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.”

Keep it simple

Look, y’all. I’m interested in your reports and everything, but let’s try to keep it simple, okay?

I don’t care that the patient had her gallbladder removed in 2004. It has nothing to do with the tibia sticking out of her skin.*

I sure as hell don’t care that the patient got bitten by a spider eighteen weeks ago.*

I don’t care that the patient stopped taking Lisinopril three years ago when his doctor switched him to Cozaar. And I don’t care why the doctor made the switch, because it probably had something to do with the cough the Lisinopril gave him.*

I don’t care that the patient speaks Spanish, because we are communicating just fine with her in English. Also, working in the Southeast United States, I’m pretty good at spotting Hispanic people.*

Just tell me what hospital they want to go to.

And don’t bother with the vitals. Because we both know you need them only to write them on your report, and I am going to take my own.


*all things I have actually been told by first responders

Pick one

“Unit whatever to radio.”

“Whatever, go ahead.”

“Yeah, we need a second unit out here for an additional patient at this MVC.”

“Do you need that other unit emergency or non-emergency?”

“That depends. Where are they coming from?”

Wrong answer.

Distance has virtually no bearing on how an ambulance should respond. I don’t care about response times, and I don’t care about the company meeting their response time goals. Your patient can either a) wait just a little while to go to the hospital, because they aren’t dying right now, or, b) needs to go to the hospital five minutes ago, and you can’t take them.

Pick one. 90 percent of our emergent responses are bullshit anyways.

Listen and learn

Newguy is out today. He and his wife are finding out the gender of their new baby, so he is going to the appointment. Well, Mrs. Newguy says they aren’t going to find out, but Newguy says he is going to cheat and sneak a peek at the ultrasound. He even has a plan and everything for how he is going to do it.

Nobody tell Mrs. Newguy, okay?

I’m working with a kid today. I did the math, and he was in diapers when I started in EMS. And he already has a bad attitude.

There is a difference between burned out and a bad attitude.

We get a call for a lady who is sick. It turns out the lady is visiting her daughter from Oregon, and has been confused, febrile, and weak for the past few days, and it is getting worse.

Daughter hands me an insurance card and says she needs to go to the hospital about 45 minutes away. While she is saying this, Babyface pipes in.

“Well, we could take her to Local Hospital, and they can just transfer her if needed, but they will probably just let her go if she just has a fever.”

Daughter looks excited, then goes on to explain that the sick lady is allergic to Tylenol and Penicillin, and has a diagnosis of primary biliary cirrhosis. No other medical problems though, which is good for a grandmother in her late seventies.

Finally we see the patient. She’s confused, sure enough. She’s pale, and the jaundice is pretty apparent in her sclera. (What is the plural of sclera? Is there one?) So, she’s sick, and probably needs to spend a day or two in the hospital for some IV antibiotics.

“Okay, we’ll take her to Westside Hospital. We are going to go bring our stretcher in here, and we’ll be out of the way.”

Babyface is absolutely apoplectic. “Why can’t we just take her to Local Hospital? It’s across the street. Westside is forty-five minutes away.”

I get stern with him. “I know where we are, and I know where the hospitals are, and we are going to take her to Westside Hospital.”

Later, at Westside, he decides to assert his position once again.

“Man, we should have just taken her to Local. This doesn’t make any sense.”

“What is primary biliary cirrohsis?”

“She’s probably an alcoholic, and she drank too much, and now her liver is shutting down.”

“Wrong. What is the first thing that comes to your mind when you hear that a person is confused, weak, and febrile?”


“Fair enough. Does the diagnosis of primary biliary cirrhosis change that? You still thinking sepsis? What about her jaundice?”

“I don’t care about her cirrhosis, she just has a fever.”

“No, her ammonia levels are high, and she needs lactulose. She is very confused, and only responds to verbal stimuli, which suggests hepatic encephalopathy, and she needs an ICU. Taking her to Local Hospital would have been a bad decision, and a waste of time.”

He was still mad at me for the rest of the shift.

The dynamic duo is back

Slimm and I are going to be partners again.

We had to pull a lot of strings, call in some favors, make some offers, and do some shift trading, but we made it happen. A well-executed plan is quite something to be a part of.

I’ve enjoyed working with Newguy for the past few months, but I need to be back with my partner.

I wasn’t going to last much longer without Slimm.

We are already planning on hugging it out before our first shift back together.

I’m very happy.

Sometimes we pick up chicks

Somebody got tased by the long arm of the local law. Which means, of course, that an ambulance has to ‘check him out.’

Which means, of course, that we turn on the lights and sirens because someone requested our service.

Policy, you know.

Also, because an ambulance is going, the fire truck is going as well. In case, you know, the person is actually on fire. We generally can’t trust police officers to determine whether or not a person is on fire, so we might as well cover all our bases.

The dispatcher hasn’t finished reading the call to us before I stop paying attention and go back to my book. I’m reading The Pillars of the Earth again. I’m at the part where Aliena is about to marry Alfred.

“What are we going to?” asks the student third rider from the back seat.

“The cops tased some guy. Probably bullshit.”

Like all the other calls.

Sure enough, there’s a guy sitting in the back of a cruiser with taser barbs sticking out of his back. He is obviously not an upstanding member of society, and probably didn’t finish high school, judging by his lack of a vocabulary. He’s being such an asshole that I wish we could tase him again just to shut him up.

He’s even being a dick to me as I take the barbs out of his back.

Newguy goes to apply some band-aids to the puncture wounds on the patient’s back.

“Man, I don’t want no damn band-aid!”

“Tough. I don’t want you bleeding on Officer Nicely’s car.”

“Man, this is some bullshit! All this over a dirty ass hoe!”

We glance over to the alleged dirty woman when this rude man with holes in his back informs us of the reason for the argument, which resulted in the assault charges he now faces.

“Man, that bitch gave me HERPES!”

Newguy doesn’t miss a beat.

“So you’re saying she’s single now?”

Jimmy Swaggart

A 70-year old female at the assisted-living facility who might be having a stroke. 20 minutes before my end-of shift. Great.

Our local fire-putter-outers are on scene, and they seem to be pretty convinced that she is not, in fact, having a stroke. I know these guys pretty well, so I’m not concerned when I see them standing around, chatting.

“Ma’am, what’s going on today?”

She yells at me. “I told these guys that I’m having a stroke!”

The mustachioed smoke jumper chimes in. “Why don’t you just tell this incredibly handsome, exceedingly nice, overly qualified, life-saving paramedic what happened this morning?” (Those may not have been his exact words.)

“Well, I woke up this morning with a headache, and I never have headaches. NEVER! So I got on the Google, and I looked up stroke symptoms, and I had FIVE OUT OF THE FOUR! And-”

“What time was that? I interrupt.

“Oh, some time this morning, right after I woke up. And I have a low-grade fever, and my temperature is always low, on account of the praying I do to the Lord.”

I sneak a peak at Mustachioed Man and he winks at me. In my right ear, I hear the home administrator whisper to the “nurse” that is standing next to her.

“Who the hell let her get on the computer?”

Good question.

I turn back to the somewhat agitated patient who, after further assessment by Newguy, is certainly not having a serious cerebral event. Hell, her vital signs are better than mine. Plus, we are something like 15 hours into the alleged event.

“So which hospital are we going to this evening?” That usually moves things along right nicely.

“I want to go to North Bumblefuck Medical Center!”

There she is with the yelling again. A quick calculation and a glance at my watch leads me to believe that I’m going to get at least 2 hours of overtime out of this one call. Sweet.

We get loaded up, finally, after several trips for her feather neck pillow, and another one for her cellphone, and another trip for her Bible.

On the way to NBMFC, I hear her making a phone call. She is asking someone to pray for her. It sounds kinda like she is leaving a voice mail. Maybe there is a phone chain or something, I don’t know. She hangs up and cranes her neck to look at me, sitting in my confessional seat.

“That was Jimmy Swaggart. I watch his program EVERY WEEK! He is going to ask his flock to pray for me, Lord bless him.”


“Are you Pentecostal?”

“No ma’am, I’m not.”

“I need someone to LAY HANDS ON ME! Are you a spiritual person?

“No ma’am.”

“Well you should be. I’m going to call Pastor Swaggart back and ask him to pray for you.”


I wonder if she knows about the prostitutes?

Are all FTOs ignored?

A few days ago, I had a new-hire employee riding along with me, for her evaluation rides. My company seems to think that 3 rides with a Field Training Officer is enough to prepare new EMTs for the field, and this was her third ride. So, ostensibly, it was also her last. Her two previous rides were with a different FTO, on the other shift

In the morning, I got an email from Topper, the other FTO that she rode with the previous day. His email was purely objective, and simply stated that the employee drove only for a short while, but was proficient with radios, the MDT, the computer, and checking the truck off.

Essentially, she was going to spend the day with me, driving, and she would occasionally ride in the back with me to the hospital. I like to have a game plan with new employees. We don’t get a lot of time with them, so I try to focus on the things they need the most.

When she introduced herself to me, I noticed something was ‘off’ about her personality. I couldn’t tell exactly what it was, but she was pleasant, and that’s always a good start. She needed some prompting to check the truck off, and to log into the MDT, which I thought was strange, remembering she was with Topper just the previous day, and she did all of this stuff.

Then the day just spiraled downhill.

Her driving was terrible. Not in the rough sense, but in the sense that she was scared to drive. She consistently drove 10 miles an hour under the speed limit. On every road. She was driving on the interstate, complaining that the tractor trailer in front of her was going 45 miles per hour. For several miles. Yet she never tried passing, even though there was virtually no traffic on the interstate. She stopped completely at a green light while we were traveling to an emergency, because “I thought that car was going to turn in front of us.”

She wasn’t interested in patient care, at all. While at an accident scene, with two patients quite some distance apart, I looked for her. I needed some extra hands, and she was standing at the back door of the ambulance, looking around, with her hands in her pockets. After loading a patient from the scene into the ambulance, she had to be told that Newguy needed vital signs taken, and then had to be told to take them when she failed to act.

Typing all this out makes me feel like I am lamenting my position as an FTO. I really don’t want that to be the case. But what we had here was a person who obviously was not Local Ambulance Company material, and maybe was not cut out for EMS at all.

Newguy and I tried talking with her several times throughout the day, but she was either not interested or couldn’t comprehend what we were saying. Neither Newguy nor I are rude, but this girl simply didn’t get it.

So I wrote as much in my evaluation of her. I have never had to give a negative evaluation on an employee since I have been an FTO at this company, and I suppose my naivete’ got the best of me. In my review, I explained what I explained here, and in further depth. I suggested the new employee receive some more FTO-monitored third rides, and perhaps not be hired full-time.

I guess I expected the Training department to call me or email me and want to discuss my concerns. I think most of my readers will know that I wasn’t contacted at all. Of course not. My review was essentially ignored, and the employee was scheduled to ride on her own the next day.

Which lead me to ask the questions: if FTOs aren’t listened to, what is the point of having us out there? Is it like this at every service? Is the joke really on me, because I expected more out of my management team?

Is this just another straw on the camel’s back, causing more burn out, or do I feel slighted because I’m burned out?