Training

I'm sure that at some point you've knelt on the floor in some firehouse annex or church basement learning the fundamentals of rescue breathing with one of these.



And when you take EMT class, you are invariably faced with the Bag 'o Babies:


If you are especially lucky, you have the model for 'emergency childbirth' demos, complete with a rubberized vagina and a palpable fetus and a removable placenta that looks just like a grape fruit roll-up. I had the good fortune of sitting directly in front of the training pelvis for one whole evening while it was parked on the table in front of my regular seat. You'll just have to take my word for it; it was creepy. I can't find a picture and to be honest I am scared to try harder.

All I can say is, if Pennsylvania EMS protocols ever necessitate the use of THIS training item, I quit.

LIfting Assistance

Friday night I took a four hour piece of the duty section for a couple who were on their way back from somewhere. I was folding laundry and making some sort of point about something or other when my pager went off. Difficulty breathing call. I went to the station and arrived pretty much at the same time as the rest of the pinch-hitting crew and we responded quickly. The driver asks me as I go to jump out whether the patient is a man or a woman.

"A woman. Why?"

He cuts his eyes sideways. "You'll see. Just go inside."

I go inside and it doesn't take too awful long to figure out what he was talking about. Before I can even say it the call goes out for lifting assistance and pickups start pulling into the driveway.

I'm not good at eyeballing such things but I'd say my patient is somewhere in the region of 400-500 pounds and all day she has felt like she hasn't been able to catch her breath. We help her stand, turn, and sit on the stretcher, and when we try to pull her up the blanket rips in half. I suddenly feel very grateful I've been spending five days a week at the gym because lifting one of her legs onto the stretcher takes pretty much all I've got.

Anyone who knows me is probably wondering why I'm even writing about this; I'm not a small person. I guess that's the point. This lady scared the holy hell out of me. She couldn't move. Her body wasn't just betraying her; it was suffocating her. It made me think of what it means to live in a prison of your own making, and how much further I still need to go to break out.

You hear a lot of still, small voices in the ambulance. One of the most chilling and persistent is 'This can happen to you'.

Binge

Fourth of July weekend, I volunteered to cover an extra duty section. The husband and wife who faithfully cover our Friday nights went on vacation and since I wasn't going anywhere, I figured, what the heck. I imagined all sorts of holiday emergencies to which I might fly, ready to render comfort and aid to citizenry impaled by bottle rockets or pinned in spectacularly mangled vehicles. I sat reading a book on my couch, listening to the distant pop of firecrackers, waiting for the inevitable page, the feverish search in tall grass with a powerful flashlight for missing digits.

It didn't happen. In fact, nothing happened at all. So when one of the Saturday night crew called me Saturday morning to ask if I could cover for her so she could have an evening off, I gladly agreed. She's a dispatcher as well and, in my view at least, deserves a break.

It was a busy night; one minor car accident with two transported, a syncopal episode that resulted in an orbital fracture because the person landed on their face on a hard floor, a kid who rolled a new dirt bike and ended up being transferred to another hospital to get his splintery bits screwed back together. I got to bed late. I thought I was done.

02 45. Dispatch for a woman behind a local establishment 'semi-conscious'. I check the time and reflect on what this is going to be. I decide its going to suck. I am not wrong.

We back in behind the bar and the bright lights flash across a knot of patrons standing a cautious distance from the 5-0. Something about their vacant gawping sort of pisses me off, so I give them a peevish once-over as I pull the doors open and grab the stretcher. Our patient is sitting on the ground unable to support the apparent terrible weight of her head. She's not a small girl, and with no gravitational cooperation coming from her side it takes a couple of guys to hoist her up onto the stretcher. We strap her in and lever her into the ambulance. As I close the doors I see her lurch to her left. I briefly consider simply running.

I need to pause here and mention what I left the house in. An unseasonable chill had settled in our valley and I grabbed a sweatshirt on the way out the door. Two layers up top: check.
I'm a deep sleeper. I've often joked that on most calls I am fully awake right around the time we are at the far end of the ER putting new sheets on the stretcher. This is the excuse I will have to use for the fact that I was wearing shorts and Birkenstocks. No layers down bottom: check.

So I guess you know where this is going.

I pull myself up into the back of the rig just in time to witness a rather violently projected wave of something in the margarita family which lands mostly on the floor, partly on the stretcher, and, because she's spittin' for distance when she gets to the chunky bits, all over the bench. She has enough power behind it that I figure suction is a waste of time and I position myself on the opposite side and swab off anything with a towel that looks like it might go back in. She wetly gurgles "I'm soooooorry!" during her brief periods of not-vomiting.

The good news: Since she apparently didn't eat all day its mostly alcohol.
The bad news: Its all over my (my!) horribly bare legs and feet.

Our friend is sliding off the stretcher so I grab her by the front of her hoodie and pull her back to center as best I can. Its good, sensible activity that is not only protecting the well being of the patient but its keeping me from screaming. We get her to the ER and I step out of the stall when it comes time to transfer her to the bed, because if I'm going to get up under this girl and lift her, I'm going for the feet. The nurse can take the head. We manage this transaction without incident but just as I step out of the curtain I hear the unmistakable sound of someone else catching a juicy wave.

It takes a good twenty minutes to render the bus inhabitable again. I go on a chunk-search on the bench seat with a couple of paper towels, fully expecting to recover cherry stems, swizzle sticks, a cocktail napkin or two. We're told the boyfriend is en route, which is good because we don't even know this girl's name. He doesn't show, but the paramedic gets the info from the police and we find her in the computer. Mystery solved, we can leave, only to return half an hour later with a fall victim. As we are wheeling her into the ER, we see the boyfriend pushing his besotted love down the hallway in a wheelchair, destination unknown, though I am encouraged to see her holding up her own head. I want to say to him: "Were you looking out for her tonight? EPIC FAIL, dude." I settle for a hard look that I hope conveys annoyance with a soupcon of disgust and go home to scrub my legs again.

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.