Monday, November 30, 2009

Sometimes the patient

Yeah, its been quiet. I'm afraid that my patients just haven't yielded the sort of experience that bespeaks a whole post. The dislocated hip lady who was also ETOH x 3 the legal limit refused transfer, so I didn't get to have an hour and fifteen minutes of her company, which was alternatingly histrionic and unconscious. I haven't tangled with any ill humored ER nurses in other hospitals lately.

What I HAVE been doing, though, is thinking about my own health. Which is for the most part okay, but for the whole part, not so much. I've decided to take an honest look at the fact that I'm about half a parsec away from NFPA standards and, more than just LOOK, actually DO SOMETHING about it. So here's my post, over on my blog about this kinda thing, that tells you where I'm starting from.

I'll be back to my regularly scheduled hijinks very very soon.

Sunday, August 23, 2009

Every now and then you have to light a candle

You work codes and unfold sheets. You put your arm around onlookers and family members and guide them away. You listen to them in the hallways of the ER. Wiping their eyes roughly with the heel of a grimy hand, going over and over the last thing they said, yesterday morning when they fussed at him for getting into the sugar.

Whether we want to admit it or not every death takes its little dig out of us. Every shattered helmet and flat green line and 'unknown downtime' puts a little dent in the armor, every LODD takes the whole works up and shakes it with a rough, unmerciful hand. So every now and then I just have to sit down and cry for no one and everyone, for the things that could have been prevented and the things that could not be helped. I have to gently place them all in a little paper boat and set it adrift; leave that red pillar shining in the quiet of the church for all the broken hearts and empty places at the table.

This song helps.

Friday, August 7, 2009

You know you are in trouble when nurses are apologizing

Kids, kids, kids. Where has the time gone?

Without boring you with details, its 'peak season' in my paying job, which means that most weeks I'm driving hundreds of miles through the New York and Pennsylvania countryside, keeping my own company, practicing show tunes, and deepening my affinity for Jack Link beef jerky while I studiously adhere to the speed limit and handsfree cell phone laws because you can only talk your way out of a cell phone ticket in New York State on account of being a Volley and an EMT once because more than once is bad karma.


Just as I was reflecting on how I hadn't been on a transfer in a while, prayers were answered. (Prayers I didn't exactly PRAY, you have to be careful with that kind of thing.) It was my first night home on time in a while. I'd made supper, there was a batch of blueberry jam in the bread machine, (I'm not nuts, it was in the manual!) and I was looking forward to an evening of pretty much nothing.

Phone Rings. I look at the screen. It says 'Xfer Hotline'. I should change it to 'Change of Plans'

Dicker: "What are ya doooin?" (This is his standard greeting. I like it better than "Let me tell you what you are going to be doing in 15 minutes." Even though that's exactly what it means.)

Me: "Eating dinner," (I'm suddenly acutely aware of the fact that I am actually wearing an APRON. As if I could wrap myself in a second layer of staying-in-ness.)

Dicker: "We got a transfer," (Well, obviously. But something about his tone tells me this one is special.)

Me: "Uh-huh..."

Dicker: "Its to Philadelphia."

For those of you who don't know where I live, visualize the pointy-cornered rectangle that is Pennsylvania. Put a dot in the lower right corner. That's Philadelphia. Now put one on the very, very top edge were the green cow-laden part of New York touches us, in the very center. Now imagine one of those maps like in the old 'Road to' movies where the line goes from one to another. Wheee-doggy, there's tolls and turnpikes and whatnot 'tween here and thereabouts.

I reluctantly took off my apron, changed my shirt, and went on down. We grabbed some petty cash and headed to the hospital. After wrangling the paperwork, arguing about completion, discussing cost with the family, it was time to get our patient and go. That's when the nurse meets us.

"Um, I got some supplies together for you." (Supplies? I'm suddenly in mind of the orderly cabinet in my office, full of notepads and packs of Post-Its. ) Our nursing friend looks unusually penitent, and this is a concern.

"The patient was given a dose of lactulose, because the doctor ordered it." You can go ahead and click on that link. I didn't have the benefit of a link, and had to fall back on my patented blank 'I'm not a nurse so I'm going to stare at you until you explain yourself' look.

"Um, one of the side-effects of it is loose stools." (This, my friends, is called understatement.)

Our nurse friend hands over a giant plastic bag containing a full package and a half of adult diapers, an entire ream of c-fold towels, a couple of random quilty looking things of indeterminate purpose, a bottle of skin cleanser, and the piece de resistance, a giant tube of 'skin protectant', much used, which I am helpfully told is needed because of 'the irritation'.)

Oh, and a gleaming metal bedpan wrapped in a pillowcase. Which would turn out to be useful only if we had the powers of both prescience AND levitation. It would remain nestled in its cheerful pink swaddling for the duration of the trip.

There was nothing funny about the patient's condition; he was the bright yellow color of an old bruise and it was painfully clear that a lifetime of hepatic and renal abuse was finally paying terrible dividends. This transfer was, no doubt, an effort to get him closer to family before his last day. He was reasonably cheerful, though, and we kept things light as we got him on the stretcher for the five hour trip.

As soon as we got going, the patient turned on his side, closed his eyes, and seemed to be sleeping. Great, I thought. Maybe he'll sleep and we'll get away without any major issues.

Oh, the altruism of a silly silly EMT who doesn't want to get pooped on. Somewhere in the Poconos the first alimentary grenade was launched. It was like Mr. Cosby said-- "First you'll say it, then you'll DO it." "Oh, s--t!" The patient said. I believe "INCOMING!" would have been more appropriate. His trajectory was mostly due north but the blast radius was knees to shoulder blades. We pull over. Gown? Gone. Sheets? Gone. Stand up, hose him down, change everything, wallpaper 10-12 square feet of everything with chux, and try again.

This happens three more times, though the volume and intensity, mercifully, decrease. I learned some valuable lessons, not the least of which was, if a large sick man is lying partially on a used adult undergarment, the way to get it out from under him is NOT to take hold of it and hoss it on out. Because it may fly apart. And bits of it may stick to your person. And you will again reset the limits on what you are 'okay' with. By the time we were rolling down Roosevelt Boulevard we could re-Depend faster than a pit crew at Talladega.

We pull into the ER entrance at the hospital and the security guard meets our driver at the back door. I would have chalked this off as an urban stereotype or made for TV drama but the first thing he says is "Do you have the gunshot victim?" "Um, no... were we supposed to?" Jeez.

The ER is a circus. I'm sure our blinking in the blinding light, such a contrast from the diaper changing mood lighting we had going on the bus, made us look even more like we'd just rolled up with the patient on the back of a hay wagon. "Wellsboro?" the guard said to me. "Where's that?" We're pointed to a security door just through the metal detectors and we make our way to the 6th floor. The patient is exhausted and we're just glad he's in good hands. "Youse guys aren't trying to go back tonight, are you?" he asks. "Yep," I said, "The ambulance doesn't fit in the parking garage at the Four Seasons." He laughed. We left.

The back of the ambulance looks like the aftermath of a very messy, very creepy party. I clean up as we 'look for a place to eat' which, given the viability of parking a $177,000 vehicle in Center City Philadelphia translates to 'drive to Allentown'. Stumbling into the turnpike rest stop is immediately disorienting; my beloved high-volume McDonald's with the always blazing hot fries and my Auntie Anne's pretzels has been replaced with a Starbucks and a Roy Rogers. Roy Rogers still exists? Yes, and its staffed with cheerful Chinese girls with a sketchy grasp of English and no patience for your decision making time despite there being no line whatsoever, making the whole food-ordering experience feel like a dream engendered by a warm beer and a bad burrito. I eat a very dubious egg sandwich and listen to the lack of sleep humming loudly in my ears. We fuel up, chatting with a truck driver who is interested in 'What one of them things costs'. I'm too tired for an apparatus weiner-measuring contest. I tuck the toll ticket and $10 under the edge of the Horton light and siren panel and go inside for one more pass at the facilities before we hit the road again.

What? Stuff can fall behind that panel? Oh. Frack sticks. Five miles before our exit I realize that the $10 is still there but the ticket is not. I turn to the driver and explain she will have to employ her winningest smile and we'll see if country charm can get us through the tollgate without a ticket. (Some stats: Times I've ever done this: 0. Number of EZ Passes in our apparatus: 0)
We pull into the only tollgate that is open and, with $30 in my hand, showing my absolute willingness to pay 'The highest toll to exit', I explain my situation.

"The ticket fell behind the panel." (Toll guy shakes his head.)

"You have to have the ticket."

"Okay, but see, I don't know where it is. This doesn't open. I can't feel it."
"You need a ticket to exit."

"Um, I realize that, but see, we DON'T have the ticket, we have our $7.85 receipt from where we came down, but what would you like us to do right now?"

"You'd have to pay the highest toll, $23.90." (I show him the $30 I have in my hand, again demonstrating my willingness to OBEY THE LAW. Trucks began to stack up behind us.)

"Okay, well, um, okay." he looks at the side of the ambulance. "Here's what you do. Give me your driver's license. " (The hell? I give it to him.) As he writes up this mysterious form, he says "I haven't ever done this before, but if anyone asks you, you came through MID COUNTY not Valley Forge and you went through the EZ Pass lane. Okay? You went through EZ Pass by mistake. And its $5.00."

So, lets review. I lost the ticket. I have the money. If we find the ticket later we can get reimbursed. But because this guy feels sad about taking so much money from an ambulance and its 3 in the morning I now have to be complicit in an ELABORATE LIE and deceive the PA Turnpike Commission and get a $2.85 discount on our return trip for NO REASON. But since the trucks behind us are starting to sound like they are idling in a slightly more hostile manner I pay my $5, take my mysterious paper that explains a different error than the one I made, and my license, and we go. I'm still waiting for that phone call wherein I perjure myself to the Turnpike Police and they Come For Me and there are Dire Consequences.

We rolled back in to town at 6:45am. I went home, showered, changed my clothes, and drove to Syracuse NY. I drank a lot of coffee and overshared to a handful of store clerks and the sun was very very bright all day and I sang at fierce volumes to stave off those weird daydreams that feel very much like sleeping with my eyes open.

Mr. D, you were worth a sleepless night and it was a privilege to meet you. I'm glad you got to see your grandson race on Saturday before your tired body gave out. Rest in peace.

Monday, April 20, 2009

Psych Transport

Well I’ve had this damn sinus infection for three weeks now and I was downtown and thought I’d go to the hospital but I couldn’t hardly stand up and I was afraid I wouldn’t be able to get out of the car at the hospital so I drove home and came back up the ramp and I was just sitting here and all of a sudden I couldn’t hold my head up (dog barks) SHUT THE F**K UP! (dog stops) so right I should give him any more cigarettes? F**k him. He smokes his and mine too and I have to buy him more and he never pays me back, that rotten son of a bitch. I should quit smoking? F**k you! Okay so I guess I can go with you but I’m not getting on that damn stretcher that’s how they get you, you know, so we can walk down the ramp hold me up now, hey you are nice and warm I’ll hold on to you okay oops be careful I don’t know if I can make the steps I’ll just sit here on the bench no, okay, I had better lay on the stretcher because now I feel sick to my stomach -- do you have a bucket? Well you’d better get one because as soon as this thing starts moving I’ll be making a mess of this place.I’ll tell ya, it never gets any better, the patches was what they give me and the damn stuff makes me throw up the first thing the doctor did was try to take away my cigarettes but Jesus Christ, I’m bi-polar already, can you imagine what I’d be like if I couldn’t smoke? I only smoke a little, maybe three or four a day, and some pot, that’s it, then I stopped, they give me a prescription for the patches but how do you get the stuff? You’d think they’d give a person a disability check on time for Chrissakes. I was down to see Fred, and I told him, I can’t deal with your shit anymore, I had the nurse talk to him, I don’t know what she said but he was bawlin’ when she got done. It’s a hell of a thing living on social security, but my car runs on air, so at least I don’t have to worry about that.

Note: This call was dispatched as a 'near syncopal episode'. This post is, to the best of my memory, a transcript of the breathless, pauseless, unbroken monologue of our patient.

Wednesday, March 25, 2009

Overheard at ITLS

I took this excellent course last weekend, after a feverish three days of reading as much of the textbook as I could in 72 hours while still sleeping and giving a full time job due diligence. It was a great weekend, having practical time alongside Paramedics and RNs as well as EMTs from other stations was an excellent opportunity to sharpen skills, learn new things, and share what works with people from other departments. Even through I didn’t ‘get a weekend’ rest-wise, I came back Monday morning with my Patient Care batteries recharged. Hearing one of my former EMT instructors say how proud she was of her ‘graduated students’ reminded me what I like about doing this ‘free job’ I’ve got.

As usual, there were occasions for a few laughs.

During a lecture on ‘Patients Under the Influence’ our instructor told us a lot of things about what is going on in schools that convince me that I made the right decision limiting my children to the four legged, fur bearing variety. Apparently the ‘new and improved kegstand’ involves inverting oneself while beer is inserted into the anus. It would seem the alcohol crosses into the bloodstream faster and one can get drunk more quickly on less beer. Good grief, people. I feel like I’m taking a walk on the wild side when I eat a sleeve of Sprees and drink a Pepsi. Many questions spring to mind, as well, including but not limited to:

What about the carbonation?
Is there a separate keg for people who want their beer the old fashioned way?
Is there a surefire way to differentiate same that doesn’t involve sniffing the tap?
If you can actually stand on your hands and let someone do that without falling over (or, even more compelling, do it YOURSELF) is there a better outlet for your talents that might be in some way financially lucrative? Oughtn’t you check this out?

We’re all shooting the breeze during lunch on day 3 of class, discussing other training opportunities. A student (who is frequently an instructor) was telling us about Wilderness EMS, and I said we should have that this summer. I volunteered to be the ‘S’Mores Officer’ for the weekend.

(I realize the last couple of anecdotes seem unrelated. Bear with me.)

Said student went on to say that when he took Wilderness EMS the ‘patient’ he had to ‘keep alive’ in his scenario was hypoglycemic and unconscious, and that they had considered ‘putting chocolate up his butt’ as a possible solution.

There was a moment of silence while this was considered. Then I said,
"I guess that would be like a ‘S’mores Stand’. Though I don’t recommend using the graham crackers." (general laughter)


Oh, and I passed. Not as high a grade as I’d like but I’m obsessive about such things. So if you wreck in the 'Boro on a Wednesday night, if you'd keep your injuries around a B+, I'd appreciate it.

Thursday, March 12, 2009

Its paid for, but please don't......

I finally got to ride in our sweet new ambulance Tuesday night. After countless bone jarring ambulance transfers in a 4WD vehicle that would have eventually resulted in breasts I could kneel on, we got a 2WD that offered a smooth ride and steps you can negotiate with a wide butt and short legs without looking like you just fell off a Mardi Gras float. Yaay for me!

It still has that 'new ambulance' smell, which is kind of like the 'new car' smell, if new cars came with extrication tools and the smell cost about $160,000 extra. Everything is shiny and unused.

We set off with a patient onboard who had difficulties that were not of the elimination variety, so I was alarmed when she had a whispered conversation with the nurse on board that ended with said nurse saying, "You have to POOP?" This was followed with a reassuring explanation of how very close we were to our destination, a place where she could do what needed done, possibly even without three onlookers in close quarters. This reassurance lasted exactly 45 seconds. I was at the head of the cot so I couldn't hear much of what was being said, only "Right NOW? Are you sure?"

A bedpan (which I prayed to the Patron Saint of Inopportune Defecation was actually IN the storage bin) was located, and we pawed through the layers of straps, tubing, non washable and very vulnerable-looking wool blankets, and ether blanketing to get to the patient and slip it in place.

Have you ever gotten on an elevator and experienced that awkward silence that settles in after the doors close? Or been witness to the 'party lull' where everyone stops talking at the same time for no particular reason? I would submit to you that these experiences run a distant seventy-third to dropping trou so you can poop in front of strangers in a moving vehicle.

We got the patient sorted out, then field tested something called the 'Power Vent'. (Ambulance manufacturers, whoever thought of a ceiling-mounted fan that sucks smells out of the back so they can hover malevolently over random municipalities, THANK YOU. It works like a champ.)

And nothing cheers up the staff of my favorite ER like walking in with a big red biohazard bag and saying, "Do you have someplace I can put this?" I wish I had one for them every day.