Flirting with Adrenaline

Popped Balloon

2011-08-12T06:29:00.002-05:00

I've only had one OB call before this...some of you may remember Toilet Baby.

It was 30 minutes before shift change when the call came out. I put everything on the stretcher I could think of. When we got there the medic said take it off, she walked to the door which meant she could sit on the stretcher and get wheeled into the ambulance.

She was Honduran, they say pain makes you revert to your native language, which is exactly what she did. Thank goodness for Argentina. I haven't spoken that much Spanish since I left South America two years ago, it was a "pleasant" refresher.

4 months, no major issues, just pain started when she tried to poop earlier that morning...only no poop came out.

She was in pain, but nothing was happening. Medic asked me, I asked her, she responded and we went on our merry way...then she started squirming...Is the pain coming in waves? When was the last wave?

The waves were more painful and more frequent, but she swore no blood and minimal discharge. After the third wave of pain within five minutes I asked again if there was anything different down there...low and behold her panties were growing (The medic said she was pitching a tent, which is a bit too vulgar for me, but I have to give Medic props for the joke).

Before either of us had chance to react her water went flying...like a popped balloon, which is a really upsetting image now that I created it.

I asked medic what do I do? I'd never done this before. Dare I say I was clueless and more than willing to admit it. Medic gave me shears and said cut the panties. Then out popped the legs. My first thought was that they didn't look human. Yes they were human-esque, but disproportionately so. (after this call Toilet Baby medic would joke that they look alien...it's a weird image, but it definitely fits the category of humor that keeps you sane)

I told her not to look and made her push...nothing happened. We had one arm and two legs.

Medic told Basic to step on it, and asked Dispatch to have the ED staff meet us outside...this was that kind of baby.

I later went in the room to help translate, but mom kept asking how is my baby. I had intentionally avoiding this conversation. At the hospital we learned baby was 19 weeks 3 days, 4 days shy of viability....96 fucking hours shy...but who's counting? The baby had already been hanging half way out of mom for 20 minutes, survival was probably out of the question regardless.

Dr. said meurto. "Dead" in Spanish, but I asked isn't that too simple, don't you want me to explain? Dr. said she would find out eventually might as well tell her now. I truly wish I hadn't had that honor. Or at least I wish I had been given half a second to figure out a more gentle way of saying it. Telling someone their relative is dead is one thing, telling a mother half way through a pointless labor is a whole other story. That moment will stick with me.

Then we left. Mom was alone in the room, face up, legs wide, half of a dead baby hanging out her vagina...crying out in anguish. The painkillers may have worked on the "dolor" but they wont help the pain in her heart...from her perspective only God will be able to explain this one. Let's just hope he does a better job than me.

It's 7 am, baby was "born" at 0430. I'm physically and emotionally exhausted. Thank goodness for EMS for putting life in perspective....and Thank God for the medics who allow humor to help them survive.

Placebo Effect

2011-03-10T14:11:00.003-06:00

I want to talk about the definition of crazy. As a neuro/psych major it is a word that is seldom heard, and never in the context of my formal education. People aren't crazy, they have chemicals that go hay-wire and connections that aren't connected properly, but they never "lose their minds."

Do we go with the textbook version, or do we trust the Einstein had it right (insanity is doing the same thing over and expecting a different result)? I'm a personal fan of the colloquial. Maybe it's because the everyday version of crazy gives us more availability to apply it as we wish, but I would argue it's typically pretty close to accurate.

In essence of the everyday we don't see the neurons firing incorrectly, and most of us don't make a living talking "How does that make you feel?" But what we do understand is what goes beyond normal; those that don't, can't, or won't fit in are the same people that more often than not end up in the back of an ambulance because of a health care system that lacks an adequate solution. (Sorry if this is too much politics, this is NOLA and rather close to my future career goals).

Mardi Gras day I rode with North shore paramedic and Intermediate dispatcher. They were nice, it was definitely an entertaining combination. Patient of the day award goes to the 50 something woman who was allergic to strawberries....and latex, and grass, and the flu shot, and just about everything under the sun. At the hospital she even managed to win two allergy wristbands because her information couldn't fit on just one.

As we all know Mardi Gras makes you do crazy things and this woman was no different, she decided to drink some daiquiri. No problem, we all get drunk as some point during Carnival, myself included...only most of us know what we're drinking. She drank a friend's red daiquiri without asking the flavor, and as it turned out it was a strawberry flavored one.

Now since she is allergic to strawberries low and behold she started having an allergic reaction, you all know how that goes. The sprint truck got there first, but due to the noise of the parades they couldn't really hear what she had to say. It was until I had slammed the door that her story began to make sense...

Apparently she is allergic to real strawberries, not the artificial kind. Which means that her said allergic reaction was caused by the real strawberries they used in the strawberry daiquiri. Is anyone catching the first possible kink in this story? How many daiquiri shops use real fruit, or real fruit products for that matter? Not many.

Once she informed us of the strawberry issue, she started panting for Solu-Medrol. I mean she knew it was the drug for her....cause not only had it worked in the past, but she also used to be a nurse. So the paramedic pushed the "medicine" and within seconds her panting decreased. Do you see the second kink in this story? How fast does an IV push of Solu-medrol take to have an effect? Longer than 20 seconds, right? So therefore, what was in the syringe? Saline.

As we drove to the hospital our patient would occasionally freak out, argue that the medicine wasn't working, that she couldn't breathe. By the end of our journey I noticed her pattern, she only freaked out with the intermediate turned on the sirens, other than that she was fine, physically anyway. In my EMS course I was always trained to not have complete faith in the numbers, machines can lie and there was an expectation to make sure that if trusting a machine I had secondary evidence to support it. So if a patient says they can't breathe they should have a lower than 100 O2 saturation on room air, they should be making some auditory noises if their airway really is closing due to an allergic reaction, and they should, on the extreme end of things, have a tinge of cyanosis.

Her O2 was 100% the entire time, the only noises she was making were of her own free will, and her skin color was as normal as one could wish for.

When taking her medical history she mentioned that her sister has bouts of anxiety, but when we asked whether or not she did, she refuted the idea with a tinge of disgust. I love the stigma that is associated with psycho-pathologies. But what would you call her "allergic reaction"?

Is she crazy, probably not. Does she have an anxiety disorder of some type...I would argue there is a strong possibly.

We can talk about the morality of placebos another day because don't worry, I'm not always a fan.
CrC

The End...Sorta

2009-05-10T12:33:00.002-05:00

It’s been a transformation since that first night. For me it wasn’t really the initial 12 hours that imprinted in my mind just how clueless I was; it was my first code that taught me the value of informed idiocy. In those twenty minutes everything I had learned about CPR went out the window. My version included an automated AED, a lack drugs, an OPA, a BVM, and one or two partners. In my training firemen didn’t exist, paramedics were a foreign concept, and oxygen was the only drug anyone trusted me with.

It took me four active codes to realize that in the ALS version of things, you can continue to bag the patient while CPR is in progress. Yes, I had learned that after the first night, but it took awhile to register. I felt like a dumbass when on my third code the medics had to remind me I could continue to bag even though one of them was concurrently cracking our patient’s ribs.

But no matter how ridiculously out of place I ever felt the medics and EMTs stood by me. Willing to put up with my mistakes and lack of comprehension, I just hope I gave them something in return.

For me this is my final paper, a summary of the semester. It isn’t a play-by-play or one big, long thank you note – although both of those aspects are included. It is a way for me, as an outsider, to explain what I learned; beyond the medicine, signals, and back routes within the city. Because of my time on the streets I have fallen in love with this place. It is like nothing I have ever seen or experienced, and although I have been here three semesters prior, the parts of the city I had witnessed contained none of the true cultural aspects New Orleans is so famous for.

Family

I have one, and for those that have been paying attention you know that my dad has been in EMS since he was my age. He has been a volunteer licensed paramedic since before I was born. He was my introduction to this messed up version of reality, he was the vital example that I needed. But when it comes to the streets of New Orleans, he isn’t the family I’m referring to.

Perhaps I am mistaken, but I consider myself part of the NOEMS family. I’m a new member, I’m about as inexperienced as you can get; and I’m also about as young as they come. There are many ways of saying it, but they all mean the same thing – I am where every single one of you once stood – clueless, incompetent, slow, and even a little naive. Each of us started in our own way, the medics and EMTs we worked side-by-side with helped mold us into the healthcare provider that we are today. Some of us, myself included, are still being molded, learning something new with every call, improving after every ride.

Whether you came from the backwoods or have never left the city, you are here now, working the streets of a place that is like no other. We run more calls with fewer medics, we live in a city that the rest of the country seems to think has gone to the heathens, and the personalities that we encounter on a nightly basis could never be considered “normal” in any other urban society. Every city has many of the same aspects, but New Orleans puts a twist on people that cannot be compared.

For me it was this twist that bonded the medics. The jokes, the complaints, and the moral support tended to revolve around the aspects of the city that don’t always seem natural. From drunks on Bourbon, to frequent fliers across the board, and even the occasional call to Iberville; every medic has seen some version or other; and every medic can be there when one of their own needs a break. I wouldn’t say a pat on the back is the style; but sarcastic jokes, silly pranks, and mutual stories tended to break the ice and clear the air.

Learning

When it comes to EMS I understand the power of a certain amount of knowledge mixed with a certain level of experience. When those two aspects combine within a provider who cares, it’s an unstoppable force.

I seek knowledge so that one day I can be in your shoes: sleep deprived, emotionally exhausted, with limited resources, attempting to help someone who refuses to realize that I’m the good guy. Even when less hectic, more sane roads are easily available.

If I wanted to take the easy way out I would be in an air conditioned lab, during normal business hours, cataloging samples for an experiment that I probably wouldn’t have any emotional interest in. No thanks; I’m good with the blood, the projectile vomit, the code browns, and the disgusting toenails. But most of all I’m good with the wacky hours, the people who make this bearable, and the one in a million times someone remembers to say “thank you.” I’m good with “wasting” a considerable amount of my time sitting in the back of ambulance, attempting to do homework, for that one patient. The one who makes the impact, the one who gives me the chance to learn something my professors and white-picket-fence classmates will never have the opportunity to experience. To me there is no waste in this. Like I always say, what I’m learning is too important in the long run. It’s worth the minor sacrifices and times when I could be piss-ass drunk, but instead am stone cold sober, freezing my ass off because the call is on the street and the patient isn’t cooperating. I wouldn’t trade this for anything. It’s one Hell of a ride but it’s worth every curve ball patients throw our way.

I’ll be coming out of this semester with a slightly lower GPA, two years into college with enough hours to be considered a senior, and the realization that I will be retaking organic chemistry this summer. Had I not spent so many odd-ball hours on the trucks I’d probably have done a bit better in one or two of my classes. Oh well, no regrets. I wouldn’t take back a single hour or a single patient. If I learned one thing from the past four months, life isn’t just what you learn in books and labs, and sometimes the best form of knowledge isn’t written, but experienced first-hand. Don’t worry, I’m not quitting school, but this glimpse of the real world has allowed me to further recognize the necessity of education for my long term plans.

Thank You

I believe in emergency medicine. It’s not every day that a life is saved, or a disaster averted. But when it matters, EMS is there, you are there, ready to go. Politically, financially I am sure there are better methods than the current US health care system; but now, in the moment, I am honored to be here.

Every medic and EMT taught me something different, but each of you taught me something. Thanks for the opportunity, not only to invade your space, but to spend your time asking questions; to get in your way when I wasn’t sure where to stand, and to mess things up by trying to help, when all I could manage was making things worse. And don’t worry I’ll be back, ready to go, and ready to stay come January.

Catherine

My Numbers - 34 Shifts - 408 hours - An average of 6 patients per shift.

Short Straws

2009-04-30T12:06:00.004-05:00

We walk into the bedroom and he is on the ground, squirming. He should be up, walking around, doing whatever it is men do past midnight on a Friday morning - only one side of his body isn't working. We all know what that means...

His wife tells us it can't have happened very long ago. Which means our three hour window still exists. Which means hope still exists. Once the medic realizes this she has a one track mind. No wasted time allowed, she is edgy. With every CVA I remember an advertisement in the bathroom stall of the bar back home, "Time is brain." Simple, concise, it says everything with three words. Now why they felt the need to advertise to drunks is a whole other conversation.

The medics get him loaded up and leave me to deal with the wife. She is frantic, keys, IDs, phone, a blouse to wear over her tank top. I help in her search for the missing items, all the while knowing what I am missing in the truck. I love CVAs, for me they are the perfect altered mental status call. There is so much to learn from them, so much to do with them. No down time, you have to interact, check vitals, prep for curve balls. Fun times.

Only I wasn't having fun. I was in the house trying to corral the wife. I tried. It worked to an extent, in the sense that I had perfect timing. As I was walking out, wife trailing behind me, the other medic was jumping from the back, ready to put the truck in gear.

We got him to the ED and they got the clot buster in him with time to spare. It broke everything up. "We saved him." Only I didn't feel like I did anything of particular value. I love dealing with the family, while at the same time working with the patient. This time they were completely separate and I felt as if I had drawn the short straw. Then again, there's always next time.

CrC

Moments

2009-04-27T18:10:00.005-05:00

I thought she was a boy, a feminine boy in very male clothing. Especially given the way she giggled when I asked her if she were pregnant. Although in that case I should have known she was a girl based on the giggle. Boys don’t giggle; it’s not the manly thing to do.

It was 0230 and we had been called out for a nosebleed. She had been picking her nose at dinner, and it hadn’t stopped since. She was embarrassed beyond belief, but the medic just looked at her and said, “It’s alright sugar, everybody does it.”

The supervisor was standing at the side door, I had just hooked up the 12-lead. “Catherine, what’s his respiration rate?” I looked at him like he was crazy, was this a trick question, no one had ever asked me to get that vital sign, patients were always either 18 times a minute or in the toilet either direction. I put my stethoscope on his chest but couldn’t hear, so I counted the number of times his belly rose. And multiplied by four, the entire time thinking what I fool I was; I must be doing something wrong.

News crews had been listening to the police radio, a few of the medics shouted warnings when the first arrived. I had no idea how to react, but when I asked one of the medics what to do, I didn’t get the answer I was expecting. “Don’t smile and wave, going ‘Hi, Mom!’”…Gee thanks for the advice.

The husband worked at Hospital A, but Hospital B was set up for this kind of care. He was adamant we should go to A. I don’t know what the medic said, but when she got back into the truck the husband had shut up and we were headed code three to Hospital B.

Our patient had severe gout in her foot, the ED doc walks up and starts touching it, asking about pain levels. This doc, arguing over where the patient should be placed in triage, touched the feet of one of our patients with no gloves on. That’s just sick.

Wearing a sparkly New Orleans shirt, and skinny jeans; only the wallet was attached to the patient’s jeans with a chain and had the words “Dawn of the Dead” stamped across the front. Male or Female?

The juxtaposition of my drunken classmate at the Boot less than two hours after I watched a man die because the CPR just wasn’t effective.

The desire for warm food on a busy night.

The 3am Dr. Peppers.

The circles of medics on various ED ramps at odd times of night, cracking jokes and sharing stories. Coping in the only way they know how.

The ED doc walking up to Green Army's patient, exclaiming that she is seizing. The medic's adamant response that those are just the jitters.

The pranks, jokes, and inappropriate behavior.

The insanity that makes this "job" sane.

The exhaustion of 7am when the shift is over and I barely have the energy to go home, shower, and crawl into bed. I would contemplate on my night, but I'm just way too tired.

The medics response to a SWAT Roll she didn't know was going to be there. We might have gone around the block a time or two before getting to our patient.

And of course, all the times I laughed, even when everyone else found absolutely nothing remotely entertaining.

CrC

Kid Sister

2009-04-27T17:51:00.001-05:00

The medic warns me to stay close. It is my first night on the streets, a busy day on Bourbon. Pat O's is packed, and she isn't taking any chances. It would look pretty bad if she lost the Vigor on my first night.

He's a regular, only his wheelchair doesn't have side bars. That means anytime he's so drunk he can't stay in the chair we get called out. As vitals are measured and an IV is started he looks up at me and asks, "Hey baby, what's your name?" The other medic quickly replied, "She ain't your baby." I had no time to respond, he was between the patient and I; quickly averting any issue that might arise. Drunks seem to think they have magical pick up lines, of course this one was no different. The medic then continues on, "She ain't your baby, she's mine." At this point I join in. Within seconds the three of us are cracking up with laughter. Especially once I make it clear that I belong to no one. Oh well, I guess I could have gotten his number, although I doubt my mother would have approved.

The call came out as medic needs assistance, by far the loudest tire screech I've dealt with. When we got there the medic in the passenger seat told me to stay in the truck. Silly me, I didn't listen. Of course she knew this would happen, since when do I listen? Her argument for staying in the truck had merit, the whole I'm just a volunteer thing. Oh well, in the end I escaped unharmed and even got to see what all the commotion was about.

"Hey man, keep your hands to yourself." He never touched me, but once he was within the imaginary boundary the medic was quick to make sure he didn't try.

I pick up his arm, but it slides back down; awkwardly landing a bit too close for comfort. The medic witnesses it and tells me to switch seats. She isn't taking any chances.

And of course my personal favorite, "You back there?"

Just a few of my moments with the overprotective medics of NOEMS. Thanks ya'll, it's nice to know that sometimes you really do see me as more than just "Hey, Vigor..."

Thanks guys.

CrC

Pink Ribbons

2009-04-27T17:21:00.002-05:00

"Science is just data. Life is miracles."

"Science is just one word. Life is everything else."

Sitting in the wheelchair, her strength is long gone. She tells us she is on hospice care, a concept most of my classmates don't recognize, but one I have come to understand.

Her head is wrapped in a scarf as vibrant as her personality. The pink hues symbolic of more than her good humor. Pink is the color of her love, of her fight with cancer. If only she could say that she was winning the battle.

She cares about her students more than most, and her biggest goal has always been to pass on the lesson that life is more than textbooks and memorized vocabulary. It is the lessons that our stories teach us. It is the experiences that drive us close to insanity, yanking us back at the last instant, allowing us a glimpse but never letting us fall off of the edge.

She is full of good humor, ignoring the tears on half our cheeks. Jokingly acknowledging that the Boot isn't the best place for a "wheelchair lady."

I learned almost nothing from her class, I learned more than I can imagine from her. On the first day of classes I walked out wanting to drop it then and there, only I needed that class to go to Argentina in the fall. So I stuck it through. It was by far the easiest class I will ever have. When your professor is dying of cancer they tend to be pretty lenient.

In all likelihood I will never see her again. But with every patient I meet that in any way resembles her, I'm screwed. I pray that what I learned from her is the strength of compassion for those patients, rather than the scary reality that many will not live to see three months down the road.

She is an amazing woman, full of life even in the face of death. I wouldn't have it any other way.

CrC

19 Something

2009-04-21T17:19:00.000-05:00

At nineteen what were you doing with your time? Did it fit the plans and ideas you had held for yourself five years prior?

At nineteen I knew I would be an EMT, riding with someone, learning something. I knew I would be in school doing the 4-year degree thing. With my parents I had no choice in regards to that one. I knew I wouldn't be in Texas, knowing that I needed to leave behind what I love to learn why I love it so much. Texas is my heart, it has this culture that I can't explain. I know a lot of you may not have enjoyed your visits there post-Katrina, but for me Texas will always be a huge part of who I am.

At nineteen most barely consider me an adult. I am in this transitional time period. I can't drink, but I can smoke, vote, and join the Army. More importantly, at nineteen my parents still watch out for me, while at the same time giving me enough space to grow and mature. I spend my summers earning money at the stereotypical rowdy Texas sports bar, I spend my school year at one of the best schools in the country, learning material that I will never again need to know. Most of the time I feel like the important things aren't coming from what I learn in the classroom, but rather from the streets of New Orleans, the bar back home, and the people I meet along the way. But then again, that's what my mom always warned me would happen.

For the next two weeks I am still eligible to be a patient at Tulane Peds and Children's; if that tells you just how young I am. When I first started riding my age wasn't something I shared willingly; I was worried the medics would automatically discount me because of everything they believed time would have yet to have allowed me to witness.

I wasn't completely wrong. But I realize now that what I get credit for knowing has nothing to do with my age, but rather with what I have witnessed in their presence. My merit is earned on how I react to problems, on how I treat patients in their moments of vulnerability, and on how I treat my position as a guest on their trucks. To me that's what I am, a guest. I may be common company, but in the long run, I'm just a visitor - in all likelihood I won't be there tomorrow.

I am who the patients make me. Yes, we treat them equally, but some are more equal than others. Some make me smile, others make me furious, and my favorites give me an excuse to laugh at things most medics have seen a hundred times before and no longer find quite so entertaining.

I have seen things that most could never fathom. I have been in the presence of death, helped sustain life, and witnessed the pain of everything in between.

I have shed tears of frustration, emotionally breaking down in moments of exhaustion and sleep deprivation, wondering just how people handle this field. Then I fall sleep, wake up, and realize I too am strong enough.

I have wondered how patients can let it go this far. I don't think any of us will ever know the answer to that question. So rather than go on judging them, I prefer to get to know them, and learn the lessons they have clearly earned to the right to pass on.

At nineteen I am starting to break away from those my own age. My priorities are changing. Two Fridays ago I wasn't at happy hour drinking a Boot Long Island, I was in uniform, sweating from the effort it took to compress a 91 year-old man’s chest. I was fighting for a life that wanted to quit. I was concentrating on something other than the roommate drama from the past week. I was there; helping, participating, growing.

At nineteen I'm not doing all the things I expected to be involved with at this age; but I don't mind, the path I'm on isn't too bad. I might even prefer it to the original one.

At nineteen I'm honored to have been given the chance to do what I'm doing. Don't worry you aren't rid of me yet, but if you ever allowed me on your truck, thanks for the opportunity. It really does mean a lot.

CrC

Flicker into Flame

2009-04-16T12:08:00.000-05:00

I'm fine with the dead ones. The bodies that are cool to the touch, in the beginning stages of rigor, that don't have a shot in hell of being brought back. EMS isn't Dr. Frankenstein, we don't create life from death. We encourage life when life has almost been extinguished. We nurture the kindling, if we breathe too hard it losses power; but if we are patient and follow the rules that experience has laid out for us, we can turn a flicker into a flame.

In our efforts of invasion we crunch their chests, all the while upsetting their stomachs; we drill holes into their bodies; we stick tubes down their throats; we push drugs into their bloodstream that could kill a healthy human; and we force air into lungs that can't seem to work under their own power.

I know most don't come back. I know the lucky few that have hearts beating as we pull up to the ED will be nothing more than vegetables for the remainder of their lives. I know the longer we work them the less likely they will ever resemble what they once were. For me this is the hardest part.

I avoid thinking about the human patient and focus solely on the actions of the medics, or occasionally on my specified job. The guy on our stretcher isn't alive, he's a body with a beating heart - or at least that's what I tell myself. In the rush of the calls it's easy to avoid thinking about the human and focus on the medicine. Everything we do tends to be simple enough for me to understand, while complex enough to keep my brain occupied.

For the ones that make it to the hospital, the human aspect doesn't usually hit home until I'm in the ED room watching the doctors, nurses, and techs try their own version of life saving. By this time the patient is on a vent, and the medics have left the room. They have more important things to be doing, they've all seen this numerous times. I on the other hand am so insatiably curious I won't leave the room until the medics tell me it's time to go.

Keeping a patient alive is one thing. Turning a flicker into a flame is an entirely different brand of miraculous.

The patient is no longer an androgynous corpse, but rather a father, daughter, or brother - with family and friends anxiously awaiting the news. I always get sick to my stomach at this point. But I can never seem to leave the room. The un-jaded glimmer of hope still present in my thoughts; that somehow, in thirty minutes my patient will just wake up and walk out.

But I know it doesn't happen like that, no matter how many fingers and toes I cross.

CrC

Staying Alive

2009-04-14T13:13:00.007-05:00

This post is so appropriate for Easter I'd argue that yet again the EMS Gods have a sick sense of humor. And yes, I have taken to blaming the EMS Gods for my variety of calls rather than the medics I'm riding with, the 911 callers, or worst - dispatch. It just saves me a a lot of grief.

In three shifts I worked two codes. These codes were polar opposites. The first a white, 91 year-old man on death's doorstep; his daughter was outside his nursing home room asking us not to revive him. One problem: she didn't have the paperwork. The second a black, 26 year-old man, the needle in his pocket a dead giveaway that his friends and family were "poor historians" as the medic would have put it. Every person on scene - or over the phone - that I spoke to became more and more frantic with time. To them this wasn't happening. At the hospital a crowd of twenty plus family members awaited news.

There is one huge similarity between the two calls, we got them back. Return of Spontaneous Circulation achieved. I always smile when I hear that over the radio, even if it isn't my code. Call it a form of family pride for what we do.

On the first code I was given the score of a 2 for my BVM skills. For me that was a low blow, I normally get compliments in regards to that one. I wasn't insulted, shocked is probably a better word. On my second code I was given a 4 or 5, honestly I can't remember. The biggest difference beyond grading styles was the time period since my most recent code. Two days verse two months. With the first code the knowledge I had gained in regards to the yellow numbers and bumps on the monitor helped me significantly when it came to managing the breathing of the second code.

The first code had been called in as a choking, only I hadn't thought to bring in the suction. Supposedly there was something blocking our patient's airway and I hadn't remembered the suction...not my brightest moment. I ended up jogging a good little bit to get that forgotten item. In the process I needed directions getting back to the patient, and one of the nurses had to hand me back my knife; for some reason it wasn't really in the mood to go for a quick run.

On the second code I ran back to the truck three times for three different items. For whatever reason we hadn't had all the supplies in the bag that were necessary; I'd tend to argue a drip set is pretty necessary for spiking an IV bag.

I have come to recognize that on the bad calls, the best way for me to help the patient is to do the shit work for the medics. Whether that means I'm bagging for 15 minutes straight or running out to the truck on numerous occasions, on these calls I'm happy with the chance to witness what is going on as well as do the mindless stuff. Although to consider bagging mindless is a joke.

That said, I'm going to argue for the chance to remain active. For a multitude of reasons, the big one being that if I'm going to get stuck watching someone die, I best be able to say that I helped. I know that sounds a little selfish, but right now, at my current emotional maturity level when it comes to death and dying I need that little morale booster at the end of a bad call.

The first code had no fire, one basic, and four medics. We watched him crash, his airway posed no significant issues, and compressing his chest was easily possible, even for someone my size. The second code had one medic, two basics, and three firemen; he was a difficult airway, and his ribs and body size reminded me of my first code; it took some effort to get his chest moving, even for the firemen.

On both calls the medics said I did a "good job," not the most productive critique, but I'll take it. On both calls I was slightly flustered because every team has their own system, and if I don't have something to do, I'm never quite sure what I should be doing in the mean time.

But with every code I know I am learning that much more in regards to what the medics need most. Opening the seperate bags of the p-bag may seem simple, but as I have argued before, it's the little things.

CrC

Jumping & Sliding

2009-04-12T13:38:00.004-05:00

Living with so many women in such a condense space can have its advantages. If one of us has a great day, we all know. If one of us gets ignored by the cute guy she has been flirting with, we’re all there, ice cream and vodka on hand. If an outfit doesn’t work, it’s immediately altered or replaced. Funny thing is; if I have a bad day on the truck they don’t know what that means.

One of the girls is even an EMT out of Virginia. She’s been doing it over the school breaks for two years. But NOLA isn’t really the same as anywhere else. Only in New Orleans is a religious holiday considered a state of emergency by city officials. She tries to understand, but since about a month in I realized that she didn’t know what it means to run the types of calls that I have seen. Yes, she has had the training; but as I am such a prime example of, training doesn’t mean jack shit until you’ve seen it in real life.

It’s different when the patient is there in front of you, in place of a well known classmate on a white cotton sheet. Patients have personalities and deficits, along with issues that can’t be duplicated in the check mark or multiple choice setting. Patients have histories that give them attitudes and ideas that may or may not act in our best interests.

My dad calls New Orleans a war zone. Not in the sense that he is clueless and still thinks the city is under water. But rather in regards to the extremes of the calls we deal with on a day to day basis. This isn’t a nursing home service or a hospital transfer service. NOEMS sees shit call after shit call hourly.

Growing up in white-picket-fence suburbia and then moving to NOLA to attend school has been a culture shock of sorts. Back home it was rare to hear a siren or to see a truck more than once a week. I come to New Orleans and I hear at least two sirens a day if not more.

Now that I’m here, I can’t imagine trying to learn this stuff anywhere else. It has been extremely difficult adjusting. I feel like I hit the ground running, but that occasionally something tries to rip it out from under me. Like the frog climbing up the side of a well, for every three jumps closer to the top, the frog slides back the distance of two jumps. For every new thing I learn there is something associated that pulls me back down to reality.

For the past half a dozen shifts or so all I felt was sliding backwards. Never did I do something, or catch something that seemed to earn a jump forward. Up until this morning I was coming out of every shift wondering if there was anything I hadn’t done wrong. In the long run, probably not the best way for me to be thinking about it, but for that time period, it was all I could do.

Last night fixed it. That’s the only way to say it. I didn’t do everything perfectly, but I think I did more jumping than sliding. The pair of medics I ran with worked seamlessly. Their relationship as friends outside of work allowed them to quickly adjust to any of the situations within work. One of them said it probably helped that we had all good calls, our first bullshit patient of the night not existing until 330 in the morning.

I would love for all shifts to be like last night, but I know that isn’t how it works. We get good sets of calls right next the bad sets. We can save the life of one patient, and then forget something and almost kill the next. No pressure.

CrC

About Damn Time

2009-04-12T13:34:00.003-05:00

One of the medics called me, I wasn’t in the truck and we needed to go. They told me it was a shooting, but if you think I believed them, you’re crazy. I trust these guys, but I would not put a good prank past them.

I started believing them pretty quickly; especially when the calm driver, started driving like the crazy driver. I’ve riden with this medic a few times; he’s never driven like that.

It was in the projects, the guy was young. Lying on his side, he could have been sleeping. One problem: the pool of blood flowing away from the body. The outside of the pool was the typical color, however inside has this whitish sheen to it. It was two different liquids mixing that were never intending to mix.

Our shooting very quickly became a homicide, and given the fact that his eye was almost sticking out of its socket I didn’t really find that all too surprising.

CrC

So Not A Code Two

2009-04-12T13:30:00.004-05:00

The call came out as a man down in the French Quarter. And that’s just what he was. A man, lying down, in the middle of the sidewalk, calm as can be.

We get him in the truck, stick the 3-lead on and before I know it the Sprint Medic is exclaiming, “He’s in V-TACH!” She immediately went for the pads, slapped them on and started up the machine. I stood near the side door watching. I had been considering getting a manual pressure but one of the other medics was in the process of getting a line in on the left arm while the Sprint Medic’s actions took over the entire right side of the patient.

Both talked him through the shock, warning him that it sucks to do it without drugs, but they had no choice. Even I was holding the ceiling bar rather tight in anticipation. I’ve never seen a patient take a shock very well while awake. They tend to not like people afterwards. But for a man who didn’t have a working heart, he sure was a nice guy. He took it well, no fighting, or cussing.

The next few minutes were spent getting lines in, administering drugs, checking his vitals and hooking up the 12-lead. You know; the usual post-almost-dying routine.

He was fine the whole way in, appreciative, polite, quiet. He had a few questions, but was rather stubborn when it came to what had gone wrong. He was determined to say it had everything to do with his new medication and nothing to do with the passage of time and a change in his physiology, but even the ER doc had his doubts.

I had a V-TACH that was talking. I hear it doesn’t happen all too often, I didn’t understand half of what the medics were doing with various drugs and administering the shock themselves, but that was a good call.

CrC

Don't Jinx It

2009-04-10T13:52:00.002-05:00

I couldn’t hear the radio, but when the medic turned around she looked excited. It’s a 34s (shooting), two hours ago I had been explaining to her how I don’t get shootings, or traumas, or anything remotely bloody. That just isn’t the way fate hands me my calls. I could tell she was excited for me.

I asked if they were kidding, I’m gullible, I would fall for that. But they weren’t. I was getting excited. I couldn’t believe I finally had one. Then I yelled to the medics “Wait, don’t jinx it.” I think they both laughed at me.

Racing down the highway I was trying to remember what to do with a gunshot patient. Playing with the gloves in my hand, my mind was too busy with the excitement of the situation. I was glowing, finally this call, it was about damn time. It’s only been 30 shifts and three months. Statistically, I should have had a shooting by now. Every time I’m on a truck they always tell about the great one they had the other day. Yes, thanks for rubbing it in. I don’t get traumas, I get it.

I kept thinking something was going to change. I kept thinking, “Please let him stay shot.” Once you’re shot, your shot. No idea why I thought saying that in my head would help.

As we were pulling off the freeway the medic yelled that he wasn’t shot. Shocking right, of course he wasn’t shot. If he were shot that would mean the EMS Gods were being nice to me, I’m beginning to think these EMS Gods have a sick sense of humor.

The medic said he had just been hit by a gun. I can take that, guns are heavy, they inflict pain. They can be bullet-less and still cause severe trauma. Right…I just had to keep telling myself that.

We get on scene and he’s holding his stomach, someone had driven by, smacking him in the belly with a shotgun. He had no apparent anything, and was not acting like someone in pain.

That’s when one of the police officers walked up and said “103M.” I know the NOLA medics know what it means, for those of you outside of this city, take a guess. In the politically incorrect way of phrasing it, the patient is crazy.

Yes, that’s right. I went from a shooting in the hood; to a 17 year old, mentally unstable kid who had broken out of his mom’s house. If I’m on your truck, this is how it works, no matter how much of shit magnet you may think you are.

CrC

Distraction Game

2009-04-10T01:37:00.004-05:00

The call came out as leg pain, but of course we had to drive half way across the city to get there. The man at the front desk had called 911, unaware that our patient was always in this amount of pain. She had a pinched nerve, which left her with an obnoxious level of consistent pain, no matter what measures the doctors took.

She had an easy smile, and was a complete sweetheart. Once she was loaded up we asked which hospital she would prefer, she didn’t care. She had only been in New Orleans for two weeks. The last time she had called this city home, she had been on a bus headed God knows where, no choice on the matter.

Since there wasn’t much to do beyond taking her vitals and making her comfy, I started playing the distraction game. Call it my way of treating patients like family. The goal: talk to them about anything and everything beyond why they are sitting on your stretcher. For me it’s an easy game. It didn’t work in Lying & Deception, but you can’t win every time.

Only I didn’t really have a chance to make the first move. She was already in play. The pulse ox on her pointer finger had become a miniature puppet. I haven’t the faintest idea what her one act play was about, but I can tell you that each character had its own voice as well as personality.

The medic and I couldn’t keep a straight face to save our lives. But then again neither could our patient. She is one of the few people I have met on the streets who laughed more than I do. She was a nice break from the usual.

When we got to the hospital I questioned her sanity, but the medic seemed to think she was as sane as they come. However, I’m not sure what that means about the medic’s mental state. Although he’s normally pretty calm and level-headed…

We had been on the wall waiting to get triaged when two Room 4 patients came in. Two shootings back to back. Like the kind I’ve never had. When a Room 4 comes in, the triage area goes on hold. The patients that are having no issues with survival go to the back of the line, but then again I guess that’s why they call it triage.

What’s weird is, had we not gotten our patient we probably would have been one of the units called out to the shootings. Just my luck, right? Now that I've experienced her enthusiasm, I would have taken our patient over a shooting any day. I know that sounds surprising, I never get traumas; I should be jumping at the chance for mangled bodies. But she was different, she glowed. The pain didn’t make her angry and bitter, it forced her into a level of happiness I've rarely seen rivaled. And that’s something I can aspire to.

CrC

Sidebars

2009-04-10T01:30:00.003-05:00

There were five trucks on the ramp and a Room 4 - read “Level One Trauma Room” – was on the way. Within 20 seconds the medic had forced all but one of the trucks down the ramp. Not all EMS services feel the need to clear the ramp for a Room 4; but this medic wasn’t going to have it any other way. She was determined.

“You have gloves?”

Always

“Alright, I’m going to drive this last truck down. Stay up here and help out.”

I pull out my gloves; I can see the Room 4 truck coming. I turn around expecting to see a few other medics like I usually do; only I’m alone. Just me and my gloves. Talk about daunting.

The medic in the truck smiles at me as he pulls up, I return an enthusiastic wave. I think he might be as surprised as I am that I’m the only welcome party they are getting. Looking back I sort of figured no one would trust me enough, technically it’s hard for me to mess up packaging a patient to get them from the truck into the hospital, but that doesn’t mean I haven’t given it an honest try before.

I open the back doors; the motorcyclist is strapped down and hooked up. The medic is calm as can be. She’s Tortoise, from Tortoise & the Hare. I unhook him from the monitor and it’s time to unload.

The medic who grabbed the back of the stretcher hands it off to me, I have the gloves on, and half of everything is covered in blood. I’m at the patient’s head, so I’m the first one in Room 4. I’ve never walked into Room 4 with a patient (Anti-Shit Magnet); I’m usually trailing behind whichever crew got the trauma, hoping to squeeze into an empty corner. Eyes open, ready to absorb the chaos.

We line up the stretcher with the bed, the medic and I make eye contact. My count: one, two, three. Only I grabbed the stretcher rather than the spine board, so I’m trying to lift something that has no possibility of sideways movement. Luckily, one of the nurses at the head grabbed the spine board as well. I bet that lift was a little heavier than she was expecting. As the medic pulls the stretcher away I go to lift up the sidebars of the bed. Out of habit I guess. It’s not until the head nurse stops me twice that I realize what I’m doing. Traumas strapped to spine boards can’t really fall off the bed as easily as the usual patient. I guess never really thought about that until now.

CrC

Lying & Deception

2009-04-06T13:20:00.008-05:00

The creator of PostSecret came to Tulane last week. For those of you that have never heard of it, click the link. In essence it is a social science experiment that has snowballed. Participants (anyone) can write their secret on a decorated postcard and mail it in to a total stranger (the creator). Some of these secrets are posted online, some in books, and some probably manage to get lost in the mail.

The creator has become relatively famous, specifically in regards to one of his quotes, "There are two types of secrets, those we keep from others, and those we keep from ourselves."

Earlier today I sat through a neuroscience lecture titled none other than "Lying and Deception." If I didn't know better, I would argue karma was trying to say something. So here it goes...

Most of you have an opinion in regards to College EMS. I've heard the good and the bad, and have even, occasionally, been known to defend them as more than a glorified taxi to my fellow students. What can I say; I went through Basic class with half of their current third riders, if their training sucks, so does mine. No comment on that one.

In my freshman year I naively applied to College EMS. I had known about them since first visiting Tulane, and had immediately decided I wanted to be a member. I saw College EMS as the best way to serve my community, as the best way for me to get my hands-on experience. Don't judge me too harshly, at the time I didn't know about the VIGOR program.

I heard through the grapevine that I was barely denied membership. Turns out a few of them questioned my ability to show compassion in an emergency situation.

There's a Garth Brooks song that goes, "Sometimes I thank God for unanswered prayers."

I don't pray, but the point's the same. Even immediately after I didn't get in, I realized it was probably the best thing that could have happened. Were I a member of College EMS, I wouldn't be writing this, I wouldn't be running with NOEMS as often as I do, and I sure wouldn't have the same amount of appreciation in regards to what we do. I would just be one of the many with an increased hours on duty to call volume ratio. And that's no fun.

It was early morning when the call came out, an hour that guarantees a certain level of ETOH. The street was a common one, there are three different versions within a half a mile of campus. It could have been a little old lady who fell, or in our case, a drunken sorority sister. Their blood's the same color regardless, right?

The whole night I had been playing the distraction game with our patients; get them talking about anything other than why they called 911 and they calm down, answer our questions, and let us do what needs to be done. I tried with her, I really did. She goes to my school, she shares my name, I knew her date - I thought it was a done deal. Boy was I wrong.

Once we were in the truck she wouldn't stop complaining, crying, wiggling, and all told being annoying. She whined about her hair, her embarrassment, the IV stick, her missing cell phone, and my favorite - the fact that this had to happen the first time she wasn't blackout; meaning she would remember it in the morning.

I couldn't stand her, she was the worst possible representation of a Tulane student. She made me angry because I knew that this is what so many people see when they think Tulane. It's not the public service we do, or the kick ass education we get, it's Broadway & Zimple at 3am on a Wednesday morning when the rest of the city - beyond Bourbon - is sleeping.

College EMS was right, I had absolutely no compassion for her. I know you are supposed to treat every patient like they are a member of your family, but I just couldn't. It was all I could do to hook her up to the monitor, take her BP, and keep my mouth shut. I had walked into the call with an open mind, but her attitude grated me in just the wrong way.

Looking back on the call, some sleep and warm food in my system I realize how immaturely I had been acting. She chose to drink, but she didn't choose to fall down the stairs. Like so many of us, she just wanted to have a good time with a cute guy. And I wouldn't dare fault her for that. Her version of the story may have been a little different, but I had no right to judge. The laceration on the back of her head was real, the pain she felt was real, the embarrassment she went through was real, and even the urgency with which she needed her cell phone was real. Her way expressing it may have annoyed me to no end, but that was her right.

I was lying to myself that night. In my mind I had done everything she needed. She was belted in, vitals were stable, no profuse bleeding from her laceration. What else was there to do? I did everything that was necessary, but then again I guess that's why the word "could" exists. I can always do more for the patient. Whether it's something I can say, a concept I can explain, or a pillow I can invent. But in that moment I was so distracted by my own anger I lost track of my priorities. Now I'm just mad at myself.

I actively did nothing wrong, but that doesn't change anything. She deserved better, no matter what lies I may have been telling myself in the moment.

CrC

Keeping Pace

2009-04-06T10:34:00.004-05:00

Twenty years old, 32 weeks along. Her contractions were three minutes apart, lasting 30 seconds max. She was as consistent as you can get.

She sits on the stretcher, and questions start flowing. She tries to start telling the, "What I was doing when this happened story," but she is interrupted. There are more important things that need to be known. How many pregnancies? 4. How many kids? 2. Medications? Vitamins. Allergies? NKA. Gestational diabetes? No. Did your water break? "It never does, they always have to do it for me." Do you feel the need to push? No. Pre-eclampsia? No.

The questions kept coming, at the forefront of the discussion as they were thought of. Weird thing is that I was doing a lot of the talking. I might have even cut the medic off a few times, sorry. In the end the medic probably asked the important ones, but honestly I can't remember.

All I know is that I wasn't silent. I was there, in the moment, not at a loss for words; not in awe at the medic's ability to remember to ask all those questions because I was there, keeping pace with him.

Yay, go me.

CrC

Running on Caffeine

2009-04-06T08:18:00.004-05:00

When I'm running on caffeine I forget to think things through...

Like how I was sitting on the UH ramp drinking my Dr. Pepper, talking to a friend. The medic comes out and announces that our last guy really was on drugs. Our patient lied, what a shocker. So in my infinite wisdom I decide to release my frustration rather loudly, while the doors to the ED entrance are open.

I got five nurses and a UH police officer outside within ten seconds. Oh and a nice little chiding on how not to yell on the ramp of Charity.

Now why was I frustrated, it's not like he coded in front of everyone and I yet again missed something? But in my infinite wisdom, that's what I thought happened.

CrC

~ I know it's not the usual, but I find my retarded moments sort of hilarious.

A Real Emergency

2009-03-28T13:09:00.005-05:00

This time last year, driving home from Colorado. Our Scout Troop had been on the road for a day and a half; we were 2 something hours from home. But as usual my bladder decided not to cooperate, so we made one of our all too common pit stops. I had the chance to drive, but neither my dad nor I wanted to have me driving through north Houston traffic with the trailer, I just didn't have enough experience.

We loaded up, the boys in the back, too exhausted to even play the X-Box they had somehow configured - it's a big truck but even I didn't realize it's game room potential.

My dad reached highway speeds, the road was clear ahead, the only traffic 100 meters back in our rear view mirror. That is until the white SUV pulled out in front. She had been sitting on the right hand shoulder, but then decided to make a u-turn across the median using one of the "Official use only" paths. My dad swerved to the left, onto the opposite shoulder. Our truck was within inches of her front bumper. When he went to bring the truck back onto the road something happened. Maybe he over-compensated, maybe the trailer was yanking in the wrong direction; but either way, we were spinning. First to the right, then back to the left, the wheels making a screeching sound that the yells of the boys barely covered. All I kept saying was, "I love you daddy."

Once the truck stopped, the trailer was at a 90 degree angle to the hitch, we were facing oncoming traffic, the back axle of the truck off the side of the road, along with one wheel of the trailer. The white car had kept going, probably a mile in the other direction, clueless at the mayhem she had caused.

My dad immediately jumped from the truck, and I wasn't too far behind. I yelled to the boys to stay in their seats, we had all escaped uninjured, but we didn't need to take any unnecessary risks at this point. The passing motorists had had no choice but to stop, had any one of them hit our truck, the outcome would have been significantly different.

Amazingly the trailer and the truck sustained only slight damage. Both were still drivable. We got lucky.

Upon returning to the truck I talked it over with the scouts. All of them two or three years younger than me, all of them finding what had occurred amazingly funny. I guess you could say it runs in the family to laugh when something like this happens, because my little brother was laughing the hardest. He was recounting his version of the tale, but his was a little different than the rest of ours, he hadn't been wearing his seat belt.

I've never been more furious. I've written about Angry Love, but in that moment, I was living it. In the next two minutes I used more foul language and inappropriate terms than I probably use in an entire six months normally. I told him just how idiotic his actions had been, and I kept asking what he thought would have happen had the truck rolled. He kept laughing it off. I wasn't finding it very funny, although the relationship that I have with this group of scouts made it nearly impossible not to laugh with them, as they laughed because of me.

It is this moment that I remember when we go on calls where there is family present. Where the family is overbearing, in your face, wanting to know what the next step is. Those calls where you would have barely any breathing room normally, but the family is nearly suffocating you. On calls like that I always have to remember what it feels like to be in their shoes, with their level of experience, and typically their lack of training.

What if we had rolled? Our truck is well built, but seven people in an SUV, one unrestrained, at highway speeds, a trailer on the back end. We got lucky. At that point in my training I had only learned about traumas, I had only learned about MVCs. I had never responded to one, cared for the victim of one. In that moment, all I could feel was the gut instinct that, had we rolled, my brother would have had no better chance than a sour patch kid in a blender.

That's why when we arrived on scene to a pick-up facing the wrong direction, missing both of it's front wheels, I was ready to deal with the patient's daughter. She told us to take her mom to the closest hospital, "This is a real emergency." Our emergency was smiling, in very little pain, only a bad bruise on her sternum, like the kind you could get from a seat belt during an MVC. But to her daughter this is probably one of the scariest things she's ever been through. All I could do was smile and say, "Yes ma'am, we'll take care of her."

CrC

Déjà Vu

2009-03-22T19:02:00.006-05:00

5000, a post I have learned to appreciate…occasionally, in very limited doses. However, I don’t want anything to do with it after three hours of nothing. Thank goodness for Folgers. What would I do without those guys and all of their clogged arteries?

I had no idea where we were headed; I heard chest pain and thought, “Thank God it’s not bullshit.” I tend to have more patience with the bullshit when I have had some other calls to balance it out. Three hours of nothing is not a good way to get me pumped for a frequent flyer.

Driving in I knew we were out in no man’s land. But there was something familiar about the view from the back of the truck. I had seen this area, at night, from the same position. But I couldn’t place it. An advantage to not having a radio; each call is like a present, I have no idea what to expect, but I better be ready to hide my emotions if it comes to that. Don’t worry Folgers didn’t let me down.

The minute I saw the NASA signs I knew where we were, and my gut sank. Memories of Four-O-Five came flooding back. Not again. What with all the coworkers watching as we couldn’t save him, the empty oxygen tank, the dead man’s phone ringing as he was being pronounced. It was his wife, clueless, probably upset because he didn’t answer immediately. Not my favorite call ever. Not a nightmare, but no one likes reliving moments like that. You question every action from the first time, all while wondering if you aren’t making the same mistakes in a different way this time around.

The medic had heard of this call, he knew I had been here, he knew what had happened. That was surprising. Yes, I wrote about it, but reading what I write isn’t the same as hearing the story and seeing my face change as I describe a call. I know how to write, but I’m not that good. He knew what I had seen, but I doubt he recognized what it meant to me, he probably won’t fully realize that call’s impact until he finishes reading this post.

I’ve always heard about the calls that haunt you. The ones that make you question your sanity and even your presence in this field. I can’t say I’ve had any nightmares about calls, but whenever anyone outside of EMS asks me if I’ve gotten any good calls I always think of the first time I went to Folgers, and immediately answer “You know, the usual. Chest pain, trouble breathing, I had my first so and so the other day.” They don’t need to hear about my good calls, I don’t want them hearing about my good calls. I’m not going to ruin their day if I don’t have to.

My good calls are emotional, the ones that remind me we are all human. That remind me of the good we do, and the sheer power of a willing pair of hands and a caring heart. My favorite calls are the ones that I learn the most from; where I not only see the patient but get to interact with the onlookers. Each time I see a new mixture of reactions - the fear, the love, the willpower of survival - it makes me love being on the truck that much more.

Six weeks ago I watched as the Folgers night shift saw one of their own pronounced. They watched as the firemen pounded on his chest, they watched as the medics and doctor started to realize there was no getting him back. They were desperate to do something, anything to animate him again. This couldn’t possibly be happening; an hour ago he had been shooting the shit with the rest of them. It had to be a bad dream.

As far as emotions go, these were the ones I’m talking about. They were raw. Macho complexes and bitchy tendencies out the window. Shit like that didn’t matter. He was dead.

Six weeks later we pulled up to the factory, a different area. The smoke from some equipment creating an eerie fog resting at ground level, the kind you see in bad movies, too fake to be real. Only this was as real as it gets.

The other medic wondered why I was bringing in the suction - because last time a man wearing a shower cap had to escort us to the patient on a golf-cart. This time around we went 15 feet into the building. Thank goodness. The patient’s internal pacemaker/defibrillator was the only thing that kept him from giving me déjà vu. No pacemaker and he would have been on the ground, and the medic had better have been proud of my foresight. Lord knows how I would have handled it; at this point I wasn’t particularly enjoying myself.

As the medics were getting the patient on the stretcher one of the supervisors questioned their actions. He was confrontation, his fear coming across as anger. I’m sure it happens often, it happened in Angry Love. I’m just glad I didn’t lose patience. Now why he had the urge to ask me, I can’t say. Maybe it’s because I was the one not actively involved in the patient’s care, I was the one most easily attacked. Who knows? I bet it’s not because I looked like I was in charge.

On the ride in I was silent, the confusion of the patient’s off-set pacemaker causing enough commotion to keep the medics occupied. I sat next to the heart monitor, silencing it anytime his PVCs broke the boundaries. With this call I was nothing more than a bad tech. I had trouble getting his blood pressure, I put the right leg lead on his left side, and I was slow reacting. Now you know why. Even my usual sanctuary of laughter couldn’t help me; nothing was funny about this one.

I hear with time it gets easier. A rather discomforting thought.

CrC

The Purple Disc One

2009-03-22T18:43:00.003-05:00

Not an area of town I would walk down at night, alone, or at all. Well that’s most of the city, but you get the idea. He was sitting at the bus stop, the surrounding area desolate. I didn’t even realize we had gotten to the call until both medics jumped from the truck.

In the truck I went to put the 12-lead on, only both of his shirts were soaked through. I thought maybe he had been playing in the sprinklers, but that version of the story didn’t seem to fit his personality or location. If only I were kidding. I always hear about diaphoretics, but this guy, he was swimming in his own sweat. I had my own internal personal victory dance when the stickys finally stuck.

Tourettes and asthma, his lungs completely blocked; the familiar wheezing of trapped air inaudible. He was bad. I get him on oxygen, but the non-rebreather stayed useful for maybe 20 seconds before the Atro-vent was ready to go. Great timing Mr. Medic.

He had no ID and his difficulty breathing made it that much harder for him to answer our questions. Good thing the most important question only required that he shake his head in acknowledgement that our efforts involving the blue cigar and the “big stick” were working.

He was one of the most even tempered patients I have ever seen; no complaining, no grimace with the IV, no sound effects to accompany the fear of no air, and even a lack of curiosity involving the transport. Just the rise and fall of his chest as each intake progressively get easier. I wonder if it was the Tourettes that initiated his silence, or simply his inability to breathe. Even respiratory patients have questions, concerns, or commentary when it comes to our way of doing things.

This guy was one of the few patients where I can admit to looking back on him and actively hoping he is doing alright. Yes, I wish the best for my patients, but I like the theory of no worrying about them once they are in the hospital’s hands. Even the ones that I write about tend to disappear after I am done with that particular post. As if my initials at the end of each entry equals the end of my involvement with them. But I wouldn’t mind hearing this guy’s story. I’m sure he has a good one, and I’m sure he has had plenty of experiences with the misunderstandings caused by the Tourettes; including a few that I might learn something from.

CrC

Breaking Bad Habits

2009-03-20T06:54:00.003-05:00

Takes initiative without being asked........3

Every time without fail. Every other medic gives me straight fours or fives, with no variation. But the two of you. You know I'm not perfect, and I'm not always above average. There are some things that I'm sure I even do below average. Ya'll just never admit it. Honestly, that would probably hurt my feelings if I ever got a 2 on anything. I'm not a big fan of below average.

The two of you have seen me at my absolute worst. By far, my shifts filled with one too many moments of stupidity and a lack of common sense have been under your guidance. Who knows, maybe I'm just more comfortable around ya'll, more openly willing to be the idiot that I occasionally embody. In any case, I would hope you don't hold those moments against me.

In 25ish shifts I have become accustomed to being the third rider; while yes, I am better VIGOR than most of the medics have ever dealt with, my red shirt comes with expectations that even I can't escape. Any time I ride with a medic I've never met, it's like my first day of school all over again. Learning the ropes, learning how they want things done; figuring out their sense of humor, and whether or not I am truly welcome on their truck, or just another burden accompanying the long shift ahead. I am always timid on the first call, I'll carry things, I'll talk to family, but rarely do I interact with the patient. For me the first call is my "get to know you session" with the medics. You may know nothing about me beyond the gossip of the streets or my words on this site, but I learn more than you realize based on how you handle a call and treat a patient. After the first call it's up in the air. If I think the medics are comfortable with me I tend to do more, but I am still wary of walking in first or being the immediate connection between the patient and the medicine.

That said, I can't take initiative if you don't give me the chance. I'm going to process things slower than you, and I am going to react with a lack of confidence that comes with a lack of experience. I know my limits, and even though I have faith that ya'll would never let me forget something vital to life, I still need more time than you are used to allowing.

So I'll make you a deal. Force me to go up first and talk to that patient. Hound me until I have completed every necessary step. Make sure nothing slides. But give me the time to process. Every time I do it, it will be that much faster, until one day I'll finish before you realize I even started.

From my point of view, I am a third rider trying to break the habit of being a third rider. No matter who you are, as a medic you learned to treat the patient with two pairs of hands, that's it. How often do you have a truly competent third rider? It's different when I'm with you. I want to get my hands dirty, I want to be a part of the mess and the muck, but if the system you and your partner share has no room, or no patience for me, then I back down. I need a shove; I need to know that you really are okay watching me handle a call, rather than just saying it for show. This isn't going to happen after two shifts. But if you're willing to put up with me again I'll be there, eager and ready to go.

See you in April,
CrC

P.S. - BB I haven't forgotten about you, and I would love the chance to ride with you.

Toilet Baby

2009-03-17T13:57:00.009-05:00

Leaning against the bathtub, her thong at her ankles. A towel was laid across her lap, on it a fetus, maybe 18 weeks old. Her friends were in the room down the hall, trying to control their emotions, not succeeding. She was the calmest of them all, in a daze from the baby she hadn't known about until 30 minutes prior.

This was her second miscarriage, she was 21, from my hometown. She had taken a pregnancy test a while back, but they had told her she wasn't carrying. Boy were they wrong.

The medic immediately took the fetus, wrapped it in the cloth from the OB kit and placed it in the plastic bag. She used the cord clamp to seal the bag. Most of items in the kit were used, only for a different purpose than originally intended. The kit doesn't say it is to be used only with the live babies, I had just never associated it with the ones that don't survive.

The hardest part about this call was convincing the patient to get into the stair chair. Yes she could walk, but we had no plans of taking that kind of risk. We had no way of knowing her level of blood lost, or her shocked body's level of stability. Technically she had just delivered a baby, a dead baby, a toilet baby, but a baby. No way in Hell was she walking.

At the hospital she asked the medic if she could hold the bag containing the fetus. A strange request from my perspective, but since I've never been pregnant or had a miscarriage I wasn't going to comment. Warm, wet, and dead; not a combination I ever want to hold for an extended period of time. The entire set up reminded me of the pig fetus dissections from Bio Lab, they come packaged exactly like the baby was then. I was more relieved than I could have realized when the nurses transferred the fetus to a pink bin. Now it was just a plastic bin with a towel across the top, not a plastic bag with a distinct shape.

Nothing exciting happened between the ED and L&D, I just kept thinking how glad I was that I didn't have to take any bio labs in the near future.

CrC

Angry Love

2009-03-16T23:40:00.006-05:00

She referred to her husband's battle with cancer using the pronoun "we." As if she were the one who's body was fighting for every breath. As if she were the 60 year old man spitting up green mucus everywhere, as if she were the one pronounced terminal. No matter that the medic was intentionally facing the husband, his back to the wife, she continued to answer. No matter that we used words like "sir" and "you," the wife was just as sick as her silent husband. Who, by the way, didn't seem to see what the big deal was. He was hacking with every breath and only had a 90% saturation on oxygen, but he was fine. Those anti-anxiety drugs must have been working like a miracle.

It's been a long time since I've seen anger like I did coming from the wife when I went to read the pill bottles. I immediately gave her the option of listing off the medications, hoping to console whatever feelings I had offended. Instead, I could swear her gaze became more intense. My red shirt seems to make some people assume I'm the one to talk to, I stick out. I can't imagine why, I'm always the youngest one on scene. I could have sworn people didn't trust youth; we are "flighty, immature, and lack the experience to make any rational judgements." But since she was glaring at me, I just listened and glanced at the medic as he wrote them down, praying he would ask the right questions for each medication. Remember I don't know meds, and I don't particularly enjoy being on that side of that kind of anger - not a good combo. He finally asked a question, the kind even she couldn't answer. Forcing her attention to focus on finding the magic drug sheet. A useless sheet to us, but at least it got the negative energy directed towards an inanimate object.

The disease had overtaken their lives, a cramped apartment in the city rather than the spacious ranch she was so used to. A bouquet of cigarettes on the side table rather than the usual bouquet of wildflowers. A small patio overlooking a dark alley rather than a porch with rocking chairs. If she wasn't answering our questions about her husband she was huffing and hawing about their horrible living situation. On St. Charles Ave, their horrible living situation. She paced between the bedroom and living room occasionally sipping her coffee - maybe that's why she was so jittery. It was clear that she was distraught, but I felt like she was putting on a show. Normally I will notice one or two of these qualities in a loved one, not all of them at once. To top it off she had her Reverend there, not their Reverend, her Reverend. Although he reminded me more of an absent-minded professor than a man of God, but what would I know; I tend to spend my Sunday mornings catching up on sleep from the Saturday night shift.

When we had arrived the wife was surprised by our numbers, three from the ambulance and five from the firehouse. I guess she was used to a little less attention when her husband's condition got to the point of hospital transport. I just kept thinking that things work a little differently in the city. If we have the resources available why not use them. The rule where fire responds to every chest pain and respiratory call may not make sense to everyone, but it's fine by me. I feel no dismay at not helping move the patient when there are five burly men ready to prove their strength. Plus this gives me a chance to put everything back in the truck or clean the mucus off the stair-chair without a sting of regret.

CrC

Razors in the Fanny Pack

2009-03-16T19:43:00.001-05:00

He told us that he hadn't called the police because every time they came, guns were drawn. The medic and I just looked at each other, I've never felt more safe. Of course the leg pain outside the McDonald's wasn't leg pain, but it wasn't bullshit either. This was about as crazy as crazy gets. It had been one of those nights full of giggles, I've never had something sober me up so well. Even my newbie self could figure out that laughing in the presence of this guy would only cause serious problems.

He managed to talk his way out of the blood glucose prick, saying he freaked anytime someone pricked his fingers. Being a heroin user we could prick his arms all we wanted, but no way in Hell were we touching his fingers. Thank goodness he told us this before I said, "little stick." I was the one leaning over him, unbalanced, most easily caught off guard had his behavior come to that.

On the way in the medic and I sat in silence, occasionally exchanging glances when the patient's casual conversation become uncomfortable. Why he thought we would feel the urge to discuss his previous violent psych outbreaks is beyond me. He rambled for the entire drive, a rather long one given the EMT driving had managed to take a wrong turn or two on the way to the hospital. Any other call and it would have been funny; but on this one, there was nothing laughable about five extra minutes in the truck with this patient.

Once our patient was in the psych room of the hospital I was not only relieved, but happy I had been lucky enough to get that call. It had been the first real call of a night that had been frustrating me with bullshit and drunken revelers. I won't say I was scared for my safety, but I had no plans of hosting a tea party with this particular patient as a guest any time in the near future. Hell, I've never really enjoyed tea so I think it's a moot point.

I like psych calls, but I don't get many of them. Each patient has a personality that can be explained in a way that fascinates me. They are a uniquely alternative way of looking at the world. He was no exception. I would never want to be crazy on a regular basis, but I wouldn't mind being able to momentarily see the world through his eyes, feeling his anxiety and fears. Better able to understand his perception and outlook. Then I might even be able to figure out why he had razor blades in his fanny pack.

CrC

Back to Basics

2009-03-16T14:13:00.003-05:00

What does DCAP-BTLS stand for?

To assess what do you do?

How do you feel?

How does a previous CVA change the report?

PSMs times how many...?

Oh yeah, we have four extremities. She may be paralyzed on her left side, but there better still be a pulse. I don't function well without food, or maybe that's just another excuse and I flat out don't remember this stuff.

I felt like an idiot, he had warned me I probably would, I'd thought he was kidding. He was calling me out on my shit, and I deserved every ounce of criticism. I had been so busy focusing on learning how to help the medics I'd forgotten how important the BLS is. Medics do it in their heads, flying through well-rehearsed checklists. Lists I haven't needed to know since last October, that is until he started questioning me.

I'm useless if I can't provide basic-level treatment to a patient. End of discussion. I can make up every excuse in the book, but that's the bottom line.

I need to cement the real way into my routine, watch the medics, borrow what I like, discard what doesn't work for me; and in the end come out able to handle the calls in a way that appropriately treats the patients without driving me crazy in the process. If I can manage that, then we can talk about a 5 out of 5. Until then I think I earned those 3s and 4s.

I get distracted by the drugs, by the patient history. I become wary of drugs I've never heard of and conditions I only barely understand. There is a reason the medical section of the Basic exam has low blood glucose as the cause of altered mental status. Why didn't that automatically come to mind on the seizure patient who kept shaking our hands? It took over ten minutes to get him into the truck so that we could check him out, it should have been immediate.

I can watch as many calls as I want from the third position, but until I get my hands out of my pockets and am the first to talk to the patient I'll learn only so much. I need to do. I've learned it, whether or not I'm too timid to admit it, I've learned this. I don't remember it all, but at this point I just need to jump and hope I can swim. Like the medic said, "I'm not going to let you kill anybody."

CrC

Night & Day

2009-03-16T12:45:00.004-05:00

Disclaimer: I'm not even going to begin to say I have experienced a true selection of days shifts, I don't even count my experiences at night as that much to compare to, so how could I possibly say I know what it's like to ride days?

At night the lights bounce off of everything - from the roof tops and guardrails to the front grilles of the cars. In the daylight there is no bounce, the lights are lost to the sun. The only reflections I ever see come directly off the shop windows. If the medics don't use the sirens I don't know we are going on a call until a busy intersection gets between the truck and the caller. If the call gets cancelled I'm clueless until we sit long enough so that I realize a red light is in our path. I like the bounce of the lights, it illuminates the city. Filling the shadows with vibrancy, even if for only a brief instance.

At night I use the CCC bridge as a beacon of sorts. Tell me which side of the river we're on, show me the bridge, and I can tell you what part of town we're in...in my own words of course. I don't know the districts, I don't know all your common locations, but I have developed my own system that gets me by. In the daylight I had trouble finding the bridge, it lost its beacon qualities; in the daylight it's grey, boring, and tended to blend into a gloomy day rather easily.

Rather than the few distinct features that are always illuminated at night, the sun shines everywhere; forcing my attention away from the things that normally clue me in. I have an easier time driving in this city at night than I do in daylight. Somehow I'm not surprised.

At night that city shines, plywood and blue tarps become concealed in the shadows and starlight. The city looks cleaner. It becomes hard to tell that fields haven't been mowed and buildings that have been empty since the storm aren't just momentarily vacant office space because businessmen don't work hours like ours.

On the calls that matter, when 4 am rolls around I always remember the silence of the scene; sirens become less necessary at that time of night, lights and a lack of excess traffic being enough to move most cars out of the way. Small talk is lost at that hour. Outside the truck, the streets resemble ghost towns but for the ever present hum of a diesel engine.

The medics took me out to a roll-over MVC, that whole anti-shit magnet having prevented me from seeing a truly bad collision. I'd call this one bad. I was able to see the mechanics of the crash and even the staying power of a well-placed barbed wire fence. What was most surprising had nothing to do with the crash, it had to do with the sheer number of people that responded to that call. One of my friends told me it could have been a scene from a Vin Diesel movie, I guess that's why there were three dozen plus city officials there along with a few non-discreetly hidden news crews. I have yet to see something at night garner this much attention.

Faces I have come to recognize didn't exist in the daylight. I felt brand new to an organization I've clearly earned at least a foothold in. The attitude of the hospitals was different, or maybe that fact that I was a new face prevented me from seeing the ever present cynicism I have come to expect on any given shift. I find the night-time humor comforting, a reminder that we are all in this together. No matter how bad the call, or how annoying the patient, you can count on someone to make you laugh. There was a different brand of humor in the day.

It's a different view when there is more light coming into the truck than is being let out. The city changes, I don't want to say it becomes more vibrant - that's not the right word. But it wakes up in the light, looking more like any other metropolis and less like the New Orleans I have come to appreciate. Or maybe I'm just adjusting too well to the night shift.

CrC

One of Those Moments

2009-03-13T12:57:00.007-05:00

I walked into room 13 and they had already tubed him - even on the good calls I miss the fun stuff, but of course I've managed to see at least half a dozen urinary catheters. I tell you...not as cool.

The phrase "patience grasshopper" keeps coming to mind. Although medics tend to just say "you will" with a distant look in their eyes. I will, someday, any day.

So I'm in the room and the nurses are joking around, passing the time. One of them comments that the patient had ice in his pants. My first thought: why did my patient have frozen water in his pants?

Just think, to some of you, I am the next generation...

CrC

Fighting Lysol

2009-03-12T18:58:00.005-05:00

A year and a half old, crying like the world is coming to an end. He had found the Lysol bottle and managed to spray it across his face. I'd have been screaming bloody murder too. When we first held him down to drip sterile water in his eyes he just screamed and wiggled. Each progressive time he got smarter. By the fourth time he was using his arms, legs, and even screams to prevent his eyes from being opened. What had taken two of us to do the first time, took four by the last cleaning. He was a fighter.

This call got to me, besides it being one of the only pedi calls I have been actively involved in, it felt funny. Something tells me I won't be able to forget this little guy for awhile.

CrC

Grandma's Attitude

2009-03-08T18:43:00.004-05:00

OK 10 and 32 - you know who you are. Only because I enjoy the mockery oh so much. Enjoy, and have a wonderful evening. P.S. if it sucks I'm blaming writer's block, or the o-chem test I should be studying for.

"Squeeze my hand. There you go, doing great."

IVs hurt, only she is squirming more than the average patient. Each time she moves it makes it that much harder for the medic to get the line.

"Just keep squeezing my hand. You're doing amazing. Almost done."

Eighty something with chest pain, I guess her previous surgeries hadn't helped with her aversion to needles. I had been trying to get her blood pressure, but somehow my hand became a pressure ball half way through getting the cuff on.

Sometimes it's not the medicine that matters.

She was a woman with attitude, the kind of grandmother every kid hopes to have. We were doing things at her pace, and that chest pain wasn't going to slow her down. It had taken more time to get her out of her apartment than it had to figure out it was probably time to leave for the hospital. She wasn't going anywhere without everything she needed. Only different people have varying definitions of "need." I definitely liked her style. It was kind of disheartening that she lost her particular brand of attitude once the needle broke her skin. Pain becoming the only thing that mattered.

She was one of the worst reactions I've seen to an IV, most people fear them beforehand, but sit and deal as it happens. She didn't really protest until the vein wouldn't cooperate with the medic. Then it was time for my knuckles to get their fair share of discomfort. Got to love it.

CrC

Beer & Aspirin

2009-03-08T18:31:00.003-05:00

Not my perfect dinner combination, but this guy seemed to think that it might do the trick. 21, only legally able to drink for the past nine months, although I'm sure his liver and mine are not in comparable states.

Even though he weighed about as much as I do, the eight beers and ten aspirin didn't seem to be working in the fashion he had intended. So two hours later we are strapping him in, but only after making sure his house and car are locked up - it's the little things that ease their fears.

Urban Cowboy to the letter, including the boots and a worn out NASCAR baseball cap; I wondered if he had ever rode a horse. Not important in the long run, but the thought crossed my mind.

He was one of those examples on how not to handle stress. Guess I'll stick with laughing at my stupidity, running on St. Charles, and when neither of those methods work, eating all the Ben & Jerry's I have in the freezer. Plus my liver might be a little happier with me in the long run.

CrC

If Only I Had a Brain

2009-03-08T18:26:00.005-05:00

En route to a car wreck, we pull up to lane 12 of the CCC, a crowd of fire and police personnel surrounding a woman, seated on the curb, using a non-rebreather. I'm a little confused why she doesn't have spinal stabilization in place, but that thought disappears about as quickly as it comes. It's past midnight, my brain is done for the day.

I get into the side compartment grabbing the spine board, only as I walk up the medic yells that we got re-routed, code three, asthma attack, in the middle of a busy highway - makes perfect sense. Why would I possibly think anything other than a MVC in the middle of the CCC?

That's crystal clear communication I must say.

CrC

Why Volunteer?

2009-02-25T22:26:00.002-06:00

You tell me...

Wide Eyed Newbie

2009-02-25T21:51:00.009-06:00

0630 Mardi Gras Day and Boss-man warns us we will be humping stretchers. He calls me out on my expression of confusion. Humping stretchers, not a concept I was familiar with. I understand it now, but in that moment it was just another reminder of how green I am.

Call this my midpoint review. Even though I'm only a third of the way through the semester, given my large number of rides lately this seemed like a good idea.

I like being a newbie, it gives me room for mistakes. I've made plenty, but I prefer the theory of not dwelling on them. Learn from your mistakes and move on.

As far as I know I have yet to ride with a medic who didn't like having me on their truck. But then again if I were a medic I don't know how comfortable I would be handing a Vigor a bad review after spending the past 12 hours with them. Seems like that might be kind of awkward. On top of that maybe they don't want to let me down, allowing my eagerness to make up for any of my faults. I'm no where near perfect, and I never feel like I did everything right. But I also recognize that mistakes are human, and the little ones can be easily recovered from.

Different medics have different styles. I am learning rather quickly which styles I prefer.

I like the speed, the adrenaline, the rush. Getting to the calls quickly, pushing cars out of the way, making yourself known. I know transportation times with trauma calls, codes, and CVAs are important; but I also recognize the sense of relief that exists when the ambulance arrives. The patient and their family are scared, we tend to relieve at least some of the fear.

I find it hilarious when medics get on the megaphone and talk to the drivers. Giving them instructions they should have learned at 16. Then again I find almost everything hilarious. I love to laugh and being in EMS has made me appreciate the funny moments even more. Sometimes I can't control it, sometimes I laugh at absolutely the wrong moment. I find the strangest things funny; and the stuff that the rest of you find normal still cracks me up. Then again I hope I'm laughing at the same things ten years from now.

I like having a plan before hand, so I hate not knowing what the call is before the medics open the back doors. I'll play guessing games based on how they are driving, but I have yet to win at that one. I could ask the medics every time, but if it is a call that requires attention, that doesn't seem like a good idea. I wore a radio on Mardi Gras day, didn't mind knowing all the calls from across the city, but recognized that my polo isn't set up for carrying a radio. Plus I got jealous any time we missed a good call, and that's no fun.

I like being in the mix; going in and doing the simple stuff, prepping what you need before you ask for it. I want to see what you see, hear what you hear, and understand how you reach the conclusions that come naturally to so many of you. I don't have nine months of condensed paramedic school under my belt. I have chemistry, biology, anatomy & physiology, and neuroscience. I'm missing the clinical education, the cookbook version of which symptoms combine to form which conditions. But I'm working on it.

Medics -

You each have your own style. Many of you do so many things that I appreciate and would never have thought to ask for. Since I've rode with such a variety, here are a few things that make me more comfortable and thus more useful on your trucks:

It doesn't take but ten seconds to tell me the call, I know you are trying to find how to get there, and half the time you might forget I'm in the back; but I feel so much more involved when I know what is going on in advance.

By letting me do the simple stuff that I find so amusing and that you find amazingly boring; it keeps me entertained; it allows you finish the paperwork more quickly or focus on the dying patient (whichever you prefer); and it also gives me a significantly higher view of you as a medic - yes I play favorites.

By forcing me to listen to the breath sounds that are funny, or learn about the heart rhythm that is wacky, the next time I see it, I know what's going on, and am thus better equipped to help.

By giving me the chance to ask the beginning questions, I am in the "doing" phase of "Learn, Do, Teach." A theory I firmly believe in. It forces me to get a better wrap around what's going on with a certain combination of symptoms. Plus once I run out of questions, you can easily fill in the blanks that my lack of knowledge creates.

If I do a good job tell me, if I do a bad job tell me why. I'll learn a heck of a lot more from my mistakes than my successes. Success only shows me one method, failure plus a better explanation gives me two.

If I ask the right question at the wrong time, tell me to ask later. If I ask the wrong question at the right time, give me the answer I need to know. You have the experience, you know what needs to be known to survive in this field, pass on your knowledge.

Thanks. If I sound a bit demanding, I probably am.

EMS is my sanity time. Living with seven other women could drive anyone crazy, by going on calls and seeing people in real trouble it reminds me that I don't have it that bad. I may want to kill some of my roommates, but at least I'm still breathing at the end of the night, so I can't really complain.

Dr. Pepper is my drug of choice. Hamburgers and french fries make me happy. And Peanut M&M's keep me from passing out at 3 in the morning when I haven't eaten since an hour before shift change.

I may be crazy, but at least I'm trying. You can't fault me for that.

CrC

Anti-Shit Magnet

2009-02-24T22:35:00.006-06:00

I don't attract violence, or traumas for that matter. Even though I've only been here for 20 shifts, I honestly believe I am an anti-shit magnet. Yeah, yeah, I just jinxed myself. I hope so, I feel like I'm missing out. I've had some really cool medical calls; I prefer medical calls, they are mentally challenging. But that doesn't mean I don't want a little violence in my training every now and then.

I got a pretty fair share of violence this weekend. That said, I wasn't ecstatic when we were pulled from the multi victim shooting to go tell a guy that had passed out to eat some breakfast. Bullets or breakfast, I pick bullets any day.

I was with the sprint trucks for the Monday and Tuesday, which meant I ran quite a few calls and transported absolutely no one. Walking up to my second shooting ever, the three docs, two other sprint units and ambulance medics (with their medic-in-training) had already loaded the victim onto the stretcher. As they walked up one of the medics yelled, "If you aren't actively helping get the fuck out of the way." Don't worry I stood in the background, looking through the side window, mentally creating a checklist. Sooner or later I'm going to be on a unit that responds to a shooting, and when it happens I'll be ready. This whole standing around clueless thing doesn't really work for me.

"Why aren't you in there."

He said to stay out of the way. Plus we got here late.

"You should have jumped in the truck as they walked up."

They don't need me

"How are you ever going to learn if you aren't in the action?"

...Great question. Let's hope that mental checklist holds up.

CrC

Red Bull Tears

2009-02-24T22:23:00.009-06:00

A teenager, scared, expecting to have a good time on Mardi Gras. Only the can of Red Bull she drank has caused her to start hyperventilating. Hands clenched, heart rate at 180, tears rolling down her cheeks.

"Baby girl...baby girl, look at me. I need you to calm down. Let's sit down, you comfy? Good."

She was leaning against my leg, and for the next 25 minutes my body was half way wrapped around hers, trying like Hell to keep her in a position of comfort. That was painful getting up from.

Anytime the crowd got too curious, or her attention shifted anywhere other than "my white face and pretty blue eyes," her breathing would speed up, her oxygen stat would go down, and her heart rate would skyrocket.

I tried to get her to focus on her breathing: in, out, in, out. But that only got her heart rate down to 130. Turns out telling her to breathe in, hold for three, and then breathe out obtains significantly better results. Along with forcing her to realize that she was in control of the tears and the panic. We were there to help, she just needed to trust our methods. When she did her heart rate would drop to 115. Still fast, but a heck of a lot better than what we started with.

She is only four years younger than me, but she automatically earned the name "baby girl." I wonder which medic I got that one from...? Respiratory calls are one of my favorite types of calls, and this one was no different. Being able to witness the turnaround in patients has allowed me to reach a state of awe in regards to the simple things we do for calls like this. No drugs, no docs, just words and a comforting tone.

CrC

Sky Blue Pride

2009-02-23T23:45:00.002-06:00

The call came out for an officer injured, had it not been Mardi Gras and on the riverside I'd bet there would have been a significantly larger response.

Spine in a neutral position, hands clenched to the chair. She was in a controlled panic. "What if" questions probably racing through her mind. A bag of beads to the back of the head can do some damage, especially if they chuck them hard enough.

I grab the c-collar and the medic talks her through it, "I'm gonna put this on real tight, cause you're a cop, it's going to be uncomfortable."

We load her up, minus the gun belt. And strap her down tight, as if she's a combative patient, this cop isn't budging.

"I'm going to let you lead the way." The cops clear a path, only one officer was necessary, we had six. That was a big path.

The medic and I had just come from a similar call, bump to the back of the head. But this call wasn't the same. She was one of us. She wore the badge and served the city. She protected what she loved. She was family. No matter what you tell me, everyone treats family a little bit different.

I wonder what the cops were thinking as they cleared the path. Worry, concern, fear, pride? In that moment I was proud, I know it was a bad moment for her, but I was there to help, and I had done just that. She had gotten the best care possible because of the medic, myself and the half a dozen other officers standing around eager to assist. I hope they at least felt an inner glow of usefulness if nothing else. They were involved in some form, rather than standing on the sidelines waiting for news. They had plenty of time for that after the ambulance left.

I know most of us are sick of the beads, boozers, and floats; but in that moment Mardi Gras meant nothing. All that mattered was the officer and her well-being.

CrC

Drunk of the Day II

2009-02-22T14:42:00.005-06:00

AKA - Best Patient Ever

Sitting on the Westbank it was 230 in the morning and we had only gotten four calls. Mardi Gras wasn't turning out as hectic as I had imagined. I had been so excited to run, this was supposed to be the busiest night of the year, if only. Then the call, a drunk on Bourbon. I would take anything at this point.

Our patient walked up to the truck, handcuffed, c-collar in place. Jumping from the second story of a burger joint will earn you just that. He didn't understand why he needed to go to the hospital, he felt fine, he was just pissed.

Strapped to the spine board he couldn't really fight us, but the minute he wouldn't answer the medic's questions and started thinking about escape it was time for restraints. Triangle bandages sure do come in handy. So do square knots.

His language didn't want to cool down either, so he earned a non-rebreather. I don't like being called names in general, but at that hour when we're trying to help you, it's just not cool.

The rest of the ride was nice and calm.

At the hospital he got angry again. Chill pill man, don't fight the twenty people trying to help you out, you're going to lose. He lost, but not before a spit hood, real restraints, a couple of head banging sessions with the wall, and a second dose of a B-52 cocktail.

I have to give the guy credit, if I'm going to have a combative patient, he might as well go hard and heavy the entire time. But then again what do I know, as far as he is concerned all we deal with are "band-aids and blood pressures."

CrC

No Hablo Ingles

2009-02-22T14:41:00.004-06:00

The first call of the night, my first call ever with a medic I had been trying to run with since I started. It was worth the wait getting on his truck.

He was missing his ring finger, sawed off two hours prior. Why did he wait this long to call us?

He had no ID, and had only been in the country for a week. This meant no phone number, no SS number, no address. All I got out of him was a misspelled name and some computational error involving his date of birth.

I've been in Spanish classes for six years, but I always need some warm up time before it seems to translate. 20 seconds and "no hablo ingles" does not equal warm up time.

Fast forward three days later, only this time I hear the radio. A fight, the victim does not speak English. My mind starts racing, thank the lucky stars this call was further out of the city. I find the page on fights in my phrase book, but then remember what a rather smart medic once told me, "a phrase book does no good unless you understand what they are saying back to you." Just in case I leave it on the counter.

I was able to translate what happened, thanks to the word "botella" in my book. Other than that I relied on what I knew. We got a decent history, and a half way decent description about what had happened. This call was nothing like the last one. I was talking to him, explaining, not simply using one word phrases and commands. As the intermediate jokingly put it, "for once you were finally useful."

CrC

Drunk of the Day I

2009-02-19T16:01:00.001-06:00

He went from being 28 and legally intoxicated to 20 and annoying all within the time it took us to get him into the truck and strapped to the spine board. A Texas frat brother he was the kind of guy I had been all to happy to escape when I came to Tulane. Silly me, I forgot that Mardi Gras brings in every type of person.

He seemed like he was having a good time. He refused to stop moving his neck, even realizing that he could still see me in the captain's chair from his horizontal view. I love how excited drunks get when they figure out that I am still visible, like it's the greatest discovery and one I would have never thought of. Tonight is going to be entertaining.

CrC

Stick-Figure Heart

2009-02-15T23:08:00.007-06:00

We sat in the back of the truck, it was two something in the morning and as usual I was curious about a patient. He was explaining the drug adenosine and its effects. His stick-figure heart nothing more than a circle drawn into quarters on the sheet covering the stretcher, that's my kind of classroom.

I can guarantee had I not had my neuroscience background I would have had only a vague idea of what he was attempting to describe. That said I can admit to falling half asleep in more than one of my neuro lectures, yet I am extremely glad for that background to cement my knowledge.

I don't know most of the drugs the medics carry; it's never been one of those things I found pertinent to organic chemistry, or any of my other classes for that matter. But I also know that each time a medic uses one in my presence I can count on them to, in the very least, briefly explain what is going on in the body. Some descriptions are more helpful than others, some are more accurate than others, but in the end I am learning something more complex than I would have thought existed.

"This drug doesn't just stop the heart, here is how and why." Those are the kinds of answers I have begun to look for; I don't just want to know what is going on, but also why its effects are so important.

CrC

Altered Mental Status

2009-02-15T15:58:00.014-06:00

Four daughters, two medics, an EMT, and their mother - who just can't seem to wake up. The call came out as possible stroke, she wasn't responding, scaring the daughters in a way most things can't. The first thing the medic did was take her glucose, "Lo."

"Give us ten minutes and she'll be back to normal." Looks of relief crossed all four faces. Who knew paramedics could work that kind of magic with the stick of a needle.

We push the D-50, glucose is up to 256, only she isn't responding in the same fashion most of the diabetics I have seen do. She won't talk, she barely acknowledges our requests and questions. They say some people take longer to respond, and given this patient's recent diagnosis of Alzheimer's, we have trouble getting a straight answer in regards to her normal mental status.

It's only once we ask the patient if she wants to go to the hospital that we immediately start loading her up. Her head nod ended the debate in the quickest way possible. As we pull away there is a train of cars following the truck; "Keep Back 500 Feet" means nothing.

~~~~~

A veteran last seen twelve hours prior, only his inability to move the entire right side of his body gives us cause for concern. His stereotypically perfect stroke symptoms make up for the last call's lack of such events. Only this call came in as an unresponsive, possible code. Now I know why there is are two sprint cars pulling up as I get the stair chair. They were both gone by the time we came down, patient in tow.

I really liked this call, but don't have much to say about it. He was a nice guy, confused, but calm. The worst part of the call was when the medic driving realized there was a parade in his way, and decided to make up the lost time...yay for fast cars and freedom.

~~~~~

He fainted in the French quarter, only this time it wasn't caused by a Hand Grenade or Hurricane. After switching stretchers with the ASAP unit I get in the truck and realize there are four medics, another basic, myself and the patient all in the back of the ambulance. I never seen this many medics respond to one call. You would think he was about to code...

He didn't, but his 12-lead wasn't amazingly perfect either. When I took his blood pressure I didn't trust it, a concept I am always willing to admit. I'm never going to give a medic a number I don't have faith in, they have more experience, and it doesn't take that long for them to double check me.

Once the truck had emptied out our patient wondered where the funny guy was. I ran with two very different medics, each with his own brand of humor. The medic who self proclaimed an "Abbott and Costello" vibe also described his partner as "more of a Monty Python" kind of guy. I'll trust them on this one, I really don't have any experience with either of those types of humor. I'm sheltered, I know.

One liked the rush, the other taking a more calm approach. Both doing what they thought was best for the patient. Both itching for good calls, not to fulfill their own needs, but because they wanted me to see it all. We drove half way across the city to a wreck for the possibility that I might get a few of those traumas I seem to be lacking. No luck, but thanks for the effort.

Most of the medics I have run with tend to use some form of silent communication with their partners. While I witness this, I am not normally included in it - I was tonight. On some calls it was difficult to keep a straight face, on others it was damn near impossible, but when it mattered it was a rather efficient system.

"How did you get stuck with these two?" I chose them. And two shifts later, I don't regret it.

CrC

Friday the 13th...of February

2009-02-13T14:43:00.002-06:00

The medic takes out the new CPAP to give the Intermediate and myself a lesson when the alarms go off. Of course, the minute it's time to learn, at least we didn't lose any hot food to this call.

From the front seat she yells, "code." I haven't worked a code with her yet, this could be instructional. I get excited, one word: newbie.

We did nothing; he was in rigor, fixed & dilated, asystole. Time of death 4:27.

Cops didn't arrive immediately so we waited outside. For every minute we were there, another person showed up at the house. Most hugged his daughter and then stood in the driveway; in a daze from the time of day as well as the circumstances. Twenty plus people bonded by something that was foreign to them and becoming all too common for me.

Eighty minutes later we were at another house giving the same news to a different family. He was cool to the touch, long gone. Only he was young, thirty and sick.

I want one to survive, I want to go on a code and see the medicine work, see the life come back into their eyes. I don't like feeling any connection to the Grim Reaper. Happy Friday the Thirteenth.

CrC

Impressive & Expected

2009-02-13T14:05:00.006-06:00

Two nights later I am writing, only I am having trouble remembering the patient from this story. They are starting to blur together, one call reminds me of another, and then they get confused. I guess the ones that impacted me two weeks ago aren't as life-altering anymore.

He's an old man, his extensive medical history takes tiny writing and shear will to fit into the box normally allocated for that information. He was facing the window, in a semblance of the tripod position, trying. I lean to set the heart monitor down, but it's time to go.

Four people, one on each corner. We all cram into the elevator, the medic pushing the stretcher demanding to carry something - you have the patient let me have the bags. Then she hands over pushing and rushes to the ambulance. Got it, this is that kind of call. Fire can do the lifting, we need to prep for one of those not-so-fun trips to the ED.

His fingers were too swollen to fit the usual Pulse Ox; it doesn't matter, he needs the big, red, fancy one anyway. When they have this much trouble they get the good technology. 78%. That's no good.

Atrovent gets him up to 90%, no IV, no blood pressure - I couldn't get it, but then again neither could the medic. He's wheezing. "Not the good kind." I didn't know there was a good kind of wheezing.

Time to bag. "Do you remember how?" I think so. Every time I'm with you we end up needing to bag. "Help him breathe." Sounds so familiar.

This guy is different from Concentration. He isn't as simple as "in, out, in, out..." His body is compensating. From the front of the stretcher I lean in trying to catch his rhythm, but I can't seem to go at the right moment. He's only at 94% when the back doors open. I'm trying, C and E seal in place, but it won't go any higher. It's not until we are in the ED and I watch him for a minute that I realize he is taking two breaths in for every one that he breathes out; his body fighting whatever is keeping his lungs from working. Ten minutes later he still sitting at 94%. I guess I was doing something correctly.

This call wasn't old hat to me, but it was one of those things that is starting to fall within my realm of normality. I wasn't nervous when I realized what needed to be done, I was just glad I could do something to help the medic keep the patient alive.

I don't think it should be as surprising as it seemed that I was bagging, yes I am a volunteer, yes I am just a basic, but that doesn't mean I can't bag. It shouldn't be "impressive," it should be expected. First time is impressive, second is a reminder, third is nothing new.

CrC

A Bloody Mess

2009-02-13T13:26:00.004-06:00

"Have I stopped bleeding?"

"Yes ma'am, it's stopped."

She repeats the question, as if a stop in blood flow earns an automatic stamp of survival. With a pressure of 60/40 it's a wonder she has any more blood left to bleed. On the ride in the medic had warned me to grab extra gloves, this was going to be a bloody mess, she wasn't kidding.

The pool of blood stretched out two feet past her body, thickly covering the floor. She was slumped against her bed; awake, but paralyzed by the fear that any movement would cause more blood to gush out. Her blouse was soaked through, coated in a layer almost as thick as the one shining up from the tiles. What once was lavender in color, now held a deep burgundy hue that is unmistakable. I'd never seen that much blood.

With fire, the sprint unit and the medics, there wasn't much room for me. I became the go-for. Grabbing sheets, the stair chair, and her ID's; returning the heart monitor and blue bag that we obviously wouldn't have time to need. The firemen who weren't needed inside stood downstairs near the stretcher. Each time I was carrying something a hand was offered in assistance, each time it seemed like too much of a hassle to accept. I may be small and weak in comparison, but I can carry my own. At three in the morning, half asleep, it may be a different story; but at 10 pm with Dr. Pepper in my system, I'm good to go.

Everything that she touched turned red, the stair chair, the medic's trauma shears, the stethoscope, the blood pressure cuff, everything. Getting her IV took longer than any of us could have wished for, none of the veins in her neck would cooperate, and on top of that the ED didn't seem to realize we were coming as we walked in. It wasn't until one of us yelled that her pressure was 60/40 that they began to react.

I always thought my shirt was red to make sure the medics didn't lose me, like a kid at the fairgrounds. Now I realize how easily red cotton conceals blood in comparison to green or worse, yellow. Not that either of those two colors sound remotely appeasing even on the blood-free calls.

CrC

Use Less Energy, Not More

2009-02-11T14:11:00.004-06:00

The medics were silent; this guy was in bad shape, too bad he had no idea. I stood in the background, this was my fifth call ever. What could they possibly expect from me?

"Get him on some oxygen."

"Where's the oxygen?"

The medic quickly looks around, "You must have left it on the stretcher."

I rush out to the front of the house and grab the green canister. My boots making firm, resounding echoes off of the wood floors.

Inside I set down the tank. The supervisor looks up at me and asks where the nasal cannula is. In response to my flustered expression, he smiles.

"I'll go get one."

I come back inside, the same sound resonating off the walls. I rip the plastic, uncoil the tubing, and stop.

I've never held a nasal cannula, it is a foreign concept to me. In training we talked about them, but in practice we always used non-rebreathers. I hook it up to oxygen and put it in his nose, knowing that the minute we move the patient it's going to fall to the ground.

My mind is racing; I look to the medic, at a loss on how to admit defeat to three feet of plastic tubing. He is too busy focusing on the dying man in front of him. My failures can wait...

And then it clicks. I see the picture in my head, maneuver the tubing, and tighten it around his ears and neck. Ten seconds later we are lifting him on to the stretcher, the nasal cannula still in place.

~Since that night I always know where the oxygen is on chest pain and respiratory distress calls. I always hand the medic the item they request, not the unopened package. I know where the nasal cannulas and non-rebreathers are located in the blue bag. But most importantly, I know the location of the "Sound off" button on the heart monitor without taking a second glance.

CrC

Concentration

2009-02-09T12:05:00.003-06:00

We were in my part of town, where anything beyond a drunken college student is rare and unexpected. His oxygen saturation was steady at 83% on oxygen, time to bag. "Help with his breathing, follow his pace, don't force it, make a better seal, like that...good, he's up to 90%, keep going, you are doing great." A blur of concentration; all I notice is the red circle as his breath pushes it out and I squeeze it back in, out, in, out...91, 93, 94, 96 - good job.

The jolt of the stretcher hitting concrete, don't break the seal, he isn't in the clear yet. Room one, the ED is ready. Staring at the red circle, in, out, in, out...

One, two, three; damn he's heavy...I broke the seal. It's okay, he's at 99%, lucid, confused. "Sir, you are in the hospital, your wife called 911, you're having a heart attack, we're here to help."

Wow, I did it. I helped him breathe. This is what it feels like when you don't lose them after the requisite 20 minutes. This is why you do it. I know BVM is a basic skill, but thanks for having faith, thanks for gently correcting the small stuff, and thanks for giving me credit for something so simple.

The medic was there, pushing drugs, doing the real work. I was extra muscle, squeezing every time he sucked in air. But she was there for me as well, guiding my concentration, allowing me to be more than just the BP, HR, glucose tester. Thanks. That call meant a lot.

~~~~~

She's two, seizing, the real call of the night. Her body only fills up a quarter of the stretcher, she's small. This isn't what a healthy two-year-old looks like.

Hands so small, where do you stick the pulse ox? Upside down on her big toe. 78, 64, 83 - the numbers are everywhere but up.

A long drive, the sheriff right behind, this little girl means something to him. She may not be his daughter, but there are three more uniforms when we arrive. Cavalry is here; that's love, fear, and concern all in one.

The truck stops, sirens off, no more flashing lights; "I don't like these stats, give me a second. Damn, where's the pedi mask...got it." The knife he uses to cut the box is longer than her arm, men and their knives. The tiny bag for her tiny lungs. Through the entrance, nurses, techs, residents, EMTs - their stares filled with concern for this little girl. The medic guides the stretcher as he bags; hat backwards, concentration, worry, compassion. I walk behind, in a shield of invisibility caused by the spell this little girl casts over the room. Their emotions are raw; their problems lose merit, this baby girl with her magical pull of innocence is all that matters.

Green Army asks me what was wrong, I guess I wasn't completely invisible, damn this red shirt. I turn to the medic-in-training, "seizures." One word, his word, I remain silent. I've always heard that pedi calls are the worst, I didn't feel it.

I was worried, but I trusted the medic. She was young, not a tiny adult, but a child without words. Getting emotional would have done nothing, steady hands and faith in the medicine are what's important. You know what the problem is, you apply the treatment, if it doesn't work, you adjust. Semper Gumby. Right now I need it to be that simple. And the medic did just that.

Until this call I had never seen him take things seriously, four of our past five calls together had been AMAs. All I knew about him was that he liked to joke around and talk about food. Now I know why.

The real calls balance the bullshit, the saves balance the ones that get away, and the humor balances those calls that could rip any good medic apart.

CrC

The Tortoise & The Hare

2009-02-07T13:44:00.013-06:00

Two medics, two very different styles, one of those nights that makes this all worth it.

Still in high school, eight months pregnant, shot in the foot. However, the most attention the foot got was to fulfill our curiosity regarding the path of the bullet. Your guess is as good as mine. My first shooting; I'm liking these warm-up calls dispatch gives me. I'm not sure if it's because she was pregnant, shot, or sixteen; but this call managed to accumulate a supervisor, a sprint car, the doctor and her shadow, an ambulance, and three cop cars. Even though we were the truck taking her to the hospital, the supervisor and sprint decided they were the ones to load her up. Maybe because they are male, maybe because they were there first, maybe it just made sense at the time. All I did was get barked at for getting in the way and then still manage to take one damn fine blood pressure - remember I'm a newbie, that's still a skill that escapes me at times.

~~~~~

Eighty years old, laying on the floor, watching Dr. Phil; only it's dark out, and Dr. Phil ends before dinner time. She says she spilled her food, but the puke-like substance all over her and the wall looked vaguely like someone had already swallowed it. For the first time I noticed the puke and didn't step into it...GO ME. Fire had taken the too-nice-of-a-blood pressure 150/90. Note to fire: there is a 20% chance one of your numbers will end in a zero, there's only a 4% chance both of them will. Spice it up.

Our drive up was relaxed, bumpy, and uneventful. This patient couldn't have been sweeter, she's the kind of patient you pray for. Casual conversation, hindered only by the facial droop and sheer exhaustion covering her face. She smiled, she glowed, she remembered that the only IV anyone can ever get in her is a butterfly. No wonder the medic was having trouble. We got to the hospital and she went to the front of the line, three docs came over and checked her out. The head doc filled with a kind of concern I haven't seen from an ED doc, ever. If I were scared, disoriented, and sick I wouldn't mind having him on my side. She got the bed up front, I hope she's okay.

~~~~~

The Patient of the Night Award goes to our twenty something year old assault victim. We'll call her Loud & Laughing. L&L's husband decided to use her face as a momentary punching bag. Good thing she was so drunk all she cared about was sending his ass to jail, and making sure she didn't end up there. L&L requested one of those hospitals that takes more than "5-7 minutes" to get to. Once she got there she gave a 30 minute performance on how to clear a c-spine, and I learned the valuable lesson that there are certain situations in which you automatically restrain the patient. She also went through all five stages of grief: denial, anger, bargaining, depression, acceptance. If only more had been wrong with her than a busted lip. L&L was an emotional roller coaster, but she managed to remember who I was, and still find the humor to laugh at me as well as with me.

~~~~~

At 0430 one of the medics woke me up when she yelled code. This was the first time the medics had consciously told me the call before opening the back doors. I went to sit up, and realized I needed to pee. Fuck, Shit, Damn. I know from neuro class that in stressful situations - a code - my sympathetic nervous system will take over and relax my bladder, allowing me to think about something else. If only we hadn't had to go four wheel driving to get there. Each bump made life that much more entertaining. It definitely kept my mind away from nervousness on the way to the call.

I wasn't anxious, but I kept thinking that this was only my third code. My first two had been with the same medics. They knew what I was capable of; they didn't have outrageously low or high expectations. I wanted to make them proud. I wanted to prove that I really had learned something from Four-O-Five.

Our patient was DOA. She had lived her life. At eighty-eight I'm not sure what else to expect. The only thing that struck me was the smell, I don't know if it was the house, the dead body, or my brain making things up; but it was a new smell.

Once we had loaded everything, including suction - GO ME, I started writing. Five in the morning: "Now I'm awake, exhausted, need to pee, and sitting in the back of an ambulance writing about my feelings in a 99 cent spiral; when I could be in drunken stupor from last night's Happy Hour." I don't think I would have it any other way.

~~~~~

No call stuck out tonight. What amazed me was the juxtaposition of the tortoise and the hare. I've never learned more about being a basic from a medic than I did tonight. I asked Hare if she had a system, she said it didn't matter, she's just the basic, I needed to do things the way the medic wanted them done. Hare: I'm just a basic, and everyone has something to teach me. Most of the basics I ride with don't always give me a play-by-play, I think they assume that the easy stuff is automatic. I've known how to hook up a 12-lead since my second night, I learned where they hide the c-collars last night...

CrC

Four-O-Five

2009-02-01T18:56:00.009-06:00

After my first code the medics I had worked with warned me I would be pulled back to that night anytime I got a similar call, or had a patient that looked like him, or something random from that night came back to the front of my mind. That code wasn’t only my first code, it was my first time to see death occur, my first time to see the intubation tube as it slid down his throat – even though the medic had to use a King Airway in the end; my first time to try with all my might to do CPR, my first time to hear the sobs of a family as they heard the news, it was my first time to get frustrated – unsure of what I was supposed to be doing; it was my first. For me that call sealed the deal, I wasn’t a virgin EMT anymore. I am still clueless, I still can’t seem to lift the stretcher half the time, I still don’t know where everything is hidden in the truck, but that call grayed the skies.

He was young, it’s not like he was 60 something and had had the time to clog his arteries with greasy southern food. In three years I will be his age. He was a baby in the eyes of time. I know he was a big man, fully grown in the eyes of the law, but that doesn’t change the fact that his mother had to say goodbye.

Ask me what I remember most about that call and you’ll get numbers. I trust numbers, they are concrete, and they have predetermined value: four epinephrine, three atropine, one sodium bicarbonate, and two IOs, one successful. But I realize now those numbers are going to become all too familiar, for every code they will begin to be more and more repetitive.

Four-O-Five. Time of Death. Ask me about my first code and that is the first thing that comes to mind.

I had my second code last night, it was different. I was nervous as Hell. This time I had an inkling of what to expect. On the ride in all I could do was replay various scenes from the last code, the order of things, where everything was in the blue bag, what the medics had needed first. I put my gloves on as soon as the call came out; by the time we got there my hands were sweating, pinking up from the powder on the inside of the latex. I think I prefer nitrile gloves, you can blame the call, the sweat, the nerves, it doesn’t matter. Blue gloves it is.

It took forever to get out there, all I wanted to do was get to the patient – get to the back of the building the made me crave coffee. Slippery floors, stretchers that had a mind of their own, slow down, don’t slip. It’s their emergency, not yours. Cubicles, coworkers staring, standing around, unsure of what to do, not enough oxygen, run to get some, grown men out of breath, scared, wanting to help, in too much of a shock to turn their heads. Too bad we didn’t need those extra tanks. Time of Death 00:47.

“Wait, why are you stopping, I’ll keep going.” We’ve done everything we possibly could have. Ya’ll were great, you did everything perfectly; you gave him the best chance he could have had. Damn I’m 0 for 3 tonight. AED’s save lives, just not tonight. Six shocks, this time it didn’t work. It used to be that patients were loaded in immediately, however, equivalent hospital level care on scene gives them their best chance. You did everything perfectly. You gave him every chance he could have had. You can’t blame yourselves. But they will question every action.

I was in my own world, internally keeping myself sane while he died, knowing that I’m not ready to fall into the negative emotions. I tore boxes, switched oxygen, ripped plastic, but most importantly demanded knowledge. I am learning my curiosity isn’t just because my dad always answered my “Why” questions as a kid; it’s because with knowledge I better understand the confusion of situations like this. The more knowledge I have, the closer I get to the medics attempting to save a life, rather than the coworkers watching in shock. If I don’t understand why I am doing an action, it loses value to me, and thus importance. It may not be the best way to look at it, but it works for me. I am developing my own coping system without even realizing it.

I saw a man die today. There is no changing that. We did everything we could, he had every chance. Maybe it was his time, maybe it was something else, but I can’t second guess myself. What I learned today is too important to be lost in the blur of a call that doesn’t end like you want it to.

CrC

Seizing Fear

2009-01-29T17:41:00.008-06:00

Two shifts, three seizure patients...that's quite a collection

Number One: My HIV patient from the last post.

Number Two: He's 70 something and the size of a 13 year old girl. He had been dismissed from the Emergency Department less than four hours prior, they hadn't even gotten the chance to fill his anti-seizure medication before he had another one. We got to the room and the nurse was half way through changing his colostomy bag, image that smell... There were at least eight admins, nurses, and techs surrounding him; although the minute his paperwork was filled out they all magically dispersed. Then it was just two medics, an EMT, and a smelly old man.

What stuck with me, was that despite his smell, he was one of those nice patients. He understood that he didn't want to go to the hospital, but at the same time if he was going to go he wanted to go to Charity. You see the conflict (to you non-New Orleans types, Charity used to be the big hospital before Katrina, it has yet to re-open). He didn't fight, not that he could, and he essentially stayed in his old man world the entire ride. I just wish I could have know whether the seizures were keeping him there, or if it was his semi-senile self.

Number Three: She's 38 with a loving, scared, and slightly frustrated husband. Her kids are looking on, but she has no idea that they exist. The only person she won't fight is her "Alma." She trusts Alma. She is claustrophobic and dazed. We try to get her into the stair-chair but her phobia takes over, all she wants to know is what happened. Why are there these strangers trying to tie her down?

She alternates between fighting physically and trying to reason with those around her. Since I wasn't one of the ones actively tying her down she turned to me a few times, "Help me miss." I can't say what expression crossed my face, I'm hoping it was the right one. We get her on the stretcher, and she comes around. She needs to pee. The kids instantly realize that this is their mother. We let her pee downstairs, stair-chairs may be one of the most useful inventions in recent times, but we aren't going though that again.

She was young, no history, and instantly became this whole different person. As she started to come back she had the same fear in her eyes that I am learning to associate with certain patients, seizures in particular. Their expressions remind me of puppies, but of course I know that's not the right way to think of it. I never know what my expression in return should be, there probably isn't one right answer, but I'm sure there are some wrong ones. I don't want to do the wrong ones.

CrC

High Five

2009-01-27T18:19:00.014-06:00

We got called out to a seizures in progress call. The kind where only the newbie gets excited. I'm the newbie, this was my first seizure call. Even though it was 3am, and I had just woken up, I was excited...what can I say? We walked into the house, full of cigarette smoke and the smell of one too many mangy pets. He was naked on the bathroom floor, his towel off to the side; once he had succumb to the seizure nothing else existed. As I passed the door he looked up at me, with eyes full of fear, like he was a child with no idea what was going on.

Off to the side his roommate just kept talking, one of the medics egging him on, attempting to calm his nerves by letting him ramble. I wasn't expecting to learn much from our rambler, that is until he repeated HIV & Hep-C positive for what must have been the third time. The second that it clicked the attitude of the call changed. The other basic and I became tense, doing things with minimal contact. The medic was unaltered.

We treated him the same as any other patient, even giving him a nasal cannula instead of a non-re breather (probably a bad idea given that he wouldn't stop coughing). The one difference I noticed was the sheet we gave him that collected the excess blood from his IV, not a drop hitting the ground. However, even the sheet could have been attributed to the chills he was having. It was strange how calm the call was from an outside perspective, when internally I know that my mind was racing. I kept having to repeat everything I knew about HIV, just to remind myself that I couldn't get it from taking his blood pressure and hooking him up to a 12-lead.

I can't definitively say I have ever known someone with HIV or AIDS. In all likelihood it was one of those things that didn't need to be discussed, but still. To my knowledge this was the first HIV positive person I have associated with, and I really wanted nothing to do with him. I have sat through the classes on how it spreads, and given this I know I should be more concerned about the Hep-C than the HIV, but even so. I followed BSI, I did what I was taught, but that can't change how much I didn't want to be around that patient. I'm sure he is a nice guy, or at least I would hope so, but it doesn't matter.

Some of the medics tell me that you get used to it. You follow the rules, and learn to realize that if you do it all correctly the chance of transmission is minuscule. I have faith in the protocols, I just hope I am more contained internally on the next call.

CrC

Crazy Preganant Lady

2009-01-25T19:57:00.003-06:00

Or at least that is what I will forever remember her as.

We were stopped outside a new bookstore, I was in the truck studying for finals, the medics were inside exploring. They came out in a hurry; the only time I had seen them move faster was for our Shockable Rhythm patient with a supervisor at the scene. This one got their attention. Once we got to the call our concern would drop drastically...if only we had known what time had in store for this woman and her baby.

When we arrived at the address there was no sign that we had been called. A dark street, the kind no one would want to walk down alone after dusk, was the only thing that greeted us. Ambulances are safe, we carry the best narcotics in town, with little or no protection, but that's a whole other post. Back to my dark street...

Once we made it upstairs the bedroom consisted of nothing more than a wet mattress, the bucket CPL was told to pee in, and the smokiest room I have ever been in - including an Afroman concert with so much pot smoke I swear I was getting high off the second hand smoke alone. Since calling 911 CPL had taken the time to apply lipstick (red-orange if you must know), as well as grab her little black dress and begin attempting to zip it up. If only she weren't less than a month from giving birth. When she realized that the zipper wasn't going to work she even asked us for help, one of my partners was able to convince her, between hidden giggles, that all those layers of clothing were going to come off anyway. Five minutes later, CPL went to grab her coat. And what a coat it was. The faux-fur with no sleeves matched the little black dress with lace sleeves, as well as the sky blue pajama bottoms. If only pictures were allowed.

CPL didn't get her name by drinking one too many cups of coffee in a short period of time. And I have to believe that based on the father's curiosity as to whether or not we had figured out what was wrong with CPL, he deserves a title similar to hers. CPL is pregnant, that's what's wrong with her. After that question the medic in the driver's seat stopped making small talk, it was hopeless.

We got her up to L&D just fine. After informing the nurses that CPL's water had broken, as well as the "ooey gooey" discharge that had managed to get all over the unmade bed, we left, thinking this was the end. She was the case that made the night, the story that topped them all.

I'm not quite sure how to end this because I know her story isn't over. I came on the next week to the report that the baby had been born breech, and that CPL was taken in for an emergency c-section later that morning. Both she and the baby had coded in the OR. I still don't know if either survived. That night she won "The Most Entertaining Patient" award. Later that day she was dying on an OR table. I guess what I am trying to wrap my head around is the strange factor. It doesn't matter how healthy a patient seems, vitals change, conditions worsen, people die. This is going to be one heck of a learning curve...

CrC

Shockable Rhythm

2009-01-21T19:49:00.001-06:00

And so it begins, as if my path as an EMT is some big saga. I guess for me it is, for the rest it is just another clueless newbie messing things up. I think I prefer to think of it as a saga.

We had two MIs within two hours, the hospital was happy/not happy to see us. I guess they had some conflicting emotions. As astounding as this may seem I have been sitting through CPR classes since I was a brownie - think a 7 to 8 year old - and had yet to see it done in real life until last night. One of the medics ran outside, grabbed me, and shoved me in the corner. This was a teaching moment, one they were not going to let me miss.

I didn't miss his fingers moving, as if he were semi-lucid, wondering, while someone was pounding on his chest. I didn't miss the alternating jiggle of his belly each time the ED nurse thrust into him. I didn't miss the look in his eyes. There was something behind that gaze.

I didn't miss when they shocked him, not like the fake hospital shows, or the plastic dummy with the over-used pads. The jolt was big, expected by all but myself and the patient; I don't think I will ever forget the moment they shocked him. The memory is very comfortably ingrained in my mind. A reminder that this is real.

I didn't miss when the two ED docs couldn't get the airway in, and stubbornly kept trying. Each time they missed they became more frustrated with not only themselves but the dozen other ED personnel crammed into the exam room. I didn't miss when the medic went out to the truck to grab an airway tool this hospital couldn't seem to find. I didn't miss the hidden conversation when the medics exchanged glances.

I didn't miss each time one of the medics saw a heart rhythm she recognized, standing on her tip-toes tempted to say something to the ED docs. I'm not sure if she left the room out of normality, or due to frustration.

I didn't miss the news of patient number one as we cleaned up from patient number two. CPR can save lives. Other times it just prolongs the inevitable. One is on a vent, two walked out later that night.

CrC