<br /><br />The mood in the room was broken by the arrival of my partner.<br /><br />“So what do we have?” she asked me.<br /><br />“Probably OD, they have their hands full in there.” I motioned over to the room with all the commotion in it. “He’s naked and filthy.”<br /><br />“Who’s this?” my partner thumbed to the ex-girlfriend.<br /><br />“The girlfriend, but she’s not helping much.” I said loud enough so she could hear.<br /><br />“EX-girlfriend!” she corrected. This was getting comical.<br /><br />Now that everyone had arrived, it was time to corral Party Boy and get him out of the ex-girlfriend’s house. <br /><br />“How do you want to do this?” I asked the lieutenant.<br /><br />“I guess we just grab him and go.”<br /><br /> “I’ll get the straps and the gurney ready” my partner said and stepped out.<br /><br />One of the firefighters went high, the other went low and quickly he was off his feet and struggling. The rest of us jumped in, everyone got a limb. We were walking in short little steps since Party Boy was doing everything possible to free himself by writhing around and flailing his restrained arms and legs. I was walking down the steps backwards when stepped in something squishy. Immediately everyone smelled it.<br /><br />“Who stepped in the dog crap?” one of the firefighters asked wrinkling his nose as we negotiated the corner on the landing.<br /><br />I knew it was me. Great, this was all I needed to make this call better. A naked guy, his pain in the butt ex-girlfriend, blood, vomit, and now dog poo on my boots. Just great.<br /><br />“I don’t think it’s our guy” one of the firefighters said looking for feces and not seeing any.<br /><br />“No, that would be me.” I said. “I stepped in it on the steps.” I would have to clean that up later. Right now, it was time to take care of Party Boy before he hurts himself worse.<br /><br />As soon as he hit the gurney we wrapped him up and tied him down. He had a wild look in his eye like he wanted to communicate, but his brain was way too blotto to allow for words to be formed. Instead, he was left with grunts and snorts to work with.<br /><br />We wheeled him into the ambulance and I was for the first time able to really assess him. He had a broken nose, from what I am not sure. He kept opening his mouth so I could see there was no other oral trauma other than his split lip and the nose. I think the blood was from his nosebleed dripping down the back of his throat. I had to sit on him to get a blood pressure and pulse since he was thrashing around careful to avoid his erection standing at full mast under the blanket. Then it came to me, all the while he was pleasuring himself as we were trying to corral him, that was what he wanted to do. I freed one of his hands and he immediately went to work on his penis under the blankets. It significantly cut down on his manic behavior, but the way he was staring right through my partner with this hypersexual behavior was giving me and her the creeps. His grunts and snorts switched to noises that sounded happier, so I guess we were meeting the need of reducing his suffering. This distraction bought me time to get an IV and get some Benadryl on board to calm him down which significantly reduced his manic behavior. <br /><br />We brought him into the hospital, masturbating vigorously the entire time through the ER and onto the hospital bed. I gave my report and left, happy to be rid of Party Boy. Besides, I had to hose the doggy doo off the bottom of my boot.<br /><br />About three hours later we were back at the same hospital wrapping things up with a different patient and we saw Party Boy in one of the observation rooms. He was awake, sitting up in bed and looking bewildered. His hair was messed up and he was now clothed. He had a look in his eye that told me he was much more oriented. It’s funny how when the lights are on inside someone they look like a different person, almost unrecognizable as the wild man we had met earlier. I decided to pop in and ask him some questions since I was missing a lot of info from my report and I wanted to be sure we could bill him for this one.<br /><br />“Hey dude, how are you feeling?” I asked.<br /><br />“Like crap. He said.”<br /><br />“I need to get some info from you” I asked getting what I needed out of the way. I got his name, address, phone number, SSN, and insurance info. <br /><br />“You don’t remember me do you.” I said.<br /><br />“Nope. I don’t remember anything.” He said genuinely.<br /><br />“You OD’d on GHB. I brought you in.” I said.<br /><br />“What? What the heck is GHB?” he said. He was a skilled liar. <br /><br />“It’s a drug. Some people call it a date rape drug. It’s an anesthetic used recreationally as a hypnotic.”<br /><br />“Never heard of it. I don’t do any drugs. That can’t be. I’m totally clean.” He said flatly.<br /><br />“That’s funny, your girlfriend, uh I mean EX-girlfriend says you are addicted to it.”<br /><br />“I don’t know anything about that.” He said knowing that I knew very well that he was lying. “Can I go home now?” he said.<br /><br />“Not my call, bud. That’s up to the doctor. Feel better.” I said and left the room.<br /><br />He was yelling after me tugging on his wrist restraints as I left and that was the last I saw of him. Fitting given the hell he gave us back at the house.<br /><br />I stopped back in about an hour after that and asked the nurse about him.<br /><br />“So where’s Party Boy?” he knew exactly who I was talking about.<br /> <br />“We took the restraints off and he took off leaving the hospital in his gown only. He didn’t have shoes, a wallet, phone, nothing. “<br /><br />“Did he ever cop to the GHB?” I asked.<br /><br />“Nah, he just kept on denying. Deny, deny, deny.”<br /><br />“How did his tox screen come back” I asked.<br /><br />“Pretty much positive for everything. He was tanked up on everything including alcohol. I’m gonna say that was one hell of a party going on in his head.”<br /><br />“Yeah, something tells me we will be seeing him again.” I said.<br /><br />“For sure.” The nurse said before turning and getting back to his other duties.<br /><br />I turned and walked back out of the sliding double doors feeling the cold blast of damp air hit my face. It was still pouring rain out there. Another call was out there waiting for me. Another adventure just over the horizon.Jon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com1tag:blogger.com,1999:blog-3334925321777651151.post-71802632776009562322010-11-29T21:18:00.000-08:002010-11-29T21:24:50.049-08:00Go with your gut!<meta name="Title" content=""> <meta name="Keywords" content=""> <meta equiv="Content-Type" content="text/html; charset=utf-8"> <meta name="ProgId" content="Word.Document"> <meta name="Generator" content="Microsoft Word 2008"> <meta name="Originator" content="Microsoft Word 2008"> <link rel="File-List" href="file://localhost/Users/jonkuppinger/Library/Caches/TemporaryItems/msoclip/0clip_filelist.xml"> <!--[if gte mso 9]><xml> <o:documentproperties> <o:template>Normal.dotm</o:Template> <o:revision>0</o:Revision> <o:totaltime>0</o:TotalTime> <o:pages>1</o:Pages> <o:words>1323</o:Words> <o:characters>7546</o:Characters> <o:company>Double Funk Crunch</o:Company> <o:lines>62</o:Lines> <o:paragraphs>15</o:Paragraphs> <o:characterswithspaces>9267</o:CharactersWithSpaces> <o:version>12.0</o:Version> </o:DocumentProperties> <o:officedocumentsettings> <o:allowpng/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:worddocument> <w:zoom>0</w:Zoom> <w:trackmoves>false</w:TrackMoves> <w:trackformatting/> <w:punctuationkerning/> <w:drawinggridhorizontalspacing>18 pt</w:DrawingGridHorizontalSpacing> <w:drawinggridverticalspacing>18 pt</w:DrawingGridVerticalSpacing> <w:displayhorizontaldrawinggridevery>0</w:DisplayHorizontalDrawingGridEvery> <w:displayverticaldrawinggridevery>0</w:DisplayVerticalDrawingGridEvery> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:dontgrowautofit/> <w:dontautofitconstrainedtables/> <w:dontvertalignintxbx/> </w:Compatibility> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="276"> </w:LatentStyles> </xml><![endif]--> <style> <!-- /* Font Definitions */ @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Cambria; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style> <!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin;} </style> <![endif]--> <!--StartFragment--> <p class="MsoNormal" style="text-indent:.5in">
<br /></p> <p class="MsoNormal" style="text-indent:.5in">It was the first call of the day on the week of Thanksgiving.<span style="mso-spacerun: yes"> </span>It was cool and blustery outside, raining on and off.<span style="mso-spacerun: yes"> </span>The leaves, which had made their final curtain call, were ablaze in yellow, orange, and red; contrasting the dull, gray, overcast skies that threatened us ominously.<span style="mso-spacerun: yes"> </span>Many of the leaves had already made the leap to the ground creating colorful, yet slimy masses waiting for an ambulance to try and take a corner too quickly.<span style="mso-spacerun: yes"> </span></p><p class="MsoNormal" style="text-indent:.5in">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">My partner and I were wearing our rain gear, which is too hot for sitting in an ambulance, but too difficult to deal with taking on and off each time we get in and out.<span style="mso-spacerun: yes"> </span>Besides, our seats were already wet from our clothing, so we would have to deal with it.<span style="mso-spacerun: yes"> </span></p><p class="MsoNormal" style="text-indent:.5in">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">The call was in a more upscale part of Oakland.<span style="mso-spacerun: yes"> </span>This particular part is walking distance from a quaint section of downtown that has a Main Street feel to it.<span style="mso-spacerun: yes"> </span>The patient had already been walked down to the portico and was sitting on the front steps, protected from the rain.<span style="mso-spacerun: yes"> </span>He was wearing a T-shirt, jeans, and sneakers and was not looking like today was his best day.</p><p class="MsoNormal" style="text-indent:.5in">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt"><span style="mso-spacerun: yes"> </span>Using and umbrella in the 911 system is not an option.<span style="mso-spacerun: yes"> </span>Not only does it limit where you go, it also takes away a valuable hand that you need to do the job correctly.<span style="mso-spacerun: yes"> </span>We put up our hoods and made the dash from the ambulance to the doorway without the gurney.<span style="mso-spacerun: yes"> </span>It was raining hard enough that taking the gurney out would be a bad idea unless it is absolutely necessary.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“So what do we have?” I asked the Lieutenant.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Looks like abdominal pain” he responded.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Might be cardiac” the medic said and raised up the sublingual nitroglycerin spray pump to the patient’s mouth.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Hold on…” I tried to stop him from delivering the spray.<span style="mso-spacerun: yes"> </span>It was no use.<span style="mso-spacerun: yes"> </span>He was on it.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">When nitroglycerin is delivered for a suspected cardiac event, most notably indicated by chest pain, it causes vaso-dilation of the coronary arteries and often relieves the pain.<span style="mso-spacerun: yes"> </span>This is good.<span style="mso-spacerun: yes"> </span>The problem is, it often can hide the indicators of a heart attack from the EKG until the medicine wears off. <span style="mso-spacerun: yes"> </span>Time we don’t have to waste.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“OK, let’s just get him in the ambulance.” I said wanting to get things moving along.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">We loaded the patient up and I got to work assessing him.<span style="mso-spacerun: yes"> </span></p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Any chest pain sir?”</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Nope.<span style="mso-spacerun: yes"> </span>Where is my newspaper?” he asked.<span style="mso-spacerun: yes"> </span>Really odd question given his situation.<span style="mso-spacerun: yes"> </span>Where were his priorities? I thought.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Any shortness of breath?”</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Nope” he was however breathing faster than normal and appeared anxious.<span style="mso-spacerun: yes"> </span>I put him on oxygen anyway.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">His behavior had me a bit confused.<span style="mso-spacerun: yes"> </span>Where was this call going?<span style="mso-spacerun: yes"> </span>He was sweaty and it was cold out, but it was possible he could have been in the rain this morning or could still be damp from a shower.<span style="mso-spacerun: yes"> </span>I asked and both of these answers came back negative.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Where exactly does it hurt?”</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">It’s like heartburn, right here” he said pointing to his upper stomach, right where you would expect acid reflux or a hiatal hernia to hurt.<span style="mso-spacerun: yes"> </span>“My wallet is in my back left pocket in case I die.”<span style="mso-spacerun: yes"> </span>He added nonchalantly.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">I started to wonder about this talk we were having.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Any medical history?”</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Nope”</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Allergies, medications, eat anything unusual? Acid reflux? Nausea, vomiting, diarrhea, blood in stools or urine? Any cardiac history?<span style="mso-spacerun: yes"> </span>Diabetes? Ulcers?”</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">The answers were “no” to all of those questions.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">While I was asking these questions I was taking vital signs and hooking him up to the monitor for a 12 lead electro-cardiogram.<span style="mso-spacerun: yes"> </span>I shot the EKG and it came back negative for clear signs of a heart attack, but did show some depression in the ST segment; this was a possible harbinger of impending doom.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">My partner was standing in the rain at the end of the bench by the open doors typing the info into the computer as I spit it out to her.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“So, what do you think?” she asked quietly.<span style="mso-spacerun: yes"> </span>I leaned into her to talk, out of earshot of the patient.</p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“I’m not sure.<span style="mso-spacerun: yes"> </span>My gut is saying cardiac, but I have nothing showing.<span style="mso-spacerun: yes"> </span>Maybe it’s just anxiety or psych?”<span style="mso-spacerun: yes"> </span>I half-asked, half-stated.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Is that dynamite?” The patient loudly asked pointing to our road flares with an anxious look on his face.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Yeah, we carry dynamite on all emergency rigs in this county.<span style="mso-spacerun: yes"> </span>You never know when you are going to need to blow something up”<span style="mso-spacerun: yes"> </span>I replied sarcastically.<span style="mso-spacerun: yes"> </span></p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">He took the answer at face value and didn’t question it.<span style="mso-spacerun: yes"> </span></p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">I looked at my partner with a look that said “See what I mean?”</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Let’s just roll to Summit” she said.<span style="mso-spacerun: yes"> </span>“They are a cardiac center anyway, best place for him either way."</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">We were literally blocks from the hospital so I had my partner go ahead and go code 2, but alert them that we are suspecting a cardiac patient, but we don’t have the proof.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">In route I took another couple of EKGs.<span style="mso-spacerun: yes"> </span>They were all still negative, but it was progressing.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“I can’t get this guy to shoot an MI, but he totally looks like one” I yelled up to my partner.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Maybe try a right sided EKG?” she suggested.<span style="mso-spacerun: yes"> </span>It’s nice to have a smart partner.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Good idea.” I tried it, but still no indication clearly pointing to the heart attack I new this guy was heading for.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">This is when the fear and doubt sets in for paramedics.<span style="mso-spacerun: yes"> </span>We are alone out there and have to follow three simple steps: Assess, Decide, and Act.<span style="mso-spacerun: yes"> </span>Assessing is easy.<span style="mso-spacerun: yes"> </span>So is acting.<span style="mso-spacerun: yes"> </span>It’s the deciding to act that is the problem in these borderline cases.<span style="mso-spacerun: yes"> </span>Do I act conservatively and go full cardiac?<span style="mso-spacerun: yes"> </span>What if this guy is just a psych case and has us fooled?<span style="mso-spacerun: yes"> </span>What if he is just an odd-ball with an ulcer starting?<span style="mso-spacerun: yes"> </span>What if his references to his own death are his sense of impending doom that sets in prior to cardiac arrest?<span style="mso-spacerun: yes"> </span>Do I want to give four aspirin to a guy with a stomach acid problem?<span style="mso-spacerun: yes"> </span>Why is he sweating?<span style="mso-spacerun: yes"> </span>Am I so sure that I am willing to risk the trust and reputation I have built with the Emergency Room staff on a gamble?<span style="mso-spacerun: yes"> </span>All of these thoughts and many others immediately swirled in my head.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">Assess.<span style="mso-spacerun: yes"> </span>Decide…</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">Assess.<span style="mso-spacerun: yes"> </span>Decide…</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">Assess.<span style="mso-spacerun: yes"> </span>Decide…</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">I kept stalling out.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">I closed my eyes for a second and blanked my mind.<span style="mso-spacerun: yes"> </span>I decided to open them and go with the kind of patient I saw when I opened them. </p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt"><span style="mso-spacerun: yes">Eyes open:</span></p><p class="MsoNormal" style="text-indent:11.6pt"><span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:11.6pt">CARDIAC.<span style="mso-spacerun: yes"> </span>It was clear as a bell.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">This entire evolution in my mind took about 15 seconds but felt like an hour.<span style="mso-spacerun: yes"> </span></p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">I quickly fell into the routine of treating a cardiac patient.<span style="mso-spacerun: yes"> </span>All doubt was gone.<span style="mso-spacerun: yes"> </span>My sense of calm had returned and I was working through a familiar protocol in my mind.<span style="mso-spacerun: yes"> </span>Oxygen, Nitro, Aspirin, IV, vital signs, backup EKGs, blood sugar.<span style="mso-spacerun: yes"> </span>The next two blocks we drove were like clockwork.<span style="mso-spacerun: yes"> </span></p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">I could hear the familiar beeping of the ambulance backing up into the bay.<span style="mso-spacerun: yes"> </span>I thought to myself, what musical note is that? Enough of that nonsense, we were here and it was time to switch everything over.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">I was met by the triage nurse in the doorway.<span style="mso-spacerun: yes"> </span>He was a bit confused as to what we were bringing in.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“So what is this now?” he asked.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“ABD pain, epigastric, feels like heartburn.<span style="mso-spacerun: yes"> </span>It looks cardiac to me. Can’t get the EKG to back me up though.<span style="mso-spacerun: yes"> </span>Good depression in the ST segment.”<span style="mso-spacerun: yes"> </span>I said with confidence.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">“Put him in X” the nurse said indicating the room for the stat patients.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">I gave my turn over and got to work on my paperwork.<span style="mso-spacerun: yes"> </span>The nurse walked out of the room telling me that they were getting a “positive” for an MI.<span style="mso-spacerun: yes"> </span>A heart attack.<span style="mso-spacerun: yes"> </span>The Nitro had finally worn off and the heart attack was showing through on the diagnostic equipment.<span style="mso-spacerun: yes"> </span>It got really busy in there.<span style="mso-spacerun: yes"> </span>Chest X-rays, preparations were made for the cath-lab and the patient was whisked away.<span style="mso-spacerun: yes"> </span></p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">An hour later we were back at the hospital and I was told that the patient had suffered a massive heart attack.<span style="mso-spacerun: yes"> </span>His lateral anterior descending coronary artery was 100% occluded; it needed to be cleaned out and stented in order to restore adequate blood flow to the muscle of the heart before the tissue dies.<span style="mso-spacerun: yes"> </span>I looked at my partner and she at I.<span style="mso-spacerun: yes"> </span>We were right.<span style="mso-spacerun: yes"> </span>Dangerously close to not being right. <span style="mso-spacerun: yes"> </span>If we had brought him to another hospital that say was not suited for cardiac care there would have been valuable time wasted in transferring him to a cardiac center.<span style="mso-spacerun: yes"> </span>This delay could potentially result in unrecoverable cardiac muscle tissue that would significantly reduce output.<span style="mso-spacerun: yes"> </span></p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">The cardiologist and nurses all echoed my sentiments that this particular patient was a peculiar one.<span style="mso-spacerun: yes"> </span>He was very anxious, kept asking odd questions, and needed to be given ativan to control his anxiety.<span style="mso-spacerun: yes"> </span>The odd things is that his anxiety was not directed at the fact that he was suffering a heart attack, or at least he didn’t point to that.<span style="mso-spacerun: yes"> </span>He was more worried about his clothing, the time, his newspaper and other seemingly insignificant worries.</p><p class="MsoNormal" style="text-indent:11.6pt">
<br /></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt">In my younger days, (without dating myself too much) REO Speedwagon, a Canadian rock band had a hit called “Should I Follow my head or follow my heart” that while they applied it to relationship choices, still rings true.<span style="mso-spacerun: yes"> </span>Your mind can talk your “gut” out of making decisions that at a base level you know are correct, perhaps you just can’t articulate why in a manner suitable to satisfy your intellect.<span style="mso-spacerun: yes"> </span>I thought about this and decided from here on out, I am going to follow my gut more.<span style="mso-spacerun: yes"> </span>I’ll see how it goes.</p> <p class="MsoNormal"><o:p> </o:p></p><p class="MsoNormal"><o:p>
<br /></o:p></p> <p class="MsoNormal"><o:p> copyright 2010 Jon Kuppinger</o:p></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:11.6pt"><o:p> </o:p></p> <!--EndFragment-->Jon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com1tag:blogger.com,1999:blog-3334925321777651151.post-51930525385280545962010-10-07T21:50:00.000-07:002010-10-07T22:00:27.633-07:00Field Save<!--StartFragment--> <p class="MsoNormal" style="text-indent:.5in">It was an unusually warm Monday for being before noon.<span style="mso-spacerun: yes"> </span>Normally in downtown Oakland, the sun doesn’t burn off the fog until around noon or so.<span style="mso-spacerun: yes"> </span>On this day, the grey blanket that serves as our own built in air conditioner had made an early departure.<span style="mso-spacerun: yes"> </span>The temperature was already up over eighty degrees at eight AM.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">My “black cloud” was in full effect.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span>This kind of thing runs in cycles and when it is on, we call it the black cloud.<span style="mso-spacerun: yes"> </span>A sort of tribute to the cloud that followed the Pink Panther around.<span style="mso-spacerun: yes"> </span>When things are light we call it the white cloud.<span style="mso-spacerun: yes"> </span>Silly superstitions, but they can get in your head and mess you up if you let them in.</p> <p class="MsoNormal" style="text-indent:.5in">My partner this day, Sarah, was an entertaining one.<span style="mso-spacerun: yes"> </span>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.</p> <p class="MsoNormal" style="text-indent:.5in">“Five One Two, Five Twelve, can you clear the hospital for a code three?”<span style="mso-spacerun: yes"> </span>The dispatcher asked.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">My partner raised an eyebrow at me with the inquisitive look that asked “what do you want me to say?”</p> <p class="MsoNormal" style="text-indent:.5in">I nodded.</p> <p class="MsoNormal" style="text-indent:.5in">“Sure, what do you have?” my partner Sara responded over the radio.</p> <p class="MsoNormal" style="text-indent:.5in">“Sixty-four year old male, shortness of breath.” And they followed with the address.</p> <p class="MsoNormal" style="text-indent:.5in">“Ten-eight.” She said, meaning we were on the way.</p> <p class="MsoNormal" style="text-indent:.5in">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.<span style="mso-spacerun: yes"> </span>The fire engineer was leaning up against the engine fiddling with some gadget and waved to us as we pulled up.<span style="mso-spacerun: yes"> </span>He looked very relaxed so our guard went down a notch.</p> <p class="MsoNormal" style="text-indent:.5in">“Hey guys” he said over the chugging of the idling diesels. “Looks like an SOB” (meaning shortness of breath.)<span style="mso-spacerun: yes"> </span>“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.</p> <p class="MsoNormal" style="text-indent:.5in">“Friggin’ beautiful!” I responded.<span style="mso-spacerun: yes"> </span>“Finally summer arrives in Oakland”. <span style="mso-spacerun: yes"> </span>Now we were in casual mode and it was all smiles and jokes.<span style="mso-spacerun: yes"> </span>How bad could it be if our sunglass bespectacled member of Oakland’s Bravest was so relaxed?<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">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. <span style="mso-spacerun: yes"> </span>I estimated this house was probably over one hundred years old and nobody had cared for it in the last thirty to forty years. <span style="mso-spacerun: yes"> </span>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.</p> <p class="MsoNormal" style="text-indent:.5in">I walked up the red painted steps leading up to the front door.<span style="mso-spacerun: yes"> </span>The thick red paint was chipped showing the century old cement underneath.<span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span>The steps were littered with old dead potted plants, old kitchen appliances and beer cans.<span style="mso-spacerun: yes"> </span>Trip hazards galore.<span style="mso-spacerun: yes"> </span>The handrail was wooden and worn.<span style="mso-spacerun: yes"> </span>Sections of it were missing, others were replaced with what looked like broomstick handles. </p> <p class="MsoNormal" style="text-indent:.5in">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.</p> <p class="MsoNormal" style="text-indent:.5in">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.<span style="mso-spacerun: yes"> </span>It almost looked like the letters were floating and bobbing on their own in the darkness. <span style="mso-spacerun: yes"> </span>The smell of dirt and old tobacco was there to greet me as I approached the door.</p> <p class="MsoNormal" style="text-indent:.5in">I popped my head into the front room.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">When my eyes adjusted to the darkness I realized this place was filthy, and not the kind you could fix.<span style="mso-spacerun: yes"> </span>Everything inside was so covered with dirt, smoke damage and dust that it all had settled into a dark brown grayish color.<span style="mso-spacerun: yes"> </span>There were already way too many people in this dingy room.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span>His dingy clothing and unkempt skin and hair made him blend in with everything else in there that was dark brown and grey.<span style="mso-spacerun: yes"> </span>I wondered how many years he had sat in that exact chair watching the world go by, day by day in the darkness.</p> <p class="MsoNormal" style="text-indent:.5in">“What do we have?”<span style="mso-spacerun: yes"> </span>I asked the fire medic trying to get a look at the patient.<span style="mso-spacerun: yes"> </span>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.</p> <p class="MsoNormal" style="text-indent:.5in">“Shortness of breath, might want to grab a stair chair, he’s not gonna walk for us” the fire medic responded.</p> <p class="MsoNormal" style="text-indent:.5in">I walked back out to the porch and yelled down to Sarah to grab the stair chair.<span style="mso-spacerun: yes"> </span>She was just setting up the gurney at the bottom of the stairs anticipating the patient coming out.</p> <p class="MsoNormal" style="text-indent:.5in">“Got it” she yelled back as she headed to the back of the ambulance to fetch the dreaded stair chair.</p> <p class="MsoNormal" style="text-indent:.5in">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.<span style="mso-spacerun: yes"> </span>It is a collapsible aluminum framed wheelchair of sorts with extendable handles and straps.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span>This thing is a paramedic killer.</p> <p class="MsoNormal" style="text-indent:.5in">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.<span style="mso-spacerun: yes"> </span>Our patient was indeed clearly struggling to catch his breath and “tripoding” with both hands on his knees.<span style="mso-spacerun: yes"> </span>He was breathing at least fifty times a minute.<span style="mso-spacerun: yes"> </span>He was too dark black and the room was too dark to see the quality of his skin tone, but<span style="mso-spacerun: yes"> </span>I could see what little light there was reflecting off the sweat on his face and neck.<span style="mso-spacerun: yes"> </span>His oversized glasses were fogging up from his exhalations escaping through the top of his mask.<span style="mso-spacerun: yes"> </span>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.</p> <p class="MsoNormal" style="text-indent:.5in">I glanced over at the cardiac monitor and it made me jump a bit.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“Guys, he’s in SVT at 220 bpm!”<span style="mso-spacerun: yes"> </span>I said.</p> <p class="MsoNormal" style="text-indent:.5in">“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.</p> <p class="MsoNormal" style="text-indent:.5in">“Got it” the extra firefighter who was previously just standing there said and got to work on getting an IV line flooded.</p> <p class="MsoNormal" style="text-indent:.5in">“I’ll get the drugs” I said.<span style="mso-spacerun: yes"> </span>“meanwhile, this guy is going to need CPAP”</p> <p class="MsoNormal" style="text-indent:.5in">“You think so?” he asked.</p> <p class="MsoNormal" style="text-indent:.5in">“Yeah, I think so.” I said.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">The patient suddenly slumped and the monitor went completely unorganized.</p> <p class="MsoNormal" style="text-indent:.5in">“He coded” the medic said.<span style="mso-spacerun: yes"> </span>The guy in the corner didn’t react.</p> <p class="MsoNormal" style="text-indent:.5in">Just then Sara stepped in and saw us lowering him to the floor.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“I’ve got CPR” she said and jockeyed for position at the old man’s now bare chest.<span style="mso-spacerun: yes"> </span>She began chest compressions immediately.<span style="mso-spacerun: yes"> </span>I went over to the gear and grabbed a BVM and tossed it to the fire medic.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“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?”</p> <p class="MsoNormal" style="text-indent:.5in">“There’s a light over there.” The silent grey man from the corner spoke up in a gravely drawl that gave me the creeps.<span style="mso-spacerun: yes"> </span>“You can cut it on over by the door.”<span style="mso-spacerun: yes"> </span>How much do you have to drink and smoke to get that voice?</p> <p class="MsoNormal" style="text-indent:.5in">“Do we have that line yet?” <span style="mso-spacerun: yes"> </span>I asked the medic?<span style="mso-spacerun: yes"> </span>I was feeling like I was clearly in charge now and everyone was willing to just take orders.</p> <p class="MsoNormal" style="text-indent:.5in">“I can’t get it” he said.<span style="mso-spacerun: yes"> </span>There were a number of needles in the guy, none of them flowing.</p> <p class="MsoNormal" style="text-indent:.5in">“Don’t worry about it, clear the patient, charging” The defibrillator began it’s rising siren that signifies the capacitors are charging up.<span style="mso-spacerun: yes"> </span>Then the tone changed to one that sounded like the European cop cars.<span style="mso-spacerun: yes"> </span>It was time to shock.</p> <p class="MsoNormal" style="text-indent:.5in">“Clear!<span style="mso-spacerun: yes"> </span>Shocking now!” I yelled.</p> <p class="MsoNormal" style="text-indent:.5in">The patient jerked, and everyone jumped back into action. </p> <p class="MsoNormal"><o:p> </o:p><span style="mso-tab-count:1"> </span>Sarah was doing compressions, the medic was still trying to get a line and I was prepping the meds and watching the monitor.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Yall’ve been here before, same kinda thing I think” he said in his rotten zombie voice to the lieutenant.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Hold CPR, I’m going to check the rhythm” I said.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal"><o:p> </o:p><span style="mso-tab-count:1"> </span>The monitor showed a nice tight rhythm.<span style="mso-spacerun: yes"> </span>It was a bit slow, but still very promising.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Check for a pulse” I asked the medic.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Yup, he’s got one.<span style="mso-spacerun: yes"> </span>Weak, but it’s there.”</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Breathing on his own?”<span style="mso-spacerun: yes"> </span>I asked.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“I need suction” Sarah said.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>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.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“LT, we need to get this show on the road” I said to the lieutenant.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>He stepped out to the steps and whistled to his engineer who popped his head around the corner of the fire engine.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Get the backboard up here, we’re heading out.” </p> <p class="MsoNormal">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.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“I’ll run ahead and prep the gurney”<span style="mso-spacerun: yes"> </span>Sara said as she squeezed by everyone and headed down the stairs.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>We lifted the man, four of us, two at each end and began to walk with him out the front door.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Coming out feet first!” the captain yelled.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>We descended the steps and strapped the patient to the gurney, all the while continuing to assist with respirations.<span style="mso-spacerun: yes"> </span>I could see his chest rising and falling.<span style="mso-spacerun: yes"> </span>This was a good sign.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>We had developed a group of neighborhood people on the sidewalk watching.<span style="mso-spacerun: yes"> </span>Ghetto paparazzi, as I call them, were recording the whole event on their cell phones.<span style="mso-spacerun: yes"> </span>This was status quo these days in Oakland.<span style="mso-spacerun: yes"> </span>All police and fire actions were recorded by the citizens just hoping that we did something wrong or illegal.<span style="mso-spacerun: yes"> </span>The news channels pay well for that kind of footage if something is done wrong.<span style="mso-spacerun: yes"> </span>Sometimes they will even provoke and critique us to try and get a reaction they can film.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>Once in the ambulance we headed off to the hospital code 3.<span style="mso-spacerun: yes"> </span>The fire medic was in the seat just over the head of the patient helping him breath.<span style="mso-spacerun: yes"> </span>I was down at the body.<span style="mso-spacerun: yes"> </span>I established IV access and was just hanging the line when the patient regained consciousness.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>It was slow at first, but he came around pretty quickly.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Good morning sunshine!” The fire medic said looking down into the patient’s face from the top.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“What happened?” he asked very confused as to where he was.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“You died sir, but now you are back. “ the fire medic said.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Oh, not again.” He said.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Again?” the fire medic asked?</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Yeah, I<span style="mso-spacerun: yes"> </span>died and you guys shocked me back about a year ago.”<span style="mso-spacerun: yes"> </span>He said nonchalantly.<span style="mso-spacerun: yes"> </span>He wasn’t thanking us, just stating the facts.</p> <p class="MsoNormal" style="text-indent:.5in">“Well, happy we could be here for you” I said as I checked his lung and heart sounds.<span style="mso-spacerun: yes"> </span>His heart sounded fine, but his lungs were junky, like someone crumpling up cellophane.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Let’s get him on CPAP” I suggested to the fire medic who was taking care of the respirations side of things.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Is he filling up again?” he asked.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“He’s almost full.”</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>The CPAP creates positive pressure in the lungs to force the water back across the alveolar barrier and into the blood stream.<span style="mso-spacerun: yes"> </span>This creates great relief for the patient, but is not without it’s drawbacks.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>After we arrived at the hospital and I gave my turn over to the ER doctor, I got to writing my report.<span style="mso-spacerun: yes"> </span>This would be a long one.<span style="mso-spacerun: yes"> </span>A lot happened in that short ten minutes we were with the patient.<span style="mso-spacerun: yes"> </span>After my report was done, I stopped by to see the patient and he was sitting up in bed and talking.<span style="mso-spacerun: yes"> </span> </p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Hey, Mr. Paramedic!” he said, still a bit rough sounding, but amazingly alert and spry for having just died less than an hour ago.<span style="mso-spacerun: yes"> </span>In the good light I could now clearly see the man I had been working so hard to save.<span style="mso-spacerun: yes"> </span>He was about seventy years old with a shock of receded grey hair.<span style="mso-spacerun: yes"> </span>His skin was leathery from too much sun exposure and he had a barrel chest with spindly arms and legs.<span style="mso-spacerun: yes"> </span>Tell tale signs of a chronic COPD patient.<span style="mso-spacerun: yes"> </span>He was breathing comfortably now and all his vital signs had normalized.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“How are you doing sir?” I asked.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Oh you know, I’ve seen better days.” He said in a southern drawl.<span style="mso-spacerun: yes"> </span>“Probably gonna see a few more thanks to you guys.”</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Ah, don’t worry about it.<span style="mso-spacerun: yes"> </span>Just doing our job.”<span style="mso-spacerun: yes"> </span>I said.<span style="mso-spacerun: yes"> </span>“Although it is nice to meet you now that you are alive.” I joked.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Sit down here, let’s visit a while.”<span style="mso-spacerun: yes"> </span>He said.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>We sat and talked for about a half an hour, periodically interrupted by nurses and interns. <span style="mso-spacerun: yes"> </span>Everyone wanted to see the guy who coded and was now right as rain.<span style="mso-spacerun: yes"> </span>I learned that he was from Mississippi and he learned that I was from New York.<span style="mso-spacerun: yes"> </span>He worked forty years at the Port of Oakland off-loading ships and I was in the Navy.<span style="mso-spacerun: yes"> </span>He had been married for fifty years before she died a few years back.<span style="mso-spacerun: yes"> </span>I showed him pictures of my wife and kids.<span style="mso-spacerun: yes"> </span>We talked.</p> <p class="MsoNormal" style="text-indent:.5in">Eventually, Sarah poked her head into the room “Hey, they need us to clear for the next call” she said.<span style="mso-spacerun: yes"> </span>“Oh hi!” She just realized how well he was doing.</p> <p class="MsoNormal" style="text-indent:.5in"><o:p> </o:p>“Hello there young lady”.</p> <p class="MsoNormal" style="text-indent:.5in"><o:p> </o:p>“Sir, this is the woman who was pumping on your heart” I told him.</p> <p class="MsoNormal" style="text-indent:.5in"><o:p> </o:p>“Oh, pretty girl like that, surprised she didn’t steal my heart.” He flirted.</p> <p class="MsoNormal" style="text-indent:.5in"><o:p> </o:p>“Yeah, I have my strengths” she said fluffing imaginary curls.</p> <p class="MsoNormal" style="text-indent:.5in">He even signed my paperwork for the transport.<span style="mso-spacerun: yes"> </span>That is a first.<span style="mso-spacerun: yes"> </span>I have never done CPR on someone and then had them sign for themselves at the end of the call.<span style="mso-spacerun: yes"> </span>Usually a crying family member or the receiving RN signs the paperwork.<span style="mso-spacerun: yes"> </span>Usually the patient has passed at that point.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">We cleared the hospital and headed out for the next call without knowing what it was going to be.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal"><o:p> </o:p></p> <!--EndFragment-->Jon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com0tag:blogger.com,1999:blog-3334925321777651151.post-12570448267992792222010-07-06T17:41:00.000-07:002010-07-06T17:45:38.837-07:00Oopsy-Daisy!<!--StartFragment--> <p class="MsoNormal" style="text-indent:.5in">It was well past midnight on a slow night on the west side of Oakland.<span style="mso-spacerun: yes"> </span>Sometimes the city sleeps, but not for long.<span style="mso-spacerun: yes"> </span>More like cat-naps. My partner and I were enjoying the fact that there was not much to do.<span style="mso-spacerun: yes"> </span>We were killing the time by watching some nursing school lecture videos.<span style="mso-spacerun: yes"> </span>I think it was one on blood chemistry.<span style="mso-spacerun: yes"> </span>Really fascinating stuff, until the peace of the night was interrupted by a call.</p> <p class="MsoNormal" style="text-indent:.5in">The call was for a fall, with back pain.<span style="mso-spacerun: yes"> </span>We showed up to the fourth floor of an apartment complex on the west side.<span style="mso-spacerun: yes"> </span>This was the kind of place where all the hallways were exterior to the building.<span style="mso-spacerun: yes"> </span>There was nothing but a wrought iron railing keeping you on the ledge.<span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span>The light blue paint was chipping off the stucco in dinner plate sized flakes, which were scattered around the foundation.<span style="mso-spacerun: yes"> </span>No one had bothered to pick them up.</p> <p class="MsoNormal" style="text-indent:.5in">This particular call was a “code 2” call, meaning the 911 dispatcher had determined that the fire department was not needed.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span>In this instance, they made the right call.<span style="mso-spacerun: yes"> </span>It was not a significant emergency. </p> <p class="MsoNormal" style="text-indent:.5in">“Hello? Paramedics!”<span style="mso-spacerun: yes"> </span>I announced as I opened the door after knocking several times with no response. </p> <p class="MsoNormal" style="text-indent:.5in">“Don’t let the cat out!” a voice yelled back in a neurotic tone.<span style="mso-spacerun: yes"> </span>I guess you have to have your priorities and for this guy, it is the cat.</p> <p class="MsoNormal" style="text-indent:.5in">I opened the door to find an apartment with all kinds of take-out food boxes everywhere. <span style="mso-spacerun: yes"> </span>Chinese boxes.<span style="mso-spacerun: yes"> </span>Pizza boxes.<span style="mso-spacerun: yes"> </span>Fast food wrappers and bags.<span style="mso-spacerun: yes"> </span>The urge to kick the two liter soda bottles as I waded through them was a little overwhelming, but I managed. <span style="mso-spacerun: yes"> </span>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. </p> <p class="MsoNormal" style="text-indent:.5in">We found our patient sitting in the cool blue light of his old 30-inch tube television.<span style="mso-spacerun: yes"> </span>He was on an old shaggy couch in the middle of his apartment.<span style="mso-spacerun: yes"> </span>He was a fuzzy headed nerd of a guy wearing dark rimmed glasses and an old Star Trek T-shirt.<span style="mso-spacerun: yes"> </span>He was watching the TV and sitting stiff-legged in a very awkward position with a look of feigned distress on his face.<span style="mso-spacerun: yes"> </span>He was easily 350 lbs if he was an ounce.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“Sir?<span style="mso-spacerun: yes"> </span>Did you call 911?”<span style="mso-spacerun: yes"> </span>I asked.</p> <p class="MsoNormal" style="text-indent:.5in">“Yes, I can’t move my legs”.<span style="mso-spacerun: yes"> </span>His gaze was fixed on the television.<span style="mso-spacerun: yes"> </span>Apparently not wanting to miss the next segment of Babylon 5.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“Hmmm…..Can you normally move them?”<span style="mso-spacerun: yes"> </span>I asked further.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“Yes”<span style="mso-spacerun: yes"> </span>not exactly a fountain of information.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“OK then, did you hurt your legs or fall down?”<span style="mso-spacerun: yes"> </span>I asked even further.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“I fell down the stairs today and hurt my back." </p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“Those stairs out there?”<span style="mso-spacerun: yes"> </span>I asked and he nodded in reply.</p> <p class="MsoNormal" style="text-indent:.5in">Oh great.<span style="mso-spacerun: yes"> </span>I walked around behind him and held C-spine.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“Megan, let’s get some vitals”<span style="mso-spacerun: yes"> </span>I asked my partner. “And turn the TV off and the lights on please”</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“Sure”.<span style="mso-spacerun: yes"> </span>She got to it.</p> <p class="MsoNormal" style="text-indent:.5in">“Awwww man, did you have to turn off the TV?” he whined.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“Sir, where does it hurt?”<span style="mso-spacerun: yes"> </span>I asked ignoring the question about the TV.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“Everywhere”.<span style="mso-spacerun: yes"> </span>He replied not making any eye contact with me.<span style="mso-spacerun: yes"> </span>His tone was smug and almost teasing.<span style="mso-spacerun: yes"> </span>Perhaps this was not his first rodeo.</p> <p class="MsoNormal" style="text-indent:.5in">“I can’t clear this guy, we are going to have to put him on a board” I told my partner.<span style="mso-spacerun: yes"> </span>“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.”</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“I’ll go get the equipment” she said.</p> <p class="MsoNormal" style="text-indent:.5in">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.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">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.<span style="mso-spacerun: yes"> </span>I was pretty embarrassed to call them.<span style="mso-spacerun: yes"> </span>I know this is BS.<span style="mso-spacerun: yes"> </span>They will know it is BS.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span>For that, I needed more manpower.</p> <p class="MsoNormal" style="text-indent:.5in">My partner came back up with the equipment.<span style="mso-spacerun: yes"> </span>I wasn’t sure how I was going to be able to do this by the book.<span style="mso-spacerun: yes"> </span>He was very large and probably not too compliant.<span style="mso-spacerun: yes"> </span>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. </p> <p class="MsoNormal" style="text-indent:.5in">I decided the best bet was to shove the board down from behind him on the couch.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span>Megan had to straddle him and grab his belt to get his hips to move forward.<span style="mso-spacerun: yes"> </span>With the collar on the board did indeed slide behind his stiff body and then I just pulled the couch out from under him.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">Just then I heard the familiar yelp of the fire engine’s air breaks out front.<span style="mso-spacerun: yes"> </span>Megan finished up with the straps and the head bed and I went outside to meet the fire crew.<span style="mso-spacerun: yes"> </span>They knew this guy and his games and were in no hurry to get up the stairs.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">I met them just outside the door.</p> <p class="MsoNormal" style="text-indent:.5in">“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”.</p> <p class="MsoNormal" style="text-indent:.5in">“It’s cool Jon” the medic said. “We’ve been there before”.<span style="mso-spacerun: yes"> </span>I had run several hairy calls with this particular crew.<span style="mso-spacerun: yes"> </span>We trusted each other.</p> <p class="MsoNormal" style="text-indent:.5in">The fire medic walked in the room and began to question the patient to try and clear his C-spine.<span style="mso-spacerun: yes"> </span>He didn’t get anywhere but frustrated and looked back to his Captain.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“Let’s get in here and get him downstairs” he said to his crew.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“See what I mean?” I asked him, looking to bolster my case.</p> <p class="MsoNormal" style="text-indent:.5in">“Yeah, let’s just get this over with.<span style="mso-spacerun: yes"> </span>Four point work for you?” he asked the group. </p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">We all made affirmative gestures and/or grunts and got into position. </p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“Where is the elevator in this building?” the Captain asked the patient.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“What elevator?” the patient asked. </p> <p class="MsoNormal" style="text-indent:.5in">“You have got to be kidding me” the Captain replied under his breath.<span style="mso-spacerun: yes"> </span>A dark feeling was sinking in to all of us that we may have to carry this guy down four flights of stairs.<span style="mso-spacerun: yes"> </span>Not cool.<span style="mso-spacerun: yes"> </span>The Captain made a sweeping motion with is hand and the most junior firefighter jogged out of the room and down the hall.<span style="mso-spacerun: yes"> </span>He came back confirming the bad news.<span style="mso-spacerun: yes"> </span>There was no elevator.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">So we picked the guy up.<span style="mso-spacerun: yes"> </span>This would have to be done the old fashioned way.</p> <p class="MsoNormal" style="text-indent:.5in">The complication posed to us with this guy was he could not, or should I say, would not follow simple directions.<span style="mso-spacerun: yes"> </span>A backboard can be uncomfortable.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span>It gets more complicated when you are obese and your jiggling waves of fat over-exaggerate every movement made by your weight bearers.<span style="mso-spacerun: yes"> </span>A slight tip to the left becomes a full-on list control issue with an extra hundred pounds of undulating adipose cycling behind it. </p> <p class="MsoNormal" style="text-indent:.5in">So given that little twist, we had decided to lift the patient using the four point method.<span style="mso-spacerun: yes"> </span>Similar to the way pall-bearers carry a coffin.<span style="mso-spacerun: yes"> </span>Two at each end with a person on each side helping to control list.<span style="mso-spacerun: yes"> </span>This worked fine going down the hallway.<span style="mso-spacerun: yes"> </span>It was tight, but with a little shuffling and sucking in of guts, we were able to make it to the stairwell.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">This is where we took a pause and looked at the daunting task ahead.</p> <p class="MsoNormal" style="text-indent:.5in">The stairwell was wide enough for two people to walk comfortably next to each other, I would say three feet at the most.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span>The only answer was to take the corners wide.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">This was not a good idea, but it was an idea.</p> <p class="MsoNormal" style="text-indent:.5in">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.<span style="mso-spacerun: yes"> </span>This was not so bad on the side facing the apartments, but on the outside it literally meant nothing under him but our arms.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">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.<span style="mso-spacerun: yes"> </span>So if this guy falls, being strapped to a board, he pretty much dies.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span>Anyone who had moved a couch through a doorway and had to execute a turn knows this one.<span style="mso-spacerun: yes"> </span>As we tipped the patient up he began to flail his arms around yelling that he couldn’t breath.<span style="mso-spacerun: yes"> </span>OK, this wouldn’t work.<span style="mso-spacerun: yes"> </span>Back to plan A.</p> <p class="MsoNormal" style="text-indent:.5in">We planned it out pretty well.<span style="mso-spacerun: yes"> </span>My partner ran ahead to prep the gurney for our arrival and to clear all the trash out of the stairwell.<span style="mso-spacerun: yes"> </span>Feet first is the safest and easiest way.<span style="mso-spacerun: yes"> </span>We put one guy in front to assist with step counts and catch any stumbling firefighters. <span style="mso-spacerun: yes"> </span>We stuck with the four-point approach with one person on the side to try and stabilize him and provide emotional support.<span style="mso-spacerun: yes"> </span>It was only four flights, that’s sixteen turns.<span style="mso-spacerun: yes"> </span>Piece of cake.<span style="mso-spacerun: yes"> </span>I had a lot of muscle with me.<span style="mso-spacerun: yes"> </span>I wasn’t worried.<span style="mso-spacerun: yes"> </span>I got on the front by the feet being one of the bigger guys and we began our descent.</p> <p class="MsoNormal" style="text-indent:.5in">So far so good.<span style="mso-spacerun: yes"> </span>The patient was whining a bit, but no real problems.<span style="mso-spacerun: yes"> </span>It was very challenging to keep the patient at chest height.<span style="mso-spacerun: yes"> </span>My concentration was fixed on using good lifting form and not slipping on the stairs.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">One flight down.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“Anyone need to rest?”<span style="mso-spacerun: yes"> </span>The captain asked.<span style="mso-spacerun: yes"> </span>Great question, looking out for his guys.</p> <p class="MsoNormal" style="text-indent:.5in">“Nope” we all said through gritted teeth.<span style="mso-spacerun: yes"> </span>Sometimes it is just better to do it all at once. </p> <p class="MsoNormal" style="text-indent:.5in">Everything was going fine until we rounded the outer edge of the third floor.<span style="mso-spacerun: yes"> </span>The feet had just gone over the edge and we were swinging the head around to make the turn when our patient began panicking.<span style="mso-spacerun: yes"> </span>He was grabbing our arms, grabbing the wall, grabbing anything he could and was swinging his body around.<span style="mso-spacerun: yes"> </span>This was not good, there was nowhere for us to go with him.</p> <p class="MsoNormal" style="text-indent:.5in">“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.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“I’m gonna fall!” the patient yelled and began to lunge. </p> <p class="MsoNormal" style="text-indent:.5in">“Ahhhh” yelled one the firefighter on the head side.<span style="mso-spacerun: yes"> </span>He let go and was grabbing his lower back.<span style="mso-spacerun: yes"> </span>Something had twisted and suddenly we had three points of contact.</p> <p class="MsoNormal" style="text-indent:.5in">The patient sensed our momentary loss of control and completely panicked swinging his arms around and screaming.<span style="mso-spacerun: yes"> </span>We were losing control fast and everyone was yelling.<span style="mso-spacerun: yes"> </span>The patient was over open space and then the weirdest thing happened.</p> <p class="MsoNormal" style="text-indent:.5in">All at once, he just flipped upside down.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span>The lone guy at the head was doing everything he could to not let go.<span style="mso-spacerun: yes"> </span>The captain had jumped in at the waist level and was using his feet to brace himself against the half-wall.<span style="mso-spacerun: yes"> </span>Without him, it would have been over.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“OK,<span style="mso-spacerun: yes"> </span>everyone on three…one, two, THREE!” the captain said.</p> <p class="MsoNormal" style="text-indent:.5in">And the patient came up and over the wall landing down on the stairs face down.<span style="mso-spacerun: yes"> </span>Not hard enough to hurt him, but clearly enough to freak him out.<span style="mso-spacerun: yes"> </span>Hell, we were all a little freaked out.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">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.<span style="mso-spacerun: yes"> </span>He had the true look of terror in his eyes.<span style="mso-spacerun: yes"> </span>And then he suddenly calmed said the weirdest thing.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“I dropped my wallet”.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">What the hell, we almost killed this guy and he was worried about his wallet?<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span><br /> </p> <p class="MsoNormal" style="text-indent:.5in">“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.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“When did you fall?” he asked the patient with his authority voice on.<span style="mso-spacerun: yes"> </span>It would be clear to anyone that he meant business and his questions were to be answered directly.<span style="mso-spacerun: yes"> </span>It worked.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“At two o’clock.”<span style="mso-spacerun: yes"> </span>Our plus-sized near-death survivor responded.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“A.M. or P.M.?” he asked further.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“P.M.” <span style="mso-spacerun: yes"> </span>It had been over twelve hours, it was now three A.M. </p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“Then what happened?” he urged on.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“Then I went to get something to eat and came back home and watched TV until I called 911”.<span style="mso-spacerun: yes"> </span>He stated.</p> <p class="MsoNormal" style="text-indent:.5in">“Can you move your hands and feet?<span style="mso-spacerun: yes"> </span>Can you feel this?<span style="mso-spacerun: yes"> </span>Any pain in your neck or back?” he was now getting very confrontational and hostile to the patient.</p> <p class="MsoNormal" style="text-indent:.5in">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.<span style="mso-spacerun: yes"> </span>The medic ripped all the straps off.</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“Get up”</p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“I can’t, I fell today, I hurt my back”</p> <p class="MsoNormal" style="text-indent:.5in">“Get the hell up, I am not going to ask you again” he was now standing over the patient in a threatening pose.</p> <p class="MsoNormal" style="text-indent:.5in">Get up he did, with a quickness.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span>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.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in;mso-outline-level:1">“That would have been nice to know at the beginning of the call” I thought to myself.</p> <p class="MsoNormal" style="text-indent:.5in">From the bottom of the stairs on, it was easy to load him into the ambulance and the ride into the ER was uneventful.<span style="mso-spacerun: yes"> </span>The whole way he kept muttering that he was sorry and expressed that he did not want me to be mad at him.<span style="mso-spacerun: yes"> </span>He was not actually hurt, he just needed an adjustment to his psych meds at the most. </p> <p class="MsoNormal" style="text-indent:.5in">The firefighter who hurt his back ended up being OK, though he again added another injury to an already weak back.<span style="mso-spacerun: yes"> </span>He got a couple weeks off to recuperate and some physical therapy.<span style="mso-spacerun: yes"> </span>I would be upset if he had a possible career-ending injury<span style="mso-spacerun: yes"> </span>given the situation. </p> <p class="MsoNormal" style="text-indent:.5in">It took me a little time to decompress from this one.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">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.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">What was the number to that truck driving school?</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <!--EndFragment-->Jon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com2tag:blogger.com,1999:blog-3334925321777651151.post-28978376444219419782010-06-08T16:06:00.000-07:002010-06-08T16:09:11.166-07:00The Heat of the Moment<!--StartFragment--> <p class="MsoNormal" style="text-indent:.5in">It was one of those unseasonably hot Sundays in the valley.<span style="mso-spacerun: yes"> </span>If you live out that way you might remember the actual day a couple years back. I had picked up a valley day car that was available earlier in the week as an overtime shift. <span style="mso-spacerun: yes"> </span>I was thinking it would be a nice break from the Oakland grind completely unaware of the impending heat wave that was coming.<span style="mso-spacerun: yes"> </span>The thermometer on the bank’s digital sign blinked 104F, but it felt even hotter.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">We were spending the bulk of the day between calls looking for shade spots to park.<span style="mso-spacerun: yes"> </span>It’s a kind of game you have to play in the summer if you are going to be out on the street all day.<span style="mso-spacerun: yes"> </span>A large eucalyptus tree here, an overhang there; a bridge overpass will do nicely.<span style="mso-spacerun: yes"> </span>Anything to escape the relentless heat that was building up and fuming off the asphalt.<span style="mso-spacerun: yes"> </span>Our inadequate air conditioner in the ambulance was doing a poor job keeping up being an older model and probably mostly out of Freon.<span style="mso-spacerun: yes"> </span>These poor ambulances get run so hard 24/7 we are lucky to get five years out of them.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">The supervisors that day were tasked with chasing all the units around with coolers full of water and Gatorade. If they found us hiding in our shady corners, we had to drink a full water in front of them on demand.<span style="mso-spacerun: yes"> </span>Dehydration was a serious concern and given the heat, the exercise was justified. They didn’t want us becoming patients too. <span style="mso-spacerun: yes"> </span>To make matters worse, the call volume was up from heat related illnesses so we were working even harder.<span style="mso-spacerun: yes"> </span>Hot days like this, especially in succession tend to thin the herd a bit. </p> <p class="MsoNormal" style="text-indent:.5in">Anyway, as I was saying, it was a blistering day. We had been run pretty hard.<span style="mso-spacerun: yes"> </span>I remember noting that I had drank close to a gallon of water without having to go to the bathroom all shift.<span style="mso-spacerun: yes"> </span>I was sweating it all out.<span style="mso-spacerun: yes"> </span>We stopped into 7-11 for popsicles when the call came in.<span style="mso-spacerun: yes"> </span>It was for chest pain.<span style="mso-spacerun: yes"> </span>I had no trouble wolfing down the frozen treat by the time we got to the call.<span style="mso-spacerun: yes"> </span>Nice to have some ice in my belly and the windows down on the way provided some relief. </p> <p class="MsoNormal" style="text-indent:.5in">My partner this day was an exceptionally laid back guy.<span style="mso-spacerun: yes"> </span>Nothing seemed to faze him.<span style="mso-spacerun: yes"> </span>We’ll call him Doug. </p> <p class="MsoNormal" style="text-indent:.5in">We pulled into the parking lot of a steakhouse up by the interstate to find a single car and the fire engine over in the corner of the lot under a shade tree.<span style="mso-spacerun: yes"> </span>The restaurant would not be open for several hours and the parking lot was deserted. </p> <p class="MsoNormal" style="text-indent:.5in">The body language of the firefighters was that of uncertainty.<span style="mso-spacerun: yes"> </span>They were standing around a brand new, glistening model of Mercedes that I was unaware even existed.<span style="mso-spacerun: yes"> </span>It had to be an $80,000 car at least with gull wing doors; the driver’s side was open and fully extended up.<span style="mso-spacerun: yes"> </span>I could not see what they were looking at, all I saw was a wall of turnout coats as the firefighters were circled around what I assumed had to be the patient with the chest pain. </p> <p class="MsoNormal" style="text-indent:.5in">“Wait on the gurney Doug, I’m gonna hop out and see what we have here”. <span style="mso-spacerun: yes"> </span>I said to my partner.</p> <p class="MsoNormal" style="text-indent:.5in">“Sure” he said in a tone that really said “whatever, I’m hourly”.</p> <p class="MsoNormal" style="text-indent:.5in">As I approached the car, I thought maybe the heat was getting to me.<span style="mso-spacerun: yes"> </span>I could see a pair of long legs with fishnet stocking terminating in stiletto heels sticking out to the side.<span style="mso-spacerun: yes"> </span>“What was I getting myself into?” I wondered.<span style="mso-spacerun: yes"> </span>I could hear the firefighters talking and a faint whimpering from the direction of the as yet faceless but leggy patient.</p> <p class="MsoNormal" style="text-indent:.5in">I rounded the wall of firefighter backs to a fairly shocking find.<span style="mso-spacerun: yes"> </span>It was a young lady in her late twenties sitting sideways in the driver’s seat with those long legs sticking outside the car.<span style="mso-spacerun: yes"> </span>She was wearing an impossibly short black mini-skirt and low-cut halter-top combo with plenty of silver accents. It was the kind of clothing you would expect a stripper or maybe a showgirl of some sort to wear.<span style="mso-spacerun: yes"> </span>She had a large bouquet of long stemmed roses and baby’s breath bound together with tulle and cellophane draped over one of her forearms similar to the way you would expect Miss America to hold it.<span style="mso-spacerun: yes"> </span>I half expected to see a tiara on her head and a “Miss Livermore” sash draped over her shoulder.<span style="mso-spacerun: yes"> </span>If this wasn’t odd enough, one of her halter straps was undone and hanging freely and the other hand was cradling one of her naked oversized, obviously surgically enhanced breasts in a move of mock modesty.<span style="mso-spacerun: yes"> </span>She was openly weeping and having trouble choking the words out through the tears.<span style="mso-spacerun: yes"> </span>I sensed these were not tears of pain.<span style="mso-spacerun: yes"> </span>Something else was going on here.</p> <p class="MsoNormal" style="text-indent:.5in">“What do we have?” Doug yelled over to me from the ambulance.<span style="mso-spacerun: yes"> </span>This was more a “What do you need” kind of question.<span style="mso-spacerun: yes"> </span>Once he knew the nature of the call, he would know what equipment to grab.</p> <p class="MsoNormal" style="text-indent:.5in">I shrugged back at him with the international sign of “I don’t know”.<span style="mso-spacerun: yes"> </span>I really didn’t know what to make of this.<span style="mso-spacerun: yes"> </span>Was this an assault of some sort?<span style="mso-spacerun: yes"> </span>Was this a psych case? “You better get over here and check this out”.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“So what is the story?” I asked the Captain.<span style="mso-spacerun: yes"> </span>He was a burly middle-aged guy.<span style="mso-spacerun: yes"> </span>He had a balding head, walrus mustache, and the kind of belly that takes years of firehouse eating to develop.<span style="mso-spacerun: yes"> </span>He was a little on the grumpy side today, probably the heat. </p> <p class="MsoNormal" style="text-indent:.5in">“I guess her breast hurts?” he said in a questioning tone.<span style="mso-spacerun: yes"> </span>They must have arrived just before us and I don’t think they had gotten anywhere with her yet.<span style="mso-spacerun: yes"> </span>I could tell this call was making him uncomfortable being that she was such an attractive young lady and looked like something out of a Calvin Klein ad.<span style="mso-spacerun: yes"> </span>I took their uncertainty as a cue to jump in.<span style="mso-spacerun: yes"> </span>I squatted down next to her and put on my best concerned look of authority.</p> <p class="MsoNormal" style="text-indent:.5in">“Ma’am, what seems to be the problem?” I asked trying not to choke on the fumes from her sickeningly sweet and quite liberally applied perfume.</p> <p class="MsoNormal" style="text-indent:.5in">“My breast is killing me” she said looking down at her breast.<span style="mso-spacerun: yes"> </span>The body glitter on her chest was catching the sun and was distracting me.<span style="mso-spacerun: yes"> </span>Making me squint.</p> <p class="MsoNormal" style="text-indent:.5in">“OK, do you have any chest pain or shortness of breath?” I asked.<span style="mso-spacerun: yes"> </span>Had to stick with priorities even if I am talking to a human Barbie doll.</p> <p class="MsoNormal" style="text-indent:.5in">“No” she blurted and got back to sobbing.</p> <p class="MsoNormal" style="text-indent:.5in">“Any other medical conditions I need to know about?”</p> <p class="MsoNormal" style="text-indent:.5in">“No” again.</p> <p class="MsoNormal" style="text-indent:.5in">“Did you hurt it somehow?” I asked. “Did <i style="mso-bidi-font-style:normal">someone</i> hurt you?” adding the next question with more emphasis before she could answer the first.</p> <p class="MsoNormal" style="text-indent:.5in">“No, nothing like that.” She said as she regained her composure for a moment.<span style="mso-spacerun: yes"> </span>“I think it popped” she looked up at me with mascara streaking down her cheeks.<span style="mso-spacerun: yes"> </span>This girl was wearing a lot of make up.<span style="mso-spacerun: yes"> </span>Her hair and nails spoke of hours of expensive treatments.<span style="mso-spacerun: yes"> </span>Her sculpted body told me she was concerned with appearance, this was hard for her to have a problem with a part of her body that she obviously held so dearly both figuratively and now literally.</p> <p class="MsoNormal" style="text-indent:.5in">“What popped?” I asked.</p> <p class="MsoNormal" style="text-indent:.5in">“My implant, I think it popped” she stated flatly.</p> <p class="MsoNormal" style="text-indent:.5in">That’s when the call took a turn to the bizarre.</p> <p class="MsoNormal" style="text-indent:.5in">“Look, see how different they are?”</p> <p class="MsoNormal" style="text-indent:.5in">She dropped her hands down and let both sides of the halter top drop exposing both of her enormous breasts.<span style="mso-spacerun: yes"> </span>The Captain let out a strange noise that was half snort and half cough. <span style="mso-spacerun: yes"> </span>I looked over at him and thought his head was going to explode.</p> <p class="MsoNormal" style="text-indent:.5in">“Jesus Christ!” he said, took two steps backwards, turned away and said to me, “this one is all you Jon”.<span style="mso-spacerun: yes"> </span>He made a bee-line back to his rig.<span style="mso-spacerun: yes"> </span>Something in him said “get out of here” and he was listening.<span style="mso-spacerun: yes"> </span>I tried not to chuckle.<span style="mso-spacerun: yes"> </span>A big, tough, grown man paralyzed by breasts was a sight to see.</p> <p class="MsoNormal" style="text-indent:.5in">I looked back at Doug and he was just standing there transfixed as were the other firefighters.<span style="mso-spacerun: yes"> </span>Mouths slightly open.<span style="mso-spacerun: yes"> </span>Everyone was just soaking it in and not sure how to proceed.<span style="mso-spacerun: yes"> </span>This was definitely not in the training manual.</p> <p class="MsoNormal" style="text-indent:.5in">I had to do something.<span style="mso-spacerun: yes"> </span>I was a bit uncomfortable with this scene.<span style="mso-spacerun: yes"> </span>Five grown men, servants of the public no less, in a parking lot standing around an attractive young lady dressed, or should I say undressed, to the nines.<span style="mso-spacerun: yes"> </span>This sideshow had run it's course, time to get back to business. </p> <p class="MsoNormal" style="text-indent:.5in">“OK, dear, let me help you” I pulled her straps back up and walked her over to the ambulance signaling to my partner with my eyes to head over that way.<span style="mso-spacerun: yes"> </span>I had Doug help her step up into the back of the ambulance, which was no easy feat with those spikes she was walking on.<span style="mso-spacerun: yes"> </span>He got started gathering info and taking vital signs for me freeing me up for a moment.</p> <p class="MsoNormal" style="text-indent:.5in">I walked over to the fire crew.<span style="mso-spacerun: yes"> </span>They were all red-faced and quietly chatting with smug looks of humor in their eyes.<span style="mso-spacerun: yes"> </span>This was a strange call for a bunch of young men to go on.<span style="mso-spacerun: yes"> </span>Not in any way emergent and quite surprising.<span style="mso-spacerun: yes"> </span>The heat was not making it better.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“You OK Cap?” I teased.</p> <p class="MsoNormal" style="text-indent:.5in">“What the hell was that?” he asked through his bushy firefighter mustache with his hands on his hips.<span style="mso-spacerun: yes"> </span>He almost looked exhausted<span style="mso-spacerun: yes"> </span>“I thought I was going to have a heart attack when she pulled those things out!”<span style="mso-spacerun: yes"> </span>he said.</p> <p class="MsoNormal" style="text-indent:.5in">“I thought you were too” I joked.<span style="mso-spacerun: yes"> </span>“You guys can clear, we got it from here”</p> <p class="MsoNormal">“OK” he said and walked back over to the back of the ambulance with me.<span style="mso-spacerun: yes"> </span>The shock was wearing off and he was getting back to his jovial self. <span style="mso-spacerun: yes"> </span>The back of the ambulance was still open.<span style="mso-spacerun: yes"> </span>The Captain popped his head in to say his goodbyes and wish her good luck as good Captains do to wrap up their portion of the contact.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">Unfortunately he walked in on the wrong part of the conversation.<span style="mso-spacerun: yes"> </span>Again she had bared her chest and was demonstrating to my partner the differences in how they moved, bounced, felt, etc… My partner did not seem to mind the demonstration.</p> <p class="MsoNormal" style="text-indent:.5in">“Will you stop that!” the Captain said to her gruffly and walked back to his rig shaking his head.<span style="mso-spacerun: yes"> </span>“I am too old for this crap!” I couldn’t hold back the laughter anymore.<span style="mso-spacerun: yes"> </span>I walked around the side of the rig.<span style="mso-spacerun: yes"> </span>The whole fire crew was laughing now.<span style="mso-spacerun: yes"> </span>Luckily the patient was out of earshot in the back of the ambulance with the A/C blasting.</p> <p class="MsoNormal" style="text-indent:.5in">In the end it was a non-emergent call and all went routine from there on out.<span style="mso-spacerun: yes"> </span>We transported the patient to the emergency room at her request even though in our opinion she really did not need this level of care or transport.<span style="mso-spacerun: yes"> </span>I am glad we did as it turned out that she had a good amount of alcohol and cocaine on board though we did not smell or detect anything.<span style="mso-spacerun: yes"> </span>Perhaps our minds were distracted enough to dull our normal “Spidey-Senses” for things like alcohol. If we had let her go on her way, she could have really caused a horrible accident and injured herself or someone else.<span style="mso-spacerun: yes"> </span>That would have been tragic. </p> <p class="MsoNormal" style="text-indent:.5in">The emergency room doctor concurred that she probably did have a rupture of an implant and prescribed her some mild pain-killers to hold her over until she could see her regular physician.<span style="mso-spacerun: yes"> </span>She put on her little asymmetry demonstration for whomever at the hospital was willing to sit through it.<span style="mso-spacerun: yes"> </span>Being mostly female nurses, there were not many takers.</p> <p class="MsoNormal" style="text-indent:.5in">After the call, my partner and I spent a good amount of time over popsicles speculating who she was and what her back-story was.<span style="mso-spacerun: yes"> </span>This young lady was something of a mystery and it was fun to try and make something more out of her than she probably was. </p> <p class="MsoNormal" style="text-indent:.5in">Was she a beauty queen on her way home from a contest?</p> <p class="MsoNormal" style="text-indent:.5in">Was she a high-priced call girl on her way to service a celebrity? </p> <p class="MsoNormal" style="text-indent:.5in">Was she some kind of secret agent on a mission undercover as a stripper?</p> <p class="MsoNormal" style="text-indent:.5in">Was she just some superficial gal who had landed a rich sugar daddy?</p> <p class="MsoNormal" style="text-indent:.5in">We will never know, but that call will go down in my memory as one of the more unusual and entertaining calls I have ever been on, and probably ever will.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="tab-stops:255.2pt"><span style="mso-tab-count:1"> </span></p> <!--EndFragment-->Jon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com0tag:blogger.com,1999:blog-3334925321777651151.post-50757713009627445982010-05-05T23:59:00.000-07:002010-05-07T05:05:00.629-07:00He works in mysterious ways<!--StartFragment--> <p class="MsoNormal" style="text-indent:.5in">It was a nice sunny afternoon in Oakland when the call came in for “man down”.<span style="mso-spacerun: yes"> </span>I love that description, seems so sinister, yet rarely is.<span style="mso-spacerun: yes"> </span>We pulled up at the same time as the fire department to a boxy, two story apartment complex that had the look of a converted cheap hotel.<span style="mso-spacerun: yes"> </span>This one was badly in need of a new roof and paint.<span style="mso-spacerun: yes"> </span>The external stairways and walkways were framed with rusty wrought iron railings and a decent amount of trash to navigate through.<span style="mso-spacerun: yes"> </span>There were several older large black women dressed as if coming straight from church waving to us from the top step.<span style="mso-spacerun: yes"> </span>Wool dresses, matching hats, purses and pumps.<span style="mso-spacerun: yes"> </span>Color coordinated to the max.</p> <p class="MsoNormal" style="text-indent:.5in">We made our way up the rickety steps.<span style="mso-spacerun: yes"> </span>They were center supported concrete slabs with spidery cracks veining the cement.<span style="mso-spacerun: yes"> </span>The corners of most of them were chipped off, one was only two-thirds of a step. <span style="mso-spacerun: yes"> </span>The center steel beam that held up the steps from below creaked and groaned under the stress of three firefighters, my partner and I plus all of our equipment trudging up the steps.<span style="mso-spacerun: yes"> </span>I tried not to think about it.<span style="mso-spacerun: yes"> </span>Much the way you don’t look at the cheap cotter pins that hold together a Farris wheel when you are stopped at the top.</p> <p class="MsoNormal" style="text-indent:.5in">At the door on the second floor, the church women met us.<span style="mso-spacerun: yes"> </span>They were excited, sweaty and all talking at once.</p> <p class="MsoNormal" style="text-indent:.5in">“We just got home and she aint right”<span style="mso-spacerun: yes"> </span>one said.</p> <p class="MsoNormal" style="text-indent:.5in">“I don’t know what happened, she was fine this morning” said another.</p> <p class="MsoNormal" style="text-indent:.5in">“Oh Lord don’t take her like this!” pleaded another one at the sky above.</p> <p class="MsoNormal" style="text-indent:.5in">We were calmly led to the back bedroom by the woman who seemed to have the most control over her emotions.<span style="mso-spacerun: yes"> </span>On the bed we found an obese younger woman, approximately forty years old dressed in an old fashioned pale pink dress lying face up on the bed.<span style="mso-spacerun: yes"> </span>Next to her was an empty bottle of opiate-based pain-killers.<span style="mso-spacerun: yes"> </span>Another empty one was sitting on the nightstand.<span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span>Just clues.<span style="mso-spacerun: yes"> </span>Gotta keep your eyes and ears open and let the scene talk to you.</p> <p class="MsoNormal" style="text-indent:.5in">The woman was breathing maybe four times a minute and shallow.<span style="mso-spacerun: yes"> </span>She did not respond to our shouts or when we shook her.<span style="mso-spacerun: yes"> </span>I could tell she was not getting enough oxygen without testing her pulse oximetry.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“Let’s bag her”<span style="mso-spacerun: yes"> </span>I said to the firefighter.<span style="mso-spacerun: yes"> </span>“one every five seconds” I added.</p> <p class="MsoNormal" style="text-indent:.5in">As the firefighter repositioned her airway and began to assist her with her respirations, I continued with my assessment.<span style="mso-spacerun: yes"> </span>Her radial pulses were weak and she was sweaty. Her pupils were pinpoint and she had some frothy sputum around her mouth.<span style="mso-spacerun: yes"> </span>I noted it and moved on.</p> <p class="MsoNormal" style="text-indent:.5in">The engineer was just finishing getting the blood pressure.</p> <p class="MsoNormal" style="text-indent:.5in">“It’s really low and hard to hear…maybe sixty over palp?” he more asked than stated.</p> <p class="MsoNormal" style="text-indent:.5in">I could hear my partner asking questions in the background of the family.</p> <p class="MsoNormal" style="text-indent:.5in">“What medicines does she take?<span style="mso-spacerun: yes"> </span>Does she have any medical problems?<span style="mso-spacerun: yes"> </span>Any allergies to medications? Does she drink or take any illegal drugs? When did you last see her normal?<span style="mso-spacerun: yes"> </span>Has she been sick lately?” All the right questions.<span style="mso-spacerun: yes"> </span>Nothing obvious was sticking out.<span style="mso-spacerun: yes"> </span>I kept thinking about the empty pill bottles, our only clue thus far.</p> <p class="MsoNormal" style="text-indent:.5in">“Let’s get a line going.<span style="mso-spacerun: yes"> </span>Can you spike me a bag?” I asked the engineer.</p> <p class="MsoNormal" style="text-indent:.5in">“Sure” he said and got to it.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“Can you put her feet up please?” I asked the Captain who was standing at her feet.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“Copy” He got right on it. </p> <p class="MsoNormal" style="text-indent:.5in">“I’ll check her sugar.” </p> <p class="MsoNormal" style="text-indent:.5in">When you anticipate a patient needing medications or fluids and it seems as if they are going to be a stat patient, we will often start an IV on scene to get it going before we move.<span style="mso-spacerun: yes"> </span>In the case of this patient, she was not only hypotensive, but I was suspecting an overdose.<span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span>We would not be playing around too much here, it would be a stat transport as she was not doing well.</p> <p class="MsoNormal" style="text-indent:47.6pt">“I’m going to try some Narcan”<span style="mso-spacerun: yes"> </span>I told the captain.<span style="mso-spacerun: yes"> </span>I spun around and grabbed the box of Naloxone, better known as Narcan.<span style="mso-spacerun: yes"> </span>Narcan is a wonderful drug that is a competitive opiate receptor inhibitor.<span style="mso-spacerun: yes"> </span>It will bind to the opiate receptors and prevent the opiates, such as heroin, morphine, or methadone from having the effect of slowing down the breathing and ultimately killing the patient.<span style="mso-spacerun: yes"> </span>The drawbacks are that it will not remove the opiates in the system, just block them so when the Narcan wears off, they will OD all over again if enough opiates are still in their system. Narcan also will take away the high instantly sending an addicted patient into acute withdrawal syndrome which could including seizure, profuse sweating, explosive diarrhea, abdominal pain and vomiting, heart attack to name a few, so we are careful with it.<span style="mso-spacerun: yes"> </span>Only enough to get the respirations normal.</p> <p class="MsoNormal" style="text-indent:.5in">Just as I was preparing the Narcan, in walks a mousy woman in all black wearing a matching black hat with black roses and a short veil pinned up.<span style="mso-spacerun: yes"> </span>She had thick glasses from the 80s that magnified her eyes.<span style="mso-spacerun: yes"> </span>She was holding an old leather bible.<span style="mso-spacerun: yes"> </span>It was clear by the way the rest of the family was acting that this was someone to be respected.<span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span>Possibly an elder of the family or a holy person.</p> <p class="MsoNormal" style="text-indent:.5in">“Excuse me” she said in a meek voice.<span style="mso-spacerun: yes"> </span>“Do you mind if I say a prayer?”</p> <p class="MsoNormal" style="text-indent:.5in">“Well ma’am we are working real hard here to save this young lady, pray if you need to it certainly can’t hurt”. The Captain reassured.</p> <p class="MsoNormal" style="text-indent:.5in">“Thank you” she said quietly and jockeyed for a good position at the patient’s feet.</p> <p class="MsoNormal" style="text-indent:.5in">I don’t understand what happened in the next few seconds, but this meek and mild old woman suddenly became aflame with the holy spirit. She turned into the shouting preacher complete with throwing her hands up in the air and punctuating the pertinent syllables in her sentences like she belonged in a travelling revival tent in the turn of the century south.</p> <p class="MsoNormal" style="text-indent:.5in">“Lord!” she started with a dramatic pause letting all the air leave her before springing back up “It is not time to take this humble servant!” she said impossibly loud with an elongated “ssssssss” on the “this”.<span style="mso-spacerun: yes"> </span>“She has so much more of your work to do!<span style="mso-spacerun: yes"> </span>Do not take her today, I beg of you.<span style="mso-spacerun: yes"> </span>Give us more time.<span style="mso-spacerun: yes"> </span>Do not take her.<span style="mso-spacerun: yes"> </span>Not like this. Not like this!<span style="mso-spacerun: yes"> </span>Not like this!” The repeated part got louder and more dramatic with each pass.<span style="mso-spacerun: yes"> </span>The other women were starting to grunt and nod in agreement getting more involved in this impromptu prayer meeting.</p> <p class="MsoNormal" style="text-indent:.5in">She was throwing her body onto the legs of our patient and wailing.<span style="mso-spacerun: yes"> </span>She was throwing elbows to keep us back.<span style="mso-spacerun: yes"> </span>The prayer was much more than we had expected.<span style="mso-spacerun: yes"> </span>Her arms ran from the tops of the patient’s thighs down her legs and she chanted and pleaded with her maker to reconsider what surely must be a mistake.</p> <p class="MsoNormal" style="text-indent:.5in">It got to the point where we were not able to get to the patient to do our job anymore.<span style="mso-spacerun: yes"> </span>The little prayer had turned into a full-on sermon complete with theatrics, call and answer, and singing.<span style="mso-spacerun: yes"> </span>It was time to shut this down, or at the very least get some room to work. </p> <p class="MsoNormal" style="text-indent:.5in">“Ma’am please, I understand you need to pray, but we need to work here”<span style="mso-spacerun: yes"> </span>the captain reasoned.<span style="mso-spacerun: yes"> </span>“If you don’t let us help your friend here, she will die.<span style="mso-spacerun: yes"> </span>And soon.” </p> <p class="MsoNormal" style="text-indent:.5in">“You can’t save her, only the Holy Spirit can make that decision” she retorted sternly in the captains face “Do you hear me boy?” she redirected her eyes up<span style="mso-spacerun: yes"> </span>“You can save her!<span style="mso-spacerun: yes"> </span>Only you!” she shouted at the cracked ceiling with the old fashioned fixture on it before swinging her hips to block the path of the captain the way a defensive guard does underneath the basket.<span style="mso-spacerun: yes"> </span>We gave her another ten seconds of sermon time before we shut it down.<span style="mso-spacerun: yes"> </span>This was getting ridiculous.</p> <p class="MsoNormal" style="text-indent:.5in">“Let’s go” the Capt said nicely as he forcibly removed her, pinning her arms to her sides.</p> <p class="MsoNormal" style="text-indent:.5in">“I’m not done!<span style="mso-spacerun: yes"> </span>I’m not done!<span style="mso-spacerun: yes"> </span>Hear me Lord!”<span style="mso-spacerun: yes"> </span>she yelled over her shoulder as she was lifted out of the work zone.</p> <p class="MsoNormal" style="text-indent:.5in">“Well you can finish from over there” the now-miffed Captain stated gruffly.</p> <p class="MsoNormal"><span style="mso-spacerun: yes"> </span><span style="mso-tab-count:1"> </span>With the would-be prophet out of the way, we got back to work.<span style="mso-spacerun: yes"> </span>I quickly started a line and pushed 2 mg of Narcan and stood back to witness the chemical miracle that Narcan is, from a distance.<span style="mso-spacerun: yes"> </span>Sometimes people come out of this violently or start projectile vomiting.<span style="mso-spacerun: yes"> </span>I didn’t need that.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">Nothing. </p> <p class="MsoNormal" style="text-indent:.5in">I looked over at my partner.<span style="mso-spacerun: yes"> </span>“Get the stair chair, we need to roll”. </p> <p class="MsoNormal" style="text-indent:.5in">By the time the chair was there, I pushed an additional 2 mg and had delivered a 500 ml bolus of normal saline.<span style="mso-spacerun: yes"> </span>Still nothing. </p> <p class="MsoNormal" style="text-indent:.5in">We all looked at each other, this wasn’t right.<span style="mso-spacerun: yes"> </span>“Come on!” I thought.<span style="mso-spacerun: yes"> </span>“Everything is pointing to overdose, accidental or otherwise.<span style="mso-spacerun: yes"> </span>What the hell is going on here?” I thought silently in my head.<span style="mso-spacerun: yes"> </span>Protocols were flashing before my eyes, but no answers. </p> <p class="MsoNormal" style="text-indent:.5in">“Suggestions? Ideas? Anything?” I asked my fellow rescuers.<span style="mso-spacerun: yes"> </span>They were as dumbfounded as I.<span style="mso-spacerun: yes"> </span>We all at once decided to get her out of here.<span style="mso-spacerun: yes"> </span>At least do something we know how to do that will benefit the patient.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">We managed to get her lifeless, slumped over body strapped onto the stair chair and get her down from the second floor and into the ambulance.<span style="mso-spacerun: yes"> </span>It took all five of us and we were pretty shot by the time we got her down. </p> <p class="MsoNormal" style="text-indent:.5in">I grabbed the fire medic to ride with me and we took off code three to the hospital.<span style="mso-spacerun: yes"> </span>It was just a short hop, maybe three minutes total transport time.<span style="mso-spacerun: yes"> </span>I was grateful for that.<span style="mso-spacerun: yes"> </span>This would soon be over and she would have a higher level of care available to her.</p> <p class="MsoNormal" style="text-indent:.5in">Once at the hospital, we told the doctor the whole deal and how we suspected narcotic overdose but the Narcan wasn’t working.<span style="mso-spacerun: yes"> </span>Of course he ordered up another 2 mg of Narcan, guess he thought I must have done it wrong.<span style="mso-spacerun: yes"> </span>I wasn’t offended, he needed to see it for himself.<span style="mso-spacerun: yes"> </span>It didn’t work any better than the previous two doses.<span style="mso-spacerun: yes"> </span>I left the patient with the team who was now aggressively searching for a cause.<span style="mso-spacerun: yes"> </span>Younger people don’t usually just present like this.<span style="mso-spacerun: yes"> </span>There has to be something. </p> <p class="MsoNormal" style="text-indent:.5in">About five hours later I returned to the hospital and they told me she had passed. I was a bit confused.<span style="mso-spacerun: yes"> </span>The doctor filled me in.<span style="mso-spacerun: yes"> </span>She had had a major vessel in her brain spontaneously rupture.<span style="mso-spacerun: yes"> </span>This caused enough brain herniation to pinpoint her pupils and reduce her respirations which ultimately killed her.<span style="mso-spacerun: yes"> </span>He told me there was nothing we could have done differently.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">The lesson I walked away from on this call was two fold.<span style="mso-spacerun: yes"> </span>The first is obviously to keep an open mind and think outside the box.<span style="mso-spacerun: yes"> </span>Everything is not always as it seems.<span style="mso-spacerun: yes"> </span>The second is that there is no end to people’s arrogance to think that if they just say one more prayer or shout louder, their God will hear them and reverse a medical situation.<span style="mso-spacerun: yes"> </span>Prayer is a powerful tool and provides comfort for many in times of need, but when it gets in the way of saving someone’s life, it is another thing all together.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">I am reminded of a joke I once heard in a sermon.<span style="mso-spacerun: yes"> </span>Here it is modified to fit the scene. </p> <p class="MsoNormal" style="text-indent:.5in">A woman’s friend is dying in a bed and she calls 911.<span style="mso-spacerun: yes"> </span>She yells out to God to save the friend.<span style="mso-spacerun: yes"> </span>The paramedic tries to save the friend but she jumps in and says “No, God will save her.”<span style="mso-spacerun: yes"> </span>Then the fire captain picks up the gear and tries, and she likewise beats him back citing God will save her.<span style="mso-spacerun: yes"> </span>Finally an EMT jumps in and tries but is again beaten back similar to the other two.<span style="mso-spacerun: yes"> </span>The friend dies right in front of them despite her pleas to God and she is distraught.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">Many years later when the woman dies she goes to heaven and meets God and asks “Why didn’t you save my friend when I pleaded for your help?<span style="mso-spacerun: yes"> </span>Have I not always been your humble servant?”<span style="mso-spacerun: yes"> </span>God took a deep breath and said “What more did you want, I sent you a Paramedic, a fire Captain and an EMT!!” </p> <!--EndFragment-->Jon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com1tag:blogger.com,1999:blog-3334925321777651151.post-88769326074334109832010-04-15T21:54:00.000-07:002010-04-15T21:59:53.516-07:00Milk it does a body good<span class="Apple-tab-span" style="white-space:pre"> </span>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. <br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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. <br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Fire department!” The captain announced as he knocked on the slightly ajar door causing it to swing open a little more.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“In here! In here!” replied our soon-to-be patient.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Ma’am, we need you to hang up the phone” the captain said.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Just a second” she said with a defiant finger up and a wild-eyed look that warned us to not come any closer.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Ma’am, please, tell them you will call them back,” the captain persisted.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“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?”<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Ma’am, did you call 9-1-1?”<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Well, there’s no one else here is there?” she snapped back.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“No there isn’t ma’am.” The captain said calmly, rethinking his approach. “Do you have a medical emergency?”<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Maybe you should stop drinking it if it is making you vomit” he said.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“But I have to, I was poisoned” she said as if we were idiots.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>Red flag. OK, this had potential to be a little more than we thought at first glance.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Please sit down on the couch over here” Joe directed. <br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>She complied, bringing the phone and the now empty milk jug with her.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“How much weed are we talking about?” Joe asked.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“All of it” she answered. “That whole baggy was full.”<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“So what’s with the milk?” Joe dug deeper.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“I was afraid I was poisoned and I know that you should drink milk if you are poisoned” she said.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“But you didn’t actually ingest anything you smoked it!” One of the firefighters interjected, obviously irritated at this point.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Do you want to go to the hospital?” Joe finally asked, after all, taking people to the hospital is what we do.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“No no no, I just wanted to get checked out. If I’m OK I’d rather stay home”.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Oh yeah, I can call my cousin, she’ll come right over.” She said.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Five one two, five one two, copy code three” the radio said. It was us.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Five one two, go ahead” Joe said, he was driving now.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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”<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“We are so fired” Joe said.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Just get there. Fast.” I said.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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. <br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“AHHHHHH…..I’m just playin’ with yall!” she laughed.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Ma’am, we got a call of CPR in progress, what’s going on?” The fire captain asked.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Nobody, dyin’ here” she said with a laugh. “I’m just messin’ with you”.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>I could see the rage building up in the firefighter, but he maintained good customer service. <br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“So you have no medical complaint?” he asked. <br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Nah, I’m just playin’” she responded.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.”<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Well I aint going to no hospital” she said.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“Perfect” I responded “hook her up” I said to the cop.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>“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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.<br /><br /><span class="Apple-tab-span" style="white-space:pre"> </span>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.<br /><br /><div>copyright 2010 Jon Kuppinger </div>Jon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com1tag:blogger.com,1999:blog-3334925321777651151.post-25049018059894494272010-03-27T12:24:00.000-07:002010-03-27T13:18:28.589-07:00The Bleeder<!--StartFragment--> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span class="Apple-style-span" style="font-weight: normal; "><span class="Apple-tab-span" style="white-space:pre"><b> </b></span>It was the first night without my regular partner in a while.<span style="mso-spacerun: yes"> </span>She had transferred over to critical care transport on the day shift leaving me with what we affectionately call “mystery meat”.<span style="mso-spacerun: yes"> </span>Mystery meat is when you don’t know who your partner is going to be.<span style="mso-spacerun: yes"> </span>It is a bit of a gamble really.<span style="mso-spacerun: yes"> </span>If you roll a seven you get a great partner who knows their job and can hold a conversation.<span style="mso-spacerun: yes"> </span>If you roll snake eyes you get a lazy partner or maybe a dead fish that doesn’t speak for the entire twelve hours of the shift.<span style="mso-spacerun: yes"> </span>This night I was lucky and rolled a seven.</span></b></p> <p class="MsoNormal" style="text-indent:.5in">Nadine was a tall, well-mannered young lady who obviously was a bit classier than the typical EMS worker.<span style="mso-spacerun: yes"> </span>Her soft-spoken confidence spoke to someone who knew her job, but wouldn’t tell you so.<span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span>We were having a good night of conversation between calls with the new Sade album playing softly in the background when a call came in for the west side.<span style="mso-spacerun: yes"> </span>It was a shunt bleed.</p> <p class="MsoNormal" style="text-indent:.5in">When a patient’s kidneys fail, they are often offered dialysis as a way to prolong their lives.<span style="mso-spacerun: yes"> </span>Three times a week they go a dialysis facility and a machine is hooked up to a port, usually on their arm.<span style="mso-spacerun: yes"> </span>Their blood is cycled out of their body and through a machine that cleans their blood and removes excess toxins and volume. <span style="mso-spacerun: yes"> </span>The machine serves as a form of artificial kidney for the patient.<span style="mso-spacerun: yes"> </span>The port is called a “shunt” and is the direct line into their major veins and arteries.<span style="mso-spacerun: yes"> </span>If this port breaks open, they will bleed out in a short time.<span style="mso-spacerun: yes"> </span>It is a true life-threatening emergency.</p> <p class="MsoNormal" style="text-indent:.5in">“Have you ever had one of these?” I asked.</p> <p class="MsoNormal" style="text-indent:.5in">“Yeah, a couple, they can get real messy” she replied as we sped through the abandoned and darkened streets of downtown.</p> <p class="MsoNormal" style="text-indent:.5in">“I had one a couple months back and she almost bled out.<span style="mso-spacerun: yes"> </span>The room was like a murder scene, blood everywhere”.<span style="mso-spacerun: yes"> </span>I ran through my bleeding control protocol in my head quickly.<span style="mso-spacerun: yes"> </span>There would not be any time for fooling around, we would have to go as soon as we arrived. </p> <p class="MsoNormal" style="text-indent:.5in">We pulled up in front of the run-down apartment complex at the same time as the fire department was arriving.<span style="mso-spacerun: yes"> </span>There was a thirty-something woman standing in her pajamas waving to us frantically.</p> <p class="MsoNormal" style="text-indent:.5in">“Please hurry! Please hurry!” she pleaded.<span style="mso-spacerun: yes"> </span>“We can’t stop the bleeding”.</p> <p class="MsoNormal" style="text-indent:.5in">“I’ll grab the trauma dressings and wrap” I yelled to the fire captain, ”You guys check it out”.</p> <p class="MsoNormal" style="text-indent:.5in">The captain nodded to me and they headed in with the frantic woman.<span style="mso-spacerun: yes"> </span>I often worry about taking control like that, after all, technically it is the fire captain’s scene but it was clear the fire crew had just woke up and were in no mood to be leaders.</p> <p class="MsoNormal" style="text-indent:.5in">“Nadine, not sure what we are going to need, jus bring the gurney to the bottom of the stairs please, get some extra sheets, I’m going to run ahead with the trauma dressings”.<span style="mso-spacerun: yes"> </span>She gave me a look that told me she understood.<span style="mso-spacerun: yes"> </span>We were all in work mode now.</p> <p class="MsoNormal" style="text-indent:.5in">I walked into the apartment and was surprised at how many people were there.<span style="mso-spacerun: yes"> </span>There were at least six adult women in this house not counting myself or the fire department.<span style="mso-spacerun: yes"> </span>One was sound asleep on the couch.<span style="mso-spacerun: yes"> </span>Sleeping through all this commotion.<span style="mso-spacerun: yes"> </span>Interesting.<span style="mso-spacerun: yes"> </span>I made a note. </p> <p class="MsoNormal" style="text-indent:.5in">As I poked my head into the back bedroom that everyone was pointing to, I saw our patient lying on the bed.<span style="mso-spacerun: yes"> </span>The contrast of the bright red blood against the white sheets was startling.<span style="mso-spacerun: yes"> </span>There was a steady stream flowing from her upper right arm and her middle-aged daughter was trying to hold pressure with a towel.<span style="mso-spacerun: yes"> </span>I ripped open all the dressing packages and asked the firefighter to cut off her nightgown sleeve.<span style="mso-spacerun: yes"> </span>It was completely blood-soaked anyway and was ruined.<span style="mso-spacerun: yes"> </span>I asked the daughter to carefully pull away the towel and when I did a pulsing stream of fresh blood shot through the deep-red coagulated jelly that had collected around the site of the shunt due to the towel being on her arm.<span style="mso-spacerun: yes"> </span>I quickly pressed a trauma dressing on her arm and began wrapping it as tightly as possible.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">Around and around and around we wrapped the dressings until her now-oversized upper arm looked like that of a bodybuilder.<span style="mso-spacerun: yes"> </span>Blood was still streaming out of the end of the dressing at her elbow.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“Squeeze here, and here, and lift it up” I directed the firefighter. “And get comfortable, you can’t let go until we get to the hospital”. </p> <p class="MsoNormal" style="text-indent:.5in">“Are you kidding me?”<span style="mso-spacerun: yes"> </span>He asked.<span style="mso-spacerun: yes"> </span>He was just a kid.</p> <p class="MsoNormal" style="text-indent:.5in">“Congrats buddy, you just got the worst job in EMS.<span style="mso-spacerun: yes"> </span>Holding a bleed”<span style="mso-spacerun: yes"> </span>I smiled at him.<span style="mso-spacerun: yes"> </span>His captain winked at me, he thought it was funny.<span style="mso-spacerun: yes"> </span>They love to see the new guys squirm.</p> <p class="MsoNormal" style="text-indent:.5in">The patient’s daughter was pacing around the room.<span style="mso-spacerun: yes"> </span>She was worried and needed a job to do.</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span>“Can you grab me a robe, some slippers, and her medical card” I asked.<span style="mso-spacerun: yes"> </span>Having a task is very helpful for people who feel helpless.<span style="mso-spacerun: yes"> </span>She disappeared into the other room, the tears stopped temporarily replaced by determination.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“Gurneys at the steps, need a stair chair?” my partner Nadine shouted from the front room.</p> <p class="MsoNormal" style="text-indent:.5in">“Awww crap” I thought to myself. Of course we would need one, I had forgotten we were on the third floor and there was no elevator.</p> <p class="MsoNormal" style="text-indent:.5in">“Yeah, good idea” I said a bit embarrassed I didn’t think of it myself.</p> <p class="MsoNormal" style="text-indent:.5in">“Good thing I brought one up” she teased.<span style="mso-spacerun: yes"> </span>I love partners like this that think proactively.</p> <p class="MsoNormal" style="text-indent:.5in">We loaded the patient into the chair and buckled her in for safety.<span style="mso-spacerun: yes"> </span>I got on the bottom and one of the firefighters took the top.<span style="mso-spacerun: yes"> </span>The patient only weighed about one-fifty.<span style="mso-spacerun: yes"> </span>We could easily handle that.<span style="mso-spacerun: yes"> </span>We decided to just carry her down instead of going step by step.<span style="mso-spacerun: yes"> </span>I find it easier on the back with lighter patients than the up and down of dropping on each step.<span style="mso-spacerun: yes"> </span>That way you only have to bend over once, not at each step.</p> <p class="MsoNormal" style="text-indent:.5in">Once in the ambulance I threw another dressing around the existing one and began the bizarre dance of working on the back of an ambulance around a fully necessary firefighter who was stopping the bleeding, but now serving as a roadblock to the front half of the ambulance.<span style="mso-spacerun: yes"> </span>The patient was getting pale now and her eyes were starting to swim the way they do before you pass out. </p> <p class="MsoNormal" style="text-indent:.5in">Right out of the blue she vomited.<span style="mso-spacerun: yes"> </span>And I don’t mean just a little vomit, more like the projectile kind you see little kids do.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“Don’t let go!”<span style="mso-spacerun: yes"> </span>I coached the firefighter really holding back a giggle, after all this was a serious call.<span style="mso-spacerun: yes"> </span>But it was funny to see this kid getting assaulted from every side. He was getting covered.<span style="mso-spacerun: yes"> </span>His arms were already soaked up to the elbows in blood and now his chest and hair had vomit in them.<span style="mso-spacerun: yes"> </span>Good thing he had a long sleeve pull-over on.<span style="mso-spacerun: yes"> </span>That thing was going in the garbage when the call was over. </p> <p class="MsoNormal" style="text-indent:.5in">“What do you need?” It was Nadine.<span style="mso-spacerun: yes"> </span>She had slipped in the side door and was going to help from the other side of the firefighter.</p> <p class="MsoNormal" style="text-indent:.5in">“Suction.<span style="mso-spacerun: yes"> </span>She just puked all over.” </p> <p class="MsoNormal" style="text-indent:.5in">“OK, got it” she said as she turned on the electronic suction and began clearing the patient’s airway.<span style="mso-spacerun: yes"> </span>Aspiration can be very serious and lead to life-threatening pneumonia.<span style="mso-spacerun: yes"> </span>Nadine would try and clear as much as she could from her mouth. </p> <p class="MsoNormal" style="text-indent:.5in">As soon as her airway was clear and it looked like she wasn’t going to vomit anymore, we all knew it was time to go. </p> <p class="MsoNormal" style="text-indent:.5in">Our patient’s daughter who had waved us in was now standing at the back of the ambulance watching us work and coaching her mother to “Keep on living” and to “fight”.<span style="mso-spacerun: yes"> </span>She was fighting tears and trying her best to bury her own fears and give all her strength to her mother. </p> <p class="MsoNormal" style="text-indent:.5in">“Where are you taking her?” she asked. </p> <p class="MsoNormal" style="text-indent:.5in">“The closest, it’s just around the corner.” I said. </p> <p class="MsoNormal" style="text-indent:.5in">“No don’t take here there, she’ll wait forever!”<span style="mso-spacerun: yes"> </span>She pleaded.<span style="mso-spacerun: yes"> </span>The hospital in question was a busy one and you could wait there for hours as it is often overrun with patients.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“Don’t worry, they won’t make her wait this time” I promised.<span style="mso-spacerun: yes"> </span>The back doors closed.<span style="mso-spacerun: yes"> </span>Bleeds don’t wait.</p><p class="MsoNormal" style="text-indent:.5in">“Code three, shunt bleed, hypovolemia, approx 500-1000 mls.” I shouted up to the cab. </p> <p class="MsoNormal" style="text-indent:.5in">“B/P is 90/P, tachy at 128 bpm, pale and cool, starting IV now, GCS 14” I added. </p> <p class="MsoNormal" style="text-indent:.5in">“Copy” Nadine yelled back, signaling she understood.</p> <p class="MsoNormal" style="text-indent:.5in">The sirens came on and we bounced along down the pothole-ridden streets. <span style="mso-spacerun: yes"> Being that the firefighter</span> couldn’t free up a hand to reach for anything on his end of the ambulance or risk spraying more blood on the walls and floor of the ambulance than there already was I had to get creative and contort myself around him.<span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span>It was becoming like a disgusting game of Twister.</p> <p class="MsoNormal" style="text-indent:.5in">I got my vital signs, started and IV flowing wide open and put the patient on oxygen just in time to pull in.<span style="mso-spacerun: yes"> </span>It was only a mile or so, felt longer.</p> <p class="MsoNormal" style="text-indent:.5in">We wheeled in fast with the firefighter in tow.<span style="mso-spacerun: yes"> </span>His forearms had to be burning by now.<span style="mso-spacerun: yes"> </span>Blood was streaming off his elbows and leaving a trail from the back of the ambulance, through the triage plenum, past registration and into the trauma room.<span style="mso-spacerun: yes"> </span>We wouldn’t be hard to find. </p> <p class="MsoNormal" style="text-indent:.5in">For some reason, the resident doctor doing his rotations at the hospital kept hearing “shot” instead of “shunt”.<span style="mso-spacerun: yes"> </span>Perhaps it was because he has seen so many gunshot victims.<span style="mso-spacerun: yes"> </span>In any event, it provided a moment of levity as we did this round of Abbott and Costello. </p> <p class="MsoNormal" style="text-indent:.5in">“Where was she shot?”</p> <p class="MsoNormal" style="text-indent:.5in">“Shunt not shot” </p> <p class="MsoNormal" style="text-indent:.5in">“What?<span style="mso-spacerun: yes"> </span>Yeah, shot” </p> <p class="MsoNormal" style="text-indent:.5in">“Shunt” </p> <p class="MsoNormal" style="text-indent:.5in">“I know, <i style="mso-bidi-font-style: normal">WHERE</i> was she shot?” he emphasized.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">Funny stuff.<span style="mso-spacerun: yes"> </span>But this was serious, we just bowled through him to the room where they take all the stat patients.</p> <p class="MsoNormal" style="text-indent:.5in">The code team at the hospital was ready for us.<span style="mso-spacerun: yes"> </span>We quickly transferred her to the bed, the firefighter was still holding her arm through this exercise.<span style="mso-spacerun: yes"> </span>Most of the team had gloves, gown, and face shields on now. </p> <p class="MsoNormal" style="text-indent:.5in">“OK you can let go now.”<span style="mso-spacerun: yes"> </span>The doc said.<span style="mso-spacerun: yes"> </span>He was ready to resume control. </p> <p class="MsoNormal" style="text-indent:.5in">“You sure, it’s gonna blow if I do” the firefighter said.<span style="mso-spacerun: yes"> </span>He knew, he was holding it. </p> <p class="MsoNormal" style="text-indent:.5in">“Let go, we need to see what we have” </p> <p class="MsoNormal" style="text-indent:.5in">My partner, myself and anyone else in the room who had seen this kind of thing before faded back.<span style="mso-spacerun: yes"> </span>I actually left the room to the other side of the glass.<span style="mso-spacerun: yes"> </span>The new doc leaned in. </p> <p class="MsoNormal" style="text-indent:.5in">As soon as the firefighter let go and the bandage was off, the doc got covered with blood.<span style="mso-spacerun: yes"> </span>So did the bed, the equipment, the floor, pretty much anything within three feet. </p> <p class="MsoNormal" style="text-indent:.5in">I laughed to myself.<span style="mso-spacerun: yes"> </span>So did an number of the senior nurses.<span style="mso-spacerun: yes"> </span>They saw it coming.</p> <p class="MsoNormal" style="text-indent:.5in">“Clamp it down clamp it down! “ the new doc shouted. </p> <p class="MsoNormal" style="text-indent:.5in">A quick thinking nurse put a B/P cuff above the shunt and pumped it up.<span style="mso-spacerun: yes"> </span>It stopped.<span style="mso-spacerun: yes"> </span>Half the people left the room.<span style="mso-spacerun: yes"> </span>This emergency was over.</p> <p class="MsoNormal" style="text-indent:.5in">Over the next few hours this patient would receive as much fluid and blood products as she could take to replace the volume she had lost.<span style="mso-spacerun: yes"> </span>The emergency was over and she would live to see another day.</p> <p class="MsoNormal" style="text-indent:.5in">I cleaned myself up, finished my report and went out to the ambulance bay.<span style="mso-spacerun: yes"> </span>Nadine was out there scrubbing the back of the ambulance.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“We better go delayed” I said, meaning that dispatch would be told we were out of service for a while to clean up. </p> <p class="MsoNormal" style="text-indent:.5in">“Already on it” she said with a smile.<span style="mso-spacerun: yes"> </span>Again, a step ahead of me.<span style="mso-spacerun: yes"> </span>When the little details are taken care of, it really takes a lot of stress off a paramedic, especially on stat calls. </p> <p class="MsoNormal" style="text-indent:.5in">“You hungry?” </p> <p class="MsoNormal" style="text-indent:.5in">“Starved, let’s go eat.”</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <!--EndFragment-->Jon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com1tag:blogger.com,1999:blog-3334925321777651151.post-71920785163489701122010-03-16T10:20:00.000-07:002010-03-20T11:38:24.380-07:00Ed the KillerTonight I met a killer.<br /><br />He was sitting in handcuffs in the back of a police cruiser with no shirt on. He was wearing nothing but baggy jean shorts, tattoos, and a fresh coat of sweat. This was peculiar because it was a cold and damp January night. There was steam rising off his slick shaved, scarred scalp and blood trickling down from the corner of his eye into his carefully manicured pencil thin moustache. He had a split eye the way you see boxers get when they are punched too many times in the eye area. He was mess, but determined to control the situation. <br /><br />“Hey man,” I opened with, “I’m not a cop, I’m a paramedic and I don’t care what the hell happened, I just want to check you out and make sure you are not hurt. Is that OK with you?” <br /><br />“Whatever, I aint sayin’ shit.” He replied with a dead forward stare.<br /><br />I questioned him over and over again and he just kept throwing out inappropriate answers to common questions. Name. Date of birth. Address. All came back with non-sense answers, just as the police had told me when I first rolled up. I sensed he was not actually mentally altered, but more enjoying this game of cat and mouse with the police and now me. He wanted us to think he was crazy and give up, which would land him in the hospital and ultimately the psych ward instead of jail. But he was different from the typical nut, his eyes were too sharp and calculating, not vacant. This was a ruse.<br /><br />“Look buddy, I’m not trying to come down on you, but if you don’t start answering these questions appropriately, I am going to have to assume you have brain damage and you are going on a backboard and getting an IV. When we get to the hospital they are going to have to go through all kinds of tests and scans for possible brain bleeds or concussions. They usually start with a finger up the butt. That’s the best part. It gets worse from there.” I was lying, but he straightened up and from that point forward answered all questions appropriately. Of course he still wouldn’t budge on why he was bleeding or what circumstances led up to us meeting this chilly winter night.<br /><br />I approached the police officer, leaving the patient in the patrol car.<br /><br />“So why is this guy being written up on a 5150 again and what do you know about him?” A 5150 is a psychiatric hold you place a patient on when you feel they are a threat to themselves or others. Usually the person needs to make suicidal or homicidal statements or attempts to qualify. In this case, the police didn’t want to deal with him so they were throwing him over the fence to the ambulance crew to take away instead of taking him to jail. Probably because they had nothing to hold him on and he knew it. <br /><br />“Says his name is Ed, no ID. Neighbor called saying they found him sitting on the curb all sweaty and bloody so they called. He’s going on a 5150. He’s a danger to himself” the cop stated in that bravado way cops talk.<br /><br />“Did he say anything to make you think that?” I dug a bit deeper.<br /><br />“He’s just not making sense so he’s going with you guys,” the cop replied, punctuating the sentence by ripping off the duplicate of the form and handing it to me with a smile. He was obviously irritated with where I was going with this and the conversation was over.<br /><br />“OK, I’ll take him,” I conceded, as if I had a choice. It wasn’t worth the battle. It wouldn’t be the first time I have taken a healthy, mentally sane person to the hospital on a 5150 hold and Lord knows it won’t be the last.<br /><br />En route, the patient did not talk to me much but was generally cooperative. I kept prying. His body told a rough story of life lived hard. He had gang tattoos all over him and obvious scars from bullet and knife wounds of various ages. I wanted to hear the story from his mouth.<br /><br />“Can you run the siren?” He broke his silence in an almost a childlike tone. “I like the siren” he smiled through bloody gold teeth.<br /><br />“Sorry Ed, it’s not that kind of emergency”.<br /><br />“Well then take me out of these restraints.” He tugged at the leather restraints on his wrists and ankles.<br /><br />“Sorry again man. It’s procedure. Just go with the flow and it’ll be over soon. You’ll be out in no time.” I half lied. I knew there was no way this guy was going to be a treat and release. They would hold him to run warrants and photograph his tats and try and get some info out of him. They would try. If he was lucky, he could slip through on the psychiatric path and the law would forget about him Seventy two hours later, if he could prove to doctor he was sane, he would be free. In the meantime he would have a safe place to sleep and eat. Not a bad deal. Beats jail.<br /><br />Once at the hospital, we were stuck in the triage plenum, a room with locking doors on either side where the ambulance crew waits while the ER staff are preparing a bed for the patient, or in this case, when they don’t have one available. You can wait there for hours on a busy night. Tonight was a busy night. The ER was buzzing; people were swarming in every direction with equipment, clipboards, and gurneys. A triple shooting had just come in and two of the victims didn’t make it. The third was in critical condition and all hands were on him so I had to wait. I was fine with the wait until Ed started talking.<br /><br />“Man, you like this job?”<br /><br />“Sure, it’s fun.” I replied into the screen of the laptop I was writing my report on.<br /><br />“So you like tying up people and being the cops’ bitch?”<br /><br />“It has its good days and bad days.” I replied flatly. I knew where this was going. I was not taking the bait and addressing the slur.<br /><br />“Do you ever think about this stuff at home? I mean do you have nightmares about all the people you kill?” He asked. I think he was serious so I bit.<br /><br />“Come again?”<br /><br />“All the muthas who get smoked because of you askin’ all these questions. Trying to get people to talk. When someone talks, someone dies. Fat Face is a killer and didn’t even know it.” He chuckled. “That’s OK, I am too. We are a lot more alike than you thought, huh….”<br /><br />I stopped typing. Ed had my undivided attention. This was the kind of perspective I was looking for. I just wasn’t sure why he was turning the tables on me as a perpetrator. I don’t wear a badge. I don’t wear a gun. I don’t chase the bad guys, I just patch them up after the excitement is over. He continued, now aware that I was listening.<br /><br />“Man you are out here in this game and completely unaware of the game you are a player in. How is that possible?” His tone and cadence were now ratcheting up. He was feeling it. We both were. “I know, I know, just doing your job. Right? WRONG! Your job is getting people killed. And not just killers like me…mothers, kids, brothers, we get the family if we can’t get the guy. I do it with a gun, and you do it too with your bullshit snitch questions.”<br /><br />He was rolling now, and I was not going to stop him. Morbid curiosity assured that much. The bulging veins on his forehead and neck backed up his harsh words.<br /><br />“You have no fucking idea what you are doing out there. Every day I smoke mutha fuckas and you come pick up their almost-dead asses and drag them here. But you never see me on that gurney, do you? Look at this tattoo. Look at it and read it!”<br /><br />“1 8 7 – Fuck a ho, kill a bitch.” I read. Charming. “That’s nice work, where did you get it done? San Quentin?” It wasn’t nice; I was trying to change the subject and feign interest in his ink. Maybe we could stop talking about “smokin’ bitches”.<br /><br />“It’s professional, this aint no jailhouse gank.” He was more amused than offended. “You stupid. Now you look at this scar from where I got shot.” It was a dull red scar from the bottom of his rib cage to below his belly button. He wore it like a badge. “Every time, you see. Every time. Ev-A-Ree time I get shot but I keep living and the other mutha fucka dies. That’s what happens. You can’t kill me. I do the killing. I end up here and they sew me up. I don’t die but the other guy does. Every time. Just like those guys in there.” He was pointing towards the direction of the trauma rooms where the dead gunshot victims were lying. He knew this place.<br /><br />“Mmmmhmmm,” I was now looking through the little window out to the rest of the world. The world that was not in this box with this maniac.<br /><br />“You listening to me fat face?” Apparently I had a new nickname. “I will fuck you in the ass and kill you if I want to. It’s the way it is. I decide! Let me outta these restraints and we’ll see what’s what.”<br /><br />“Whatever you say.” He was getting overly agitated now, I didn’t want to probe further. I was done with my little foray into his world. I wanted back into mine.<br /><br />“We have a bed for you” The nurse popped in not a second too soon.<br /><br />“Hear that Ed the Killer?” I teased. Two could play at the nickname game. “You have a bed.” I had a new sense of confidence. I was back in a routine I was comfortable with and had the support of the staff there. It would be OK form here on out.<br /><br />“Haven’t you been listening to me?” he snorted. “I don’t need a bed, I need to get outta here so I can get back to work. I have mouths to feed and people to smoke.”<br /><br />I left Ed the Killer with the nurses in the psych section of the emergency room. Ed was not a psych case, he was a killer. A triple shooting had taken place 3 blocks from where he was found about 15 minutes prior to finding him. It was likely he was involved somehow. I didn’t understand how the connection was not made, but police work is not my job. I take patients to the hospital regardless of their indiscretions.<br /><br />Some hours later, I was at the psychiatric hospital talking with another crew as we waited to unload our patients. The psych center only takes one at a time and the lengthy admissions process ensure we have plenty of time to chew the fat with the other ambulance crews. One of the other guys was telling me about their patient they had just brought in. A transfer from the hospital psych unit. Apparently they had a live one. <br /><br />I told them about my deceptive killer I had earlier and said the name Ed. <br /><br />“What a coincidence, our guy is Ed too” said the EMT.<br /><br />“No way!” I looked at my partner. We had to look. We went around to the back of the ambulance and peeked in the window. Sure enough it was Ed. He was smiling back at me. With those gold teeth. He had convinced the hospital that he was in need of psychiatric care and was going to be able to hide out at the psych center. He had succeeded in his plan.<br /><br />After that shift I was driving home. The commute offers me a bit of solitude to decompress and prepare to enter what I call “the real world”. This day I was rehashing what Ed had said to me earlier. It was sticking with me for some reason and I had to work through it. In his insane ramblings there was a bit of truth. Newton’s law states that for every action there is an equal and opposite reaction. I believe that law can also apply to social situations. There were actual consequences to all of my actions, as clearly as there were to Ed’s. I sometimes take the job lightly, not considering the world I am operating in, where a moment of weakness can mean your untimely death or someone else’s. Is it possible that in our zeal to do what is right, to tell the truth, to try and help people we could actually be making it worse? <br /><br />Not a chance, I decided. I didn’t choose the life Ed or his targets chose. They chose that life and understand the consequences of that choice. Likewise I chose my path and it is a path that leads me to the other side of the fence from Ed and his pals, the fence that separates us from the killers.<br /><br />copyright 2010 Jon KuppingerJon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com2tag:blogger.com,1999:blog-3334925321777651151.post-49210292584711461762010-03-04T23:41:00.000-08:002010-03-20T11:38:57.651-07:00Life in the MinutiaeIt was a Sunday morning in Oakland. The sun was coming up over the mountains and was blinding to the bloodshot eyes of vampires like me that work the night shift in the city. The rising sun often came as a welcome reminder that the night was over and our shift was coming to an end. A kind of new beginnings signifying the end of a rough night of weekend calls. I work from 9:30 PM until 9:30 AM. Getting off shift at that hour of the morning is challenging because the morning is a time when the call volume is very dense. In a matter of a few short hours our system quickly becomes depleted of available resources. It makes sense when you think about it. Early morning is when you have people first arising and realizing that their loved ones (or themselves) have a problem. Compound this with the large amount of people who get up and pass out in the bathroom or just get up to fast and have strokes or heart attacks and you have a busy timeframe. My partner and I have learned to anticipate that we will get a call too close to our OD (short for off-duty) time and will get held over. It’s OK if you learn to embrace the extra overtime money you will receive. <br /><br />Today was such a day.<br /><br />The call came in for a particularly affluent portion of the Oakland Hills called Piedmont. Piedmont is where the doctors and lawyers and anyone else who has done well in Oakland lives. Most of the houses are multi-million dollar, three-thousand square foot plus houses that are built into the mountainside with outstanding views of the San Francisco Bay and all of it’s well known landmarks. The Golden Gate, Alcatraz and the Trans-America pyramid are all clearly visible from this perch, when the famous fog gives you a break. Since the more affluent types of people rarely call unless it is a good reason, your guard is generally up a notch when you head up the hill. <br /><br />We arrived at a well-kept, modern house on a very narrow canyon street that the ambulance fit down, but blocked traffic both ways. The house was built vertically so that you had to go up two flights of outdoor stone steps before you even got to the front door on the ground floor. From there the house went up another three stories. It was a code 2 call, which means that the dispatcher had determined that the patient was a “less urgent” patient and we would be responding alone without the fire department as is customary on most medical calls. <br /><br />Our patient was found lying on the upstairs bathroom floor in good spirits. He was an approximately fifty year-old man in good physical condition. Apparently he had passed out earlier when going to the bathroom, but was feeling much better right now. His spouse was a MD and had fully assessed him and did not find any pertinent findings but had a gut feeling that he should go with us as a precaution. She would follow in her personal car. We were fine with that. All of his vital signs were near textbook perfect and the patient was not orthostatic, meaning that there was no drop in blood pressure with changes in position from lying down to sitting to standing. This would be a finding we would expect for a patient who passed out due to a lack of adequate blood flow to the brain. Also his blood sugar was at a perfect level. We were stumped, and our guard was down. After all, it was probably nothing and this would be an easy call. Good way to end the shift.<br /><br />We assisted the patient down the several flights of stairs. He did fine and did not complain of any dizziness or pain at any time. His color was good and his coordination was normal. I was walking down backwards in front of him in anticipation of him falling. He found this odd.<br /><br />“Jon, you don’t need to do that, I’m perfectly fine”. <br /><br />“Steve…”not his name, but we’ll call him Steve to protect his identity “I have had people fall out on me that seem right as rain. I’m not taking any chances on these steps”. <br /><br />Steve shrugged me off and continued his descent from the castle to the ambulance.<br /><br />Once in the ambulance we talked about football, his job, and the neighborhood. All small talk to pass the time and make the best of an awkward situation. After all it is a bit unusual for one grown man to be poking and prodding another in the back of a van. I did all the checks I do on everyone and everything checked out. My partner Megan started the slow roll to the hospital through the windy canyon streets.<br /><br />When it came time to start an IV, he was very nervous about the needle. <br /><br />“I hate needles” he said.<br /><br />“Nobody has ever told me they like them” I joked back at him “but most people are surprised by how quick and painless I make it. So who are you calling for the Super Bowl?” I kept him talking about things to keep his mind busy and off what I was doing.<br /><br />He bore down hard when the needle broke his skin. I was a little surprised at how intolerant to pain he was. Most guys in his condition don’t even flinch. His teeth were gritting and his face was turning red. He was starting to slow his own heart rate down from the internal pressure and I wasn’t too excited about that, but a guy like him would recover fine.<br /><br />“Aww come on, it’s not that bad Steve, just breath in through your nose and out through your mouth.” I coached. “Steve? STEVE?! STEVE!!!”<br /><br />He was staring straight at me when the lights went out in his eyes. <br /><br />I looked at the monitor and saw his heart rate drop by tens. I heard a sports announcer from the seventies in my head:<br /><br />“Sixty… Fifty… Forty… Thirty… he… could… go… all… the… way! Twenty, Ten, Five, TOUCHDOWN!”<br /><br />Steve was now gurgling with no cardiac activity on the monitor. His face was turning purple and the lights were out in his eyes. He began to sweat a profuse sweat we call diaphoresis. This was really bad.<br /><br />“Shit!!! Megan! GO! GO! GO! GO! GO! CODE 3! GO!”<br /><br />My partner Megan lit ‘em up and hit the gas. Getting back down to civilization on these windy, narrow streets, and doing so with a quickness, was going to be a trick. A trick she was up for, but none-the-less a trick.<br /><br />“What do you have?” She yelled back, part morbid curiosity, part need to know, trying not to take her eyes off the road.<br /><br />“No pulse, asystole, not breathing” I was really yelling now more in disbelief than anything. “Just go! PLEASE LET’S GO!”<br /><br />“We are going” she said. We were going, I was whipping a horse that was already charging. It was time to stop yelling and start working. I couldn’t figure out how to communicate how quickly I wanted to be at the hospital now. Working a code blue alone was a nightmare. It’s a hassle even with a team. <br /><br />“Steve! Come on man, wake up!” I gave him a brisk sternal rub that would have woken the dead. Nothing.<br /><br />I don’t know what made me look out the back window. Maybe it was that feeling you get when someone is watching you. I saw his wife in the car behind us trying to keep up and straining to see what was going on with all the commotion in the back of the ambulance. I was like a tornado bouncing from cabinet to cabinet pulling out equipment thanking God I had done my rig checkout that day. There was so much to do. I pulled out my shears and cut his shirt from the neck to the belly button in one fast motion. I slapped the defibrillator pads on him and passing by his head to grab the BVM I instinctively bumped his O2 to high flow. CPR was going to start in a second and I wanted everything out that I would need. My mind was reeling, my heart was pounding in my ears, and I was a bit stunned. I was alone back there, but I could do this. I had no choice. Of course I could do it.<br /><br />“What do I tell them? What do we have?” Megan broke my trance with a solid question. You don’t just fly into a hospital, you need to tell them you are coming and what kind of a mess you are about to drop in their lap so they can gather the appropriate resources.<br /><br />“He just coded” I gasped, “I don’t know if this a seizure or a code or what” I felt for his carotid pulse on his neck. Nothing. No pulse. The gurgling had stopped and he was in a blank, dilated, motionless stare.<br /><br />I ripped open a nasal pharangeal airway (or NPA as we call it) and lubed it up. He was going to need a secure airway and did not have one. I glanced over at the monitor and saw a ripple here and there. IVR. This was not good. This guy was healthy. We were just talking. He was a walking and talking guy with no complaints thirty seconds ago. What the hell was going on? My mind raced for answers as my body automatically ran through the well-rehearsed algorithms on autopilot.<br /><br />Just as I was sliding the NPA into his nose he popped awake.<br /><br />It was just like a light switch had been thrown on. His eyes suddenly became animated and his facial muscles regained the composure that makes Steve look like Steve. This is the oddest thing to see. It’s like the return of somebody’s soul to their body. Like a robot that had been switched on.<br /><br />“Kaiser Oakland, go ahead” I heard the radio crackle from the front. It was time for the report.<br /><br />“He’s back, we got him back!” I yelled into the cab. His heart rate did the reverse run like an end zone interception. “Zero, Ten, Twenty, Thirty”<br /><br />Steve opened his eyes and took a deep yawning breath like a little kid just waking up from a nap.<br /><br />“That was weird” Steve said in a dry, even tone. That was weird? This was his response from the grave? He really looked like a guy waking up from a refreshing snooze.<br /><br />“Steve, you scared the hell out of me” I was reaching for his neck to check his pulse. It was back and strong. He was breathing normally. All his vitals quickly returned to normal.<br /><br />“What happened? I felt like I was drifting off to sleep. Did I pass out again?” He was curious, but not concerned.<br /><br />Meagan was eavesdropping on this exchange. “What do I tell them?” We were getting close to the hospital.<br /><br />“Crap I don’t know, he just had two minutes of asystole with no breathing and now he’s back like nothing ever happened.” I was stabbing at the dark “I don’t know. Give me a second to get a blood pressure and take a sugar.”<br /><br />His vitals were back to textbook levels again. What was going on? Did that just really happen?<br /><br />“Steve, what did you see?” I asked. “Was there anything peculiar or different?”<br /><br />“Not at all. I just felt sleepy.”<br /><br />This gave me a huge sigh of relief. Perhaps death was not this awful thing to fear? I thought about my relatives who had recently died. Maybe it was as peaceful for them too. That would be nice.<br /><br />Megan’s chaotic ring-down was an accurate description of how baffled we were I don’t fault her a bit. What do you tell someone when you don’t know what the heck is happening? The situation was radically changing even as she was talking into the mic. She ended it with a cringe anticipating the eventual laughs and jabs from everyone who heard it.<br /><br />When we arrived in the ER we were quickly brought into a room with a team waiting. I had to tell and retell the story of what happened to no less than five different doctors. They all wanted to hear it straight from me because something must have been lost in translation. Healthy people don’t just die for a few minutes and come back unaware that anything had transpired. I talked with the ER doc, a cardiologist, the ICU doctor and his resident, and the patient’s family doctor who just arrived with Steve’s wife the doctor. I printed out EKG trend strips and re-enacted it over and over. They all were hunting for an obvious flaw in the assessment, but I had been diligent with this one and left no stones unturned.<br /><br />Steve seemed to be doing fine in the hospital bed. A little anxious and confused about all the hub-bub but overall doing well considering a few minutes ago he was dead for all intents and purposes. I was another story. All this insanity on the tail end of a busy night had my nerves shot. I had already run a freeway accident, a “hot stroke”, and a near arrest patient on a ventilator. I was feeling the sting in my limbs and chest that you get when you go through repeated adrenalin cycles without rest in between. It feels as if your bones were replaced with metal. That’s the only way I can explain it. I was happy that Steve was alive, but still completely confused about what had just transpired. I was curious from a clinical standpoint but I was also personally invested being that this happened to a patient in my care. Was there something I could have seen or noticed to arouse my index of suspicion? More importantly, how do I make sure this doesn’t happen again?<br /><br />I debriefed with my partner and retold the story about ten more times to curious hospital staff and fellow EMS workers we ran into. We were done for the day and ready for some much earned rack time. On the way back to the barn Meagan and I laughed, cranked the stereo, and talked about who was going to beat whom to bed first. We were shot. Later that day I couldn’t sleep so I called a senior medic friend who related to me a similar story. It sometimes feels good to hear a common story. He also reiterated the mantras from medic school regarding that this is exactly why we take every call seriously and perform due diligence on every patient. If I had not been careful with this patient and gathered all my information first and eggressed from the residence without the proper precautions this could have been a very different call. What if he coded and stayed dead and I had no line or no baseline vital signs? What if I had talked him into staying at home? <br /><br />I know this call will change the way I look at patients, if only for a while. The hum-drum day-to-day grind will eventually again deviate my sense of normalcy, but in the meantime, I need to find that balance between paranoia and being slack. Living life in the minutiae.<br /><br />Copyright 2010 Jon KuppingerJon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com0tag:blogger.com,1999:blog-3334925321777651151.post-15940940018365599462010-02-17T00:39:00.000-08:002010-03-20T11:42:12.234-07:00Turkey and Pumpkin Pie<!--StartFragment--> <p class="MsoNormal" align="center" style="text-align:center"><b style="mso-bidi-font-weight: normal"><span class="Apple-style-span" style="font-weight: normal; "> <span class="Apple-tab-span" style="white-space:pre"> </span>It was an unseasonably warm late afternoon for the time of year.<span style="mso-spacerun: yes"> </span>Being just past Thanksgiving, you would expect the air to have more of a nip to it.<span style="mso-spacerun: yes"> </span>Instead the still air had a comfortably warm heaviness to it, like an old comforter.<span style="mso-spacerun: yes"> </span>Though it was only four o’clock, the shadows were stretched long across the Starbuck’s parking lot the way they do in early December.<span style="mso-spacerun: yes"> </span>Perry and I were not complaining.<span style="mso-spacerun: yes"> </span>We were having a nice slow shift that almost felt like a day off.<span style="mso-spacerun: yes"> </span>Almost.<span style="mso-spacerun: yes"> </span>The conversation turned to how it had been a long time since either of us had a “real call” meaning the kind of “stat” stuff you see on TV or the movies.<span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span></span></b></p> <p class="MsoNormal" style="text-indent:.5in">“Man, over the summer I was the grim reaper, but the past month has been nothing but bogus calls.”<span style="mso-spacerun: yes"> </span>I joked. </p> <p class="MsoNormal" style="text-indent:.5in">“I know bro, you have a reputation for that.<span style="mso-spacerun: yes"> </span>Everyone has a ‘Kup story’ about a crazy call they ran with you this year.”</p> <p class="MsoNormal" style="text-indent:.5in">The way the call deck gets shuffled is beyond approach.<span style="mso-spacerun: yes"> </span>I stopped trying to figure it out a long time ago.<span style="mso-spacerun: yes"> </span>Some nights you will get murdered.<span style="mso-spacerun: yes"> </span>Critical call after critical call in a steady stream like a chain-smoker lighting one off the last.<span style="mso-spacerun: yes"> </span>Then for the next two weeks you wont have anything above a sprained ankle or headache.<span style="mso-spacerun: yes"> </span>There is no rhyme or reason to it.<span style="mso-spacerun: yes"> </span>I’ve tried tracking the day, time of day, the lunar cycles, the times of year, you just can’t put a finger on it.<span style="mso-spacerun: yes"> </span>The only thing you can count on in Oakland is that the dragon will eventually find you.<span style="mso-spacerun: yes"> </span>It lurks and waits in the belly of the city until your guard is down and strikes with extreme prejudice.</p> <p class="MsoNormal" style="text-indent:.5in">“You know, I could go for a code.” I said, meaning working up someone who has just died.<span style="mso-spacerun: yes"> </span>I didn’t mean at all that I wanted someone to die, just that if someone’s time was up, (and in a big city, somewhere, somehow, somebody’s number is up right now, it’s just statistics) I wanted to be there to help and to sharpen my skills as they were getting soft in this current slump.</p> <p class="MsoNormal" style="text-indent:.5in">“Dude, I totally feel you.<span style="mso-spacerun: yes"> </span>I haven’t had a code in months.” Perry replied. </p> <p class="MsoNormal" style="text-indent:.5in"><span style="mso-spacerun: yes"> </span>This form of small talk has a lot more behind it than seems on the surface.<span style="mso-spacerun: yes"> </span>A couple of things are going on here.<span style="mso-spacerun: yes"> </span>First off, we were trying to gauge our respective critical call volume as compared to the other guy’s.<span style="mso-spacerun: yes"> </span>We always futilely try and make sense of it all, if not just for sport.<span style="mso-spacerun: yes"> </span>Secondly, you are trying to see if your partner is “due”.<span style="mso-spacerun: yes"> </span>This is silly superstition.<span style="mso-spacerun: yes"> </span>Nobody is ever due, just like a blackjack table is never “hot”, but often enough it seems like it, so you still ask the questions.<span style="mso-spacerun: yes"> </span>When you are due, you know it and walk around with the specter of death just a few steps behind you.<span style="mso-spacerun: yes"> </span>You know it’s coming, just not when and are relieved when it comes. </p> <p class="MsoNormal" style="text-indent:.5in"><span style="mso-spacerun: yes"> </span>The third part of this silly little verbal dance, and this is important, is we need to talk about what we do.<span style="mso-spacerun: yes"> </span>We need to hear about each other’s calls and relay our information to them about what happened, how we responded, and lessons learned. <span style="mso-spacerun: yes"> </span>This is part learning and part therapy.<span style="mso-spacerun: yes"> </span>To recount a crazy and stressful situation is to revisit it using the front seat of the ambulance as a psychiatrist’s couch.<span style="mso-spacerun: yes"> </span>When this is done to sympathetic ear that really understands the job, you get to chip away at a little piece of the burden we carry around in memories and bad dreams.<span style="mso-spacerun: yes"> </span>That is the therapeutic component.<span style="mso-spacerun: yes"> </span>The learning side is also important given that most patients do not fit into the neat little boxes in our protocol book or in our training session in school.<span style="mso-spacerun: yes"> </span>You may go your whole career and only get one opportunity to see one odd presentation or unusual set of circumstances.<span style="mso-spacerun: yes"> </span>If your partner has already hit the jackpot, you want to know about it and store it away in that little dark corner of the mind that paramedics hide all these heinous stories for retrieval later.<span style="mso-spacerun: yes"> </span>Then when you get your chance to shine, you access that dark place and dig it out.<span style="mso-spacerun: yes"> </span>Turn a negative into a positive. </p> <p class="MsoNormal" style="text-indent:.5in">This unseasonably warm evening in that Starbuck’s parking lot my door was opened and my feet were propped up in a position that shouldn’t have been comfortable, but somehow was.<span style="mso-spacerun: yes"> </span>I was in deep relaxation.<span style="mso-spacerun: yes"> </span>Shooting the breeze with one of my buddies and sipping on an iced coffee.<span style="mso-spacerun: yes"> </span>It had been over an hour since there had been any traffic at all on the radio.<span style="mso-spacerun: yes"> </span>It was quiet out there, but the dragon was lurking.</p> <p class="MsoNormal" style="margin-left:.5in">“Can you believe we get paid to do this?” I asked Perry. </p> <p class="MsoNormal" style="text-indent:.5in">“For real” Perry is kind of a hippie/surfer type from Santa Cruz and has the lingo and longish locks of black hair to prove it.<span style="mso-spacerun: yes"> </span>Well, long for the public service sector anyway.<span style="mso-spacerun: yes"> </span>His boyish looks cause many to mistake him for a student, which is the source of much razzing.<span style="mso-spacerun: yes"> </span>All in good fun.</p> <p class="MsoNormal" style="text-indent:.5in">“So tell me about what would be your worst call right now if we got one.”<span style="mso-spacerun: yes"> </span>I asked with my eyes lazily closed behind my sunglasses, basking in the sun like a lizard on a rock. I love to chew the fat about the job.</p> <p class="MsoNormal" style="text-indent:.5in">“I hate the kid calls” he said.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“Not me, for me it’s breathing calls.<span style="mso-spacerun: yes"> </span>I can’t stand the anxiety and panic the patient goes through when they can’t breath.<span style="mso-spacerun: yes"> </span>It’s as if some of their anxiety gets transferred to me”.<span style="mso-spacerun: yes"> </span>I wasn’t kidding, I hate those calls, but I am learning to embrace them since they are a bread and butter call for us.</p> <p class="MsoNormal" style="text-indent:.5in">“I feel ya bro.”<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">Just then a call came in for a familiar SNF.<span style="mso-spacerun: yes"> </span>A SNF is short for a Skilled Nursing Facility or as we call them SNIFFs.<span style="mso-spacerun: yes"> </span>Perry was very familiar with this particular SNF and had run several calls recently on the same guy who says he is “short of breath” but really isn’t.<span style="mso-spacerun: yes"> </span>To make matters worse, this guy weighs in at a portly three hundred plus pounds and doesn’t really help you out much so you have to carry his dead weight.<span style="mso-spacerun: yes"> </span>Ahhh people.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">As we pulled up Perry was telling me about the guy we were about to run on and I was mentally preparing how I was going to deal with it. The whole day had been a day at the beach and neither of us were going to break that vibe.<span style="mso-spacerun: yes"> </span>We sauntered up the front door and were let in by a very anxious Filipino nurse.<span style="mso-spacerun: yes"> </span>She was like a rabbit running around, talking too fast for us to understand and pointing us down the hall. <span style="mso-spacerun: yes"> </span>She was standing next to an oversized and gaudily decorated Christmas Tree with various presents under.<span style="mso-spacerun: yes"> </span>Empty cardboard boxes with festive wrap and bows on them, no doubt. <span style="mso-spacerun: yes"> </span>It’s always weird running calls in the presence of all these icons of happy days and good spirits.<span style="mso-spacerun: yes"> </span>That spell was broken by the familiar stench of the SNF, which is a combination of urine, feces, vomit, and rotting decubitus ulcers.<span style="mso-spacerun: yes"> </span>How people work an eight-hour shift in these places I will never understand. </p> <p class="MsoNormal" style="text-indent:.5in">“She down there.<span style="mso-spacerun: yes"> </span>She can’t breath.<span style="mso-spacerun: yes"> </span>She have asthma.”<span style="mso-spacerun: yes"> </span>The Nervous-Nelly nurse shot-gunned at us in a constant loop until we responded.<span style="mso-spacerun: yes"> </span>Already our gears were turning.<span style="mso-spacerun: yes"> </span>Asthma was an easy one.<span style="mso-spacerun: yes"> </span>We deal with it all the time and can often times fix it in the field.<span style="mso-spacerun: yes"> </span>She was awfully high-strung for an asthma call. </p> <p class="MsoNormal" style="text-indent:.5in">As we walked down the corridor decorated with cheap dollar-store Santa cut-outs, gold and red garland, and generic greetings for a joyous season, we could see some of the fire departments medical gear boxes and bags sticking out of the doorway of a room down the hall.<span style="mso-spacerun: yes"> </span>Perry looked at me with a puzzled look.</p> <p class="MsoNormal" style="text-indent:.5in">“Dude, that’s not his room”<span style="mso-spacerun: yes"> </span>he stated with just a hint of surprise.<span style="mso-spacerun: yes"> </span>I just shrugged.<span style="mso-spacerun: yes"> </span>A call is a call, I could certainly go another day without meeting our frequent caller.<span style="mso-spacerun: yes"> </span>Besides, this was an asthma call.<span style="mso-spacerun: yes"> </span>Easy as pie.</p> <p class="MsoNormal" style="text-indent:.5in">I was at the front of the gurney and was the first to pop my head in the room.</p> <p class="MsoNormal" style="text-indent:.5in">“Crap Perry, they’re intubating her!” </p> <p class="MsoNormal" style="text-indent:.5in">I snapped the cool breeze vibe we had been riding. It was too good to be true anyway.<span style="mso-spacerun: yes"> </span>The reality was that firefighter was not actually intubating her, he was looking down her throat with the laryngoscope.<span style="mso-spacerun: yes"> </span>The patient was a fifty year-old grey haired lady lying face up on the tile floor.<span style="mso-spacerun: yes"> </span>She was pale, unconscious and struggling to breathe.<span style="mso-spacerun: yes"> </span>The captain was busy writing down the patient’s medications and trying to get some information out of another nervous nurse The engineer was preparing an IV bag of saline.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">We left the gurney in the hall and quickly entered the room, it was time to get our heads in the game. </p> <p class="MsoNormal" style="text-indent:.5in">“What do you need?” asked Perry.<span style="mso-spacerun: yes"> </span>It was his call after all. <span style="mso-spacerun: yes"> </span>Since we trade off every other call, I was functioning as the EMT on this dual medic bus, an assistant of sorts. </p> <p class="MsoNormal" style="text-indent:.5in">“Get me a line, she’s really tight.<span style="mso-spacerun: yes"> </span>Not moving any air at all.<span style="mso-spacerun: yes"> </span>I’m trying to see if I can see any blockages.” the firefighter responded.<span style="mso-spacerun: yes"> </span>He quickly turned to setting up the BVM with an albuterol nebulizer in-line.<span style="mso-spacerun: yes"> </span>He was going to try and force some albuterol into her lungs, maybe it would free her up a little.</p> <p class="MsoNormal" style="text-indent:.5in">Perry went straight to the patient’s head.<span style="mso-spacerun: yes"> </span>I stayed at the feet.<span style="mso-spacerun: yes"> </span>It was obvious the engineer was not going to get an IV.<span style="mso-spacerun: yes"> </span>He had already tried three times with no success.<span style="mso-spacerun: yes"> </span>I went straight for the bone drill.<span style="mso-spacerun: yes"> </span>This patient was going to be critical, possibly a code blue.<span style="mso-spacerun: yes"> </span>I didn’t want to waste any more time with IV needles.</p> <p class="MsoNormal" style="text-indent:.5in">“So what’s the deal?”<span style="mso-spacerun: yes"> </span>Perry asked in an even, laid back tone.<span style="mso-spacerun: yes"> </span>What does it take to fire this guy up?<span style="mso-spacerun: yes"> </span>I was happy he was here. </p> <p class="MsoNormal" style="text-indent:.5in">“She’s sat-ing really low” reported the firefighter referring to her oxygen saturation in her blood. “and when I try and bag her, I don’t hear any lung sounds. It’s really weird” the firefighter was understating the gravity of the situation, which we sometimes do to cut the tension.<span style="mso-spacerun: yes"> </span>Without oxygenation to the lungs this patient had minutes or even seconds to live depending on how long she had been down.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">I had the ears near me so I put them on and listened as he tried to bag her.<span style="mso-spacerun: yes"> </span>He was right, you couldn’t hear any of the air movement you were accustomed to hearing and I found this creepy, like nails on a chalkboard.<span style="mso-spacerun: yes"> </span>Was she tight from her asthma or was it something more sinister?<span style="mso-spacerun: yes"> </span>The patient was struggling to breath.<span style="mso-spacerun: yes"> </span>Her inter-costal muscles around her ribs and collarbone were contracting around the bones outlining her rib cage.<span style="mso-spacerun: yes"> </span>Her heaving abdomen was jerking and working overtime to try and draw in even a squeak of air.<span style="mso-spacerun: yes"> </span>She was getting tired.<span style="mso-spacerun: yes"> </span>She would give up soon.<span style="mso-spacerun: yes"> </span>For now she was compensating and maintaining a pulse and cardiac rhythm, so at least we had that for the time being.<span style="mso-spacerun: yes"> </span>We just needed a bit of time to figure this out.<span style="mso-spacerun: yes"> </span>Just a few more seconds.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“Hang on lady, we’ll get you fixed up” I thought to myself.</p> <p class="MsoNormal" style="text-indent:.5in">Meanwhile, I got back on task and drilled her leg for IV access.<span style="mso-spacerun: yes"> </span>It went in easily and smoothly.<span style="mso-spacerun: yes"> </span>I could overhear Perry and the firefighter talking at the head.</p> <p class="MsoNormal" style="text-indent:.5in">“Let me take a look” he said grabbing the laryngoscope.<span style="mso-spacerun: yes"> </span>“Hmmmmm, pass me the Magill’s” he was referring to the Magill’s forceps.<span style="mso-spacerun: yes"> </span>An unusual set of forceps that have an angle to them that allows them to be placed deeply down a patient’s throat.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">Perry retracted the forceps quickly and they were empty.<span style="mso-spacerun: yes"> </span>Like when you play that game with the big glass enclosure and the claw that tries to pick up stuffed animals; the one nobody ever wins.</p> <p class="MsoNormal" style="text-indent:.5in">“Dammit, I almost had it”.<span style="mso-spacerun: yes"> </span>Now we were all intrigued.<span style="mso-spacerun: yes"> </span>We were still performing our tasks, but looking up to Perry to see what “it” was that he almost had.<span style="mso-spacerun: yes"> </span>This was getting interesting.</p> <p class="MsoNormal" style="text-indent:.5in">“Perry, you’ve gotta hustle bro, she is brady-ing down”<span style="mso-spacerun: yes"> </span>I said with more than a little stress in my voice.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">The patient was brady-ing down, which means that her heart rate was slowly decreasing at a steady pace.<span style="mso-spacerun: yes"> </span>It was at thirty and on it’s way down.<span style="mso-spacerun: yes"> </span>She would be dead in moments.<span style="mso-spacerun: yes"> </span>Her oxygenation level was also dropping and now had hit the lowest the meter will read, <50%.<span style="mso-spacerun: yes"> </span>She was turning that color they turn just before they die.<span style="mso-spacerun: yes"> </span>Not good.</p> <p class="MsoNormal" style="text-indent:.5in">“She’s going to code, get ready for CPR!”<span style="mso-spacerun: yes"> </span>It was time to rally the troops. This call was about to change radically for the worse.</p> <p class="MsoNormal" style="text-indent:.5in">“I just need a sec….hold on……there!”<span style="mso-spacerun: yes"> </span>he said and with one smooth move pulled “it” out.</p> <p class="MsoNormal" style="text-indent:.5in">We were all stunned.</p> <p class="MsoNormal"><o:p> <span class="Apple-tab-span" style="white-space:pre"> </span>“It” was an unbelievably large piece of turkey the size of a cell phone.<span style="mso-spacerun: yes"> </span>Nobody in the room could believe it.<span style="mso-spacerun: yes"> </span>It was coated in an orangey-brown substance that instantly grossed everyone out.<span style="mso-spacerun: yes"> </span>Well, almost everyone.<span style="mso-spacerun: yes"> </span>You could smell the aroma of the puree on the chunk of meat and it was decidedly pumpkin pie.<span style="mso-spacerun: yes"> </span>They say that smell is the most potent memory recall device of all the senses.<span style="mso-spacerun: yes"> </span>This was a festive smell that one associates with the best times of the year and childhood memories of Grandma’s house not this horrible situation we were in.<span style="mso-spacerun: yes"> </span>Why were these two now juxtaposed images being thrust together?<span style="mso-spacerun: yes"> </span>Better yet, why was I getting hungry in the face of this crazy call?</o:p></p> <p class="MsoNormal"><o:p> <span class="Apple-tab-span" style="white-space:pre"> </span>I broke my little mental trip to see Perry at the head holding up the piece of turkey.<span style="mso-spacerun: yes"> </span>He was pretty damned happy with himself and experiencing a bit of disbelief in the face of this surreal situation.<span style="mso-spacerun: yes"> </span>How did this giant piece of meat end up in this woman’s trachea?<span style="mso-spacerun: yes"> </span>Nobody would ever eat a piece that big.<span style="mso-spacerun: yes"> </span>What exactly was going on here?</o:p></p> <p class="MsoNormal" style="text-indent:.5in">Anyway, it was time to get back to business. As soon as that piece of turkey cleared her windpipe, the wonders of homeostasis took effect.<span style="mso-spacerun: yes"> </span>She took a big deep breath, and then about fifty more.<span style="mso-spacerun: yes"> </span>Her heart rate jumped back up over one hundred and her oxygen saturation crept up by twos until it was over 90%.<span style="mso-spacerun: yes"> </span>Was this really happening?<span style="mso-spacerun: yes"> </span>Was my little surfer buddy truly saving a life just like they do on ER?</p> <p class="MsoNormal" style="text-indent:.5in"><o:p> Back to reality, there was still much work to be done.<span style="mso-spacerun: yes"> </span>Now that she was breathing she would need a secure airway and to be transported urgently code 3 to the nearest hospital.<span style="mso-spacerun: yes"> </span>She was not out of the woods yet.<span style="mso-spacerun: yes"> </span>Her air had been cut off for quite a few minutes and that means her brain was not being oxygenated.<span style="mso-spacerun: yes"> </span>Brain damage to some level was certainly possible and recovery was not guaranteed.<span style="mso-spacerun: yes"> </span>The firefighter rode with us to support Perry and I drove as fast as possible.</o:p></p> <p class="MsoNormal" style="text-indent:.5in">Once we had turned over the patient at the hospital we popped outside and started talking about the call.<span style="mso-spacerun: yes"> </span>We all had to metabolize what had just happened.<span style="mso-spacerun: yes"> </span>Perry was beaming.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in"><o:p> “Dude, that was a career call!” He kept saying over and over.<span style="mso-spacerun: yes"> </span>“Some guys go their whole career and don’t get to do that!”</o:p></p> <p class="MsoNormal" style="text-indent:.5in">Perry was right, it was a career call and one to be proud of.<span style="mso-spacerun: yes"> </span>One that will certainly go into heavy rotation on the story wheel when we sit around and talk about our craziest calls.<span style="mso-spacerun: yes"> </span>I couldn’t help but start to get a little private eye on this one.<span style="mso-spacerun: yes"> </span>There were a few odd circumstances.</p> <p class="MsoNormal" style="text-indent:.5in"><o:p> For one, why was the patient fed such a large piece of meat?<span style="mso-spacerun: yes"> </span>In reading over the patient’s file at the hospital she needed to be fed.<span style="mso-spacerun: yes"> </span>Secondly, why were the nurses trying to sell us on asthma?<span style="mso-spacerun: yes"> </span>Someone had to have been feeding her at the time it happened.<span style="mso-spacerun: yes"> </span>It’s not like she swallowed a six-ounce piece of meat and coughed it up and aspirated it again.<span style="mso-spacerun: yes"> </span>I made sure that my concerns were heard at the ER.<span style="mso-spacerun: yes"> </span>This is always a sticky situation when you suspect a fellow health-care worker of foul play or more likely incompetence.<span style="mso-spacerun: yes"> </span>The way I usually handle it is to present the facts in an order that allows people to see the inference without making it for them.<span style="mso-spacerun: yes"> </span>If they feel it is worth pursuing, they will.<span style="mso-spacerun: yes"> </span>The ER is really good about that.</o:p></p> <p class="MsoNormal" style="text-indent:.5in"><o:p> So Perry and I did what most people do after a big call.<span style="mso-spacerun: yes"> </span>We went delayed and ate a big old dinner.<span style="mso-spacerun: yes"> </span>Food always helps.<span style="mso-spacerun: yes"> </span>Sharing a meal with someone else is a great way to de-stress and get your energy level back to normal.<span style="mso-spacerun: yes"> </span>Sharing it with a hero I call partner is even better.</o:p></p><p class="MsoNormal" style="text-indent:.5in"><o:p>Copyright 2010 Jon Kuppinger</o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <!--EndFragment--> Jon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com0tag:blogger.com,1999:blog-3334925321777651151.post-2540706080118840722010-02-09T22:51:00.000-08:002010-03-20T11:40:46.857-07:00Crispy Critter<!--StartFragment--> <p class="MsoNormal" style="text-indent:.5in">It was five in the morning and we were awoken from our first fifteen minutes of sleep all night.<span style="mso-spacerun: yes"> </span>It came fast, hard, and dreamless.<span style="mso-spacerun: yes"> </span>Our ambulance was parked high up in the hills overlooking the twinkling lights of Oakland now covered in a thick, fresh blanket of fog.<span style="mso-spacerun: yes"> </span>From up here above the clouds, the city seemed serene and less troubled than we knew it to be.<span style="mso-spacerun: yes"> </span>A welcome illusion at this hour.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">The radio crackled again, startling me as my ears perked like a sleeping dog to listen for my identifier.<span style="mso-spacerun: yes"> </span>My eyes remained shut.<span style="mso-spacerun: yes"> </span>If it wasn’t ours I would be back to sleep in seconds.<span style="mso-spacerun: yes"> </span>Or at least what passes as sleep.<span style="mso-spacerun: yes"> </span>I never really sleep on the ambulance.</p> <p class="MsoNormal" style="text-indent:.5in">“Five-five-four, five-five-four, copy code three”<span style="mso-spacerun: yes"> </span>Crap.<span style="mso-spacerun: yes"> </span>That was us.</p> <p class="MsoNormal" style="text-indent:.5in">“This is five-five-four” I managed in a gravely, dry voice after fumbling with the mic.</p> <p class="MsoNormal" style="text-indent:.5in">“Five-five-four, copy code three at the corner of “this and that” streets, West End, unknown medical, map grid six forty-nine, charlie three.<span style="mso-spacerun: yes"> </span>Structure fire in area.<span style="mso-spacerun: yes"> </span>How do you copy?”</p> <p class="MsoNormal" style="text-indent:.5in">“Ten-eight”<span style="mso-spacerun: yes"> </span>I replied, my even professional radio voice betraying the disappointment I was feeling.</p> <p class="MsoNormal" style="text-indent:.5in">A structure fire standby is usually as non-urgent as it gets and fun to watch. <span style="mso-spacerun: yes"> </span>It can burn up a large portion of your shift and rarely produces much work.<span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span>Maybe you wrap up a small burn on a firefighter’s wrist or take a B/P on an overzealous rookie that overexerted himself.<span style="mso-spacerun: yes"> </span>This was a code three call though, so perhaps there was something to this one.<span style="mso-spacerun: yes"> </span>It came in as “unknown medical”.<span style="mso-spacerun: yes"> </span>Could we get a bit more specific?</p> <p class="MsoNormal" style="text-indent:.5in">I wasn’t driving, my partner Angela was.<span style="mso-spacerun: yes"> </span>She was a five-foot three bundle of energy who walked confidently and held her own doing the demanding physical work of an EMT drawing comments and compliments from the firefighters on most calls.<span style="mso-spacerun: yes"> </span>She was and EMT that has been working in Oakland for ten plus years, so I was happy to have her driving.<span style="mso-spacerun: yes"> </span>She always got us there quickly and safely. I wasn’t worried, even as we rocketed down the hill blinded by the fog, sirens wailing.</p> <p class="MsoNormal" style="text-indent:.5in">I, the paramedic, have the job of navigating on the way to the call.<span style="mso-spacerun: yes"> </span>I opened the laminated, dog-eared map book to page six hundred forty nine and through bleary eyes followed our progress as we crossed town.<span style="mso-spacerun: yes"> </span>There was no traffic to speak of, it was five AM so we made good time.</p> <p class="MsoNormal" style="text-indent:.5in">As we entered the neighborhood, I noted that the narrow, pothole riddled streets were a virtual corridor framed with rows of tiny bungalow houses, the likes of which you see all around the older parts of Oakland.<span style="mso-spacerun: yes"> </span>Most are two bedroom and one bath.<span style="mso-spacerun: yes"> </span>Few are larger than eight-hundred square feet.<span style="mso-spacerun: yes"> </span>These houses were generally built around the nineteen twenties or so and are now in serious disrepair from years of neglect, weather, and earthquakes. <span style="mso-spacerun: yes"> </span>The wrought-iron fences interlinked the front yards, penning in snarling pit bulls, rottweilers, and old cars. </p> <p class="MsoNormal" style="text-indent:.5in">As we approached the street, I threw the map book up onto the dashboard.<span style="mso-spacerun: yes"> </span>I no longer needed it, it was obvious where we were going.<span style="mso-spacerun: yes"> </span>The house on the south-east corner was fully engulfed in fire and lit up so brightly I was surprised we didn’t see it from the hill. <span style="mso-spacerun: yes"> </span>The sky above the house was a brilliant orange as the fog and belching smoke reflected the fire.</p> <p class="MsoNormal" style="text-indent:.5in">The street was completely blocked with emergency apparatus.<span style="mso-spacerun: yes"> </span>Fire engines, ladder trucks, police cars, utility vehicles.<span style="mso-spacerun: yes"> </span>People were running in all directions, carrying out their tasks in the mad symphony that is an emergency scene.<span style="mso-spacerun: yes"> </span>In the intensely thick fog, the red, white, and blue strobes were making the scene confusing and surreal.<span style="mso-spacerun: yes"> </span>I felt like I was in a makeshift outdoor disco.<span style="mso-spacerun: yes"> </span>Movement, captured by your eye in the strobes, makes everything choppy like the firefighters were doing “the Robot” dance or were ball players from silent movies.<span style="mso-spacerun: yes"> </span>We cautiously approached.</p> <p class="MsoNormal">“Stop here, Angie, I’m going to jump out and see what we’ve got”<span style="mso-spacerun: yes"> </span>I didn’t want to get the ambulance too close and potentially get blocked in.</p> <p class="MsoNormal" style="text-indent:.5in">I had to weave my way around the miles of fire hose that was coiled and wrapped around like gigantic snakes.<span style="mso-spacerun: yes"> </span>Some of them even moved like snakes as they were pressurized and depressurized with nozzle manipulation at the business end of the hose.<span style="mso-spacerun: yes"> </span>Some of the hoses were spraying out from the couplings and minor leaks like some kind of yard sprinkler toy you would buy for the kids and let them to run through. <span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">I glanced over at the house as I walked around it. <span style="mso-spacerun: yes"> </span>I had a few seconds to assess the safety of the scene and take in what was happening. The flames licked up from the eaves and lapped the edges of the roof like thousands of little orange hyperactive hands massaging the roofline.<span style="mso-spacerun: yes"> </span>There were several firefighters ventilating the roof with a chainsaw. <span style="mso-spacerun: yes"> </span>Smoke and heat were blasting out of their new hole. <span style="mso-spacerun: yes"> </span>The dragon was here. <span style="mso-spacerun: yes"> </span>Looking through the smashed out windows, I could see the pinpoints of light dancing around in the pitch black of the scorched living space from the flashlights hanging off the turnout coats of the firefighters battling the blaze form the inside. They looked like miniature little search lights, but these lights were not lazily scanning the skies for enemy bombers, they were twitching around wildly in the smoke like a mass lightsaber duel.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">Outside, where I was, firefighters in full gear were hustling equipment to and from the house.<span style="mso-spacerun: yes"> </span>A guy ran into me carrying a large gas powered fan.<span style="mso-spacerun: yes"> </span>Another tripped over a hose dropping a length of hose he had been carrying on his shoulder.<span style="mso-spacerun: yes"> </span>These guys were working hard. <span style="mso-spacerun: yes"> </span>Some were resting on the grass out front bathed in sweat and water.<span style="mso-spacerun: yes"> </span>They relished these few moments of rest before suiting back up and charging into the house. </p> <p class="MsoNormal" style="text-indent:.5in">I quickly found the chief.<span style="mso-spacerun: yes"> </span>He was easy to find.<span style="mso-spacerun: yes"> </span>White helmet and the only guy not carrying anything.</p> <p class="MsoNormal" style="text-indent:.5in">“Over there,” he growled over the deafening chorus of diesel engines pumping at high idle.<span style="mso-spacerun: yes"> </span>He pointed around to the west side of the house.<span style="mso-spacerun: yes"> </span>He was older than the rest and this was obviously not his first fire.<span style="mso-spacerun: yes"> </span>His cracked face and oversized grey mustache told me that much.<span style="mso-spacerun: yes"> </span>He could have been the poster boy for fire chiefs.</p> <p class="MsoNormal" style="text-indent:.5in">I made my way around the northwest corner of the house, careful to not walk under any ladders, and saw what I was looking for, the familiar open orange medications box indicating I had found my patient.<span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span>Several firefighters were kneeling, others were watching with disgusted looks on their face.<span style="mso-spacerun: yes"> </span>I tried not to get tunnel vision as I approached.<span style="mso-spacerun: yes"> </span>This was a working fire and a very dangerous scene and I was not wearing any protective gear.</p> <p class="MsoNormal" style="text-indent:.5in">The subject of all the curiosity was a man that was burned to the point you could not tell what race or age he was.<span style="mso-spacerun: yes"> </span>He was lying face up, his back arched in an involuntary spasm of pain.<span style="mso-spacerun: yes"> </span>He was still smoldering. <span style="mso-spacerun: yes"> </span>He had charred skin peeling off of what I quickly estimated to be over eighty percent of his body.<span style="mso-spacerun: yes"> </span>I checked in with the medic and ran back around the house to where I had left Angie and the ambulance.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“Angie, bring the rig around!”<span style="mso-spacerun: yes"> </span>I shouted with the international home run signal.</p> <p class="MsoNormal" style="text-indent:.5in">“Why, what do we have?”<span style="mso-spacerun: yes"> </span>She asked, she was awake now.<span style="mso-spacerun: yes"> </span>We both were.</p> <p class="MsoNormal" style="text-indent:.5in">“Crispy critter.<span style="mso-spacerun: yes"> </span>Just one.<span style="mso-spacerun: yes"> </span>He’s all burned up.”<span style="mso-spacerun: yes"> </span>I replied.<span style="mso-spacerun: yes"> </span>I could feel the adrenaline now starting to flow.<span style="mso-spacerun: yes"> </span>I fought it.<span style="mso-spacerun: yes"> </span>I needed a clear head.</p> <p class="MsoNormal" style="text-indent:.5in">Crispy Critter is just one of the colorful euphemisms we use to describe our patients.<span style="mso-spacerun: yes"> </span>People who work with the dead and dying everyday need to find ways to dehumanize the horrors they witness without losing touch with the fact that this is a person with a family, friends, dreams, and hopes.<span style="mso-spacerun: yes"> </span>One very common way is to use come up with playful or abbreviated ways of describing horrendous situations.<span style="mso-spacerun: yes"> </span>If you are shot, you are a GSW (Gun Shot Wound).<span style="mso-spacerun: yes"> </span>If you drop dead in front of the paramedics, you DFO’d (Done Fell Out).<span style="mso-spacerun: yes"> </span>Sometimes we use number codes to make it easier to say.<span style="mso-spacerun: yes"> </span>It’s also easier on the ears of the public who do not speak our coded language.<span style="mso-spacerun: yes"> </span>162s are rapes.<span style="mso-spacerun: yes"> </span>187s are murders.<span style="mso-spacerun: yes"> </span>242s are assaults. 10-55s are dead bodies.<span style="mso-spacerun: yes"> </span>It just makes it easier to deal with.<span style="mso-spacerun: yes"> </span>Angie knew what a Crispy Critter is so I didn’t have to elaborate more. <span style="mso-spacerun: yes"> </span>This wasn’t her first rodeo. </p> <p class="MsoNormal" style="text-indent:.5in">She carefully, but swiftly brought the ambulance around to the other side and <span style="mso-spacerun: yes"> </span>found a safe place to park with a good escape route.<span style="mso-spacerun: yes"> </span>I ran back to the patient to see what had been done and what I could do.<span style="mso-spacerun: yes"> </span>It was obvious they had just pulled him out of the fire.<span style="mso-spacerun: yes"> </span>He was completely naked.<span style="mso-spacerun: yes"> </span>You could tell the clothes had been burned off.<span style="mso-spacerun: yes"> </span>The burns were slightly less severe in the areas where the clothing would have been thicker and in some spots scraps of cloth and who knows what else were still clinging to his now plasticized skin.<span style="mso-spacerun: yes"> </span>He was conscious and still breathing.<span style="mso-spacerun: yes"> </span>I have no idea how someone could survive such an ordeal.<span style="mso-spacerun: yes"> </span>He would open his eyes if you yelled at him.<span style="mso-spacerun: yes"> </span>The firefighters had already laid down a sterile burn sheet and were done with cooling him.<span style="mso-spacerun: yes"> </span>Now that he was no longer on fire, hypothermia would soon follow.<span style="mso-spacerun: yes"> </span>He needed to be protected and covered.<span style="mso-spacerun: yes"> </span>Now.</p> <p class="MsoNormal" style="text-indent:.5in">“I’m going to need two of your guys.”<span style="mso-spacerun: yes"> </span>I told the captain.</p> <p class="MsoNormal" style="text-indent:.5in">“You and you, drop your gear and go” He barked at two medics.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“Yes sir!” They dropped their helmets, air bottles, masks, and coats and stood in front of me, looking for direction.<span style="mso-spacerun: yes"> </span>They were soaked and their chests were still heaving from exertion of being in the fire.</p> <p class="MsoNormal" style="text-indent:.5in">“I need one of you in the airway seat, the other with me in the back” I said using my most calm and authoritative voice I could muster up.<span style="mso-spacerun: yes"> </span>I really wanted to turn around and run.<span style="mso-spacerun: yes"> </span>To be anywhere but here.<span style="mso-spacerun: yes"> </span>But my morbid curiosity was starting to gain control over my fear and I wanted to get to assessing my guy.</p> <p class="MsoNormal" style="text-indent:.5in">By the time I finished that sentence I turned around and four very large men were holding the board the patient was on.<span style="mso-spacerun: yes"> </span>The patient was packaged and it was time to go.<span style="mso-spacerun: yes"> </span>Seconds count in this game from now on.</p> <p class="MsoNormal" style="text-indent:.5in">Before we closed the doors I quickly asked the captain “What do we know about this guy? Name, age, birth date, anything?”</p> <p class="MsoNormal">“Nope, just pulled him out, feet facing the fire, that’s why his head is not as burned”<span style="mso-spacerun: yes"> </span>He said and closed the back.</p> <p class="MsoNormal" style="text-indent:.5in">“Angie! Go!”<span style="mso-spacerun: yes"> </span>And go she went.<span style="mso-spacerun: yes"> </span>The ambulance was now flying down the worn out, pot hole infested streets of West Oakland.<span style="mso-spacerun: yes"> </span>We were bouncing around in the back like popcorn kernels in a hot air popper.</p> <p class="MsoNormal" style="text-indent:.5in">I took a few seconds, probably milliseconds, to collect my thoughts.<span style="mso-spacerun: yes"> </span>I was now in the back of a van with two profusely sweating firefighters and a patient who produced a smell you can only know if you have smelled it.<span style="mso-spacerun: yes"> </span>I pulled back the burn sheet to see what we were dealing with.<span style="mso-spacerun: yes"> </span>I had to look, it was my job, but every bone in my body resisted, like when you are watching a horror movie and want to filter the scene through your fingers.<span style="mso-spacerun: yes"> </span>Again my curiosity won.<span style="mso-spacerun: yes"> </span>I looked.</p> <p class="MsoNormal" style="text-indent:.5in">He was burned.</p> <p class="MsoNormal" style="text-indent:.5in">No, that is an understatement.<span style="mso-spacerun: yes"> </span>His skin was peeled off and black at the edges of the peeled sections.<span style="mso-spacerun: yes"> </span>The open sections were pink and smooth like raw chicken.<span style="mso-spacerun: yes"> </span>You could easily trace the musculature of his body now that it was on the outside.<span style="mso-spacerun: yes"> </span>There was an unsuspected shortage of blood for all the skin that was missing.<span style="mso-spacerun: yes"> </span>I guess it all evaporated away and the veins were cauterized.</p> <p class="MsoNormal" style="text-indent:.5in">His lower legs must have been closer to the fire.<span style="mso-spacerun: yes"> </span>His skin had sloughed off and now looked like he was wearing a pair of ill-fitting grey leg warmers from the eighties.<span style="mso-spacerun: yes"> </span>The man was loudly whispering “water” in a sandpaper voice usually reserved for the guy who has been walking in the desert for days in cheap B movies.<span style="mso-spacerun: yes"> </span>He did not have his teeth in and the inside of his mouth and nose were coal black from taking in copious amounts of noxious smoke.<span style="mso-spacerun: yes"> </span>But again, he was alive and breathing and could talk.</p> <p class="MsoNormal" style="text-indent:.5in">I glanced up and noticed the firefighters who were with me.<span style="mso-spacerun: yes"> </span>One was maybe twenty years old, a light skinned black man with a tightly cropped haircut.<span style="mso-spacerun: yes"> </span>He was clearly amped and enjoying himself.<span style="mso-spacerun: yes"> </span>He kept letting out interjections of “Wooo!” and “Damn this is some crazy shit!” The other was in his forties and clearly enjoying being there for the younger one’s first experience.<span style="mso-spacerun: yes"> </span>He had a very smooth way of talking and encouraged the younger firefighter.<span style="mso-spacerun: yes"> </span>After a few more comments I gathered the younger one, I’ll call him Junior, was the one who actually dragged our patient out of the fire.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">“OK, priorities Jon, priorities.<span style="mso-spacerun: yes"> </span>Airway”<span style="mso-spacerun: yes"> </span>I thought to myself.</p> <p class="MsoNormal" style="text-indent:.5in"><o:p> “Can you intubate him?” I asked Junior.</o:p></p> <p class="MsoNormal" style="text-indent:.5in">“No way man, <span style="mso-spacerun: yes"> </span>dude be like fighting it”<span style="mso-spacerun: yes"> </span>Responded Junior.<span style="mso-spacerun: yes"> </span>This guy was young.</p> <p class="MsoNormal" style="text-indent:.5in">“OK stick with bagging him, I’ll get the IV”</p> <p class="MsoNormal" style="text-indent:.5in">I went to work looking for IV access.<span style="mso-spacerun: yes"> </span>I had no delusions that I would succeed, but I had to check.<span style="mso-spacerun: yes"> </span>He desperately needed morphine, and lots of it.<span style="mso-spacerun: yes"> </span>As it turned out, one of his arms must have been bent when he was in the fire.<span style="mso-spacerun: yes"> </span>There was a small circular spot on the inside of his elbow about an inch and a half in diameter that was actual skin.<span style="mso-spacerun: yes"> </span>It was sooty, but it was skin.<span style="mso-spacerun: yes"> </span>I could see the anticubital vein.</p> <p class="MsoNormal" style="text-indent:.5in">“No way”<span style="mso-spacerun: yes"> </span>I said to myself in surprise.<span style="mso-spacerun: yes"> </span>“Spike me a bag”</p> <p class="MsoNormal" style="text-indent:.5in">The older firefighter handed me an IV bag and a flooded line.<span style="mso-spacerun: yes"> </span>I got what was possibly the only surface vein this guy had on his body left and began to flow fluids into hip wide open.<span style="mso-spacerun: yes"> </span>As I was securing the line, someone stopped their car right in front of the ambulance.<span style="mso-spacerun: yes"> </span>Angie had to take major evasive measures to not flatten the sedan with the nine thousand pound ambulance. Unfortunately, this included steering into a pothole that could have doubled for a tiger trap.</p> <p class="MsoNormal" style="text-indent:.5in"><o:p> “Hold on!”<span style="mso-spacerun: yes"> </span>she yelled.<span style="mso-spacerun: yes"> </span></o:p></p> <p class="MsoNormal" style="text-indent:.5in">“To what?!” I thought as I fell down partially onto the patient’s chest, propped up by my hand that was not holding the IV.<span style="mso-spacerun: yes"> </span>This made the patient jerk and the line popped out.<span style="mso-spacerun: yes"> </span>Only vein on his body, and the line got knocked out.<span style="mso-spacerun: yes"> </span>Working in an ambulance tearing through Oakland is like trying to sew in a jumpy house. Not safe and not easy.</p> <p class="MsoNormal" style="text-indent:.5in">“God damn it”<span style="mso-spacerun: yes"> </span>I was beginning to lose my cool.<span style="mso-spacerun: yes"> </span>I needed to punch something.</p> <p class="MsoNormal" style="text-indent:.5in">“Jon man!<span style="mso-spacerun: yes"> </span>Jon man!<span style="mso-spacerun: yes"> </span>Chill bro, it aint no thing!”<span style="mso-spacerun: yes"> </span>reassured the older firefighter, “Let’s just do what we can.<span style="mso-spacerun: yes"> </span>Do what we can! That’s all there is.<span style="mso-spacerun: yes"> </span>Do what we can.”</p> <p class="MsoNormal" style="text-indent:.5in">He was right.<span style="mso-spacerun: yes"> </span>We needed to do what we could.<span style="mso-spacerun: yes"> </span>Besides, judging from our rate of travel, we would be at the trauma center in a couple of seconds.</p> <p class="MsoNormal" style="text-indent:.5in">I hit him hard with the maximium dosage of morphine we could give him.<span style="mso-spacerun: yes"> </span>Anything to make him more comfortable.<span style="mso-spacerun: yes"> </span>He was probably not going to live.<span style="mso-spacerun: yes"> </span>At least we can limit his suffering.</p> <p class="MsoNormal" style="text-indent:.5in">The ambulance whipped around and the back doors were opened by the receiving staff at the hospital.<span style="mso-spacerun: yes"> </span>There were so many of them.<span style="mso-spacerun: yes"> </span>I have never seen so many residents and students in the ER.<span style="mso-spacerun: yes"> </span>They must have called all of them down to the ER to “see this”.<span style="mso-spacerun: yes"> </span>The gurney was pulled out and wheeled in.<span style="mso-spacerun: yes"> </span>I followed with the firefighters, it was showtime and we were being rushed to the stage.<span style="mso-spacerun: yes"> </span>I stood up on a step stool to be seen and heard and yelled out my report to the thirty or so people in scrubs and gowns who had now showed up.<span style="mso-spacerun: yes"> </span>Nobody moved and everyone was looking at me for those few seconds as if I were a preacher and they were my flock.<span style="mso-spacerun: yes"> </span>A freeze frame.<span style="mso-spacerun: yes"> </span>I ended with “that’s all I have” and it was like the referee just dropped the ice on the puck.<span style="mso-spacerun: yes"> </span>Everyone was in action.</p> <p class="MsoNormal" style="text-indent:.5in">I realized I was stumbling as I exited the ER.<span style="mso-spacerun: yes"> </span>My body had just gone from zero to 120 mph and back to zero and my metabolism and equilibrium were all out of whack.<span style="mso-spacerun: yes"> </span>I went to the radio and called us delayed for clean-up.<span style="mso-spacerun: yes"> </span>Angie was sweeping the extra skin out of the back and scrubbing up the odd yellow fluid that was on the floor.<span style="mso-spacerun: yes"> </span>I didn’t even want to know what that was.<span style="mso-spacerun: yes"> </span>She was also investigating how to get rid of that smell.<span style="mso-spacerun: yes"> </span>It would take days to get rid of the memory smells that sneak up on you days afterwards.<span style="mso-spacerun: yes"> </span>Those are the worst.</p> <p class="MsoNormal" style="text-indent:.5in">I walked back into the ER to see what was up.<span style="mso-spacerun: yes"> </span>I felt calmer now.<span style="mso-spacerun: yes"> </span>The patient was now sedated, intubated, and a catheter was being placed into his bladder.<span style="mso-spacerun: yes"> </span>They had found a vein in his groin and neck that now were flowing liters into him as fast as the tubing would allow.<span style="mso-spacerun: yes"> </span>He looked so peaceful on that bed.<span style="mso-spacerun: yes"> </span>He was getting his water.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in">In this line of business one wonders what happens to these people.<span style="mso-spacerun: yes"> </span>I don’t mean what happens to them physically, we know that. This guy will be transferred to a burn ICU and eventually die of a massive irreversible infection sometime in the next twenty-four to forty-eight hours.<span style="mso-spacerun: yes"> </span>That much is certain. <span style="mso-spacerun: yes"> </span>What I mean is that this guy lived ninety-six years and ended up dying in a house fire two feet from the door.<span style="mso-spacerun: yes"> </span>He didn’t get cancer, he didn’t get emphysema, he didn’t die of a heart attack, he didn’t have a stroke.<span style="mso-spacerun: yes"> </span>He beat all of the insurance actuary tables.<span style="mso-spacerun: yes"> </span>He was a winner.<span style="mso-spacerun: yes"> </span>I pondered on of all the lives he touched.<span style="mso-spacerun: yes"> </span>All the events and advancements he experienced in the last century both historic and personal.<span style="mso-spacerun: yes"> </span>All the tastes, smells, sounds, and memories all snuffed out in an instant.<span style="mso-spacerun: yes"> </span>It makes you wonder.</p><p class="MsoNormal" style="text-indent:.5in">Copyright 2010 Jon Kuppinger</p> <!--EndFragment-->Jon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com2tag:blogger.com,1999:blog-3334925321777651151.post-75443803690501939692010-02-03T18:48:00.001-08:002010-03-20T11:42:48.877-07:00Alcoholic<!--StartFragment--> <p class="MsoNormal">I poured the beer the same way I always did.<span style="mso-spacerun: yes"> </span>A forty-five degree tip of the pint glass, so as to not make too much of a head.<span style="mso-spacerun: yes"> </span>I watched the golden nectar cascade from the mouth of the bottle and roil around in the bottom of the glass like the rapids in a raging river.<span style="mso-spacerun: yes"> </span>The liquid was not sure which way to go, but going all the same with a reckless head of steam.<span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span>The bubbles danced like fairies in the night sky, calling me closer, dancing their seductive dance.<span style="mso-spacerun: yes"> </span>The gases infused into the beverage, now free,<span style="mso-spacerun: yes"> </span>cascade upward in a reverse waterfall growing the rich, thick, foamy head to a consistency of the icing on a wedding cake.<span style="mso-spacerun: yes"> </span>I, thee wed.</p> <p class="MsoNormal"><o:p> I knew the first taste would be the best.<span style="mso-spacerun: yes"> </span>The tickling of the tongue, like a million miniature bolts of lightning shocking me back into a time before worries, before my life as I sit in it now on this wooden stool.<span style="mso-spacerun: yes"> </span>I could now smell the hops.<span style="mso-spacerun: yes"> </span>It reminded me of a long lost love of whose name I can’t, but should remember.<span style="mso-spacerun: yes"> </span>I longed for that forgotten, nameless love as I watched the head finish and the glass settle out.<span style="mso-spacerun: yes"> </span>There was clarity in my life now, for the last six weeks, four days, and fifteen hours that mirrored the serene clarity in that pint glass.<span style="mso-spacerun: yes"> </span>The drink was still beautiful and enticing, but no longer a raging sea of gas and water smashing against each other in a twisted web until no sense could be made.<span style="mso-spacerun: yes"> </span>Seeing that beauty is enough.</o:p></p> <p class="MsoNormal">I will not drink tonight.</p><p class="MsoNormal">Copyright 2010 Jon Kuppinger</p> <!--EndFragment-->Jon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com1tag:blogger.com,1999:blog-3334925321777651151.post-8550976623950059332010-02-02T01:34:00.000-08:002010-03-20T11:43:15.495-07:00The March of the Ants<!--StartFragment--> <p class="MsoNormal"> The ants weren’t concerned.<span style="mso-spacerun: yes"> </span>They were just being ants.<span style="mso-spacerun: yes"> </span>Probably some scout went out on patrol looking for a Kool-Aid spill or a cookie crumb and realized he had hit the motherlode.<span style="mso-spacerun: yes"> </span>He sent word back through their intricate communication system<b style="mso-bidi-font-weight:normal">.<span style="mso-spacerun: yes"> </span><span class="Apple-style-span" style="font-weight: normal;">A system based on neurochemical transmitters and receivers 100 times more advanced than anything we have developed, but the ants seem to have figured it out.</span></b> <span style="mso-spacerun: yes"> </span>Go figure.<span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span>I guess eventually, the word got back to the base camp that a line should be formed, something had been found, things needed to be done.</p> <p class="MsoNormal"><span class="Apple-tab-span" style="white-space:pre"> </span>Busy feet, busy hands, busy mouths, busy ants.<span style="mso-spacerun: yes"> </span>It was like clockwork for them and no source of worry, all in a day’s work.<span style="mso-spacerun: yes"> </span>I wish I could say the same for my trainee.</p> <p class="MsoNormal"><span class="Apple-tab-span" style="white-space:pre"> </span>“Do you think he’s dead?” he asked me.</p> <p class="MsoNormal"><o:p> <span class="Apple-tab-span" style="white-space:pre"> </span>“What do you think?” I sarcastically quipped.<span style="mso-spacerun: yes"> </span>There was no way this guy was still alive.<span style="mso-spacerun: yes"> </span>He was frozen in a pose like a praying mantis with his elbows bent and hands curled inward.<span style="mso-spacerun: yes"> </span>How long had he been there?<span style="mso-spacerun: yes"> </span>My estimation was at least a day.<span style="mso-spacerun: yes"> </span>Probably not too much longer as it was warm out and I couldn’t smell him from the door as he laid face up on the pale yellow linoleum kitchen floor.<span style="mso-spacerun: yes"> </span>Probably not how he imagined he would go. In his boxer shorts.<span style="mso-spacerun: yes"> </span>On a cheap floor.<span style="mso-spacerun: yes"> </span>In a run down apartment.<span style="mso-spacerun: yes"> </span>Not the stuff dreams are made of.</o:p></p> <p class="MsoNormal"><o:p> <span class="Apple-tab-span" style="white-space:pre"> </span>The ants marched on.</o:p></p> <p class="MsoNormal"><o:p> <span class="Apple-tab-span" style="white-space:pre"> </span>“What do I do?”<span style="mso-spacerun: yes"> </span>Jeez this kid was full of questions.</o:p></p> <p class="MsoNormal"><o:p> <span class="Apple-tab-span" style="white-space:pre"> </span>“What does the protocol book say to do?” Two could play the question game.</o:p></p> <p class="MsoNormal"><span class="Apple-tab-span" style="white-space:pre"> </span>“I guess I need to check him out and make sure he is dead.”<span style="mso-spacerun: yes"> </span>I could see his brow was starting to get that nervous sweat on it.<span style="mso-spacerun: yes"> </span>Opening day jitters, performance anxiety, whatever you want to call it, he had it.</p> <p class="MsoNormal"><span class="Apple-tab-span" style="white-space:pre"> </span>“Sounds good to me.”<span style="mso-spacerun: yes"> </span>I vacantly replied.<span style="mso-spacerun: yes"> </span>Ray Charles could have seen this guy was dead, but if my trainee wanted to get his hands dirty and get in there, who was I to stop him?<span style="mso-spacerun: yes"> </span>Besides, I was distracted imagining the deafening din of thousands of microscopic combat boots hitting the pavement in perfect unison like so many jack boots in a parade.<span style="mso-spacerun: yes"> </span>“Your left!<span style="mso-spacerun: yes"> </span>Your left!<span style="mso-spacerun: yes"> </span>Your left, right, left!” the miniature caller would shout, probably not as manly as in the army movies.<span style="mso-spacerun: yes"> </span>Maybe more like Alvin and the Chipmunks.<span style="mso-spacerun: yes"> </span>Yeah, that worked better.</p> <p class="MsoNormal"><span class="Apple-tab-span" style="white-space:pre"> </span>The trainee got to work checking the dead man for any signs of breathing or circulation.<span style="mso-spacerun: yes"> </span>Of course there were none.<span style="mso-spacerun: yes"> </span>The sour look on his face told me that at least subconsciously, in close quarters, the smell was there to indicate decomposed tissue. The heart monitor was picking up a bit of artifact from the trainee’s movement that produced ripples in the EKG waveform from the familiar flat-line everyone knows from TV and movies. <span style="mso-spacerun: yes"> </span>Artifact has given many green medics false hope that there was some activity in the patient’s heart. <span style="mso-spacerun: yes"> </span>Classic mistake.<span style="mso-spacerun: yes"> </span>The trainee bit.</p> <p class="MsoNormal"><span class="Apple-tab-span" style="white-space:pre"> </span>“Is he flat line?”<span style="mso-spacerun: yes"> </span>I asked feigning interest already knowing what he was thinking.<span style="mso-spacerun: yes"> </span>This was a teaching moment I couldn’t let pass.</p> <p class="MsoNormal"><o:p> <span style="mso-spacerun: yes"> <span class="Apple-tab-span" style="white-space:pre"> </span></span>“I think so, but I might have something. Let me check a few things.”</o:p></p> <p class="MsoNormal"><span class="Apple-tab-span" style="white-space:pre"> </span>“Sounds good.”<span style="mso-spacerun: yes"> </span>I was fine to let him go as long as he wanted, and long he went through every possible check.<span style="mso-spacerun: yes"> </span>I could tell he wasn’t sure about rigormortis and kept checking and rechecking for stiffness like a kid who keeps poking a sleeping dog expecting it to wake and snap at him at any moment.<span style="mso-spacerun: yes"> </span>I remembered back to when I was a trainee and how the only way to learn about things of this nature was to jump in and just do it, so I let him go.<span style="mso-spacerun: yes"> </span>Besides, a crowd was forming and the cops and coroner were just pulling up so I went over to chat with them and let them know the kinds of things they want to know.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal"><span class="Apple-tab-span" style="white-space:pre"> </span>With the police, fire department, ambulance crew and now the coroner, we were beginning to form our own version of the work line to and from the body.<span style="mso-spacerun: yes"> </span>Lots of gathering of facts and opinions from witnesses and the unlucky fellow’s personal effects.<span style="mso-spacerun: yes"> </span>More opinions than facts were offered.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal"><o:p> <span class="Apple-tab-span" style="white-space:pre"> </span>“Your left, right, left!”</o:p></p> <p class="MsoNormal"><span class="Apple-tab-span" style="white-space:pre"> </span>There was a lot of work to be done. Shuffling of paperwork. Trips to the ambulance and back.<span style="mso-spacerun: yes"> </span>Radio reports back to base. Busy pens, busy boots, busy mouths, busy humans.<span style="mso-spacerun: yes"> </span>It was like clockwork for us and no source of worry, all in a day’s work.<span style="mso-spacerun: yes"> </span>I still wished I could say the same for my trainee.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><span class="Apple-tab-span" style="white-space:pre"> </span>After fifteen minutes or so, I started to develop a conscience and pulled the kid off the corpse.<span style="mso-spacerun: yes"> </span>“OK, that’s enough, come on you have paperwork to do.”<span style="mso-spacerun: yes"> </span>We did.<span style="mso-spacerun: yes"> </span>Besides it was time for everyone to finish up.<span style="mso-spacerun: yes"> </span>Very soon both production lines would be shut down.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><span class="Apple-tab-span" style="white-space:pre"> </span>Meanwhile back at the ant line, production was in high gear.<span style="mso-spacerun: yes"> </span>They were moving morsel upon morsel back to the hill.<span style="mso-spacerun: yes"> </span>They were completely oblivious to the fact we were there.<span style="mso-spacerun: yes"> </span>Even more oblivious to the impending fact that their find would soon be snatched away as quickly as their meal’s life had been.<span style="mso-spacerun: yes"> </span>I don’t know how or why this particular gentleman passed on.<span style="mso-spacerun: yes"> </span>There was nothing to indicate either way, and it’s really not my job to figure that out.<span style="mso-spacerun: yes"> </span>Much like the ants, for me it didn’t really matter, the fact was there was a body on the floor and there was much work to be done.</p><p class="MsoNormal">Copyright 2010 Jon Kuppinger</p> <!--EndFragment-->Jon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com1tag:blogger.com,1999:blog-3334925321777651151.post-1237242661626529122010-01-27T22:48:00.001-08:002010-03-20T11:43:41.038-07:00Pedi call<!--StartFragment--> <p class="MsoNormal" style="text-indent:.5in">The call came in as “Man Down”.<span style="mso-spacerun: yes"> </span>It was the first one of the day, we had barely finished logging in from the parking lot and it was only 6:08 in the morning.<span style="mso-spacerun: yes"> </span>It was chilly and grey as a thick blanket of fog sat over Oakland and it’s immediate suburbs.<span style="mso-spacerun: yes"> </span>“Man Down” is a very common call and can mean anything from a bum taking a nap to a drug overdose to a murder victim to anything else you can come up with that would make you lay down outside.<span style="mso-spacerun: yes"> </span>Quite often we arrive and the “man” is not only no longer down, but no longer anywhere to be found.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">The labor is divided up on a dual medic unit such as the one that I was on that day.<span style="mso-spacerun: yes"> </span>If you are driving, you are responsible for of course safely driving, any radio traffic, verbal reports, and filling out the daily activities log (or DAL).<span style="mso-spacerun: yes"> </span>On scene you assist the paramedic that is the “patient medic” with various duties such as gurney manipulations, gathering vital signs, negotiating egress from the house, etc…<span style="mso-spacerun: yes"> </span>If you are in the “hot seat” you are the patient person in charge of all patient care.<span style="mso-spacerun: yes"> </span>You make all the decisions on patient care, destinations, and priority of transport.<span style="mso-spacerun: yes"> </span>Before you get there, you are primarily the navigator and a second set of eyes as where the patient is located is not always as easy as it would seem.<span style="mso-spacerun: yes"> </span>Today I was in “the hot seat.”</p> <p class="MsoNormal" style="text-indent:.5in"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">“Copy man down, show us enroute to the call” my partner Jeff replied into the CB microphone.<span style="mso-spacerun: yes"> </span>We were both a little irritated that we didn’t get our first cup of coffee right after login, but this would probably be a quick cancellation and then we could get our caffeine levels up and possibly a tasty muffin to boot.<span style="mso-spacerun: yes"> </span>Little did we know but the coffee would have to wait.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">As we turned the corner to the street of dispatch, I noted the types of things I try and notice.<span style="mso-spacerun: yes"> </span>The street was a dead end and probably not paved or repaired in the last 20 yrs.<span style="mso-spacerun: yes"> </span>The lawns (if there) were not well kept and more used for storage for broken down cars.<span style="mso-spacerun: yes"> </span>The housing was run down, single family and multi-plex units in need of paint. <span style="mso-spacerun: yes"> </span>Probably lower to no income families.<span style="mso-spacerun: yes"> </span>More often then not representative of a lower education level and high occupancy.<span style="mso-spacerun: yes"> </span>All part of the picture. <span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">The fire department had arrived before us, as usual, but they were all huddled in the street behind the engine.<span style="mso-spacerun: yes"> </span>The sun was just starting to come up so it was difficult to see what they were doing.<span style="mso-spacerun: yes"> </span>Probably putting their gear back together, I thought.<span style="mso-spacerun: yes"> </span>I think my partner joked they were “working” the street meaning that they were performing CPR on the pavement.<span style="mso-spacerun: yes"> </span>Typical medic humor, taking a cheap shot at the firefighters.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">The first thing I saw was the soft, pastel yellow color. Just a flash of it through and elbow or knee of the hunkered down guys.<span style="mso-spacerun: yes"> </span>Not a color I am used to seeing, especially in the street.<span style="mso-spacerun: yes"> </span>It caught my attention.<span style="mso-spacerun: yes"> </span>The captain looked up<span style="mso-spacerun: yes"> </span>as we approached and his stare said everything to me; something was very, very wrong.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">I was squinting to see as we rolled up, I could feel the muscles in my forehead tensing, but I still could not figure out what I was looking at.<span style="mso-spacerun: yes"> </span>Suddenly for whatever reason it all became clear.</p> <p class="MsoNormal" style="text-indent:.5in"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">“Dude, it’s a baby.” I said.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">“Shut up”</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">“No I’m serious, it’s a friggin’ baby.<span style="mso-spacerun: yes"> </span>Son of a bitch” I said.<span style="mso-spacerun: yes"> </span>Instantly I felt a cold sweat.<span style="mso-spacerun: yes"> </span>I didn’t care about the coffee anymore.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">“Bro, I have never run a pedi code”<span style="mso-spacerun: yes"> </span>my partner said tentatively referring to our common contraction for pediatric, meaning child or baby.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">“Me neither” I relied.<span style="mso-spacerun: yes"> </span>“Let’s get at it”<span style="mso-spacerun: yes"> </span>My door was open before we even stopped.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">I was struggling to not allow the tunnel to close in on my vision.<span style="mso-spacerun: yes"> </span>I knew in this neighborhood it was important to keep your eyes open and mouth shut or things could go south very quickly.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">Pediatric CPR is very weird to see.<span style="mso-spacerun: yes"> </span>We practice it all the time so it shouldn’t look so odd, but it does.<span style="mso-spacerun: yes"> </span>It seems almost barbaric, but at the same time absurdly silly.<span style="mso-spacerun: yes"> </span>Grown, muscle-bound men using two fingers to compress the chest of an infant they outweigh by over two-hundred pounds.<span style="mso-spacerun: yes"> </span>The captain looked at me with a very concerned look, clipboard in hand.<span style="mso-spacerun: yes"> </span>He had been collecting information from the gathering family who were standing in the gutter by the curb.<span style="mso-spacerun: yes"> </span>Their sobs were audible.<span style="mso-spacerun: yes"> </span>Palpable.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">“Downtime?” was all I could come up with to say. As sad as this was, I could only serve this child and his family by getting these answers.<span style="mso-spacerun: yes"> </span>After all, I had to pass the info on to the ER doctor.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">“Unknown.<span style="mso-spacerun: yes"> </span>The baby was warm, but pulseless, apneic, and cyanotic when we arrived.<span style="mso-spacerun: yes"> </span>Last seen normal at bedtime last night”</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">The captain asked me what I wanted to do.<span style="mso-spacerun: yes"> </span>The firefighter quietly suggested “calling it” <span style="mso-spacerun: yes"> </span>on the down low so none of the family would hear.<span style="mso-spacerun: yes"> </span>“Calling it” would mean that it was a lost cause and we would stop life-saving efforts. <span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">That was not going to happen.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">I looked up and saw a couple large SUVs pulling up filled with family members.<span style="mso-spacerun: yes"> </span>These people were streaming out of their clown cars without shutting them off or closing doors.<span style="mso-spacerun: yes"> </span>The extra light from their headlights was welcome, their menacing approach was not. Dressed in the uniform of the hood, long oversized white T-shirts, pants falling down, and tattoos. They were also very large people, even the women, Maybe Samoans or Tongans.<span style="mso-spacerun: yes"> </span>I had a baby in the street, traffic backed up, and a crowd that was growing more and more agitated. The women went straight to the other women on the curb.<span style="mso-spacerun: yes"> </span>The men were bee-lining for us with authority. <span style="mso-spacerun: yes"> </span>Their disbelief and anguish converting to anger, the only emotion they are comfortable displaying in public.<span style="mso-spacerun: yes"> </span>It was time to go.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">“Let’s get the hell out of here.”</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">I scooped the kid up and we were driving in seconds.<span style="mso-spacerun: yes"> </span>I took the firefighter with me to serve as an extra pair of hands and emotional support.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">Enroute we were quickly doing everything that needed to be done.<span style="mso-spacerun: yes"> </span>It was like clockwork.<span style="mso-spacerun: yes"> </span>We both knew it was a lost cause, SIDS kids generally don’t come back, but still, we had to try.<span style="mso-spacerun: yes"> </span>I suddenly realized I knew very little about this child.<span style="mso-spacerun: yes"> </span>Our retreat had been so hasty, I did not even know the sex of the child.<span style="mso-spacerun: yes"> </span></p> <p class="MsoNormal" style="text-indent:.5in"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">The rest of the call was a blur and the patient was out of my hands and swarmed with emergency room personnel before I knew it.</p> <p class="MsoNormal" style="text-indent:.5in"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">The family arrived and the wails were too much, I had to leave the hospital.<span style="mso-spacerun: yes"> </span>I went over to the fire engine that had followed us in.<span style="mso-spacerun: yes"> </span>I locked gaze with the firefighter.<span style="mso-spacerun: yes"> </span>There was nothing to say really.<span style="mso-spacerun: yes"> </span>So we joked about something else.<span style="mso-spacerun: yes"> </span>Perhaps the absurdity of the scene or the guys coming at us.<span style="mso-spacerun: yes"> </span>We wrapped it up pretty quickly.<span style="mso-spacerun: yes"> </span>Everyone was sizing each other up, but too much man to ask if we were all OK.<span style="mso-spacerun: yes"> </span>The jokes were more a barometer and emotional release than humor.</p> <p class="MsoNormal" style="text-indent:.5in"><o:p> </o:p></p> <p class="MsoNormal" style="text-indent:.5in">I am having my second child this spring as I write this.<span style="mso-spacerun: yes"> </span>I try to never put myself in the shoes of the people I serve.<span style="mso-spacerun: yes"> </span>It is far too dangerous and I fear I may not make it back to me.<span style="mso-spacerun: yes"> </span>I just hope I never have to know a day like that day.</p><p class="MsoNormal" style="text-indent:.5in">Copyright 2010 Jon Kuppinger</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <!--EndFragment-->Jon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com2tag:blogger.com,1999:blog-3334925321777651151.post-19842666735542709342010-01-13T22:38:00.000-08:002010-03-20T11:44:08.796-07:00The Bad Call<!--StartFragment--> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;">“We’re losing her, Jon! Get that tube now!”<span style="mso-spacerun: yes"> </span>shouted my partner Dawn from the open doors at the back of the ambulance.<span style="mso-spacerun: yes"> </span>She was right.<span style="mso-spacerun: yes"> </span>As I looked into the pale watery eyes of my patient and saw her struggle to squeak in a breath and buy her a few more seconds on this earth, I made a realization.<span style="mso-spacerun: yes"> </span>This was really happening… to the both of us.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;"><o:p>As a paramedic rolling through the rough streets of Oakland, I have had my share of what we would call bad calls that I carry around in my head and heart.<span style="mso-spacerun: yes"> </span>For each paramedic, the definition of a bad call is unique.<span style="mso-spacerun: yes"> </span>There are, of course, the calls that nobody likes such as the pediatric calls.<span style="mso-spacerun: yes"> </span>You would have to search far and wide to find someone who wants to work around sick or dying children in an emergency setting. <span style="mso-spacerun: yes"> </span>Still, most medics have specific kind of call that really bothers them.<span style="mso-spacerun: yes"> </span>For me, it is not so much the type of call or any specific pathology that gets me; rather, it is my own disappointment in my ability to help someone that earns that call the status of “bad”.</o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;">As far back as I can remember, I have always been a giver and have valued the concept of being “the helper”.<span style="mso-spacerun: yes"> </span>I have tutored, taught, and mentored throughout my life.<span style="mso-spacerun: yes"> </span>But the one frustration I have always struggled with is to not be able to help, regardless of my level of effort.<span style="mso-spacerun: yes"> </span>And that was exactly what I was dealing with here as I cradled the head of a woman I had only just met moments ago.<span style="mso-spacerun: yes"> </span>I suffered with her. <o:p></o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;">“ I’m trying but there’s just too much fluid, I need suction now!”<span style="mso-spacerun: yes"> </span>I responded, realizing I was yelling even as the words came out.<span style="mso-spacerun: yes"> </span>I wondered if I sounded too harsh.<span style="mso-spacerun: yes"> </span>After all, we were all concerned and trying. Dawn was only a mere three feet away.<span style="mso-spacerun: yes"> </span>I could touch her.<span style="mso-spacerun: yes"> </span>She did not seem fazed as she was completely engrossed in trying to get IV access.<span style="mso-spacerun: yes"> </span>The firefighter assisting me got the suction without a word.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;">“I got it!”<span style="mso-spacerun: yes"> </span>I shouted, as if I had just scored the winning touchdown.<span style="mso-spacerun: yes"> </span>A rush of pride mixed with completion washed over me, but only for a second.<span style="mso-spacerun: yes"> </span>“Don’t get cocky” I thought.<span style="mso-spacerun: yes"> </span>I was on a roll, but there was a lot more to do.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;">“Hold this and DON’T move it” I told the silent firefighter who was assisting me. <span style="mso-spacerun: yes"> </span>He nodded in agreement, controlling his emotions, but his eyes told me a different story.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;">I turned my back to grab a few additional pieces of equipment when I heard some gurgles and the firefighter broke his silence with a yelp.<span style="mso-spacerun: yes"> </span>Apparently he had been splashed by the overabundance of fluid from the patient’s now full respiratory system and he was not too pleased about it.<span style="mso-spacerun: yes"> </span>When I turned back I noted that the firefighter had indeed inadvertently moved the tube, and it was now in her esophagus not her trachea. I didn’t blame him, he was scared and clearly feeling like he did not sign up for this, which was manifested in his frozen frown and voiceless nods.<span style="mso-spacerun: yes"> </span>I immediately pulled it out and noted the color of my patient change to a raspberry ashen color, much like rain laden clouds with a setting sun trying to break through.<span style="mso-spacerun: yes"> </span><o:p></o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;">It was then that she died.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;">Those watery eyes that were our only form of communication, our connection, dilated for the last time.<span style="mso-spacerun: yes"> </span>Her fight was over and there wasn’t a damn thing I could do about it.<span style="mso-spacerun: yes"> </span>I didn’t have long to lament, I still had a lot of work to do, but this part was easy.<span style="mso-spacerun: yes"> </span>We are heavily trained in what to do with people whose hearts cease to function.<span style="mso-spacerun: yes"> </span>I fell into my training and went through the familiar motions of CPR.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;">It was almost silent as we breached the doors of the emergency room.<span style="mso-spacerun: yes"> </span>It was like walking into a hopping nightclub club from a quiet street.<span style="mso-spacerun: yes"> </span>There were people everywhere, bright lights, lots of bustling around and shouting.<span style="mso-spacerun: yes"> </span>I joined in and shouted the words I needed to shout and the doctor shouted questions back and shouted orders to the nurses who shouted to other people, and on and on.<span style="mso-spacerun: yes"> </span>Once they had what they needed from me, I slowly slipped out of focus and everyone was on the patient like yellow jackets around a picnic lunch.<span style="mso-spacerun: yes"> </span>It was an odd feeling.<span style="mso-spacerun: yes"> </span>It was as if I could feel the white-hot spotlight slowly panning off of me until I realized I no longer had a part in this play.<span style="mso-spacerun: yes"> </span>My character had no more lines. <span style="mso-spacerun: yes"> </span>I needed to leave the now darkened stage. <o:p></o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;">I walked outside alone and a bit dazed. My heart was still racing.<span style="mso-spacerun: yes"> </span>I realized I could hear my breathing and I was soaked in sweat.<span style="mso-spacerun: yes"> </span>I felt like I had just been involved in a car accident.<span style="mso-spacerun: yes"> </span>There is not much to do, but I felt as if I needed to do something very extreme.<span style="mso-spacerun: yes"> </span>Anything to dissipate this now waning adrenalin surge.<span style="mso-spacerun: yes"> </span>Instead, I called my wife and told her I loved her.<span style="mso-spacerun: yes"> </span>I needed to touch base with reality.<span style="mso-spacerun: yes"> </span>Slowly over the next hour I calmed down with the mundane tasks of the job.<span style="mso-spacerun: yes"> </span>Cleaning.<span style="mso-spacerun: yes"> </span>Organizing.<span style="mso-spacerun: yes"> </span>Putting things away. Paperwork, always paperwork. Need to get ready for the next call.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;">In the end my patient was revived and transferred into the ICU.<span style="mso-spacerun: yes"> </span>She passed away a few days later of severe pneumonia, which was not a surprise, but still the same left me with that melancholy feeling paramedics know all to well.<span style="mso-spacerun: yes"> </span>I had tried so hard to bring her back.<span style="mso-spacerun: yes"> </span><span style="mso-spacerun: yes"> </span>I comforted myself with well worn clichés designed to ease the confliction of emotions at these trying times.<span style="mso-spacerun: yes"> </span>“It was her time.”<span style="mso-spacerun: yes"> </span>“We did the best we could.”<span style="mso-spacerun: yes"> </span>“There is only so much we can do.”<span style="mso-spacerun: yes"> </span>“It’s in God’s hands now.”<o:p></o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;">I knew it was not my fault, but still, as I reviewed the call over and over in my head, my heart searched for reason in all the chaos that surrounds a bad call.<o:p></o:p></span></p><p class="MsoNormal" style="line-height:200%"><span class="Apple-style-span" style="font-family:Arial, serif;">Copyright 2010 Jon Kuppinger</span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="line-height:200%"><span style="font-family:Arial;"><o:p> </o:p></span></p> <!--EndFragment-->Jon Kuppingerhttp://www.blogger.com/profile/13014793835405359316noreply@blogger.com0