Quack

Some gal had a seizure at a bagel shop. Which is too bad, because we are hungry and it’s generally frowned upon to buy breakfast while a patient is having a medical emergency.

Of course, there’s no shortage of unhelpful bystanders on cell phones, and for some reason, the fire guys are wearing their turnout gear.

There’s too many people crowded around this college-age looking gal lying on the floor, so I’m hanging in the back. I guess the stripes on my sleeves make me look important, as another lady who appears about the same age, and shoves a phone in my face and tells me her father is on the phone.

“Yes, hello? This is C with the ambulance. How can I help?”

“Hi, this is Dr. Duckman. I’m her father. Can you tell me what happened?”

“Well, sir, it appears that she had a seizure. The bystanders describe a grand-mal seizure that lasted approximately one minute, but she’s coming around now.”

“Is she hurt?”

“It doesn’t appear that way, and my partner is taking good care of her.”

“Is she going to the hospital?”

“It looks that way, since they’re getting her up onto our stretcher right now.”

“Well, which hospital is she going to?”

“To Local Hospital, right up the road. Do you need the address?”

“No, I know where it is. Could you have the ER doctor call me? And make sure she doesn’t have any X-rays or CAT scans or MRIs?”

“Uh…I’ll pass the info along, but that will be up to the physician at the hospital, If you’d like to come to the hospital you can -”

“No, I can’t, because I’m in Connecticut. Can you hand the phone back to her roommate?”

We find out later this girl has been having seizures for several years, but has never seen a neurologist. Her father, who called himself a physician and a doctor, had been treating her (against all sorts of ethics rules). Get this: he has been treating her with adjustments because he “doesn’t believe in pills.”

He’s a chiropractor.

We did the wrong thing

An old lady fell in the bathroom at her nursing home. She hit her head and suffered a minor laceration.

It wasn’t even bleeding when we got to her.

There wasn’t any bleeding from her head, and no blood to be found on the floor of the bathroom.

A band-aid probably would have been too much.

But she had to go to the hospital to “get checked out.”

She cried when we picked her up out of the bed to put her on the stretcher.

She cried the entire 30-minute ride to the hospital.

She cried for the duration of her 5-hour hospital stay. She didn’t even get a band-aid.

She cried for another half hour when the other ambulance took her back.

She stopped crying when they put her back in her bed and covered her up with her special blanket.

Only to fall again a day later.

Sex, gender, and yet another complaint

“I’m going to sit behind you and call the hospital to let them know we’re coming, okay?”

“Okay”

<Ring, ring>

“Emergency Room, Brandy.”

“Hey Brandy, it’s C on Med 2. I’ve got a report for you.”

“Alright, whatchagot?”

“We’re about ten minutes away. We have a twenty-year-old male who-

“Umm, excuse me?”

“Hang on a sec, Brandy…Yes?”

“Umm, did you just assume my gender?”

“Did I what?”

“Did you just ASSUME my GENDER?”

“I have no idea – what – no…wait – what?”

“You don’t know me, and you just ASSUME that I’m a MAN?”

“Well, I did see your penis a few minutes ago, remember? When you were running around your apartment naked and screaming?”

“That doesn’t make me a MAN!”

“But, like, seriously, you have a penis. Your sex is male. Your gender is none of-”

“My penis doesn’t make me a man!”

***

Seriously, though. Sex and gender are two different things. A patient’s gender doesn’t matter one bit to me, and neither does their sex. A patient’s sex only matters on the PCR, and in the patient report. I’m just saying, if you’ve got a penis, your sex is male. That doesn’t mean your gender is, but again, I don’t care.

I really don’t have time for this. I’m getting tired of writing these reports.

 

Genius

Some lady attempted suicide.

The MDT notes say she left her car running all night in her garage, and was found on the floor of the garage by a neighbor. It’s 6 o’clock in the morning, and she’s been there all night, and the car was still running when the neighbor found her.

The neighbor only found her because he thought the red light glow coming from her garage was strange. Apparently she left her headlights on. Neighbor broke into her house, opened all the doors and windows, turned the car off, and somehow dragged the lady outside into her driveway before calling us.

Somehow, she’s still breathing.

Brave man. Now he’s over in the bushes throwing up breakfast.

No, it wasn’t an accident. The note she left in her car removes all doubt of that.

Shaq and our supervisor are getting some stuff done while I gather information before we leave.

One of the fireman comes out of the garage and walks over to the ambulance. “Hey, do you know which hospital you’re going to go to?”

“Yeah, we’re gonna go to Saint Catholic’s. They have that hyperbaric chamber there they can put her in.”

“Cool. Good deal. Make sure you tell them the readings we got from our meter is six hunnert and fitty parts per million.”

This guy is speaking some language I don’t understand. But whatever. “Sure thing, dude. Six-fifty parts per million. Got it.”

He looks over my shoulder at my supervisor and nods “How is she doing? She gonna be alright?”

“I don’t know, man. She looks pretty sick. But her O2 sat is at one hundred percent, so at least that’s good.”

Fireman and I make eye contact and neither one of us have anything to say.

And Supervisor McDipshit wasn’t trying to crack a joke, either.

 

I looked it up later. At 400ppm, a normal adult will have headaches within 1-2 hours, and it is life-threatening after 3 hours. 800ppm is nausea, vomiting, and convulsions within 45 minutes, unconscious within 2 hours, then death. And this lady’s garage was over 600ppm, and she spent the better part of 9 hours in there.

Nobody could figure out how she survived. But she did.

The O2 sat of 100% is probably what saved her.

We can all do better

This might be a long post, but there’s a lot of things I want to cover.

The crux of it revolves around our latest experience with the healthcare system: my wife and I had a baby yesterday. But we weren’t supposed to.

A few days ago, my wife noticed some dark red blood, and spoke to her obstetrician. After consult over the phone, she went to the doctor’s office, had an ultrasound performed, and was sent to our hospital for some longer monitoring. It was determined that everything was okay, and that the contractions she was experiencing were nothing abnormal, and she was sent home, and given instructions for some bed rest.

Nothing is wrong with any of this. This is what we expected, and we are grateful for the office and hospital staff. We were relieved there were no problems, and expected to wait another six weeks to meet our new daughter.

Until my wife woke me up.

It started at midnight. “This pain is different,” she told me. “And now the blood is bright red.” With her past pregnancies, there was a dramatic shift in the quality of her contractions, and this is what she was experiencing. My wife labored for four hours with our first child, and only two with our second one, and here she was telling me that she was in labor.

Six weeks early.

I’ve always prided myself on my ability to remain calm, and to reassure my patients, and their family members. Except in this case, my patient was my wife and unborn baby, and my patient’s family was myself and two small children. My wife is also a former paramedic, and hasn’t practiced in several years, but she was concerned as well.

After performing my own exam (probably against all recommendations, please don’t tell our obstetrician) her cervix was only minimally dilated, at one, but she was becoming effaced. And there was a lot of bright red blood. Her contractions were coming every five minutes, and lasted about 30 seconds. We both felt that delivery was imminent, unless we could stop it.

So we headed to the hospital, and called the obstetrician on the way. Luckily, the office had a physician in the hospital, and we were assured the doctor would come see us right away after we arrived.

But we got a midwife.

Now, listen. I have nothing against a midwife. Nothing at all. I fully understand how vital a role midwives play, and I am sure they are more than competent. But there were two exceptions in my case. First, this was a woman who was nowhere near full term, and second, we made it perfectly clear that we expected a physician in the room, as opposed to any midwives.

Let’s be realistic: when the shit hits the fan, the midwife is going to call a physician. So let’s just cut the crap, and have the physician in the room in case the shit hits the fan. Meanwhile, we have a woman in labor, with bright red bleeding, who is only 34 weeks along, with a documented history of short labors.

That fan was spinning pretty fast.

Of course, the midwife was upset when I specifically requested a physician. “I’m more than capable of delivering babies” she said.

“And so am I. I delivered a baby just last week in the camping section of a Wal-Mart. But we want a physician, specifically a perinatologist, and some terbutaline might be in order if we have any chance of stopping this preterm labor.”

I try really hard not to walk into situations with a chip on my shoulder, and I don’t volunteer that I am a paramedic unless it is called for. In this case, I felt it was called for. The midwife left the room, probably to soothe her hurt feelings, and we were moved to a delivery room quickly.

But I don’t care about her feelings. We had a situation which she could not handle, and it is my belief she should have called a physician on her own, instead of having to be prodded.

Our perinatologist was a fantastic doctor. Just all-around great. She was very reassuring, and explained everything that was going to happen. She ordered and administered the terbutaline, which gave my wife a lot of comfort, except the contractions didn’t stop. Their intensity decreased, but their frequency did not.

This perinatologist explained after a quick exam that my wife was 4 centimeters dilated, and 60 percent effaced. It didn’t look like we were going to be able to stop this labor. When I mentioned that I was concerned about a possible abruption, she assured us that delivery was the best option after all.

We didn’t see any abruption on the ultrasounds, but that didn’t mean there wasn’t one. The presentation was certainly indicative of placental abruption, instead of a bloody show, which is what the midwife called it.

My wife requested an epidural, and the anesthesiologist was called, and he came into the room only several minutes later. We were pleased with the alacrity the hospital staff was showing to our situation. In the meantime, a nurse and respiratory therapist from the NICU came to talk to us, and answered a few of our questions.

It was explained that everything looked just fine with the baby, and they weren’t expecting any complications, but that the baby might have to spend a little bit of time in the NICU if she was having any trouble. The NICU staff was very professional and reassuring, and they assured us they would be in the room for the delivery, as opposed to regular L&D nurses.

Once the anesthesiologist came in, we became somewhat concerned. Our nurse, who was very helpful and friendly, seemed a little too friendly with the doctor, and it seemed as if they were flirting, for lack of a better term, while he was performing the epidural.

As I was standing in front of my wife, with the anesthesiologist behind her performing the puncture, my wife looked at me and said “my head hurts and my toes feel warm.”

Of course, this caused the doctor pause, and after a few more questions, he removed the catheter, and applied a dressing to her back, then we laid my wife back on the bed. Only mere moments after the injection, my wife mentioned that she couldn’t feel her legs, which indicated to the anesthesiologist that he went too far, and administered a spinal block instead of an epidural.

This damned doctor was so busy flirting with our nurse that he went too far with his needle.

Right about now, I notice my wife looks terrible. She looks pale, complained of dizziness and nausea, and was beginning to sweat.

Her blood pressure was 70/30, and her heart rate was 160.

And I was noticing some late deceleration on the fetal monitor.

Our nurse quickly called the perinatologist, the NICU staff, and another anesthesiologist.

Our second anesthesiologist came into the room, and instead of talking to us, conversed with the nurses in the room, and talked about giving “neo.” Our nurse had already given my wife some ephedrine, with no change in the blood pressure.

The anesthesiologist looked at us and said “there’s nothing to worry about here, all this is normal, and we do this every day.”

Y’all, I about lost it. Just about.

“Don’t tell us there’s nothing to worry about. I’m the son of a physician, and I’ve been a paramedic for 17 years. My wife, your patient, is also a paramedic, and we generally act a little more concerned when we have a diaphoretic, hypotensive, tachycardic patient. And if that patient happened to be in preterm labor, and was having bright red bleeding, and we saw late deceleration on the monitor, we wouldn’t be all nonchalant.”

Of course, I hurt this anesthesiologist’s feelings. So now I’ve possibly made two people cry.

But we weren’t playing. This was a serious situation, and it seemed like there were three people who appreciated the seriousness of it: the perinatologist, the patient, and myself.

In the end, the anesthesiologist left, and the perinatologist and I (yes, she let me deliver) delivered a very, very tiny baby girl. She weighed 4 pounds, 3 ounces. Her apgar scores were 8 and 9, which were impressive and reassuring. The NICU staff determined our new baby girl could stay with us instead of going with them.

So we now have a premature, yet very healthy, baby girl. And we couldn’t be happier. Her mommy, daddy, big brother and big sister are very much in love with her, and we can’t wait to bring her home.

But we all need to do better.

Things should have been explained better to us. Granted, we aren’t typical patients, but we still should have things explained to us.

When you have a chest pain patient, do you tell them “I’m going to give you some aspirin, and I need you to chew them up, instead of swallowing them.”? That’s good, because you should. But you should also tell them “aspirin is going to work by making your blood clot slower. That way, in case you’re having a heart attack, the clot won’t be as big, and it will be easier to fix.”

Do you just administer a breathing treatment to an asthmatic, or do you tell them “this medicine might make more spit in your mouth, and might make you feel a little jittery, but that’s how the medicine works; it works by relaxing your lungs, making it easier for you to breathe, and it makes your heart beat a little faster, too.”

Do we do a good enough job explaining these things? When our patients are really sick, do we get in an ‘automatic mode’ and just do a lot of things quickly? Or do we take the time to explain to our STEMI patients that “you’re having a heart attack, and we are going to do a lot of things very quickly.” Do we tell them that they “are very sick, but I am going to take very good care of you, and not let anything bad happen to you.”

I think we owe that to our patients.

Most of us are very competent, capable providers. But that doesn’t reassure patients.

Touch your patients. Skin-to-skin if you can. I like to put my hand on their shoulder, just at the base of the neck. Look them in the eyes. Don’t tell them “everything is going to be okay” because that isn’t always the case. Tell them what is happening to them. Tell them what you are going to do for them, and tell them why.

Tell them you are going to take good care of them.

And mean it.