Better Living Through Chemistry

I don't want this third cup of coffee. But I'm going to drink it anyway.

Besides, I need something to take the pill with. I hold it in my fingers, wondering whether my feeling better has more to do with feeling like I'm doing something than the actual medical action of this particular drug. I decide it doesn't really matter, that improvement is improvement and whatever dispels the dark is welcome.

I see skinny, tanned, shirtless country boys everywhere, ones like the one we loaded to fly a few weeks ago. The first crew onscene found him standing uncertainly next to a wrecked car, cradling his arm, his shoulder not so much dislocated as relocated. They had to ask him if he was in the wreck. "Which car were you in, sweetheart?" she asked. He pointed to the one wheels up in the middle of the road. He'd been asleep in the back seat, ejected somehow without a scratch on him, except for the shoulder. Twenty years old and terrified of needles. All I could do is stroke the five square inches of velvety crewcut that was not encircled with c-spine stabilizing plastic and vinyl and say over and over, "Its going to be okay, it'll only take a second, you have a great vein there, just relax." I wondered at the sinewy length of him and just how he was ejected without more damage. A perfect jacknife dive out of a broken window. The car was small. With every MVA my grasp of physics becomes less science, more mystery and chance, possibly miracle. Possibly. That accident put my skills in perspective. The damage was done. We cleaned up the mess. Maybe, maybe, we prevented more damage.

You walk out of EMT class with your certificate and your patch and think (secretly) that you are going to save the world. You stare hard at strangers whose perfusion seems questionable, watch them make their tentative way up sidewalks, down steps that never seemed so precarious. You shake your head at bikers gliding bareheaded through intersections. It doesn't take long to learn that your ceremonial duties are limited to cleaning up the aftermath of someone else's choices, or asking questions and bearing witness to forces of time and disease beyond all control, particularly yours.

Later on, after my third cup of coffee, I step to the front of the church and receive the cup, the throaty rumble of motorcycles behind me, headed to their destinations. Perhaps I am headed the same way in a hail of sound and flashing lights, though with a swallow of sacred wine and the knowledge that I do not save anyone, not even myself.

Contempt

It was bound to happen eventually.

Saturday, the latest in a string of early risings, only this time for no reason. Last year I watched dozens of racing bikes hum down an ill-advised hill at an even more ill-advised speed. There were no crashes. But we were there. This time there were no crashes (as far as I know), but we were not there since the rest of the crew didn't show. My powers of invisibility were great yesterday, my questions met with shrugs and blank stares, turning away to more interesting conversation, punctuated by the occasional unreturned phone call. I completed some other tasks as the darkness descended. I was angry, but not because of this. It was time to go home. I had to walk a few blocks through merriment I wanted no part of just to find the person who had parked me in.

I hate people, I thought.

I tasted that thought, contemplative, settling into it like an ominous easy chair, pressing my shoulder blades into its sumptuous upholstery, my elbows resting on its portentous girth.

I don't know what other people do when they feel this way. Actually, I take that back. I do know what they do. They drink and fight and fall down and take things they shouldn't or buy things they shouldn't or otherwise do what they shouldn't to avoid the feeling, push back the sucking dark. Sometimes we have to go after them, get them out, wrap them up and strap them down, feeling for damage while they search our faces with anxious eyes, attempting hope and excuses for trying and failing to ride the tide. I opted to hide in the house. Hating people pretty much means you should avoid them for a little while. It definitely implies that, at least in the short term, you should probably not attempt to render quality emergency medical service. I ignored a text for a transfer, knowing no drivers were available anyway. I pulled my pager out of my waistband and shoved it in my purse, thumbing it off as it went. Off went the phone. 1R-259 is OOS, I wanted to write on the whiteboard in the garage. Only I have to do my own warranty work.

Today may be better only because I'm still in the house. But its better. One by one necessary chores get done. I'm at least willing to look out the window, and I may even go out there, soon. I know this sabbatical is short, no more than a day. There are things to do, you see. Obligations to the family I adopted and persuaded to set a place for me, the brothers, the sisters (maybe), the God who watches over us, shaking His head, protecting what we do not treasure.

Overheard on the Bus

Its only May, and my collection of DUI humans grows by the week. I had considered waiting until the end of the summer and doing a wrap up of all of the fun conversations I've had with alcohol-fueled drivers but I can't wait until August or I will forget them all.

First, I'm glad they had a mock DUI at the high school. They should have made parental attendance a condition of graduation. So far this summer every single one of my drunk-wrecked has been between 45-55 years old. Post-boomers: Get your crap together. Seriously.

Exhibit One: Love the One You're With, if in fact you are with her.

Patient: "Did I cause an accident?" (He rammed his car into a tree. There was a large bottle of vodka rolling around on the floor of the car.)

Me: "You had an accident, sir." (I'm holding his head while others are coming in from the other side to get him in a KED.)

Patient: "How is my truck? Did I have an accident?"

Paramedic: "You ARE the accident, partner. Just hang on and we'll get you out."

Later, in the ambulance: "Did I wreck my truck? Is Amanda* okay?"

Paramedic: "We aren't the police, so we don't care, but how much have you had to drink tonight, partner?"

Patient: "6 or 7 shots. Why?"

Paramedic: "Because you were driving a Dodge Neon and Amanda's not with you."

Patient: "OH MY GOD! I WRECKED MY MOTHER'S CAR!!"
__________________________________________________

Exhibit Two: In which its more important to look good than to feel good.

The patient failed to negotiate a 'T', rolled through the stop sign, and rolled his truck several times. When we got there, he'd self-extricated and the truck was on its roof.

Patient: "Oh, shit. My truck."

Paramedic: "We aren't the cops, so we don't care....but how much have you had to drink tonight, partner?" (See a theme? We get to say this a lot.)

Patient: mutters something about just a couple of beers, then turns to me earnestly and says
"Oh man, is my face all messed up?"

Me: "No sir, you are just fine, just a little cut on your head."

Patient. "Oh, good." I guess his modeling career is safe. "Man, that ditch, man. It just...." (Just what, jumped up and grabbed you?)

Later on...as we're bringing him out of the ambulance.....

Patient: "Well, that's the rodeo."
____________________________________________________

Exhibit three: Getting your story straight isn't always enough

We arrive to find a large motorcycle leaning carefully on the embankment with two guys sitting beside it looking for all the world like two kids who got caught stealing in a candy store. Neither of them will look at us directly. Not much debris other than a broken amber turn signal lens, a wristwatch, and a pair of glasses. Both refuse treatment, which seems fine for the one guy but the other one's forehead is busted pretty good and he's trying to nonchalantly swab the blood off with a headwrap. I'm thinking five stitches minimum. We start filling out the refusal paperwork. (Translation: we start killing time until the state police arrive.)

One guy starts to tell us how they were coming up the road and jeez, there was a deer. Just come out of nowhere & ran right into the back of the bike. Ran off that way. And so we called someone to come and get us and while we were waiting, we had a couple beers. Four beers. Apiece.

Now. This scene was about a five minute ride from town. We were enroute probably no more than four minutes after the call went out. So in nine minutes, these gentlemen did the deer tango, got the bike off the road, called a friend, hopped a squat, and had four beers apiece. Because nothing says Miller Time like a close encounter with wildlife. I suppose they were careful to stash the empties back in the saddlebags for recycling because I didn't see eight empty cans anywhere around. Gentlemen: Do not piss on my leg and tell me its raining.

I hand my guy a handful of 2 X 2s for his head. I take a walk in the direction of travel and see a thirty foot long scrape on the blacktop that extends from the apex of the curve and starts just over a rough spot and I get an idea that's where things went tits up for these two and no deer were harmed in the making of this film.

Refusal forms complete, we wait. Oddly, the ride they called does not arrive. But the staties do.
I can honestly say I've never been in the kind of trouble that involves the state police; once a very kind Delaware State Trooper gave me a ride to my office when my car broke down on a busy and dangerous stretch of highway. So I can't say what it is about that slow saunter across the road from the black and white car that changes things for a patient/victim/defendant, but suddenly, the deer story was abandoned in favor of a finger-pointing meltdown over who was actually driving. I had walked away but I overheard one of the troopers saying something like "Okay. So I'm gonna ask you ONE MORE TIME...."

State troopers have the magic touch when it comes to getting impaired folks to get in the ambulance. Its called the "You can come with us" speech. As in: "You have two choices: You can go with them or you can COME WITH US." Its downright miraculous how people have a sudden awareness of pain they had not noticed to that point and elect an ambulance transport. Our busted head guy did us one or two better.

As soon as he was immobilzed he started shaking. It wasn't so much an involuntary tremble as it looked like he was reprising Tom Cruise's role in Cocktail. Then it started:

"Oh man. I'm gonna go back to prison. I don't wanna go back there. Please don't send me back to the Gulf. (the hell?) I don't wanna go back. Three times was enough."

"Sir, we're just taking you to the hospital to get you taken care of."

This refrain is repeated all the way to the hospital. In between he manages to tell us he has PTSD, he broke his back in the exact same place three times, and suddenly his back hurts an awful lot. Despite my very best efforts with a handlight I cannot get his pupils any smaller than dimes. All the way to the hospital we have to assure him many times we are not shipping him back to the Gulf. I get his arm out of his leather coat without complaint so I can get a BP but as soon as the ED nurses touch him he shrieks like they set him on fire.

He ends up being released with a couple of stitches in his head.

Its only May.

Department of Vehicular Awesomeness

I'm too lazy to cross-post. So I will just give you the link to my new post over here, wherein we talk of ambulance-related happiness.

Riding Season

All EMS professionals must face death. The need for coming to terms with death is universal; death is part of an EMT's everyday duties. These professionals must not only learn how to respond to death, but also how to react to it and integrate it into everyday life. EMS professionals employ several strategies to control the stressful effects of death. The most frequently used defense mechanisms are educational desensitization, humor, language alteration, scientific fragmentation, escape into work, and rationalization.-- Emergency Medical Technicians Forum, Encyclopedia of Death and Dying

Monday wasn't a duty night for me, I was hanging out at the station waiting for a meeting to start. I went to a quick NH call because I happened to be there, thought that was going to be it. Then we heard it.

Alert tones and two beeps.

Two beeps is a car accident, usually. It is also an invitation for our entire department to LOSE OUR FREAKING MINDS.
In twenty seconds every piece of equipment we have was screaming down the road at 80 miles an hour toward what we were told was a motorcycle accident. Helicopter was in the air, we're lurching all over the back of the ambulance pulling equipment out on the stretcher. I guess some of us were excited about the possibility of saving someone's life. I'm still new enough that I was hoping I'd be useful and not in the way. I don't know.

The first thing that I saw was a little cluster of young guys. Guys that looked like they'd been working on cars or something. Guys of the normally "I'm invincible" variety suddenly looked very young, and a little lost. They were standing a little way away from our patient/the body. Amazing how quickly he went from one to the other. We got there in time to help turn him over and watch as the paramedic attached leads to him, in time for the bright green line. We got sheets and covered him. He looked so small.

A lot of time passed, that was spent standing around waiting for the 'stuff that happens when this happens'. Painting lines. Lighting flares. Measuring. Taking pictures. People that have to come and give the official imprimatur to what we already know to be so very finally and permanently true.

I read a lot, see a lot of movies, and probably think about stuff like this more often than is any good for anyone, but standing there with someone who probably got up that morning and looked forward to riding his bike and enjoying the hell out of a beautiful day waiting for the go-ahead to put him in a bag kinda rams it home for you like nothing else does: every day we get through is a miracle and not a single one of them is guaranteed. I don't think I had real faith until I stuck my hands into how it all breaks down. Damage. Loss. Disappointments. Fatal errors in judgement. Things that happen that aren't fair. At the end of the day it comes back to a verse that just sounds better in the old King Jimmy translation: "Whatsoever ye do for the least of these my brethren: you have done it unto Me."

And that's why I'll be back tomorrow.

Nineteen Months

Wednesday I got a call right at the end of the work day for an ambulance transfer to Geissinger. I said I could be there in twenty minutes and headed out of the office.

When I got there I questioned, just for a minute, my "Say yes and ask questions later" methodology.

The transfer coordinator was still on the phone trying to secure a driver. He mentioned, as he deftly punched buttons on his cellphone with one thumb while spraying down a truck that had just come back from a fire call, that it was a 'pediatric patient'. I had visions of entertaining a 9 or 10 year old on the way down the road, letting them mess around with all the 'cool stuff' in the back of the ambulance.

Driver secured, we went to the hospital. He and I quickly threw together two cups of coffee which he took back to the bus while I went upstairs. All the way down the hallway I'm following a man of about 25 carrying a carseat in one hand. Odd, I think. If his kid is getting out of the hospital why don't they just carry him downstairs and put him in the car? I lose him in the bank of elevators.

The nurse points me to the children's ward, and as I roll down the hallway an insistent wailing is getting closer and louder. I wait. I shuffle my papers. A nurse appears and I point hopefully at the door across the hall from the banshee-ing and ask, "Is this where we are?"
"Nope," she replies. "In here." I turn around and my young father is standing there. Another nurse comes out and plunks the carseat in the middle of the stretcher. We all look at it for a moment like apes contemplating the monolith. I break the silence.
"Look, I have to be honest...I don't have kids, so I don't know how to work one of these." The nurse smiles, we grab the straps on the stretcher, and figure out how to thread them in the back. So ends the very easiest part of this process.

According to the 10th Edition of Emergency Care (Limmer & O'Keefe), toddlers:
-Do not like to be touched or separated from their parents
-Do not like having their clothing removed
-Have a fear of needles and pain
-Understand more than they communicate
-Don't like oxygen masks

In short, this experience could not really suck more for this kid than it already did. Except that she had pneumonia that wouldn't go away, she was exhibiting a lot of accessory breathing, her sats were crap, and her respiratory rate was tanking.

When kids are too young to understand certain things, you try to coax them to comply. Sometimes you trick them a little. In the hospital, you have to force them to comply. You can imagine how happy this makes them. Her arm was splinted and wrapped so she couldn't bend it or touch the IV port. Her nasal cannula was held in place with two large pieces of tape on her face. It took three people to disentangle her from the tubes and machines so she could be placed on the stretcher. Her eyes were two standing puddles of tears, as she kicked at the straps and looked at her mother in disbelief. She was still wailing but it was obvious she was wearing out. It was time to go.

Do you know how, in movies, people are on airplanes, but you can't actually hear any noise? Just quietness, and their conversations? If you've flown, you know it isn't like that. Its noisy. Ambulances are the same way. You have to speak loudly to be heard. Every pothole feels like you are riding the mechanical bull at the fair. It didn't seem like a place where an already agitated child would fall asleep. But weariness took over and little by little, as her mother sat stroking her hair, her eyes grew heavy, and soon her long dark lashes were resting on her cheeks and she was out. We all looked at each other and smiled a little.

A tiny comet-shaped bruise where an IV had been marked the back of her small hand. Monitor wires trailed out from under her doll-sized hospital gown to a machine that told us how she was doing. (Not horrible, not great.) Once she awoke with a jerk and turned toward me, the sun catching her golden brown eyes. She was in an instant very young and ancient, an unbreakable soul in a very breakable vessel.

The wailing started up again when we got to the hospital; she didn't like the noise of the stretcher or being brought out the back doors. It was a long walk to the PICU and we tried to go as fast as possible, though we were only bringing her to another whole group of strangers to do those things she didn't want done. I was, admittedly, happy to be out of earshot once all of our equipment was removed and it was time to go. Sometimes there is not a lot you can do to make a patient feel better. That is someone else's job. I wished I could have left her with a lullaby. This will have to do. You can sing along too, if you like.

Once there was a way to get back homeward

Once there was a way to get back home

Sleep pretty darling do not cry

And I will sing a lullaby

Golden slumbers fill your eyes

Smiles awake you when you rise

Sleep pretty darling do not cry

And I will sing a lullaby

Sonrisa

"Our birth is but a sleep and a forgetting: The Soul that rises with us, our
life's Star, Hath had elsewhere its setting, And cometh from afar: Not in entire
forgetfulness, And not in utter nakedness, But trailing clouds of glory do we
come From God, who is our home…"
--William Wordsworth

12:30am. My gut fills with the familiar shot of nausea inducing adrenaline that comes from a sudden loud noise piercing the silent dark of the bedroom. When will I ever get used to that? I swing my feet out from under the flannel sheets and search for my sweatshirt, fumbling my feet into shoes and feeling blindly for glasses. I leave the house as quietly as possible and slip into the frozen night, saying a quick prayer as my sleepy, growling ignition catches and my car rumbles to life. I drive the empty streets to the station and take my pick of parking spaces.

Our patient is a 92 year old woman at an assisted living facility with difficulty breathing. She had a coughing spell and then got very dizzy, could not catch her breath. Someone who was with her decided she'd better go to the ER and get checked out. No bronchitis or recent colds, surprisingly few chronic meds, and she is able to get on the stretcher with very little assistance. We swaddle her against the punishing cold.

"Will I come back here?"

"Yes ma'am, I'm sure you will, we just want to make sure you are okay."

"I'd better take my glasses. Do you have my glasses? I don't have my glasses. Maybe I should leave them here. Where are my glasses?"

"Why don't we leave them here, so we know where they are and you can get them when you get back."

"Okay. Just don't forget my glasses."

We wheel out of her room and toward the exit while an honor guard of sleepy looking nurses holds all the doors for us. Frigid air eddies through the stairwell as we negotiate doorsills, ramps.

"Will I come back here?"

"Yes ma’am."

I walk around the side as she is being loaded so I can take my seat alongside the stretcher. I try my best to be there when they slide in so they don’t feel alone. As I join her and reach for the blood pressure cuff she turns to me with wide blue eyes and a brilliant smile.

"I’m sorry, do I know you?"

"Yes ma’am, I’m an EMT with Wellsboro and my name is Kimberly. We’re taking you to the hospital now."

"Okay."

We swing onto the main road, back into town, toward the hospital. I put my hand on her arm, to reassure her over the bumps. Her eyes open and I am again treated to the smile, like watching sunrise over and over.

"I’m sorry, do I know you?"

"Yes ma’am."

We trundle into the hospital driveway and she grimaces briefly against the cold when the doors are opened, squinting against the bright busyness of the emergency room. The nurses help transfer her into a bed. I gather our paperwork and give her hand a pat as I leave. She beams with the merry eyes of a sister who has just shared a secret.