My Mountaintop Blog

I don’t make a habit of getting into a patient’s personal life. I am supposed to be the consummate impartial observer. Sometimes, though, it just doesn’t work out that way.

We were dispatched lights and sirens for an abdominal pain. The update from dispatch indicated a 26 year old female that was conscious, alert, and breathing normally, with an acute onset of abdominal pain below the navel. As we drove to the call, my partner and I did what we always do and tried to guess what the diagnosis would be. My partner was going with appendicitis. I went out on a limb and said ectopic pregnancy. The patient was in the right age group to be pregnant, I argued, and anyway I was feeling adventurous.

We pulled up to an apartment building and strode up one flight of stairs. The fire department was there and the update we received from them was pretty much the same thing dispatch said. I went to the patient, who was sitting on a sofa and holding her abdomen. She wasn’t pale or diaphoretic. Her vital signs were normal. She did appear to be in a lot of pain, though. I went through the routine assessment of asking whether she could be pregnant (not a chance, she was on the pill), what she had eaten recently (pizza, breadsticks, and soda), if she had experienced any trauma (nope), and if her bowel habits had been normal (yes, for God’s sake!). I palpated her abdomen and didn’t get a grimace or guarding.

She was becoming increasingly agitated and finally blurted out, “Can we just go?!”

“Um, sure,” I said. “Can you walk or do we need to carry you out?”

“I’ll walk,” she answered, and stood up.

Her boyfriend had been hovering around, pacing back and forth, and didn’t say much. The patient didn’t say much to the boyfriend. We walked the patient to the ambulance, got her situated on the cot, and then I started in on my secondary assessment. As I was asking her more questions, I started an IV and gave her just enough Morphine to take the edge off. Then we started for the hospital.

I suppose I should have left well enough alone, but I was genuinely perplexed by this abdominal pain, so I kept assessing. I asked her a million more questions, but then I made the mistake of asking her to describe what the pain felt like.

“Like a cramp,” she said.

“A cramp?” I asked. “You mean, like if you went swimming and didn’t wait thirty minutes after eating…that sort of cramp?”

“Just a cramp,” she said.

“Okay, um, well, does the pain radiate anyplace else?”

“It starts in my sphincter and goes into my stomach. It is more like a spasm, I guess.”

I am sure the expression on my face must have looked like someone that had just heard a priest pass gas. It wasn’t something I was expecting to hear. My partner could overhear the conversation and I could hear her laughing. I was stumped, and not sure where to go next with this assessment.

“Okay, so it feels like your sphincter is spasming?” I finally asked.

The patient rolled her eyes. “Yes.”

“Okay, well, any ideas what might be causing this?” She didn’t answer and I could tell she was getting even more unsettled. “Okay, um, what were you doing right before the, um, spasm started?”

The patient folded her arms in a huff. “We were having sex.”

This wasn’t the first patient I had picked up that was having ‘complications,’ shall we say, from having sex. It was still embarrassing, though, for me and the patient.

“Um, I am not trying to pry, but was this sex…”

“We had anal sex, okay? Gawd! We had anal sex! I didn’t want to but he kept pushing me and pushing me!” she said, and then turned her face away so I couldn’t see her.

The laughing coming from my partner was making it even more difficult to concentrate. I called report to the hospital and the charge nurse was laughing uncontrollably before we hung up.

I am not a prude, at least in my eyes, but I do have my limits. It was an involuntary response. Really, I couldn’t help myself.

“Your anus should be used for an exit, not an entrance,” I said.

The patient snapped her head around to face me. “Ya think! Gawd!”

When I wrote the narrative for my chart, I had visions of her insurance company’s claims person breaking into hysteria and calling everyone in the office over to read it. The poor girl.

I have never understood the obsession of gorging yourself on turkey and dressing, taking a tryptophan-induced nap, and then going out in the wee hours of a cold morning to shop and save maybe 20%. In other words, Black Friday. I am writing about this now because we had a call today at the mall that reminded me of Black Friday. I hate Black Friday. I hate the mall. I hate the mall on Black Friday more than anything.

My most recent Black Friday experience started with our truck being dispatched to the mall at around two AM for a diabetic problem. The patient was a sixty-some-year-old female found sitting on a bench outside of Sears. When I say sitting, I am being gracious. She was pale, diaphoretic, her breathing was labored, and she was slumped forward. Like most hypoglycemic patients, she looked like she was ‘knock, knock, knocking on heavens door.’ Christmas music was blaring over the speaker system. Thousands of shoppers packed the place and as they walked by and saw the woman, they looked the other way. Nothing can deter a Black Friday shopper that is on a mission.

This lady had most likely been a diabetic her entire life, but she still didn’t account for being outside in the cold and her body having to burn sugar to stay warm. Nor did she account for being in the mall in the middle of the night and burning up sugar while trying to keep up with the other frenzied lunatics. She was there with her daughter, and the daughter seemed completely disinterested that her mom had become a lump of sweaty flesh outside of Sears. Instead, she paced around and kept glancing toward the Gap – fifty percent off the entire store inventory while supplies last.

After checking a blood sugar (31), I started an IV and gave the patient an amp of D50, a very fast acting sugar. Within thirty seconds of pushing the medication, the woman’s eyes cleared up and she came around. The first words out of her mouth were that she didn’t need an ambulance and wanted us to leave her alone. When I tried to explain that she needed to eat something, she waved me off like I was trying to sell her life insurance. She stood and tried to walk away but when the IV tubing drew taut she realized that she was still tethered to a bag of normal saline. She impatiently tapped her foot while I removed the IV catheter from her arm. It was all I could do to get her to hold still and give me her billing information. After signing for my services, she bolted off into Sears without saying thank you, good bye, or kiss my ass. Power tools were forty percent off but only until five AM.

We only got a few blocks from the ‘maul’ when another call came out. This one was for a fall in the parking lot. It took ten minutes to find the patient due to the traffic, the patient’s inability to accurately describe where she was, and the fact it was pitch black. We finally found her after a Good Samaritan that happened to be passing by waved us down after noticing the woman lying on the ground.

The woman was in her forties and had to weigh in at three hundred pounds. She was from some little town and had been one of the first in line when they opened the doors – a fact she proudly bestowed on me several times. She had gone to her car to put some of the treasures she had purchased in her trunk. Her intent was to secure her purchases so she didn’t have so much to carry, and then go back in and continue shopping. Unfortunately for her – and my back – as she leaned in to put her purchases into her trunk, her feet slipped on the ice, and she ‘jackhammered’ her knees into the ground. She was whining in a shrill voice about her knees but voiced no other complaints other than being cold, and that she was upset because she wasn’t done shopping.

Wrestling this three hundred pound mall-dwelling whale off the ground and onto our cot was a challenge, but once the feat was accomplished and we were getting her into the ambulance, I noticed she was clinging to a bag from Radio Shack. I suggested that she leave that bag in her car and she adamantly refused. Apparently she had been lucky enough to get ahold of the latest gee-whiz-bang electronic game for her son and she was not about to risk leaving it in her car where someone could steal it. I let her keep it because I was in no mood to argue with an injured, demented bargain hunter. It would have been easier to take a piece of meat away from a starving grizzly bear.

Once she was safely in the ambulance and out of the elements, I asked her to rate her pain on a scale of one to ten, with one being no pain at all and ten being the worst pain imaginable, like it might feel to get your arm cut off with a chainsaw. She rated her pain as an eleven. I am pretty sure I rolled my eyes, even though I was trying so hard not to. I grappled myself into a sweat getting her out of her coat, sweater, and other layers of clothes. The newly purchased video game never left her hands and I tried not to show my annoyance that her death grip on that bag was making it even harder to get her skin exposed. Once I had access to her arms, I tried three or four times to start an IV so I could give her pain medications for the bumpy ride to the hospital. Her arms bore rolling layers of fat tissue and finding a vein was nearly impossible. I finally gave up because each time I poked her with a needle she let out a blood curdling scream, like it might sound when someone was getting their arm cut off with a chainsaw. I filled a syringe with ten milligrams of Morphine and stabbed it into one of her massive thighs. Admittedly, I took great satisfaction in that.

By the time we got to the hospital, she was sufficiently loopy and was even gushing on and on about how appreciative she was for our service to the community.  She was too far gone for me to explain that I wasn’t a volunteer and that I get paid to hoist fat people off the ground. She probably wouldn’t have remembered anyway.

Maybe this year I will buck the trend and take Black Friday off. If I do, though, what would I have to write about?

I was at the end of back-to-back sixteen hour shifts and intently watching the clock as we neared quitting time. The ambulance was cleaned and restocked, the station picked up, my stuff was packed away in my backpack, and there was STILL ten minutes to go. Then the unthinkable happened: My pager started vibrating and the irritating tones of a dispatch sounded over the radio. I was shamelessly begging for this call to belong to one of the other stations. Begging might be an exaggeration. I was actually praying. My prayers went unanswered.

We were dispatched code three for a sick person, and the call was way across town. I mean, seriously, we almost had to stop and refuel because it was so far away. My partner was livid and driving without ‘due regard.’ Then the update from dispatch indicated the presence of a ‘strong language barrier.’ My partner cut her speed and let loose with an impressive string of profanities. It is really difficult to take a code three call seriously when there is a strong language barrier. (I will address that someday when I am feeling more politically correct)

We arrived on scene and met the fire department at the door. The fire guys take their stuff pretty seriously so when we got an eye roll as a greeting, we knew this was yet another bs sick person call. That infuriated me even more.

We sent the fire department on their way so they could go back to bed, and then waltzed inside. A guy of ‘non-American-decent’ was sitting on the sofa, arms folded across his stomach, and rocking back and forth. I walked up and used the four most important words in EMS, “Do you speak English?” The guy shook his head no, and I wondered how he was able to understand me. There was a woman there that I assumed to be his wife. I asked her the same question. She shrugged and I wasn’t sure if that was a yes or no. I asked her what happened, and she shrugged again. We would have to play charades.

Using pantomime and talking really loud, we were able to zero in on the guy’s stomach. I concluded that either he had a belly ache or he couldn’t poop. Or, maybe his belly ached because he couldn’t poop. After ten more minutes of playing guess-what’s-wrong-with-me, a younger person of the same descent walked in. She spoke perfect English. Yes! I asked the new person to ask the patient why he needed an ambulance. They exchanged a bunch of words that I didn’t understand and then the interpreter said the patient ate too much. I asked again, just to make sure there was nothing lost in translation, and she said the same thing. Before I could cut loose with a tirade about calling for an ambulance due to gluttony, especially at the end of a shift, the woman explained: The man had just come to America from Somalia. He was so overwhelmed by all the food that was available here that he couldn’t help himself and ate too much. He had eaten two extra value meals from McDonalds, and topped it off with a hot fudge sundae. The guy only weighed one-hundred-forty pounds.

I looked at the guy and then back at her. She either didn’t get it, or didn’t appreciate my sense of humor, when I asked her if he had supersized his extra value meals.

It was a late call, and a stupid one, yet I was having a difficult time staying pissed. The guy came from a country where three meals a day was unheard of. I was pretty sure that sometimes even one meal per day was probably a luxury. And now he was living in a place that had so much food that a person couldn’t spit without hitting a fast food joint, grocery store, or convenience store. I told the woman to tell the gluttonous newcomer to loosen his pants, drink a glass of water, and give it an hour. She did. The patient smiled through the pain from his bloated belly and shook my hand. We left and went back to the station so we could go home.

I went through the McDonalds drive-thru on my way home and had an epiphany when the voice from the speaker asked if I wanted to supersize my Quarter Pounder with Cheese extra value meal:  It was just a matter of time before this pencil-thin, one-hundred-forty pound newcomer put on fifty pounds and started bitching about his cholesterol.

Welcome to the land of plenty.