Friday, October 29, 2010
Monday, October 25, 2010
Friday, July 16, 2010
The patient politely asked if his “little brother” could accompany him to the hospital. I took a look at the individual, appropriately outfitted in an incredibly oversized shirt, sagging jean shorts, and an impressive swagger. He appeared to be a young teenager, and I immediately decided he was harmless. Perhaps this young one would learn a valuable lesson on the importance of the use of prophylactics. “Sure, but he’ll have to ride in the front and wear his seatbelt.” My crew and I took them both to the hospital, where the staff and I shared a laugh at the absurdity of the “emergent” situation. The day prior, I treated a man having a heart attack and a woman experiencing ventricular tachycardia, both of whom I decided would be just fine by ghetto standards.
While driving the ambulance to the hospital during the next call of the day, I was singing along to the radio, and I realized the passenger seat visor looked unusually empty. The universal garage door opener was present, but the spot where I typically clip my iPod was empty. I replayed the events of the day in my head: I came to work, be-bopped around the wash bay, and checked off the ambulance equipment listening to my “Happy” playlist. None of this was unusual. My partner, Vigilante Medic, is accustomed to finding me in the box of the ambulance shaking my thang or occasionally rocking the air guitar. I’m fairly certain he’s never seen me use the laryngoscope as a microphone, but I do tend to keep that show strictly between myself and my imaginary fans. I distinctly remembered standing on the running board of the ambulance, wrapping my headphones around the iPod, and clipping it to the passenger visor.
Upon arrival to the hospital, I immediately asked Vigilante Medic if he moved my iPod. He’s always looking out for me, I trust him completely, and it isn’t offensive or peculiar for him to get into my personal items. He told me he made sure my book bag was zipped and my Kindle (I’m a woman utterly dependent on technology) was put away before anyone entered the ambulance, but he didn’t think to look for my iPod. I scoured the ambulance, finding remnants of crews past and our belongings, but no sign of my iPod. If Vigilante Medic did not move my iPod, only one person was capable of taking it. I was enveloped in emotions of fury, horror, and personal violation, but the only thing that escaped my lips was, “That little ghetto fucker!” I personally gave this premature hoodlum permission to ride in the cab of my ambulance, which is my safe haven for 12 hour shifts, and he stole from me.
I called the hospital to which I took Penis Guy, and they told me he had been discharged with ample time to leave the premises. I called my supervisor, who has always been a wealth of wisdom, and he gave me his condolences and advised me to make a police report. I then called our communications department, who connected me to the non-emergency police line (we may be county funded, but we’re not strictly ghetto). The police department offered to send an officer to the hospital to take my report, but I declined, knowing first hand that with a growing murder rate and gang activity, our vice division has much better things to do than fuss over my stolen iPod. I had no proof that Penis Guy’s “little brother” stole from me, but I had more than reasonable suspicion. I was told I’d be contacted within ten days. Vigilante Medic found me at the ambulance with a furrowed brow and a pouting, quivering bottom lip.
Incidentally, this is not my first encounter with iPod thievery. My last iPod was stolen from my personal vehicle at my former apartment complex. I responded with a passive-aggressive note stating:
Dear Douchebag That Stole My iPod,
I hope you choke.
Apparently, the letter I wrote, made 200 copies of, and distributed happily at that apartment complex was not well received given the response I got accusing me of threats. I moved within a week.
Vigilante Medic proposed an alternate route entirely, “If it were my iPod, I would show up with my biker friends tomorrow, and take back what’s mine.” We knew precisely where the hoodlum in question was picked up, and it was a fathomable assumption he would be there tomorrow. I tried to picture showing up in the ‘hood the next day, me leading a posse of my girlfriends each weighing in less than 140 pounds with an affinity for reading. I saw myself at the head of a group of Caucasian girls decked out in glitter shrieking, “If you don’t give me back my iPod, we’ll squeal in very high pitched tones, asshole!” We may look cute in proper lighting, but I don’t think vigilante justice suits us. I’m pretty sure I’d just injure myself if I tried to wield a gun, considering sometimes I fall down attempting to step out of the ambulance. I couldn’t conjure up a single scenario in which a situation of this caliber concluded in my favor. I’m more of the passive-aggressive letter writing type.
Inspired by the situation at hand, Vigilante Medic inquired our supervisor of potential legality issues, then called the communication department requesting a trip back to the ghetto. Communication informed him that the area was covered, but managed to assign us to the area anyway, putting an end in my mind to the age old idea that our dispatchers “aren’t looking out for us.”
I drove straight to the house where Penis Guy lives, in front of which Vigilante Medic, New Guy, and I strode out of the ambulance on a mission. We probably looked more like two dudes in uniforms with a chick looking around as if her head is on a swivel stick thinking, “Are we going to get shot today?” We were met by the father of Penis Guy, who informed us that the perpetrator was not his son, but he would be more than willing to assist us in locating him. At this point, I let Vigilante Medic do all the talking; I was stuck in the mode of thinking is the scene safe? I had one hand prepared to hit the emergency button on my radio and was constantly scanning the area for a potential gunmen or hoodlum wielding a knife. This was not an answer to a 911 call, I was completely out of my element, and I was scared.
Penis Guy’s father enlisted the help of Penis Guy, who was suddenly furious and quickly gaining my respect. Penis Guy told us he saw that exact iPod, my stolen iPod, and dialed into a cordless phone. He spoke into the telephone in a manner of incredulousness, anger, and exasperation that made me think I had judged his intellect and morality completely inaccurately. He demanded that my iPod be returned immediately, informed us of the whereabouts of the thief, and told us that it would be returned without delay or struggle.
I drove the ambulance to a gas station down the street, where we were met by the prepubescent bandit. I saw him walking, and he was shorter and scrawnier than me. I’d barely noticed him on scene originally, but was now realizing the thug I’d built in my mind was far different from this diminutive creature. Finally, someone I can pick on. I approached him with an outstretched palm, and he reached into his right pocket, placed my iPod in my hand, and begun to walk off. I heard Vigilante Medic say, “That’s not good enough.”
The young thug turned and said, “Sorry” while looking at his feet.
I told him, “You need to look me in the eye and apologize.”
He looked up only with his eyes, “Sorry.”
“Do you understand the gravity of the situation? I was helping your friend, and you stole from me while I was doing that. I choose to have a job where I help people in distress, I don’t get paid much, and you stole directly from me. I made a police report and I’m not convinced I should call and cancel it.” I held the young crook’s gaze and tried not to lose faith in humanity. “Have you learned anything from this?”
“Yes,” he said to his feet again.
I turned and walked back to my ambulance muttering, “This little jerk hasn’t learned shit,” and thrilled that I’d regained an item I thought was indisputably lost forever. I pushed the appropriate buttons on the iPod and found that of all the angry music on my iPod, the perpetrator had been listening to, or trying to hock an iPod playing Adele. Seriously? He would have been more suited to tune into The Clash’s version of I Fought The Law and The Law Won, but in his case the lyrics would have had to been rearranged to the effect of “I Fought The Medics and The Medics won.”
Wednesday, May 26, 2010
I recently was dispatched to a cardiac arrest, in which my unit was the first to arrive. I drove to this call completely mentally prepared to face death and attempt to combat it on behalf of another human being. I walked into a middle class house to find a young woman unconscious and barely breathing. She’s not dead, but it is not surprising that her family thought she was. She is in her early 20s, Caucasian, thin, dressed in a tank top and jeans, with long hair and a pretty face. Her family tells us that she was just released the day prior from a rehabilitation facility, in which she was treated for heroin use.
I’ve never done serious drugs, which I completely accredit to the fact that I’ve spent the majority of my life terrified of them. My mother raised me as a single mom, and has dallied in drugs and a darker culture enough to know and recognize all the signs; simply put, I couldn’t get away with that kind of shit. My mother has seen firsthand the toll drugs can take on a person’s life and how much harder said person has to work to overcome even the most basic of life’s responsibilities and tasks. She refused to allow me to assume that disability. As a teenager at the height of my mischievousness, any time I tried to deceive or outsmart my mom, she quickly and efficiently put an end to it. I once came home with some friends stoned and honestly believed she didn’t know. The next day at a video store, I picked up a copy of Dazed and Confused, and asked my mom if she’d seen it. Her response: “Yeah, when you and your friends came in last night.” Following the realization that I was not savvy after all, my mother taught me all about drugs, making sure that I would be informed when I inevitably encountered them. She answered my inquiries with brute honesty, never omitting the good, bad, funny or sad. It was like having a personalized in-house D.A.R.E. program, but this one actually worked.
While my mother instilled truth and warnings about drug use in me, my father was a fine example of why. My father has always been involved in my life, despite his divorce from my mother when I was an infant. His poison of choice is cocaine, although he has experience in other endeavors. His demeanor has always been evasive, defensive, and cagey toward the topic until recently. Over the years, I watched him hurt himself and other people with his drug use, and I’ve had my heart broken a seemingly infinite number of times by my dad because of drugs. I distinctly remember being shocked that my dad was different that those of my friends, and even more shocked and hurt when I found out chiefly why. I found him impossible to understand, but I continuously tried because he was my father and a fundamentally good person despite it all. I listened to him tell me it wasn’t a problem and he could and would stop whenever he wanted. I learned to protect myself from pain and heartache when he didn’t show up, forgot about me, ignored me, or became angry at me for no reason. I learned to hope, but not believe him every time he told me he was quitting.
Recently, my dad has given up drugs. I have been struggling with wholeheartedly believing him as a result of the failed attempts in the past. In the past few years, he developed hallucinations that nearly drove him to insanity, lost his marriage, and lost his home. While he is not solely responsible for the misfortunes that have taken the limelight in his life, he appears to have come to terms with his role. He and I have had long conversations about things that actually matter for the first time in my life. He asked me, “How did I end up with a daughter who is so good, when other people that didn’t do the things I did have bad kids?” I have no answer, and I’m not totally convinced I’m all that good. I often view myself as damaged and weird. I think what he means is that I take care of myself, don’t get into trouble, and don’t do drugs. My mother played a huge role in that, but she’s fallible and so am I.
When I saw that unconscious girl who just relapsed, I saw myself. We’re around the same age, dress similarly, and both clearly are fighting our own demons. In some alternate universe, she and I would be in opposite positions. For reasons I can’t fully explain, I didn’t do drugs and she did. I assembled Narcan, the antidote for heroin and my partner administered it nasally. The girl began to wake up a long minute after we gave her the medication. We stopped breathing for her and took out the OPA, an instrument used to hold back the tongue during ventilation. She sat up and looked straight at me, doe eyed and terrified. I told her that she overdosed and almost died. She cried and told me that wasn’t possible. It seemed that most of the people in the room despised that girl. They saw her as a pathetic and weak drug addict who couldn’t hack it sober for a day, while I held her and told her it was going to be okay. Every molecule of my body ached for both her and me.
I know that it is virtually impossible to quit a drug without episodes of relapses that are sometimes more dangerous than using regularly. I have spent my entire life enclosed in a veil of humor, distrust, and doubt as a method of self preservation that has leaked into nearly all aspects of my life, and even now I can’t allow myself to be totally unprotected. I keep in the back of my mind that most addicts relapse at some point, and I try to prepare myself in the event it happens to my dad. That girl almost died as a result of a relapse, but didn’t because someone called 911 and we showed up. We were able to breathe for her and give her a medication that saved her life. She forced me to face a huge obstacle I’ve pushed into the deepest crevices of my subconscious and come to terms with the fact that there is no wonderdrug like Narcan to combat cocaine.
Sunday, May 2, 2010
As my partner and I pull up to an apartment complex, a first responder approaches to inform us that the patient is on the third floor, there’s no elevator, and his vitals check out fine. My partner and I roll our eyes in tandem as we mentally prepare ourselves for another monotonous experience and waste of valuable resources.
Three flights ascended, we determine the patient is stable, has no priority symptoms, and our equipment will not be necessary. In fact, the patient turns out to be such a nice person, I feel kind of like a jerk for secretly wanting to be with critical patients instead. I prepare the ambulance for a routine headache call, meticulously laying out all the things I think we might need, while my partner (who is pretty much the best paramedic on the planet and my role model) stays with the patient. I prime an IV line, turn on the oxygen tank, lay out the glucometer and blood pressure cuff, and by the time I start spying specks of dirt and spot cleaning, I realize everyone has been gone far too long. What the hell is going on up there? About the time I poke my head out of the back doors of the ambulance, a first responder comes running toward me yelling, “He passed out! We need it all!”
I scramble the equipment back together in a flash, and the first responder and I make the three story hike once again. I arrive to an unconscious, breathing patient, who has been positioned with his feet up to increase bloodflow to his brain. I quickly apply oxygen and put him on the cardiac monitor.
My partner and I simultaneously look at the monitor, look at each other, look at the patient, and look at the monitor once again, with similar blatant quizzical facial expressions. The monitor shows clear and obvious ventricular fibrillation, a non-perfusing lethal rhythm. The patient is breathing, moaning, and moving his head. We frantically double and triple check the cables, convinced there is an error. The fire department must think we’ve lost our minds. We can’t find a pulse, and we absolutely must initiate CPR. My partner prepares to shock the patient, and I perform a chest compression. The patient retorts with a clearly audible “Ow!” I have done plenty of CPR, but never on anyone who is capable of informing me that it hurts. Furthermore, I’ve never in my life seen a dead guy breathe, moan, or move on his own accord. My partner and I lock eyes, and I know we’re thinking the same thing: there’s only one explanation for this—he’s a zombie.
We actually have a cardiac arrest bag full of all kinds of goodies just for this occasion, but I didn’t think to bring it. No one thought we had a dead guy on our hands, what with all the signs of life, so we’ll have to make do with what we have. My partner sends 150 Joules of electricity into the zombie’s chest, which he clearly does not like, judging by the sound he makes. The man turns purple from the nipple line up, a textbook sign of a pulmonary embolism. I continue to perform CPR, while concurrently instructing first responders to prepare equipment.
My partner says he’s going to start an IV in a vein in the man’s neck. I have someone take over CPR, and I practically tackle my partner, which is my standard response when he’s about to do a cool procedure I’ve never done. I insert a large bore catheter in the zombie’s external jugular vein, with my partner expertly walking me through the motions.
After a few more minutes of CPR, code drugs, and defibrillation, while not being distracted by the obvious life-like state of our dead guy (for which the American Heart Association did not prepare us AT ALL), he gets a pulse back. That is to say, our zombie is now un-dead, which goes against all the comic books I devoured as a nerdy, antisocial kid. While this is obviously great for the patient, the return of spontaneous circulation also works out nicely for us, because there was no freaking way we were going to make it down three narrow flights of stairs and do CPR.
A 12 lead ECG shows the patient is also having a monster of a heart attack. So, to sum it up thus far, we have a formerly dead guy who appeared remarkably alive while dead with a possible stroke, pulmonary embolism, and big fat myocardial infarction (that’s just a fancy way of saying heart attack). This is all my fault; I pouted and wished for excitement, and the EMS gods came through with alarming alacrity.
En route to the hospital, we do the zombie-CPR-shock-drugs-un-die dance a few more times. At one point, I’m performing CPR again (I love to do CPR. There’s something thrilling about being a physically fit girl doing manual labor in a largely male dominated field, when big burly dudes say, “Need me to take over for you?” saying and honestly meaning, “No, thanks. I’m good.”) and my partner contemplates aloud, “Because he is having an MI, perhaps the epinephrine will be too much of a strain on his heart and make it worse.”
“True,” I respond, proud of the fact that I can talk and do chest compressions, “but having no pulse at all is probably the larger of the evils.”
“Good point,” he says. He pushes another round of drugs, and I get another break from CPR.
Upon arrival at the hospital, the ED staff has the delight of encountering the same bizarre circumstances as we did, and again, he regains a pulse. Doctors, nurses, and techs are all astonished, while my partner and I play the role of the experienced wise ones in this unusual scenario; after all, this is old news for us by now. The staff takes him, un-dead again, upstairs where he will undergo tests and catheterization to try to combat the zombie trifecta.
The next day, my partner and I take a non-critical patient to triage at the same hospital. My partner suggests we investigate the patient’s outcome, and I eagerly agree. We mosey up to the ICU, trying to give the perception that we belong here, despite the obvious contrast of our uniforms, radios, boots, and shiny badges to the hospital staff’s comfortable scrubs and tennis shoes.
We find a nurse, explain who we are and what we are looking for. The nurse tells us, “Sure! He’s doing great and he’ll probably be discharged by the end of the week. He’s awake if you want to go see him.”
He’s awake. This is far better than either of us had imagined. Honestly, we came to find out if he was dead or a vegetable, but this man is awake.
My partner knocks on the door gently, and he and I enter the patient’s room, mouths agape at the conscious man who is clearly not on life support. The patient looks at us and says, “Well, judging by the uniforms, you must be the people who saved my life. The doctors say that if you hadn’t have been there and done what you did, I wouldn’t be here.”
We stayed and chatted with a man that died in front of us the day before, which is the single greatest experience I may ever have in my career. All his faculties are intact, and he has even managed to retain his sense of humor. I’m more astounded than I was when he was a zombie, but I kept that to myself.
“You know, I’m really sore from it all. I’d like to know what mammoth of a man you had doing CPR on me,” he tells us.
My partner looks at me, and I feel a girl-power grin that starts from my gut and works its way up. “For the most part, I did the CPR. You didn’t seem to like it much then, but it was better than the alternative.”
“Well, thank you both.”
The intense school, the paltry paycheck, the abusive patients, the generalized assholes, and all the crap that goes along with EMS, after seeing that man alive, was worth it.
Monday, March 8, 2010
I experienced my claim to urban EMS fame with my very own rumor during paramedic school, a year and a half into employment at the agency, and a few months into the paramedic program. Until this point, I’d managed to stay under the proverbial rumor radar, largely by keeping my nose tucked safely into whatever book I’d gotten my hands on that week, with minimum fraternization with my coworkers. As a mere paramecium, I was completely engulfed in the world of learning paramedicine, and had little time or energy remaining for anything remotely indecent, however tempting.
The county my agency has the delight to serve is also provided with a fine publication called The Slammer, available primarily at superior establishments located in the hearts of our many ghettos. This may seem odd upon initial examination, but is an excellent way to keep up with the recent activities of loved and/or despised family members, cohorts, and acquaintances. I am simply giddy at the occasional glimpse of a high school classmate, although it is much more likely to catch a snapshot of the recent arrest of a frequent flier of the EMS variety.
Unbeknownst to me, The Slammer had published the latest arrest of a young lady who shares my first and last name, but is in an entirely different line of employment as myself. While not a dead ringer, Tiffany’s mugshot does not necessarily look unlike me: she’s young, Caucasian, and blond. Listed directly under the black and white photo are the allegations against her—Prostitution and Crimes Against Nature.
This particular edition of The Slammer was circulated during the opposite shift as the one I worked prior to enrolling into paramedic school. That is to say, employees of that shift were familiar with my name and had merely a vague idea of my appearance, as our paths rarely crossed. Presumably, a coworker and ardent reader of The Slammer purchased a copy, found “me,” and produced the “evidence” to the supervisor on duty, who was not particularly familiar with nor had never actually met me. The supervisor on duty then called my direct supervisor, Paramom, who was enjoying an adult beverage on her well deserved weekend off work. As I understand it, Paramom’s reaction to “my” crime was: “Are you sure? Tiff’s in paramedic school. I really don’t think she has time to hook.”
Meanwhile, “I” was cut out of that particular edition of The Slammer, and the tabloid was left at the logistics window, free to be perused by at least one member of every crew that must wait at that window for the necessary items that are required for every ambulance. While a hole in a publication that reports criminal arrests may have seemed inconspicuous to some, inclined inquiring minds had the ability to fill the void with minimum investigative efforts.
My personal rumor was brought to my attention by Paramom, who approached me during my usually anticlimactic lunch break during school. I was having a pretty fantastic day. All morning, I’d received smiles and salutations from paramedics and EMTs alike that typically ignored me or viewed me as an unobtrusive piece of the scenery. Obviously, I thought I was having an extraordinarily great hair day. Paramom casually sat at the table in the office kitchen as I shoveled in another forkful of the weekend’s leftovers, “So, did you have an exciting weekend?”
“Not really. I’m having a tough time getting all of these drug dosages down, but I think I’ll get it if I keep at it. There’s just a lot to absorb.”
Paramom asks me with a nervous laugh, “I see. So, you definitely weren’t incarcerated on your weekend off?”
When I applied at my agency, in addition to all jobs I’ve applied for in the past, I’ve been asked about the possibility of a criminal record as a formality. I’ve been subjected to standard background checks and known company policy requires full disclosure of criminal charges. I have, however, never been asked in a straightforward manner about any criminal activity, particularly when some details have been quite clearly established. It has simply never come up, and I was not entirely sure of the proper social protocol; I settled with nearly choking on my reheated pasta. “Um, no. I’m fairly certain I would have remembered that.”
Paramom proceeded to fill me in on her interesting telephone call that seemed too absurd to investigate over the weekend, but had to be addressed as a matter of course. She also informed me that she had yet to actually see the “evidence” in person. We set off to acquire our own copy of The Slammer, conveniently sold at the gas station next to our agency (we’re county funded). A few pages in, there “I” was, in all “my” mugshot glory, nestled in the middle of a section specifically dedicated to sexual crimes. Her middle name was different than mine, putting a definite end to the investigation in an official capacity on the spot. “What exactly constitutes a crime against nature?” I asked Paramom, but even in her infinite wisdom, she was dumbfounded. On the bright side, my namesake was definitely the hottest prostitute published that week.
My classmates and friends teased me with a vigor that occasionally resurfaces to this day. With Paramom’s blessing, I made no efforts to squash the rumor with the field crews. I cat walked the wash bays with my head held high and an extra swagger in my step. In an agency of a few hundred people, I had my very own rumor, which I didn’t even need to fuel with my own offensive behavior. Simply put, I had made it.
Thursday, February 11, 2010
Good Crazies and I get along very well, perhaps due to the “it takes one to know one” theory. Good Crazies and I can see eye to eye and get to the hospital without physical restraints, threats of/attempts at bodily harm, or the sudden inescapable desire to unbuckle oneself from the seatbelts on the stretcher and fling oneself out of the back of the ambulance at 55 miles per hour on the highway. We may even share a laugh, a common interest in books/music/serial killers, or a personal epiphany into the insight of mankind. People of the Good Crazy variety tend to see me, decked out in pigtails, with big blue eyes and girl-next-door freckles, as the kind and loving creature I try to portray my image to be, and immediately assess that I am not only far from a threat, but willing and able to help them. Good Crazies get my personal specialty, 50cc of love: hand holding and head patting as necessary.
Examples of Good Crazy:
Alzheimer’s Patient Who Seems To Have Developed Tourette Syndrome: This patient is almost always a delight for me. You just can’t be mad at them. You can be annoyed with the nursing home staff for calling 911 and reporting that the patient has an altered mental status, despite the fact that their normal mental status is indistinguishable from an altered one, but not at the patient. Furthermore, every time they drop the F-Bomb, it gives me the giggles like nitrous oxide. There’s just nothing like a 200 year old lady swearing like a sailor. I realize how hard this must be the patient’s family members, but if I spend much time analyzing the true misfortune of my patients, I’ll spend the rest of my life munching on serotonin reuptake inhibitors.
Mentally Handicapped, But Incorrigibly Happy Kid: I walk into the room and this kid (or technically adult as the case may be, but they always strike me as kids) just BEAMS at me with a smile that could replace the sun. I introduce myself and ask if we can be friends, and they always want to be my friend. People who want my friendship may be appealing from a person with all their mental faculties, but people who have been dealt a seriously shitty hand and have a sunny outlook are impossible not to adore. I realize that perhaps they’re incapable of knowing the nature of their illness, but I can’t force myself to care. They actually want to be my friend for no reason (perhaps this requires another self-psychoanalysis in the future, but I digress)!
The Happy Drunk: While it is obnoxious to continuously take people to an emergency room when they are clearly not having an emergency, it’s apparently unavoidable. If I must transport a drunk, I infinitely prefer The Happy Drunk, which is not to be mistaken with The Drunk That Vomited Red Wine On Me And Now I Can’t Even Smell It Anymore Without Feeling Nauseous. They may take for freakin’ ever to load into the ambulance because they feel the need to say goodbye to everyone on first response and stumble around incessantly, but they don’t throw punches or insult public safety personnel. They even laugh at their own slurring, inability to speak a clear sentence, and hiccups. The Happy Drunk is occasionally homeless, and this is his or her primary escape from the harsh reality of the world, for which I can’t really blame them. I suppose The Happy Drunk takes me back to my days in college, where I didn’t realize my EMS training had begun by taking care of my friends who frequently morphed into The Happy Drunk. In fact, I have been The Happy Drunk, just never in an ambulance.
The Schizophrenic Lady Who Puts Lipstick All Around Her Eye Like Petey The Dog, Or Other Harmless Aberrant Behavior: Bystanders only called 911 because this patient is clearly off her rocker, and they have no clue what to do. Think about it: you see someone with blatant atypical behavior, but do you really know if they’ll go off on you if you ask about it? Bystanders don’t see this patient normally, because they tend to be tucked safely away in the care of family members or mental institutions. They see someone painting their face in hot pink and babbling incoherently and have no idea what to make of it. When I show up, I compliment the color and let her know if she missed a spot. In retort, we have a peaceful ride conversing about the nice Martian she met last week.
Bad Crazy, on the other hand, is the total opposite, and even worse, they see right through my docile appearance. Bad Crazies know I’m not totally sane (who in EMS is, anyway?), and they thrive on it. They love to pick fights, force us into physically restraining them (without even acknowledging how handy I am with soft restraints! Jerks!), or make grand accusations of our intentions/races/religions/sexual preferences/possibilities of demonic nature or possession. Bad Crazies will NOT accept even my most compelling charm, which quite frankly, annoys the crap out of me. Well, that and sometimes they try to hurt me, which sucks for obvious reasons.
Examples of Bad Crazy:
The Patient Who Makes Really Ineffective Suicide Attempts Regularly: This patient either has the IQ of a fencepost or is really searching for attention, not an end to their existence as they know it. This patient only falls into the Bad Crazy category because they’re hurting the people who care about them, albeit emotionally. Cutting your finger, taking a dose of an over the counter medication that is less than the recommended dose, jumping out of a window on the first floor of a building, banging your head onto a concrete wall (but not hard enough to leave a mark), stabbing yourself in the leg with a pencil, refusing to take your vitamins, taking your prescribed medications when and as you are instructed (seriously), scratching your forearm with a dull knife, or staring at the sun will probably not kill you. These patients typically need either a stage complete with spotlights or Darwinian intervention. Better luck next time.
The Paranoid Schizophrenic Conspiracist: These people are very mentally ill, usually with a multitude of psychiatric disorders, and typically have experienced such awful things in life that their mind literally surrendered. These people know for a fact that myself, my crew, and all first responders and police officers are all minions to those orchestrating an elaborate scheme to “get” them. Granted, it doesn’t help my case that the patient was full body tackled by a police officer to get under my care in the first place, but you simply cannot run half naked, at top speed, through the back yards of a middle-upper class neighborhood; people frown on that kind of thing. Logic is of no use with these patients. My oxygen is really noxious gas, my lancet for checking glucose levels is actually a poison dart, and my blood pressure cuff is a cleverly disguised torture device. These patients are highly unpredictable and are so intensely fearful that they honestly believe I can and will hurt them. They interpret my attempt at a calm voice as a ruse and my ambulance as an embodiment of the evil that is set to destroy them. I can’t entirely blame them…if you were actually looking at a hallucination of “El Diablo,” how can you not believe higher powers are looking to destroy you? After all, seeing is believing, right?
The Dimwitted Criminal: This particular type of patient exists largely to make me feel of superior intellect. This patient dons stylish house arrest anklet, yet led the highway patrol on a high speed chase for no apparent reason, hit the car of a passerby at an off ramp, took off on foot, got bit in the leg by a dog from the canine unit, and fails to see the irony in the fact that I forgot to put my phone on vibrate and The Clash’s “I Fought the Law, and the Law Won” rings from the pocket at my right breast. Nicely done, Dimwitted Criminal, you may have just won yourself a stay at the big house! I see the biggest injustice as the fact that these delinquents always seem to procreate; can the spawn of those responsible for keeping prison recidivism rates exceptionally high really stand a chance at success in life?
The Mean Drunk: I despise The Mean Drunk. The Mean Drunk has poured alcohol down his throat in whatever form he/she can find every waking minute of every day, regardless of the fact that the juice makes them grow horns and spit fire. The Mean Drunk knows that he or she is a raging asshole under the influence, and probably wouldn’t be such a dick if he/she quit drinking mouthwash every day, but just doesn’t care. The Mean Drunk is full of threats of violence, and occasionally acts them out. He/she flails about, swinging fists and feet, yelling threats and insults, spitting and refusing to cooperate. Really, Mean Drunk, I’m practically Aryan in appearance; it just doesn’t make much sense to call me the N-word. Also, please keep your HIV, Hepatitis, TB, or other communicable disease laced saliva to yourself. On occasion, The Mean Drunk picks me out of all the people available as his victim, which never fails to baffle me; aside from an emaciated teenaged fireman, I am likely the smallest person on a scene, and I wear my hair in pigtails regularly…PIGTAILS! “I’m gonna rearrange your pretty little face!” Yeah, Mean Drunk, you said that last week, and guess what! Face. Still. In. Tact. Seriously, Mean Drunk, this whole slowly killing your liver ordeal is for the birds; just aspirate your vomit and die already. Perhaps the most disturbing thing of all is that these people don’t actually scare me anymore. Sure, I’ll be more alert, keeping my arms constantly prepared to block a swing or ready to use four point restraints, but I’m no longer afraid. When I was a new EMT, these people scared the crap out of me; these days, I just think these patients are probably why we don’t use paralyzing drugs in my system.
I’ve barely covered the tip of the craziness ice burg in the emergency setting, but I can’t be bothered to write a novella on the experience. Besides, most of it is depressing. The comic book version of myself lifts The Good Crazies effortlessly and compassionately, delivering them to hospitals capable of curing their incurable problems. She protects the world from the Bad Crazies with speed, strength, and intelligence. Of course, the superhero within is a fantasy, so I’ll settle with not being dumbfounded and doing the best I can in whatever situation I find my patients and myself in.
Tuesday, January 26, 2010
I am a bona fide paramedic; I've worked hard to learn about the myriad of disastrous complications the human body can endure and ultimately, what interventions can be made on my part to keep a person alive in the face of abominable circumstances. Essentially, I was ready. Bring on the Grim Reaper-I am ready to stare him down and pull lives from his grimy, heart-stopping, possibly mummified hand! This is honestly how you feel when you've been a paramedic for a week: part superhero and part purist. Your heart is full of altruism, your brain is full of knowledge you'll likely lose from lack of use, and the rest of you is petrified that you'll kill someone. Ah, the life of a para-pup.
Then it happened: I got my first priority (read: really bad, possibly about to kick it to the next adventure, depending on your particular brand of spirituality) patient. The dispatch came over the radio, and I wasn't necessarily anticipating anything serious in nature considering the vast majority of the people who call 911 are in no severe distress what-so-ever. The possibility still remained that this person could be in severe distress and I could swoop in and save the day with my knowledge, medications, and equipment. I can nearly see it in frames of a comic book, vibrant colors showing my hair blowing (and possibly a cape, too, for good measure) as I defibrillate the patient's heart, stopping a lethal rhythm from claiming the life of yet another innocent soul. I intubate the patient with grace and style, protecting his or her airway from the always dreaded aspiration injury. I give life-saving medications through an intravenous line that I have managed to administer without so much as spilling a drop of blood. I can see the sparkle off my teeth as I wheel the patient into the hospital with nothing left for the doctors and nurses to do because I have saved the day. The patient, their family, and doctors and nurses thank me profusely, as they are positive that without my interventions, the patient would have inevitably experienced a harsh and painful death. On top of all that, I have never looked better in my uniform as with the added advantage of a touch of cleavage. My fantasy world quickly comes to a halt as I pull the ambulance into the parking lot of your standard ghetto-fabulous apartment complex.
True to form, the apartment itself matches the façade: smoke wafts through the air, the furniture is minimalist and cheap, untidiness is abundant, evidence of fast-food is scattered throughout the areas I see, and more people appear to live there than the fire code will likely allow. I see my patient sitting upright on a battered couch, her hands on her knees, clearly struggling to suck precious air into her lungs. Shit. Shit! SHIT! I realize two things for certain: if I don’t do something immediately, this woman will die, and I have absolutely no idea what I’m doing. Reality sucks. I can only imagine how I must have looked to my patient: a 26 year old blonde with the color drained from my face, eyes wide and unblinking, frozen. Perhaps she thought that I was fulfilling the agency’s special needs requirements for equal opportunity employment.
Luckily, I’m working today with an experienced paramedic who I would trust with my own life. She’s the real superheroine here, and I find this comforting enough to snap myself out of my stupor. Somehow, my training kicks in, and I become a woman of action, albeit a clumsy woman of action, fumbling with my equipment with shaking hands, mostly unsure of every patient care decision. I call out for the patient to be put on oxygen. Holy crap! The firemen are doing what I say and instead of looking at me like I’m speaking tongues. Well, that’s kind of cool. I listen to breath sounds, note wheezing all over and diminishment in the lower lobes of the lungs. I attach a probe to her finger that reads oxygen saturation levels: 74% and dropping with a high heart rate. The patient is unable to speak and tell me her medical history, but she is relatively young and is able to answer some yes or no questions; I just have to choose them wisely. The patient is able to nod that she has asthma and that this problem came on quickly. She shakes her head when asked if she’s allergic to any medications.
I call to my partner to set up a nebulizer with albuterol, stronger than her home version of the drug. I tell her to toss me the epinephrine, I want it readily available in my pocket. A fireman reads off medication names from a grocery bag full of medications, “albuterol, metformin, hydrochlor-I can’t say that one, but it’s a big word, lasix, and prozac.” Fantastic. Those medications indicate that she could be either having an asthma attack of the worst kind or drowning in her own blood, and if I treat her wrong, I’ll kill her.
I listen to her lungs again and there is no change, her oxygen saturation level is holding steady. We pick her up to put her on my stretcher, and as I put my hand around her left arm, I feel the swoosh of blood that indicates she has a dialysis shunt, and I briefly panic. She could potentially have toxins and fluid backing up in her bloodstream and into her lungs, and the medication I’m giving could be helping her drown if this is the case. Super. “Have you missed any dialysis appointments?” She shakes her head no, and a family member says that she went to dialysis yesterday. Here’s hoping I don’t screw this one up.
It feels like we’ve been here entirely too long, but I know it couldn’t have been more than two or three minutes. We need to get moving immediately, and I ask a fireman to drive the ambulance to the hospital, with what I like to think was politeness and urgency, but probably appeared more along the lines of frazzled bossiness.
Her blood pressure is dangerously high, making me again concerned that I’m treating my patient totally inappropriately. I reconsider and decide that this has asthma written all over it, and I make an active decision to stick to my guns and see what happens. My partner is furiously working to put together the CPAP, a machine that forces air into one’s lungs, while I’m searching for IV access. She yells out to me that the machine isn’t working as I yell that the patient has no IV access. Abandoning paramedicine in lieu of permanently living in my comic book fantasy is looking more appealing by the second. In one arm, her veins have been totally deteriorated by diabetes and high blood pressure, and in the other her veins have been altered by the surgical placement of a dialysis shunt.
I peek up at my patient to see the beginning of The Look. The Look is not a new concept for me. I’ve seen The Look as an EMT-Basic and not directly responsible for doing things like keeping people from dying. Until now, The Look meant I should say to the paramedic, “Hey, you should probably do something about that,” because The Look is typically followed by death. Now I’m the paramedic. Crap. I suggest to my partner that I think it’s time to give epinephrine, but she disagrees. My partner thinks this very strong medication could put too much strain on her heart. That’s a distinct possibility, and by doing this we could give her a heart attack. We agree to hold off on the epinephrine for now, but keep it close by.
My partner is able to rig the CPAP machine with brute force; it leaks, but it works. Good enough. The oxygen does the trick and The Look is gone for good. The patient’s oxygen levels steadily rise until they reach 100%, where they remain. We have managed to alert the hospital prior to our arrival, and as we roll the stretcher into the waiting room, the doctors and nurses immediately get to work. The room is crowded and wires and tubes seem to fling through the air as our equipment is traded out for that of the hospital’s. I manage to relay my report to the room, despite the frenzied activity, without appearing to be a complete idiot, which is no small feat. An experienced nurse is attempting to obtain IV access and I hear her say “She has absolutely no IV sites.” Well, that makes me feel a little better.
As I leave the room, my hair is matted to my head with sweat, I didn’t save the day with grace and style, and I have no tasteful cleavage. I did, however, get the patient to the hospital alive with the invaluable help of an experienced partner and an accommodating fire department. As I replay the events in my head, I remember and remark to my partner that I’m most impressed that we never got distracted by the fact that there was a midget on scene to begin with; she agrees that this is an achievement worth celebrating.
After what seemed like an eternity, I finished the bulk of my written report and documentation. I reentered the patient’s room for a little bit of early follow-up. The patient is sitting up, on continuous nebulizer treatments and finally able to talk. “Honey, did I scare you?” she asks me.
“Don’t worry. You did a good job.” Well, it isn’t people falling at my feet to appreciate my valiant efforts, but I’ll take it.