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..

Wednesday, January 21, 2009

What Goes "Bump" In The Night

OK, I'll admit it. I'm something of a "classist." Didn't think I was. Thought I was pretty much rock bottom, socially. Until I moved to Virginia.

Now don't get me wrong, Virginians are a salt-of-the-earth, wonderful people. Southern hospitality, small town hominess, friends helping friends, old-fashioned neighborliness... you can find them all here.

And then there's the trailer park.  Or the "Tornado Magnet," as we like to call them.

I was pulling a shift the other day in the Hospital for my clinical rotations, and one of my patients took my breath away as soon as I opened the curtain... she was about 500 lbs on the hoof, and looked as if she could seriously provide her own gravitational pull.

And she was just CONVINCED that she was pregnant.

So? Not that uncommon, right? (Except, of course, for the obvious question that popped into my mind as to how that union was logistically consumated... which forced me to run screaming, mentally, to my Happy Place).

As the nurse and I started to talk to her to get a history, she informed us that she had 4 children, one of whom was there with her and her hubby... who also weighed in at around 400. Both of them looked like they had crawled, literally, on hands and knees right out of Frog Level, VA, in the burrow pit, after a long rain.

Turns out, she hadn't missed a menstrual period... at all... even though she had missed them when she was pregnant before (some people just don't miss them, for some reason, until sometime in their first trimester). She was certain that she was "3 weeks pregnant."

We asked how she knew that, if she hadn't missed a period. And she then said, and no, I'm not making this up... "Well, I can feel it move right up here..." at which time she pointed to the TOP of her very large, very rotund belly.

The nurse and I looked at each other, and I started to lose it, to which the nurse gave me a threatening glare and a hard pinch on the soft underside of my upper arm. She patiently... and sweetly... tried to explain some basic A&P to them (anatomy & physiology) about how big a fetus is at 3 weeks, WHERE it would be at 3 weeks, etc. Blank stare.

The patient was not convinced. Neither was her husband, who was QUITE indignant, and insinuated that we HAD to be idiots. "What else could make her titties bounce up and down?" he demanded... hands on very large hips.

I had several thoughts in response to that question that were entirely inappropriate, but decided to let discretion be the better part of valor and kept my mouth shut. At least until later.

The nurse assured them that we would do both a blood test and a urine test to see if she was pregnant, which seemed to pacify them... a little. Of course, they came back negative.

When we left the room, the nurse grabbed my arm and RAN down the hall with me in tow... when we reached a safe distance at the other end of the ER, we both BURST out laughing, until tears were streaming down our cheeks...

Unbelievable. And remember... these people reproduce... and VOTE.

Family Units

I was just settling in my 11pm-5am shift at the Station, and was in the process of making up my bunk when I was startled by a pounding on the window...

I raised the blinds to come face-to-face with two very frightened women who looked like they had just seen the Ghost of Marley. They frantically waved a syringe and what looked like a box of medication at me, and motioned towards the bay doors. Not a good way to start a shift.

The station I was working out of has an interesting architecture... it's a brand-new HUGE 2-level structure with the only semi-"front" door on the lower level, in BACK of the building, while the 12 apparatus bays were on the upper level. The women, not finding a main entrance on the street level, looked for the first window they could find... which happened to be the bunkroom.

I ran around to the apparatus floor, raised the bay doors, and before I could say anything, they rushed in and blurted out "How much is 9 units????"

I looked at the medication... it was insulin... the syringe was a 1 mL syringe, which is marked off in 1/10 mL increments... .1, .2, and so on. A unit of insulin is a very small amount... .01 mL. When I pointed out to them how much 9 units would be, they turned white as a sheet... they screamed in unison "We need you!!!!"

As the story unfolded, these two women had given their mother her "insulin." She hadn't really eaten all day, and they took her blood sugar when they got home from work, and it was 79. Normal, for all you non-EMS people out there, is 80-120. So, she really didn't NEED insulin to begin with. But she was getting a little "lightheaded," so they decided to dose her.

Unfortunately, they filled the syringe to the .9 mark... which is 90 units of insulin... not 9.

I grabbed a jump bag out of our truck and asked where the mother was.. expecting (I know, fool that I am) that she would be in their car or somewhere in close proximity. No such luck. They had left mom at home, loopy and alone. It is still pretty much a mystery to me why some of our more esteemed citizens cannot muster the grey cells to pick up a phone and call 9-1-1 instead of making a 20-minute drive, all the while forgetting to actually bring "momma" with them to get help. But I digress.

Insulin is a wonderful drug... when you give the prescribed dose. Give someone 10 times that dose, and they're going to be seriously swirling the drain in a matter of hours... death was almost a given, if not treated.

So, I scampered around the station looking for my long-lost partner (who was out fishing in the man-made pond behind the station), and armed only with the street name (they hadn't been too clear on the address), I radio'd in to dispatch that we were headed out to that neighborhood, and what the circumstances were, much to the amusement (and bewilderment) of the dispatchers. Fortunately for us, the street was a VERY short one, and we quickly found the family gathered on the front steps.

"Mom" protested that she didn't want to go to the hospital, and then promptly collapsed, which kind of made the decision for her.

After we got her into the truck, her blood sugar was 55 and dropping like a rock. Glucometers stop reading under about 25-30. I've seen patients following the little animals and/or exhibiting signs of a stroke at about 50. So this was a Big Deal.

I pushed a tube of REALLY nasty Glutose into her mouth, and told her to swallow it, and that raised her blood sugar to about 60... so we gave her a bolus of diesel and got her to the hospital before she bottomed out. It killed me that I had an amp of D50 3 feet away in a locked cabinet, and couldn't get at it... even though I was an ALS provider for years in the '80s and '90's, I let my certs lapse, and am just finishing retaking Intermediate school... so I'm not released as an ALS provider yet, and probably won't be until June. UGH!

Anyway, we arrived at the hospital, the incredulous staff promptly juiced her up, and she was fine... but it was one of those rare moments when you know that a call could have gone WAY the other way. I got lucky. This time.