Foxx's Journal
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Tuesday, January 5, 2010
I went, I experienced, I ran like hell.
I hope you had a good New Years. I'm willing to bet, it was better than mine.
Here's a day by day recounting of my trip.
( Read on. . . )
Tuesday, July 28, 2009
Allow me to share with you a story.
So there I am; dutifully doing a clinical/intern rotation in one of the more 'remote' (Read: Rural) agencies that we were offered the chance to ride with. My goal here was to see how things worked outside of the "big" city, in a place where your average patient transport time was about an hour.
As the morning progressed, and we saw a few patients. After the first few, I had a tremendous personal "EUREKA" moment. Turns out people are people, no matter how far from the city they may be. Their problems, anxieties, and fears don't really change. So much for country living.
But this isn't a story of one young mans journey to self enlightenment. There will be no "coming of age"-ness to this tale. No. This is a story instead, of how I was almost murdered by a platoon of US Special Forces.
Dispatched to an allergic reaction, at a factory on the outside of town. So there I am, a guest in this foreign county stuck in the back with the only view to the outside being what I can see through the side-door cut out, and the back doors. As we were racing down the road (Dispatch felt this was 'bad', and told us so.) I offhandedly made the remark to my preceptors in the front seat. "Good god is that a lot of razor wire." For that's what I could see. At least a mile of razor wire, on top of a 12 foot high fence in front of this otherwise unassuming forest. "Heh." was the answer I got from the front seat. Slowly our ambulance decellerated and took a turn into the razor wire. Peering up between the front seats, I saw that we were driving into the razor wire. Or more accurately, a security gate cut out into the razor wire fence. As we drove past the automated doors, I turned and noted that the people at the gates were wearing camo uniforms and carrying assault rifles. "Oh, fuck" I would have said outloud had I not at that moment turned to look once more out of the front of the ambulance. My mind need a moment or two to adjust to what it had seen. Slowly it began filtering in information, albeit in a random and abstract order. Some of the more obvious fragments: Armed Escort, Massive Factory, Army Minesweepers, A lot of Army Minesweepers, Soldiers on Parade, Driving Into The Hanger, More Minesweepers being assembled, More Soldiers, Backdoors being opened, ASSAULT RIFLES, SOLDERS WITH ASSAULT RIFLES, LOTS OF SOLDIERS WITH ASSAULT RIFLES.
And other such nonsense. I was far too focused on the job at hand to even notice anything other than what was... oh who was I kidding. I stepped outside, told the soldiers what needed to be unloaded, and then looked around the inside of this massive 433,000 sq/ft factory. (I verified the size later.) So we were lead to the patient (Himself a uniformed soldier, if you sense the theme), who was exhibiting acute/albeit non-life-threatening symptoms of Montezuma's Revenge. Or badly reheated mexican food if you want to be more specific. And not say, an allergic reaction. So without even thinking, I did my thing. Kneeling on the floor before him, talking to him, assessing, etc. Just like I'd been doing it for years. (And at this point, I think I have. I'd have to actually count days.) But as I was talking to him, my spider-sense was tingling and so I looked around. At the ring of soldiers, all protectively encircling their stricken comrade, and glaring at me. Like I mean, Glaring. Like, "I haven't eaten in 6 days because I've just crawled down the desert mountains on my belly with only a knife to fend off the wind, dust, rocks, and scorpions and you are holding the last steak for 12 miles." Glaring. I looked the emblem on their shoulder, some fancy schmancy stylized "AA" sort of thingy. I think it also said something about 101 such and such. *shrug* And then I looked at the emblem on MY shoulder. "paramedic STUDENT". Suddenly, the whole concept of "scene safety" took on a whole new meaning. And I was shaken badly by this whole scenario. Truth be told, I was actually scared. (Reminder: Edit out that part later.) So I did really all I could to turn the odds in my favour. "Can we take you to the hospital, please?" "Sure." "Great." Stood up, stood back, and let the fire guys do their thing of getting the patient on the cot and outside to the ambulance. As I was walking out, this very large, immacuately coiffed, and very very NOT humorous looking man steps in front of me. I can reasonably guess that he at one point in his life, or another, probably bit the heads off his sisters Cabbage Patch dolls and left the severed bodies laying around because he enjoyed hearing her tortured cries. That sort of humourless. "May I come with you?" Says he. "Yes sir, you may." Say I. Then some hidden aspect of training kicks in. "But you'll have to ride in the front." Says I. "I will end your life impudant man" Says he. Well, not really, but if a grunt could say a thousand words... those would be in there.
So there I am pushing the stretcher through this very large hanger, surrounded by soldiers. Some armed, some not, with one of their own in my STUDENT care.
The rest of the call unfolded in typical Fold A into B order. As I was making my usual cheesy small-talk while starting a large IV into the patient, I made mention how unsettling it was for me to have been in there; being a resident alien and all. He smiled, and said he understood completely.
He was also Canadian.
Friday, May 15, 2009
This will be the record of one of the most memorable calls of my life, and one which I will carry with me throughout my career. I know, I know. I've said that before. And each time I was telling the truth! This one will be no exception.
And it all started off so innocently.
( Read more... )
Wednesday, March 25, 2009
So.
40 y/o M with complaint of heart palpatations and dizziness.
Found laying on the couch. Cyanotic, Diphoretic.
Patient endorses a long, complicated cardiac history. Has an implanted defibrilator.
Is not able to say what long term diagnosis was made, because one has never been made. Does say that he has history of going into V-Tach for reasons unexplained. My impression is that both him and his wife are very intelligent, and so am willing to accept what they both say as the truth. (As they understand it.)
Is in exceptional physical condition, and in an exceedingly affluent neighbourhood. Used to run Boston Marathon's until about 15 years ago when this heart issue started.
Called EMS this afternoon after being woken up by a 'fluttering in his chest'. Defibrilator has not gone off today. Says it's keyed to go off when his HR reaches 130+. We're clipping along at 128 currently, so I'm moving all metal objects away from him and making sure my stethoscope doesn't dangle.
I'm one of two basics, and one medic on the call. Medic is content to stand in the back of the room and let me play. We've got an engine company rearranging furniture, holding the wife's hand, and getting all our Bio.
Leads going on, LP12 coming online, I'm absolutely dreading what the 3 lead is going to show. It comes on the monitor, and I double take at it. It's an organized rythm, SA in origin, with wide and ungodly looking QRS. I blink at it, and turn to the medic and mouth "What the *fuck* is that?" She's got the same expression on her face and mouths back "I don't know."
12 lead placement ongoing, and I pull off a strip of the 3 lead to look at. Consider glasses, but then realize that it is in fact just that bizarre.
Tilt my head a few times, nothing coming to me. Ask the patient a few more questions about his V-Tach, and to make sure he's still alert while I'm doing this. Also trying to work out in my head the things that tend to morph into V-Tach. He is. Just my B partner is giving him the "We're about to do a 12 lead" speech, I've finished deconstructing the pathway in my head. I don't think I actually said "Eureka!" out loud. In fact, I'm fairly certain what I said in fact was "Holy shit, there it is." The reason it looks so bizarre is that the delta waves start marching up almost immedieatly after the T's, which are inverted. It looks more like an army of snow-cones than an actual rythm.
The LP12 starts its analyzing algorythm and I turn to the patient and start asking him a whole bunch of new questions. "Has anyone ever mentioned WPW? Or said the word "Wolf" around you when discussing your heart?
"No." Says both the patient and the wife.
By this time the 12 lead strip is coming off, and is immediately snapped up by the medic. (Who's no longer at the back of the room)
"Wow, great catch." She says.
And on the 12 lead, it jumps right off the page. There be Delta's in that there P-R interval.
And in something that nobody I've talked to has ever heard of before, the LP12's "Man in the Box" prints neatly at the top
"Sinus Tachicardia"
"Wolff-Parkinson-White"
At this point, we all co-ordinate the "Let's get the hell out of dodge" dance, and are out the door in about 3 minutes.
The ambulance tears out at Code-3 while we all hope the guy manages to maintain till he gets to the ER.
As it was my turn to drive the 'Medic car, I don't know how things shook out on recieving end. But when I arrived he was in the acute cardiac bay with people swarming over him. I walked up to his doc later and asked about the diagnosis, and treatment. "Are you the one who saw the WPW?" "Yessir." "What would you have done for him?" He asks, not answering my question. "Nothing in the field. Once here, you're going to have to try to shock out that rythm and force the current back down into the AV node and out of the Kent bundles. Long term? Probably electro-radio-whassitcalled to try to sear out the conducting pathways."
The doctor gave me that stern look, fixed his glasses a bit, then turned and pointed to the chart on his computer screen.
And 'lo, the patient was scheduled to go have radiofrequency catheter ablation, or something similar.
I was pretty hard to be around for the next hour or so as I did my little dance of joy.
Monday, March 16, 2009
So, yes Virginia, he is still alive.
I won't say that I've forgotten this bloggy-thing, but I will say that with everything happening this is one of the lowest priorities. Sorry. You know I still love you right?
Currently I'm juggling, in no particular order. 1 E911 EMT-I job, 1 E911 EMT-B job, EMT-P school, EMT-P clinicals, Appropriate Study/Research papers for previous, Various Con-Ed requirements, 1 Marriage, 3 Cats, 1 New house (Our first), 4-5 hours of sleep, 1 WoW raiding character (That's Mr Twilight Vanquisher to you). Add in eating, and well, there's not a lot of time left in the day for things like my once-faithful readers. If I had some way of just beaming updates from my brain, without having to sit down and type/edit/format stuff at an un-mobile computer terminal, it'd be a ton easier to do. Donations will be accepted for the buy me a laptop fund! I keed. I keed.
Another throttling factor, is the current discussion on the ethics and legalities of blogging. Let's face it, I hold a position that has a ton of legal, ethical, and moral responsibilities. I come into your house unannounced, in your time of need, having been woken up after 20 minutes of sleep, and become more intimate with you than most people in your life. Then, after 35 minutes, I walk out of your life forever...we both hope. We also have a responsibility to our profession to educate the public as to what we do, and to encourage trust in us. If I'm on here writing derrogatory comments about all the stupid I see it could be construed as demeaning of my profession, breech trust, undermine the fabric of society, and cause my great grandchildren to have to carry the weight of the lawsuit. Or so I'm told. As of yet, I've no hard and fast 'thou shall not''s from any of my employers.
So, I can write!
Fortunately, this last week has provided numerous moments of complete and utter sublimation that just must be shared.
Words of EMS Wisdom: If your shift starts at 6am, and you are doing CPR by 7:30am, it is a *bad* day.
( The storiez )
Friday, January 9, 2009
Found while reading my various EMS Blogs and Periodicals. It's not my writing in the slightest, but since I've been sort of kind of (completely) neglectful in updates - the least I can do is to provide you with something in lieu of my own laziness.
Stolen/Borrowed with love from http://roguemedic.blogspot.com/
(Start shameless copy)
Once upon a time, in an EMS system far, far away, there was a brand spanking new medic. No, I did not spank him, but some others did. This is the story of how they were wrong. A story of how they were the ones, who needed to be spanked.
In this system, the medic is all by his lonesome, in a fly car, in the middle of nowhere. Our hero, Spanky, is brand new as a medic, is not familiar with the area, and has not even had a real orientation to the system. In other words, this situation is just made of WIN!
In this moderately busy system, there are 911 calls. Dispatch sends out the ambulance and medic for the particular location of the call. So far, so good. Spanky is dispatched, not to his own territory, the nowhere that he does not even know his way around. Spanky is dispatched to the next medic's territory, a whole different nowhere, a nowhere that he did not even know existed prior to being dispatched. This nowhere is between 10 minutes and 20 minutes away. That time is assuming that one proceeds directly to the location.
Spanky is driving like he is at Daytona, because that is the way he sees other medics driving. He is reading the map at the same time, because that is what the other medics do, too. Texting while driving would only improve driving ability, here. Spanky is kind of lost, but after some assistance from dispatch, he does arrive on scene.
The dispatch was for cardiac arrest. This is back before the concentration on not interrupting compressions. The main reason for a medic to drive 10 - 20 minutes to a cardiac arrest is in case the person turns into a vampire. The medic is the only one authorized to drive a stake into the vampire's heart. It is an invasive procedure, after all. Hospitals become upset if ambulances transport vampires without staking them, first.
Spanky arrives, parks, grabs his gear, and goes to the ambulance. The ambulance is sitting there, lights flashing, maybe the siren is also on, and the driver is sitting in the driver's seat, ready to go. Spanky opens the doors to the back of the ambulance, where the patient is. As soon as the door closes, before Spanky has a chance to grab a seat, a history, a patient assessment, or even to catch his breath, Ricky Bobby takes off.
Now, to properly understand the benefit provided by Mr. Toad's Wild Ride, while you are reading, you should bounce up and down and side to side, occasionally throw yourself into the wall. If no wall is handy, throwing yourself off of a balcony might be a reasonable substitute. You should imagine that you are trying to deliver patient care, while this is happening. I even tried to type this post, while using this method, but I crashed the computer.
(End Shameless Copy)
Remember folks...Stake your own vampires, and let us sleep.
Tuesday, November 11, 2008
To those who left their home, their families,
I remember.
To those who never came home,
I remember.
To the men and women who swallowed the terror in their hearts to fight for me,
I remember.
To those caught in between,
I remember.
For innocence lost,
I remember.
For those who suffered through atrocity and persevered,
I remember.
Thought I have been called to duty away from the land my family gave their lives for,
I remember.
For my grandmother, and my grandfather,
I remember.
For those who continue to make the same sacrifices,
I remember.
I do now, and always will, remember.
I will honor your sacrifices, and love today, tommorow, and forever.
My children will be raised to know, understand, and love you through the stories and pictures of your sacrifices.
On this Remembrance Day, and all those to come,
I will always remember.
For those who do not, will not, or can no longer,
I remember.
Thank you.
http://www.youtube.com/watch?v=f4NZsD0zjAQ&feature=related
Wednesday, July 23, 2008
1:30am, dispatched out to the middle of nowhere for an abdominal pain call in a female of advanced age. We'd already been running pretty hard, this was our 4th call since coming on shift at 6pm. They teach you in school that "All abdominal pain in a female is pregancy until proven otherwise." Personally, I hold a different standard. If she's got osteoperosis, I'm not ruling *in* pregancy for any call other than "Hip Fracture". So we get there, saunter up to the door of this very. Very. VERY rural farmhouse that was built circa 1867. I swear to god, there were banjo's backing up the crickets. For serious. Entering to find a husband and wife, both well over 70, sitting around a black and white TV with an antenna with I Love Lucy on. Both of them had been partaking in the sauce this evening. Patient had been having pain for well over a week, but just decided at 1:30am on a Friday night that it was just too bad to live with. (By the way, we love that. Tell it to us everytime you see us "I've had this pain for a week...". I guarantee you'll get the best customer service like that.) So my partner is talking to the patient, and I'm talking to the husband trying to get an idea of what's going on and what sort of medical dealings she's had in the past. The following is an exact recap of that conversation. The punchline is in there, I promise. But, like my osteoperosis crack you need some sort of medical knowledge to 'get it'.
Me (Who after 12:30am tends to get more than my usual level of terse): Can you tell me what she's been in the hospital for in the past?
Husband: Who? Me?
Me: No sir, your wife.
Husband: Oh.
Me: Well?
Husband (Drunken countrified accent): Well, I tell ya what her doc's told me.
Me: Please.
Husband: (Motioning me closer) Well, her doctor said she's got a problem with her heart.
Me: How so, sir.
Husband: Well, he says it stops working for minutes at a time.
Me: (Getting nervous, and flipping on our lifepack with my toe) When was the last time this happened?
Husband: Oh, it's not a problem son.
Me: (Holding a package of Defib pads) How is it not a problem, sir. Does she have a pacemaker?
Husband: Naw, no need. Doc says her liver takes over pumping blood. So if you see her stomach jumpin' up and down, it's okay. It's just her liver working as her heart.
Me: . . .
Friday, June 20, 2008
One of the hardest parts of the job is inevitably, dealing with the patients themselves. I can teach anyone to start an IV line. I can teach anyone the algorythm to use to save someone's life in cardiac arrest: and then drill them till it flows on an unconscious level. How to load, lift, and carry a stretcher? Absolutely. I can teach you what drugs you need to administer "If you see this...". What I can't teach you, what in fact anyone can't teach you, is how to actually talk to and empathize with a patient. Someone who's unconscious or barely conscious? (Or dead for that matter.) No problem. But when you've got a living breathing person, with their own idiosyncracies; (I never claimed spelling was something I'd mastered yet.) you're in a whole other world. See, the brain is a wonderously fantastic little device. It, as you may know/suspect, regulates your entire state of being. Some on a conscious level, most on an unconscious level. It can kill you just as easily as it can keep you alive. So one of the chief aspects of therapy that we have to bring to the table is that mystical 'bedside manner'. Like it or not, to your patient, something is wrong enough that they (Or their friends/family) felt it necessary to activate the emergency system. We have the responsibility of seeing people at their absolute worst, at their most urgent time of need. And in those times, it's up to us to help them. Sometimes that means providing the appropriate treatment and medication, sometimes that means simply holding their hand and listening to them. Sometimes of course, it also means playing straight shooter and reigning them in using blunt force logic and reasoning. It's probably the hardest part of our job, and it's something that you can't teach. You either have it, can develop it with practice, or have no hope in hell of ever being good enough with people to help. There's another category for those who are close to or burnt out, but that's another chapter. I'm blessed enough to have this ability innately. I've come a very long way in EMS in a very short amount of time exactly because of this. By nature we have to be good at identifying people's personalities, and we always know who can and can't handle people at their time of need. See, it doesn't matter what *WE* think, we're not the ones who called 911. We're not there for ourselves, or our paycheques, we're there for the person who dialed 911 asking for help. I make less than $11 an hour. If I was only concerned with money, I could make more at Best Buy - with better hours, less stress, and less strain on my family. But then, I wouldn't be fulfilling my own personal goal to leave this world a little better place each day. Not many people who push high end TV sales can really make that claim in seriousness. And if you catch someone who does, please give them my phone number. It's pretty easy to remember. 911.
Monday, May 26, 2008
Most EMS workers will go through their entire careers without doing it.
Many will try, but the odds are infintesimal at best.
And yet, the other night while working on a 12 hour clinical shift (That went 15.5 hours) I happened to accomplish what many won't.
What's that?
Well, you'll have to read on; won't you.
It was a clear and stormless night. . .
Wednesday, April 9, 2008
The following is slightly different from my normal format, but I felt it was powerful and important enough to include as it does have some interesting perspectives on it as to what it means to do EMS, both the good and the bad.
It is a copy of the narrative I submitted following my most recent clinical rotation at one of the local hospitals. As part of my training to go to the Intermediate level, we are required to put in a certain amount of hours in various places in the ER.
This narrative was generated for my most recent Critical Care Unit shift.
Sunday, March 16, 2008
Here's a brief list of things that you need to know, and memorize, before even stepping foot into an ambulance.
Thursday, March 13, 2008
Chances are, most EMS/Fire folk can and will frequently beat you around the head and make your life seem meaningless, dull, and insignificant in light of the 'bad days' they can have.
Here's a little pearl to help bring your own day into perspective. Free, as it were, to my LJ readership.
On shift at 7am. Dispatched at 7:03am (After starting the coffee maker working, alas) to a call at a local skilled (!?!) nursing home.
By 7:14am I was inspecting 88 y/o bleeding vagina.
Yeah man, that 8:15am unexpected meeting must suck.
I'm totally in agreement with you.
Wednesday, March 5, 2008
2:07PM
The Good, The Bad, The Incomprehensible.
An EMS Rookie's Perspective: Volume II
Last time I wrote, I managed to somehow make a full 12 hour shift sound interesting, fun, and jam-packed with amusing facts. Going forward I knew that this wouldn't be a format I'd be able to keep going forever. The fact of the matter is, we're zen masters of the art of "Hurry up and Wait". Depending on what service you work at, you may get anywhere between 2 and 10+ calls a shift. So if you consider that a typical call depending on the level of "Pucker Factor" (think about it, it'll come to ya. I've faith.) may get turned (This is me working on my street cred by using regional lingustic shortcuts. Word.) in between 15 and 60 minutes, well... that leaves a lot of time over the course of a shift. And as decent a writer as I am, you'll forgive me; but I just can't make 10 hours of sitting around a station polishing fire trucks (Apparatus, sorry) sound interesting.
So, what I plan to do going forward is to let the 'good ones' accumulate, till I get about 3 or 4 that I can then throw out.
So why am I writing this?
Because!
Us vs Them vs Us vs Everyone Else.
There are a few rules of engagement in EMS. One of these, is that everyone on a truck is convinced that those in the Dispatch center are only working there between shifts at McArby Bell. To be fair to my dispatch readers, the converse of this is also true. They are convinced that those of us on the trucks are only working there between shifts for environmental services at the nearest hospital. The main crux of the frustration and mutual resentment is that on the road, we are entirely dependant on our dispatchers. To tell us where to go and what's going on. We're cowboys. We like doing the wrangling. We don't like being wrangled. We also don't like having to repeat ourselves. You'd likely be shocked to know how often regions go without coverage because someone in a dispatch center didn't hit a button to put a truck back in service. For example: "Medic 98 is clear and available." "Copy Medic 98, show you clear and available" Okay. Now this seems like a rational, reasonable exchange of terse information. Absolutely 100% sufficient to get the job accomplished. Now, when you hear two hours later, "Dispatch; Medic 98." "Go ahead Dispatch...." "Medic 98, why aren't you cleared from your last call?" It is at this point that you become very proficient in the art of speaking at the radio, without depressing the push-to-talk button. But what's worse than that, is the complete lack of relevance our dispatch information either is, or isn't. "Medic 98 respond to Blahblah for 48 year old Male with fractured extremity and hemmorage." Okay. So, you're up and out of the station, rolling down the road. You think to yourself you've got a great idea of what to expect. You're going to roll up. You're going to find an older dude. He's going to have a broken arm/leg. It's going to be bleeding. No problemo. The reality is; you roll up. Find a 9 year old with his hand stuck in a mason jar, crying, and hysterical, while his dad tries his best to reassure him. While holding a hammer. "Oh, thank goodness you're here." Says the hammer wielding parental unit. "I was just about to break the jar." "Uh sir, we were told that there was a 48 year old male with a broken arm, or leg or something. And blood." "Oh heavens no, I said I wanted help because I was going to have to break the jar around my son's hand and was worried it'd cause bleeding." ". . ." That's an example of information irrelevant by its presence. My personal favorite. "EMS Report. Medic 98 respond to YYZ Mega Computers at Blahblah Rd. Cardiac arrest. Unknown patient. History of previous cardiac events. Response code 3"
My brain just about emerged from my head carrying an umbrella, a suitcase, and a one way ticket to Maui when I heard that one. So let's see. We know that someone, somewhere at this industrial complex the size of Haiti, is having a cardiac arrest. We don't know whether it's a male or female. We don't know his/her/its age. We don't know his/her/its race. But we do, somehow, know that his/her/it has a previous history of cardiac arrest. To this day I don't know how you end up with some pretty specific past history on a patient without knowing which restroom they use, or a relative age. And things like this, are common. Very. I'll leave it up to the dispatchers to respond in kind. I'm sure we do some seemingly idiotic stuff too. But I'll let someone else defend them. Me? I want to go home close to the end of my shift tonight. So I'll be sure to tip you next time I see you at McArby Bell.
License and Registration, Ma'am.
It's about 20:30. Me and my partner were scheduled to get off at 19:00. But, because of a transport to a nursing "facility" that had to be done, we ended up in some extremely rural area about 50 miles out of our normal coverage area. Clearing from our drop off, we get a "request" from dispatch to head back inside because they've got a problem with a patient and would like an evaluation. We're so far into overtime, we don't even care anymore. Sure. We go. We do our thing. And 30 minutes later we head back outside to our ambulance to begin heading home. Walking up the hallway to the entrance, we come across.. a wheelchair. Empty. Sitting by the door. We stop. Look at it. Shrug, and keep going. Now, before I go on, I need to point out that it's very common for us to leave ambulances running while we're inside doing a call. In a business where seconds can matter (God I love being able to be justifiably dramatic!), not having to wait for the glow plugs, or power system to fire up, hey..it adds up. So we're walking out to our ambulance and see the passenger door open. We approach, now pretty on guard, and find this elderly woman sitting in the passenger seat looking at us in desperation. After a few minutes of explaining that no, we can't take you, I head back inside to find one of the CNA's, or RNs, or LPNs, or whoever she was that happened to draw a certificate out of a Cracker Jack box and applied here. I find one, a young woman flipping her hair in the reflection from a photo of the founders of the facility and informed her that one of her charges has not only escaped, but has taken up residence in my ambulance. "Oh, well that's not my responsibility." "I'm sorry, I thought you worked here." "Oh, I do. I just don't..wait, did you say a patient of ours is outside?" "Yes ma'am. That's what I said." "Oh my god." And she goes scampering off. A few minutes later, an alarm goes off (?!?!) and a posse comes out to the ambulance and pretty much drags our would-be stow-a-way back inside. Stopping long enough to plop her into the empty wheelchair (Ah-hah!). As we sat there observing this surreal moment, the woman turned back to us with venom in her eyes and spat out, "I hate you." as she was dragged back into her facility. Throwing protocol to the wind, I lit up a cigarette and looked at my partner. "So, was it good for you?"
Cross your I's, Dot your T's, and Don't forget to pack your Head.
I had a very rough Christmas. Being the rookie, naturally, I get the crap shifts. Paying dues, seniority, whatever you want to call it... I'm on shift. This last christmas was one of those days. Now, before I proceed; a warning. Not all of this job is happy, fluffy, laugh a minute, "Oh that Hawkeye, he's so bad.", and the like types of feeling. It's hard. And when it gets bad. It's bad. Being able to maintain an emotional disconnect is an absolute necessity. This is something you either develop, or don't. The following two anecdotes are on the 'bad' side. Just saying. But I add them as a way of providing contrast, and as a mini-sermon on the absolute and utter importance of making sure that if you are told to do something by your doctor; you do it. Period. I don't care how much of a drag it is. How busy you are. If you're told that something is absolutely important for you to ensure you do; you do it. Pull into work at 7am on Christmas Day. Partner by the door as I walk in. Says not a word. Grabs me by the arm and drags me out into the lot towards our Baratric Unit (Huge specialized ambulance for huge specialized people). Our call? To assist neighbouring county's EMS and their FD with the extrication of 700 pound man. I work for a local transport/convalescence facility when not doing Fire Department/School stuff, and this sort of patient is one of our companies specialty 'niches'. Arrive to a maelstrom of people. 2 Ambulances, 2 QRVs, 1 Supervisor, 1 Batallion Chief, 1 Engine Company. Long story short; the man was visiting his family from out of state. He had been diagnosed with sleep apnea and prescribed a CPAP machine to wear while sleeping. For whatever reason, he didn't bring it. Didn't purchase a replacement. He will not get a second chance to make that mistake. Dead at 48. He should have followed his doctor's orders. If he had of, he'd not have put his family through that on Christmas day. And that was the first call of the day. The last one was even worse in terms of emotional impact, and again it could have been avoided due to attention to detail. A family was having a final christmas with their son/husband/uncle who was in his last few days following an illness. He was laying in the bed he and his wife shared in healthier times. At the end of the proceedings, we were dispatched to return the man to his hospice bed. As something to walk into, not something I'll ever forget. My partner spoke with the patient's wife getting things in sequence, while I did a patient assessment. This man was in the last few hours of his life. No doubt about it. But. The wife had failed to secure a very important document. The one which says, if the patient is to go into arrest in front of us, we are not to act. We point out that without this form, we will have to do everything we have at our disposal. She does not wish this. We understand, but without the form... Communication breaks down at this point, and we tactfully withdraw. To this day that room haunts me, and the wails of the wife as she realized that her husband was going to die in their bed in front of her. If she had only had that form. If the damned facility had only made sure that she had one before they let him go. If. If. If. Long story short, all of that could have been avoided but for a crossed I and/or dotted T. So remember, when dealing with medical professionals... If they tell you to do something. Do it. Or get a second opinion, and then do it. And make sure it's documented, that you have *all* of your documentation up to date, and with you if you have need for it. It can matter. A lot.
And that folks, is this episode. I'll try to stick with all fluffy happy stories next round!
Cheers.
Wednesday, January 30, 2008
Rookie Shift #1:
Or: Holy shit they're asking for ME when they call 911!
Now, in preperation for my first 'real shift' in this new Fire Department EMS gig, I went and got a more 'severe' hair cut. I had laid the boots to half the unruly mob on my head back in September. Now, it was time to scalp the rest, earlier last week. So when I arrived at the station for my first shift, and the Captain looked at me with a unmistakable "Who are you, why are you wearing my uniform" look, I had to coax him into remembering that yes he did have a new EMT who was coming in tonight for his first "No hand holding" shift. And, AND, it was 7pm to 7am.
As he had entirely forgotten I was to be there (Despite it was in clear lettering on the calendar) he hmm's and haw's and looks at me, looks at the other part-time EMT, and decides I look the more 'professional' of the two and gulags me to the infamous "Station 2". S2 being the EMS only station in the middle of the district that gets the 'best' calls. This wouldn't phase me in the slightest were it not for the conversation I had with the Asst-Chief EMS an hour previous to which lead to her quote of "When people get more confident in your skills, you'll likely see more time at Station 2 since it's just one crew EMS only".
Great! So I make it to S2 not through a confidence in my skills, but through sheer indifference! Rock on! Go team Me!
After sitting through two hours of 'Fire Fighter Daily Training", I was ready to practice jugular IV access on myself. Really. 2 hours of watching Fire Fighter memorial/funeral coverage videos to remind us to be safe, and not make stupid decisions. 2 hours. With about 1/2 of that being money shots of the grieving widows and orphans. Seriously. So now I'm firmly convinced that I'm going to become one of those statistics of rookies who die on their first shift. 2 hours. Funerals. Great. Fabulous.
The medic unit had moved over to Station 1 for training, so it was time to skulk back to Station 2. I guess they're used to all rookies and new people completely being incompetant, because it took me about 15 minutes to convince my captain, and crew that I did indeed know where this station was, wouldn't get lost, no I don't care that the last 3 rookies they sent there still haven't turned up ever again. Unphased, I departed and made it there well ahead of the ambulance itself. At least they didn't act all surprised to find me loitering by the doorway when they showed up.
Note to self: Loveseats aren't comfortable places to sleep at my height. Further note to self: Bring a pillow and blanket on nights. Patient linen...Well, let me say this. I'm going to start carrying around a backpack with a nice, warm blanket on the off chance I have to attend someone whom I actually care about.
Enough about that, let's discuss calls! There were 4 between 12a and 7a. So firmly in the category of a 'busy' night.
How new am I? I'm this new. I was afraid I would miss the alarm going off. That I would sleep through it. That I'd just keep snoring through, oblivious, while the Medic and Driver left their wayward EMT dreaming peacefully on the couch. That I would wake up with the sun and yawningly look around wondering where everyone was.
Wow. Was that a stupid concern. The first time I heard it, what I can only explain to the un-initiated as a Howler Monkey having coitus with a Garbage Disposal system, I was actually standing and going into a seizure before my brain decided to peek out through the blast doors of consciousness enough to go, "Woah, uh, wha..where...oh right, the Truck!"
Medic Report: Patient is 33 y/o male suffering from a GSW. Addressaddressadress. PD and Medical Response Code 3.
(For those who don't know, Code 3 is the full lights, sirens, audible glory of a pissed off emergency service vehicle asking you ever so politely to, 'Get the fuck out of the road. Old Chap. Tut. Tut. Please. NOW.')
Oh, and I should probably do this too. G:un S:hot W:ound. Apparently, and I certainly missed this directive in the procedure book, there is an appropriate dance that must be made at being sent out to a GSW. A happy, festive skipping that must be done. I say this because I was the only one not doing it. "Yay! Gunshot! Time for fun!" went the other 2/3 of my unit. I'm proud to say my complete indifference and reserved sauntering to the unit threw off the air of professionalism, and apparently came off as "Oh, *yawn*, not another one."
So we get out on the driveway, lights come on, 'Medic and driver are discussing quickest route when...
Dispatch, this is Medic 8. We're 3 minutes from scene. Stand down Medic 62.
At this point, the entire front of the ambulance erupted into the sort of reaction you'd expect from a group of guys watching their favorite (Geographical Appropriate Professional Sports) team blow a game in the last few seconds. You see, our GSW had just been stolen from us. Our 'medic swapped to the Ops channel and told Medic 8 that they were those who indulged in the having of sex with mothers. This was met with laughter on the other end, and a verbal 'pat pat' on the head as they sent Cindy, Don, and Betty Lou Who back to bed with milk and a cookie.
So back we go into the station, grumbling and griping about getting sniped, and I squeeze myself back into the loveseat. By this time, I'm glaring angrily at the ceiling because when I find that alarm speaker, I'm going to castrate it with a roll of duct tape and a pillow. Fool me once.... About 10 minutes after this, just as we had all started going back to sleep...
Hold on baby, this Howler Monkey is almost there....
Medic Report: Patient is on the phone with 911, recently assaulted, claims profuse bleeding. Patient is standing on the end of a driveway at addressaddress. PD response Code 3. Medic response Code 2.
(Code 2 is regular traffic. Sure, we still trash talk anyone not smart enough to get out of our way, we just don't use the flashy lights and loud things.)
If that alarm survives the night, I'm going to claim it as a tremendous testament to my emotional maturity. So off we go. Now. During our saunter over to an admittedly NOT SAFE scene, our dispatch location changes 3 times. See, this guy is on a cell phone. One which does not accept incoming calls. (?!?) Here's what was dispatched. 1 Ambulance Unit (That's us. HI MOM!), 4 Police Cruisers, 1 Engine (Fire) Unit. So you've got 4 units actively looking for this guy, and 1 unit (Us! HIHIHIHI!) who damned well do NOT want to find this guy before the PD do. Eventually out of the concern that maybe this guy is really FUBAR, we join the search a bit. Nothing. 10 minutes later, everyone is convinced that this is a false alarm. And so, we clear and go back to station in case we're needed. The PD keep searching. Apparently, this is common in the 'poorer' region of Durham. We're pretty sure from the notes the call taker is getting that there is really a patient out there, and that he probably does need help, but we can't spend all night looking for him. Back we go to S2, and back I cram into the seat. I decide that the pillow over MY head may be more condusive to my further affiliation with this department.
OH YEAH BABY. LIKE THAT. YEAH THATS HOW I LIKE IT...
Did I really. REALLY, earlier worry that I wouldn't hear that infernal thing? I go back to thoughts of practicing my external jugular IV technique. Which at this point, is non-existant. (Hint: That's the point.)
Medic Report: Patient Ageage recently assaulted, bleeding on head. PD is with patient at this time. Medic response Code 2. Ops Channel 3
This is Medic 62: Is this the same patient from earlier?
Ops3: Yessir.
So. Baaaack we go. Arrive on the scene. All 4 PD cars from earlier are here, and all 4 PD guys are standing around what looks like a grizzly bear that wandered down from the hills, got his head stuck in a Slurpee jar, and now is just wanting to find a cave to crawl into to hibernate. The police are all, ALL, looking like they're having the time of their lives.
And now we meet the gentleman who introduces himself as "Bulldog". If you ask him, he's a former Marine, SEAL, Airborne Ranger, Navy Diver, Army Grunt, Demolitions Expert, Sharpshooter, Engineer, Mechanic, and all around just one man army. He is also...drunk. And in his grizzly adams like beard, he has what I'd estimate to be maybe about 5ml of blood. Yet he's convinced he's dying. The very moment we get in earshot, we note that the police are absolutely clowning it up. Turns out Bulldog here was evicted from the "House" he shared with another person. As all his bags are packed, and sitting on the end of the little gravel path into a copse of trees or "Driveway". (One of the police helpfully offers to take the bags to the ambulance. Dropping them in the back with a snicker while proclaiming, "His magesty's matched luggage.") Some memorable quotes from the resulting assessment.
"I checked out the house. The person who assaulted him is there. Charming fellow. Very sophisticated."
"House?"
"Well, okay. More like a shanty."
"Well, this is a nice neighbourhood."
"Oh, absolutely. I'm thinking about moving in next door."
The police laugh at us as we begin wheeling in the by now fully immobilized "Bulldog", and actually break into a Can-Can line while singing, "Na Na Na Na..Hey Hey Hey...Goodbye" as we depart with our patient.
The transport was about what you'd expect from a very large, homeless, and drunk man who's convinced he's going to die. Many, many shared looks between me and the Paramedic who by and large is just perching on the bench seat twirling his pen and wondering how the hell he's going to call this in.
"Feel free to do whatever you want."
"You need anything else?"
"Nah. But if you want to start an IV, give 'er."
"Sorry, not an I yet."
"But you're in the class right?"
"Yep."
"Then give 'er. I'll sign you off a stick."
"Sorry man, we haven't even done the class portion of it."
"Oh. (Long pause.) Want to learn?"
We both snickered, but didn't poke the poor drunk Bulldog. He was already going to have a hell of a hangover in the morning, and likely will lose a great section of hair in the removal of the C-Collar and Head Blocks we had to put down due to some past medical issues of his.
So we get back at about 3:30 am. We all sort of grunt at each other in acknowledgement then fall/collapse/contort ourselves into our appropriate sleeping area.
I'm already getting into the hang of up, down, up, down. At least well enough in that I fade off to sleep...And we almmmoooosssttt make it to the end of our shift....
MORE HOWLER MONKEY/GARBAGE DISPOSAL SEX THIS TIME WITH AN ICE MAKER PROVIDING FLUFFING DUTIES!
Ugh. Night 1: I'm happy to report, I hate that thing. And my head is going to be ringing for dayyyyyyssssss. It's also 6:30am I note, which means, I we missed the relief crew by 15 minutes and are likely going to be out till 9am. #*$%$&%$!
Medic Report: Patient is an ageage woman at Assistedlivingfacility. Possible seizures, was found by nursing staff this morning unconcious and not alert. Addressaddress Medic Response: Code 3
There wasn't really anything to this last call that as a regular prowler of the halls of nursing homes I wasn't down with. The typical situation where Granny decides to try her damndest to wake up dead, and her 'care givers' object with that as a course of action. She was a full DNR/DNI, so there'd of been nothing we could have done anywayl. Fever of 106.7F.
And so, with Grandmother safely delivered to the ER, and not having made a fool of myself all night, I gave the apparent standard currency of "Low gutteral grunt, with 1/4 head nod" and slunk to my car. And slept.
And not once, did I hear any howler monkey's getting it on with household appliances.
Bliss. Rapture.
Can't wait to do it again.
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