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.

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?”

So long, Slimm

After three years, and thousands of calls, the end of C and Slimm is here.

Management has seen fit to end the best work relationship either one of us has ever had and give us two new partners.

We did the math a few days ago, and figured we have run 3,285 calls together. Give or take a few. That figures 6 calls per day on a 12 hour shift. We’ve run some awesome calls: together we have almost 25 saves (seriously, he is that good), delivered 5 babies, one being a set of twins, and we even made the news a few times. He looks handsome on film. I just look stupid. We’ve run the bad calls too: nasty car wrecks with fatalities, more than a handful of deceased shooting victims, both homicides and suicides, a person hit by a train, and the man who asked us not to let him die. We failed him.

It’s been more good than bad, and even through the bad times we had each other.

We’ve laughed. A lot. We’ve cried. Not really. We’ve spent dozens of hours throwing a football, and even more arguing about what to get for lunch.

We had lengthy conversations during the Presidential election, and I couldn’t win the arguments. Slimm was hung up on the Mormon thing.

So now I get a new guy. He’s from Minnesota or something like that. Some state that isn’t Mississippi, but starts with an ‘M.’ I haven’t given him a nickname yet. I guess he’s going to have to earn it.

I often call Slimm my ‘brother from another mother of a different color,’ and I mean it. Slimm has become a trusted confidante, and an even better friend. I’m sure going to miss working with him.

“Fixed it”

Slimm and I are taking some poor lady to the local rehab hospital. This poor hapless soul made the mistake of slipping on ice, and banging her head on the pavement. Now she has a tracheostomy and needs a ventilator.

Unlucky for her, she is now here.

We make our way to the room after the obligatory signing in of the patient at the front desk. Which makes no sense to me, but I’m just an ambulance driver transporter paramedic, and not a policy maker.

We hear the alarm before we make it to the room.

Slimm makes it to the door first and I can hear his eyes roll from the other end of the cot.

Inside the room is an obviously exasperated respiratory therapist, fumbling with the hospital ventilator. Obviously, something is not like it should be.

“I can’t get it to work! Something is wrong!” she says very excitedly. “I’ve never heard it do this before!”

Slimm catches my eye, and his eyes glance at the wheels of the hospital bed, and back up to mine, and I get it. Three years of silent communication are good for a partnership.

Meanwhile, the RT has reached the end of her wits. She looks like she is about to quit.

She pulls out her phone and punches the numbers violently. “SOMETHING IS WRONG WITH THE VENT IN FOUR EIGHTEEN AND I NEED ANOTHER ONE AND THERE IS A PATIENT HERE ON A VENT WITH AN AMBULANCE AND I DON’T KNOW WHAT IS WRONG WITH THIS VENT AND I KEEP HITTING ‘SILENCE’ BUT IT WON’T GO OFF AND SOMETHING IS WRONG.” she says, to someone who might have more experience in these matters.

She turns to us: “I’m going to have to go get the vent from across the hall” she says as she walks out.

Slimm’s face doesn’t move, and his eyes don’t turn. His right foot makes an almost imperceptible movement to the foot of the bed, and activates the bed’s lock.

The alarm stops. Like we both knew it would.

Our patient continues to be unconscious and unresponsive on our cot.

The respiratory therapist reappears at the door, less exasperated and more perplexed.

“What happened?” she asks.

“I fixed it.” Slimm replies. “It’s cool now.”

 

Nunnya

Slimm is in a mood. He hasn’t had his coffee or his sausage biscuit, and it is cold outside. Slimm doesn’t do well when cold, hungry, and decaffeinated.

We are running a call for a “sick person” who “doesn’t feel well” at an office building. Your typical Monday morning call. “Please. I don’t want to be at work either” Slimm mutters as we get out of the ambulance.

We make our way to the patient. She wants to go to a hospital 30 miles away, past 5 other hospitals that are perfectly capable of handling her lack of a medical problem. Coincidentally, the hospital of her choice is around the corner from her home. The patient is playing opossum, which is absolutely fine with us.

As we leave, we get accosted. By a security guard.

“What’s going on? What is wrong with her?”

Slimm responds. “Nothing, ma’am.”

“Is she going to the hospital? What hospital are you going to? What’s wrong with her?” She even has a clipboard in her hand, a pen perfectly poised to record the details of her exciting shift.

“We really can’t tell you anything, ma’am.”

“You have to tell me, I need to put it in my report. I’m in charge of security here.”

Slimm stops walking as a fireman and I continue walking with the patient through a lobby. His voice rises, and we are still able to hear him.

“Fine. She has NUNNYAtitis, her condition can be described as NUNNYA, and we are taking her to NUNNYA Medical Center. Put that in your report.”

Cath lab

I’m running a call with Joe again. A little old lady fell down.

Literally.

Fire is on scene. We all mosey into the house.

“Hey, guys. Whatchagot?”

“Hey, this is Maude*. She fell right here walking to the kitchen. She has a complete heart block.”

“Okay. Is she hurting anywhere?” to Maude, “Hi. Are you hurting anywhere-”

“Dude, she has a complete heart block.”

Joe and I both notice the leads are on Maude, but not the combo pads. That, along with the fact that Maude looks like she feels better than 50 percent of us on scene, don’t worry us too much.

“Yeah, I heard you. How about we get her on the stretcher and out to the truck?”

“Man, I don’t think you understand. She has a complete heart block.

“Okay, okay. I get it. Let’s get her on the stretcher and move her to the ambulance.” Joe is good at hiding his annoyance. Very good. But someone has a point to make, apparently.

“Dude! Listen to me! You aren’t hearing me! She has a COMPLETE HEART BLOCK!”

Joe turns to the Captain on the engine, who, up to this point, has been expertly wielding the clipboard.

“Hey, man. Can y’all run out to the truck and grab the cath lab? We forgot to bring it in.”
“Dowhatnow?”

“The cath lab. I left it in the truck. Can someone run out there and get it for us? Oh, that’s right, we don’t have a cath lab in the truck. Maybe we should take her to one?”

 

*obviously I made that name up.

MCI review

When at an MCI, assignments are given to you. For example “take those three patients from that car right there to Local Hospital.” But we all knew that already.

When those instructions are given, it isn’t necessary for you to hang around and give scene reports to the arriving units, directing them to where their patients are.

Incident Command is the one with that responsibility.

When informed that you are to “transport them to Local Hospital,” that doesn’t mean you hang around for another 15 minutes with your thumb up your butt then ask the IC “hey, is it cool if we leave now?”

“Your ambulance should have left 15 minutes ago!”

MCIs work much, much smoother with just a tad bit of cooperation.

Guns are a bad idea for EMS

The gun-carrying for EMS debate is getting stronger down here. It hasn’t totally died down, but for some reason it is becoming more and more of an issue.

I really think that EMS carrying guns is a bad idea. For several reasons.

People call us for help. They don’t call us to protect them, but to help them. Carrying guns on our persons will change the relationship between the public and EMS. I want patients and caregivers to trust that I am there to take care of them, and not there looking for a reason to punish them.

Guns will change the perception that the public will have of us, even if that gun is concealed.

What are we really doing to ensure our safety on scene? How often do we walk straight to the door of a house without even a cursory glance at windows, shrubs, cars, or any other part of a house? Do we walk straight across a broad lawn, or are we in the habit of walking down a driveway? How often do we make our way to a house with our hands full? Is it not a good idea to keep a hand free, in case something bad goes down? Do we allow people inside homes to get between us and the door? Do we even notice when people get between us and the door? Do we look for other methods of egress when we walk into a house? Do we really perform an assessment on our patients, touching their body, looking for something wrong with the patient, and something on the patient that shouldn’t be? How often do we practice contact and cover?

Does every provider in EMS even ask one of those questions? Ever? Or are we complacent?

Slimm and I have safety plans, and we have discussed these things. We have two wives and 6 children between us, and we are going home at the end of the day. We have a safe word, and we are willing to do whatever it takes to get both of us out of any situation. That is also a benefit of working together for a few years now.

We trust ourselves, yet we still don’t trust each other with guns. We know that if something bad went down, and a gun was involved, the chances of neither one of us going home at the end of the shift is much higher.

We are both comfortable with guns. I carry, both concealed and open, virtually all the time when I am off duty. I own several firearms, and I train with them. I am a good shot, and safe. I can, and have, shoot well enough to qualify with my handgun at a police qualification. But this isn’t about my resume’.

I want you to think about this: Imagine every person you’ve ever worked with in EMS. Every person at your service, or your department, or in your hospital, or whatever. Even that guy with the short temper and the bad attitude. We all know and work with a jerk with a bad attitude. Take out a piece of paper, and write down the names of the 5 coworkers who are most likely to create a violent incident.

Now, do you trust your life to that coworker? Do you trust that coworker to change his ways, minimize emotions, and react rationally to a scene? You’ve never met me, do you trust me with a gun on your scene?

Or do you just want to be a badass and carry a gun on your ankle?

Dirty carpet

Working with a new guy today. He told me his name, but I forgot it after I fell asleep. It was like, 4 in the morning. Cut me some slack, okay? He has had no fewer than 6 cups of coffee in the past 2 hours. So I call him Joe.

Joe and I get called to a house for a middle-aged dude with abdominal pain.

Abdominal pain has got to be one of the lamest complaints ever. After all these years, and responding to “abdominal pain” thousands of times, I think that maybe three of them were legit. One very serious appendicitis, one with a triple-a, and one guy that had abdominal pain secondary to the large stab wound he forgot to mention to the call-taker. The rest of them could be handled by calling a friend for a ride.

But, anyways.

We are met at the door by what must be the complainant’s wife. Impeccible home, and I catch a whiff of vanilla coming from behind her. The money she spent on surgery certainly wasn’t wasted, either.

He is in the bathroom upstairs” she says as she turns to lead the way.

She turns back as we step in the door. “Oh, but you need to take your shoes off.”

Joe will have none of it. It is his call, so I let him take lead. “Ma’am, our boots are part of our uniform, and they are part of our personal protective equipment. We don’t take our boots off.”

But I just had my carpets cleaned.”

Well, we can either walk upstairs to him with our boots on, or he can walk out here to our stretcher.”

Hrrumph” she says as she turns and leads the way.

He is sitting on the toilet in the master bath. His door needs a biohazard sticker. This dude came up about 25 feet short of the toilet, and now his entire floor is covered with, well, you know.

See” Joe says, looking at the wife and pointing to the bathroom floor, “this is why we leave our boots on.”

But now you are going to track it all over my carpet!”

Yeah, but it won’t be on my feet.”