Hold your applause, please

Med four, you’re available at Local Hospital?”

Ten-four. My partner is walking out now, we’re ten-eight.”

Ten-four. Copy a 911 at Local ER. Female patient, white t-shirt, blue jeans, leaving the hospital now, wants to go somewhere else.”


Med four, EMS Captain is clear, switch to talkaround.”

Ten-four…Four on Talkaround.”

Hey, guys. I’m clear on the call, I’ll head up there if you need me.”

Okay then. I’m not sure if we will need you yet. Shaq just got back in the truck.”

I’m clear. Just be advised, we can’t transport any patient from the ER from a 911 call.”
“Come again?”

If a patient calls 911 from the hospital, they have to be evaluated at that hospital, then the hospital has to arrange for a transfer if needed. We can’t take a 911 patient off of their property. The patient will have to leave the property before we can transport”

Okay, we’re clear.”


“Hey, buddy. You want some of these Oreos? They had them in the EMS room — what the hell is this on the MDT?”

“We got a call.”

“How did we get a call? We just went in service?”

“The call is here. Some gal is going to be walking out of the hospital. Wants us to take her to another hospital apparently.”

“Oh, so this has BLS written all over it, and you want me to handle it?”

“You’re the professional one, Shaq. Now how about them Oreos? Did you get me any milk?”

“Boy, I swear, I’m about to smack you upside your head. That must be her right there” he says, pointing to a woman meeting the description.

“Yeah, let’s go check it out.”

My mouth is full of the aforementioned Oreos as we watch a young, marginally attractive woman shuffle out of the ER front entrance, and shuffle her way over to a bench. We walk over to meet her.

“Hi, ma’am. I’m Shaq, and this is my partner C. Are we here for you?”

“Yeah. Y’all need to take me out of here to another hospital.”

“Well, what’s going on?”

“They are just rude in there, and they won’t take care of me. Take me somewhere else.”

“What brought you into the hospital this morning?”

“Well, me and my boyfriend was having sex, then after, I started hurting and burning.”

“Okay, What did they tell you inside?”

“I’ve been here for like, four hours and they try to tell me that I have gonorrhea or some shit like that. I ain’t got no gonorrhea. Me and my boyfriend are clean!”

“Well, did they do a pelvic exam and take a swab?”

“Yeah, the doctor did all that, then he tried to give me antibiotics, but I’m telling you, I ain’t got no gonorrhea.”

“Well, they are doctors, and those antibiotics are really important for you and your boyfriend to take.”

I ain’t got no disease. Take me somewhere else!”

“Well, I’m terribly sorry, but we can’t take you anywhere else.”

“You have to! I called 911.”

“I understand, but since you are at the hospital, you have to be evaluated and treated here, then the hospital has to have you transferred to another hospital.”

“That’s bullshit. You aren’t going to take me anywhere else?”

“No, ma’am. We spoke with our supervisor, and he says that we can’t.”

“Well what the hell am I supposed to do?!”

“It seems like you have several options. You can go back inside, and get those prescriptions filled. You can call someone to pick you up and either take you home or take you to another hospital, or you can leave the hospital property and call 911 again.”

“I can’t believe this. Y’all are going to make me leave and won’t take me to a hospital!”

“We are happy to take you to a hospital, but we can’t pick you up from this one. You’ll have to leave the property.”

“Fine then, I’m leaving.” she says, after which she gets up and starts shuffling off, down the sidewalk.

I’m still enjoying my Oreos, when Shaq turns to me.

“Let’s get in the truck. It’s gonna take her at least ten minutes to make it to that Citgo. We can probably be at the next post before she calls back.”

Med four.”

Med four.”

Ten-eight again. She’s gonna call back once she leaves the property.”

Ten-four. I’ll show you guys in the area standing by. I’ll let you know when she calls back.”


Well-earned complaint

Shaq and I are running a non-emergency for a female who is weak. Which means there is absolutely nothing wrong with this woman. This is the same county that requires emergent response to ear aches, so use that when assessing the severity of this call.

According to the notes, she “doesn’t feel good.”

Call me a library book, because I’m already checked out.

We find this lady sitting in a chair in her living room. I wish I could say she was watching Maury, but the television was off. Shaq does all the talking, and we learn that she “doesn’t feel good.”

Chalk one up for the call-takers. Good job, everyone. Strong work.

We move the stretcher a little closer and Shaq asks if she can stand up to sit down.

“Oh, no, I’m just too weak.”

“Well, ma’am, forgive me for asking, but how did you get in that chair in the first place?”

“Oh, I walked here, but that was several hours ago.”

Mind you, I’m still checked out, and I only have vague recollections of what transpired next, but it ended with us lifting her out of her chair and putting her on the stretcher.

“Which hospital would you like to go to, ma’am?” he asks.

“Oh, I have to go to North County, they have my records.”

“That certainly won’t be a problem. C knows how to get there.”

“You guys aren’t going to put me in that…that…room with all those Mexicans, are you?”

“Well, ma’am, I’m not really sure what you mean. We don’t have anything to do with room assignments at the hospital.”

“Well, I don’t want to be in that room with all the Mexicans.”

Then he lets loose. “That hospital takes care of all sorts of people, ma’am. They take care of Mexicans, Indians, Canadians, Africans, Jews, Catholics, Asians, Russians, Italians, Australians, Caucasians, Muslims, Christians, and everyone in between-”

“-that’s not what I meant-”

“-they will even take care of bigoted American women. Now let’s go.”

The rest of the ride was real quiet. And then we got to sit in the supervisor’s office for a little while.

But it worked itself out.

It worked

The drug overdoses (that either aren’t dead, or are awakened) always go the same way: Shaq and I stand around with between four and six firemen, and at least two police officers for upwards of an hour trying to convince this guy to go to the hospital.

And they always wind up going. But we waste a lot of time.

The cops can’t threaten these patients with arrest, because the state has an amnesty law. Basically, if a call for help is made, then a cop can’t arrest for drugs that are found out in the open. I think that is a bit ridiculous, but it is what it is.

Doctors won’t commit these patients involuntarily, so we can’t threaten them with that.

Usually it is just a matter of wearing the person down.

And it gets tedious.

So we ran one of those today. A guy in his thirties relapsed, and shot some heroin after being sober for two years. This guy can’t help that he’s an addict, but he certainly has to take responsibility for shooting heroin into his veins. It turns out his ten-year-old son found him lying in bed, not breathing, then called 911. The son woke the patient with a glass of water splashed on his face.

And enter Shaq and C.

There’s the requisite crew standing around: six firemen, two cops, one shirtless guy with dirty hands sitting on the floor, and one crying mother in the living room. Of course the patient first attempts to deny that he did the drugs, then admits to it when confronted with the full syringe in the bathroom. Then he says he is fine, and doesn’t want to go to the hospital. Shaq and I are standing kinda in the background when he nudges me: “watch this, dude.”

Shaq makes his way to the shirtless guy on the floor, and stands all of his 78 inches over the guy on the floor. Kneeling down to get somewhat on his level, he delivers an excellent oration:

“Hey, dude. Check this out. You’re going to wind up going to the hospital with us today, that’s a fact. You say you don’t want to, but you’re going to. These guys in light blue? They’re from the fire department, and they get off at 7 in the morning. These guys in dark blue, they’re cops. They won’t arrest you, but they won’t leave until we tell them it is okay for them to go. Your mother out there in the living room? She’s calling your wife at work, and she already called your father. They are both on the way over here. Between the twelve of us, we will wear you down like a cheap pencil, and you will walk down those stairs, and you will sit on our stretcher, and you will go to the hospital. So what my partner and I are going to do now is walk outside. We are going to go outside to your front door, lower our stretcher, raise the head of it up, and undo the seat belts. And then we are going to stand there, and stand there, and stand there, until you walk outside and sit on our stretcher. It’s up to you how long that takes, and how much bitching you want to hear from your parents and your wife. When you’re ready, we’ll be outside.”

Then he stands up, turns to me, winks, then walks out.

I’m dumbfounded. I just witnessed a sentinel moment. So, I turn on my heels, and follow Shaq outside.

We barely make it outside before he’s trying to sit on our stretcher.

We’ve been on scene for less than five minutes, and now we’re leaving. On a call that would typically take at least half an hour.

I can’t wait to try that again.

Doctor Jack Wagon

An ER physician cancelled my cath lab activation the other day. No, I didn’t save the 12-lead.  I should have, and maybe I will try to find it once I go back to work.

It was a male in his mid-forties. He had just gotten back home from a walk around the neighborhood, and couldn’t catch his breath, and kept sweating. It’s been a little warm around here for the past few days, but not that warm.

So, duh, he’s having an MI.

For some reason, the interpretation didn’t pick it up. He was in a sinus bradycardia with an (apparently new) left bundle branch block. He met all the Sgarbossa criteria. He was hypotensive. His skin was diaphoretic, even though it was 74 degrees outside.

We transmitted the ECG to the hospital, and I called the cath lab number on my phone, like we always do from the field. After loading up in the ambulance, I called the hospital to give them my ETA.

That’s when I was told my activation was cancelled.

“By who?”

“The ER doc.

It turns out that the nurse who receives the ECGs we transmit shows them to a physician. Not a specific physician, mind you, just any physician he or she can find in the hallway. And this time the physician cancelled my cath lab activation.


Wait for it.

Because my 12-lead didn’t say “STEMI” on the top.

No joke.


This jackass in a white coat cancelled my cath lab activation because the interpretive statement didn’t recognize an MI in the presence of a left bundle branch block. This isn’t a case of a false activation, either. I took the 12-lead upstairs to the cath lab to show a cardiologist friend of mine.

“Where’s this patient?” he asked me.

“Downstairs in the ED.”

“What the hell for? Why isn’t this patient up here?”

“Ask the jack wagon in Trauma 4. I activated you, but jack wagon cancelled the activation.”

Where was the patient?

In Trauma room 4. Twenty minutes after we walked in the doors, he arrested. He went into v-tach and tried to die. He was resuscitated, but now, several days later, he is upstairs in the ICU on a ventilator, with a balloon pump hooked up to him.

Because some jackass doctor can’t interpret 12-leads.

Zero percent effective

“25YOF ABD PAIN” reads the MDT. For some reason we are going lights and sirens. As is a big red truck. I still don’t know why.

Oh, that’s right.


Whatever. I’m trying to find a stopping point in this book, Killing Patton before we get there, so my partner for the day drives slow. Without the lights and sirens. Policy be damned.

We arrive on scene to find what appears to be the patient in the midst of what could be a day care, but is actually an apartment. A cursory head count reveals around 8 kids, nope, make that 9, because the lady watching TV is holding another one.

This lady is watching some judge show on TV with the volume at full blast. I don’t know what show it is, and I don’t know what the case was about, because the first thing I did was turn the TV off.


“Well hello yourself. What seems to be going on?”

“Like I told that lady on the phone, my stomach hurts.”

“Okay. How long have you been hurting?” I ask as the unnamed partner starts to get some vitals.

“‘Bout a week.”

“Hmmm. Okay. Any nausea, or vomiting? Have you had any diarrhea? Has anyone in the house been sick lately?”

“Naw, I ain’t been sick. Just hurting.”

“Okay then. Any chance you could be pregnant?”

“Well I don’t know.”

I am always intrigued by the “I don’t know if I’m pregnant or not” answer. Understandably, I don’t have a uterus, but most women I come in contact with know if their period is late, early, or whatever.

“Well, when was your last period?”

“Like, maybe October? Or maybe September?”

“Have you been pregnant before?”


“Okay…how many times?”

“I don’t know. I gots 2 kids.”

How in the name of Sam Hill do you not know how many times you’ve been pregnant?

“Um, have you had miscarriages, or abortions?”

“I ain’t never had no miscarriage. But I had five abortions.”

Pulling out my calculator, I plug in the equations and deduce she is gravida 7.

“Well, let’s take a quick look at your belly” I say as we lay her down on the chaise. “So has anything else been strange lately? You said you haven’t been sick, but have you felt weird or anything?”

“Yeah. It’s weird. I’ve been craving chicken and pickles lately.”

“Yeah. I like chicken and pickles too. Are you sexually active?”

“Well, duh” she scoffs, as if I should be surprised.

“Fair enough. Do you use birth control?” I ask as I do some quick Leopold maneuvers. There is definitely a baby up in there.

“Some times. But not all the time. But I do take my pills. I can’t be pregnant because I’ve been taking my pills.”

“Well, if you want to put your hand right here on top of mine, you can feel the baby in your tummy.”

She does as instructed, and I push with my other hand, making the baby kick. She obviously feels it. This baby is good sized, probably 20 weeks or so, probably more, which jives with a missed period in September.

“But I can’t be pregnant!”

“Well, I don’t have an ultrasound machine, but the fact that you haven’t had a period in five months, and this fetus moving around in your belly tells me you are.”

“But I’ve been taking my pills!”

“Pills don’t always work. What kind of birth control pills do you take?”

“I don’t take birth control pills.”

I feel like I’m being set up.

“Okay then, what kind of pills do you take?”


Holy shit.


I’ve got nothing.



“Haldol isn’t birth control, and it wont’ stop you from getting pregnant.”

“For real?”


“What’s wrong with her?”

“Nothing. She’s got the tachylawdys.”

“Geez. Take her to triage.”


‘Tachylawdy’ is a thing down here. Along with sick rags, but that’s a whole different post. Never have I seen tachylawdy present in a sick patient. Not once. The only times I have seen tachylawdy present in the field are:

  • anxiety
  • doesn’t want to be at work
  • [pick your male family member] is getting arrested
  • anxiety because of being at work
  • getting pulled over

I have never seen a patient present with the tachylawdys without the presence of other concerned family members. Nor have I ever seen a male patient present with the tachylawdys. I have, however, seen the tachylawdys present in female family members that were present while I was caring for another person, be it male or female.

Basically, you walk into a house and find a female, usually with the back of her hand on her forehead, always with her head turned away from you, eyes closed, not a damn thing wrong with her:

“Oh, lawdylawdylawdylawdylawdy…. OOOOOOOH, lawdylawdylawdylawdylawdylawdyheppmelawdylawdylawdy…”


Bradyjeezus now, is much, much more serious.

English major

A call for a “person in pain” about two blocks from our local hospital.

I decide to go ahead and finish my game of Mahjong on the computer while we are driving to the call, while Slimm opines on the situation awaiting us.

“Man, twenty bucks says she just walked out of the hospital, and wants to go all the way downtown.”

Knowing that our bets never involve the actual exchange of money, I accept.

“What’s going on?”

“I’m hurting everywhere.”


“I want to go to the hospital.”

“Good for you, there is one right over there,” as I point to the hospital, about 100 yards away.

“No, I don’t want to go there. I want to go downtown.”

Slimm wins. Again. “Why don’t you want to go to that hospital right there?”

“They are mean to me. I just left there. I don’t want to go back.”

“Okay, then. Hop up here on the stretcher.”

Downtown is at least a half an hour away, so I have plenty of time for more Mahjong on the way. I’ve also started listening to Handel on the Law podcasts, and enjoy a brief show while I match tiles on the computer screen.

The radio report is made, and it was one of the best ever.

I wish you could have been there to hear it. I felt like such a hero.

“Umm, did you have to tell them that?” asks the person on the stretcher.

“Tell them what?”

“That I just walked out of the other hospital?”

“Well, yeah. It is kinda pertinent to the current situation.”

“What does that mean?”

“It means it is relevant, or germane.”

“Who is Jermaine? I don’t know nobody named Jermaine.”

Bad decision

A middle-aged male calls 911 because he doesn’t feel well. We find him sitting in a chair in his bedroom, looking terrible. Pale, cool, diaphoretic, cyanotic, and in obvious distress.

What my father would call “looking like death eating a cracker.”

He had a CABG a few years ago, and has high blood pressure. His wife says he has never had a heart attack though, and only did the CABG after an abnormal stress test.

He’s having one today though.

The 12-lead shows a big anterior infarct, with lateral involvement, and with lots of ectopy on the continuous ECG. His blood pressure is low, too.

Lots of bad things are going on.

“Sir, let’s get you on to Local Hospital.”

“No, I want to go to Southside Hospital.”

Southside Hospital is thirty minutes and two counties away. And this guy doesn’t have thirty minutes.

“We really need to go to a closer hospital, and Local is only five minutes away.”

“I will not go to Local Hospital. Take me to Southside” he says between breaths.

“Sir, you are having a heart attack. Southside is half an hour away, and that is just too far. We need to go somewhere a lot closer.”

“I don’t care. I am NOT GOING to Local Hospital.”

Slimm was wise, as usual, and had the patient sign a refusal form on which Slimm wrote ‘Patient refused closest hospital.’

I hated to take a firefighter so far out of the county, but I really didn’t have a choice. We told the other guys on the engine that we would bring him back. I really don’t like to take riders, but I felt like something bad was going to happen, and I would need the help.

Something bad happened, and I needed the help.

About six minutes after passing Local Hospital, the patient went into v-fib. Even though my defibrillator pads were already on, and it took about 5 seconds to deliver the shock, it didn’t work. After Amiodarone and two more defibrillations, he was in asystole.

Slimm diverted us to Local Hospital, and the patient never came out of asystole.

If he would have gone to Local Hospital, the outcome would likely have been the same, but I can’t help to think that it might have been different. If he would have listened to the advice of the providers on scene, he might have survived. But he made a bad decision.

Someone once told me something very wise.

“People have the right to make bad decisions.”

It’s like a Hollywood script

Finally, Slimm and I are back together. This will be our first time back on a truck together in what feels like years, but has really only been about one year.

I have to wake up 5 hours earlier than I am used to, but I think it’s worth it.

We hugged in the parking lot. It was a brief hug, but it was a hug nonetheless.

Then we got breakfast.

And our breakfast was interrupted because some guy fell out of bed. Now my gravy is going to be cold, and nobody likes cold gravy on their biscuits.

“Radio Med One.”

“MmmmGohead” I reply sleepily.

“Caller is advising agonal respirations.”


I turn to Slimm. “I hope the caller is just stupid.”

“Me too, bro. Me too.”

“Radio Med One”

WHAT?! “Gohead”

“Caller advises full arrest. They are starting CPR.”


This sucks. The sun isn’t up yet, and neither am I.

Sure enough, it’s a full arrest. The fire guy recognizes me.

“What’s up, C?” he asks as he’s doing compressions. “You pick up an extra shift?”

“Naw, man, I’m back on the truck with Slimm again. Whatcha got?”

“Glad to hear you guys are back. Wife woke up and found him here about ten minutes ago. AED says ‘no shock,’ Bubba got the LMA in, and Chester is about to start the IO.”

I feel around this guy. I don’t see any obvious trauma, but his skin sure is cyanotic. And cold. I mean, remarkably cold. Most people I have felt this cold before have either had lividity or rigor, but he has neither. He is in asystole, and his pupils are dilated and fixed.

Basically, he’s dead. But not dead enough to stop working.

“C, you want us to stop, or keep going?”

“Nah, keep going, let’s move him out into the kitchen, and we’ll work him there. We have more room there.”

Somebody gets the IO, and I see Slimm putting together the bicarb and epi. He looks over at me. “We going to do the two rounds then call it?” he asks.

“Nah, buddy. We’re gonna get him back.”

I wink. Just joking, of course.

But we did.

Five minutes later he had a pulse, was breathing on his own about ten times a minute, and had a blood pressure of 130/90.

“We have to stop doing this.”

“What? Getting people back?”

“Not that. But doing it so easily.

“They should make a movie about us.”


An unknown problem at a house. Which begs the question: how does the caller not know why they are calling?


We pull up right in front of the engine, and we all make our way towards the door. We can hear the gurgling from outside.

Inside, we find a lady who is obviously in the throes of death, laying in a hospital bed. She has that open-mouth look that healthy people don’t have.

Someone who looks like she might be a nurse of some sort is anxiously standing in the shadows, clutching what looks like a home-health folder.

“What’s going on?”

“She has anemia” says a guy who looks like he could be her husband.

Meanwhile, this lady has one foot through the pearly gates.

The fire dudes are doing their thing, getting vitals, and trying to put in an OPA, which is complicated by her wide-open mouth.

“Okay. She has anemia. What is going on today? How long has she been this sick?”
“She has anemia. That’s what’s going on.”

Obviously, I’m getting nowhere. “Okay then, why is she in the hospital bed?”

“Because she has anemia.”

Newguy has now decided to sink a tube. This lady has almost no blood pressure, and her heart rate is in the forties.

“Does she have any other problems besides anemia?”

“I don’t know.”

I gave up.