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.

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.

Estoy aprendiendo español

Slimm is out again today. Sometimes, I think that guy calls out just because he doesn’t like me. He gave me some lame excuse about his daughter getting her tonsils removed.

Whatever.

My partner today seems to be a nice guy. He obviously showered, doesn’t make me listen to country music, and leaves me alone while I’m reading.

We get a call for a “person down at a bus stop.” No doubt called in by some hero roaming the streets of our county, saving victims from themselves with phone calls. We never get to meet this hero, likely because he or she is always off in a rush to save the next poor soul, and can’t stick around the scene.

It’s a drunk guy laying on a bench at the bus stop. He is obviously Hispanic, or a really tan Texan with a penchant for western wear. He’s awake, but groggy. I think ‘somnolent’ is the correct medical term.

“Hi.”

“Ayyyyyy”

“Hola. Cómo estás?”

“Estoy bien.”

“¿Habla usted Inglés?”

“Eh, pero un poco. “

“Mi español no es muy bueno, pero lo intento.”

“Suena bien.”

¿Estás bien? ¿Tiene dolor en alguna parte?

“No. No tengo dolor.”

“¿Está usted enfermo?”

“No, cansado.”

“¿Cansado?”

“Sí.”

“¿Borracho?”

“Sí. Muy borracho.”

“¿Beber toda la noche?”

“Toda la noche. Muchas bebidas.”

“¿Cerveza? ¿Vino? ¿Tequila?”

“Sí.”

“¿Cuál tomaste?”

¡Todos ellos!”

“¿Quieres ir a un hospital?”

“¿Por qué?”

“Mi jefe me pregunto.”

“Su jefe suena estúpido.”

“Buenes noches.”

I look at my partner and the fire guys. “Alright, let’s pack it up. I think we are done here.”

“What the hell just happened?

“He says he is just tired because he is absolutely wasted, then he called our boss stupid.”

“Really?”

“Yeah. He doesn’t want to go to a hospital, either.”

“He called our boss stupid?”

“Yep.”

“Smart guy.”

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.

TBD: Think Before Denying

Newguy and I are inside the home of a delightful lady who was complaining of chest pain, at least according to our dispatchers.

Our intrepid local first responders are huddled around the patient, in a mad dash to save her from the throes of death.

They seem to be succeeding at preventing her imminent demise, and also are sucessful in their attempts to create a large pool of blood all over the patient’s hardwood floors.

It’s a win/win situation so far.

One of the patch-wearing heroes rattles off some vital signs, and they are all better than mine, with the exception of her blood sugar: 331. Alas, she is a diabetic.

I really enjoy when the pieces of the puzzle assemble themselves.

Our infirm female has said several times now that she needs to “tinkle,” and asks if she can go. Newguy wants to get the 12-lead first, so he asks her to wait just a minute or so. It’s normal, by the way.

“Okay then, can I have a glass of water while I wait? I’m really thirsty.”

“Nothing to eat or drink until you see the doctor” the intrepid hero reflexively replies.

Newguy is nonplussed. “Why can’t she have anything to drink?” he asks.

“I don’t know” is his reply. Clearly, he has no idea.

“Were you guys going to put saline in that IV over there?”

“Well, yeah…”

 

Why don’t we think about these things? Don’t we all recognize what is going on here? This lady is hyperglycemic, and polydipsic and polyuric. Because her blood sugar is ridiculous. Granted, I’ve seen higher, but she’s going to get a large amount of fluids in her IV on the way to the hospital, so is there really any harm in giving her a glass of ice water?