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?”

Another farewell to Slimm

He’s gone again.

This time for real. It is going to stick.

He turned in his notice, then a few weeks later, his uniforms and his badge and everything.

My partner left.

I don’t blame him. He got a really sweet job outside of healthcare, and I wish him the best.

I’m really happy for him. And I’m sad for me, too.

I’ve worked with Slimm for many years now, almost close to five. We have added a total of three children to our families, and both bought homes. We’ve run thousands of calls together. Good calls, bad calls, happy calls, sad calls, legit calls, bullshit calls. We’ve been on the local news several times, and delivered half a dozen babies. We have eleven cardiac arrest saves together, and every one of them is to his credit.

And now he’s gone.

We call eachother ‘brothers from another mother of a different color,’ and I think we both mean it. I certainly mean it.

Really, I’m happy for him. But it is bittersweet.

I stayed in EMS because of Slimm. He made coming to work easier. We understood each other. Mostly, he tolerated me, and kept me from getting fired.

I really do love the man, and enjoyed every minute of every shift we spent together.

I couldn’t even say goodbye when our last shift was over.

I just told him I would see him Monday morning.

Write-up

One hospital requested an ambulance to travel emergency to transport one of their patients to another hospital. Why? It doesn’t matter. And no, the patient was not ready.

“Hi, could you give me a brief report on this patient?”

“I already called the other hospital, they are waiting on him.”

“Okay, but could you tell me a little bit about him?”

“Like what?”

“For example, why he is here, what his history, medications, and allergies are, why he is being transferred? Stuff such as that.”

“I don’t understand why you would need to know that. I already called the hospital.”

“Well, I see that you have dopamine hanging. Perhaps you could let me know why you have dopamine hanging?”

“Because his blood pressure was low.

“Yes, I understand what dopamine is used for. Do you have any paperwork that I can take a look at? Maybe his chart?”

“No. The other hospital has access to that on the computer system, and I can’t let you see the chart.”

“Mmmkay. Why not?”

“Because of patient privacy.”

“Yeah. Okay. There’s no breach of his privacy rights here. I am a healthcare provider, so you can tell me stuff.”

“But I already told the other hospital.”

“Yes, we discussed that.”

“Why do you want a report? Why can’t you just take him? They are waiting on him.”

“Because you are transferring care, and I need to know how to take care of him.”

“Put him on your bed and drive him there. Isn’t that what the ambulance does?”

“Well, kind of. We also take naps and watch Bosch on Amazon Prime. Occasionally we throw footballs when the weather is nicer. Do you think you could give me that report now?”

“No. I already told you, I gave report to the other hospital.”

“Indeed. Indeed you did. I have an idea; how about a little role-playing scenario? It won’t take but maybe thirty seconds. Whaddya say?”

“Umm, okay, I guess.”

“Okay. Let’s pretend you are a nurse at another hospital, and you just got on shift. I walk in with Slimm here, and a patient on a Levophed drip, with some propofol hanging, on a vent.”

“Okay.”

“This is where I say ‘Hi, ma’am. Can you sign my computer for me so I can put this patient on your bed’?”

“What do you mean? Why is he here?”

“I don’t know. Some bitch at the other hospital wouldn’t give me a report.”

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.

Brilliant!

“Medic 4, caller reports a male in his twenties possibly overdosed. PD is en route with you.”

An overdose at the drug-treatment center. This seems ironic.

“Medic 4, update. Caller reports patient is unconscious but breathing. Caller advises come to the intake area.”

“Medic 4 received. Radio, show us on scene.”

Slimm and I make it inside with our equipment, walking with local fireguys. Slimm is still incredulous that Marshawn Lynch didn’t get the ball on those last plays from the goal line.

The scene looks like something out of a sketch comedy: fifteen people running around like chickens with their heads cut off, while some guy is lying unconscious on the floor. There’s two women in the corner, on a floral sofa, crying softly. One appears matronly, and the other could pass for a sister or girlfriend.

“Hey, y’all. What’s going on?” even though it is pretty obvious.

“He came in for <gasp> treatment, but then <pant, pant>, he acted like he was really high, and <gasp> then he went unconscious.”

Fire dudes are taking care of the supine gentleman on the floor. They say something about him breathing 6 times a minute. I see them get a BVM out. The chickens start to run faster.

Slimm looks exasperated. Not about the Lynch thing any more, but the current situation. He turns to the ladies on the sofa; “Ma’am, any idea what he could have taken, or how long ago it might have been?”

His mother tells us between light sobs “He does heroin and oxycontin. He probably took some pills on the way here or something, I don’t know.”

Well this should be easy enough.

“Okay, no big deal. We’ll give him some medicine, make him breathe a little faster, and we’ll get him over to the hospital next door, okay?”

One of the chickens says she will go get their Narcan.

This can’t take long, right?

5 minutes later, she’s still not back. It looks like fire dude’s hand is cramping.

“Any idea where the lady is with that narcan?”

“Oh, she had to go across campus. And then she probably had to get the key from the director”

“You keep the narcan somewhere else?”

“Yeah, we don’t keep it here.”

“You don’t keep narcan in the intake area of a drug treatment center, and instead you keep it more than five minutes away, under lock and key?”

If we had known that, we would have simply left a long time ago. And here I am, trying to save my boss a little money.

They give cops that stuff now days, and I’ve seen addicts with it. But the one place most likely to see an overdose and need the drug, is the one that makes it the most difficult to get to.

“Ma’am, please…”

“Hi, ma’am. I’m C with the ambulance service. What’s going on today?”

“My baby need to be checked out.”

“The sleeping child right here in the car seat? We can certainly take care of that for-”

“No! Y’all need to take him to the hospital!

“Alright then, we can certainly do that for you-”

Now!

…and later on…

“Ma’am, please don’t feed your child in the back of the ambulance-”

“But he hongry!

“I understand that, but first, he is 2, and second, the hospital won’t want him to eat anything until the doctor sees him.”

“But he hongry! He gotta eat!”

“Yes, ma’am, but – what are you doing?”

“You won’t let him eat, I’m bout to give him some milk!”

“Ma’am, please don’t breastfeed your child in the back of my ambulance.”

 

Sigh.

Unconscionable

One of my coworkers caused the death of a patient. In layman’s terms, my coworker killed someone. There really isn’t much to discuss, or wiggle-room, or room for doubt.

That’s what happens when you act arrogant and talk a big game around veteran EMTs and Paramedics – your actions are scrutinized just a little bit more.

And it doesn’t help that my coworker doesn’t understand what she did wrong. She tries to defend it, when her actions scream negligence.

We’ve all seen the EKG. We’ve heard the report. We’ve heard the excuses. We know what happened.

A person is dead now because of the negligence of one of my coworkers. Sure, the patient may have died anyways, but my coworker assured that the patient would die.

And that lady still has a job.

And she won’t be fired.

Because she shows up to work on time.

I can’t respect management that allows that to happen.

I won’t respect management.

They are unconscionable.

Detective Doggy

An “83 year old female with back pain and can’t move.” Great. This sounds serous. At least the dispatcher didn’t say “new onset of immobility.”

That’s the catchphrase lately.

We arrive at the residence, a two-story attached townhouse in a nice area. The door is locked. The fire department meets us at the door, and refuses to allow me to kick in the door.

Something about a “hidden key.”

“But she could be dying in there!”

One day, they are going to let me kick in a door, I can just feel it.

So we find this lady, who, sure enough, is 83 years old. And, what do you know, she says her back hurts. And, if you can believe it, she says she can’t move. Dispatch is 3-for-3 on this one. She is laying in bed, with her dog standing next to her. I notice the dog has stairs to get up and down the bed.

I learn the dog is a Bichon Frise’. His name is Hercule. He looks like a fluffy soccer ball. The patient/lady/owner/doggymommy says she is a big fan of Agatha Christie. She thinks I won’t get the reference.

I do, but just don’t care.

“Ma’am, we are going to put our stretcher next to your bed, then we will lift you and move you.”

“Okay. Is someone going to take my dog?”

“We will put him in your bathroom while we move you over, then we can let him out once we get you in the ambulance.”

“No, he needs to go with me.”

“Ma’am, he can’t go with you.”

“But he has separation anxiety.”

I cannot believe that I am actually hearing this shit. My eyes roll so far in the back of my head, I can see my senior prom. Slimm is dumbfounded. The fire guys are scratching their heads.

“He has separation anxiety?”

“Yes. It’s very bad.” She looks at Mr. Poirot, and kind of whispers to us “He probably needs…medication.

“Ma’am, we can’t take the dog.”

“But you have to.”

“Is he a service dog?”

“A what?”

“A service dog. Is he trained to help you with some sort of disability?”

“No, he’s like my son.”

“He’s not coming to the hospital with us.”

“Then I’m not going either.”

Sigh. “But you said you can’t move.”

“I’ll call my daughter, and she will come take Hercule, and then I will call 911 again.”

Sigh. “Sign here.”