My Mountaintop Blog

I hadn’t even clocked in yet and we were dispatched for a cardiac arrest. Having worked until midnight the previous night, I was operating on only five hours of sleep. I was working with a medic that couldn’t run calls yet because their license had not been ‘formalized’ by our governing board. This was not a good way to start a shift, especially since I hadn’t even smelled coffee yet.

The patient was a 40 some year old female with a newly diagnosed brain tumor. Her husband indicated that she had undergone treatment in the last two weeks and had seemed to be tolerating it quite well. I won’t even pretend to understand how cancer treatments can ‘unwire’ the human body. I called medical control for any pearls of wisdom concerning radiation and chemo and was pretty much told, “Good luck.”

Intubating this woman was difficult. I was struggling to find my landmarks and pass a tube into her trachea. I was laying on the floor, face-to-face with the patient, and straining to see past the Laryngoscope blade. I turned my head for a moment to allow my eyes to readjust. I noticed a little kitten sitting only a foot or so from where I was laying. I made the comment to whomever was listening to be careful not to step on the cat. This whole scene was frightening enough for the kids. I could only imagine the insult to injury if their new kitten got stepped on, too.

I went back to intubating, finally got the tube passed after a momentous struggle due to her small mouth and no chin, then got up on my haunches. We were having zero success getting this woman back. The kids and husband were crying. The little kitten was still there so I reached over and picked it up. As I got to my feet and walked to the kitchen to safely deposit the cat, it crapped on my shirt. If that wasn’t bad enough, when I set the cat down I noticed that it was dragging its hind legs. Someone had already stepped on it.

We were unsuccessful bringing life back to the woman. My uniform was sticky and smelled like cat poo. As we were packing up to leave, I noticed that the cat wasn’t moving and had died, too.

This was not a good way to start the day….

We were called lights and sirens for a pregnancy. I happen to like delivering babies. It doesn’t happen that often but when it does — and things go smoothly — it is one aspect of EMS that is totally positive. The update was that delivery was eminent and that a language barrier ‘might’ exist. Upon arrival, we found an approximately 40 year old patient lying on the floor, rolling around in pain, and moaning loudly. Her water had broken, as evidenced by the stain on the carpet, and she had the ‘look.’ I have delivered a few babies. I will never forget the ‘look.’ I asked her what her name was and she didn’t answer. I asked her how far apart the contractions were and again, she didn’t answer. There was another person the in the room. I asked if he spoke English and thankfully he answered that he did. As we were getting our stuff ready, I had the man ask the woman the routine questions about her medical history, etc. Nothing alarming jumped out at us.

Once we were set up, an IV started, and a ‘landing zone’ established for the baby, it was time to deliver. I looked the woman in the eyes and gave a kind of ‘okay, here we go’ nod. I pulled back her sarong to see if the baby was crowning. It was. A second later my face exploded in pain from being slapped by the mother-to-be. The room went silent as everyone waited for a reaction.

I stared disbelievingly at the woman. I was too shocked to say anything. I rationalized that labor pains cause women to do and say desperate things, so I forced myself to remain professional, even though my face was on fire. I tried to proceed and she kept squirming away from me.

The interpreter spoke up and said that in her country no man can look at a married woman’s privates except the husband. There were four male fire guys, two male paramedics, and two male cops. Delivery was eminent as the baby was crowning and her contractions were pretty much continuous. We didn’t have time to track down a female medic or cop that could deliver a baby.

I asked the man to tell the patient that she was only minutes away from delivering and that we were not going to have time to drive to the hospital or wait for a woman. She either didn’t care or didn’t understand because she kept fighting with me. I asked one of the cops to get a hold of her arms to keep her from swinging at me. She started screaming bloody murder.

We delivered a healthy baby about five minutes later. After drying and wrapping the baby, and cutting the cord, I handed the baby to the patient and asked the man to tell her congratulations. She looked at me with hatred and muttered something which the man refused to relay.

About a week later, one of the cops that had been on scene got in touch and asked if I wanted to press assault charges. He told me that while the woman was in the hospital, she slapped a male PA that was trying to assess her vaginal area. I also found out that she had filed a complaint letter through Lutheran Social Services that I had violated an ‘indoctrinated cultural belief.’ The woman had been in the United States for over 8 years. If she hadn’t adapted to American culture by now, she probably never would. Putting her in jail wasn’t going to accomplish anything, so I passed.

I understand that she probably came from a war-torn, oppressed country in which her life was threatened every day simply because of her political and/or religious beliefs. I understand that she had probably spent many years in a refugee camp and had lived in deplorable conditions not fit for an animal, let alone a human being. But that nightmare was over for her and had been for 8 years. She had been one of the lucky ones that had been rescued from a living hell and now her every basic need was taken care of, including free housing, free food, and free healthcare. (Brace yourself) And I am helping to pay for her new life, yet she assaulted me after calling 911 and I showed up to help her.

I have thought about this call many times over the last couple of years. I am not proud of some of the things I have thought since then concerning other cultures that have established a presence in this country. If this had been an isolated incidence, I am sure I would have filed it away under the ‘weird call’ category. But it wasn’t an isolated incident. I have dozens of experiences involving a clash of cultures.

Whereas I tend to be more middle of the road with my political philosophies, that one event moved me closer to actually wanting to listen to someone like Rush Limbaugh. I love this country. I love baseball, hot dogs, and apple pie. I get goosebumps every time I hear a beautiful rendition of our National Anthem. And I don’t expect everyone to feel the same. However, if someone CHOOSES to live here then they should at least try to adjust and not just assume that we are going to know or even be able to adhere to their cultural norms. During my most hardened right-wing moments, I want to tell people like that woman that I will gladly buy her a one-way ticket back to the hellhole she came from.

But I won’t. It always sounds good in my mind, though.

We were called to a private residence for a fall. We were met at the door by the patient, a woman in her late sixties. She was holding a dish towel to her elbow and had a laceration that was going to require stitches. She walked us into the kitchen and she sat at the table. She explained that she had been walking her dog and fell, but didn’t give a reason as to why or where. She voiced no other complaints other than her elbow was ‘smarting’ and she didn’t want to go to the hospital by ambulance. Instead, she asked me to call her son, which I did, and then we started making small talk while we waited.

Normally I would have the patient sign a refusal form and we would be on our way, but she had fallen for unknown reasons. Her vital signs were normal but my inner CYA voice was saying to stick around. Plus, she seemed pretty frail. The woman offered to make us coffee. Being old school, I accepted her offer so that I didn’t seem rude. The woman made the coffee and served us. She asked if we wanted a brownie. Again, why not? While we sipped coffee and ate brownies, we chatted about the weather, where she was from, how long she had lived there, etc. She opened her mail while we were talking then started putting away dishes from the dishwasher, wiping off the counters, and other menial tasks.

About fifteen minutes later I got a call back from her son wanting to know where we were. I told him that we were at his mother’s house and he said that HE was his mother’s house. After a long pause I looked at my pager and read off the address that we had been dispatched to. He said the address I gave him was the next block over then said that he would be right there.

Enter confusion.

I went into the garage and found a couple of bicycles, a motorcycle, and some impressive power tools. I peeked into the living room and saw leather furniture and a 50 inch plasma TV. I asked the patient if she lived alone and she said she did. I asked her what her address is and she hesitated. I asked her what month it was and she hesitated. I asked her where her dog was and she said she didn’t have a dog. About the time that my head was going to implode, her son knocked on the door. I let him in and he went to his mom and asked why she was there. She couldn’t answer.

It turned out that his mom had dementia. She thought she had been walking a dog that she didn’t have and fell in front of the house that she didn’t live at. We concluded that when she called 911 she must have looked at the address on the mailbox and then walked into an unlocked house. What really had me perplexed, though, was that she knew where the coffee and coffee filters were kept. She knew that there were brownies made. She knew where the dish towels were so she could clean off the counter. She knew where to put the dishes that she had unloaded from the dishwasher. Either she had fallen a lot earlier in the day and had been rummaging around her neighbor’s house, or she was the next John Edward. <Shudder>

The son took his mom to the ER. I called for PD to file a report so that when the proper homeowners arrived home they wouldn’t freak out. And when we were finally on our way back to the station, I made a mental note: Never assume.

I rode with a newer medic recently, which was kind of refreshing because the job had not taken the luster off of his excitement for EMS yet. His enthusiasm, albeit somewhat trying at first, was also infectious. As the day progressed and we went from call to call, I found myself feeling some of the same zest that I had felt when I was a new medic. We were dispatched mid-afternoon for an unconscious person. Before we were saddled up and moving, we were upgraded because the patient was pulseless and not breathing. The second update was that the patient was a male in his thirties.

It was the new persons turn to take the call. If I had a dollar for every cardiac arrest call that I have been on that turned out to be a passed out drunk, and some other drunk had become convinced that his buddy wasn’t breathing and called 9-1-1, then I could buy a new stethoscope. And a nice one, too. I wasn’t getting too worked up but my new-to-EMS partner was. So, I asked what things they were thinking about in terms of what might cause a younger person to go into cardiac arrest. He excitedly recited the six H’s and T’s from the text book. In a morbid kind of way, I was hoping this call was the real deal so this new medic could get a ‘good’ one under his belt.

I think it is EMS rule number six or seven, I can’t remember, but loosely stated: Patients that decide to have their heart stop need to be in the attic, bathroom, down in the basement, or any other cramped place that makes gaining access a chore. In this case, it was in the basement in a small utility closet. The patient was heavyset and, indeed, without pulses and not breathing.

Like a seasoned veteran, my new-to-EMS partner started giving direction. The patient, resembling a 300 pound bag of wet cement, was moved to an open area. CPR was started immediately. We had two IV’s running and had the patient intubated in record time. A couple rounds of CPR/defibrillation/meds and we had pulses back. My partner actually let out a hoot when he felt a carotid pulse. The fire guys gave me a curious look and I gave them a shrug and a look as if to say, ‘let him enjoy his job.’

Getting the patient out of the basement was horrendous; a steep staircase with a turn, through a small kitchen, through a narrow doorway into the living room, out onto a creaky porch, down four or five creaky steps, onto the cot, down a bumpy, uneven sidewalk, down three more uneven steps, and then to the ambulance. Unfortunately, before we completed step one of the extrication process, the patient went back into vfib. We shocked. We got pulses back. We started our exodus again. When we got to phase three – the living room – we lost pulses again. We shocked. Nothing. We started CPR again and shocked again. We got pulses back. We continued.

As we were negotiating the uneven sidewalk, we lost pulses again, but we got them back with one shock. We were in the back of the ambulance and getting orders for another round of an antiarrhythmic medication when we lost pulses again. I was getting frustrated. My new-to-EMS partner was undaunted and thoroughly enjoying the challenge.

Shock. CPR. Shock. Meds. We got pulses back.

I jumped in front and took off for the nearest hospital. We delivered a living patient to the ER and went out to get the truck cleaned up and restocked. My new-to-EMS partner approached with a broad smile. Then he did something that I had not seen for a long, long time. He raised a hand in the air. We high-fived.

Wow. I had forgotten how to enjoy this job.

This is a rant. Sorry, but I need to get this off my chest.

This is concerning motorcycle rallies:

When an ambulance gets called to a motorcycle rally, wouldn’t it be nice if law enforcement, who use the same radios that we do and know we are on our way, would have a path cleared for the ambulance? Maybe they could have the barricades moved, or at least have someone standing by to move the barricades so the ambulance crew doesn’t have to get out of the truck and move them. Or, you can just stand around like you did and let us fend for ourselves, and add about 3 or 4 minutes to our response time.

Wouldn’t it be nice if people got the hell out of the way when a five ton ambulance with its blinding lights on is trying to maneuver through thousands of people and motorcycles? How about not flipping us off after you finally turn around and realize we are right behind you? How about realizing that maybe one of your ‘kind’ is laying on the street and has no pulse and isn’t breathing and the longer it takes us to get there, the less chance they have to survive?

Wouldn’t it be nice if the band would realize that shutting down their music for a few minutes would be incredibly helpful? One of your fans keeled  over in front of your stage. Someone is doing CPR so only an idiot wouldn’t be able to figure out that the situation is serious. Being able to communicate amongst ourselves is kind of important when dealing with cardiac arrest. I’m sure your ‘sound’ is amazing and your next CD will go platinum but I really think someone’s life is more important at that moment.

And when someone gets their face sliced open by a rival gang member, wouldn’t it be nice if they didn’t threaten me by asking what my name is and where I live? You have serious injuries, including a deep laceration that might have severed an ocular nerve. I know you have an image to maintain with your leathers, tats, and shaved head, and you want to act macho in front of your ‘posse.’ But, you are drunk, and for that reason alone you have lost your right to decide whether you are going to the hospital or not. I didn’t put a gun to your head and make you drink so much that you blew a .33. One thing I am certain of, though: Should I have cowered to your attempts to bully me and I had left you there, you would have no problem suing me because you lost your vision in that one eye. Where would your machoness be then, tough guy, when you are sitting in front of a jury and acting like the victim?

Lastly, if you tip your motorcycle over and thump your head on on the curb, don’t act so indignant when I strongly suggest that you go to the hospital and get a CT of your brain since you weren’t wearing a helmet. I realize you don’t want to look like a nerd by wearing a helmet, but what kind of nerd will you look like when that possible brain bleed you have causes you to fall to the ground and flop around like a goldfish out of water?

I know I am bitching, and instead of just bitching, here is my solution: The local and county governments that approve the permits for events like this should pass an ordinance that stipulates that EMS show up at the periphery of the event and not be required to go any further. The event organizers need to be required to hire their own medical staff. When someone needs an ambulance, they can bring them to us and we will take it from there.

Enough said.

This post isn’t about a horrendous fireworks tragedy that turned into a mass casualty incident. It isn’t about seared flesh, severed limbs, or the inane actions of some drunk playing with fireworks.

Quite the opposite.

I had worked on the 4^th of July for four years running partly because that was how the schedule worked out, because I wanted the overtime and, embarrassingly, because I just didn’t have anything better to do. This year, however, I had a lot of incentive to take the 4^th of July off. That incentive was by way of the wonderful woman I am seeing, and to reacquaint myself with celebrating a holiday like a normal person.

The 4^th of July has always been one of my favorite holidays, second only to Christmas. I mean, seriously, a holiday that allows a person to legally blow stuff up? What could be better? From a very early age I learned the fine art of positioning Black Cats just right so that the model airplanes that I had meticulously assembled throughout the year would blow apart into a million pieces. If I was lucky, the airplane would catch fire, too. I learned just how long I could hold onto a smoking cap stick before it blew up and burned my hand. I learned that if I lit enough smoke bombs all at once and put them in a trash can, the fire department would show up. I learned that the larger bottle rockets – the ones with the 3 foot sticks – would shatter a kitchen window if aimed just right. When I was a kid, M-80s were still legal. I discovered that the more confined the space that the M-80 blew up in, the bigger and more powerful the explosion. I learned that if I tightly wrapped an M-80 with duct tape to a tree that was six inches in diameter, for example, doing that about four times would fell the tree. Unfortunately, it was my neighbor’s tree. That year I spent the 4^th of July in my bedroom, in bed, with the lights out, while the rest of the family oooh’d and ahhh’d while my dad blew up a load of fireworks that would make anyone salivate.

And then there were the heated (no pun intended) bottle rocket wars with my neighborhood buddy. Within an hour of the fireworks stands opening for the year, we would each secure a fairly large cardboard box. We would cut a hole to see out of, and another one to shoot out of, and then proceed to try and shoot a bottle rocket into the other person’s fortress and ignite their ammo dump. One year I snuck a Roman Candle into my arsenal because my buddy had figured out a way to shoot multiple bottle rockets and I needed a leg up. He didn’t stand a chance under the heavy barrage of ‘rocket fire’ from a twenty shot Roman Candle. When his cardboard box caught on fire, he had to bail out. I declared a victory. He demanded a rematch.

This year it was very dry so blowing up a bunch of stuff wasn’t practical due the high probability of setting about 500 acres of grassland on fire. We still managed a few daytime parachutes, and a couple of fountain cones. We also set off several packages of Black Cats that put my dog in manic mode. What really made the night special, though, was the view I had while sitting on my deck with the love of my life; our bellies full from grilling, a warm buzz from the beer, and watching four or five professional displays simultaneously light up the horizon. This is the third year I have lived in this house and I didn’t know that I had such a great view.

Sad.

My lady friend (saying ‘girlfriend’ makes me sound young and I am WELL beyond young) happens to be a scanner nerd, something I happen to like very much about her. While we relaxed with our feet up, sipping on cold adult beverages and watching the panoramic view of the night sky being illuminated with the rockets red glare, we listened to the Police, Fire, and EMS scanner. She listened because she is a non-EMS person and curious about what goes on. I listened because, well, I was not working and for reasons that I am sure are not entirely pure, I got a sense of satisfaction in knowing what I was missing. We heard over 30 dispatches for fireworks-related grass fires, and the resulting updates about ‘civilians’ trying to put them out. And then, just as most celebrations were in full swing, there was a dispatch at around 10:30 for chest pain. The patient was in their forties with a several week history of chest pain. The update was that they would be waiting outside by the curb for the ambulance.

I could hear the irritation in my co-worker’s voices as they answered up for the call, and even more irritation after they had made patient contact and were en route to the hospital. I had been in their position many times before: Christmas, Thanksgiving, the 4^th of July…there always seemed to be a certain segment of society that chooses to call for an ambulance during a holiday for an affliction that they have had for several weeks. I envisioned that this person was attending a 4^th of July party and while everyone else was reveling in the holiday, they needed everyone to feel sorry for them. As calloused as this might sound, it is reality…and a sad one at that. This year, however, I didn’t have to deal with it.

Bonus.

It was a warm, still night. I had wonderful company. We had a spectacular view of people celebrating the independence of this country.

I hope I get to do it this way next year, too.

I know that I have become callused over the years. Death, suffering, violence, and abuse  has desensitized my humanity. But something happened today that restored at least a small sliver of faith that I haven’t become a complete monster.

When I left for work this morning, my dog – a very lovable but terribly unintelligent creature – scurried into her indoor/outdoor kennel. But this time, instead of turning and waiting for the biscuit that I always give her and the pat on the head, she stopped suddenly and I heard an ominous hissing sound. My dog had come face-to-face with a raccoon.

Instead of going crazy like a normal dog: Raised fur, bared teeth, menacing growl…she tried to sniff the raccoon’s butt. She is not a bright animal. The last time something like this happened it was a skunk, and sniffing a skunk’s butt was, well…she obviously didn’t learn.

I  coaxed my dog out of her kennel and stood there for a few seconds trying to figure out what to do with this varmint. My first inclination was to get a 2×4 and whack it on the head. This was a raccoon. They are a nuisance. They carry diseases. They are destructive. I put my dog in the house because she was driving me nuts; prancing around and whining like I had just brought a puppy home from the pound. Then I went back out to deal with it. The raccoon was still in the kennel and it didn’t seem the least bit alarmed as I rummaged around my lumber pile looking for a suitable board. I glanced over and the critter was watching me, oblivious to its impending death. For some reason that really pissed me off. Why wasn’t it acting afraid? Why wasn’t it looking for an escape route? I couldn’t find a board that would do the trick and I decided to give it a fighting chance, so I left the raccoon in the kennel with the door open in hopes it would wander away. I went to work.

All day long I bragged to my co-workers that I was going to beat this thing into a new hat for Daniel Boone if it was still there when I got home. I reiterated many times that I didn’t want to have some stinking, disease-ridden rodent hanging around my place. I have a reputation, after all. My co-workers were in my corner. A few even offered to lend me their guns.

When I got home, I found the raccoon curled up on my dog’s blanket and napping. The kennel door was still wide open so it could have left whenever it wanted. As I approached, it lazily lifted its head and looked at me then went back to its nap. WTF! That pissed me off even more. I went into the house and grabbed a tree branch that I had made into a walking stick and went back outside. I started poking at the raccoon. It stood, stretched, then sauntered out of the kennel. It walked right past me, and in no particular hurry. It was acting as if I had inconvenienced it by waking it up. This was my chance. The stupid thing was walking slowly away from me and I could easily smash its skull and be done with it. Then I noticed it was limping.

Damnitalltohell.

It stopped near the garage door and looked back at me. I swore it was baiting me; daring me to take a roundhouse swing with the baseball bat-sized tree branch and knock it into eternity. I nudged it along for several feet, again hoping it would just leave. My manliness was taking a terrible beating. I decided that I would lie to my co-workers and tell them that I had splattered its brains all over the ground. It was meandering toward the road and just as I thought the problem was solved, the cute, furry raccoon with the bum leg went into the yard and climbed a large oak tree.

And there it lounged like it was on vacation. So, I went inside.

As God as my witness, I started to worry about this raccoon. How was it going to get down? What if it was hungry? What if it needed….um…medical attention for its bum leg? As soon I would catch myself feeling bad for it, I would get angry that I hadn’t knocked its head off when I had had the chance. This was embarrassing. What kind of a man am I?

I was looking out of the window at the raccoon and talking to my wonderful girlfriend on the phone about this issue, and she said something that caught me off guard. She said that she loved me for being so compassionate. And then I realized that maybe I do still have a shred of decency left in me. Maybe I haven’t become as cold and unfeeling as I had thought.

At my girlfriend’s suggestion, I put some dog food and water out at the base of the tree. I know it will eventually come down and probably head off to a more natural environment…and not near a mentally challenged dog that wants to sniff its butt.

The partner I was riding with on this day is not a good driver. That is my opinion, of course. They jackrabbit start, make sudden stops, hit curbs and then act all crazy that someone had the audacity to put the curbs there, cruise over speed bumps as if they are merely a suggestion to slow down, and yell every profane word they know when traffic doesn’t cooperate. It is as if their driving acumen IQ drops fifty points when they get behind the wheel of the ambulance. I don’t think it is official, but rumor has it they hold the record for the most drivecam activations in a single shift.

We were transporting a patient that had had a single seizure. They were conscious but not yet alert. Their vital signs had returned to normal. I stood to get the Ativan out in case the patient started to seize again, and then the patient did start to seize again. We were only a few minutes from the hospital so I yelled up to my partner to upgrade to lights and sirens and make a dash for the ER instead of stopping and helping me arrest the seizure.

I should have been prepared. I always think of these things when it is too late.

I was standing toward the back of the ambulance and holding on with my right hand to a grab bar for stability. My partner floored it. I am not a small person so the centrifugal force slammed my two hundred pounds against the back doors. This normally wouldn’t be a problem. It should never be a problem. Under normal circumstances, I would have sworn under my breath, regained my composure, and I would have pushed the Ativan to stop the seizure. Unfortunately, when my left side rammed up against the back door, the door flew open and I found myself staring down at the blur of yellow lane marking paint, while putting a death grip on the grab bar to keep from falling out.

It is unclear as to whether we just didn’t get the door closed tightly before we took off, or if the latches on the truck, which had over 200,000 miles on it, had just worn out after the thousands of times those doors had been opened and closed. Regardless, I discovered that there is an element of truth in what people have said about your life flashing before your eyes during a moment of terror. The entire event lasted maybe five seconds yet the number of thoughts that coursed through my mind in those five seconds were numerous:

1. If I survived, I wanted to tell my partner that I thought they belonged in the EMS hall of fame as the worst driver ever.
2. Was I wearing underwear without holes?
3. Assuming I survived, which nurse in the ER was going to make the first catty comment about my manhood? How were they going to deal with having to treat one of ‘their own?’
4. I thought about my kids and how they would take the news of my demise. I wondered if they would argue over what few meager possessions I had.
5. Was the house clean?
6. I wondered how much life insurance I really had.
7. I thought about my mentally challenged dog and wondered who would have the patience to take care of her. Who was going to understand that she is afraid of lightning, and that she usually won’t eat unless someone is in the same room with her?
8. I wondered how my girlfriend and the love of my life would react to all this. Would she be angry with me for being so careless? Would she want to rip out the eyes of my partner? Who would know to call her? If I survived and was going to be bound to a wheelchair for the rest of my life and drooling on myself, how would I convey to her that she needed to move on and not feel guilty about it? The last time I talked to her, did I tell her that I loved her?

My thoughts went from terror, to anger, to silliness, to practicality, to a melancholy sadness…all in the span of five seconds.

I wrangled myself back inside, thanks in large part to my partner braking to turn a corner and  centrifugal force working to my advantage. I planted my butt firmly on the bench seat. I was drawing up the Ativan with shaky hands when I heard my partner yell back, “The door alarm went off!”

I couldn’t think of anything nice to say, so I yelled back, “I wanted to make sure we still had a back bumper.”

I didn’t get a reply. And I didn’t say anything more. From that day on I have made a point to be seated if at all possible while the truck is moving. I owe that much to the people that care about me, and ultimately to those that would be caring FOR me, and to not put them in an awkward position.

I try not to be superstitious but there is something about EMS that just brings it out of me. When I lay down on the sofa at the station to take a nap, I don’t remove my boots because if I do I know we will get called out. I don’t bring food to the station that requires anything more than a zap in the microwave because it is almost a certainty that just as I get to the critical phase of adding milk and butter to the mac and cheese, we will get called out. And when I return, my mac and cheese will be an inedible hardened lump of starch. And, God forbid, that someone use the “Q” word. That is by far the worst.

I was working with a newer medic that didn’t understand the ominous need to avoid the catastrophic triggers that will send us packing, never to return until the end of the shift, and with a dozen unfinished charts. I was just preparing to lay down on the sofa, boots on, of course, and partake in some continuing education by watching an episode of Emergency! when my young, naïve partner said, “Dang, it sure is quiet today.”

As if on cue, we get toned out. Not only did we get toned out, but it was for a cardiac arrest. And not only did we get toned out for a cardiac arrest after my partner’s gaff with saying the “Q” word, it was a cardiac arrest involving a man in his early thirties. CPR instructions were being given. This was the real deal.

We were on scene within four minutes, and other than swearing at traffic, the only words that passed between my partner and I was me chewing her out for pissing off the EMS gods. We pulled up to a nicely kept, smaller house in a lower-middle class neighborhood. It was the kind of neighborhood that we rarely got dispatched to. When we walked into the house, the patient was lying in middle of the living room floor, and the fire guys were doing hard and fast chest compressions. A young wife was standing in the dining area holding their one year old son. She was crying and had that look as if someone had just told her the world was about to end. She said that her husband had just gotten home from work, took a shower and changed clothes, and then collapsed without saying a word.

We got busy doing what we do with cardiac arrest patients: IV, intubation, medications. I asked the wife about his medical history and she said he was a recovering alcoholic but had been clean for three years. Other than occasional heartburn, he didn’t have any medical history. I try to treat all cardiac arrest patients the same, but it seems the younger they are, the more aggressive I am. We pushed all the medications. We considered all the possible reasons that a seemingly young, healthy man would go into cardiac arrest, and came up with nothing.

As we were working the code, I could hear the wife tearfully talking to the police. I overheard her say that they had dated since high school. They got married three years ago after he had secured a decent job at a local manufacturing plant, and had made a commitment to stop drinking. He was even volunteering his time with Alcoholics Anonymous. She was pregnant with their second child. They had just bought this house after scrimping and saving and working a lot of overtime. As I looked around I could see the pride in ownership with freshly painted walls, clean floors, and a tidy little kitchen. They were living their dream…a man that had overcome the demons of the bottle, marrying his high school sweetheart, starting a family, and giving back to the community. Isn’t that what we all hope for? Just a shot at being happy; being in love, feeling productive, overcoming the odds and proving to the world that you can have a positive influence on society?

We worked the code for thirty minutes without success, and I have to admit that I honestly did consider that my partner’s ignorance in using the “Q” word had placed us in this very unfortunate position. And even though my rational side said otherwise, all I wanted to do was throttle my partner. When the decision had been reached that our efforts were futile, I had to tell the young, pregnant wife that was holding their one year old son while standing in the dining room of their dream house that her husband had passed away.

At 3:34 PM on a Friday afternoon, it felt as if I had just informed her that her dreams had died.

We had assisted an elderly man off the floor and into a chair. He voiced no complaints of injury so this call was turning out to be just a lift assist. But something didn’t seem right. He looked tired. Very tired.

“Are you sure you don’t want to go to the hospital?” I asked. “No offense, but you look really tired.”

“It’s because of that damn music,” the man replied. “Every night, just as I get into bed, the music starts up.”

“That doesn’t sound very pleasant,” I offered.

“I haven’t had a good nights rest for two weeks!” he complained.

“Have you filed a complaint with the police?” I asked.

“No, but I’m going to have to. It is driving me crazy. Just as soon as my head hits the pillow I hear this ‘thump…thump thump. Thump…thump thump. It’s the same damn song every night. Probably some young punks that live around here.”

I gave him a quizzical look. The rhythm of the song the patient had just described sounded familiar. I asked, “Do you mind if I take your blood pressure?”

“Go ahead,” he said, and rolled up a sleeve.

I attached the blood pressure cuff and pumped it up. The result was as I expected: Hypertensive at 188/102. “Do you take medications for your blood pressure?”

“Nope. Never needed it,” he replied. “Why?”

I tried not to smile. “Sir, I think the music you are hearing is your heartbeat in your ears.”

“Poppycock,” he muttered. “I know what music sounds like.”

“Okay, well, why don’t you lay down on your bed and let’s see if the music starts up,” I said.

He looked at me like I had just asked him to to do a cartwheel while singing the national anthem. But then he shrugged, stood up, and climbed into bed. He closed his eyes, and about five seconds later he suddenly popped his eyes open. He sat up, scratched his head then finally said, “I’ll be go to hell. I guess I should go to the hospital, huh?”

“That would be my advice. You will probably sleep a lot better,” I said, and we assisted him to the ambulance.