Overheard on the Bus

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

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

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

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

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

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

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

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

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

Patient: "6 or 7 shots. Why?"

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

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

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

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

Patient: "Oh, shit. My truck."

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Its only May.

Department of Vehicular Awesomeness

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

Riding Season

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

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

Alert tones and two beeps.

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

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

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

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

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

Nineteen Months

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

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

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

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

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

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

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

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

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

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

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

Once there was a way to get back homeward

Once there was a way to get back home

Sleep pretty darling do not cry

And I will sing a lullaby

Golden slumbers fill your eyes

Smiles awake you when you rise

Sleep pretty darling do not cry

And I will sing a lullaby

Sonrisa

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

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

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

"Will I come back here?"

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

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

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

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

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

"Will I come back here?"

"Yes ma’am."

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

"I’m sorry, do I know you?"

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

"Okay."

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

"I’m sorry, do I know you?"

"Yes ma’am."

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

Snow Storm

I present for your consideration a guest post from one of my fellow
EMTs. My friend here came through EMT class with me (with one of the
highest grades and best recommendations, I might add) and in his short tenure of
certification has had some pretty intense experiences. He's one of
those teens that reminds you that this generation is really pretty okay.
More than okay.

Hello everyone! I’d like to start out by thanking the lovely blog host for letting me add a guest story here and there. I hope to interest some of you out there to join your local fire department or ambulance service. Just a little about me, I joined the fire department and ambulance as soon as I was of age and have been loving it ever since, but enough about me, onto the stories that you’ve been waiting for…

Snow Storm
The local weather service had been predicting a heavy snow storm for that night, and for once they got it right, except it all came as ice…The ice and sleet pellets were inches thick. I awoke to my pager’s annoying sound at 2am after being in a deep sleep. Dispatch reported a full arrest at our local apartment building. I didn’t bother getting dressed. I have a firm rule that after 1am if anyone needs my help that badly, they won’t mind me in my pajamas. I carefully made my way to the car attempting not to ice skate down the sidewalk. In the heat of the moment, taking the time to clean off my car didn’t seem like good idea. It did shortly thereafter. It is amazing what adrenaline and a sleepy mind will do to your common sense.

While driving down our main highway to the station I soon figured out that driving on a ice covered road with only a paper-sized port hole to look out of was not a good thing. Fortunately the general public has enough smarts and doesn’t drive too much at 2am on icy roads so it was deserted. I arrived at the ambulance building where a crew who didn’t have to drive was already there, one had decided to stay the night while the other lived next door. I jumped on board and away we went, with the bus occasionally sliding a bit. That experience will open your eyes very quickly.

We arrived onscene with the hospital’s paramedic beating us to the scene. We quickly found out that the building was locked down after a certain time and we were never given a key. The special emergency entrance had been locked as well. Somehow the paramedic had gotten in but we could not, so we radioed the communications center to have the police officer on duty come let us in. Just as he arrived a good citizen inside heard our knocking and let us in. We quickly boarded the tiny elevator and headed upstairs. We navigated the hallways looking for the room until we found it. Once inside we knew there was no help for this poor soul. The paramedic had determined that he could not be resuscitated, and we would have to remain on scene for the funeral home. The man’s wife was inconsolable, as anybody in her situation would have been.

She needed to notify family but was in no state to do so. Being the jacks-of-all-trades that EMT’s are, we began calling her family. We then called her friends who lived in a nearby town to come be with her. This was not a time for her to be alone. Of course, this was during an ice storm, so everything took a bit longer. We kept the woman company while waiting for the funeral home and friends, which would take at least an hour. She began to tell us about her life when she lived in New York City and how things were so much different here. It was actually quite interesting and got her mind off the situation.

After an hour of small talk and thinking to myself, what do I say…what can I possibly say to this woman that holds any significance and will help her cheer up? Unfortunately nothing came to mind. At last the funeral home arrived with Barney Fife and friend. These two were a pair to say the least, but they were there, and I was ready to be going. We quickly placed the body in the bag lifted him onto their stretcher. The friends arrived as we were leaving. After the funeral home completed everything they needed, we were on our way as well, carefully negotiating the slippery curves of town back to the station.

Once home, I hopped into bed and found that I could not get to sleep. The thought of death was on my mind. After dealing with so much death, it finally gets to you and you begin to realize we are all human and death is possible at any minute so we must cherish every moment.

Policy

Another double-transfer week.
Tuesday night, we went south to Williamsport. Wednesday was another visit to the fine folks at Robert Packer Hospital. Our patient was stable, the trip was uneventful, we got her tucked into bed, met up with another crew to grab some equipment to take back to our hospital, and we were on our way.

We only had one problem. Sayre, apparently, has a curfew. And we were past it.


Need a cup of coffee after 9pm ANYWHERE in a five mile radius? Tough. Because everything is closed. Everything. Our driver just wanted coffee. The rest of us were a mite peckish, but the driver having coffee is kind of important. We drive around and no luck. We finally find a Wendy's, which is open, but only the drive through. Surely, we reason, we'll be able to get coffee here.

Now. An ambulance is higher than a pickup, has a noisy diesel engine, and enormous side-vew mirrors so we can see past the patient compartment. Which means if we pulled up to the ordering thing, we couldn't get close enough and they would never be able to hear us. Never mind that we could never successfully complete the transaction on the other side of the building, between the height difference and the mirrors, without getting out. So we park the ambulance ON THE LEFT SIDE OF THE BUILDING WHERE THEY CAN SEE IT and walk up to the window. This is the retardation that ensues.

Our driver: Are you open?

Window Idiot: The drive through is open, but the dining room is closed.

Driver: Can we just order here?

WI: No, you have to be in a vehicle. I can't take your order at the window.

The driver and I part and gesture to the AMBULANCE which is parked IN FRONT OF HER STUPID HEAD.

Me: We can't drive around the building in that, you'd never be able to hear the order over the engine.


Driver: I can't even just get a cup of coffee and pay cash?

WI: No. That's the rule.

Me: But we're in an ambulance.

WI: Sorry, that's the policy. We can't serve people on bicycles either.

I am so close to pulling her through the window I'm experiencing involuntary muscle twitch. Because, you know, four people on an ambulance transfer from an hour and a half away who are just trying to not FALL ASLEEP AND WRECK on the way home are just exactly like some douchebag on a bicycle. We all freeze for an instant and let the pointlessness sink in, then get in the rig and go home.