In an effort to simplify my life I have merged my three blogs into one glorious adventure of Me-dom! From now on my EMS musings will appear on my main blog, Dispatches from the Northern Outpost. So if my several fans wouldn't mind, c'mon over and Google Connect/Subscribe over yonder.
Thanks!
Tuesday, March 22, 2011
Monday, November 8, 2010
You Wanna Hear a Story?
I spent the summer running ambulance like it was my full-time job. Mostly because my actual full-time job became an 'eliminated position' in June. This resulted in 37 (thirty-seven) interfacility transfers in one quarter, sometimes as many as three a week. I spent most of Labor Day weekend in the back of a Horton.
Which is fine.
Sometimes there are great stretches of time in this endeavor where nothing much happens. It was a summer of cardiac rhythm disturbances and possible CVAs. There was the odd car accident. But last Friday night was a reminder of why I have a special place in my heart for people who make poor life choices on a regular basis.
00:35. We're called out to assist an airmedical agency, and on the way we find out its a 'hot load'-- we have to get the patient at the hospital and take him directly to the helipad so he can be on his way. This usually means that whatever is going on is pretty serious and there isn't time to pick up the helicopter crew, ferry them to the hospital, let them dink around and then wrap the patient in what I call the 'flying burrito wrapper' (their fancy insulated blankie) and take them back to he helipad. I know the ER's been quiet, so I'm interested to know what's up.
We get there, and the ER is quiet indeed, except for our patient, a twenty-something man in plaid boxers who I can tell either just engaged in a tearful confession of some kind with the Paramedic holding pretty vicious direct pressure on his right wrist, or he's drunk.
Oh, goody.
I step behind this Paramedic in an attempt to figure out why he's holding this young man's wrist so tightly. After all, he seems boisterous, and possibly inebriated, but not particularly violent.
Oh.
Peeking around a stack of four by fours is a deep cut that seems to go most of the way around his wrist. Four more packs of gauze sit stacked beside him and he asks me to open them. "Three of them should do it." Yikes. I open the packs and watch them wrap the wound. I sense a story coming.
"So what happened?" The paramedic asks as we drive to the helipad.
"Oh, man. You wanna hear a story? So, like, we were drinking and whatnot, and I, like, fell off the porch and caught my hand on the white things, you know the white things between the windows? And, like, my hand went through it. And I fell. And blood, like, shot out like four feet."
He offered further information.
"But, you know? Okay. You wanna hear this? Last year, like, my friends and I were partying, and drinking and whatnot, and I, you know, passed out on the sidewalk. And you know what the cop did? He TOOK ME TO THE HOSPITAL. What a DICK."
(What was he supposed to do? Put cones around him so no one would trip?)
"Thirty five hundred dollars. Man. That sucked."
"You ain't seen nothing yet," the Paramedic said. "Wait until you get the helicopter bill."
We waited, listening for the distant drone of his ride coming in over the lake. The patient coughed long and deep.
"That doesn't sound to good, are you sick?" I asked.
"Nah, its...you wanna hear this? Okay, so about a week ago I was siphoning some diesel fuel and I got some in my lungs. I guess I should have them check that shit out too while I'm at the hospital."
"So, you were just going to let that go and see how it worked out?" by now the Paramedic has that look on his face that tells me I'm going to be spending the next few minutes trying hard not to laugh. "Do you ever think about, like, staying home?"
What would we do on a Friday night if he did?
<><><><><><><><>
In other news, most of you already know that I lost a job in the beginning of the summer. Some of you may NOT know that I got a new job that I have a feeling may contribute some content to this blog, though from a different 'angle'.....I'm a 9-1-1 dispatcher in training.
Yep, I'm learning to work the other side of the radio....police stuff, protocols, geography, computer aided dispatch, its a whole new world. I love it-- the co-workers, the work, even the wonky schedule is cool.
Poor life-choice makers...holla. You already have my digits.
Which is fine.
Sometimes there are great stretches of time in this endeavor where nothing much happens. It was a summer of cardiac rhythm disturbances and possible CVAs. There was the odd car accident. But last Friday night was a reminder of why I have a special place in my heart for people who make poor life choices on a regular basis.
00:35. We're called out to assist an airmedical agency, and on the way we find out its a 'hot load'-- we have to get the patient at the hospital and take him directly to the helipad so he can be on his way. This usually means that whatever is going on is pretty serious and there isn't time to pick up the helicopter crew, ferry them to the hospital, let them dink around and then wrap the patient in what I call the 'flying burrito wrapper' (their fancy insulated blankie) and take them back to he helipad. I know the ER's been quiet, so I'm interested to know what's up.
We get there, and the ER is quiet indeed, except for our patient, a twenty-something man in plaid boxers who I can tell either just engaged in a tearful confession of some kind with the Paramedic holding pretty vicious direct pressure on his right wrist, or he's drunk.
Oh, goody.
I step behind this Paramedic in an attempt to figure out why he's holding this young man's wrist so tightly. After all, he seems boisterous, and possibly inebriated, but not particularly violent.
Oh.
Peeking around a stack of four by fours is a deep cut that seems to go most of the way around his wrist. Four more packs of gauze sit stacked beside him and he asks me to open them. "Three of them should do it." Yikes. I open the packs and watch them wrap the wound. I sense a story coming.
"So what happened?" The paramedic asks as we drive to the helipad.
"Oh, man. You wanna hear a story? So, like, we were drinking and whatnot, and I, like, fell off the porch and caught my hand on the white things, you know the white things between the windows? And, like, my hand went through it. And I fell. And blood, like, shot out like four feet."
He offered further information.
"But, you know? Okay. You wanna hear this? Last year, like, my friends and I were partying, and drinking and whatnot, and I, you know, passed out on the sidewalk. And you know what the cop did? He TOOK ME TO THE HOSPITAL. What a DICK."
(What was he supposed to do? Put cones around him so no one would trip?)
"Thirty five hundred dollars. Man. That sucked."
"You ain't seen nothing yet," the Paramedic said. "Wait until you get the helicopter bill."
We waited, listening for the distant drone of his ride coming in over the lake. The patient coughed long and deep.
"That doesn't sound to good, are you sick?" I asked.
"Nah, its...you wanna hear this? Okay, so about a week ago I was siphoning some diesel fuel and I got some in my lungs. I guess I should have them check that shit out too while I'm at the hospital."
"So, you were just going to let that go and see how it worked out?" by now the Paramedic has that look on his face that tells me I'm going to be spending the next few minutes trying hard not to laugh. "Do you ever think about, like, staying home?"
What would we do on a Friday night if he did?
<><><><><><><><>
In other news, most of you already know that I lost a job in the beginning of the summer. Some of you may NOT know that I got a new job that I have a feeling may contribute some content to this blog, though from a different 'angle'.....I'm a 9-1-1 dispatcher in training.
Yep, I'm learning to work the other side of the radio....police stuff, protocols, geography, computer aided dispatch, its a whole new world. I love it-- the co-workers, the work, even the wonky schedule is cool.
Poor life-choice makers...holla. You already have my digits.
Monday, November 30, 2009
Sometimes the patient is.....you
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.
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.
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.
Anyhow.
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.
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.
Anyhow.
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.
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)
Aaaand…..scene.
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.
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.
Friday, December 26, 2008
Simple Gifts
It is the day after Christmas. Our house is decorated with enthusiasm if not style, the living room cluttered with wrapping paper. We came home from Christmas with the in-laws to find a large package on our porch, and after quick work with a pocketknife on the many layers of tape, we opened more gifts.
Its quiet. Just the hiss and swish of iron on fabric.
Getting the pleats just right takes skill. First, I take off the badge, take off the nametag, take off the tack pin that came from that first aviation assist, a shiny unexpected gift from the BDU pocket of a pilot that afforded that instant of sheer childlike delight; a tiny enameled helicopter. I take off the Hazmat certification and follow the creases that came in the shirt, iron around the patches. Promise myself I will sew them down better, another time. The pins go back on; the tiny silver angel from my mother goes back on my shoulder. The badge wrapped in black ribbon. I eye it all critically, making sure all is straight and even.
It is the day after Christmas.
The pants are easy; lint roller and a razor sharp pleat front and back. I hang it all together on the outside of the closet door, ready for the morning.
In the morning we will present ourselves in our best, out of respect. We will present ourselves to confront the unimaginable, to say to a family, he was one of us and we loved him too. To say, we cannot know your pain, but in this place where there are no words, and only tears between heartbeats, we will stand with you. We will always stand with you.
Chief Timothy R. Martin
Goodyear Hose Company
October 4, 1976- December 21, 2008
Quiescat in Pace
Its quiet. Just the hiss and swish of iron on fabric.
Getting the pleats just right takes skill. First, I take off the badge, take off the nametag, take off the tack pin that came from that first aviation assist, a shiny unexpected gift from the BDU pocket of a pilot that afforded that instant of sheer childlike delight; a tiny enameled helicopter. I take off the Hazmat certification and follow the creases that came in the shirt, iron around the patches. Promise myself I will sew them down better, another time. The pins go back on; the tiny silver angel from my mother goes back on my shoulder. The badge wrapped in black ribbon. I eye it all critically, making sure all is straight and even.
It is the day after Christmas.
The pants are easy; lint roller and a razor sharp pleat front and back. I hang it all together on the outside of the closet door, ready for the morning.
In the morning we will present ourselves in our best, out of respect. We will present ourselves to confront the unimaginable, to say to a family, he was one of us and we loved him too. To say, we cannot know your pain, but in this place where there are no words, and only tears between heartbeats, we will stand with you. We will always stand with you.
Chief Timothy R. Martin
Goodyear Hose Company
October 4, 1976- December 21, 2008
Quiescat in Pace
Friday, November 28, 2008
Not just a job, but an adventure
Ah, the station. I probably spend more time here than I should. In fact, I'm writing this here. Mostly because we have a big flatscreen monitor on the computer and the keyboard isn't full of crumbs like the one at home. (I'm not to blame. I'll leave it at that.)
Anyway, the station is a little like college. You sometimes share close quarters with other people of whom you have a certain fondness. A certain camaraderie. Okay, you tolerate them. Sometimes.
We don't have a live-in program or anything, so there isn't a full kitchen, though we do have a bunkroom that has been used now and again. I camp here myself in inclement weather, since I have a car that isn't the best handler in snow and ice. I'd rather be here already if its really bad out.
Some time ago it was decided that someone should be cleaning this place on a regular basis. I won't get into why. Just trust me. It was necessary. A price was negotiated, and the job fell to myself. I don't really mind it. Twice a week I chase away the cobwebs, wipe up the smudges, and clean the bathroom. This is a pretty uneventful experience about 98% of the time. Today was a two-percenter. I performed an intervention. Then left this note.
Brothers and sisters, this holiday season, if you stop at the station for a little 'You Time'....just make sure all systems are clear before you go about your day. That's all I'm sayin'.
Anyway, the station is a little like college. You sometimes share close quarters with other people of whom you have a certain fondness. A certain camaraderie. Okay, you tolerate them. Sometimes.
We don't have a live-in program or anything, so there isn't a full kitchen, though we do have a bunkroom that has been used now and again. I camp here myself in inclement weather, since I have a car that isn't the best handler in snow and ice. I'd rather be here already if its really bad out.
Some time ago it was decided that someone should be cleaning this place on a regular basis. I won't get into why. Just trust me. It was necessary. A price was negotiated, and the job fell to myself. I don't really mind it. Twice a week I chase away the cobwebs, wipe up the smudges, and clean the bathroom. This is a pretty uneventful experience about 98% of the time. Today was a two-percenter. I performed an intervention. Then left this note.
Some Thoughts to Ponder
1. The throne on which
you are sitting delivers water at the rate of 1.6 gallons per flush.
2. Despite the impressive WHOOSH it makes when you pull the handle, it
is a LOW FLOW TOILET.
3. If you, in the course of business here,
believe that the payload you are delivering will not be sufficiently moved into
the sewage system of Our Fine Borough by 1.6 gallons of water, a mid-transaction
courtesy flush is in order.
4. The average human anus is approximately
the size of a dime. It does not require FIFTEEN YARDS OF PAPER to clean.
5. Should you experience a plumbing emergency worthy of intervention,
a plunger can be found across the street (in the firehouse) in the ladies
room. Knock first; it’s a one-seater.
6. Should I ever have to clear a
plumbing emergency like the one I found tonight, and the perpetrator does not
make an effort to solve the problem, and leaves it to me, and said perpetrator
can be positively identified, they might find what they left behind in the
pockets of their turnouts.
Brothers and sisters, this holiday season, if you stop at the station for a little 'You Time'....just make sure all systems are clear before you go about your day. That's all I'm sayin'.
Saturday, November 22, 2008
Physics is Not Your Friend
I have no kids. Some might say I have no business dispensing advice to kids. I'm going to anyway. Its not particularly loving or kind. Too bad.
List of Realities For A Seventeen Year Old Male
1. You are too young to drink.
2. Anywhere. Anytime. Four more years to go. Wait.
3. Drinking anyway makes you a lawbreaker.
4. Drinking and driving makes you a selfish dickhead lawbreaker.
5. Such decisions are expensive. No one is impressed, least of all your parents, or the person whose rather new sportscar you totalled.
6. See #4 re: selfish dickhead
7. That body you are walking around in is essentially an animated bag of meat. It is fairly easy to break and poke holes in, particularly when you are too stupid to wear a seatbelt.
8. We all know that you know better. Since you aren't dead you get a chance to prove it. Don't screw it up.
List of Realities For A Seventeen Year Old Male
1. You are too young to drink.
2. Anywhere. Anytime. Four more years to go. Wait.
3. Drinking anyway makes you a lawbreaker.
4. Drinking and driving makes you a selfish dickhead lawbreaker.
5. Such decisions are expensive. No one is impressed, least of all your parents, or the person whose rather new sportscar you totalled.
6. See #4 re: selfish dickhead
7. That body you are walking around in is essentially an animated bag of meat. It is fairly easy to break and poke holes in, particularly when you are too stupid to wear a seatbelt.
8. We all know that you know better. Since you aren't dead you get a chance to prove it. Don't screw it up.
Thursday, September 4, 2008
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.
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.
Monday, August 18, 2008
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'.
"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'.
Wednesday, July 9, 2008
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.
Tuesday, July 1, 2008
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.
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.
Sunday, June 15, 2008
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.
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.
Tuesday, May 27, 2008
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.
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.
Monday, May 19, 2008
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.
Friday, May 9, 2008
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.
Friday, April 18, 2008
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
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