The Ladies' Man!

I'm riding with a hospital-based ALS chase car system as part of my clinical rotations. I'm loving it as I only go on ALS (advanced life support) calls that give me a chance to work up my assessment and treatment skills.

We get called to a nursing facility across the street from the hospital. An injury after an assault. We arrive at dinner time. This place is clean, orderly and has a wide range of patients. Our particular patient was bitten on the back of her right hand by the woman sitting next to her at dinner. As I hear it from a nurse, the biter has severe Alzheimer's and sometimes acts out.

My patient is calm, well dressed and not in obvious pain. The ambulance crew who arrived before me have already done an admirable job of bandaging her hand and she smiles at me as I walk in. She's pleasant and chatty as we move her to the cot and to the ambulance. She's slim and athletic looking, about 75 years old. She explains to me that she usually helps take care of the biter, picking up her clothes and spending time with her, and she can't understand why she bit her on the hand.

She tells me she plays tennis every day and is worried that she won't be able to play for a while. I jokingly explain that she can learn to play left handed and then when her right hand heals, she can play with both and take on doubles teams. She gravely considers this.

"That's a good idea. I'm going to do that!"

Up to this point, I'm thinking she's a member of the staff or a volunteer. My preceptor hands me the report paperwork and I see she's a patient with dementia and Alzheimer's herself.

She's a real sweet lady.

We chat as I get her vital signs. At one point, when I go to take her blood pressure, I rest her left forearm on my knee.

She looks over at me and winks.

"I've got my hand on your leg, young man."

And so she does!

--maddog

"...Look, Pal..."

I'm 12 years old and my grandfather is the biggest man in the world. His arms are huge and strong. He moves through the world with confidence and poise. His big belly somehow grounds him and makes him more real.

"C'mon," He says, "We're going to the Creamery."

Oh boy! Ice cream with my granddad!

We get into his big brown Buick. It's just me. No older brothers or cousins. I get the front seat. Privilege!

"I gotta stop for gas." he says to me as if he's asking my permission. Whenever he talks to me, he turns his whole head to me. He's 62 or so and I'm just 12 but he talks to me like I'm a man just like him. I adore Granddad.

"Wait here." he commands and gets out to pump the gas. I hear a voice from over the huge dashboard.

"Jim, You're a sonavabitch!" says this small voice. The owner of the voice moves into view and it's a man who's as tall as Granddad but not as big. Clearly, he's got a beef with my Grandfather and he's ready to tell him all about it.

"Hey, I got my grandson in the car and we're going to the creamery. I'll talk to you tomorrow." My Granddad works at the local gas station in his retirement and everyone knows where to find him.

"No! I'm gonna talk to you right now..." the dialogue goes on like this for a few minutes. My Granddad trying to placate and deflect this guy and the guy continuing to confront my Granddad.

The guy becomes more strident. From where I'm sitting, he seems to be jumping up to get into my Granddad's face. Granddad is doing his best to defuse but there's only so much he can do.

Then, I hear it. The phrase that even I know means business.

"Look, Pal..."

I hear those two words and I know that my huge, grounded, unstoppable Granddad has lost the last of his infinite patience.

"..I told you. I've got my grandson in the car. I'll talk to you tomorrow at the gas station."'

He turns to get in the car but the guy wants a confrontation.

In the middle of a particularly strident and inane tirade by the guy, I watch with fascination as my Granddad seems to just stick his arm out. Somehow this simple gesture has rendered the guy unconscious and made him horizontal next to the Unleaded Premium pump. Imagine the same simple and comfortable motion you would use to reach out and pick up the handset of a payphone. This is how gracefully my Granddad knocks this guy out.

If I were to give voice to this action, it would be the word, "Boop!"

He gets back in the car.

He turns to me with his head and shoulders, as if I'm the only person in the world.

"I'm sorry you had to see that."

He made me promise not to tell Grandmom.

To this day, I'm amazed by the 62 year old man who has the confidence to lay someone out at a gas station.

Two weeks ago, in a Veteran's Hospital, I held his hand and cried as I watched him die. He slipped away as smoothly and easily as we all hope we will.

He, a veteran of WWII, was buried with full military honors. My brothers, cousins and I were his pall bearers. At taps, we active and former military (in uniform and in suits) stood at attention and cried openly. We honored him with our tears.

Fair winds and following seas, Granddad. I miss you already.

--maddog

Nice Day for a Jog

I went out for a run today.

So did 30,000 other people.

26.2 miles later, I completed the 30th annual Marine Corps Marathon.

At mile 23, someone handed me a beer.

I love that man.

--maddog

Snooze for 5 miles on an interstate? Car is Definitely in the ditch!

I walk past the car that's resting gently in the ditch with water up to the doors.

"What happened?" I ask the driver, who's standing on the shoulder looking at his sinking car.

"I fell asleep." He says. "And I woke up in the ditch."

"Were you wearing your seatbelt?"

"Yes."

"Do you hurt anywhere?"

"No."

He checks out as perfectly fine. Answers my questions appropriately and doesn't want to go to the hospital.

"Where were you going?"

"Home."

"Where do you live?"

"In ****Town."

"****Town? The exit for that is 5 miles back!" Exclaim I.

"Yep, I fell asleep."

Damn!

--maddog

Doris, the smoocher!

She's 80 years old but looks like she's 60. Doris just had her knee replaced a month before. She takes medicine for high blood pressure. She was wearing her seatbelt. The airbag blew. The front of the minivan is metallic and rubber hamburger. The engine is 2 feet away from where it should be.

I gently take her head in my hands with my thumbs along her jawline. "Doris, I want you to keep your head still, Ok?"

She nods. "No, Doris, you need to relax and keep your head still."

Collar, headroll, backboard, straps, into the Medic unit. Once inside I do a full assessment. for any trauma and get a better idea of her mental status. Biggest complaint is the knee she had replaced. Hit it on the dashboard. She also has pain from the seatbelt in her chest, neck pain, back pain and her wrist hurts too. The whole time I'm talking to her to reassure her. I tell her everything that I'm going to do and I'm honest if something's going to hurt.

She's lucid and with it. No loss of consciousness, pupils are equal and reactive, no signs of head trauma. I get a good IV started and run a 12-lead to get a look at her heart to rule out any cardiac problems. Her EKG looks better than mine!

All of these procedures are difficult in a moving ambulance. (My preceptor is driving because he trusts me enough to run the call!!!!) but I also have to do them all one handed. Doris will not let go of my hand. I can get her to switch hands from time to time but, for the most part, she's hanging on to me.

I think all of the medical interventions I perform don't do as much for her as holding my hand.

Into the crowded hospital. We're in line. A doctor comes out to check out Doris's neck. He directs us to X-ray right away. I give my report to the receiving nurse and assure Doris that she's in good hands.

With a strength that surprises me and the nurse, Doris reaches up, grabs me by the neck and pulls me down for a big smooch on my cheek.

I'm almost skipping when I leave the ER.

Later, on my evaluation form, my preceptor writes, "EXCELLENT bedside manner!"

--maddog

I've been doing some of sailing. I've also run a lot of calls, gone running a lot and have no internet access at my house. (bleah!)

I know, I know. I have NOT been writing as much as I should. I shall endeavor to write entries daily but they seem to pile up. I look at the pile and I say, "Feh! I'm going sailing!"

I'll try to publish more, I promise.

--maddog

Bouncing Babies, Bleeding heads

The voting's done and #4 has squeaked by so, here we go:

Dinner's interrupted by an ambulance call. All I hear on the radio is my ambulance number and the number of the Medic unit. Out the door, I call in as "responding" and ask for the address again. Usually dispatch repeats the nature of the call and address once or twice as they tone it out again. This time the airwaves are particularly busy with dispatch toning out other calls. Basically, I'm going into a call knowing only that it's a medical call and dispatch thinks it's worth a Medic unit too.

I've got two people riding with me as observers tonight. Tootsie is a 21 year old local kid who's trying to decide what the hell she wants to do with herself. I've known her since she was about 13 when she auditioned for a play I was directing. She's joined the fire department after going on a ride-along with me. She's decided that she LOVES EMS. Goody! She's just waiting for her paperwork to clear before she signs up for EMT school.

The other ride-along tonight is Bean. She's another one I know through the theater. Her brother and I worked on A Midsummer's Night Dream together a couple years ago and I know her whole family. Bean, at 19 years old, is as tall and slender as Tootsie is short and curvy. I really like having them on board. They're both enthusiastic and helpful. All the rest of the clowns at the firehouse think I'm a pimp. HA!

We get on scene. As I hop out, "Tootsie, bring the O2 and suction. Bean, AED, I've go the Aide bag." I lead the way into the apartment building and am met by a 13 year old kid who's trying to hurriedly lead me to an apartment.

"Hold up, man. What happened?" I ask. I don't know what's going on and I want to find out a lot before I go in. Scene safety is first, right? The kid mumbles something and heads to the door. He's a little worked up.

"Stop!" That old authority voice works wonders. "What's going on?" From his mumblings I get that his 5 year old cousin fell and cut her head and she's bleeding all over the place.

Into the apartment, "Any pets in here?" No. I round the corner to find an extremely frightened young woman holding a little girl in her arms. There's drops of blood all over the floor, blood on her hands and blood on the head of a bright eyed little girl in the woman's lap.

I get right down on the floor with them and start talking to the little girl. I smile, she smiles back. I ask her her name, she tells me. I ask her if she hurts anywhere and she shakes her head. The young woman holding the girl looks like she doesn't know what the hell to do. She tells me that the girl tripped on her way into the kitchen and cut her head on one of the barrettes in her hair.

I sit cross-legged across from her and put out my arms for the little girl. The little girl gets up and sits right down in my lap with her back to me. This allows me to assess her very easily and look at the cut on her head. From the minute, I saw the kid, I'm using an assessment tool called the Pediatric Assessment Triangle (PAT). This triangle is made up of 3 factors, Airway & Appearance: which I assess by looking at muscle tone, activity level, mental status and whether the kid's breathing or not, Circulation: where I look at skin color, lips and fingers for cyanosis, obvious bleeding, capillary refill, skin temperature, pulse rate and quality and blood pressure. The final side of the PAT is Work of Breathing: Here I look at breathing effort, sounds, rate and depth. A quick assessment of these three factors can tell me if this kid's in trouble or not. With my little patient, she scores very high on all three.

The cut on her head is no longer bleeding. Again, I ask her if her head hurts and, again, she tells me, "No." I ask her to tell me what happened and she tells me a surprisingly clear, articulate and detailed account of her tumble.

The responding medic unit arrives to find a house full of volunteers, a pair of extremely frightened babysitters and a big, bald EMT sitting on a bloody kitchen floor with a giggling kid in his lap. I give them my report and ask them if they want to do any more assessment. One of them talks with the little girl for a bit and then pats me on the shoulder.

"Good job man. See you later tonight, I'm sure."

We leave about 5 minutes after mom shows up. On our way out of the apartment the little girl gives us a hearty, "Bye bye Fireman! Bye Bye!"

--maddog

On my way out of town.

I'm heading off to a remote mountain getaway for 4 days. Running water may be possible but internet is definitely out.

I'll post when I get back. keep on voting!

--maddog

Upcoming stories...

1. Death by Cheeseburger!
2. Crackhead Bobby skips his seizure meds. Medicates with malt liquor!
3. Snooze for 5 miles on an interstate? Car is Definitely in the ditch!
4. Bouncing babies, bleeding heads.

Which one do you want to hear first? Vote on the comments link below.

--maddog

Where has maddog been?

Depression is a monster. An ass-kicking, sneak-up-behind-you-when-you're-not-looking monster.

I'm on the snap-back.

Nothing can keep the maddog down.

ARRR!

more to come

--maddog

Mom's Home

Whew! I was worried!

My mom is my hero.

--maddog

More awesome mom-ness...

My phone rings. The caller ID says "MOM mobile."

We chat a bit. Here's a few quotes from Super-Mom:

"..You wouldn't believe the smell, hon... It's incredible."

"We don't have power at the clinic but we do at the hospital. Without air conditioning the air quality is pretty bad. We spend the day at the clinic until 5 and then go back to the hospital and clean some more. We're trying to get more rooms ready for patients."

I'm amazed at my mom's fortitude. She sounds tired. She also sounds cheerful and happy. She's doing something she loves. I can imagine. I think I'd be in the same mood in her shoes.

Then she says, "Wait! ...Do you have formula?"

I'm a bit confused

"Do you have enough formula for your baby? What kind of formula do you use..."

I hear another voice in the background.

Now I get it!

Mom says, "Hon, I'll call you back." *Click*

Go, Mom Go!!

--maddog

My mom is still the coolest.

My mom, who makes planes land to save lives, has shipped out to Baton Rouge with less than 12 hours notice. She's been helping to set up, clean out and get running a hospital that was abandoned in the flood. They've already started seeing patients and are setting up clinics in local schools and public buildings.

She's working with limited medical supplies, armed escorts and stifling temperatures in the 90's. (No A/C). She's been eating MREs and bottled water. Through my dad, she reports:

"...the smell of rotting food and dead bodies is everywhere, and the level of filth in the hospital and the schools is appalling. The hospial was abandoned in haste in the face of the hurricane, and perishable food was left in meat lockers and coolers and refrigerators, which then lost power. Patients were evacuated by staff, but the dead remained behind in the morgue and in the OR. When she and others are not treating patients they are cleaning - shoveling, mopping, scrubbing, bleaching, disinfecting, bagging, hauling."

...and treating what patients come in. She fears that as the word gets out, the facilities will be overwhelmed and they will run out of supplies. Their support and supply infrastructure is non-existent and re-supply is spotty and inconsistent at best.

She sleeps on a cot in the hospital when she's not out working.

Did I mention that my mom will be 61 years old in November?

Awesome!! Go, Mom Go!

--maddog

"...Thank you very much! You guys are great! I really appreciate what you do..."

A fellow classmate of mine, Guapita, and I are riding with my preceptor, Angel and her partner for a day shift in ******** City. We get a call for an unconscious person at a bus stop at suchandsuch street. Guapita and I are riding in the back of the Medic unit and we don't see anything until we arrive and jump out.

I'm greeted by the sight of several firefighters, bystanders and drunks surrounding a bench at a bus stop. Sitting on this bench is a man who's doubled over at the waist with drool and blood dribbling out of his mouth. Angel and I go up and pull him upright.

He's a big fellow. About 6ft 2in (2 meters) and about 175lbs (about 80kg). He's got pinpoint pupils, extremely slow breathing and is almost unresponsive to almost any stimulus. These symptoms combined with the neighborhood and bystanders leads me to suspect heroin as the culprit. A glance at Angel tells me she's thinking the same thing.

The guy's not so unresponsive that he can't be hauled up into the ambulance with some help from a firefighter and I. Once in the stretcher, he proceeds to snore away at a rate of 8 breaths per minute. I look at his arms: no track marks but he has beautiful veins. Angel is already preparing a dose of Narcan.

Narcan is the brand name of a drug called naloxone. It's defined as a competitive antagonist antidote for opiate overdose. In plain language, it knocks opium, heroin or morphine out of the opiate receptors in the brain and immediately reverses a opiate-based overdose. It also puts the chronic heroin user into immediate withdrawal. I notice that this guy's got big arms and shoulders. He's almost as tall as me and is pretty well built. I'm thinking that the last thing I want is for this guy to go into withdrawal in the back of my Medic unit.

Angel hands me a syringe with 0.12 mg of Narcan and a nasal atomizer. "We'll try a dose in the schnozz before we get a vein." She says. At this point, Guapita, acting as my second, has started oxygen at 12 Liters per minute via non-rebreather mask. I gently rest my knee just above this guy's knees and my other leg is barring his Left arm. His right arm is under a cot strap.

In goes the Narcan, on goes the O2 mask. "Gurgle, snort, gurgle. ..." No change in respirations or mental state. This guy also has not a single obvious track or needle mark on his body. I'm thinking he snorts his hey-ron and that might have an effect on this nasal administration.

By this time Angel's partner has prepared all the stuff to start and IV and hands me an alcohol prep. Guapita shifts around and sits on the guy's thighs and I trap the guys left arm under my armpit to give me a stable site for an IV and be ready for when he freaks out.

Pop! Perfect IV. 16 gauge in the left antecubital fossa. (the hollow of the elbow where a big vein is) and a saline lock (a small tube for the administration of medications without having to hang a bag of fluid). Angel hands me a syringe of 0.4mg of Narcan. In it goes, followed by about 10cc of saline to flush it into his system.

Needles into the sharps containers and we're tense. We're all ready for this guy to explode in a whirling fit of stinky, spitting fury at us for having taking his high for which he probably paid a lot of money.

He sits up.

He looks around.

"Hey! Woah! Thank you very much!" He nods around to each of us. "You guys are great! I really appreciate what you do."

Everyone else in the back of the Medic unit looks as dumbfounded as I feel.

"Hey, man, I feel great! Can I go home now?"

Junkies. Whee!!

--maddog

We the living.

I was working my part-time job as a Park Ranger. As I patrolled a nearby lake park, I came across a neighbor, MS, on his bike.

"Have you seen Mr. Neighborofmine?" he asked me. "His wife's worried about him. He headed out for a run 3 hours ago and she's worried about him"

I don't blame her. The temperature is approaching 100 degrees Farenheit and the humidity is about 98 percent. Mr. Neighborofmine is 70 years old and has 2 prosthetic legs below the knees. I've seen him out running every day.

I agree to keep an eye out for him and I cruise along, stopping to ask each person I see if they've seen Mr. Neighborofmine. A couple people have but not for about 30 minutes. At one point, I'm standing on the path, asking another stroller. I'm situated directly behind Mr. Neigbhorofmine's house. MS's house is the one next door. They both back onto the path that goes around the lake in this park.

As I'm speaking to a person on the path, I hear MS hollering for me. I look up the hill toward the house and see him rushing towards the back porch. I also see a lump on the back porch dressed in running clothes.

Shit.

In my bicycle saddlebags, I have a first aid kit, gloves and a mask for rescue breathing. I run up the hill, dragging my bicycle behind me. On my way I leave a trail of gear as I discard my riding gloves, helmet, sunglasses and, finally, bicycle.

Mr. Neighborofmine is lying on his side on the concrete porch. He's blue and grey. His hands are blue and his face is blue and dusky grey. I perform a sternal rub. No response. I check pusle and breathing. None.

Shit.

Training takes over. MS is a little frantic and is trying to remember CPR. "I've got the CPR. Call 9-1-1." I say.

"I've got them on the phone." Says a new voice. The neighbor from the other side, HW, has shown up and has a cordless phone in her hand."They want to give you CPR instructions."

"Tell them I'm an EMT, here's my number." I rattle it off and she conveys it to the Dispatcher. Good enough. Time to get to work. I put on my gloves and assemble the CPR mask. It's got a one-way valve and a filter to keep me from getting a mouthful of patient. I get his head positioned and try a couple breaths. Air goes in but I hear a gurgling when I blow in. I see a little bit of chest rise but I also see his stomach rise too. Damn! Am I putting air in his stomach? His belly falls as he exhales. Hm.

I move to his chest to perform chest compressions and find my landmarks are a little off. His chest seems to stick up a lot. I ask if he's had heart problems before. Trying to get a history from somebody. The answer comes back "no" and then I have an "AHA!" moment. I remember seeing Mr. Neighborofmine many times when he was out running. His back is curved forward and slightly hunched over. I've seen it referred to as Kyphosis of the spine. It can create a challenge when maintaining an airway and such while the patient is on his back.

I start chest compressions and feel/hear the crackling noise as his ribs separate from his sternum. Ugh! I always hate that. I roll through my chest compressions and back to breathing. Again, I'm having trouble getting good air in the lungs. MS is flapping around trying to both be helpful and not get in the way.

"Put your fingers like this." I say and show him how to position his thumb and finger to press on the crichoid cartilage. (This is a process where pressing on the hard cartilage of the windpipe causes it to push down and close off the soft and floppy esophagus. This allows more air to go into the lungs and helps keep whatever's in the stomach from coming back up.)

"Like this?" he does it right after a few tries.

"Yes. Now press here, gently. Good."

I try a couple more breaths and they go in much better. Still gurgling but air is getting into the lungs. I continue the cycle of chest compressions and rescue breathing. Sweat is cascading off me. Somewhere in the back of my head I remember that the heat index for the day (what it feels like) is 110 degrees Fahrenheit. I'm feeling it now.

EMS is on the way. I can hear the sirens in the distance. After a few more cycles of CPR, I check for a pulse and realize that the patient is pink. PINK!!! This means that I'm doing CPR correctly! He was blue to begin with, meaning he had very little oxygen left in his tissues. The purpose of CPR is to push oxygen into the lungs where it can dissolve into the blood, and then move it around by pumping on the heart. The fact that Mr. Neighborofmine is now pink means I'm getting oxygen in and moving it around. Right on!

At some point, I look up and see Mrs. Neighborofmine standing behind the sliding glass door. She's been watching everything.

My ambulance and Engine show up. It's all business. AED, Oxygen and BVM, move the patient to a back board and then the stretcher. I'm standing on the lower carriage of the stretcher and continuing chest compressions as we roll around the house and to the ambulance.

Into the rig we go and we roll. We meet the Medic unit en route on a nearby highway. Two medics get on board our ambulance. One starts to set up the EKG/Defribillator while the other sets up to intubate. I'm thinking, "IV access?" Of course, I can't do any of the advanced skills because my jurisdiction won't let volunteers practice ALS skills, regardless of one's certification level.

The medic who is intubating prepares a Miller blade (a laryngoscope blade that is long and flat) that's about 2 sizes too long for this patient and proceeds to dig around in the patient's mouth. He looks like he's stirring soup! The then goes to insert the endotracheal tube (ETT) and I notice he hasn't lubricated it.

He gets the tube in but doesn't secure it. I help him get the stylus out but it's stuck!! He didn't lubricate that, either. I find myself both bagging (pushing air down the intubation tube with a special bag) and holding the tube in place. I call out that I see vapor in the tube as a landmark for proper placement. The medic then checks for lung and gastric sounds as another method.

Still no secured tube. I have doubts about it being properly placed. I hear all kinds of gurgling as I push air down.

The intubating medic then connects a device that will tell him how much CO2 is coming out of the tube each time the patient exhales. This is a very definitive way of knowing whether or not you have it in the right place. A tube in the esophagus will not give out a consistent amount of CO2, whereas a properly placed tube with good air exchange will. This is read by a wave form on the EKG monitor that has a CO2 monitoring device (capnography).

The wave form is tiny, almost too small to read. "Looks good." says the medic.

"I'm still getting a lot of gurgling in this tube. Should we check it again? Maybe suction?" Says I as I turn on the suction unit next to the medic. He says nothing and proceeds to prepare another device to check the tube. This is another CO2 detector that merely changes color in the presence of CO2. We attach it, I breathe for the patient. The color remains the same. I'm thinking at this point the medic's going to re-tube the patient to be sure he's got it.

"Hyperventilate him. Go faster." He says to me.

Still doesn't change. The medic then check the inflatable cuff at the end of the tube. This cuff keeps the tube in place in the trachea and keeps air from leaking out around it or stuff from going into the lungs. It's not properly inflated and won't stay that way (this is done by using a syringe attached to a tiny air tube).

Does he remove the ETT and try again at this point? No. He prepares a dose of epinephrine to inject down the tube.

Meanwhile, the other medic has been fumbling around with the EKG. She reads asystole, or no electrical heart activity, on her monitor. She sets up another set of leads to verify and I though she's going to go into transcutaneous pacing. That's where one uses a regular rhythm of shocks to make the heart muscle flex and move blood around. It can also, at times, cause the heart to take over and beat on its own as blood and oxygen get to the heart muscle.

Does she do that?

Nope.

Does she start an IV?

Nope. She seems more concerned with verifying the asystole than with doing anything about it. Oh, yeah. she's also doing chest compressions with one hand as she's fooling with the EKG.

I notice, also that my patient, who I made pink with basic CPR, is now blue and ashen. Dammit!

Once we get to the hospital, Someone takes over respirations from me and I'm back to doing chest compressions all the way into the emergency room. People waiting in the hall show their surprise at seeing a 6 foot 4 inch, 245lb bald man soaked with sweat, standing on a stretcher doing chest compressions with the words "PARK RANGER" written across his back. I'm sure I'm quite a sight.

The hospital staff takes over, I pass what information I have about how long Mr. Neighborofmine was down and I get out of the way. I stagger through the main ER towards the refreshment station where I wash my hands and drink about 2 quarts of water.

A few minutes later, I see the hospital staff filter out of Mr. Neighborofmine's room. "We'll call it at 1358." says a doctor. I think I saw that coming. It still sucks. It always sucks. I think when it stops sucking, I need to get a job doing something else.

I phone my boss to let him know that I'm going to be a little over my shift and tell him why. He offers to come pick me up from the hospital and asks me if I'm OK. The crew from my ambulance gives me a ride back to the scene where I expect to find a disaster area. Instead I find MS has gathered up all my stuff and my bike. He's stowed them away in his shed to keep them from getting stolen.

We talk for a bit about the incident and I ask him if he's doing OK. I also make sure he knows he can talk to me or I can put him in touch with people to talk to. He lost 3 family members, including his father and his sister, in as many years. He says as much and says, "I won't say I'm used to it but I got a good handle on it and a good bunch of family." as he rests his hand on his daughter's shoulder.

At my office, where I fill out a huge incident report, everyone is great. My boss gets me another shirt, someone gets me a big, cold bottle of water. They all want to be sure I'm OK. I do a mental/emotional check and find that, yes, I am OK.

On my way home, I stop by the scene again to speak with the other neighbor, HW. She's with her family, preparing dinner. I chat with her and her husband. Her 4 year old son says, "Mr. Neighborofmine wasn't breathing! That's bad! I'm four years old! I'll be 5 soon!" I thank HW for her help and listen to her speak of feeling helpless. I assure her she did great by having the wherewithal to call 9-1-1 right away.

On my way out, I notice that Mrs. Neighborofmine has returned from the hospital with her 2 sons and a good friend. I stop by there to offer my condolences. "I think it hasn't hit me yet. Thank you very much for what you did. You were super. I can't thank you enough." she says to me. She's really touched. Wow.

As I'm pedaling home, I'm sad for the family and friends of Mr. Neighborofmine. I'm happy to be among the living. I'm also reviewing and checking everything I did to be sure I've done it all right. I think I did. I'm pretty confident I did good and I can find no major faults with my performance. I could have been more of an a**hole with the Medics to be sure they did their job right but I have a feeling that would not have ended well.

I also think about the cycle of life and death. I think I'm fortunate to have been a part of this cycle for Mr. & Mrs. Neighborofmine. I could sense that it meant a lot to Mrs. Neighborofmine to see me and speak to me afterwards. It's a situation I'm not often in. Usually I hand the patient off to the hospital and get ready for the next call. Mrs. Neighborofmine got to see that I do care, that I'm not just a stranger who takes her husband away. THAT'S hometown EMS.

I come home to an empty house. Herself is out for the evening for business. Just me and the dog and the cat. Not for long. Word travels fast and, within 90 minutes I've got a house full of friends and family and I'm making spaghetti for 6.

At some point, in the middle of the wine, food and jokes, I look around a the gaggle of people in my house. I vow to enjoy them all while I have them. It's all good.

We the living.

--maddog

Do I love Hometown EMS???

I ran a code (No heartrate, Not breathing) on a neighbor today.

It sucks.

I did a perfect job.

The patient is dead.

I visited neighbors and relatives soon thereafter.

I feel like crap.

My friends swooped in to help me.

I feel better.

I have more to write and share.

More to come...

--maddog

What a pain in the neck!!

The call that wakes me is for a stabbing. The address is in a nearby apartment complex. We roll and happen to get to the complex before the police.

"Communications to Engine XXX, Ambulance XXX, Stage at BlahBlahBlah Road to await PD"

"Ambulance XXX at staging area. Standing by" Says I.

A few seconds later, I get on the radio again:

"Ambulance XXX to communications, Patient is at Ambulance XXX. Request PD our location."

"Ambulance XXX, Copy"

The patient had walked up to my door. "He stabbed me in the neck." He says as he tries to get into the passenger seat. He's got a sweatshirt clamped to the side of his neck and he's covered in blood. I hop out. I've got him by the elbow. Five seconds later, he's on the stretcher and I'm working him.

"Lock the doors and roll. We'll meet the medic en-route." says I to my partner. I don't know if the stabber's still around waiting to finish up. I really don't want to find out.

The medic is fresh out of school and panicky. The wound is small and not bleeding anymore. The patient is alert and oriented. The medic orders a full trauma workup with spinal immobilization, tries 3 times before he gets an IV (forgot his tourniquet) and almost gives morphine. I ask the patient to rate his pain and he gives it a 2 out of ten.

"Two, eh?" I say with an eye to the medic.

Morphine goes back in the box. The medic treats me like crap for the whole ride and orders me around once we get to the hospital.

Despite the medic's efforts, the patient is delivered alive and well to the ED.

Jeez! I hope I'm not like that when I get my NREMT-P!

--maddog

"...a tree hit my car..."

The call is for an auto accident and, as it so happens, the ambulance (with me on board) is on the complete opposite side of our jurisdiction where the call is.

We arrive to find our engine and the rescue squad from the next area over in attendance.

"She's not complaining of anything but a headache. We're going to board and collar her as a precaution." This is delivered to me in a deferential tone by the FireFighter who just got back from Iraq and is in the middle of his EMT-Basic school.

"Let me talk to her first, OK?" I say.

"Sure. I'll get the gear." he says and heads off to get the gear.

I note a small SUV resting against a small tree in the median. The car has some damage but the airbag is not deployed and there does not appear to be much passenger compartment intrusion. The patient is sitting in a police car nearby.

As I approach, everyone is giving me information, status reports, patient statements, vitals and their opinions. They all sink in somewhere but my attention is on my patient. She's sitting with her feet out of the open door of a police car. She's looking around at everything and following all the activity. No blood and a good general impression.

I approach her left side and speak to her. Her head moves smoothly with no visible signs of pain as she looks to my voice. She knows where she is, who she is and what day it is. I move to the other side of the door and her head, again, follows me with no signs of restricted movement or pain.

"Did you hit your head?"

"No."

"Do you hurt anywhere?"

"No."

"Tell me what happened." I say.

I find that open-ended questions are great tools to assess someone's mental status. If I give them leave to say what they want, they'll tell me, through the nature of their answer, whether or not they're in their right mind. Since she has no outward signs of injury and denies any pain anywhere (including back, neck or head), I'm relying on this tool to tell me if I have a patient with a risk of spinal or brain injury. I listen for gaps in their story or bizarre events.

"I was just driving along and a tree hit my car!"

Um. OK. A tree hit your car. Right! I look to the left to see her car resting against a tree. My eyes track to the left to see the earlier FireFighter has arrived with the spinal board and C-collar. Good, I'm going to need that. Clearly, someone is not in their right mind.

I stand up to step around the patient and flashing lights catch my eye. Down the road, about 300 yards, are two police cars. They're positioned to keep traffic from hitting a huge tree that has fallen into the roadway.

I look at my patient's car again.

There's a big dent in the roof and windshield. The front of the car has only minor damage.

Wow! I guess a tree DID hit her car!

She, again, related no pain to her back, neck, or head and, no matter how hard i tried, I could find no evidence she had lost consciousness. Her story was consistent and (now) made sense to me.

She went to the hospital anyway at her own request. The only difference is she rode in a seat instead of on a backboard.

--maddog

Maddog, the mighty slayer!

I took the practical portion of my EMT-I test last Friday.

Not too bad, I only killed 3 people.

Needless to say I will be re-taking the 3 stations I failed. Here's the recap:

Medical Assessment: 1 Dead patient. She was having an allergic reaction to nuts in cookies. I did everything perfectly until I administered 500mg of a drug that is supposed to be given as 500mcg (That's 1,000 times the dose!) OOPS!.

IV skills: No worries. Patient got a perfect IV in the left forearm and 1mg of atropine IV push.

Adult Ventilatory skills: Intubated and did a combi-tube perfectly.

Static Cardiology: 4 cardiac rhythms interpreted and treated correctly. Awesome

Dynamic cardiology: Patient was complaining of chest pain, had an SVT of 138. I went to immediate cardioversion (Where I zap the heart to re-start it). BLAM! Dead!. I suppose I should have tried adenosine first since immediate cardioversion is only indicated for a rate of >150. It didn't matter as I ran out of time anyway.

Pediatric Intubation: Perfect

Pediatric Intraosseus infusion (putting a needle into the bone): Perfect

Basic Bleeding control: Perfect.

Trauma Assessment: Another Dead one, courtesy of Maddog. Gunshot wound to the chest. I found the exit wound right away but either didn't pay enough attention to breathing rate and assist as needed or I loaded the patient without backboarding them first. Either way: Patient Dead, I failed.

Damn.

I keep beating myself up for not studying enough but EVERYONE in my class failed. Many of us feel that the program didn't prepare us enough for the practical portion. I think that's due to the fact the the person who would be running it was suddenly gone for the semester and a series of teachers and students stood in to fill the bill. Hm.

I'll be re-taking this thing soon before the summer lazies fully set in and I forget everything about medicine. Clearly, I'm an idiot. Hopefully, I won't kill as many patients in the field.

Grrrrr!

--maddog

Vacation, et. al.

My Delayed EMT-I Practical Exam is Friday.

Since classes have ended, I've spend some quality time with the dog, gotten a part-time summer job as a park ranger and have hied off to the beach for a while. No phone, No Internet. Ahhhhh!

Currently, I'm trying to beat the beach-induced amnesia out of my head and I'm cramming like a student again.

After that, It's off to the beach again and then back home for more EMS calls, park ranger patrols and quality time with the dog.

Oh yeah, I've signed up for a marathon in October and a 50-mile ultra-marathon in November. I'll be doing a LOT of running this summer.

Whee!

More to come!

--maddog

"...peanut butter balls...."

"...and are you taking any medications, Ma'am?"

"Yeh! Ah take PeanutButterBalls"

"Excuse me?"

"PeanutButterBalls!"

"Peanut Butter Balls?" asks the student medic, careful not to offend and sure he's missing something.

"Y'know. PeanutButterBalls. So I don't fall out and get all jiggy."

The student looks to the preceptor for guidance. She's turning red trying to restrain her paroxysms of laughter.

...Phenobarbitol. It's an anti-seizure medication.

I love EMS.

--maddog

Selective Needlephobia?

"...Hello, Ma'am. My name is Maddog and I'm going to start an IV and take some blood"

"No! No! No needles! I hate needles! Please no!" She cries. She's a pretty and healthy young woman in the emergency room because she's 7 months pregnant and having abdominal pains.

"I need to get this IV in so we can give you medications if you need them."

"No! Please, no. I can't stand needles!"

I look at the 5 earrings in each ear, the eyebrow piercing, the nose ring, the 2 tongue studs, the lip ring and the large collection of tattoos on her arms.

She sees me looking. My left eyebrow lurches over the rim of my glasses.

I blink once.

"That's different." she says.

--maddog

"...Honey! I'm home!..."

I feel like the recalcitrant husband, wandering in at 3am with booze on his breath and lipstick on his collar.

I have not been kind to you, my readers. I am sorry. I know that many of my readers actually know me in person and rely on my blog as a way of keeping tabs on "what's up with Maddog." Again, I am sorry.

Why have I not been posting? Well, it's for many reasons. I have had so much happen and I don't feel I've had the time to sit down and justly write about it. Also, things keep happening, thereby not affording me the time to sit down and write. I've had so much schoolwork due that every time I sit down to write something, I feel I should be writing a page for a paper instead of for my blog. I keep telling myself that I'm not getting graded on my blog.

Well, as it always happens, fate comes along and intervenes:

I was scheduled to take the practical part of my NREMT-I test tomorrow morning at 8am. Today, I went to school and practiced and practiced some more. This is the same as I had been doing all week, between sitting for final exams and the written portion of the NREMT-I test (last Wednesday). After we closed up the lab, I met Herself and her workmates for a pint and some cheer. Being a good boy, I left early to get home and get to bed. I came home to find an email telling me that my exam tomorrow has been cancelled and no new date will be forthcoming before Monday.

Dang!

I could have stayed at the pub!

I have only one more final exam for the scholastic aspect of my education. That's scheduled for Monday and I'm not worried in the least about it. It's on field operations, tactical medicine and street survival skills. Yah, the Maddog's got that down.

Now, one has to understand that this practical portion of my exam is the biggest, most stressful part of my finals. I have been getting more anxiety and heartburn over this than anything else in my scholastic career so far.

Now I find it's in Limbo. It's the epitome of the anticlimax.

So, what do I do with my newfound Friday night? I sit down to write an apology to my readers. Of course.

As far as the exam, I'll do fine. I have a bit more time to polish my skills and be on the top of my game. No worries. My only concern is how it's going to impact my scheduled fun and recreation for the summer.

As to the summer, my plan is to relax a lot. I have a part time job that involves me getting paid to ride my bike to various parks in town and hand out information to visitors. I'll be spending whole weeks at the beach. I'll be running every day, swimming thrice weekly and lifting weights three more times a week. I have a 50 mile ultra-marathon in November that I'm going to finish, dammit!

Oh, and I'll be spending a lot of time writing, and a lot of time at the Firehouse (coming up with more material).

Somewhere in all this, I'll be getting my EMT-Intermediate certification. Since my jurisdiction currently has no correlation to the national standard of EMT-I, it doesn't mean much more than the "next big step" towards becoming a Paramedic. I'm on my way.

To those of you who keep clicking back to my blog, only to see the same, tired entry: Thanks for coming by.

More to come. I promise.

--maddog

Writing but not posting....

Sorry, all. I've been writing but not able to post them regulary for various reasons.

I'll get them up as soon as I can and I'll keep the original dates on them so they'll be listed below. Sorry for the confusion. Thanks for your patience.

--maddog

...Junkies make the best teachers for IVs....

"Hello, Sir. My name is Maddog and I'm going to start an IV line and get some blood samples." says I as I come into the room.

I'm on my first shift as an intern at the Emergency Room and the nurses are giving me all the IV line and blood draw orders.

"Yeah, ok. Ain't gonna be no worse than I done to myself." says the patient in Room 5. He's a well dressed, bathed male in his 40's. While I prepare my equipment, he tells me that he kicked his heroin habit 7 years ago and has since gotten involved in his nephew's life. He's become the assistant coach of his nephew's football team, helps him with his homework and spends a lot of time with him.

A few days earlier, he went out and got high. He thought it would be a one-time thing but it turned into a 5 day binge. Chest pains led him to call an ambulance and he has expressed his desire to clean up and "get back on track" once he's in the hosptial.

I've learned to not be judgemental in any way. I hate it when I see that in nurses and 'medics. My job is not to prostelyze, it's to provide the treatment. My patient in room 5 is in a confessional mood and his story pours forth as I get ready. His self-recrimination is occasionally punctuated by assertions that he's gotta get "back on track." We chat and get to know each other. He likes the ideas of new beginnings and my story of quitting my job and going back to school appeals to him. We get along pretty well.

He's got great veins and not all of them are scarred up. Nonetheless, I try and fail twice to start an IV.

"Well, my man." Says I, "I've tried twice and I don't want to hurt you any more than I have to. Time to call in an expert."

"No, man. You're a student. You need to learn. Go ahead as many times as you need. I've done worse to myself so go right ahead.

I try three more times and finally get it. Each time, he's giving me pointers on angle of the needle, how to keep a vein from rolling away and more. All told, we spend about 30 minutes together. At the end I've got a better understanding of veinipuncture and he's got a 20 gauge catheter in his left forearm.

Two hours later, when he gets transferred to another floor, I make sure to stop by and chat with him a bit more and thank him again for the "lesson."

"No. Thank you, man. You've done a lot for me. Good luck." He says.

"Good luck to you, too." Says I, and off he goes.

--maddog

Motivation

I ran a marathon yesterday.

About 10 of the 26.2 miles were head-on into 30mph winds.

Ugh!

The first 24.2 miles, I did fine.

The last 2, I needed some motivation. I rolled up my sleeve and, every time I felt like quitting, I read my motivation.




Thank you, Damage Controlman Third Class Nathan Brukenthal.

--maddog

The goodies are piling up.

I've got a TON of blogworthy goodies. Unfortunately, I probably don't have time to write them all up. I'll take a tip from Tom Reynolds and offer tidbits and let you all vote. You can do so by using the comments link at the bottom of this post or by sending me an email.

Here's the goodies:

-an ED rotation with Icky bedsores and cool nurses!
-a guest volunteer shift in another station with an SUV rollover!
-IV Drug Users teach me how to start IVs!
-Stabbed in the neck! Nervous paramedics! Maddog gets a blister!
-Another rotation in the ED, Maddog Tries to be an IV Jedi!
-Maddog's bedside manner, "You Funny! Go ahead. You can stick me again!"
-75lb (32Kilo) mastiff vs. Maddog. Can you guess who lost?

Ok! let me know which one you want to hear the most. I'll write up the ones that get the most votes first.

Thanks for reading!

--maddog.

My Angel has saved me!

My new preceptor is a wonderful person. She's a runner. She is a bottomless font of compassion. She's sharp. She LOVES working in EMS. She's a goofball.

Clearly, it's a match made in heaven.

I shall call her Angel. I'm sure that's what many of her patients think of her. She calls them all "sweetie," even the junkies.

We run an auto accident. Driver of car A is hit by a taxi that runs a red light. Driver A is pissed because she's been a bus driver for 14 years and has never had an accident on the job. She gets hit by a cab while driving her kids to school.

Low speed impact. All minor injuries.

At the emergency room Driver A glares at Taxi Driver while waiting for the solitary triage nurse to get around to them.

We're outta there!

Another car accident.

Only the passenger has complaints. We do a full spinal immobilization and transport. Nothing much worth mentioning here other than the fact that Angel applauds me for remembering to pad the voids of the backboard to make it more comfortable for our patient.

Wow! Compassion, skill and attention to detail! I'm home.

The next patient is "2 year old. Not breathing."

Shitohshitohshitohshitohshit.......

We arrive to find a little girl in the middle of the floor twitching rhythmically. Mom says she's got an implanted pacer/defribrillator. I see it under her skin. it's almost as big as she is.

I position the kid to open her airway and I see her stomach rising and falling in rhythm. I find a pulse. She's out like a light.

"You carry her. We're going." says Angel.

I scoop up the little girl and take her out to my ambulance.

"Hey, Little one! You there, Little One?" I say.

She seems to be rousing from all the activity. In the ambulance we get her on the cot. I remember from the pediatric seminar I attended (the morning after drinking beer and having dinner with the MacMedic), how to position a toddler to maintain the best airway. She's perfusing at 84% at first. A couple blankets under her shoulders elevate her body enough to allow her head to fall back and her airway to open.

One minute later, on 100% Oxygen, her hemoglobin saturation is up to 98%. Right!

I set up a 12 lead EKG on her. This requires me to place 10 electrodes on her body that I'm trained to do on an adult. Fortunately, the landmarks are the same and I find the 4th intracostal space (the space between the 4th and 5th rib) and the mid-clavicular line (the line straight down from the collar bone) with ease.

I crowd the big adult-style electrodes on her little body and press the button marked "12-lead". I get a readout (Sorry, I didn't get a copy) that tells me she's bradycardic (slow heart rate) with no abnormalities except a cardiac pacer spike (the electrical readout of her pacemaker shocking her heart) and a slight left sided hypertophy (the left side of her heart is a bit bigger than normal from working so hard). She's slow and low.

Meanwhile, Angel tries and fails twice to start an IV in the kid's fat little arms. We discuss an Intra-Osseous (that's where you jam a needle through the bone and into the marrow of the lower leg bone in order to administer fluids and medications) but we decide that our ETA of 3 minutes to the pediatric emergency room rules that out.

We can't get a decent blood pressure on her and I'm watching her oxygen saturation closely while trying to decide if I need to start bagging her (providing breathing assistance with a bag and a mask, effectively forcing more air inter her lungs when she inhales). Her activity level is increasing and she's becoming more responsive to pain and stimulus. These are good signs.

So far, we're thinking she's one of the rare kids with cardiac problems. I get three 12-lead EKG readings on her in sequence to give to the doctor when we arrive.

We arrive.

Into the ED. Nurses galore. Lots of consulting. Someone asks me to show them a pacer spike on an EKG readout. Eight people, one medic (Angel), one medic student (me), one nursing student and Mom are in this room.

Chaos.

Or is it?

3 minutes into it, the little girl cries.

"Moooommmmyyyyyyyy"

A collective sigh and everyone relaxes.

"Blood sugar?" asks the doc.

"Too low to read." says the nurse with the glucometer.

Blood Sugar? I look over at Angel.

An exasperated "Dammit!" is written all over her face.

We were so concerned with cardiac that we didn't test her sugar. Dammit!

The nurses couldn't start an IV (intra-venous, or needle-into-your-vein) line either. The doctor ordered an NG (naso-gastric, or a tube that goes into your nose and down to your stomach) tube and they filled her with glucose.

She came around beautifully.

I heard later that she went home the next day.

After the call, Angel was more concerned with figuring out how we could do that better next time than with justifying her actions. She is, truly, a Jedi. She believes in what she does so much that she can set down her pride and learn from her mistakes. I am humble in her presence.

All my worries about not learning or having a bad preceptor have vanished. Angel and I are of the same mind and she doesn't mind giving me the time to do the skills I need to learn.

My next shift with her is on Sunday night.

I can't wait!

More to come!
-an ED rotation with Icky bedsores and cool nurses!
-a guest volunteer shift in another station with an SUV rollover!

I've been sick. I haven't been dead.

--maddog.

10,000 hits

My blog achieved 10K hits today.

Happy birthday to me!

w00t!

I'm working on a rather long-ish post about my first run with my new preceptor ("Angel").

Stay tuned!!

--maddog

Birthday presents.

Today, I'm 34.

I've gotten 2 presents.

1. I've slept without nightmares, sweats and fevers for the first time in 2 1/2 weeks.

2. I succeeded in registering for the 2005 Marine Corps Marathon.

#1 means I feel awesome. #2 means I'll be running one of the most beautiful marathons in the world for the second time in my life.

Oh, yeah. I've gotten 3 presents.

It's 80 degrees Fahrenheit and sunny today.

I'm going running!

Once I'm done playing outside, I'll write up about some of the more interesting patients I've seen lately.

It's good to be alive.

--maddog

Sick....

This sickness has lasted for two weeks now.

Somehow, through it, I've done a rotation at the ED where I've seen a type 4 decubitous ulcer (that's a bedsore with bone showing through), moved my household goods into my home, took a midterm exam and assembled my new grill.

Bloodwork results come on Wednesday.

It's all been a haze.

The worst has been the fevers. I go to bed at night freezing cold and I wake up hours later, bathed in sweat with bizarre and nightmarish dreams.

Here's one:

My left hand grabs a magazine out of my belt as my right index finger releases the empty one from my rifle.

Hold it by the bottom. Feel the mark in the front. Jam it in. Slap the bolt release with the palm of my hand.

Sight in....

"Sproingggg!"

The M-16 makes a distinctive noise. My cheek is jammed against the stock, right over the long spring that returns the bolt to the forward position. Those on the other end of it hear the deep bark as I fire. All I hear is the spring transmitting through my cheekbone.

My right thumb switches my gun to semi-automatic. Three shots at a time.

Sight in...

BUh BUH Sproingggg!

Pick a new target....

Sight in....

BUh BUH Sproinggggg!

Next!

Sight in....

It goes on.

All of my thoughts are on my actions.

I sight in with my right eye. My left one is looking for more targets. My hands do their work. New magazine, Clear the jams. Reload. Change sights.

I focus on what to do on my end of the gun.

The nightmare is on the other end of it.

If I don't get better soon, I'm going to go crazy.

--maddog

I'm not dead......

I've been busy.

I went to an awesome conference and met the MacMedic.

I've been moving into my new house.

I've done an awesome shift with my new preceptor (15 leads and 2 year olds with implanted pacers!!!).

I've got the flu.

Blah!

More to come, I promise.

--maddog

P.E.R.L.

"I'm going to shine a light in your eyes now. I need you to look at one spot over my shoulder....."

"Pupils Equal and Reactive to Light." says the nurse with the bloody scalp wound.

She fell from standing on her bed and hit her head on the way down. She denies losing consciousness but I assume nothing.

"Yes." I say apologetically, "You know I have to check you out."

She sighs and smiles. Together, we go through all of the normal neurological tests for someone who may have a possible brain injury. She calls out their official name, what nerve they test and what it means to the examiner while I perform each test. Her neighbors got a really good education in neurology.

She passes every test. She looks me in the eye.

"I'm not riding in your ambulance."

I look at the blood trail down the stairs to the kitchen where we met her. I raise one eyebrow.

"You know scalp wounds are bleeders. Besides, My friend, Cindy, will be taking me to the urgent care center."

I want to talk to "Cindy."

Quick as a flash and without any confusion, She picks up the phone, dials, explains what has happened and then hands me the phone.

"This is Cindy."

Yes, it's Cindy. Yes, she's on her way. Yes, she knows where she's going. Yes, she's a critical care nurse too.

This is a patient refusal that I don't feel too bad about.

Good thing too. All of the hospitals were on Re-route. With a patient who's vitals were within normal ranges, we would have waited for hours, I'm sure.

"I saw you playing drums at open mic night at the Café last time. You're good, man." says a neighbor to me.

I love hometown EMS.

--maddog.

Watch out!!

I've gotten a new watch. It's a Timex and I like it a lot. I've had a digital Timex running watch and it's been my standby timepiece for quite a while. In fact, I've gotten so good at reading pulses and respirations off a digital watch that I don't even notice it anymore.

My new watch? Yes, yes, it has a sweep second hand but my recent watch purchase was really about aesthetics. First of all, I love the look and function of analog watches. Telling time on an analog watch requires the brain to interpret a picture rather than another set of numbers.

Secondly, I really like that Timex has put the Indiglo (TM) feature in all their analog watches. Now I can illuminate the entire face of my watch in a phosphorescent green/blue that I find comforting.

Thirdly, and most importantly, my watch ticks. It's a snappy and sure tick that reminds me of the insistence of time. I can hear it all the way down there (I've got loooong arms) when I'm in a quiet place.

It cost me $25; less than 4 pints of really good draught.

I am pleased.

--maddog

Changes are afoot....

        
One of my classmates from last semester's managment class is a preceptor in XXXXXXXX City. Whaddya know!

The CSC has been somewhat helpful, if busy and dismissive ("Send me an email and I'll get it taken care of!") with my problem.

We shall see.... we shall see...

--maddog

The Death of Compassion?

Rabbit and Rubber Band and I spend the day running calls to people who didn't really need ALS but could have benefitted from it greatly.

The 24 year old male who was retching from food poisoning. Rubber Band didn't want me to put him on the cot because he doesn't like to change the sheets.

The 47 year old male with back spasms, elevated pulse rate and mild chest pain. I asked if I could do a 12 lead and Rubber Band said, "We never do those." I then ask if I can at least do a 3 lead for a rhythm strip. I'm thinking I want to have some kind of look at this guy's heart. He's got a pulse of 94, a blood pressure of 180/98, he's overweight and he's got back pain of 10/10.

"Nope. We'll be at the hospital in 5 minutes."

Which we are and we wait for 10 minutes. I could have had 3-4 sets of serial 12 leads on this guy and seen what kind of response his heart was doing to all this stress but no.

We leave the hospital but don't put ourselves back on serviced for about 30 minutes. Rabbit doesn't like running calls, apparently. Neither does Rubber Band.

Here's the one that really set me off, though.

We get called across town for a 19 year old male with a shoulder injury from playing football. We take a crosstown highway to get there. Apparently, we're not the only unit in the city who's slow to go back in service. This call sends us deep into another Medic's area. On the way, I notice a minivan following very closely behind us. I'm sitting in the back of the ambulance facing out the back so I can see very well. The minivan tailgates us the whole way (about 5-7 minutes of driving) to the reported address and pulls right up to us when we get out.

"What the hell is this lady doing?" says Rabbit

"He's in here! He's in here! We called you a half an hour ago!" says the woman getting out of the minivan.

It seems she chose to follow us for 5 minutes instead of driving 5 minutes to the nearest hospital. Brilliant!

I go to the back of the minivan and am met with a young man who's covered in mud, in obvious pain and presents with one shoulder about 4 inches lower than the other. I help him walk to our ambulance and get a firm shake of the head from Rubber band when I go to put him on the stretcher. I situate him on the bench seat but once we start moving, his shoulder keeps bumping the backrest and he screams each time. I dislocated my shoulder when I was 18 and again at 32. It's no fun.

I finally override Rubber Band's disapproval and move the kid to the cot and strap him in.

Start an IV?

No

Push some Morphine for the pain?

No, we'd have to get medical direction and we're almost to the hospital, according to Rubber Band.

Well "almost to the hospital" is a 5 minute drive at high speed over the worst potholes in the city. Each scream of pain from this kid elicits a more annoyed look from Rubber Band. Rabbit's driving so, I can't see what her reaction is.

At the hospital, we're 4th in line and the kid is screaming and hollering the entire time. Rabbit tells him he needs to be quiet.

We finally get him a room and Rabbit closes the door on his screams and rolls her eyes as she walks away.

I'm ready to kill someone.

Before we leave the hospital, I walk up to the cab, where Rabbit and Rubber Band are sitting.

"Why didn't we push Morphine?" I ask.

"We'd had to call Medical Direction. Besides it's only indicated for fractures of the extremities." Says Rabbit.

"He had an obviously dislocated shoulder." I reply.

"You can't know that without an Xray." Rabbit shoots back.

"Then how do you determine a fracture in the field?" I ask.

"Look, we were almost to the hospital." She says with exasperation in her voice.

Fine. I get into the back and look up our protocols on Morphine Sulfate while we drive back to our station.

"Isolated injuries requiring pain relief " is what I find in the list of indications from our protocols. That means we can administer it without medical direction.

I've got a healthy kid with no contraindications for Morphine, who's also got an isolated injury and pain that's a 10/10. Why didn't we push the morphine?

Is it because I wasn't aggressive enough with my preceptors? Should I have insisted and told them to go to hell? How would that have looked at grading time? My preceptor holds my grade in the palm of her hand.

Is it because Rabbit and Rubber Band didn't want to deal with the hassle and paperwork of dealing with Morphine administration?

Is it because Rabbit and Rubber Band been on this job long enough that they've lost compassion?

Is it because I need a new preceptor?

--maddog

Is the honeymoon over?

Well, this post is about my preceptor and her partner. I have to come up with names for them so, here we go:

My preceptor has many qualities that I just can't seem to put into words. There are times when I wonder why she's decided to be a preceptor. I often feel like I'm a pain in the butt to her. Other times, she can be very accommodating. She always tells me I'm in charge of the call but she'll frequently take control to hurry up a junkie who's not going fast enough. I don't know. Because of her physical characteristics and the fact that I see Bugs Bunny smoking a cigar and wearing a bowler hat every time I look at her, I shall call her "Rabbit."

Her partner is a 42 year old father of 4 who looks, acts and speaks as if he just turned 21. He alternately scares and amazes me. I shall call him Rubber Band.

Rabbit and Rubber Band show up to shift this morning only slightly less hung over than they warned me they would be. I knew they were going to a big dinner function the night before and when, at 0530, they stumbled in, signed themselves to the roster and shuffled off to bed, I smiled and turned to my homework.

We only ran a few calls but they, combined with the calls I ran last shift, served to give me a clear picture on their attitude towards patients, transport and what the think a 'medic should do.

I'm far too exhausted to accurately describe my feelings. There are also some technical aspects and drug questions I'd like to ask my more experienced readers. Stay tuned. I will post again tomorrow.

Coming up....

Apathy, Compassion, Tailgating and Morphine Sulfate!

Will the fun never stop?

--maddog

More to come....I hope.

On my last duty night had no calls. Blah!

School is demanding but not exciting enough to warrant a post. Blah!

Today? I ran 18 miles. Oof!

Tomorrow? Another shift with Medic XX. There's a good post waiting for me, I know it! Whee!

Soon, I'll be doing rotations at an ED in the same area as my Medic unit. I'm SURE I'll get some blogworthy stuff out of that. I found out that next semester (fall 2005) I'll be in the same ED but I'll be shadowing an ED doc instead of cleaning vomit and hoping for a chance to do an IV stick. It made me think of Doc Shazam and her post about Teachable Moments.

More later, I hope.

--maddog

Cadavers

We went to the "Cadaver Lab" the other day. It's a place in the basement of a nearby University/teaching hospital where we had opportunities to practice some of our more invasive and damaging interventions on the cadavers (dead bodies) of some wonderful people.

Wonderful people? Yes. I found out from one of the doctors that many of the cadavers in the lab came from the Anatomical Gift Foundation. I think this is tremendously cool since that's where my mother-in-law made her arrangements when she passed.

Before we go into the lab, I have a qualm: After hearing that the two cadavers we're working with are elderly women who have donated themselves for our study, I fear that I'll see the face of my Mother-in-law. I love her very much and I'm sure I wouldn't be able to take it.

Irrational, I know. She passed in September and here it is, February. It couldn't possibly be. But the possibility leads me to a wonderful realization. Because of my Mother-in-law's generosity, a whole group of 'medics and doctors may have had the opportunity to learn the finer points of life-saving interventions and skills. It's pretty awesome when someone can be so generous after their heart has stopped. I really love her.

We enter the lab and, at first, I'm not fully prepared for the experience. I've seen a few dead people in my day but they were all so badly done in that they were clearly dead. Bloated, floating, full of critters, that kinda stuff. These two women looked sleepy. They had passed a day or two before. I wanted to ask their permission before I did anything. I was not fully prepared to see someone who looked lifelike who I knew was very dead. I was comforted to hear a mumbled, "pardon me" from one of the doctors before he started his demonstration.

Respect.

It was a great experience and I got to do a lot of interventions and see a lot of things I had only read about. Totally worthwhile. I did a couple intubations and some with a bougie (a flexible stylus to help me find the airway by feel), needle and surgical crychothyroidotomy (making a hole in the throat to allow a patient to breathe), Needle chest decompression, intraosseous infusion (putting a needle into someone's bone marrow to get fluid access) and more! All of these things, If done properly, could and will save someone's life.

At the close of the lab, we cleaned up our debris and we all thanked the ladies who made it possible before we zipped them back up. That final bit made it totally complete. They gave their remains to our education and we were grateful to them for their generosity.

What more can I say?

--maddog

"Well!...F**k Me!"

Well, a lot has happened since I got around to making a post. I'm sorry for not posting sooner.

I went out with my preceptor for a day shift. She and her partner are pretty tight. I'm not quite sure what to name them in my blog. They both have very distinct personalities. My preceptor's partner is a 42 year old man with the libido of a 19 year old. Yikes! He's very funny, whip-smart and loves to teach. So far, I haven't seen him do anything I'd frown on other than be a bit too hyper and distracted.

My preceptor herself? Well, I'm not sure how to describe her. She's kind of hard to pin down. She's definitely got mad skills in the ALS department but also seems to have a cavalier attitude about her job. She's young and pretty but could, no doubt, put any firefighter on his ass who crosses her. I've given other characters in my life "blog names" but one doesn't come to me for either her or her partner. For now, I'll just call her my preceptor and her partner will be the "other one," I guess.

We ran about 4 calls. None of them gave me the opportunity to perform any ALS interventions. Worth any mention were the seizure patient who sells his seizure medications to buy heroin and cocaine. He's so used to riding to the hospital, he put himself in the ambulance and the nurses at the hospital called him by name. There was the diabetic cook at the nearby hotel who was munching candy and smiling by the time we arrived. His manager got scared and called it in as a siezure. I checked his vitals and blood sugar and accepted his refusal of transport without a qualm. He thanked us and apologized for the trouble. I assured him he could call us back if needed. He laughed.

I've got 5 more shifts with these characters and 6 at a nearby emergency room (ED, or Emergency Department). More hijinks to come, I'm sure.

At school, there's been drama. One of the central instructors to the program has left suddenly under circumstances that nobody will discuss. We've had different instructors for our classes and I, for one, am pleased. In general, the quality of the lectures have been excellent and the academic demands a bit higher. I like a challenge. The drama lies in the person who is supposed to arrange all of our clinical rotations. Suffice it to say, she manages by crisis only. This means that everything is left to the last minute and I get frantic emails telling me I have to be at such-and-such at 2:00pm tomorrow or I will fail all of my classes, the sky will fall and I'll be excommunicated.

Well!...F**k me!

I'm a meticulous planner and I try to organize my life as much as possible to enable me to do all the bajillion things I have to do. I am now finding myself dealing with emergencies created by someone's lack of proper planning. It's really pissing me off since the people who can't plan how to take a crap are threatening me with academic failure when I don't meet their insane demands.

This person, as I've been told, is very sweet and you can ask her anything. I made the mistake of asking her what to do since I had a clinical rotation (that she knew about a week before) scheduled on the day she scheduled me to go do something else. Here's the response I get,

"This is a career choice, not a game. Only the committed ones will stay to the end & excel."

Well! Again, F***k me! I didn't know I wasn't committed! ....Let's see....I quit my high-paying job....I sold my big, lovely house.....I gave up all my free time.... I've gotten outstanding grades.... Yep! You're right! I'm NOT COMMITTED! Wow! I guess I'll go get a job as a clerk or something! I merely asked some questions (very basic ones about what was expected for my clinical rotations that should have been made clear in the handouts).

"F**k me!"

Oh, did I mention she sent this email that contained other insulting things to a mailing list that's read by the entire department? I suppose I should be used to being publicly insulted from my years in the military. After reading it, I was ready to chop somebody in the throat and taunt them with an ET tube while they died of asphyxiation.

Fortunately, the jedi in me took over and I calmed down.

I have not responded to any of this, nor have I spoken with the Cranky Spastic Cow or, CSC, as she shall be called from here on. I've still not had my questions answered. I will probably have to figure out what I need to do on my own (spend time I don't have) and also work this situation out with the department head (more time I don't have) who I suspect is not going to help because he doesn't like conflict or other silly things that take up his time.

I keep saying it because it feels like everyone's doing it: "F***k Me!"

When is it my turn?

--maddog

School again.

No, I haven't been eaten by a bear. I've started school again and it's pretty intense. I've decided that I'm going to be getting all As this semester and the fulfillment of that goal is consuming huge quantities of my time.

Calls: Not many. In fact, none. I'll start working with my paramedic preceptor in a week or so. Perhaps I'll get more then. We'll certainly see a new cast of characters!

School: The person who was my advisor and instructor for most of my classes last semester has left under hushed circumstances this semester. There has been a lot of last minute scrambling to fill in the teaching spots but, I must say, the quality of the instruction has gone up considerably. I am pleased. Unfortunately, with the increased quality of instruction, the expectation of performance has increased too. We are graded on our class performance, papers, group projects and research and clinical performance. And THEN we take our registry exams for EMT-I and EMT-P

WHEW!

I'll try better to write more. Does anyone have any good "tricks" to memorizing the ACLS drugs, sequences and dosages? I'm in a rut! Hit the comments section or email me.

--maddog

"One and Two and Three and Four and Five and Six and Seven...and Fifteen. Breathe!"

The call goes out as "trouble breathing" and I see on the printout that the patient has a stoma. That's a hole in their neck to breathe through. It's, basically, a permanent tracheotomy.

We hurtle around corners to the house. Run to the door. The wife is walking circles around the kitchen table.

"In there. Oh my god! Oh my God!" Her helplessness is expressed in her flapping arms and manic look.

Through the hall to the den. I see a man, 60-ish, in a chair. His chin is on his chest. I can't see his breathing hole in his neck. Also: He "looks like Sh*t," which, most people in EMS will tell you, means he's in trouble. Sometimes you can tell right away.

I'm at his side. I tilt his head back. Flaccid muscles. I check his pulse. Flat.

"No pulse. Let's go!"

Furniture is flying! We make room to work. (Have you ever THROWN a recliner? Wow!) We slide him from his chair to the floor and start right away.

"Um, Mask?"

He's got a hole in his neck. There's no use in ventilating him with a mask that covers his mouth!

Like Obi-Wan Kenobi's voice to Luke, during the trench run, a voice comes to me, "In the event you encounter a patient with a stoma, Use a pediatric mask over the stoma hole and invert the longitudinal orientation..." (Can you tell I was trained in the military?).

Pediatric mask is attached but we can't get a seal! Crap!

"Tick, tick, tick, tick, tick!" That's already going through my head. How long has he been down? How long has he been without oxygen? Why didn't his wife tilt his fu**ing head back?!

We can't get a seal with the mask and I improvise by putting the bag-valve mask (BVM) connector, directly into his stoma.

We get a little bit of air into his lungs. (I'm listening with a stethoscope), but most of it goes into his stomach. His belly's getting more and more distended and he's becoming a bright shade of purple.

"Crichoid pressure!" Says I!

"What?"

"Push here!" I show where to push on the windpipe to close off the esophagus (on the Crichoid cartilage) and allow the air into the lungs.

A little better but the pressure in his stomach is restricting lung movement.

Dammit! Dammit! Dammit!

We're pumping and blowing (CPR) as best we can as we transfer him to our ambulance. The 'Medics arrive and pile into the back of "the Bus."

Intubation! A tube down the throat and he's suddenly pink again. It's amazing what you can do when you can get an air "pipe" directly to the lungs.

IV! A direct line into a vein to carry drugs to he heart will work wonders when you need to "restart a ticker."

Than we go into Transcutaneous Pacing. This is where an electrical shock is delivered via electrodes attached to the skin (transcutaneous) on a regular basis to coincide with a desirable heart rhythm(pacing).

Meanwhile, we're still bagging the patient (using a breathing bag to push air into his lungs).

"Check for a pulse." says the 'Medic.

"No pulse. Radial or carotid." Says I.

"Ok! Let's see what he does now!" The 'Medic increases the energy output of the pacer.

"Check for pulse." A bit later

"I have a pulse!" says I.

"No Sh*t?" says the 'Medic.

Not only that but his blood pressure has returned to 122/82. Without chest compressions!

"Right on!" says the 'Medic.

We continue ventilations until the patient begins to breathe on his own.

We transfer a patient, to the hospital, who has a spontaneous pulse and is breathing without assistance.

For weeks afterwards, the name "Lazarus" keeps coming into my head.

I did my job as a BLS provider. I fed oxygenated blood to the brain. Did that help the patient? Is he alive because of me? Did I see this patient for what he was and act in enough time to save his life?

I don't know. So much of what we did seemed to be ineffective. The more dramatic results did not manifest until the paramedics arrived. But still. Did I, somehow, make that possible?

Since then, I have found myself checking everyone's pulse who's close to me. On the subway, I'm watching everyone breathe. Those are the important things. ABC's, Airway, Breathing and Circulation.

It's reassuring to see it.

Lazarus.


--maddog

Desk as a drum....as inspired by Martin O'Donnell.

Have you ever banged on something with a rhythm and realized that it sounds good? I play a drum. Not drums. Just one.

I was just listening to Peril by Martin O'Donnell from the Halo 2 soundtrack (yeah, I got the mp3). It's full of rhythm and strings and generally sounds great! I suddenly found myself bangin' away on my desk. I have this hollow-core desk from Ikea with great acoustics and it sounded pretty dang good!

Who knew?

--maddog

Maddog rides the fire engine! Unresponsive patients respond!

Well, the ambulance developed a pretty major fuel leak. I found out later that it blew a fuel hose and my chief could tell everywhere we drove that night by the trail of diesel fuel we left all over town. I wince at the thought of the sheen that is heading to the Atlantic Ocean as I write this.

Well, I go to bed with the thought that the ambulance is out of service and I'll sleep all night.

WRONG! HA!

At 4am the bell rings and I'm up, dressed and in the vehicle bay before I realize we have no ambulance in service. I do hear:

"...Medic local: 402 _____ Road, Apartment 103, Unresponsive person, Engine XXX (our engine), Ambulance XXX (the ambulance from my old station), Medic XX (from earlier that night), respond on channel 2."

"There's no ambulance!" Complains I.

"C'mon, Maddog! Get on the engine, It's a medic call! We'll get there first!" says LT.

I'm on the engine!

"Get the suction unit and the AED off the Ambulance!" I shout.

"Right!" says another firefighter and, just like that, It's done.

In the engine, the Cap'n hands me the suction unit and the AED. Woodchuck is in the seat next to me. LT is driving and Jr. is riding officer.

"I'll carry the AED and the suction unit. Cap'n, you follow me with the aide bag and, Woodchuck, come up with the O2 kit. Ok?"

They nod. Once again, I'm in charge. I'm thinking, unresponsive at 4am means bad business. If they're truly unresponsive, they're either really dead or recently dead. AED, O2, Suction, I'm ready for the worst.

The address is right next to where my parents lived when they moved to this town in 1966. I'm not the first out of the engine but I'm the first to the door (runner, me). The door is opened by a worried looking woman in her 20's and I see a man of the same age sitting on the couch.

"Do you have any pets or dogs in this apartment?" I ask.

"No, No pets. Just another roommate." Says the woman with an accent. (German? Russian?)

"Where's the..." I start to ask, thinking the roommate is in a back bedroom, dead or barely breathing. The guy on the couch raises his hand.

"....?...."

I see he has a glucose meter on the coffee table in front of him. Things are starting to make sense. I move in to the apartment and situate myself near the "patient." By this time, the other 3 firefighters show up with the rest of my gear.

"I get like this sometimes when my sugar is low. My girlfriend, She got scared. I'm sorry you all came out." says the man on the couch. He knows exactly what's going on. His speech is clear and well-delivered. He too speaks with an accent. Definitely German. He uses articles. I've found that Russians don't often use possessives and articles in their speech.

"Cancel the Medic." I say to LT, who has the radio.

It's done. I take vitals. All normal. I check his lungs, eyes and look for nystagmus or other signs of inebriation which can also indicate a diabetic emergency. All come up negative. The guy smells of laundry detergent and spice deodorant. He does NOT smell like he's drunk or having a diabetic emergency.

His blood sugar is 36.

"Have you eaten?" I ask. I feel my eyebrows are in my hairline.

"Yes, I just had some cereal and milk." he says as the woman brings him an apple, oddly, on a plate. The patient takes a look around his living room. He's sitting on his couch in his pyjamas, surrounded by 4 emergency responders and a worried girlfriend (I know who called 911!).

"Ok. Your girlfriend is worried. That's why she called 911. I'm worried because your blood sugar is so low. If you want to go to the hospital, we will have an ambulance take you."

"No, No. I'm fine. This happens all the time. I eat something and my sugar comes back up. I'm fine, I assure you." He converses the way people do in books. A consequence of not being a native English speaker, I'm sure. I satisfy myself that he's of a good mental state and is doing something to address his hypoglycemic state. The apartment is clean and well ordered. The girlfriend is concerned and attentive. No signs of a dangerous or risky lifestyle. I also note the lack of tracks in his arms and the lack of "smell" in the apartment.

"Cancel the ambulance." Again, It's done.

"I need you to sign this form. It says that you do not wish to go to the hospital right now."

"Ok. No problem."

"Now, I want you to understand that this does not mean you cannot call 911 two minutes after we leave. If you need an ambulance or medical attention, you call 911. I'll come here 20 times tonight if I have to. Ok?"

"Yes, Yes. I'm sorry to put you all through so much trouble."

"It's no trouble. I'm only concerned if you are OK. Are you sure you don't need to go to the hospital?"

"Yes, I am sure. Thank you." All of his dialogue is delivered appropriately and clearly.

I get up to leave. I look around to find all my gear has already been gathered up and put away. Deferential looks from the Firefighters. Walking back to the engine, clearly the domain of the firefighters, I'm struck by the strangeness of it all. I'm surrounded by people I greatly value, respect and look up to yet, here they are, looking at me like I'm in charge.

Back at the station: "G'night, Maddog. Thanks"

Thanks? Me? No, No! Thank YOU! Wow!

I write a loooong report and go to bed.

--maddog

ALS-a-go-go!

"... Medic Local. 125 _____ Road, The Step Club, Chest pain, Trouble breathing. Ambulance XXX, Medic XX, Respond on Channel two."

I know exactly where the address is (I've lived here my whole life) and I know the Step Club is a meeting place and hangout for recovering substance abusers. It's right next to the grocery store and in the basement of the barber shop.

I'm assuming it's a heart attack but I'm also ready to be greeted by someone who's fallen off the wagon and making a scene (it's happened before).

We roll and, this time, my LT is driving. He's also in charge of the EMS side of things at my station so, I'm kinda glad he's along. I'll get to "strut my stuff."

We arrive on scene in 2 minutes and find a man being walked out to our ambulance by a friend. He looks like crap but he's walking, alert, oriented and answers my questions appropriately. I ask him if he can climb into my ambulance and he says yes. I'm prepared to help him up but he has no trouble. Good.

In the ambulance we get him situated and get his complaint:

"My heart's racing and I have a funny feeling in my chest."

"Does your chest hurt at all?"

"No, it just feels funny

I give the guy a full check out. The pulse oximeter(PulseOx) is showing he's got a pule of 114 and saturating at 99% on room air (no oxygen supply) and talking. I check his pulse manually and it feels strong but irregular. I look over at the PulseOx and compare what it's rhythm says to what my fingers tell me. The PulseOx clips onto a finger tip and reads the electrical impulses of a heart rate along with how saturated the blood's hemoglobin is. These are great things to know but they don't mean anything by themselves.

I notice that his wrist doesn't always pulse when the PulseOx is saying he should. He's dropping beats, or, his heart's not beating all the time. That would explain a "funny feeling" in his chest!

Otherwise, this guy is unremarkable. He's 49, healthy-looking, sober and has a good mental status. He says it all started when he was on the treadmill earlier that day. The rest of my exam reveals clear lungs, eyes: PERL (Pupils Equally Reactive to Light), skin: warm, pink and dry, no edema at the lower extremities and his carotid and distal pulses match in all 4 extemities. I take a careful listen to his heart in 4 places and it's giving me an unusual "harrumph" at the apical point that's faintly echoed at S2. Hmmmm.....

I look across the cot at LT. "Medic Status?"

He checks via radio and I hear they're about 3 minutes out.

"Medics? What's wrong with me?" asks the patient. He's worried.

"I don't know." I say honestly. "There's definitely something funny going on with your heart. The paramedics have much better equipment for looking at your heart and more advanced interventions if you need them. I'd be a lot more comfortable with them here."

"Oh, man. This is bad. I don't know what's wrong with me. I work out every day...."

He's worried and it's making him more anxious which is making his heart rate go up again.

"Look, you're about to be in an ambulance with 2 EMTs and 2 paramedics. If anything is going to go wrong, this is the best time for it, okay?"

"Okay." He's calming down again. I watch his pulse go from 105 to 88.

The paramedics arrive and climb in. I give my report to the lead medic. I tell him about the guy's pulse and the pulseOx reading on room air, the patient's family history of heart disease (brother and mother had heart attacks) and exercise intolerance(the symptoms appear when he exerts himself. I also tell him of the "Pertinent negatives:" No unusual lung sounds, No briuts in his carotid, no edema in the extremities, skin condition, etc..

The medic leans his head over to look over my right shoulder. I follow his gaze thinking someone got in the cab of the ambulance.

"Hm, I was looking for a paramedic patch on your shoulder but all you're wearing is a Basic patch. You don't sound like a typical EMT-B."

"Oh! Uh..thanks. I'm going to 'medic school" (I'm actually BLUSHING!!!)

"Really? Where?"

"Up at _______."

"Yeah, I've talked with ______ (My advisor) a couple times. I'm thinking of taking the management program there."

We turn our attention back to the patient.

"You remember your 12-Lead placement?" he asks me.

"Sure!"

"Great! there's the kit. Go to it!"

He directs his partner to start an IV line and, as I'm setting up the leads for the EKG, I notice she must be new at this. She doesn't warn the patient that she's going to stick him, she has a hard time finding the vein (She went for one she could see easily and it kept rolling away.) and once she's got the vein, the guy's bleeding all over the place because she forgot to take off the tourniquet.

Fortunately, she's paired up with a pretty squared away medic. He decides that we're taking the patient to a cardiac specialty center that's a longer drive than 3 other local hospitals. He's clearly more concerned about the patient than getting back to his dinner or TV show (There IS hope!). He also decides to ride in the back of my ambulance with me helping while his partner follows us in the medic unit.

On the way he takes a good 12 lead and 3 lead strips. He hands them to me for interpretation prior to saying anything and we discuss how it could or could not be a Type 2 Mobitz II AV heart block. He then asks me what drugs I would give this patient and the only one I can think of that was appropriate would be Aspirin. He's not in obvious need of Nitroglycerine (no chest pain), His pain and blood pressure don't indicate Morphine and I'd already started him on 15 liters per minute of O2.

"The aspirin is in the top of the drug box next to you. Go ahead."

He quizzes me some more. We talk some more. At the hospital, we hand off the patient, re-stock our rigs and he wishes me luck.

All in all, a very enjoyable call.

Up next:

Maddog rides the fire engine! Unresponsive patients respond!

Stay tuned!

--maddog

Am I an angel?

The bell rings. One long bell. My eyes go to the scrolling LED display high on the wall and I see it's an ambulance call. I also see that it's a personal injury after an assault and it's 2 jurisdictions away. It's been a busy night and we've been called into this one because the ambulances in the neighboring areas are all occupied.

I grab the printout to be sure of the address and am deep in the map book for that area by the time Helga hoists herself into the driver's seat. It's a long drive but we don't get lost. Once we get close, the lights of the fire trucks and police cars act as beacons, guiding us in.

As I'm grabbing my bags, I ask the nearest cop what happened.

"She and her boyfriend were arguing and he stabbed her. She ran to a neighbor's house, in there."

"You got the boyfriend in custody?"

"Nope."

Great.

One of these days it's going to be me vs. assailant. I'm not looking forward to that but I'm sure it will end badly for the assailant. (Let's see, I'm 6'4" (2 meters) and 245 lbs (110Kilos), yep, bad day)

In the house I find a crying 35 year old woman from El Salvador sitting in a chair and being attended to by 3 firefighters. She is being administered oxygen by an infant non-rebreather mask(NRB) (about the size of her nose) and has a wad of trauma sponges on her neck. Hoo boy!

To the firefighters: "Hey, fellas. What do we got?" as I pull an adult NRB out of my oxygen mask.

"We didn't have any adults in our aide bag on the engine." says one of them apologetically.

"No worries. What happened?"

"We don't know, we don't speak Spanish."

"Hola, Señorita. Me llamo Maddog. Me voy a ayudarte. Digame que pasó."
"Hello, Miss. My Name is Maddog. I'm going to help you. Tell me what happened"

She cries and, through the tears tells me that her boyfriend is not happy that she's renting a room in a house that is populated by men. He stabbed her with a knife.

"¿Un cuchillo de cocina?"
"A kitchen knife?", I ask.

"Sí, sí. Al primero vez, un grande pero yo lo luchó. Él tiró de mi pelo y me lanzó en el suelo."
"Yes, at first a big one but I fought him. He pulled my hair and threw me on the ground."

I see that chunks of her long, black hair are missing.

"¿Con qué tipo de cuchillo él le apuñaló?"
"What kind of knife did he stab you with?"

"Un pequeño, para las frutas."
"A small one, A fruit knife."

I gingerly pull away the dressing from her neck to find a small incision at the angle of her jaw. right to the bone of her mandible. Two inches further back, and I'd be bagging a corpse. Wow!

She's upset. She's crying. She's scared.

"¡Oye! A mí, hay seguridad. Yo, y las policia, vamos a protectarte. ¿Me intenedes? En mí ambulancia, es un espacio seguro. Es importante que usted va al hospital. Voy a tomarle allí. ¿Bien?"
"Listen! With me, you're safe. I and the police are going to protect you. Understand? My ambulance is a safe place. It's important that you go to the hospital, I'll take you there. OK?"

"¡Sí, sí gracias, gracias, gracias!"
"Yes, yes, thank you, thank you, thank you!"

In the ambulance, I take the time to explain everything that is happening. The neighbors have gotten her a change of clothes to replace her blood-soaked dress. I'm gentle with her. She's scared and fragile.

"¿Porqué eres bueno?¿Es usted un ángel?"
"Why are you so good? Are you an angel?"

Wow!

--maddog