I hop in the ambulance, gobbling chili as I go. The call is to an address I know pretty well. The fire engine is already out on another call and as we climb the hill to our destination, we see it. There's a fire right across the street from where we're going. A friend of mine lives in that set of townhouses and I think, "Gee, I hope he's ok." I find out later that he is ok but it was his house burning.
Poster Girl, Sky Captain and I enter the house of my patient. I know this woman. Her son taught me to ice skate when I was 8 years old. She has a bunch of medical conditions including, diabetes, high blood pressure an amputated leg, extremely brittle and breakable bones. According to all her doctors, she should have died a few years ago but she's still going. She's persistent, energetic involved in the community and irrepressibly cheerful. She's one of my favorite people.
Not cheerful tonight. She's got abdominal pain 10/10 with nausea and vomiting. Hasn't been able to keep anything down for the past 18 hours. I greet her and her husband. She even manages a smile when she sees it's me. She's in a lot of pain but her mental state is good and she answers all my questions appropriately. She's got a blood pressure of 238/180. She hasn't been able to keep her blood pressure pills down. The call was dispatched as an ALS (Advanced Life Support) call and the Medic unit arrives soon after I do.
I give my report to one medic while the other seems to be doing his best to find a reason to downgrade the patient to BLS (Basic Life Support, i.e. me) so they won't have to transport her. They're giving each other the look I've seen before.
"I was going to palpate her abdomen to rule out a AAA when you got here." I say. A "triple A" is an Abdominal Aortic Aneurysm. That's where the main aorta going down the abdomen gets a tear in it and hurts like crazy. The real danger is if it bursts then the patient will quickly bleed to death. Not much I, as a basic provider can do for that.
Both medics look at me. Then at each other.
"If I'm going to take her, I'd really prefer one of you to come with me. With her pressure and abdominal pain, I'm a little nervous. There's not much I can do if she bonks." says I.
Both medics sigh, nod their heads in resignation and one tells me to get their cot. I'm getting a reputation, I suppose, of not letting the local medics get away with anything!
Back at the station, it's midnight. Blessed sleep.
At 4:30 the bell rings again. I stagger out of the bunkroom and think I'm still asleep. "14 year old female, Chest pains, trouble breathing." Squawks the radio.
14? Chest pains? Great, I'm surely still asleep. I look at the printout. Sure enough: 14 years old.
I put my bunker pants on over my flannel pajamas and hop in the ambulance. Poster Girl is driving, Sky Captain has found his sleepy way into the back.
In the apartment, I find a worried mom, a pair of sleepy siblings and a 14 year old girl sitting on a couch. She's crying and rocking back and forth while clutching her chest.
I get her to calm down a bit and get her to describe the pain. She says it's a burning that work her up about 4am (20 minutes before). Poster Girl interviews mom to get medical history, medications and allergies. I hear the mom say, "She takes Prevacid."
"Does she have acid reflux disorder or GERD?" I ask.
"Oh yeah." says mom.
"Has this happened to you before?" I ask the daughter. Still crying, she nods. Her vitals are all good for a 14 year old kid but she's in a lot of pain. We walk her out to the ambulance and I sit her in the cot as upright as it will go. I hook up some oxygen and get her strapped in. As we drive to the hospital her pain decreases to almost nothing.
We have to wait a bit in the ER for a bed. Mom is there with the two little siblings. The boy is about 6 and has a look of constant skeptical distrust. I lean over as if to tell him a secret.
"I'm wearing pajamas." I say in a stage whisper. He looks even more skeptical. I hike up the cuff of my bunker pants over the top of my boot, revealing a plaid flannel pajama leg. I wink at him. A couple minutes later, I hear him whisper to his sister.
"He's wearing pajamas!" Giggles ensue.
--maddog
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