Rhetorical

A “person shaking and cold after having an ultrasound” according to the dispatcher and the MDT

We are going by ourselves, and a quick glance at the directions tells me it might be a 15-minute ride. Just enough time to set my fantasy lineup for the weekend.

How do we know which house it is, if we are having trouble locating? That’s right, it’s the one with all the cars in the driveway.

Four cars this time.

Sure enough, some lady is sitting on a couch, shaking. She complains of being cold, and thinks this is some sort of a reaction to the ultrasound she had earlier.

I have already checked out, but we load the nice lady up anyways, and do a full workup.

Her pressure is better than mine, 12-lead is a sinus rhythm in the sixties, blood sugar is around 100, she’s afebrile, blah, blah, blah.

So we head on over to the hospital with, you guessed it, a guy following us in his car. He’s playing it tight, too. Less than one car length behind us, and he even has his flashers on.

Instead of brood over how stupid people are, I try to decide between starting Antonio Brown or Dez Bryant in my flex spot.

Before we can get this lady out of the ambulance, the follower is all up in Slimm’s face.

“What took you so long to get to the hospital?!”

“Nothing? It took about ten minutes.”

“Why didn’t you go emergency? Use the lights and the siren?”

“Because it wasn’t necessary? Because your wife’s vital signs are all just fine.”

“Hell, I could have brought her here in less time!”

“Okay…”

“Why the hell did I call an ambulance if I could have taken her to the hospital just the same?!”

“…uhh…”

Gotta love it when they answer their own questions.

Not even close

We’re posting. We have a new hire, and Slimm is in the back. From the sounds of it, he is in deep slumber. I’m pecking away on my computer.

“What are you doing over there?”

“Just writing.”

“Oh. What do you write?”

“I have a blog. I’m just writing some posts out.”

“Oh, you have a blog?”

“Yeah.”

“Where’s your blog?”

“It’s anonymous. I don’t put my name on it.”

“Oh. So, like, you write stories about EMS and stuff?”

This chick is brilliant. “Yeah, something like that.”

“Like, ohmygod! Are you Burned-Out Medic?!”

“Ha! Not even close.”

“OOOOH, I BET YOU ARE.”

I don’t think my mom even reads my blog. Heck, I don’t think my mom even knows that I have a blog.

Yonder

Yesterday, I wrote about how Slimm and I were discussing the definition of ‘yonder’ while on the way to a call to pick up a bossy lady.

Seriously, that’s what we do.

We suggest that everyone eschew the common, accepted definition of yonder, which can be found at dictionary.com. While it may be used to describe some “place, more or less distant; over there,” we propose a new definition:

yonder

[yon-der]

adjective

1. further than you can throw, but not too far to walk

“I’m going to head over yonder to pee. Holler if we get a call.”

Now you know.

Bossy

A lady fell in her home and hurt her hip. At least according to the MDT. Slimm and I debate the definition of ‘yonder’ on the way to her house.

We are met outside of a palatial townhouse but one of the fire gals. She is standing next to the truck with the bags and clipboard.

When one of the grunts has the clipboard, you know it is some serious bullshit.

“This lady fell ten days ago.”

“For real?”

“Yeah. Anyways…so she fell ten days ago, and went to the hospital. They said there was nothing wrong with her, and sent her home. Now she is in there demanding to go back to the hospital.”

“Whatever.”

After five minutes of moving this lady around and getting her outside her home, and onto the stretcher, then locking all the locks on the door, then getting her loaded into the ambulance, then hiding the key back under the statue of the cherub by the front door, we finally have her loaded into the ambulance, and I’m covered in sweat.

The South sucks in summer time.

“I want some water.”

“I’m sorry, ma’am, we don’t have any water in the ambulance.”

“Well, go back inside and get me a bottle out of the fridge.”

Now, normally, I am not opposed to giving patients water. Especially when I’m pretty sure there is nothing wrong with them, but one thing I am not is an errand boy.

“Ma’am, we aren’t going back inside your house to get a bottle of water. You will have to talk to the doctor when we get to the hospital.”

“Why aren’t we moving yet? Why is it taking so long to get to the hospital?”

“Because we just got you loaded into the ambulance, and then we were discussing your water request.”

“Well, if you aren’t going to get me any water, at least take me to the hospital.”

Later:

“I want you to call my doctor.”

“You can go ahead and call him if you would like.”

“I don’t have a phone, so you need to call him.”

“That is interesting. I don’t have a phone either.”

“I want them to put me on the fourth floor of the hospital.”

“That will be up to the doctors at the hospital.”

“No, that will be up to me.”

Just a few minutes later, after I call the hospital on the radio (since I don’t have a phone):

“Ma’am, the hospital says they are on diversion, and it might take a while for them to find a bed for you in the Emergency Room.”

“I don’t want to go to the Emergency Room, I want to go to the fourth floor!”

“But you have to go through the Emergency Room.”

“Take me home.”

We are literally almost there. I can smell the antiseptic, and see the hospital through the front. “What do you mean, ‘take you home’?”

“I don’t want to wait. I want to go right to a room.”

“What are you going to do when you get home?”

“I’m going to call 911 and have someone take me to the hospital.”

“Ma’am, the people that show up when you call 911 are myself and my handsome partner up front. That would just be a huge waste of everyone’s time.”

Thankfully, Slimm has been ignoring this lady, and has pulled up onto the ramp already. But she is still at it:

“I want you to call my son.”

“Ma’am, I will make sure to get you a phone when we get inside.”

“I don’t know his number!”

“Okay, I’m sure that you can call Directory Assistance, and they will help you find his phone number in this city of several million people.”

We wheel her inside and put her against the wall while we wait for a room assignment. The charge nurse looks over my shoulder and sighs.

“Oh crap. This bitch again?”

“So you’re familiar.”

“I took care of her like, last week. Wouldn’t quit bossing people around.”

“Sounds about right.”

“Put her in triage.”

“She is going to raise a big stink.”

“I don’t care. You need me to sign something?”

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.”

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.”

“Mmmmkay.”

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.”

Shit.

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?”

“Sepsis?”

“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.