Working at Big City substation, barely settled in, and the tones went off:

*Eleven respond, area of 15th and 5th; Elderly female fallen, bleeding from the head*

We get in the truck and head up the avenue.

*Eleven update: Subject is walking down 5th toward 14th*

We both shout, to nobody in particular, “STOP HER!” Traffic is bad, and as usual, nobody pays attention to our lights and siren until we’re right on the back bumper.

*Eleven: PD is on scene with the subject. They’re asking that you step it up.*

We pull up and see two officers, standing with a little old woman. I do a little scene size-up:

“Holy S%^t, it’s a F#$^ing bloodbath!”

Yeah, that about covers it. This poor little old woman is standing there, looking like a murder victim.  She’s got a big avulsion over her right eye, and the flap involves her upper eyelid. Her eyebrow is hanging down by her earlobe. The bleeding is pretty slow, so I assess her mental status.

“I was just foolish. I shouldn’t have tried to come down that hill. I fell, then I gathered up my things and kept walking. I don’t think I’m hurt. I’m not in any pain or anything. See, I think I fell on a dead animal or something. There’s something on my face…”

We gaped at her.

I put the flap back in the area it was supposed to be, put a couple of 4×4 over it, and secured it with rolled gauze. I got her loaded on the cot and into the truck, checked her vitals (all normal), started an IV, drew blood, and called it in. She told me about how she had never had any alcohol to drink, except “Once, in about 1970, I had a cold, so I went across the street and had an martini.”

She was a sweet old woman, and she never did complain of any pain. She was good experience for the new nursing students, too… =D

They actually left us alone much longer than usual. I was able to take a nap for a couple of hours at the beginning of the shift.

Then, around 3am, the tones dropped, for a 31yom, c/o difficulty breathing.

Arrived and walked into the house, and it was like being hit in the face with a Jamaican pillow. The patient was sitting on the couch, leaning forward, breathing a little heavily. Partner says, “Let’s just get this outta the way first. How much dope have you smoked tonight?”

“I just smoked one, man…” (One? One what? I had a roommate in college who fantasized about smoking out of a tuba. Did you have one tuba-full?) “I dunno man, I just had one.”

He said that he wasn’t having trouble breathing, but that he was anxious, and that his mouth was dry, and his heart was pounding.

While I was processing this info, his roommate came in and offered us “a beer or something?” Yeah, we declined.

The guy was pretty agitated from the outset, but we managed to get him calmed down enough to get a set of vitals and get him to the truck. He got worked up a little more in the truck, but I got him settled down again. I told him, “I’m not leaving you alone, but I have to go right behind you here, to let them know we’re coming. If you need anything, or if anything changes, let me know, okay?”  He was okay with that, so I proceeded to call in my report.

About halfway through, with no warning whatsoever, the guy just comes totally unglued.

“WWWAAAAAAAAAHHHHHHHHHHHHHHHH!! WHY AREN’T YOU HELPING ME??!? I’M DYING! I KNOW I’M DYING! I CAN’T BELIEVE THIS IS MY LAST DAY!!!! OH, I HOPE MY BUDDY CALLED MY MOM!!!”

…and through it all, he’s beating himself about the head and face with his fists.

I still had the mic keyed while all this was going on, so I said, “…aaaaaaaaand we’ve got THIS going for us, too.”

Three minutes later, when we arrived at the ED, security guards had appeared, as if by magic.

It was set up like a “Toughman” contest. Three rounds at a minute apiece, with sixteen-ounce gloves and headgear. Amateurs with 16oz gloves is like a pillowfight. There’s not a whole lot of danger of serious injury. The only patient I had to examine was a first-time fighter who drew a gym owner as an opponent. He just got his bell rung a little.

One fighter came up to me and said, “I think I’m confused”.

“YOU’RE confused? I don’t take any great pleasure in hitting people, and I SURE don’t enjoy being hit! I’M the one who’s confused!”

Not a very eventful shift at General Hospital Southside substation.

We started out the shift with a call to the local warehouse for Big Retail Catalog, for a patient with a possible broken nose.  It turns out she had been working on the line, and a plastic tote had fallen from the conveyor, landing pretty much square on her nose. A lot of blood, but she was in good spirits, considering.

We got some dinner after that, then went on a DOS. Nothing exciting.

After work, I had to go straight to Hometown to work until 1730, which is where I am now. I’m going to take a nap.

The baby was on the kitchen counter, and everyone was just looking at it. That’s what I saw when I ran into the apartment. We snatched up the baby and ran, with the mother wailing after us.

A few minutes earlier, the call had come in for a 3 month old, not breathing, and my stomach had turned over. I’m the paramedic, and I’m less than comfortable with pediatrics. Everyone has a weak area, and that’s mine. EMT-Basic, EMT-Intermediate, Paramedic… I’ve always felt weak in peds. I offer up a silent prayer.

In the back of the ambulance… No pulse. No BP. Mom is in the front passenger seat, and my driver is talking soothingly to her. The baby has been down for at least twenty minutes, and probably more. Shit. There’s still a little warmth there, even though the monitor shows asystole.

We’re going to work this kid.

Dave, spike a bag, and I’ll look for a vein in his scalp. Never mind a vein… the IO kit is right behind me. Prep the site with alcohol, betadine, betadine… Insert the needle, push and twist… *pop* and I’m in the marrow. Try to aspirate some marrow fluid… nothing, but that doesn’t mean anything. Try to flush it. It’s difficult, but it flows with no sign of infiltration. Good.

“Mom, what does he weigh?” “Fifteen pounds,” she says. “Is he breathing?” “We’re doing everything we can,” I evade. Mental math… Half 15 minus ten percent is around six and a half kilos. I push 0.6 of epi and flush with about a 50cc bolus. Continue CPR. I have a minute to breathe now. Consider intubation… No, we’re getting good compliance with mouth/mouth, and he’s pinked up a bit, I think. Nobody has bothered with PPE on this call. You make sacrifices. I check the monitor again. Nothing but CPR. I pray for a spark, a blip…

I’m getting ready for atropine, and we’re at the hospital. I grab the baby in one arm, the bag of saline in the other hand, and run. They’re ready for me. They take over, and I’m left holding the bag. Literally, I’m standing there holding up a bag of saline as they take over CPR, and I give my report.

“He’s been down a minimum of 35 minutes at this point. No pulse, no BP. We’ve had good compliance and chest rise with rescue breaths. He’s fifteen pounds, so I make it 6.5 kilos. IO seems slow, but it runs. I’ve got about 50cc’s in. 0.6mg of epi in, about 2 minutes ago.”

The doctor gives another round of epi, then atropine. After a while, he asks if anyone sees any reason to continue. No one does, but no one wants to stop, either. Finally, he calls it. I realize I’ve been clinging to my bag of saline like a life preserver, and I lay it down on the edge of the bed. I take my hat off, and we all cry.

I’ve gone over the call a hundred times in my head since then, trying to think of something I missed; some way I could have forced a spark back into that lifeless little body, but the fact is, I did everything I could. I was afraid of pediatrics, but my training didn’t fail me. He was just too far gone. I didn’t freeze up or freak out. I did my job.

It’s payment, really.

The bad calls are the price we pay for getting to pat each other on the back and congratulate one another when we make a save. One bad call can sour a whole string of saves , and one save can redeem a string of bad calls. It just depends.

I love my job. I love the excitement of the emergency calls, and I love the predictability of the routine transports to and from dialysis. I derive a little bit of joy every time I start an IV or run a 12-lead, and every time I ask a little old lady if she’s warm enough and she says she’s fine. I hurt when my patients hurt, and I’m happy when they get some relief.

Really, I’m a lucky, lucky man. Maybe later I’ll tell you all the reasons.

I’m going to plant a tree for the little boy who died before he got a chance to live.

It’s interesting to look back and see what my perspective was at the time, and see how it’s changed.

As I said in my first post, I work for three departments. For the sake of anonymity, we’ll call them Hometown, Podunk #1, and General Hospital. Hometown and Podunk #1 both operate a single truck on a paid day shift. General Hospital operates three stations with a total of five trucks at any given time. They share the town with Hospital #2, and the two services alternate substations on a weekly basis. It’s kind of a cooperative competition. Both services deliver patients to both hospitals, at the whim of the patient.

Anyway, last night, I was at Southside substation from 8p – 8a. I got in around twenty minutes early, and I was waiting on my partner and shooting the shit with the outgoing crew, and the tones dropped. I said, “I don’t care which of you goes home, but I’m taking the call.” After a quick debate, Lisa stayed, and Michael went home; he wasn’t feeling well.

The call was to the drunk tank for a male pt c/o chest pain. Eyes rolled, and off we went. The pt was about 50, and denied any chest pain, but was complaining of dyspnea. He was also complaining constantly about the arresting officer.

“He din’t have any righ’ to talk a me like tha! He said I’m wastin the taxpayers’ money! How ’bout the taxpayers is wastin MY money? I got five honabul discharges! World War II veteran! I got a real bad heart!” (The dude is 50, remember?)

We were assisting him to the cart, and he told me to be careful of his elbow. “It’s real tore up!” I took a peek, and was surprised to find a decubitus ulcer about two inches across, right on the point of his left elbow. In an otherwise healthy 50 year old, my mind immediately screamed “NECROTIZING FASCIITIS!!”
We got him to the truck, and took him to Hospital #2. On the way, it was IV, labs, O2, Monitor. By the way, despite his claimed heart problems, his strip looked like a textbook example of NSR.

I was about halfway done with paperwork, and the tones dropped again. “Single vehicle rollover; two patients; minor injuries”. Lisa looked put-upon. I tried to get her to go to the call by way of the station so we could pick up my real partner and she could go home, but she refused. “I knew what the business was like when I got into it.”

We got to the scene and found a car, sideways in the road, propped up on a fence post (…and me without my camera!). There were about thirty firemen, and two dazed-looking kids, sitting on the back bumper of the BRT. Both of their parents were there, neither was hurt, and we got refusals from both sets of parents. The one was more concerned about the welfare of his guitar than his own welfare.

Clear scene and back to the station. We had barely backed in, and toned out again. “69 year old male, confused”. Lisa jumped out and Jamie jumped in, and away we went. We arrived to find an old man in bed, and two concerned neighbors. The patient looked a lot like Santa Claus after a three-day bender.

He couldn’t tell us what was wrong, but he didn’t know what day it was, and the month, he said, was “about medium”. His vitals were all reasonably normal, although he was a bit warm. The skin of his legs suggested diabetes, and his BGL was 148. His lips were dry and cracked. We were thinking it was a BHU call, until we saw the pile of newspapers outside his door. he neighbors said he gets the newspaper every morning, but they hadn’t seen him in about four days, so they came to check on him. He said his last oral intake was breakfast, “With this morning’s paper”.

So. No food for around four days, probable diabetic history, a low fever, and a BGL of 148. Ordinarily, I’m happy to see 148, but when you haven’t eaten in almost a week, 148 is pretty high. Jamie and I agreed that sepsis was likely, and dehydration was obvious, so we ran fluids from the scene back to General Hospital. Santa Claus was admitted, and is currently getting through a course of antibiotics.

The remaining calls were, from a clinical standpoint, nothing special. We were on the sofas by three, and up again at seven-thirty with no interruptions in between. All in all, a decent shift. I’m back again tonight with a different partner, so we’ll see how that goes. Cheers!

I never considered going into public service when I was younger. I was more interested in the latest scheme to get me rich without much work, or at least get me comfortable without killing my soul. I worked as a fireworks peddler, a liquor store clerk, a factory worker, a pizza driver, a telemarketer… You name it, I tried it at one time or another. It was all much much less than satisfying.

Then, in 2005, I was thrust into a position I wasn’t prepared for. My parents were in a bad head-on collision, and I was amazed at the First Responders and EMS. There they were in the rain, in the middle of the night, and they knew what to do. I took it all in, and filed it away for later.

A year later, I was approached by the Mayor of my hometown, and asked if I would be willing to take EMT training and volunteer with the local EMS agency. The light bulb went on, and I agreed. I took to it quickly, and finished the class easily. I started running with the volunteer squad, and gained experience. A year after that, the Chief asked me if I’d like to become a Paramedic. I knew it would be challenging, but I jumped at the chance.

Fast-forward to the present, and here I am. I work as a medic with three departments, and I have stories.

Oh, do I have stories…