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Monthly Archives: April 2012

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.

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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.

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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.

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“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.

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