Smoothie

“Male assaulted. PD on scene” reads the MDT. It’s raining and traffic is heavy, so I have to actually pay attention to the roads instead of the book I was reading.

I’m reading the new Grisham book, Gray Mountain. I can’t recommend it yet.

We finally make it on scene to find a guy in his early thirties standing with local law enforcement in the living room of his apartment. He has blood streaming down his face, and he is holding a towel against his head.

Shaq is taking the lead on this one. He’s going to be in Paramedic school soon, and needs to get used to assessing patients. Plus, he is really good at it. Good enough that I rarely have any questions for my patients, or tips for my partner.

After sensing an opening in the conversation with local law enforcement and the injured gentleman, Shaq breaks in:

“Man, what happened to your head?”

“That bitch hit me with a smoovie!”

“A smoothie?”

“Yeah! A smoovie!”

A glance at the gentlemen with the firearms confirms the previous point: they have no idea what is going on either, and how a cold fruit emulsion could have caused such a wound.

“She hit you in the head with a smoothie?”

“Yeah! I said that already!”

“But how did it cut you like that?”

“Cuz it’s heavy, man! Damn!”

“But, it’s soft, and it’s in a styrofoam cup or something.”

“Naw, man! It’s heavy!”

“A smoothie is heavy?”

“Yeah, man. Heavy. One of them things you smoove your clothes with!”

“One of the things you smooth your clothes with?”

“Yeah!”

“But, I don’t really…I’m confu-oh! Do you mean an IRON?”

 

Doctor Jack Wagon

An ER physician cancelled my cath lab activation the other day. No, I didn’t save the 12-lead.  I should have, and maybe I will try to find it once I go back to work.

It was a male in his mid-forties. He had just gotten back home from a walk around the neighborhood, and couldn’t catch his breath, and kept sweating. It’s been a little warm around here for the past few days, but not that warm.

So, duh, he’s having an MI.

For some reason, the interpretation didn’t pick it up. He was in a sinus bradycardia with an (apparently new) left bundle branch block. He met all the Sgarbossa criteria. He was hypotensive. His skin was diaphoretic, even though it was 74 degrees outside.

We transmitted the ECG to the hospital, and I called the cath lab number on my phone, like we always do from the field. After loading up in the ambulance, I called the hospital to give them my ETA.

That’s when I was told my activation was cancelled.

“By who?”

“The ER doc.

It turns out that the nurse who receives the ECGs we transmit shows them to a physician. Not a specific physician, mind you, just any physician he or she can find in the hallway. And this time the physician cancelled my cath lab activation.

Why?

Wait for it.

Because my 12-lead didn’t say “STEMI” on the top.

No joke.

Seriously.

This jackass in a white coat cancelled my cath lab activation because the interpretive statement didn’t recognize an MI in the presence of a left bundle branch block. This isn’t a case of a false activation, either. I took the 12-lead upstairs to the cath lab to show a cardiologist friend of mine.

“Where’s this patient?” he asked me.

“Downstairs in the ED.”

“What the hell for? Why isn’t this patient up here?”

“Ask the jack wagon in Trauma 4. I activated you, but jack wagon cancelled the activation.”

Where was the patient?

In Trauma room 4. Twenty minutes after we walked in the doors, he arrested. He went into v-tach and tried to die. He was resuscitated, but now, several days later, he is upstairs in the ICU on a ventilator, with a balloon pump hooked up to him.

Because some jackass doctor can’t interpret 12-leads.

System dairymaid

I met a lady today. She’s in her late forties, and lives in a nice, government-subsidized apartment. Much nicer apartment than I could ever afford.

She has oversized, comfy leather furniture that looks new, arranged to face a large flat-screen television on her wall.

She drives a 2015 BMW.

She gets around in her apartment with a very fancy electric wheelchair.

She carries a Prada purse and has an iPhone 6.

She lives with her husband. Except she doesn’t live with her husband. They aren’t married. She proudly admitted that they never got married, because he has a good job, and she would lose her disability benefits if they got married.

We passed at least three very capable hospitals on the way to the one of her preference, because her “doctors are there.” and “they have all my records,” and “it’s close to my friend’s house, and she is going to pick me up after.”

We transported her because her knees hurt.

Of course she handed me a Medicaid card. It was underneath her EBT card.

“Ma’am, you look really healthy. Why are you on disability, and why do you use the electric chair?”

“I have fibromyalgia. Medicaid gave me the wheelchair.”

Zero percent effective

“25YOF ABD PAIN” reads the MDT. For some reason we are going lights and sirens. As is a big red truck. I still don’t know why.

Oh, that’s right.

Policy.

Whatever. I’m trying to find a stopping point in this book, Killing Patton before we get there, so my partner for the day drives slow. Without the lights and sirens. Policy be damned.

We arrive on scene to find what appears to be the patient in the midst of what could be a day care, but is actually an apartment. A cursory head count reveals around 8 kids, nope, make that 9, because the lady watching TV is holding another one.

This lady is watching some judge show on TV with the volume at full blast. I don’t know what show it is, and I don’t know what the case was about, because the first thing I did was turn the TV off.

“Hey!”

“Well hello yourself. What seems to be going on?”

“Like I told that lady on the phone, my stomach hurts.”

“Okay. How long have you been hurting?” I ask as the unnamed partner starts to get some vitals.

“‘Bout a week.”

“Hmmm. Okay. Any nausea, or vomiting? Have you had any diarrhea? Has anyone in the house been sick lately?”

“Naw, I ain’t been sick. Just hurting.”

“Okay then. Any chance you could be pregnant?”

“Well I don’t know.”

I am always intrigued by the “I don’t know if I’m pregnant or not” answer. Understandably, I don’t have a uterus, but most women I come in contact with know if their period is late, early, or whatever.

“Well, when was your last period?”

“Like, maybe October? Or maybe September?”

“Have you been pregnant before?”

“Yeah.”

“Okay…how many times?”

“I don’t know. I gots 2 kids.”

How in the name of Sam Hill do you not know how many times you’ve been pregnant?

“Um, have you had miscarriages, or abortions?”

“I ain’t never had no miscarriage. But I had five abortions.”

Pulling out my calculator, I plug in the equations and deduce she is gravida 7.

“Well, let’s take a quick look at your belly” I say as we lay her down on the chaise. “So has anything else been strange lately? You said you haven’t been sick, but have you felt weird or anything?”

“Yeah. It’s weird. I’ve been craving chicken and pickles lately.”

“Yeah. I like chicken and pickles too. Are you sexually active?”

“Well, duh” she scoffs, as if I should be surprised.

“Fair enough. Do you use birth control?” I ask as I do some quick Leopold maneuvers. There is definitely a baby up in there.

“Some times. But not all the time. But I do take my pills. I can’t be pregnant because I’ve been taking my pills.”

“Well, if you want to put your hand right here on top of mine, you can feel the baby in your tummy.”

She does as instructed, and I push with my other hand, making the baby kick. She obviously feels it. This baby is good sized, probably 20 weeks or so, probably more, which jives with a missed period in September.

“But I can’t be pregnant!”

“Well, I don’t have an ultrasound machine, but the fact that you haven’t had a period in five months, and this fetus moving around in your belly tells me you are.”

“But I’ve been taking my pills!”

“Pills don’t always work. What kind of birth control pills do you take?”

“I don’t take birth control pills.”

I feel like I’m being set up.

“Okay then, what kind of pills do you take?”

“Haldol.”

Holy shit.

“…”

I’ve got nothing.

“…”

“What?!”

“Haldol isn’t birth control, and it wont’ stop you from getting pregnant.”

“For real?”

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.