A long story, Part I: The Freak-out

So, I’m visiting a friend’s house for a child’s birthday. I know what you’re thinking: I don’t have any friends. And you are right. Sort of. I have, like, three. And I was at the home of one of them.

His father-in-law was also there. A large, hulking man, built like a defensive lineman. Sort of like a big square with legs.

He comes up to me, and kind of hushed, says “my chest feels a little tight, C. What do you think I should do?”

I ask him about his medical history and all that good jazz. He’s 62, mildly overweight, hypertensive, with high cholesterol. He had a normal stress test a few months ago, and his EKG was “normal” according to the doctors. He’s never had a heart cath, or a heart attack, or anything major happen to him. He takes his medications regularly like he is supposed to, and everything is managed appropriately.

Our conversation is noticed, and his wife comes over and wants to know what’s going on. “My chest feels a little funny, I was just talking to C about what I should do” he tells her.

The next few minutes saw his wife almost have a syncopal episode, fan herself with a paper plate, say “lawdy jeezus” at least three times, and she summoned no fewer than two of her middle-aged concerned friends over. The next conversation went something like this:

“What should we do?”

“Probably put him in a car and take him to the hospital.”

“We should take him to an urgent care center!”

“Urgent care would be a waste of your time. Go to an Emergency Room.”

“Should we call 911?”

“No, just leave now and go to the hospital right up the-”

“I’m calling 911!”
“There isn’t really any need for that, he could be at the hospital before-”

“VICKI! CALL NINE-ONE-ONE! BUBBA’S HAVIN A HARTATTACK!”

“I really think that he would get there quicker if you just drove to the hospital yoursel-”

“BUT HE NEEDS PARAMEDICS! VICKI! WHERE’S THE AMBULANCE!”

“You do realize that I am a paramedic, right?”

“Yeah, but you aren’t working right now!”

 

I sighed, went off to find some aspirin, and sat down to wait.

 

To be continued…

Seersucker Season

Old traditions will say that it is inappropriate to wear seersucker before Memorial Day, or Easter, depending on who you ask. Those same people will say the end of seersucker season is Labor Day. Let me assuage your fears; that is old.

Out with the old, in with the new.

Seersucker is appropriate to be worn during the Major League Baseball regular season.

I was wearing my trousers earlier today at the grocery store. I’m pretty sure a middle-aged belle grabbed my butt and said “that’s how you know spring is here.”

Seersucker is where its at.

Maybe it is time for something new

I had a visit from my (former) partner Slimm the other day. He said he had a day off, and he wanted to take the trek up to my neck of the woods. I’ll always take an excuse to see my buddy, and our kids play well together. So the ladies and children went to the playground and did what kids and mothers do at the playground.

Slimm and I sat down in my living room and had a drink, and I told him that I have been thinking that I am done with EMS. “Why?” was his question, followed by “what are you going to do next?”

A good question, without much of an answer.

I’ve given this EMS thing sixteen, almost seventeen years of my life. That’s quite a long time for someone my age, and longer than many people I work with. I certainly have more years in EMS than any coworkers my age. I started in EMS in high school, after all.

It’s been a good ride, but I really think it is over.

Over the next few hours or so, we discussed our futures, specifically mine. Mostly we discussed how I came to this realization that EMS wasn’t for me any more.

“But you’re a good paramedic” is one argument I heard. But it isn’t about being good. It’s more about being happy.

I can’t point to a single occurrence, but more of a sequence of events. Kind of like when you know a relationship with a girl is going nowhere. You try, but she isn’t interested any longer.

When I first started at Local Ambulance, people listened. Management was interested. They were excited to hear my ideas, my personal and professional goals, and we worked together to accomplish some of them.

But lately that’s changed.

Over the past several years, I’ve had many meetings with members of senior management or administration. I’ve brought dozens of ideas to them, from how to improve and establish a critical care program, to courses we could offer for continuing education, to beginning a community paramedic program. Each time I’ve been fed like a puppy on a leash, and then let go. Some of my ideas have been implemented, but have all failed. Maybe it is because I wasn’t a part of the implementation, and maybe not.

Maybe I’m just tired and in a rut. I’ve spent a long time focusing on other, different projects within EMS, and maybe I need to focus on just being a paramedic for a little while.

***

Part of me feels bitter, and I think it is rightfully so. I really don’t know if every service would be the same, but I can’t think that they would be.

Maybe I’ve reached a pinnacle of progression in EMS, and there simply isn’t any more room to go up. Maybe there is more room for growth, but not where I am now.

I like being a paramedic, but at the same time, I don’t like being a paramedic anymore. This is really a strange situation I find myself in.

Slimm thinks I should stick it out some more. He tells me that the grass isn’t always greener on the other side.

“It is if they fertilize it properly.”

The flickering flame of a paramedic

Lately, I’ve been feeling myself becoming more and more burned (or burnt, whatever) out. And I don’t like it. I love this job. I love taking care of people.

But sometimes I feel as if I have an unrequited love.

When I first started in EMS, everything was new and fresh and exciting. It was easy to get excited about the calls that didn’t need excitation, and very easy to get too excited at times.

Now, after seeing hundreds of people who are simply seeking drugs, I’m cynical. I don’t want to be cynical, and I want to take care of my patients appropriately, but something is happening to me that I don’t understand.

Yesterday, I picked up this middle-aged lady, who I have picked up several times before. Her complaint? Chest pain. Every time. She says she has 14 stents, and has had 7 or 8 heart attacks. “I stopped counting after five,” she says. She then tells you that she has to go to the University Hospital, 30 minutes away, not one of the 7 (seriously, seven) other hospitals that are just as capable as the University one.

It gets better.

She’s allergic to nitroglycerin. And aspirin. And literally almost everything else you can think of. The list is incredibly ridiculous. Then she says she can’t have a heart cath done, because her doctor says if she gets put to sleep, she might die. Never mind that they don’t actually put people to sleep for heart caths, she says she can’t have one. “So what does the hospital do for you, if they can’t really do anything for you?” is the next question that probably every other paramedic would ask. And it is a legitimate question.

“They give me painkillers.”

Well, there you have it. She wants painkillers. The cynical medic in my says “fine, you want me to drive 30 minutes, past 7 hospitals, just so you can get some meds? Then I’m going to sit behind you and not do a damned thing. But I don’t want to be that medic.

Is she really a drug seeker who is simply wasting everyone’s time? Maybe. Is she having a legitimate event, and in actual need of narcotic analgesia? Maybe. If she was really a drug seeker, wouldn’t she want to go to the closer hospital so she can get her drug? Maybe. Does anyone benefit from a cynical, burned-out medic with a bad attitude?

Certainly not.

I started typing this about an hour ago, then took a break to take a walk.

And I don’t take walks.

I don’t know what I’m trying to say here, and how to say it. I don’t know what the problem is, or what went wrong, or when it went wrong, for that matter.

But something is wrong, and I don’t like it.

I miss the old medic I used to be.

New Doctor

Newguy and I are taking an older gentleman into the hospital having an active stroke. It’s a legit stroke: all of a sudden he couldn’t move his left arm or leg, and his face started drooping, then his slurred speech started.

“Hot stroke” as we call it.

I’m giving my report to the nurses, and apologizing for sticking the guy 5 times without getting an IV.

Literally, all I did on the way to the hospital was 1) call a report on the radio, and 2) make this guy a pincushion.

I’m in the midst of a bad IV streak. I was 2-for-9 that day.

Some new doctor I’ve never seen before walks into the room. Most physicians in this emergency room wear scrubs, and occasionally a white coat, but this guy looks like a Brooks Brothers catalog cover model. Pressed khakis, cordovan wing tips, light blue pinpoint oxford, and a regimental rep tie.

He listens to the rest of my report while he walks over to the patient.

As I’m finishing up my report and grabbing a signature from the nurse, he looks at me.

“So y’all didn’t get a line?”

“No. I tried a bunch, but I didn’t get one. Sorry.”

“That’s cool, don’t worry about it” he says as he turns to the nurse. “Let’s go ahead and get him over to CT, and call Neurology.”

He takes his stethoscope off and begins listening to breath sounds, and turns back to me.

“Did y’all get a sugar on this guy?”
“Yeah, it was one-forty-four.”

“Good. We need to know the sugar. That’s some important shit.”

These people got lights and siren responses

These are calls I have heard dispatched over the radio, or ran myself in the past few weeks or so since the implementation of the new policy that requires an “emergent response to all requests for services generated through the 911 system.”

  • A male with CHF who just got out of the hospital and wants to know how to take his meds.
  • A female with a swollen knuckle who can’t get her ring off (the ring isn’t stuck, her knuckle is just swollen.
  • A female who is depressed and ‘wants to talk to someone.’
  • A male in the waiting room of the emergency room who has been waiting too long and wants to go to another hospital.
  • A female who ‘has anxiety and witnessed an accident and is now having a panic attack.’
  • A male who ran out of gas on the interstate and is demanding PD drive him 40 miles home, but now PD wants EMS there.
  • A  very elderly male who is dead in bed, cold to the touch and stiff, with family refusing CPR instructions.*
  • A female who wants her blood pressure checked.
  • A school bus with 14 children on it was struck by the arm of an apartment complex gate. There are no injuries on the bus.
  • A male who was in a fight last week, and now has a swollen hand.
  • A male sitting behind a strip mall, dirty, and talking to himself.

There were others, but these are just the highlights.

But we want people to take us seriously.

*I sort of understand this one, but in reality, this family just needs a coroner.

Dumbest. Policy. Ever.

And this is exactly how it is written:

“All requests for service generated through the 911 system will receive an emergency response, with lights and sirens.”

But what can you expect these days? Competence is becoming more and more rare.

“Narc-what?”

“Person choking” is what the dispatcher says. A young person, too.

We skedaddle on over there, to find the nice fire crew already on scene. From what the friend says, the unconscious guy on the floor took a bite of a chicken sandwich then passed out and turned blue.

Somebody is bagging this guy, but “his sat is good with the bag, so I didn’t tube him.”

His vitals are okay, except for the unconscious part. He is breathing on his own, about 10 times a minute. Sugar’s normal. Heart rate is normal. Pressure is better than mine. Something about pinpoint pupils, but whatever. Everything is going smoothly so far.

While I’m thinking of the logistics of how to get this unconscious fellow up two flights of stairs, I hear some wonderkid say “Narcan.”

My ears immediately perk up, and my head turns as I say “dowhatnow?” But they don’t hear me. They are too busy talking amongst themselves.

“Yeah, we might as well.”

“It ain’t gonna hurt nuthin.”

“Yeah, it can’t hurt.”

“How much you want me to give?”*

“Give half of it.”**

“Okay.”

I interject. “Uh, if we’re gonna give naloxone, how about we go with point-four milligrams instead of one?”

“So you want me to give a fourth of the vial?”***

“Uh…”

The other guy speaks up: “Just eyeball half of it, it’ll be alright.”****

Before I can begin to process the shit show of patient care that just occurred right in front of my eyes and ears, someone gives ‘about half the vial’ of naloxone.

You know what happens next, don’t you?

Homey promptly awakens, retches, and coughs up a humongous piece of a chicken sandwich, which was obviously lodged somewhere north of his vocal cords.***** (It was just too big to go past the cords. Imagine you took a huge bite of a sandwich, and decided to inhale it without chewing. Yeah.)

My head is literally about to explode at this point.

 

* Personally, I don’t want you to give any, but the question wasn’t being asked of me.

** ”Half?” Is your partner not intelligent enough to read the numbers on the side of the little cute glass tube?

*** Okay, now we know you can’t read, and you suck at math. For the record, zero-point-four is one-fifth of 2 milligrams. Or twenty percent.

**** Seriously, I heard a paramedic say this. In the company of 4 other paramedics. Have you no shame, mustachioed dude?

***** Seriously, what the hell is going on here? The call was for “choking” and you arrived on scene to find an unconscious guy lying on the floor with a fucking chicken sandwich in his hand missing a bite. Did nobody think to look in his airway? A blade and a set of forceps would have done fixed this problem a long time ago, but now this guy’s going to have to sit in a hospital for a few hours.

 

Newguy and I are left to try to pick up what remains of our jaws from the floors. We literally can’t believe the serious shit-show we just saw happen. And meanwhile, these yahoos are patting themselves on the back.

What the hell is wrong with people?

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?

The New Guy

I haven’t given him a name yet, but I’m working on it.

Sort of.

Newguy seems alright by me. He’s a medic with a few years under his belt. I’m not sure I’m feeling the double-medic thing, mostly because I hate to drive.

He also hates driving.

But we spent 4 hours discussing Russell’s teapot and the barber paradox.

He likes Pink Floyd and found Malcolm Gladwell to be fascinating.

He literally has no idea where he is at any given moment, besides inside an ambulance, house, or hospital.

We’ll figure it out, though.