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.

Why?

Wait for it.

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

No joke.

Seriously.

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.

Policy.

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.

“Hey!”

“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?”

“Yeah.”

“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?”

“Haldol.”

Holy shit.

“…”

I’ve got nothing.

“…”

“What?!”

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

“For real?”

Tachylawdy

“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.”

“Okay.”

“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.”