Yonder

Yesterday, I wrote about how Slimm and I were discussing the definition of ‘yonder’ while on the way to a call to pick up a bossy lady.

Seriously, that’s what we do.

We suggest that everyone eschew the common, accepted definition of yonder, which can be found at dictionary.com. While it may be used to describe some “place, more or less distant; over there,” we propose a new definition:

yonder

[yon-der]

adjective

1. further than you can throw, but not too far to walk

“I’m going to head over yonder to pee. Holler if we get a call.”

Now you know.

Bossy

A lady fell in her home and hurt her hip. At least according to the MDT. Slimm and I debate the definition of ‘yonder’ on the way to her house.

We are met outside of a palatial townhouse but one of the fire gals. She is standing next to the truck with the bags and clipboard.

When one of the grunts has the clipboard, you know it is some serious bullshit.

“This lady fell ten days ago.”

“For real?”

“Yeah. Anyways…so she fell ten days ago, and went to the hospital. They said there was nothing wrong with her, and sent her home. Now she is in there demanding to go back to the hospital.”

“Whatever.”

After five minutes of moving this lady around and getting her outside her home, and onto the stretcher, then locking all the locks on the door, then getting her loaded into the ambulance, then hiding the key back under the statue of the cherub by the front door, we finally have her loaded into the ambulance, and I’m covered in sweat.

The South sucks in summer time.

“I want some water.”

“I’m sorry, ma’am, we don’t have any water in the ambulance.”

“Well, go back inside and get me a bottle out of the fridge.”

Now, normally, I am not opposed to giving patients water. Especially when I’m pretty sure there is nothing wrong with them, but one thing I am not is an errand boy.

“Ma’am, we aren’t going back inside your house to get a bottle of water. You will have to talk to the doctor when we get to the hospital.”

“Why aren’t we moving yet? Why is it taking so long to get to the hospital?”

“Because we just got you loaded into the ambulance, and then we were discussing your water request.”

“Well, if you aren’t going to get me any water, at least take me to the hospital.”

Later:

“I want you to call my doctor.”

“You can go ahead and call him if you would like.”

“I don’t have a phone, so you need to call him.”

“That is interesting. I don’t have a phone either.”

“I want them to put me on the fourth floor of the hospital.”

“That will be up to the doctors at the hospital.”

“No, that will be up to me.”

Just a few minutes later, after I call the hospital on the radio (since I don’t have a phone):

“Ma’am, the hospital says they are on diversion, and it might take a while for them to find a bed for you in the Emergency Room.”

“I don’t want to go to the Emergency Room, I want to go to the fourth floor!”

“But you have to go through the Emergency Room.”

“Take me home.”

We are literally almost there. I can smell the antiseptic, and see the hospital through the front. “What do you mean, ‘take you home’?”

“I don’t want to wait. I want to go right to a room.”

“What are you going to do when you get home?”

“I’m going to call 911 and have someone take me to the hospital.”

“Ma’am, the people that show up when you call 911 are myself and my handsome partner up front. That would just be a huge waste of everyone’s time.”

Thankfully, Slimm has been ignoring this lady, and has pulled up onto the ramp already. But she is still at it:

“I want you to call my son.”

“Ma’am, I will make sure to get you a phone when we get inside.”

“I don’t know his number!”

“Okay, I’m sure that you can call Directory Assistance, and they will help you find his phone number in this city of several million people.”

We wheel her inside and put her against the wall while we wait for a room assignment. The charge nurse looks over my shoulder and sighs.

“Oh crap. This bitch again?”

“So you’re familiar.”

“I took care of her like, last week. Wouldn’t quit bossing people around.”

“Sounds about right.”

“Put her in triage.”

“She is going to raise a big stink.”

“I don’t care. You need me to sign something?”

Breakup at the blaze

We are headed to a house fire. We can see the column of smoke from pretty far away, and there are lots and lots of big red trucks with flashing lights and lots of noise.

One of the guys in the heavy coats with the reflective stripes directs me to the front of an engine, where there’s a man sitting on the bumper. He has a prosthetic leg, and a bunch of soot on his face. Quite the interesting combination.

We can clearly see what used to be a mustache on his face, and the curly remnants of his singed eyebrows.

We already tried to get this guy to go to the hospital, but he just won’t listen to us.” says one of the fire guys.

Hey, sir, you really need to go to the hospital” says Slimm.

He wasn’t persuasive enough.

Right about that time, someone who looks like they are with the Red Cross walks up to our patient. I guess she is with the Red Cross by the words “American Red Cross” embroidered on her red shirt.

I’m telling you, I should be a detective. I’m good at this stuff.

Sir, we have a place for you and your wife to stay all set up. Do you want me to call anyone for you? Any family? Friends?”

Hell naw, I ain’t go nobody to call. And I only need a place for myself.”

Well, we have a place where both of you can stay.”

I ain’t stayin nowheres with that lady!”

The Red Cross lady looks confused. “You mean your wife?”

Hell, she might as well by my EX-WIFE NOW!”

Uhhh…”

Bitch burned my HOUSE DOWN!” he yells at no one and everyone at the same time. “I told her ’bout SMOKING ON OXYGEN!” Then he makes eye contact with a distraught appearing woman a little ways down the road.

We are DONE, LADY! I’m getting’ a DIVORCE!”

Slimm looks at me with obvious discomfiture, then turns to the new bachelor.

Sir, if you don’t want to go to the hospital, could you sign this computer for us?”

Overtime sucks

I never pick up overtime shifts. Except when I do.

Now I’m stuck in this ambulance sitting in the parking lot of some hospital in an unfamiliar county, waiting on some little old lady to finish with her lunch so we can take her back to her nursing home. With a guy that has a strange, slightly unpleasant odor, and a penchant for telling war stories. I just want to take a nap, and this guy is trying to tell me about a bus crash on the side of a mountain during the first Bush administration.

Some war stories are cool. But not this guy’s war stories.

My employer is paying me time-and-a-half for this shift. And that still isn’t enough.

Estoy aprendiendo español

Slimm is out again today. Sometimes, I think that guy calls out just because he doesn’t like me. He gave me some lame excuse about his daughter getting her tonsils removed.

Whatever.

My partner today seems to be a nice guy. He obviously showered, doesn’t make me listen to country music, and leaves me alone while I’m reading.

We get a call for a “person down at a bus stop.” No doubt called in by some hero roaming the streets of our county, saving victims from themselves with phone calls. We never get to meet this hero, likely because he or she is always off in a rush to save the next poor soul, and can’t stick around the scene.

It’s a drunk guy laying on a bench at the bus stop. He is obviously Hispanic, or a really tan Texan with a penchant for western wear. He’s awake, but groggy. I think ‘somnolent’ is the correct medical term.

“Hi.”

“Ayyyyyy”

“Hola. Cómo estás?”

“Estoy bien.”

“¿Habla usted Inglés?”

“Eh, pero un poco. “

“Mi español no es muy bueno, pero lo intento.”

“Suena bien.”

¿Estás bien? ¿Tiene dolor en alguna parte?

“No. No tengo dolor.”

“¿Está usted enfermo?”

“No, cansado.”

“¿Cansado?”

“Sí.”

“¿Borracho?”

“Sí. Muy borracho.”

“¿Beber toda la noche?”

“Toda la noche. Muchas bebidas.”

“¿Cerveza? ¿Vino? ¿Tequila?”

“Sí.”

“¿Cuál tomaste?”

¡Todos ellos!”

“¿Quieres ir a un hospital?”

“¿Por qué?”

“Mi jefe me pregunto.”

“Su jefe suena estúpido.”

“Buenes noches.”

I look at my partner and the fire guys. “Alright, let’s pack it up. I think we are done here.”

“What the hell just happened?

“He says he is just tired because he is absolutely wasted, then he called our boss stupid.”

“Really?”

“Yeah. He doesn’t want to go to a hospital, either.”

“He called our boss stupid?”

“Yep.”

“Smart guy.”

My policy trumps your policy

Today we pick up where we left off with our previous call.

To recap; some chick doesn’t want to be at school, so she either a) is having a panic attack because she forgot her homework, or, b) just wants to go home. The fireputterouters have no idea that nothing is actually wrong with the patient, because instead of performing an assessment, they went straight for the IV attempt.

And blew up both of her ACs in the process. With 22 gauge catheters.

Seriously, a 22 in the AC? Knock it off, guys.

Slimm and I fixed the flag, and we are walking out of the classroom, ostensibly in a hurry to take care of our critical patient.

Some guy approaches. This guy looks official. He has grey hair and a lanyard, AND a whistle.

“This is Missus Whatsherface. She is going to ride with you.”

“She will have to follow us down to the hospital, we can’t take riders.”

“Well, it is the school policy that a staff member accompanies any student.”

“Okay. She can accompany the student at the hospital. Slimm and I will accompany her in the ambulance.”

Now, mind you, I’m not really against people riding in the ambulance with patients. Frankly, I don’t care. Except in cases like this. First, this guy is being a mega-douche, and second, we don’t take riders in the ambulance with fakers/anxiety attacks. We give them quiet rides, with vital signs monitored. And third, I don’t like the cut of this guy’s jib.

“Umm, one of our staff members has to ride in the ambulance with her. It is our policy.

“I am terribly sorry, but it is the policy of the ambulance service that will be transporting her that only immediate family members ride in the ambulance with any patient, and that is at the discretion of the ambulance crew.”

She followed in her car. With her flashers on the whole way. Later, I find out that Lanyardman called and complained. And lo and behold, my supervisor stood up for me.  “Yes, sir, I understand, but the paramedic made the right decision, and followed our company policy.”

Maybe the third time that has ever happened.

More assessment, less IV-ment

A call at one of the local high schools. “15YOF PASSED OUT” says the MDT.

“Yeah, sure” says Slimm.

Sure enough, there is a young female lying on the floor of a classroom. I’m looking around, figuring this is a World History class, with all the flags and stuff on the wall. One glance at the chick lying on the floor, and it’s pretty obvious: ain’t nothing wrong with her.

Anxiety attack 101 is being taught in this classroom today.

“Hey, your American flag is backwards.”

“Really, I thought the stars went on the right.”

“They go on the flag’s right, which is the viewer’s left.”

“Oh. Thanks.”

“No problem.”

Meanwhile, the fireputterouters are scrambling to get an IV on this chick. I don’t know why. Her eyelashes are fluttering, she is making obvious cringing faces when they poke her with the needles, and I watch her protect her face as our third rider does the arm drop thingie. (Is there a name for that?)

These guys are sweating up a storm, frantically hoping for flash in the chamber. Meanwhile, their blood pressure cuff, glucometer, stethoscope, and everything else needed to actually perform a patient assessment remains in their bags.

“Maybe we should just go ahead and get her out of here?”

“Umm, sure. That sounds like a good idea.” I’m not really in a hurry, but I am excited to get back to that grilled chicken salad I have in the ambulance.

The next thing I know, these guys pick this chick up, and rush to get the seat belts on her. Then they take off down the hallway with my patient, on my stretcher.

I look over at Slimm. “Maybe we should follow them?”

“Yeah, probably. I locked the ambulance, so they are going to have trouble loading her.”

I know who my real employer is

Even through all the complaints I have about my employer, and their petty bullshit, I take solace knowing that I don’t really work for them.

Sure, there is a guy who signs my paychecks every two weeks, and I graciously deposit them. He pays me well for what I do, and is very generous to his employees.

My supervisor can continually come to me with nitpicky complaints, about how Slimm and I didn’t wash the truck after we got off ninety minutes late. He can get upset at me because I don’t take all the equipment out of the truck to the side of the road where a lady sits, complaining of abdominal pain. He can whine to me about ‘policy’ when I had the middle-aged lady walk to the stretcher because she wanted to go to the hospital for her depression.

My employer tends to stay out of the day-to-day operations side at his company. He relies on his employees in management to make policies, and those management employees make policies that are absolutely ridiculous. And I am glad to break those policies when my safety (and common sense) dictate otherwise.

Like responding to every single call with lights and sirens. “No, I didn’t use lights and sirens to go to that last call, because the caller said he wanted his psych meds refilled, and I didn’t feel like that warranted putting my life, my partner’s life, and the lives of countless other people on the road in danger for some guy who apparently can’t find a CVS.”

I’m okay with getting in trouble for doing, or not doing, all that little bullshit. Because at the end of the day, I don’t really work for my employer.

I work for the patient.

And as long as I do what is best for the patient, every single time, I will still have a job, and I will still do that job better than any other paramedic at my company.

English major

A call for a “person in pain” about two blocks from our local hospital.

I decide to go ahead and finish my game of Mahjong on the computer while we are driving to the call, while Slimm opines on the situation awaiting us.

“Man, twenty bucks says she just walked out of the hospital, and wants to go all the way downtown.”

Knowing that our bets never involve the actual exchange of money, I accept.

“What’s going on?”

“I’m hurting everywhere.”

“Okay.”

“I want to go to the hospital.”

“Good for you, there is one right over there,” as I point to the hospital, about 100 yards away.

“No, I don’t want to go there. I want to go downtown.”

Slimm wins. Again. “Why don’t you want to go to that hospital right there?”

“They are mean to me. I just left there. I don’t want to go back.”

“Okay, then. Hop up here on the stretcher.”

Downtown is at least a half an hour away, so I have plenty of time for more Mahjong on the way. I’ve also started listening to Handel on the Law podcasts, and enjoy a brief show while I match tiles on the computer screen.

The radio report is made, and it was one of the best ever.

I wish you could have been there to hear it. I felt like such a hero.

“Umm, did you have to tell them that?” asks the person on the stretcher.

“Tell them what?”

“That I just walked out of the other hospital?”

“Well, yeah. It is kinda pertinent to the current situation.”

“What does that mean?”

“It means it is relevant, or germane.”

“Who is Jermaine? I don’t know nobody named Jermaine.”

Bad decision

A middle-aged male calls 911 because he doesn’t feel well. We find him sitting in a chair in his bedroom, looking terrible. Pale, cool, diaphoretic, cyanotic, and in obvious distress.

What my father would call “looking like death eating a cracker.”

He had a CABG a few years ago, and has high blood pressure. His wife says he has never had a heart attack though, and only did the CABG after an abnormal stress test.

He’s having one today though.

The 12-lead shows a big anterior infarct, with lateral involvement, and with lots of ectopy on the continuous ECG. His blood pressure is low, too.

Lots of bad things are going on.

“Sir, let’s get you on to Local Hospital.”

“No, I want to go to Southside Hospital.”

Southside Hospital is thirty minutes and two counties away. And this guy doesn’t have thirty minutes.

“We really need to go to a closer hospital, and Local is only five minutes away.”

“I will not go to Local Hospital. Take me to Southside” he says between breaths.

“Sir, you are having a heart attack. Southside is half an hour away, and that is just too far. We need to go somewhere a lot closer.”

“I don’t care. I am NOT GOING to Local Hospital.”

Slimm was wise, as usual, and had the patient sign a refusal form on which Slimm wrote ‘Patient refused closest hospital.’

I hated to take a firefighter so far out of the county, but I really didn’t have a choice. We told the other guys on the engine that we would bring him back. I really don’t like to take riders, but I felt like something bad was going to happen, and I would need the help.

Something bad happened, and I needed the help.

About six minutes after passing Local Hospital, the patient went into v-fib. Even though my defibrillator pads were already on, and it took about 5 seconds to deliver the shock, it didn’t work. After Amiodarone and two more defibrillations, he was in asystole.

Slimm diverted us to Local Hospital, and the patient never came out of asystole.

If he would have gone to Local Hospital, the outcome would likely have been the same, but I can’t help to think that it might have been different. If he would have listened to the advice of the providers on scene, he might have survived. But he made a bad decision.

Someone once told me something very wise.

“People have the right to make bad decisions.”