Is it working for your patient?

3 weeks away from passing my paramedic class, I was on shift at work. My partner and I got a call for one of our regular dialysis patients. . .

"You wanna just head in?" Kyle asked me.
"Sure. Pick up is in 10 minutes but she's probably ready."
We're lead into the house by the home caretaker through the garage. As I approached our patient Mary, I heard her whimpering softly. She was lying in her bed which is set up in the middle of her large, ranch-style home. Her husband turned away from the TV only to greet us with a nod.
"Hi Mary. How ya feeling today?" I asked.
"Ooooh.. Ohhh owww.. My legs hurt... And my arms...Owwww ooohhh..." she moaned. I looked up at my partner and cocked my head to the side, giving him the 'this-don't-look-right' expression. We've been partners for awhile, so he understood immediately and held out his hand for the BP cuff and stethescope. I tried talking to her caretaker quickly to see if there was something else going on.
"No blood presha. Hard to get on her." she said in a thick accent.
"No blood pressure? Since when?"
"Tursday. Been seeek. No good."
"Ok. When was she dialyzed last?"
"MMmm... Friday. No, Saturday..ya."
"Hmm.. Ok so that's 2 days."
My partner looked up at me with obvious concern in his face. "Nothing. Can't hear a thing."
"Really? Let me see."
He handed the cuff and stethescope over and I wrapped the cuff around her arm and pumped it up to 180. I released the knob to allow the air to flow out, listening desperately for a heartbeat under her bicep. The needle jumped faintly around 60 but continued to fall rapidly. I heard nothing. I tried again, but this time the needle fell without a single twitch. I took the scope off and tried to palpate a pulse. No radial, no brachial, no carotid.
"Mary? Sweetie, you with me?"
"Ya honey. I'm ok. Just hurtin'. Owwww."
I looked over again at Kyle and shrugged. "She's alert and oriented. She probably just needs dialysis. Maybe she's just got too much fluid, causing the edema so it hurts and makes it hard to hear a pulse." I said.
He nodded again. "Should we go to the ER?"
I looked down at Mary. Since she's a regular patient, I know her well. She looked a little pale, but not bad. No trouble breathing, lungs sounded clear, but she definitely seemed ill.
"Her dialysis center is just next to the hospital. Let's head over and see how she does. If anything we can bring her into the ER if she gets worse."
He nodded again and we loaded her onto the gurney. As we walked out, I repeat to him what my paramedic instructor has drilled into my head; 'is it working for your patient?' Normally, a patient with no blood pressure and no pulse would be, well, very bad. In this case, my patient had what we call co-morbidity; a laundry list of medical problems that might contribute to her symptoms. She was awake and oriented, but in pain. There was obviously something wrong, but not necessarily life threatening. So, is it working for my patient? She was alive, and seemed basically okay.
We loaded her into the rig and I sat down beside her on the bench to do paperwork. I looked at her closely after a couple of minutes had passed. She looked strange, different than just a few minutes before.
"Mary? Mary, how are you doing?"
"Aw hun. Can you let the kitty in? She's crying. Oooohowww ohhh.."
"Mary, sweetie, do you know where you are?"
"Yea but my kitty is cryin'."
I frantically searched her again for a pulse, looking for anything that may have caused her sudden drop in mentation. I gingerly placed a finger on her neck and drowned out the diesel. I felt it. Very faint, and very fast, but it was there and it didn't feel too good. I poked my head through to the cab.
"Hey, divert to the ER. I'll call and update dispatch and have them notify. She's not okay. Don't turn on the siren just yet." I said softly. He nodded again in understanding and turned his worried face from the rearview back towards the road, focused on getting us there. When I sat back down and looked at her again, I realized what was making her look so strange. Her color had gone from slightly pale to downright gray. Almost jaundiced looking, her skin now held a yellow-green-gray color and her eyes looked sunken in and clouded. I kept talking to her, but she still wasn't making any sense, even though she had been just a few minutes prior. I called my dispatcher to update them on the situation, letting them know we would be taking her to the ER across the parking lot from the dialysis center. One of our newer dispatchers answered the phone.

"Hey Mark. We're diverting to the ER, she's not looking good." I said quickly, almost whispering.

"Okay. Give me some vitals so I can let them know."
"Uh, that's the problem. I can't get any BP or pulse on her really. I can feel a weak, rapid carotid but nothing else. Sorry. Respirations are 24, unlabored and slightly shallow on 6 liters of oxygen, but her mentation just dropped and her color is all wrong."

"Ok, so she's alive, you just can't feel a pulse or BP?"

"Yea. Just let them know we're coming in."

"Alright, thanks, I'll call right now."

We pulled into the ambulance bay and brought her in. Usually, BLS crews stand around waiting for upwards of 30 minutes for a bed in the ER, regardless of the patient'scondition. Today was different.

"Is this Mary?" a nurse asked me.

"Yea. Can't palpate or auscultate any BP or pulse. Caught a weak rapid carotid but lost it pretty quick. She's awake and talking but not making much sense and she's really ashen."

"Ok, bed 5. Hook her up to the monitor, let's try to get some vitals. Why didn't you call for paramedics on scene?"

"I, uh... I don't know. She looked okay, she just started... doing this... enroute. We thought she was okay." I replied, wheeling her into a room. A nurse came in and scowled at us, irritated with our lack of a full medical history and medications. I explained that her caretaker would be here any minute with all of that information, but she waved me away.

"Sixty over thirty, pulse 140. She's compensating, get the doctor in here." she yelled out the door suddenly. I spun around and stared at the monitor, disbelieving the numbers that had popped up.

"She was okay.... I don't understand... When we got there.... She was okay I thought.." I heard my voice trail off towards the end. I turned to walk out of the room and talk to our nurse when a doctor ran into me in the hall.

"Why didn't you ALS this?! This is NOT a BLS call!"

"Her mentation dropped enroute, and her color changed. She was alert and oriented on scene, even though we couldn't get a pulse, she didn't LOOK seriously ill."

He, like the nurse, waved me off and went into the room.

My partner and I left the ER like 2 puppies with our tails between our legs. We pulled out of the bay and parked down a nearby street so I could finish writing my report. I re-wrote the PCR at least 4 times, trying to detail everything so that I could unravel it all in my own head. Everything sounded right; at her house, she seemed to be doing alright. In the rig, she changed. I diverted to the ER like I was supposed to. So why did I feel like I had done something wrong? Kyle admitted his own guilt, saying he felt that he, too had done something wrong. When we got back into station we went over the call again with our supervisor.

"We just wanted to know what you would have done if you had been on the call."

He sighed and rested his head on his fist. "The same thing. I mean, it sounds like you guys did what you were supposed to. You're not going to get into trouble, you know. Screw the doctor, what were you supposed to do? You got her to the ER. You noticed the changes and you took her to the right place. It's not your fault, really."

"I know," I said, "and I'm not worried about getting into trouble. I'm worried that I did her wrong. That I didn't do all that I could have because I waved off the lack of pulses to her medical history. I feel like I should have caught it."

"You couldn't have possibly known. You did everything right." He replied.

I walked outside for a smoke and Kyle joined me.

"I feel a little better." He said suddenly, after a minute or two had passed in silence. I nodded in agreement. I felt a little better too, but still somewhat guilty. I brushed it off and got through the rest of my shift forcing myself not to think about it too much more.

Kyle called me the next morning while I was on my way to school.

"Mary died. At the hospital yesterday I think. I'm not really sure how, dispatch just told me. They called her house to see if we would be taking her to dialysis tomorrow and her husband said she passed away. I just thought you would want to know."

"Oh.. Yea. Um.. Thanks man." I said, slowly.

"Yea, no problem." he replied quietly.

He was silent for a second before speaking again. "I still feel bad."

"Yea, me too."

'Sixty over thirty, pulse 140. She's compensating.'

'Is it working for your patient?'

No. I thought it was, but I suppose I thought wrong.

History

We were called to pick up one of our regular dialysis patients from treatment and bring him back to his nursing home. After moving him to his bed, I turned to leave the room and noticed a bulletin board full of pictures. Most appeared to be of his children and grandchildren, but one caught my attention. I looked at it closely, then turned my head to look at the patient lying in bed.

Yup, it was him. Standing on a boat with his granddaughter. Smiling, happy, in seemingly perfect health.

I looked back again at the patient, lying motionless in bed, eyes fixed on the ceiling.

The picture was dated 2008. I turned to my partner and asked what his history was.

"CVA."
"That's it?"
"Well, after that, it all started going downhill."
"Oh. Wow."

I gazed at the photo, looking back and forth between the picture and the patient.

History in 2008: No past pertinent medical history.

History in 2009: General weakness, renal failure, aphasia, diabetes, dysphagia all secondary to CVA.

Innocence

"Unit 2, please head over to XX hospital. You have a NICU call, you'll be picking up the NICU team there and heading to YY hospital for your patient."

"2 copy, enroute."

We arrived at the hospital and brought our gurney in to trade for the mobile incubator. The RN and RT were waiting for some more meds to arrive before we could leave. We loaded everything into the back and the nurses chatted with us enroute. We pulled into the ER bay at YY hospital and are told to landline our dispatch ASAP.

"Hey Jen, its unit 2. What's up?"

"Sorry to be the bearer of bad news, but you guys are clear to head back to XX hospital."

"Um, ok... What's going on?"

"He coded. I'm sorry, but he didn't make it. Go ahead and drop off the NICU team and head back to station."

"Oh. Ok. Thanks."

I turned and explained to the nurses that the call was cancelled. Their faces twisted from confusion into grief and sorrow when I tell them that the baby hadn't survived. The ride back was quiet except for the occassional beeping of the empty incubator, informing us it's battery was low. The nurse turned it off and sighed deeply.
I looked down at the run sheet in my lap and silently drew a large "X" through it, along with "10-22," signifying the call had been cancelled. I bite my lip and decide not to include those 3 letters.

DOA.

I turned my pager over and over in my hands, stopping briefly to read the details of the call again.

'Run # 12345
Smith, BabyBoy
Respiratory failure'

Not even old enough for a name. Survived about an hour.

Not even old enough for a name.

WHERE DO I LIVE?!

"Unit 54, call coming out of [hospital]. 78 year old male, non-emergency, discharge. Respond."

"Copy, 54 enroute."

We arrive on scene at the busy ER. As we walk in, we hear a man's voice screaming random phrases through the halls. I approach the nurses' station and ask, "Let me guess, the noisy dude is ours?"

"Haha, you got it! He's a strange one. Repeats everything about 50 times.. Literally.." He pauses and motions for me to listen. Down the hall, I hear our patient..
"HELLO! HELLO! HELLO! HELLO! HELLO! HELLO! HELLO!"

I shake my head and chuckle. The nurse hands me the paperwork, explains that the guy just needs a ride back to his nursing home and thanks us for taking him. I walk to his bed and find my partner desperately holding back giggles and trying to take the guy's blood pressure.

"What's so funny?" I whisper.

"The stuff he's saying.. Oh man." he whispers back, laughing quietly.
I try speaking with the patient, but he just keeps yelling.

"Sir, we're going to.."

"I have to go to the bathroom! I have to go to the bathroom! I have to go to the bathroom! I have to go to the bathroom!"

I look over at my partner and he shrugs. "I tried to take him to the bathroom, he doesn't really have to go."

"Uh, okay then.. Sir, we're.."

"She's ripping my clothes off! Stop ripping my clothes off! She's ripping my clothes off! Stop ripping my clothes off!"
I stood there, bewildered, empty handed and about 3 feet away from him as he screamed this. A nurse ran into the room to see what all the commotion was and ended up looking more confused than I did when she saw that no-one was ripping anyone's clothes off. My partner stepped out of the room because he could NOT hold back his uncontrollable laughter at this point.

"Ummmmm... Riiiight. Okay, sir. We're taking you home."

"Where do I live!? Where do I live?! Where do I live?!! Where do I live!?!"

"Okay... Let's go."

We load him onto the gurney and he's silent until we put him into the back of the ambulance. I get in the front to drive and hear my partner in the back, trying to talk to him as he's yelling, "I'm gonna piss! I'm gonna piss all over this thing! I'm ready to piss! I'm gonna piss all over you! I have to piss!"

My partner is still stifling his laughter as he tries to get the patient to use a plastic urinal, but the patient refuses and continues to yell..
"Get me outta here! Get me outta here! Get me outta here! I'm ready to piss!"

As we bring him into his nursing home, still screaming, the nurse looks up.
"OH! Mr. Smith! You're back.. Great.."

I smile sympathetically at her and we take him to his room.
"Do you see that?! She's ripping my clothes off! I'm naked! I'm naked! I'm naked! She's ripping my clothes off! I'm naked!"

"Okay, Mr. Smith.. Have a nice day.."

We hop back into the rig and clear from the call. I turn to my partner. .

"Well, that was.."

"Stop ripping my clothes off! I'm ready to piss!"

"Hahahaha! Yea. That was interesting."

Over and out-
The PSYCH wrangler

Independence Day

"Unit 12, I have a call coming out of a private residence for you. Standby for page."

The page comes through; 25 year old male had a syncopal episode at home. We arrive on scene and find a confused young man sitting on the floor alone in his home. He doesn't really remember what happened, just that he suddenly woke up on the floor and it didn't seem right. As we pull the gurney in we try to get him to stand up. He blushes and explains that he's paralyzed from the waist down. We help him up and get him out of the house and into the rig. As my partner starts the engine I start delving a little deeper into this guys medical history.

"May I ask how you became um.. Paralyzed?"

"14 days. 14 days home from Iraq. I survived the warzone, come home and 14 days later I get hit by a drunk driver."

He shook his head and chuckled.

"How ironic is that? I mean, I came home from Iraq in one piece and 2 weeks later I'm paralyzed."

It was one of the few times in my job that I had absolutely nothing to say. I stared down at my run sheet, pen poised over the paper in the 'Medical history' column. I put the pen down and turned my head to gaze out the back window. 25 years old. A soldier in our military. And he's lost his independence because some asshole decided he was going to drive home drunk.
He sighed and laid his head back against the gurney. We dropped him off at the hospital and I give a report to the nurse. She looks at me with sadness in her eyes as I explain;
"Patient was involved in an MVA that caused the paraplegia. Drunk driver I guess.."

"Wow. That's so f***ed up. Ugh, alright, take him to radiology for an MRI."

"Yea, no problem."

"Have a happy 4th, be careful out there you guys."

"Thanks."


Over and out-
The PSYCH wrangler

More nightmares..

I woke up in the middle of the night in excruciating pain. I groggily stared at my hands in disbelief, unable to determine if the pain was real or not. The pain lessened, then disappeared as I turned my hands over several times searching for the source. I laid back, trying to piece together what I remembered in my head.
In my dream I had been at work, on a normal shift. The first call we took was at a school. When we arrived, I felt a sudden burning on the back of my hands. I looked down as the skin on my fingers sizzled and bubbled. Quickly I inspected my arms, looking for the source of the horrific burns, but found none. I immediately wrapped them in guaze, but kept quiet and continued the call. Throughout the day, call after call, the burns continued up my arms to my elbows. I sat down behind the wheel, squeezed my eyes shut and sobbed in pain until a sharp cracking sound startled my eyes open again. I was sitting in the rig, it was pitch black and an orange glow was around me. I recognized the freeway exit immediately, saw the downed telephone pole in the rearview mirror. The pole that had made the cracking noise as it fell and blocked my only exit out of the fire. I was trapped again, and time I was alone. My stomach churned as the skin on my hands and arms peeled off. I cried again, already knowing my radio was dead, already knowing what was going to happen. The smoke started to fill the cab of the ambulance through the vents, but this time I made no attempt to get out. I screamed.

"What's wrong?"
"I had a nightmare."
"About what?"
"Nothing, I'm fine. Go back to bed..."

"If in the time of duty I fall....

Help my family to hold their heads tall."

A quote from a well-known EMT prayer rings true for the EMS workers in my area today.

Due to the nature of my job, and my previous posts, I'm unable to disclose much about the events that transpired this weekend. What I can say is this:

A well-loved, dedicated and bright young EMT was killed this past weekend during a search and rescue operation when he lost control of the ATV he was on, and was then struck by the ambulance that was following him to the call.

C was 24 years old, and had been working in the field for over 2 years as a volunteer for Search and Rescue as well as an EMT for his local 911 company.

We are all incredibly saddened by this news, and our thoughts and prayers are with his family, as well as his fellow crewmembers who are devastated by their loss.

Rest in peace, brother. You will not be forgotten.

Stupid questions..

Me: "Sir, can you tell me the date today?"

JS: "Yea, the Yankees."

Me: "Oh, no sir, the DATE, can you tell me TODAY'S DATE?"

JS: "I SAID THE YANKEES!"

Me: "Ok, do you know what year we're in?"

JS: "How should I know?!"

Me: "Alright, do you know where you are?"

JS: "Are you here to get your passport? If you're not comfortable I can call the guys and have them come down."

Me: "......"

JS: "That castle, my father built it."

Me: "Sir, can you tell me your name?"

JS: "Yea, its JS! What, do you think I'm stupid or something?!?!"


Stupid? No. Insane? Questionable.

Over and out-
The PSYCH wrangler

Still alarm

It's late on a Friday night. My partner and I are headed back to station for our end-of-shift. We're downtown, stuck in the traffic that's headed to the bars and clubs. My partner is new. She's in her 40's, and just graduated a couple of months prior. She has yet to take a real call, they've been having her run nonsense calls for the past month to 'prepare' her for taking some legitimate ones. She tells me she feels incompetent, unsure of her skills and doesn't remember how to use a traction splint, has never seen a KED and probably couldn't bag a patient at the right rate if needed. I assure her that I'll help her with everything. I tell her she can call me or e-mail me on the weekends if she wants help. She takes my phone number and e-mail address down and is about to tuck it in her clipboard when an awful screeching/crunching whips both of our heads to the right.

I see a compact car wrapped around a road sign. It's completely smashed in on the driver's side. I see a large U-haul type truck pulling over. It appears that the U-haul was attempting to change lanes and, instead, t-boned the small car and shoved it against the pole. I flip on the lights, chirp the sirens and pull over alongside the compact, blocking traffic from hitting it any further. I grab the radio.

"Dispatch, unit 107, one-zero-seven, we have a still alarm TC on X highway, southbound side right before exit 1. 2 patients, we need fire. Roll highway patrol, please."

"107, confirming that's X highway northbound right before exit 1?"

"Dispatch, that's a negative. X highway, southbound side please. Southbound side before exit 1. Please roll fire, no access to patient at this time."

"Copy 107, they're on their way."

My flustered partner is anxiously trying to talk to the woman in the compact car. The driver of the truck is standing nearby, wringing his hands and apologizing. I approach the small car, now unconcerned about the truck driver as he appears to be fine.

"Ma'am? How are you doing? Do you have any pain anywhere?" I turn to my partner and tell her to go speak to the truck driver.

"Yes, my neck hurts and my nose is bleeding. Thank God you guys were right there, did you see him hit me?!"

"I'm sorry, ma'am. We're going to get you out of here, okay? I've got some more help on the way. Just sit tight for a few minutes and try not to move your head around too much, okay? Can you feel your toes?"

She nods and wiggles her feet to prove it.

"Great, just hang on, okay?"

I see the truck driver walking towards me, and I hold my hand up to him. "Sir, I'm going to have to ask you to stand back, alright? My partner will help you if you're hurt, but you need to stay away from this car, okay?"

He nods his head and stops. I hear him ask if the woman is alright, my partner assures him that we're helping her. I look up in time to see the 2 fire engines and a squad car pass us on the northbound side of the highway. I grab my radio again.

"DISPATCH, this is ONE-ZERO-SEVEN, confirming we are on the SOUTHBOUND side of the highway, please ask fire and police to reroute to the SOUTHBOUND SIDE right before exit 1!"

"107, you are NOT on the northbound?"

Goddamnit.

"107, NEGATIVE we are on the SOUTHBOUND! We need some help over here, I can't gain access to our patient, please notify fire and police to turn around!"

"Copy that."

I go back to the woman in the car. She's crying and tells me she's scared, that her nose hurts real bad and it might be broken.

"I need you to do me a favor, okay? I need you to turn your car off and leave it off. The fire department is coming, they should be here in a minute and we're going to get you out, alright? Listen to me. You're going to be fine... Stacey! Come here for a second." I manage to wedge the window down low enough to slap a neck collar on her while my partner holds her head still manually. She walks back over to the man while I continue trying to assess the woman's injuries.

I hear another screeching noise and look up in time to see the truck drive off, my partner screaming after it. She runs back over to me.

"He took off! I asked if there was anyone else in the car with him and he said no, then told me he needed to check on his wife and took off! I tried to get his plate number, but he didn't have any. Shit!"

"Hey, don't worry about it. We need to focus on her right now. Keep talking to her, tell her to hold her head still."

I grab the radio again and chirp it quickly.

"107, one-zero-seven I've got some emergency traffic."

"All units stand down, 107 go with traffic."

"107, the driver of one of the vehicles has left the scene. Please notify police that this is a hit-and-run and give description of a white U-haul type truck with NO license plates. Driver is a white male in his 40's, short brown hair and mustache. Last scene exiting X highway south at exit 1."

"107, copy that, I'll notify police."

The fire engine screeches up and I breathe a sigh of relief. The big engines are a blessing in highway accidents because they are like huge barricades, blocking us from getting hit by traffic. An older firefighter approaches me and asks for a rundown on the situation.

"We were sitting here in traffic, heard a crunch, looked up and this car was wrapped around this pole. Truck was trying to change lanes and t-boned her up against the road sign. He stopped at first, but just took off a minute ago. Woman in the car looks alright. Her nose is bleeding and her neck hurts but she's got sensation everywhere. Managed to get her in a C-collar. Windshield is spidered, she probably hit her head. No access right now."

"Awesome. We'll get the jaws out. How ya doin'?"

".....Huh?"

He chuckled and repeated himself.

"How are YOU doing?"

"Oh, heh, I'm okay. Been a long day, rookie partner. Poor thing, she's about ready to shit herself."

"Ha, yea I know the feeling. We got it from here, okay? Go back, get some rest. And thanks, you did a good job kid."

"Thanks, chief."

By now I can hear the jaws of life rumbling and glass shattering. They've got their access now, so we clear from the scene and go back to station.

"Can you BELIEVE that guy just LEFT?!" My partner exclaims as we pull up to station.

"Yea, I can. At least he made sure she wasn't dead before he took off. Most people don't even do that."

"Oh my GOD! That's just... I can't even believe that!"

"Yea, well. You'll see alot worse in your time, I promise."

And I'm sure she will. Those poor rookies, I always feel bad for them. They come in all bright-eyed, with the hopes and dreams that they're going to rescue little babies and return them to their grateful mothers and so on and so forth. In reality, there are good days and bad days, but we have no control over what happens in the end. We got lucky on this one, the lady wasn't hurt too bad, and the idiot truck driver was completely unharmed. But not all calls run like that. Sometimes there is nothing we can do, and other times, we do everything we can and it still doesn't help.

I go inside to my dispatcher and ask for an update on the call.

"Last I heard, they still haven't found the guy who hit her. Patient's okay though. She's got a broken nose and a couple stitches in her forehead, but no neck injuries. She'll be fine. Good job."

"Aw, I didn't do anything. I couldn't even get to her! Damn door was so smashed in and the other side wrapped around that pole!"

"Hey, well, you did enough and she's gonna be alright. Fire said to thank you, and told me to let you get some rest."

"Heh, sounds good to me. Have a good night."

"You too, kid. Thanks for your help tonight."

Yea, no problem. You're welcome, as always.

Over and out-

the PSYCH wrangler

Nightmare

I was woken up this morning by the sound of my own screams. It startled me, I was drenched in sweat with tears streaming down my face. Still shaking, I looked around my living room, where I had fallen asleep, for signs that it might have been real. It wasn't.
It was vivid, I had been in my kitchen doing dishes and heard the front door open. When I looked up, I saw the face of a boy our crew picked up last summer. A 14 year old kid who had attempted suicide by putting a gun to his chin. He didn't succeed. In the dream, his face had been haphazardly stapled back together. I pleaded with him to not hurt me, but he continued his advance, laughing. I stumble back and hear a shrill cry. Behind me, a baby that hadn't made it when her mother's placenta ruptured enroute to the hospital was lying blue on the ground. I scoop it up and try to get away from the boy, while trying to give the baby mouth-to-mouth. As I run towards the balcony, a hand latches onto my arm. Its the woman who died of liver cancer, the yellow, moaning woman. She's holding me where I stand and awkwardly stumbling closer to me. A fire starts in the kitchen. They're all laughing at me now, the fire gets bigger and I'm trapped. I can see a man outside, for some reason his presence is comforting even though I don't recognize him. I keep thinking that if I could just get to him, it might be okay. He reaches for me despite the huge distance between us but flames surround me and he disappears. I scream.
I wake up.

Working the system.

Call to a nearby high school to pick up a 14 y/o male complaining of 'suicidal ideation.'

Kid is placed on a 5150 hold by county health workers and handed over to us. He's grinning as he approaches the ambulance, guitar case in one hand and a backpack slung over his shoulder. I recognize him right away as a patient I have picked up at least 3 other times in the past 6 months.

"Chris? What's up, man? Why are you back?"
"Oh, I'll tell you on the way there." he replies, still grinning widely.

He hops onto the gurney and I step away from the back door to talk with the county worker. He confirms that the kid has been on several holds over the past year. Almost a dozen altogether. He obviously knows how to work the system, and approached his teacher this morning, stating calmly that he "felt like hurting himself and others." (This is almost the EXACT wording on the actual 5150 hold, one of only 3 reasons that a person can be placed on a hold.)

I climb into the back, and as we pull away, Chris turns to me and starts his explanation.
"Ok, so here's the deal. I was on a REAL hold about a week ago and I went to XXX Psych facility. I met this AMAZING girl there, she's my girlfriend now, and I'm totally in love with her. So, I acted like I needed another hold so I could go back to see her." He says this triumphantly, as if he's telling me of some master scheme he thought of to cure cancer. I'm not amused.

"Dude. You're wasting everyone's time. You're 14, it's not love, trust me. And you're not going to XXX Psych. They didn't have any room. We have to take you to YYY. Don't you think a psych facility is a bad place to be picking up on chicks, anyway?"
His face immediately fell, and he bitched the entire ride. When we drop him off, the nurse exclaims, "CHRIS?! Why on EARTH are you back here?!" He tells her the same story he had told me, and as we leave I hear her reassure him that he wont be staying for the entire 72 hour evaluation. (Even though, in my opinion, any guy who's gonna pretend to be loony to see some girl he met in a crazyhouse should DEFINITELY be given a psych evaluation.)

Later that night, we get another 515o call. I don't remember the specifics, other than that we were dropping off at XXX Psych. When we arrive, we wait for a bed and I make small talk with the nurse. Remembering Chris, I ask if the nurse recalls a young boy who was dating a girl in her female ward.
"Oh, you mean Chris? Yea, they were all over each other when he was here. He called here a little while ago to talk to her, I guess she dumped him for some other dude in here."

Sad story, right?
No. I think it's hilarious. When I explained that he had basically faked a psych problem and ended up getting booted 2 hours away to a different facility, we laughed for almost 5 minutes straight.
Am I burnt out, or does anyone else find this situation hysterical? Poor kid. I hope he learned his lesson.

Over and out-
thePSYCHwrangler

St. Jude

It was early in the evening. My partner and I were expecting to get our 10-19 soon, a call to head back to station for the night. It never came. Instead, we got a call to a nearby cancer center. It seemed a little off, patients are rarely ever transported out of there, especially not by ambulance, but we shrugged it off and took the call anyway. It was an inter-facility transport, the patient was going to a nearby hospice. I wondered why she might possibly need an ambulance for that, but again shrugged it off as an easy call.
We arrived, and I pulled the nurse aside for a report.
"56 year old female. Non-ambulatory, A&O times one, MAYBE. We just gave her some painkillers, she's DNR."
"What's her diagnosis?" I asked, wondering why that wasn't contained in the first few words out of her mouth.
"She's terminal."
"Yea, I got that. Terminal what?"
"Just terminal. What do you mean?"
I rolled my eyes, getting slightly irritated with the oblivious nurse. "'Terminal' is not a disease, a person does not go to the hospital for 'terminal.' What is the original DIAGNOSIS?"
"OH! End stage liver cancer. Terminal liver cancer. Sorry."
"Thanks. Can you give me a copy of the DNR, please? Just put it with her paperwork. And you said she's basically comatose?"
"Yea. She wakes up from time to time, but doesn't really say a lot, just looks around, moans a little. She's not in any pain, like I said. We gave her morphine just a few minutes ago. She's just going to the hospice to umm... Pass..." She said the last word quietly, leaning in towards me and glancing nervously over at the patient's family. I nodded in understanding and headed towards the room. I was trying to keep my demeanor a little more downbeat, no one was in the mood for a 'ray of sunshine' to be walking into the room.
The patient was, as promised, unresponsive. She was a fairly young but fragile looking woman. Her eyes were slightly open, but appeared glazed and extremely jaundiced upon inspection. We moved her very carefully and gently onto our gurney as the family all glared menacingly at us. I suddenly felt like I was the grim reaper himself, coming to take her away from the world. We got her into the rig, I instructed my driver to be incredibly careful as to not disturb the patient, and we went enroute to the hospice.
About 10 minutes into the ride, I heard a moan escape from her. I looked up, and her eyes were wide open, her yellow hands reaching towards me. It frightened me for a moment. I hate to say it, but she was almost zombie-like in her state. I calmed myself, removed my latex gloves and took her hands in mine. I put them gently back in her lap, holding them for a few seconds before letting go. She looked at me again, still moaning quietly as tears fell down her cheeks. Tears welled up in my eyes, and I took her hand again, trying to relax her.
What do you say to a dying woman? I'm sure she knew what was happening, sure she knew it was coming a long time ago. But now it was time, that wait was over. If a patient is dying in the back of my rig, I can usually at least ATTEMPT to stop it. In this case, I was completely helpless against God. Her time had been predetermined and there was nothing I could do to intervene, even momentarily. As we pulled into the hospice and brought her in, she gasped one final time and then was silent. I looked up at the nurse I had started to give a report to with sheer terror and urgency in my face. "Put her in her room, I'll wait for the family," she said quietly. I nodded and fought back the urge to cry again. As we left, I saw her family pull in behind us. I looked away, not wanting one of them to catch my eye and see in my face that she hadn't made it.

I've never been a religious person. I have been to church a few times, but could not understand the undying faith people had in an entity they had never seen, never touched, never talked to. Working in this field, it's hard to believe in a God that would let good people die on the side of the freeway, or keep little babies from seeing their 1st birthday. Some EMTs believe that the Saint of EMS is St. Jude. The patron Saint of 'hopeless' or 'lost' causes. The belief is that when all else fails, pray to St. Jude to help you.
I prayed that night to St. Jude. I understood a little more what it meant to have that faith that someone is with you, that you aren't alone, even when it seems completely hopeless. I don't know much about religion, I don't know how true anything in the Bible really is, but it's nice to think that there might be someone at my side, especially when I feel helpless against that greater power that might take my patients from me.

Over and out-
thePSYCHwrangler

Wait...What?!

Ever wonder what's written in those mysterious charts of yours while you're in the hospital? Here are some examples from myself and fellow crewmembers...

On a 5150 hold, under "Reason for hold" a single line reads, "Patient is crazy."

A report written by an E.R. Doc starts, "Patient presents 34 y/o female, naked."

A page containing the address of our call and the patient's name comes to my pager with this added note from dispatch, "Be advised patient is nuts. PD enroute."

In a progress report, between doctor's orders and vital signs, a nurse writes, "The patient kind of really smells bad, so I made her take a shower and now she smells better."

On a 5150 hold, a police officer writes, "Patient ran into the middle of the street because she is growing a penis."

On a page, the dispatcher gives the chief complaint as "Pillowfititis." (The diagnosis was actually 'pylo.')

On a typed report from the E.R., a nurse writes, "Patient is alert and oriented x 45." (You can only be alert and oriented x 4)


On a 5150 hold an officer writes "Patient called me a fu**ing ni**er, so I arrested him."

A page received by a coworker lists the chief complaint as "Some type of cancer."

On a report from an E.R. Nurse, the first line reads, "Patient presents 56 y/o male c/o vaginal bleeding."

Another page from a coworker reads, "Chief complaint: hiccups x 3 hrs.

A page received by myself: "Chief complaint: patient needs a ride."

The importance of a good partner..

A story from my old station..
Called to a school for a 14 y/o male who is a danger to others (DTO). We are informed by dispatch that this is a special school for children with "behavioral problems." Oh, gee, awesome. A whole school filled with little hell-raisers. We arrive and are greeted outside by a counselor who tells us the young man is locked in the "quiet room" and they are waiting for police to arrive. What's a quiet room? Picture a room you might lock Hannibal Lechter in. 4 inch thick steel door with a tiny barred window and carpet-covered walls. The counselor insists we not go near the room, fearing the boy will spot us and become even more agitated. We assure her we need to take a peek inside to assess what kind of restraints we'll need, and how to handle the patient. We walk through the silent halls with curious little eyes in every window, staring at us, trying to figure out what's happened to their classmate. My partner takes a quick glance into the "quiet room," only to be startled by the patient suddenly screaming and throwing himself against a wall. We quietly go back outside and grab every restraint we have, including a backboard and spider harness, which will hopefully immobilize him. We go back inside and 7 police officers have shown up. I hear one say, "I'm too old to be wrestling this kid. If anything happens, I'm tasing him." All the cops chuckle and wait to be let into the room. The mother of the patient asks if she can be let in first, alone, to try and calm the patient down before extreme measures are taken. The burly counselor holding the door shut agrees and allows her in. Soon after, more screaming followed by a large thump come out of the room. The kid has thrown his mother against a wall and she's now crumpled in the corner, cowering. The cops go in and tackle the kid. They tase him and he doesn't even flinch. He's brought out and thrown on the gurney, as my partner and I furiously work to get him immobilized as quickly as possible. As I move up his torso, securing all the straps on the spider harness, the kid leans up, whips his head around and a huge wad of spit hits me square....in...the forehead. The cops slam his shoulders back down and slip a spit sock over his head. I remain completely still, still hunched over him with a strap in hand. My sweet, 20 year old firefighter partner gently reaches over with a gloved hand and wipes it off my face, asking, "Are you okay?" I reply "Yeah, I'm fine.." He grabs me an alcohol wipe to clean off my face and tells me he wants me to drive so I don't have to be in the back with this kid. As soon as we load him up and hit the road, I hear my partner in the back...
"Listen, you little twerp.. I can't believe you just spit in my partner's face. Not only is she a GIRL, but she didn't do anything to you. Spit on me, or the cops that tased you but not her, she didn't do shit, didn't even SAY anything to you, you jerK. There was no reason for that..."
This continues through most of the ride, and I hear the kid gradually calm down. When we get to the hospital, I open the back door and my partner looks at our patient and says, "What did I tell you, dude? Say it, and mean it." The kid looks up at me sheepishly and says "I'm sorry.... I shouldn't have spit on you..."
My partner grins triumphantly as I tell the kid its ok, no hard feelings. When we get back in the rig to clear and my partner tells me it took a lot of strength to not immediately punch the kid in the face.
Every male partner I've had has been similiar. They become extremely protective if they sense I might be in danger. I know its just how it works but its good to know that someone has your back, especially being a female in this field. Its like having a big brother to watch out for you, and I'm pretty lucky to have a whole bunch of awesome older brothers.

Over and out-
The PSYCH wrangler

CVA

New station, new area. Downtown, dirty, grimy hospitals with little to no county funding and nurses that are completely burnt out with their jobs.

I get an IFT call to one of these hospitals to pick up an older female patient who has suffered a CVA (cerebrovascular accident, AKA stroke) a few days prior. She's being discharged to a nursing home a few blocks away, but she had originally come from home. We get there and try to get a report from the nurse, who's waving us off and trying to get away with giving us one syllable answers. We finally decide to just go check out the patient instead of trying to get any info from the nurse.
We walk into the cramped room where surprisingly, 2 beds have been stuffed where only 1 actually fits. Our patient, a middle aged hispanic woman, is lying on her side facing us. Her hand is gripping the siderail of the bed and she appears to be in distress. She also appears to be covered in blood. We furiously search her entire body, trying to figure out where the blood is coming from. It's covering her pillow and sheets, so our first thought is that she's somehow hurt her head. We comb through her hair, but find nothing. She is crying now, moaning something in spanish that neither of us can understand. We find the source of the blood, she's ripped out her IV and has been flailing her arms around for at least 20 minutes.
Her nurse, of course, never noticed a thing.
Irritated, I walk back to the nurses' station and explain the situation. The nurse wanders over to the bed rolling her eyes as if to say "big deal" and cleans the patient up. I ask the nurse if the woman is oriented at all, she says "Yea." I ask "Does she speak or understand any english?" and the nurse replies "No." I ask "Do YOU speak or understand any spanish?" and the nurse says "No."
Then how do you know that she's oriented?
I don't ask this, for fear I'll get a complaint filed against me for being rude, so I shut my mouth and try to communicate in what I call my "broken, stupid spanish." My partner and I manage to figure out that, as far as we can tell, she seems oriented. She's gripping my hand, pleading with me in spanish and sobbing. She keeps saying "I'm ok, ok, bueno" when I ask if she's hurt. She's still crying, but I don't think she's in any pain. I think this poor woman has no idea what's happened to her, she's suddenly been shoved into a closet-sized room in a dingy hospital with mostly korean-speaking nurses who have no idea (or desire) to communicate to her what's going on with her illness or treatment.
The nurse relays to me that this is the patient's first time at the nursing home we're taking her to. Apparently, the family arranged for her to go there because they would be unable to provide care for her. The sad thing is, for the most part this woman is going to be fine. The CVA was minor, she has NO apparent facial drooping or one-sided weakness. She's able to walk and communicate in her native language. She's also fairly young for a CVA.
The family has not been to see her since she's been in the hospital. They have not told her that she isn't going home. When she understood that she wouldn't be going home (the nurse had somehow told her just before we arrived) she got upset. Hence, the crying and ripping out of IVs.

I feel horrible. I wish so badly that I knew spanish, even enough just to tell her that she was going to be ok, though I know that regardless of her condition, she will probably be in the nursing home for the rest of her natural life. She wails in the back of the rig, and with each sob I wince a little. I want to hold her hand, to apologize for the disgusting hospital, for the cold nurse, for her kids who were sending her away. I want to take her home, to her things, her memories. Pictures of her family, late husband, maybe grandchildren. Her own bed, her own space. I don't want to take her to the nursing home filled with screaming dementia patients, the home engulfed with the smell of urine and stale food. The home filled with the same, cold, unapologetic burnt-out nurses.
Inter-facility transports are supposed to be the easy ones. Patients who are usually being discharged, who are feeling better and happy to be getting home.
They're SUPPOSED to be the easy ones.
So why was it so difficult to turn and walk away from this woman after putting her in her new bed??
I couldn't stand to look her in those pleading, tear-filled eyes as I left.
I hope she doesn't hate me for that.

Over and out-
thePSYCHwrangler

A Sobering Moment...

So, regardless of recent events, (ahem...see post below) I have decided that the show must go on. I have many more stories to get out of my head and into yours.. Sit back, enjoy.

After literally MONTHS of waiting, my closest friend at work and I finally got scheduled together. Ironically, our ONLY shift together also happened to be HIS last day. Lucky dog would be continuing on to a more prosperous company far far away, and it was certainly bittersweet for both of us.
This is a guy who I went to EMT academy with. A guy who, on my first day of work, walked through the door and we both yelled, "HEY! What are YOU doing here?!" and hugged excitedly. (We had no idea we were both working for the same company, he had been hired just a couple of weeks before my first day there.) He has since become one of my closest, best, and dearest friends.
This guy, who we all lovingly refer to as "Bobby" for reasons I will not explain here, is an amazing person. An incredibly compassionate, caring EMT and friend to all who surround him. He has what we call "bedside manner" that is absolutely jaw-dropping to watch. He can convince any patient, sick, crazy, or otherwise, that he is there to HELP them, and that he will do his best to take good care of them. And he does, every time. He has helped me through every bad call, nightmare, harrowing experience that I have endured through my last year in this field.

After one particularly horrendous shift, I was completely convinced that I was done with being in Emergency Medical Services. I came home early in the morning, after a 72 hour shift with probably about 5-6 hours of sleep, and sat down to have a beer. I called Bobby, and broke down. I cried for awhile, telling him I'd had it, I was done. "I can't do this anymore dude, it's so not worth it. What was I thinking?!" I kept telling him. "I've been at it for 9 months now man, and I feel like I haven't even made a dent in humanity. It's hopeless, I'm nothing. I don't help people, I just taxi them around all day." He was quiet for a minute, and then spoke.

"Hey," he said, "Do you remember that shift we worked together, before I left? We had a little girl, she was like 13 or something. Do you remember her?"

I did remember her. A young girl on a psychiatric hold who we had to search for before finding her in a dingy old apartment downtown. She had run away from home and gone to her recently-released-from-jail's brother's house to escape her parents, who were the ones sending her to the psych facility. She didn't want to go, she wanted to stay with her brother and live with him. We waited while her and her brother cried and hugged for several minutes before ushering her into the rig to go. We took her to the hospital, where we waited for a couple of hours for her to be examined. We both tried to keep her distracted, playing games with her, joking with her, deciding which of the firefighters who had come in was the cutest. We received several dirty looks from the nurses for disrupting the quiet E.R. but ignored most of them, trying to keep the girl entertained. When she finally got a bed, we hugged and with somber faces, my partner and I left. We never get to hear about what happens after we leave, and I don't know where this young girl is but I hope she's happy and doing well.

"Yea, Bobby. I remember her."
"Do you realize that she remembers YOU? And she's going to remember you for the rest of her life as the "cool ambulance girl" who took her to the hospital while she was literally being ripped out of the arms of her family? You DO make a difference, you need to remember that. She was comforted for a little while by our jokes and I hope the whole thing made it a little easier on her, I really do. We made her laugh through a traumatizing time, assured her she'd be back with her family soon. You DO make a difference."

After thinking about it from time to time, I start to realize now that I got into this field to help people. It is truly my passion, my first love. And regardless of how I manage to obtain this goal, I do my best in every situation. I see hundreds of faces a month, but those faces only see one of me in a lifetime. Even looking back on the conversation, it struck me that I still remembered the Paramedics who took me to the hospital when I was 4, after a bad car accident with my dad. I have the teddy bear they gave me to hold on to, to calm me down during the short ride to the hospital, away from my dad for the first time. I hope that I am to that little girl, what those Paramedics were to me; comfort in a confusing time of my life. Where nothing made sense, but I felt safe in their arms as they pulled me out of the smashed and burning car and into their ambulance.

I recently applied for and got accepted to Paramedic school, (after I pass an entrance exam in February.) This is all thanks to my friend Bobby, who has held my hand through all of this stupid bullshit that we love about our jobs. "The toughest job you'll ever love" is a well known quote about this line of work that rings true on several occassions over the past 18 months. I love and hate what I do at the same time, but the love exceeds all and I hope to do more good in this field for the rest of my working life.

So this one's to Bobby. I know you're reading this dude, and I want to let you know that I love you. You are such a good friend, a great EMT and you will be an INCREDIBLE Paramedic. I'll see you in school, sucker!

Over and out,
the PSYCH wrangler