Luck

Internship, day 5.

Early in the morning, while we posted, my preceptor and her partner ran me through some scenarios and we did equipment drills. I'm struggling as an intern. Not too badly, but I'm definitely not the best. I'm so nervous on scene and still not sure how to manage and delegate tasks out to everyone. My preceptor has faith in me, but she wants me to be strong. I describe her teaching method as a "Throw 'em in the water and don't jump in 'til they really start to drown" kind of idea.

We weren't far into going through a needle decompression scenario when our tones sounded over the radio.

"Medic 17, code 3 to an address for chest pain."

I sighed out of relief. Chest pain! This would be easy breezy. Go through OPQRST, SAMPLE, get a 12-lead, maybe some nitro, transport. Chest pain, I can do this!

We got into the neighborhood and ended up a little turned around. For lack of a better, more politically correct word, it was a trailer park, and one that wasn't numbered very well because we ran into the responding fire engine a few times around corners and turns before we both met at the right house. The firefighters got out, and we trailed along behind them, trying to find a good place to stick the gurney without it rolling away. Up some steep stairs and into the house, we found a 70-ish male sitting on his armchair.

At first glance, it appeared as though he was just casually lounging, waiting for us to come get him. But, even to the untrained eye, a second glance told you that something was not right. First off, it was around 10 am and still pretty foggy and cold outside, yet this gentleman was soaked with sweat and had undressed down to his boxers. Second, despite the lack of clothing and the profuse sweating, he was as white as a sheet. Third, the only part of his body that WASN'T white, was his chest... which was a deep purple and mottled.

The firefighters were good. They dropped their "let's haze the intern" act and got into serious mode, sticking an oxygen mask on the guy and sending others off to find his medications. A couple stuck around, quietly stood behind me, waiting for orders.

"Can I get a 12-lead please? What's his pressure?" I interjected between my questions to the patient.

"70 over 40.. Pulse is 120, you should look at the monitor while I hook up your 12-lead." My partner looked at me sideways and I knew something was up. I leaned around the chair to glance at the monitor that was sitting near the arm. My heart sunk. I could only see one 'view' of his heart but the rhythm was strange, unrecognizable and definitely not good. I needed a better picture and nodded at her to continue hooking up the 12-lead. I pushed my fear aside and continued my questions.

"Sir, when did this start?"

"Yesterday, I think.. I don't know really." He breathed back at me, eyes closed.

"And why did you call today, did it get worse in the last half hour or so?"

"Yes.. Yea, it started going down my arm. What's wrong, is my heart alright?"

"We aren't sure yet, we're trying to get a better picture, okay? What does it feel like, the pain?"

"I... I don't know...It hurts.."

My partner nudged me and whispered for me to give him some options as far as describing the pain. We're taught not to do that, ask leading questions, because patients will often say "Yes" to anything you describe. In this case, I took her advice because I needed some clearer answers.

"Sir, does it feel tight? Or like pressure? Like something heavy is on your chest?"

"I..I just.. I don't know it just hurts. What's wrong?"

"Okay, sir, don't worry. We'll take care of you."
My preceptor and partner ended up both searching for veins because I couldn't find one. I didn't mind not being able to get the IV because it wasn't important to me at this point. They ended up sinking a 20 into his hand.. Not great, but any access is good access.
"Okay, sir, I need you to hold really still for a few seconds while we take a look at your heart okay? Hang in there." My partner chirped from beside the chair. What seemed like hours was really only a few seconds of silence as the machine processed his rhythm and when it finally started to whir and print the EKG strip, my partner looked up at me.

"Looks like it's your lucky day, girl."

Wait.. What?!

Stunned, I stuttred back at her. "No.. You're joking, right?"

"Serious as a.. Well, you know."

"This can't be happening."

Oh God.. Here comes that spinning sensation again. She shoved the EKG strip into my hand and I saw it. Those big, looming tombstones marching out across the page. I knew what was going on, without looking at the huge print running across the top of the page that read:

***MEETS ST-ELEVATION MI CRITERIA***
Apparent septal infarct
Possible lateral infarct

He was having the big one. The most massive heart attack of heart attacks. Suddenly, everyone was rushing around, gathering up the firefighters, running outside to get the gurney, trying once again to find his medications. Bags of saline and bottles of aspirin were flying, tubes and wires and needles and alcohol swabs cluttered the carpet as we tried to zip up all of our bags and find a way to get the guy out of his house. At my preceptor's irritated demand, I grabbed the aspirin and gave the guy 2. Not that I hadn't thought of it, I had actually been looking for it when she asked me if I was going to 'give it to him or what,' but I stayed quiet and just did as I was told. My preceptor was on the phone immediately, making base contact.

"This is Michelle with medic 17, we are on scene of a 70 year old male complaining of chest pain, coolpalediaphoretic," (It always comes out as one word.) "12 lead says 'Meets ST elevation MI criteria.' Yeah....Uh-huh.. Right, no it says it right here...No pressure is too low, we gave aspirin..Okay, see you soon."

The firefighters came up behind me kneeling in front of the patient and said they were going to stand him up and walk him over to the gurney. I looked up at them, with a look I'm sure resembled that of one you would give to someone who had just grown an extra head in front of your eyes. My partner stifled a smirk and quietly responded.
"I don't think that's a good idea, guys. Let's try to get the gurney up the stairs, okay?"

My brain screamed. Not a good idea?! That's the understatement of the century! Why don't we have him run wind sprints in the front yard for an hour for Christ's sake!
The firefighters shuffled uneasily but refused to budge.
"It would be easier to walk him though. Sir, do you think you could..."

My partner interrupted him and stood, facing them.
"He's not walking."

"Yeah, there's no way. Just not happening." I included, suddenly finding my voice.

"Get the gurney up here, someone needs to spike a bag in the rig for me. Thanks." My partner finished with a polite but urgent smile.

"Oh, we're gonna need one of you guys in the rig with us, just in case." My preceptor said. It was more of a statement than a question, but it brought the point across clearly enough.

Seconds later, the gurney was miraculously beside me and the firefighters lifted the patient onto it and headed out the door. Once inside the rig, equipment was flying again. The monitor beeped, crying for help. There may as well have been a giant sad face on the screen for all it had told me. The ride seemed to take days, which made it even more irritating that when we arrived at the hospital and walked in, I heard the intercom blaring loudly;

"CODE STEMI, ER, BED 4. CODE STEMI, ER, BED 4."

You're joking, right? We called 30 minutes ago, the STEMI team should have been ready! UGGGHHHHH!!!

The patient was moved onto a bed in the ER and we stood back and watched the action. Outside in the ambulance bay, I cleaned the gurney and monitor slowly, waiting for my preceptor and partner to come back out. Michelle was out first and handed me a printout of the 12-lead to keep.
"So, what went wrong?"

What went wrong..? Did I do poorly? Damnit, I'm sure I could have done better but come on!

"I was golden until I saw the 12-lead, and then I started spinning again."

She smiled and agreed, gave me a few pointers for next time and left me alone.



Wow. That wasn't so bad.

My partner walked back out and we finished cleaning up the rig. I stared down at the 12-lead in my hand and looked at her. She looked back at me and asked if I had any questions.

"Dude... That was so. Cool." I managed.

She grinned from ear to ear. "I KNOW! You're so lucky to have seen that on your internship. Not something that happens everyday."

When we came back by the hospital later that day, we were told that the guy had gone into cardiac arrest in the cath lab, but they had rushed him over to have bypass surgery right away. We still don't know if he made it, his chances were slim but there is a possibility he survived. Hopefully, luck was on his side. If not, meaningless as it may be, his heart attack contributed greatly to my education.



"Looks like it's your lucky day, girl."