Monday, March 25, 2013

The REAL Walking Dead

I think every agency has them... patients who, for all intents and purposes, should be eating their salads from the roots up, but are still trudging the aisles of WalMart.

We had one such patient some time ago... a 62 year old woman who had suffered 8 heart attacks previously... was a Type I diabetic, and a multiple amputee.  If I'm not mistaken, she had also had several strokes and chronic high blood pressure. And she weighed about 350 sans faded moo-moo and bunny slippers.  She was what we affectionately call the "Walking Dead."  There is simply no way that this woman should still be sucking air.  But she was.  And unfortunately, that usually complicates things considerably for us.

When we arrived, I did a thorough assessment (even though I had seen her about half-a-dozen times before and knew her medical history probably better than she did), and put her on our cardiac monitor to see what was going on "under the covers."  This little box is an invaluable tool for us... it helps us to spot immediate life-threatening conditions for which we have some very powerful drugs on board that can make the difference between life and death.  I can also deliver a jolt that will literally lift you off the cot (or the floor), resetting  your heart's spasms and hopefully settling it back into a nice little rhythm that is compatible with life.

In order to administer said life-saving drugs, we have to start an IV on our patients, which consists of inserting a needle/catheter into a vein in order to be able to get medications directly into their bloodstream.  This assumes, of course, that our patients have what we call "patent veins."  The opposite of this, of course, is "crap veins" or "S#$% for veins."  This patient had the latter variety.  I knew this from my previous experiences in trying to start an IV on this woman.

That presents a problem.  How do you deliver potentially life-saving medications when you can't get an IV?

The answer today is much simpler than it used to be... although many will find it cringe-worthy.  We have a very valuable tool on our trucks called a "EZIO,"  for "Easy Intra-osseous Infusion."  Basically it's a battery-powered hand drill with a very long stainless-steel needle/catheter... it drills right into the bone, and when the needle is withdrawn (leaving the stainless-steel catheter in the bone), an IV can be attached to the hub.  Since the needle is drilled right into the marrow of the bone, fluids can be administered almost as easily as they can with an IV. 

This was the treatment of choice for this patient... much to her surprise and horror.  The good news is that it isn't as painful as you would think... either going in or coming out.  The painful part involves a "flush" of salt-water into the bone marrow to create a small "cavity" in which fluid can be pushed into... and THAT'S freakin' "lift-your-patient-right-off-the-cot-screaming" painful of the "you may feel some discomfort" variety.

Our patient survived a 9th heart attack, and will live to see a 10th, probably.  Don't know how, though.  She just is.  Ya gotta love the Walking Dead.

Sunday, May 8, 2011

A Touching Call.

Author's Note:  For those that took serious issue to this blog, I appreciate your feedback, and the reprimand.  Please keep in mind that a blog of this nature is 95% fiction, and 5% fact.  Not only would I never abuse a patient, I always go way overboard the other way to "not go there."  In fictionalized accounts, however, and having a very creative and inventive mind, sometimes you can allow yourself to fantasize what it would be like in some situations, for the sake of humor.  The instructor of my medic class was full of things like that, and I have no idea if he made them up to entertain us, or actually did them.  So, chalk it up to a poor attempt at humor on my part.  I do appreciate the chastisement... I probably did go a little overboard.

Cinco De Mayo and we had a full truck.  Myself, a driver, and 3 ride-alongs on a lazy Friday night in Spotsyltucky.  The ride-alongs were EMT's who have not been "released" to run a truck by themselves yet... they are still "precepting" under another EMT.  Tonight, they were running with me because my driver is an EMT preceptor.

We expectantly settled in, knowing that the career staff had run their butts off during the day... thinking that the volume was going to carry over into our shift from 6pm until 11pm.  We went out to eat, sure that that would spur some calls... we usually order our meals "to go" even though we stay and eat them there, and ask for our check in advance... just in case.  Can't tell you how many times we've had to rip out of a restaurant on a call, mid-bite.

Fortunately, this night was fairly quiet... no calls.  We ate in peace, then returned to the station.  Still no calls.  We sat and either worked on our laptops, watched bad TV, or congregated in the back of the truck and trained.  My driver for that night was a good friend... we love to teach... we dubbed our truck the "Learning Truck," and try to make it a place where newbies can feel comfortable asking questions and learning new skills.

We finally got toned out at about 9:45pm on an "Assist Law Enforcement" call.  I can't tell you how much I loathe those.. as I've discussed in other blogs.  We had to "stage" for a while until the deputies actually arrived on-scene, which means that we find a place to park some distance from the call until the police arrive and declare it "safe" for us to enter.  Po-Po arrived, and dispatch told us that it was safe to come in, so we proceeded to the scene.

It's not a great part of town.  In fact, it's pretty grungy.  Therefore, I wasn't surprised to arrive and find a 40-something male sitting on the curb, drunk off his proverbial butt, and looking like he had just crawled out of a dumpster.  No fewer than 5 officers were standing around the guy, who apparently was complaining of abdominal pain.  I wondered how someone could feel ANYTHING given how much alcoholic anesthetic was in his system.  

I tried to talk to him and check him out, but every time I tried to assess him, he became wild-eyed belligerent and obnoxious.  At one point, one of the deputies decided that this was definitely annoying, and immediately pounced on our patient, put his face in the dirt, and gave him a stern admonishment to behave better... as only a 300 lb, 6' 2" deputy can do.  After a few more minutes of questioning (I speak fluent Drunk), I managed to figure out that our patient had a kidney stone, a UTI, or some other sundry urinary tract problem.  I also found out that he had a serious drug problem involving popping pain-killers like cocktail peanuts.  Which he admitted to having been doing since that morning... and washing them down with his good buddy Jack Daniels.

At about the point where we were deciding where to take him, the patient suddenly went "unresponsive" (see previous blog).  He became red-faced like he was trying to initiate a "Code Brown" in his pants,and started drooling... and twitching slightly.  I called for the cot, and we all pitched in to lift him up on onto it.  When we got him on the cot, he decided that he was done being unresponsive, and that a new barrage of slurred insults were in order.  As well as grabbing one of the female EMT's ass.  Apparently he thought that he presented quite the alluring sex-machine package to our gals at that particular moment.  That promptly earned our friend the restraints.

We don't carry commercial restraints on our trucks, so we have to be rather creative.  A roll of roller gauze works in a pinch, though.  So we pulled one arm up above his head, and prepared to secure it to the cot.  Side Note:  We are taught to secure patients with one hand up above their head, and one hand below when we restrain them, so that they can't move around and get any leverage.  Apparently, our patient took serious umbrage with this, and decided that he would express his displeasure by grabbing the arm of the female EMT that he had previously groped, and squeezing so hard it make her scream.

My inebriated patient acknowledged the depth of his remorse and his intent to be more cooperative by then  grabbing the arm of the OTHER female EMT on my crew, who was trying to tie down his other hand.  She screamed, and I saw a blur out of the corner of my eye as a Herd of Deputy rushed the cot, and tried their own ad hoc science experiment: "Testing the weight limit of the cot."  Amidst a flurry of rather descriptive words about THEIR heritage and overall personal hygiene, the Herd of Deputy quickly ejected all pretense of being "nice," and handcuffed our patient to the cot via multiple elbows to the patient's throat and chest.  Of course, when this happens, one of the deputies has earned an all-expense-paid trip to Chez Hospital in the back of our humble ambulance. 

We were almost literally a stone's throw from our neighborhood band-aid stand... the "freestanding Emergency Department."  It's a place where people go who don't really need definitive care... it's like an institutional "Doc-In-A-Box" that is run by the local hospital.

We dropped off the patient, handed his care over to the overjoyed ER staff, who knew the patient by name.  As we made our way to the EMS room (near the ambulance entrance) to start writing up our reports, a nurse popped her head out of the exam room to ask if we had any ammonia inhalants.  Apparently great minds think alike.  I sent someone out to the truck to fetch one, and in the meantime, heard a commotion down the hall.  When I turned around to see what was going on, I was greeted by our patient being escorted down the hall in what HAD to be a very painful hold, followed by the same burly deputy that had ridden in with us.  Our patient was quickly relocated to Chez GrayBar.

We spent the next hour or so writing both normal run reports, and then hand-written statements about what had happened when the deputy who graced our presence on the transport stopped in and told us that the patient was being charged with 2 counts of Battery on a Rescue Provider, a Class 6 felony in the Great Commonwealth of the Old Dominion.  Guess I'll have to nag the Powers That Be to actually give me a Class A uniform shirt now for court.  Knowing that just this once... the bad guy was going to be held accountable for treating us like crap was very satisfying.

Ah, good times.  Good times. 

Sunday, May 1, 2011

A Tale Of Two Unresponsives...

Just to illustrate how much this job is "like a box 'o chocolates... ya never know what yer gonna git"... we had two different calls this week that were dispatched as the same condition... "unresponsive..." but which had vastly different outcomes.

The first call was for an "unresponsive" in the response area right next to ours.  Now... we don't usually get too excited about this call, even though it sounds ominous.  And it can be... but usually is something very different, so we take a "wait and see" attitude.

We happened to be in bed at the time trying to sleep (never happened that night), when I heard the call go out.  A fire engine arrived on scene first, and I felt my adrenaline kick in a little when the officer on the engine immediately requested ALS.

This generally means that whatever is going on is not pretty.  ALS stands for "Advanced Life Support," and it means that a medic or paramedic has been requested, which is moi... I was the only medic on that night in the entire county.  So, I got up and started pulling on clothes... as the tones dropped for the ALS Assist, the dispatcher put us on the call, and we started for the truck.

The other crew that had been dispatched was a BLS truck (BLS stands for "Basic Life Support," and is staffed by EMT's), and they arrived on-scene shortly after the engine.  At this point, we become glued to the radio, because that is our only source of information about what is going on.  The dispatcher gives us an update on the situation when we call in that we are on our way (we refer to it as "marking up"), and we received the following information:

"Medic 4-3, you're responding for a 33 year old male... caller advises that patient experienced a seizure and is now unresponsive.  CPR in progress."

Anytime you hear "CPR in progress," your nether-region's sphincter tightens up a little, because it means that this is no "eye-rolling" type of call... which we affectionately refer to as a "BS call."  The other crew arrived on-scene, packaged and loaded the patient, and started out for the hospital.  We met them en-route, about halfway in.  Typically, on ALS Assists, the medic unit meets the Basic unit en-route, stops somewhere (usually in the middle of the road), and the medic jumps off his truck, and gets on the other truck, which then proceeds to the hospital.  Medics can provide more advanced care than normal EMT's... we can start IV's, push life-saving drugs, use electrical therapy (defibrillation) and place advanced airways.

Sure enough, CPR was being performed by the very anxious, very overwhelmed EMT crew.  The patient was a 33 year old male that looked like he had been ridden hard and put away wet.  As I bustled about doing my thing, the story started to dribble out from the crew, inbetween gasps of air (CPR, by the way, is exhausting).  Turns out the guy was as coke head... habitual cocaine user... who was playing video games, talking to someone in his family, when he just fell over dead.  It's like his heart said, "Game over, man!"  He twitched a couple of times, and that's what they mistook as a "seizure"  It was most likely post-arrest neurological activity... kind of like when someone "twitches" after they die on some bad TV show.

We did everything right... good compressions, zapped him 3 times with enough electricity to drop an elephant, dropped an airway, started a line, pushed the right drugs... the ER was ready for us, and worked him for 15 more minutes... but there simply was too much damage to his heart or brain.  We never got him back.  His family was, understandably, devastated.  No one should die this young.

Contrast that with a call we had yesterday.  Same dispatch reason... "unresponsive."  Same concern.  Same adrenaline rush.  Yet, this time when we arrived (as is often the case), the "unresponsive" patient is sitting up, talking to us, and quite indignant that we are even there.  Usually they're just too drunk to stay conscious, and whoever is with them panics.  And we breathe a huge sigh of relief, as we tell the dispatcher that we're back in service and available for calls.

It's actually one of the reasons that I truly love this job... you really never know what you're gonna get... or who you're going to wind up helping.

Thursday, February 10, 2011

Of Brown-Shirted Thugs and Unicorns

We have a love-hate relationship with our local brown-shirted thugs.

We love them when things are getting dicey, and they are step between us and a Bad Person, with a little curl of a smile on their face as they fondly stroke the handle of their batons or tazer grips, hoping like Hell for a chance to use one or the other on Bubba.

We are not quite so fond of them when they try to dump patients on us to avoid having to deal with either the patient or the resulting paperwork.  When I resist their efforts to dump said human refuse in the back of our truck, and thus hinder their ability to clear from the scene and mosey back to Dunkin, they get downright testy.

That why we naturally cringe whenever we get a call to "Assist Law Enforcement."  Usually that means "We're Going to Totally Waste Your Time In Order To Cover Our Butt" or "We Don't Want To Deal With This Person, So We're Going To See If We Can Dump Them On You."  Our call last night was a little of both.

Called out for "injuries from a fall," we arrived to find a 20-something female, obviously impaired but not on alcohol, as far as I could tell, lying in the median next to the local hospital.  And when I "next to," I mean you could literally throw a rock and bust a window.  In fact, she told us that she had just come from the ER there, and proudly showed us her bandaged wrist.

Officers told us she had "fallen down a hill," and "hurt too much to move... anything."  But when I asked the patient, she told us that she had had the flu for 2-3 days, and just had body aches.  She did slip and fall down a little embankment, and was afraid that the glue holding her wrist lacerations closed had popped open.  I did a quick check, and they hadn't.  Since she was alert and oriented, and didn't have Beer Breath, or a ring of white powder around her nostrils, we couldn't take her against her will.

I made sure to explain to her that if the nice officers wanted her to go, they would have to either take her themselves, or ride with us if we took her, and the Brown Shirts started glaring.

They were putting a full court press on her to go to the hospital.  I was telling her that she didn't have to go if she didn't want to.  When she indicated that she "just wanted to go home," one of the brown-shirts almost imploded.  "You mean to tell me that you're REFUSING THE SQUAD?!"  I could see his neck veins almost ready to burst.  She meekly said, "No, I just want to go home now."  I smiled.  Brown-shirt glared.  The patient started babbling about her mother's brother's roommate's boyfriend's dog's most recent drama or something to that effect to no one in particular, and I told her that the nice officers were VERY interested in her story... and we packed up and left.  Of course, this meant that they would have to either take her home, or take her to the ER themselves, or to jail, whichever... and they glared after us as we whistled our way back to the truck.  Sometimes it's nice to be on the medical side.  :)

Chief Wannahawkaluggie

I've never been a huge fan of middle-o-the-night calls, for obvious reasons.  The older I've gotten, the more attached I've become to my mattress, it seems.

So when I get toned out at 3:20 in the blessed am, it better be something good.  And it rarely is.  In fact, it so RARELY is that we've dubbed it the "3:00am BS Call."  Seems to happen almost every night.

This night was no different.

It's 3:20am, and we're called out to a "general illness," which can mean anything from "grampa's gone on to greener pastures" to "I have a sniffle."  With apologies to Forrest, our calls are "just like a box 'o chocolates.  Ya never know what yer gonna git."

What we got on this call was a 21 year old kid whose chief complaint was "I think I need to hawk a luggie."  Not quite knowing if I heard him right, I asked him to repeat it.  "I haven't been sick in a couple 'o years, and I think I forgot what it feels like... I feel like I have something caught in my throat... I feel like I have to hawk a luggie," he said most emphatically, as if he were describing a blossoming abdominal aortic aneurysm.

I looked at my partner, tried not to laugh, and in the most empathetic voice I could muster, told him to drink plenty of fluids, and to call his doctor in the morning.  Of course, I made sure he knew that we WOULD transport him if he wanted to go that badly, but let him know that it would probably involve a LONG wait in the waiting room if he did.  He chose to sit tight.

It never fails to amuse me what people will call 9-1-1 for.  We joke about it sometimes, but honestly, our imaginations just can't compete with reality... you just can't make this stuff up!

Sunday, October 3, 2010

"Oh, SURE! It's All Fun And Games Until Someone Tries To Hit You With A Bag of Pee!"

We were toned out on my second-most despised call... "Assist Law Enforcement."  No disrespect to the Blue Canaries and Brown-Shirted Jack-Booted Thugs, mind you.  We love them dearly.  Mostly because they're the ones standing between us and the Active Shooter.

No, it was just that this type of call was second only to "rectal bleed" on the highly scientific EMS "Oh, HELL no" scale.  Nothing good is ever encountered on this type of call.  Until tonight.

We rolled out of the bunk, bleary-eyed, to hear the dispatcher monotone "Medic 4-3.. assist law enforcement.. sick person."  Great.  Just Great.  Not even a juicy butt-whoopin.  Sick person.  That usually means body fluids that I'd rather not deal with at O'Dark Thirty in the blessed a.m.

We pulled up on scene, to find a bunch of cruisers, and a little clot of the aforementioned Brown-Shirted Jack-Booted Thugs standing around.  I could see the back of someone's head in the back of the cruiser right in front of us... and what looked like a plastic umbilical cord that came out the bottom of the backseat door, and was stretched out about 6 feet... with a white bag at the end.  It was one of those priceless "What the HECK?" moments, until I realized that the plastic "umbilical cord" was actually plastic tubing, and the white bag was a urine collection bag.  THIS can't be good.

Seems that our "patient" was an elderly man who had just gotten out of the hospital, and for some reason his brain that night had turned right when it clearly should have turned left.  The gentleman had been hospitalized for a GI problem, and had been catheterized with a Foley.... which was still in place.  Hence the tubing and (full) collection bag.

With an unsettling smile, one of the deputies managed to keep a straight face while telling me to "go ahead and talk to [ the patient ] and see if we can see what's wrong with him."  I opened the rear door to see an all-but-nekked old man who greeted me with a hearty Pirate "AAAAARRRRRGGGGHHHHH!!!!" All he needed was an eye patch.  He made up for the lack of one by simple squinting one eye.

The ensuing conversation went something like this:

"Good evening, Sir.  I'm FossilMedic.  How are you doing tonight"?


"I see.  So, can you tell me if you're in pain"?


I gingerly closed the door, to the snickering of the deputies behind me.  "Did he tell you anything useful?" one of the deputies asked.

"OK," I said, "I GOTTA hear this.  What's the story?"

The detective in the group told me, with a quivering voice that was trying desperately to control yet another gale of laughter, that our "patient" had "gone rogue" about a half hour earlier... escaped from his house, and was running down the road in his neighborhood, half nekked, swinging his urine collection bag around his head like a lasso, greeting the startled neighbors who ventured out to see what all the racket was about with a menacing "AAARRRRRGGGGHHHH!!!"

The first Deputy on-scene was brand new, and still very wet behind the ears.  The snickers turned into poorly-controlled waves of laughter.  Apparently, our "patient" chased the poor deputy around his car, trying to "lasso" him with his urine collection bag.  By this time, I was gasping for breath, and had tears rolling down my cheeks.  Out of sympathy for the poor deputy, of course.

The deputy was clearly hurt.  He was red-faced, and VERY much wasn't laughing or finding it the least bit amusing.  And in one of those I'm-not-making-this-up moments... he said, "Oh, sure... it's all fun and games until someone tries to hit you with a bag of pee."  Dramatic pause.  Fresh gale of laughter.  I actually had to sit down on the side step of my truck, I was laughing so hard.  Deputy stomps off to pout.  His other compadres were clutching each other and gasping for breath as well.

I can just see it now.  For the next 3 months, that poor deputy is gonna arrive at work, go into the locker room, and be greeted by dozens of urine collection bags with apple juice in them.  Blue Canaries and Brown-Shirted Jack-Booted Thugs are very compassionate that way. I hear.

Monday, November 9, 2009

Just A Good 'Ole GREAT BIG Boy...

Got called out on a bariatric call a couple of months ago.  That's a nice way of describing, what those in fire and EMS call a "land whale."  550 lbs on the hoof.  Thank heavens for hose monkeys.  My back's already messed up.

Poor guy hadn't been out of his home in years... and lived in squalor.  His normal-sized wife had that gaunt, beleagured look that is usually only seen on the faces of the families of terminal cancer patients during the last month or so of their loved ones' lives.  She obviously had to attend to all of his various and sundry personal needs, due to his chronic lack of mobility.  That thought alone is almost enough to send a non-gagger running for a toilet.

It's hard to fathom.  How do people get that way?  It's easy to be a smart-ass, and say "One Twinkie at a time."  But typically it runs much deeper than that, and is therefore much harder to overcome.  Thin people don't understand that.  Because of their own relative fitness, they can't see this condition in terms of anything but "geez, push away from the freakin table and take a walk!"  Consequently, they find it way too easy to look down their nose at those who strain against the crushing weight of obesity.

In my own case, I've struggled with my weight ever since I was a young man.  Now, at 265 lbs., I'm gradually slimming down and hope to return to a somewhat "normal" weight within the next year.  I have to.  My health depends on it.  Probably my very life.  But it's insanely difficult, because for many people, "self control" has little to nothing to do with their weight problem.  For many, it has more to do with depression, mood disorders, metabolic problems, hypothyroidism, etc.  Depression is the one that got me.

Alcoholics and drug addicts self-medicate their problems away.  We feel sorry for them, and lovingly spirit them away to rehab centers where they can come to terms with their "disease."  Fat people are trucked off to fat farms with a sneer of judgmental disgust.

Just like alcoholics and addicts self-medicate, obese people eat their problems away.  It has the same effect as alcohol or drugs, and is far more insideous... for one, it isn't illegal.  And food is readily available.  And it gives you instant gratification.  Of course, when you eat, you feel bad, both physically and psychologically.  So you become more depressed.  And you keep the Depression Monster away by eating and gaining that temporary "food high."  It's the Vicious Cycle From Hell.

And boy, do obese people pay the price.  They suffer physically from everything from diabetes to chronic ulcers and infections to chronic breathing and cardiac/circulatory problems.   Not to mention the beating their joints take when they DO try to walk... or heaven forbid, go up or down stairs.

Psychologically and emotionally, they suffer from constant, unwavering indignties, public ridicule, abject discrimination, and withering humiliation.  And yet, none of this compares with the depth of their own self-loathing.

Heck, even the firefighters and EMS personnel laugh at them behind their backs.  And that deeply troubles me.  I got into this business to help people.  And that call gave me cause to rethink the way I feel about bariatric patients, and to seriously adjust my attitude towards them and how I approach their treatment.  I hope it sticks.  I don't want to be "that guy" who contributed to anyone else's pain... ever again.  Whether they know about it or not..