Wednesday, May 26, 2010

Drugs, Dad, and Rock and Roll

Some calls get under your skin and shake your soul to the very core. Children in distress are always a challenge to the caretaker emotionally, and facing death can take a toll on one as well. More often than I’d like to admit, the debilitating feelings of inadequacy, helplessness, and fury have overtaken me when I’ve encountered abuse, neglect, death, and other situations out of my control. Sometimes patients and their problems just hit too close to home and force you to face fears and issues you’ve spent your entire life burying.

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


My partner and I are dispatched to a headache; this is our third headache call of the day, all of which were supremely boring. While I give my headache patients the best care I can, insuring they have no signs of an impending stroke, considering all aspects of the condition, and keeping them as comfortable as possible, I’d rounded out my previous call by looking longingly out the ambulance window, watching my coworkers wheel critical, medicated, intubated patients into the hospital, seeing my colleagues’ cheeks flushed with the excitement of their call. I want that excitement! I want to make a difference in someone’s life, but here I am on the way to another mundane headache call. What’s a girl got to do to get some neuro deficits around here?

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.