My Mountaintop Blog

The scene:

A fifty-some year old male was found lying on his living room floor. He was clutching his chest and moaning. He couldn’t or wouldn’t answer questions. He was pale and diaphoretic. We placed him on oxygen, got a set of vitals, and then hooked him up to the cardiac monitor. His daughter was present, along with three grandkids. They were hovering in the corner while we tried to figure out what was going on. The daughter indicated that her father had no previous medical history, didn’t take any medications on a daily basis, and hadn’t been to a doctor for any reason in the last ten years. Instead of moving the patient to the ambulance right away, we did an EKG and the result was the most impressive looking STEMI that I have ever seen. The ‘tombstones’ on the EKG tracing were textbook.

No matter how hard I tried, my facial expression belied the gravity of the situation, which made the daughter start crying. I have never made a habit of sugar coating reality but with children present I wasn’t going to be as forthright as I usually was. I told the daughter that we needed to get her father to the hospital right away.

The patient’s house was older and getting him from his living room to the cot required total lifting him due to narrow hallways, steps, and a lot of furniture in the way. While I was sizing up the best exit plan, my partner started an IV and gave a dose of nitro and aspirin. We gently rolled the patient onto a spine board, strapped him down tightly, secured all the wires and IV tubing, and then prepared to leave. I was starting to sweat, as I frequently did with critical scenes. I had a strong suspicion the patient was about ready to go code blue on us. The last thing I wanted was to have to work a code in front of his daughter and grandkids.

We lifted the patient and started the exodus. I was walking backward and concentrating on not bumping into anything. I felt something touch my leg and turned to find a 4 or 5 year old little boy standing behind me. He was still in his Spiderman pajamas and holding his sippy cup. Before I could say anything, he asked in an innocent, matter-of-fact voice, “Is papa going to die?”

What possible response could I give that would suffice for the moment, and not make an already disquieting scene even worse? “Your grandpa is sick. We are taking him to the doctor,” I finally said. The little boy shrugged and walked away.

We continued to move toward the door and as we were exiting the house, I heard the little boy say to his mother, “Don’t worry, mama. Papa just has a cold.”

If only…

It was one of those days that we were going from call to call and virtually all of them were nonsense. We were the ‘garbage truck’ on this day; getting called to drug seekers, drunks, and 21 years old with chest pain a.k.a. I-don’t-want-to-be-at-work-today. We were on our fifth call already and it was only three hours into the shift. We were dispatched to a parking lot for an unknown medical problem. I hate unknown medical problems because, as the name implies, it could be anything. The reality is, though, whomever called 9-1-1 didn’t give enough information as to why they needed an ambulance so the call fell into a catchall category of unknown medical. Ick.

The night crew had given us an update on their activities throughout the night, including information about a ‘newcomer’ in town that was seeking drugs. Drug seekers are a cunning, crafty sort, and will go to great lengths to dupe the medical community into giving them narcotics. I have had patients intentionally slam their hand in a car door just so I would give them something for the pain. I have heard the most incredible stories about suffering and pain so great that they cannot get out of bed, even though they are showered, dressed, and fresh coffee has been made in the kitchen…and they live alone. When the habit has become so addicting that they just have to have drugs, and they have exhausted all their resources locally, the drug seeking freak show will sometimes hit the road.

Guess who had just called 9-1-1 for an unknown medical emergency?

After pulling into the parking lot, we found the patient sitting in her rental car. She was exactly as the night crew had described her, including the crutches, cervical collar, and bag of first aide stuff in her back seat. She was a pro. I was irritated with this woman before the first words were spoken so my attitude wasn’t very ‘patient friendly.’

“What can we do for you?” I asked curtly.

“I was assaulted a few days ago and I am in a lot of pain. I can’t move my legs,” she answered.

“How did you drive your car here if you can’t move your legs?” I asked.

“It’s getting progressively worse. I had to pull over.”

“Interesting. That is the same thing you told my co-workers a few hours ago,” I offered.

She was momentarily flustered, but recovered quickly. “Those people were not very nice to me.”

“Ma’am, we have a zero tolerance policy in this city for people that are seeking narcotics,” I said. “In fact, we usually call the police, so count yourself as lucky that the other crew didn’t turn you in. Prescription fraud is a felony.”

“I am NOT seeking drugs,” she answered with feigned indignation.

“Where did you get assaulted?” I asked. My impatience was growing with each passing second and I was going to try and catch her in a lie.

She rattled off some small town a few hours away. “It was horrible. I am lucky to be alive.”

“Yet, you don’t have a single bruise or scratch on you,” I said. The mocking nature of my voice was evident.

“They pushed me down and kicked me in the stomach and back,” she said dramatically. “It was horrible! My whole insides are killing me.”

I wasn’t going to let this charade get out of hand. “What is the name of the officer that took your report? I need to corroborate your story.” When she didn’t answer, I continued, “Lemme guess. You didn’t call the police.”

She knew I wasn’t going to buy her story but she couldn’t concede just yet. She tried the race card. “What good would it do to call the police? It was three Negroes. They beat me and took my purse and all my money.”

I looked inside her car at a purse sitting next to her. “You must have done a little purse shopping since the assault with the money that you don’t have anymore, you know, because you were robbed,” I said with sarcasm.

She had lost but she wasn’t going to go quietly. “Is everyone so unfriendly around here? I have never been treated so rudely in all my life. I am in extreme pain and no one wants to help me.”

“We don’t take kindly to people trying to hustle us for narcotics. Might I suggest a rehab program?”

“You’re an asshole,” she blurted out.

My tolerance for this drug seeker was done. “I suggest you find the nearest interstate and get out of town. That, or you can go to jail. The choice is yours.”

I turned to walk away, and then she brought me to a halt with her next statement. “By the way…those are the ugliest boots I have ever seen.”

I stopped cold in my tracks. I had been yelled at, cussed at, threatened, spit on, bitten, and punched. But no one had ever told me that my boots were ugly.

I looked down at my boots and then dramatically turned to face her. “That’s just plain mean. Get the hell out of here,” I said and pointed toward the street.

My partner had already gone back to the truck in case he needed to radio the police. When I got in, he asked, “So, what did she say?”

“She said my boots were ugly.”

“Wow. That had to hurt.”

“You’re telling me.”

It is easy at times to get caught up in the ‘I went to paramedic school for this?’ syndrome. The short version is this: Yes, I did. Not every call is about advanced airway management, cardioverting, or pulling someone out of a tangled wreck. Sometimes the job is about nothing more than just being human.

*****

We waltzed into the patient’s home after a light knock on the door. “Hi there,” I said as brightly as possible. It had been a busy day and we had been running from one call to the next without a break.

The patient was a very large man sitting in a recliner in the living room. He answered, “I can’t make this damn chair work.”

I looked the patient over. The call was for lift help, which usually meant that someone had fallen and couldn’t get up. “Um, okay. Are you having a medical problem? Did you fall?”

“No, but if I can’t get this chair to work, I won’t be able to get up,” he answered. “I’ll end up starving to death and then my neighbors will start bitching about my stinking carcass. My neighbors are assholes.”

The chair in question was an ‘Eazi-Lift’ chair that rises up and makes getting in and out of the chair much, well, easier. It’s was all the rage for people that had problems standing and sitting.

With as much customer-focused care and compassion as I could muster, I said, “We will be glad to assist you out of your chair.”

I got an eyeful of distain. “I don’t WANT to get out of my chair right now. I want to watch TV. I just want the damn thing fixed so if I have to take a crap I will be able to GET out of my chair and not have to sit here in my own crap all day!”

I hid my irritation that the patient had called an ambulance because his new chair wasn’t working. “Um, okay.” I took the remote control and fooled with it for a few seconds. Nothing happened when I pushed the buttons. I set the remote control down on the end table.

“See what I mean? Damn thing is a piece of garbage,” the patient said with disgust.

“How long have you had it?” I asked.

“Just had it delivered yesterday. The idiots that carried it in the house scratched my woodwork. I’m going to bitch to someone about that.”

“Was it working yesterday?” I asked.

The reply is laced with animosity. “This is the first damn time I’ve used it. If I had tried to use it yesterday, I would have called you yesterday. Can you fix it, or do I need to call someone else?”

I glanced behind the chair and saw that the electrical cord was still rolled up with plastic on it. I unwrapped the cord and plugged it in, took the remote and pushed the up button. The chair began rising.

“I think I found your problem,” I said.

“What did you do?” he asked, rudely taking the remote out of my hand and pushing all the buttons. The chair began rising, dropping, vibrating, and the foot rest moved in and out…just as advertised.

The ‘patient’ was elderly, large, cantankerous, and lacked manners. But instead of embarrassing him, I said, “The electrical intake process had not been activated yet.”

“Whatever the hell that means,” he said. “I hope to hell I don’t have to call you people again.” He turned on his TV to the Price Is Right and within seconds, it was as if we no longer existed.

“Me, either,” I said, and we left to go run the next call.

*******

“Dispatch…patient contact. False activation,” I said. I knew the outcome before we ever set foot in this senior living apartment, but we always had to check.

“Ten-four. We will notify the alarm company,” dispatch replied.

EMS and the personal medical alarm has a love-hate relationship. We love it because on that rare occasion when someone needs it for a real emergeny, they can talk directly with an operator and indicate the reason for the alarm activation. When that information is forwarded to us, it gives us a heads up as to why have been summoned: A fall. Chest pain. Shortness of breath. It’s always nice to know ahead of time what we are getting into. The hate part comes in with the number of false alarms caused by everything from rolling over on the button in their sleep, to grandkids playing with it, to using it like some people use the phone to call room service.

In this case, the woman that had activated her alarm had seen me many times before. And, as with virtually every previous false alarm, she played coy as to how ‘that darn thing’ could have gone off again. But I knew what was coming next.

“Say, while you are here…” she started innocently.

“Fluffy needs to be fed?” I asked.

“If you don’t mind,” she said sweetly. About the time I refused to feed her cat, I am sure this sweet little old lady would mutate into an ogre with red, beady eyes and fangs. “Her food is in the pantry. She likes a can of Whiskas with a little dry food mixed in. Could you also make sure she has some fresh water? Not too cold. She won’t drink cold water.”

“I know the drill,” I mumbled under my breath.

The lady with the itchy medical alarm trigger finger was hard of hearing. I could pretty much say whatever I wanted, which I did quite frequently, and she wouldn’t know what I was saying. I mixed up Fluffy’s dinner exactly as the cat liked it, and set it on the floor of the kitchen. Fluffy, a beautiful but somewhat obese Persian, sauntered in with an attitude, like most cats have, and hissed at me. I wanted to give Fluffy a little nudge in the ass with my boot but grandma was only hard of hearing….she still had good vision.

The elderly woman was playing us. She suffered with various forms of illnesses, namely because she was somewhere between 80 and 200 years old, but she did have a bad case of arthritis. On the days her arthritis flared up, we would get the I-don’t-know-how-the-darn-button-got-pushed activation because it was hard for her to get out of her chair and feed Fluffy, the cat with the insolent attitude.

“Anything else before we go?” I asked very nicely.

“I can’t seem to find the remote for the TV,” she said.

My partner went over and found it on the chair right next to her, right where it usually was. He handed it to her and painted on a warm smile – the one I had taught him to use instead of the sneer that he usually had.

“Say, if you don’t mind…could you turn the TV to the news. I can never figure these darn things out,” she said.

My partner turned on the TV and flipped the channel over to the evening news. “All set,” he said, dripping with a syrupy sweetness that made my stomach lurch. He handed the remote back to the little old lady.

“Okay, we need to go now,” I said. “You have a very good evening.”

“Would you mind…”

“Yes!” my partner started, and then toned it down. “We will make sure your door is locked and the lights are out.”

And we did. And then we hustled out to the truck to take the next call.

*****

I hate night shifts, namely because it messes with my Circadian Rhythm, but also because the ‘clientele’ is, shall we say, a little unique. I have achieved enough seniority with my company that I can generally work day shifts. On occasion, though, I pick up a night shift and by the time the sun comes up, I remember why it is that I hate night shifts so much.

It wasn’t busy. We sat around the station for three hours before the first call came in. It was the kind of night that the pillow was calling my name but I didn’t want to sleep for fear the city would suddenly explode and I would have to rely on the natural adrenaline that is supposed to kick in when people start getting hurt or sick. That didn’t always happen, no matter how exciting the night became.

We walked into an apartment at around one AM for an unknown medical problem. As God as my witness, I swore I heard dispatch say that the patient needed to have his genitals checked. I was in that twilight stage…hearing and seeing things, but not really sure if I was dreaming or it was reality.

“Hello?” I called when no one answered the door.

“Back here!” A male voice answered.

We walked into a back bedroom and found a man lying in bed. He didn’t look like he was in distress. “Ambulance,” I announced needlessly because I was pretty sure he had figured that out. “What’s going on?”

“I need my balls adjusted,” he answered.

It took me a few seconds to process his request. “Are you injured?”

“No, I just need my balls adjusted. They are up against my leg and it is driving me crazy.”

“Uh, okay,” I said, assuming there was more to this request than what met the eye. “May I ask why you don’t, um, just adjust them yourself?”

“I can’t. I’m a quad,” he said.

My partner, who was on the backside of a 36 hour shift, was ready to pop a vein. “You called an ambulance because you need your balls moved?”

“They are driving me nuts,” he said, not realizing the funny he made.

Rather than debate the merits of calling an ambulance for something like genital repositioning, I put on a pair of gloves, pulled the blanket back, and gingerly readjusted his testicles. I was blushing, partly from embarrassment but also out of frustration

“Better?” I asked.

“Much. Thank you. Hey, while you are here, do you think you could put some powder on my balls?”

“Whoa, whoa, whoa,” my partner cut in. “Just what the…”

I cut him off. “Sir, you need a home health care aide. An ambulance is not…”

“She’s on vacation,” he interrupted. “I didn’t know who else to call.”

His voice was conciliatory, and I realized how debilitating it must feel to be mostly paralyzed and relying totally on the mercy of others. If, for some reason, the home health care agency neglected to show up sometime, this guy would lie in bed all day without the ability to bath, go to the bathroom, or feed himself. I felt a rush of guilt for whatever irritation I had been feeling.

“Where is the powder?” I asked.

My partner gave me a dirty look, clearly trying to convey the message that I was encouraging this guy to use 9-1-1 for something we should not be called for. I shrugged it off.

“On the dresser,” the guy said.

I found the powder, shook some out onto his genitals, and then pulled the blankets back over him. “Anything else?” I asked.

“My billfold is on the dresser. I want you guys to take some money. Call it a tip.”

“No, sir, we can’t do that. We are not…”

“Look, I know it isn’t your job to come take care of a cripple. I appreciate you showing up. I would like to tip you.”

His humiliation was complete, and I had been a part of it. I wanted to crawl into a hole.

“Sir, as much as we appreciate the gesture, we cannot take money from you. Not only would it be unethical, it is illegal and we could lose our jobs.”

“Suit yourself, gentlemen. But thanks to you, I will be able to sleep tonight,” he said. “You have no idea how much I appreciate this.”

We turned off the light and walked quietly to the truck. We didn’t speak as we drove back to the station. There was nothing to say.

Aging gracefully was something that I had aspired to achieve in my lifetime. I silently ridicule the fifty-some year old males that I see driving little sports cars. I laugh when I see their hair dyed jet black, hip-hop music blaring over their radio, and much younger ‘eye candy’ giggling in the passenger seat.  I just cannot bring myself to try and fool people into believing that I am younger than I really am. I do not dye my hair or buy age-defying wrinkle creams. I don’t try and dress like I am 25 again. I don’t close down the bars and then show up to work bragging about how hungover I am. Not only does that sound like a lot of work, where is the dignity in having to create an illusion that I am younger than I really am?

The vast majority of my co-workers are half my age…literally. As the elder statesmen for my company, I constantly get teased with comments like, “Hey gramps,” or, “Isn’t it time to change your Depends?” or my favorite, “I bet going to a nursing home is like going to the strip club for you.” I usually fire back with comments like, “Take the pacifier out of your mouth so I can understand you,” or, “Can you get into your booster seat all by yourself or do you need help?” or, “If we hurry back to the station you can still watch Sponge Bob.” For the most part it is good natured ribbing. At least I hope that is what it is. Admittedly, though, I have become very sensitive about my age and the jokes do hurt sometimes, no matter how hard I try to laugh it off.

The ambulance service that I work for is fairly busy (10-12 calls per 12 hour shift). As an older person working in EMS (ancient by most EMS standards), I have had to come to terms with the stark possibility that my age is becoming a factor. The aches and pains are starting to add up and making the job more difficult. By the end of the week, after I have logged 50-60 hours, I am whipped.

Enter the denial phase.

When I started to notice the affect this job was having on me physically, I wanted there to be a logical reason…besides my age. I started keeping track of some things, because I was unwilling to admit to myself that my body had truly reached a point to where I might need to cry uncle. I calculated that we lift an average collective patient weight of 1,775 pounds per 12 hour shift. This is in addition to the repeated lifting and carrying of an airway bag, cardiac monitor, and medication bag up and down steps, and in and out of the ambulance. I decided that such a physical workout would make anyone tired, yet my younger partners never seemed to be affected. I found myself making a conscious effort not to grimace or limp or otherwise complain about the aches and pains around my co-workers, and that is when I realized that I was no better than the guys going through the midlife crisis; I was trying to create the illusion that I am younger than I really am.

Guilty.

I do not want  to be too old to do this job. Not yet. I still very much enjoy being a part of the solution. But am I making a fool of myself? Is it time to move on and let the kids take over? Am I risking my health and well-being simply to prove to the world that I can still do this job? At what point is pride crossing the line into stupidity? Regardless, I will continue until the day that my physical limitations are inhibiting my ability to provide good patient care. The youngsters I work with will just have to deal with my gray hair, my love of retro music, my unwillingness to ‘twitter’ every five minutes, and my disdainful comments about their tattoos and piercings. If they don’t like it then I will give them their Ovaltine and put them down for a nap.

One of my paramedic instructors said, “The very next call could be your last.” As cynically trite as that sounds, the wisdom of his words hold true. We could get into an accident on the way to the scene or on the way to the hospital. We could get stabbed or shot while on scene. We could sustain a career-ending injury from lifting a heavy patient.  We could make a critical mistake with a patient and lose our privilege to practice as a paramedic.

There are days that I feel like I am working with a time bomb strapped to my back. I don’t know when or if it will go off…I just know that it might. Although I try not to dwell on this feeling of impending doom, the sound of the ticking time bomb is never far from my thoughts. It is like a continuous pressure….ever so subtle but always there….clawing at my conscience.

We approach an intersection with lights and sirens, stop and clear each lane, and then as we proceed forward a distracted driver that is oblivious to their surroundings pulls out from behind a stopped van. I say oblivious because all the other vehicles have stopped and it doesn’t register with this person that an emergency vehicle is entering the intersection. They are obscured by the van as I tromp down on the gas pedal to proceed forward and I don’t see them until that terrifying moment when we are about to collide. I let out an audible gasp as I jerk hard on the steering wheel and swing the ambulance to the right. It is a near miss and I am still not sure how I avoided a disastrous collision.

Tick…tick…tick

We walk into a house to check on the wellbeing of a 14 year old that didn’t show up for school, and suddenly the cops yell, “Gun! Gun! Gun!” and pounce on the kid. After the police have the kid sufficiently subdued they hold up a handgun that the kid had hidden behind him. The toxic fumes from huffing gold spray paint made the kid manically paranoid and he was convinced that we were there to kill him.

Tick…tick….tick

The patient is heavy and wheelchair bound, which means bringing the cot into the house via the front porch. The house is at least one hundred years old. The porch appears to be original. As we exit the house I feel the wooden planking on the porch start to protest the combined weight of me, the patient and the cot. One of the fire guys is standing behind me when the floor board gives way and I start to fall backward. Without the fire guy there to keep me upright, I would have tumbled down eight steps onto the concrete sidewalk with a cot and heavy patient on top of me.

Tick…tick…tick

The patient had fallen over twenty feet from a ladder onto concrete. He was in critical condition with fractures to both femurs and an open fracture of his right humerus. Blood was spurting from a severed artery in his arm.  The patient was moaning but not alert or talking. His airway was open and clear but he was breathing in gasps. As with all trauma scenes, we wanted to quickly stabilize the patient and get the hell out of there. We placed him on oxygen and once we were in the ambulance then we would determine if he needed to be intubated. We stopped the arterial bleeding and secured the patient’s neck and spine. As we were lifting him to the cot, I overheard a co-worker say, “One minute he is changing a light bulb and the next he is on the ground.”  No pun intended, but a light bulb goes off in my head. I feel for a pulse and find a very weak, thready one. We set the patient down and quickly place him on the cardiac monitor. He is in ventricular fibrillation. The metal ladder had come into contact with an exposed electrical wire and he had been electrocuted. Yes, it was a trauma scene. It was also a cardiac arrest scene secondary to electrocution, and I almost missed it.

Tick…tick…tick

“Ambulance A, truck five…you are en route on an unknown problem. Address flagged for previous weapons violations. Exercise extreme caution…”

“Units en route to the roll over accident…vehicle is on fire…victims trapped inside…”

“All units en route to the structure fire, be advised that a tornado warning has been issued for this area…”

“All units en route to the fight disturbance need to stage six blocks to the south….shots fired…”

It’s never ending; the pressure….the worry….the stress to remain vigilant at all times…the acute suspicion of every person…every driver….every call that seems routine and may be anything other than routine…because the next call might be the last. The ticking never stops….ever.

“OH MY GOD, OHMYGOD, OH!   MY!   GOD!!!”

Earplugs would have been nice but we didn’t carry them as standard equipment in our truck. The patient’s voice was unusually shrill. I was sure that I could close my eyes and pick this woman out of a huge crowd by simply listening for her voice.

“Ma’am, all I did was tie a tourniquet on your arm.”

The woman stopped screaming and looked at her arm. When she realized that I hadn’t poked her with a needle yet, she relaxed ever so slightly. “Well, it hurts!!”

The patient had passed out while shopping and that is what prompted the call to 9-1-1. Her EKG was normal. Her vital signs were normal. But our protocols stipulate that when someone has an episode of unexplained syncope, we start an IV before we leave the scene in case they need medications or fluids during the drive to the hospital. People pass out for a lot of reasons, especially women with all of their pre-menopausal, menopausal, and icky hormonal stuff. Sometimes, though, passing out meant there was something going on with the patient’s heart. Sometimes. So, an IV was considered necessary. I didn’t make the rules. I just follow them.

“You always have the right to refuse an IV,” I said, hoping that she would.

“Do I need it?” she asked with a whimper.

“I would be starting an IV as a pre-emptive measure, in case you need medications while en route to the hospital.”

“Why would I need medications?” she asked.

Ah, yes, a trick question. I needed to tread ever so lightly. “If, for some reason, your blood pressure got too high or too low, or if you had a seizure, or if your heart started beating too fast or too slow, then I would give you medications and I would need IV access to do that,” I answered judiciously.

“Jeez, you make it sound like I am dying,” she squealed.

“I am just trying to explain why I need to start an IV,” I answered.

“I hate needles,” she said quietly.

I bet the person that pierced your ears is still taking sedatives, I didn’t say. “Not very many people do.”

“If you think it is necessary,” she said with resignation. She was acting like I was about to amputate one of her extremities with a dull, rusty knife.

She had a good vein in the crook of her arm. I took out an 18 gauge needle. We carried needles that were a lot bigger, and ones that were a lot smaller. My philosophy with IV’s is to use the size appropriate to the job. If someone has lost a lot of blood and needed ‘volume’ replacement, or they were critically septic and needed to be rehydrated, I used the biggest needle that I could fit into their vein. If I was starting an IV because I might need to give medications while en route to the hospital then I used a medium to small needle.

“Okay, ma’am, I am going to start the IV now. Do you want me to let you know when the poke is coming, or just do it?”

I refuse to try and dupe a patient by saying things like, “you will feel a little poke and then a burn,” or “you will feel a slight pinch,” or “it will feel like a bee sting.” No it won’t. It hurts like hell. There is nothing pleasant about having a needle pierce your skin and then pushed into your vein. It hurts worse than a poke, a burn, a pinch, or a bee string.

“Um, let me know, I guess,” the woman whined.

“Okay,” I replied, and then took a deep breath. She was making me nervous. “Please do not pull your arm away or I will have to poke you again. Okay?”

“Okay,” she whimpered.

“Okay, here we go. One…two…”

“I don’t want to know, I don’t want to know, I don’t want to know!!” She covered her face with her other hand and started hyperventilating.

I pulled the IV needle away from her arm and looked at my patient. “Slow your breathing down and try not to tense up your arm. It hurts a lot worse when your arm is tensed up.”

“I can’t help it,” she yowled theatrically.

I was growing impatient. This was an adult. She had no doubt bore the horrendous pain of childbirth at least once, yet she was wigging out over having a needle poked into her arm. We had been on scene way too long and the other crews were going to start wondering what we were doing. I glanced up at my partner, who was watching this debacle with a smirk on his face, and he shrugged, like he always did when he was taking delight in watching me suffer. I flipped him off in my mind.

I let out a big sigh. “Ma’am, let’s just get this over with. Hold your arm out straight and take some deep breaths.”

She turned her face away and without a countdown, I pushed the needle into her skin. I can only describe the sound she made like this: Imagine a big alley cat. Now imagine that alley cat is in heat. Further, imagine that big alley cat in heat having its paw stepped on while at same time having someone pull its tail. Hard. That’s the sound she made. I was sure my ears were bleeding.

Thank God I hit my mark. After advancing the catheter into her vein, I attached the tubing and made sure the fluids were running. I looked at my partner. “Let’s go to the hospital.” While he got out of the patient compartment and into the cab, I taped the IV down and said to the patient, “It’s over. I promise I won’t do anything more that hurts.”

The patient looked me square in the eyes and said, “I hate you. I hope you get struck by lightning.”

That would be preferable to ever having to start an IV on you again, I didn’t say. “I’m sure you don’t mean that,” I said as politely as possible.

“Ah, yes, I do,”she growled back.

I looked out of the ambulance at the blue, cloudless sky. “Probably not going to happen today.”

“There is a thirty percent chance of thunderstorms tonight,” she fired back.

I got the distinct impression she was serious. “So noted,” I said. “I’ll get my affairs in order when we get back to the station.”

We rode to the hospital in silence.

A lot of us in EMS have a twisted sense of humor, myself included. Some of the things we joke about would most likely be construed as repulsive to an outsider. It is difficult to explain to people that are not associated with EMS the stuff that goes on behind closed doors. Most of the time I don’t even try. So, I use humor as a means to manage the surge of emotions associated with some of the tragic things I see. The way I look at it..if I am too busy laughing then I don’t have time to be sad. So, it should come as no surprise that we even have our own little games we like to play.

Too Drunk For Detox

“….units en route to the man down…patient is a thirty year old male, highly intoxicated. PD requesting an ambulance…”

Another person that is ‘too drunk for detox.’ I figure this will be the name of a country and western song someday. Even though we are en route for what will probably be a relatively easy, garden variety ‘too drunk for detox’ dispatch, it is the repeated exposure to calls like this that have a way of wearing on my soul. Seeing yet another person – or maybe someone we have picked up many times before – whose life has deteriorated to such an extent that they drink until their liver is the size of a football, can be depressing.

“What’s the wager today?” my partner asked.

“Lunch,” I answered. “I’m hungry.”

“Can we go some place good this time?” he asked. He was obviously unimpressed with my choice of eatery the last time I had to pay off a debt.

“How many Big Macs can you eat?” I asked. “Besides, Chinese gives you gas and I am NOT living through that hell again.”

“Fine,” he said grudgingly, knowing he had no plausible defense.

“I’ll even let you pick first,” I offered generously.

“I am going with point three four.”

“I will say point three nine.”

“Same rules?” he asked.

I nodded agreement. Whoever guessed closest to what the patient’s blood alcohol level was without going over won the bet. If you guessed it right on the number then your partner had to send a company-wide email extolling the virtues of their partner. Depending on the partner, sometimes those emails were rather short.

It turned out the patient was, indeed, a run-of-the-mill drunk at 11:30 AM on a weekday.  His blood alcohol level was .41…way too drunk for detox. We transported him to the nearest hospital. The bet was a push. We ate at McDonald’s anyway.

***

Guess That Language

“…units en route to the medical emergency…a strong language barrier exists. We are trying to gather more information. P.D. is en route, also. Continue emergent for now..”

As is human nature, birds of a feather flock together. (Yes, I know. I said human nature and then used an animal cliché. So what.) With so many emigrants coming into the United States from dozens of different countries, the number of languages we were being confronted with totaled into the hundreds. However, because birds of a feather DO flock together, and depending on the address of the dispatch, I could guess with a reasonable amount of certainty as to what language we were going to encounter.

“I’ll betcha a dollar the patient speaks Shona,” I said as a matter of fact. I had an advantage because I knew the town better than my partner, but that didn’t mean I wasn’t going to try and get a dollar off of him.

My partner gave me a puzzled look. “What makes you think that?”

“Call it a hunch.” It was quiet for a few moments. I needed to set the hook. “There are, like, a billion different languages in the world and I am picking just one. Do we have a bet?”

“Why do I feel like I am about to get screwed?”

“Well?”

“Fine,” he said.

Then dispatch said, “Units en route to the medical emergency…patient speaks Shawna…”

Without keying the microphone, I yelled at the radio, “Shoooona. Not Shawna. Jeez, everyone knows that.” Then I keyed the microphone and said in a calm voice, “Copy update.” Then to my partner, “You owe me a dollar.”

“How did you know the language?”

“Look at the address,” I said. “It’s in the middle of the block on the west side of the street. If you are from Zimbabwe, chances are you live in that apartment building. Most people from Zimbabwe speak Shona.”

The birds-of-a-feather theory is not racist. It is common sense. If I moved to a different county, you better believe that the first thing I would do is find people that spoke my language…and then I would find a cheeseburger.

“Impressive.”

“I’ve been to this apartment building a hundred times. It was a sucker bet.”

“I see that now. Do you speak any Shona?”

“Hell no. I still struggle with English.”

“I don’t trust you anymore,” my partner said and shook his head.

“You’re young. You’ll learn. But you do owe me a dollar.”

***

When and Where

“Units en route to the cardiac arrest….downgrade due to obvious death…”

These types of updates caused me a lot of consternation. Someone called someone else in dead…so dead, in fact, that we were turning off our lights and sirens and driving like normal people. So now it was just a matter of how dead they were. I hate dead bodies with a passion.

“I got a buck that says at least a week,” my partner offered.

I considered his wager that the patient will have been dead for a week or longer. We were going to a poor part of town. The patient was a male in his seventies. It was a good possibility that he lived alone and someone called it in due to the smell. (Gross, yes, but this is reality) My partner knew this, of course, and was hoping he could sucker me into a bet. I wouldn’t take the gamble without hedging the bet.

“I’ll cover your dollar. But, let’s add a twist. No matter how long he has been dead, if he died in the bathroom then you owe me a dollar.”

My partner thought for a few seconds. “Now we have to pick the room, too?”

“It will keep things interesting. I will even sweeten the pot. If he has been dead more than a week AND he is anyplace other than the bathroom, I owe you two bucks. If he is in the bathroom, no matter how long he has been there, you only owe me a dollar”

“How am I supposed to remember all this?” my partner asked.

As we pulled up to the address, I opened the door and got out quickly. “I will let you know if you won. You need to trust me. Now, let’s get this over with.”

An hour later when we were leaving the morgue, I extended my hand. “One dollar, please.”

***

Who and What

“…Ambulance A, truck twelve…emergent response….two four six eight Main Street for chest pain…”

I pushed myself out of the lounger, yawned, and then said to my partner, “I’m getting an image.” I placed both hands on my head and acted like I had a headache and started humming.

“What the hell are you doing?’ he asked.

I closed my eyes. “Male. Twenty-five to thirty years old. And!” I continued, popping open my eyes. “He will have a previous cardiac history.”

My partner looked truly perplexed. “Are you losing it?”

Dispatch replied the update, “…units en route to the chest pain…patient is a twenty-eight year old male…conscious and alert. Difficulty speaking between breaths. Patient has a previous cardiac history…”

“Bingo!” I said as we got in the truck and sped off.

“You need to buy lottery tickets,” My partner said. He was truly in awe, which was even more satisfying than taking money off of him.

“It isn’t that difficult to figure out. It is Monday. We are going to the largest employer in the city. Someone doesn’t want to be at work today,” I said, giving away my secrets.

“And the previous cardiac history?” my partner asked.

“I bet this guy had really bad heartburn once and now thinks he has a cardiac history. That, or his mother told him that he had a heart murmur when he was a baby.”

And I was right. On the way to the hospital the patient told me he was really hung over and that he had a heart murmur when he was born. I should have bet the farm on this one.

***

 The games we play keep me from going insane some days. Joking around seems to be the only thing that saves me from having a nervous breakdown on occasion. The games and jokes are tasteless, I know, and probably appear to be boorish. But, these things are my coping mechanisms, so I can come back and do it again tomorrow.

Now I lay me down to sleep,                              

                  “…You are en route for a motor vehicle roll over…”

I pray the Lord my soul to keep,                      

                 “…One patient ejected at highway speeds…”

If I should die before I wake,                              

                  “…Patient is a 16 year old male. Unconscious, not breathing…”

I pray the Lord my soul to take.                        

                 “…CPR instructions being given…”

If I should live for other days,                            

                 “…All units en route to the rollover…”

Emergency Medical Services would be nothing without a well-equipped communications center, and the capabilities of the extraordinarily talented emergency medical dispatchers (EMD’s). The dispatch center that governs my area looks like something that I would expect to see at NASA. The staff is professional, polished, calm, and very well-trained. I do not envy their jobs, however, because I wouldn’t last even one day as an EMD. I know this because I inquired once about a job at the dispatch center (for the day when I am too old to work the streets) and was told they do not like to hire former paramedics because ‘we know too much.’ They were not referring to our knowledge about emergency medical services. They were referring to our knowledge of what is really on the other end of the phone, and thus an inability to take certain people seriously. I couldn’t agree more. I can only imagine how the conversations would go:

Me:       Nine, one, one. What is your emergency?

Caller:   Um, yeah, I need an ambulance.

Me:       <Big, audible sigh because I recognize the voice> Any particular reason…Bob? (Not a real name)

Caller:   Man, I’m really sick.

Me:        That’s what you said yesterday when you called and I didn’t send an ambulance then, either. Perhaps you should come up with something new

Caller:   My, um, back…I think it’s broken.

Me:        I thought you said you were sick.

Caller:   I think I am sick because my back is broken.

Me:        Unless you come up with something better than that, I am hanging up now.

Caller:    Okay, well, I think there’s a gas leak or something

Me:        <An almost audible eye roll> You mean carbon monoxide?

Caller:   Yeah, man, that’s it. I think the furnace is acting up

Me:        It’s the middle of July

Caller:   Um, well, I think my back is broken

Me:        Now we are back to that? Come on, Bob, I know better.

Caller:   It really hurts, man. I think I need some medicine.

Me:        What kind of medicine?

Caller:   Um, you know, something to make the pain stop

Me:        You mean like Morphine?

Caller:   Yeah, man.

Me:        The ambulance service is out of Morphine.

Caller:   No way! Maybe a doctor can help me out. I still need a ride to the hospital

Me:        Do you own a car?

Caller:   Yea man, but I been drinkin’ beer… <snorts and giggles>

Me:        It’s nine in the morning.

Caller:   We never stopped from last night

Me:        Color me surprised.

Caller:   Hey man, I need an ambulance.

Me:        <another sigh> Don’t you ever give up, Bob?

Caller:   I, um, I’m having a seizure.

Me:        You are having a seizure right this second?

Caller:   Um, yeah, you better send an ambulance. I’m having a seizure and I need some medicine to stop it.

Me:        Do you have a sharp object nearby?

Caller:   Um, yeah, I got a knife. Why?

Me:        Okay, I want you to take that knife and stab yourself in the eye.

Caller:   What?!!

Me:        If you can stab yourself in the eye and not say ouch, then I will believe you are having a seizure and I will send an ambulance.

Caller:   Um, yeah, I think my seizure stopped, man

Me:        No kidding…

<Long, uncomfortable pause>

Caller:   Um, are you going to send an ambulance?

Me:        I have to send the police first.

Caller:   Why you gotta send the cops, man?

<The sound of footsteps as there is a mass exodus when hearing the police might be en route>

Me:        Because you said you have been drinking and the police will need to make sure the scene is safe for the ambulance crew

Caller:   I don’t want no cops here. I just want an ambulance.

Me:        Have you been doing drugs today?

Caller:   I don’t do drugs, man.

Me:        I used to work the streets….man. Last time I was there you were so stoned that Mount Everest would be jealous

Caller:   That was you?!

Me:        Yes, and by the way, thanks for puking on my new boots.

Caller:   Sorry, man.

Me:        Do you really want me to send an ambulance?

Caller:   Uh, no thanks. I think I am okay now

Me:        Glad I could help you out

The pink slip would be waiting as soon as I hung up.

One of the unfortunate aspects of dispatching is that the EMDs can only go by what they are being told. It’s kind of like the ‘garbage in, garbage out’ theory. If the caller says something like, “OH MY GOD! THERE ARE BODIES EVERYWHERE!” then the dispatcher has no choice but to send police, fire, EMS, the National Guard, the Mayor…even though the caller might be snickering while they are talking.

One of the other unfortunate aspects of dispatching is that they have to follow a script. I have seen the scripts that the EMDs use and, like most bureaucratic endeavors, they are written without a shred of common sense. I would venture to say that whoever crafted these masterful ‘talking points’ probably never answered a single 9-1-1 call or worked out of the back of an ambulance.

This is the system we have, however, and this is the system that we live by. I appreciate our EMDs and the incredible challenges they face, and I also appreciate some of the laughs they give us, whether they mean to or not. Here are some examples of dispatches and updates from dispatch:

“The patient is unconscious but breathing.” Isn’t butt breathing urban slang for passing gas?

“The patient is a three month old female having difficulty speaking between breaths.” This is one seriously gifted three month old to already be speaking.

“Patient is conscious, alert, and breathing normally, but actively seizing.” Actively seizing? Is it possible to inactively seize?

“Patient has been in the bar for eight hours and fell off the bar stool. They are unconscious, breathing…….possibly intoxicated.” I never would have guessed.

“Patient is a white male, six foot tall, two hundred pounds, blond hair, green eyes, white pullover shirt with dark trousers, brown belt, dark socks, black loafers…had an argument with his girlfriend…patient is crying and walking north on Elm Street.” The patient sounds like a good looking, well dressed, sensitive guy, but does he have a medical complaint?

“Patient was chased on foot for six blocks by a K-9 unit. Upgrade to code three for a breathing problem.” I have a breathing problem if I run to the refrigerator.

“Patient is unconscious but snoring,” Again, more urban slang.

“Patient is conscious, alert, breathing, no bleeding. Just wants to be checked out.” They sound very lonely and desperate.

“The accident occurred on the west shoulder of the northbound lane just east of the west onramp to the interstate.” I’m not even sure if this is logistically possible. We ended up just looking for the big red fire truck and all the commotion.

An ambulance service is blind without a good dispatch system. Thank goodness I work in a city that has a good one. Thank goodness there is a calm, steady, sometimes inadvertently humorous voice on the other side of the radio when my world is going straight to hell.

In addition to responding to 9-1-1 calls, one of the necessary duties we perform in EMS is long distance transports. We pick up patients at skilled care facilities, hospitals, or even at their homes, and drive them to specialty care facilities for surgeries, procedures, rehabilitation, and sometimes just so they can be closer to their families. These trips can be just a few miles or a few hundred miles. There are times that I welcome a long distance transport so I can get off the streets for a few hours. That is, unless we get sent at the end of our shift and dinner will have to wait indefinitely. Or, the weather is bad and it will be a nerve-fraying experience. Hazardous duty pay should not just be for the military.

One such long distance transport occurred last winter. We were sent on a four hour journey to pick up a patient at their home and bring them back to a skilled care facility. The weather was iffy because of frozen fog (isn’t an ice cube frozen fog?). We were sent two hours before the end of our shift which meant I would get home just in time to go to bed and get up and go to work again. I drove on the way to get the patient, and sat in back of the ambulance on the way home. It should have taken four hours to get there, but because of the icy conditions, it took five. By the time we pulled up in front of the patient’s house, I had worked myself into a dither and was pretty cranky.

I backed into the driveway so we wouldn’t have as far to go to get the patient from the house to the truck. It would be my luck, I had decided, that this would be a 300+ pound patient that barely fit on the cot, and wheeling them down a driveway on a thin layer of ice posed all kinds of risks, not only for the patient, but for my partner and I, too. As we got the cot out of truck, I was fully anticipating that the patient would be some cantankerous person that would complain loudly for the next five hours about how uncomfortable they were, how bumpy the ride was, how hot or cold they were, and ask repeatedly if I had anything to drink in the back of the truck. If I should happen to mention with a little too much sarcasm that this particular “flight” does not offer a beverage service, I was sure this patient would write a complaint letter to the company and I would have to come up with an answer as to why I was treating grandpa with such disrespect. Bah-humbug.

The house was a quaint ranch-style home with a nice-sized two-stall garage. The house was probably built sometime in the late forties or early fifties. There was a FOR-SALE sign in the yard. As we maneuvered the cot up the porch and in the front door, I noticed that several neighbors were coming outside and gawking. Lookiloo’s, I figured, morbidly wanting to see if there was a ‘train wreck.’ As we walked into the house, I noticed several boxes stacked in neat piles. No pictures hung on the walls. The carpet was shag, straight out of the 1970’s. The walls were varying shades of greens and oranges – straight out of the 1970’s. A woman approached and introduced herself as the daughter of the patient. She had tears in her eyes.

This scene was not unfamiliar and it was never pleasant: Someone had reached the stage in life where they could no longer care for themselves and it was time to give up their independence. My heart already started aching, made worse by the tantrum I had thrown on the way there. My crabbiness was melting into melancholy.

The woman tearfully explained that her eighty-some year old father had really bad arthritis in his back and knees and was having a difficult time moving around. He had been sleeping in a recliner for the last several months because it was too difficult to get in and out of bed. He couldn’t shower or bathe himself any longer. He had fallen several times over the last few weeks trying to get in and out of the house. It was decided that it was time for him to move into a nursing home. They needed an ambulance to transport him because sitting in a car for that length of time would be excruciatingly painful. The daughter would follow us back. She handed me a check for over three thousand dollars because she already knew that insurance and Medicare were not going to cover this transport. I felt guilty taking her money.

The patient was in a bedroom sitting on the edge of the bed. I went back to introduce myself and my partner and see what we could do to help him get to the cot. He produced a quick, warm smile but the sadness in his eyes betrayed him. He politely extended his arthritic hand for a handshake. We chatted briefly and then I asked what I could do to help. With humility, the patient asked if I would allow him to walk to the ambulance.

I walked beside him as we slowly made our way into the living room, ready to intervene should he lose his balance. I told the daughter and my partner that Bill (not his real name) wished to walk to the ambulance instead of being carried out on the cot. I gave each a pointed look and they understood. My partner wrestled the cot out the door and went to the ambulance to wait. Bill stopped in the living room and gave the house one last loving look. His breathing became ragged as he struggled to keep his emotions in check. The daughter put an arm around her father’s shoulder and they both started crying.

How many memories must this house have? How incredibly difficult would it be to leave your home for the last time? How does a person come to terms with knowing they are no longer capable of caring for their own basic needs? I watched Bill and his daughter as they cried in utter agony as this new reality gripped them. I started sucking in several deep breaths and paced around the room to keep from crying myself. At that particular moment, I hated life and I hated myself.

One of the worst things about having a conscience is the price a person has to pay when they do or think something stupid and their conscience rears up and starts kicking the crap out of them. The last two hours of driving to get to this patient were spent cussing, and whining, and otherwise angry that I was risking my life to transport someone that probably could have been driven in a private vehicle. I had railed on to my partner about wasting EMS resources, abuse of the Medicare system, and how weak society had become in thinking an ambulance was needed for every little illness and discomfort. I felt ashamed and really, really stupid for being so judgmental.

After several despondent moments, Bill straightened up as best as he could, wiped his eyes, and with his voice shaking, said he was ready to go. His daughter helped him into a coat and stocking cap. As we walked out onto the front porch, at least a dozen neighbors had gathered in the front yard. The neighbors ranged in age from their early twenties to a few that appeared to be Bill’s age. A couple of the men approached and I got out of the way so they could help Bill down the porch steps. I noticed that several of the neighbors had tears in their eyes. The walk down the driveway was slow and the group of neighbors grew larger as more people came to offer words of encouragement and to say good-bye. This man was obviously well-liked.

Bill wasn’t the obese man that I had ashamedly assumed he would be, and with support from my partner and me, we were able to help him up the two steps and into the ambulance. As he gently lowered himself onto the cot, I noticed that he winched in pain. We got him as comfortable as was possible on an ambulance cot, and then I told my partner we were ready to go.

As we drove away, the throng of well-wishers waved and Bill gave a tearful wave back. My heart was up in my throat. I couldn’t even begin to imagine the emotional pain that he must be suffering at that moment.

I told Bill that this would be a bumpy ride and I offered to give him pain medications. He politely declined, which didn’t surprise me at all. Bill’s generation was proud, and willing to tough out their problems. I adjusted the heat in the patient compartment, dimmed the lights so he didn’t have to squint, and then settled in for the long drive home.

The ride was bumpy and with each dip in the road, I saw Bill grimace. But not once did he complain. I offered pain medications again, and he reluctantly agreed. I started an IV, pushed enough Morphine to dull the pain, and then settled back.

When Bill seemed to relax a little from the Morphine, he appeared to be eager to talk, so I asked him about his life: Where he was from originally, what kind of work he had done, how many kids, et cetera.

Bill was a World War II veteran and had even fought at the Battle of the Bulge. He married his high school sweetheart when he returned from the war and they had a son and a daughter. The son lived in the south and was on his way to visit. His daughter was a school teacher. He had worked as a laborer in his home town for 50 years and when he retired he had worked part time at a local hardware store until his arthritic knees had forced him to quit. He and his wife had built their own house 55 years ago. His wife had passed away 20 years ago after a long battle with cancer. He had done woodworking as a hobby and had taken great delight in making dozens of things for his five grandkids, but had been unable to pursue his hobby for the last five or six years. Bill proudly said that he had never had to borrow a dime in his entire life…that he had built a house and put two kids through college without setting foot in a bank. Again, I was not surprised. This was typical for his generation: Proud, hardworking, and responsible.

I had become so engaged in talking with Bill that the first three hours of the trip home breezed by. He was one of the most humble, charming, and charismatic patients that I had ever met, and once again my conscience was thumping me for being so audacious in assuming this was going to be a miserable long distance transport. I noticed that Bill’s eyes were getting heavy so I turned the lights off and stopped asking him questions. He drifted off to sleep.

When we arrived at the assisted living center, I gently woke Bill up and told him we were there. I could tell he was putting on a brave front when he asked if he could walk from the ambulance. Normally, I wouldn’t allow a patient that had been given Morphine to walk but I was not going to allow this man that had served his country and lived such a rich and full life to be robbed of his self-respect. We helped him out of the ambulance and assisted him inside. His daughter was already there and after taking care of some paperwork, I turned over care to the nursing staff. I shook Bill’s hand and wished him the best. He winked at me and thanked me for the pleasant conversation. But once again I noticed that he had tears in his eyes.

After getting home, I started thinking about what it would be like when I was Bill’s age. Would I handle losing my independence with the same grace and dignity that Bill had? Would I have a throng of well-wishers to see me off? What had I really done with my life that would warrant such respect? I had a lot yet to learn, I knew, and I was feeling very grateful that I had had the honor of meeting and taking care of Bill.