Night of Insanity: Final Chapter.

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

The Night of Insanity, Part Two!

I return from the previous call to a firehouse full of people. This includes a couple who live in town who are interested in volunteering. I have invited them down to check the place out. All they see is a chaos of people, fire trucks and ambulances rushing in and out. Herself is serving out chili to any takers and spirits are high.

I dash out my paperwork from the last call and go into the kitchen. The ladle is poised over the bowl, ready to deploy a spoonful of chili deliciousness when the bell rings again.

ARGH!

27 year old male with chest pains. 27? with chest pains? Whatever, off we go. I've got Poster Girl driving and Sky Captain in the back as my trainee.

Oh, yeah, and all the medics in the area are busy. I'm on my own. Great!

The guy was driving his tow truck when he began to feel funny, we respond back to the same Major Interstate about 200 yards away from the previous accident of the night and pull in front of a flatbed tow truck. I get my gear on and get out. As I do so, there is an EMS supervisor walking my patient to the ambulance. Okeydoke. In you go!

I'm interviewing the guy and he's actually complaining of a strange feeling in his chest like his heart is skipping a beat. I feel his pulse and, sure enough, he's got an extra beat in there every now and then. I turn to the EMS supervisor,

"You got a Lifepak 12 in your truck?"

He looks at me surprised, "Um, yeah."

"Thanks!" I say. He looks at me again and then heads off to his truck.

Back with the Lifepak, I pull out leads, hook up my patient and print out a strip. (don't have a copy, sorry.) Sure enough! He's got some early ectopic (unusual) heart complexes on the readout. I call them Perfusing Premature Junctional Contractions. The QRS complex is a bit too narrow for me to call them ventricular. All the same, my patient is hemodynamically stable (has and maintains good blood pressure and is heart is adequately moving blood and O2 around his body), has a good mental status (knows where he is, who he is and what day it is) and is mostly just scared.

"You coming?" I ask the supervisor.

"No, and you can't take that either." He replies, indicating the Lifepak. He gives me a smile. We introduce ourselves to each other and shake hands.

Off I go to the hospital. My patient is nervous and chatty. I tell him everything that I'm doing and why. He seems really interested and I go a bit deeper into the science. He's eating it up. My lecture on the functions and dysfunctions of the heart carry us all the way to the hospital. We ended up going to another one further away than the last but it had the attractive feature of being open to receive patients.

My patient takes no meds, has no allergies and has no history of cardiac problems. His father, however, has high blood pressure, a 4 way bypass and takes lots of meds for his ticker. Okeydoke. My patient's blood pressure is also 222/118. That's pretty high for 27 years old.

At the ER entrance there's a man waiting who looks a bit like my patient. He's wearing a guardedly anxious look on his face.

"Are you Dad?" I ask. He nods.

"C'mon." I say, indicating him to follow us into the ER.

In the ER, the charge nurse asks for and expects a full report. She listens carefully to my entire report and even asks a few questions for clarification. It's nice to be appreciated! We transfer my patient to a bed, make a few jokes, pat him on the back and get ready to leave. On my way out, Dad stops me and shakes my hand.

"Thank you very much." he says, solemnly.

"Thank you, Sir. I trust you won't take offense if I say I hope I never see you like this again."

This seems to relax Dad and he gives me a smile.

Back at the firehouse by 10:20pm. Paperwork done by 10:25. Bowl in hand, chili on ladle at 10:26. Bell rings at 10:27. I'm running to the ambulance, eating really tasty chili. Poster Girl gives me a look when I get into the ambulance, shoveling chili and rice down my gullet.

"I'm hungry!"

Coming up:

I respond to the house of one friend while the house of another burns across the street! 14 year old with chest pain!

Hometown EMS, Yoikes!

Stay tuned!

--maddog

The night of insanity, Part One!

What a night!

I arrived about 45 minutes early to the Firehouse to get dinner set up. I have a gallon and a half of venison chili in a pot on the front seat of my car and all the fixin's in the trunk. I'm opening the trunk of my car when the bell for the ambulance goes off.

Out the door I go! Rear-end collision on the Major Interstate. I arrive as the rescue squad from my old station is preparing to extricate the driver. I pop into the car to check her out briefly. She's in a good mental state, denies loss of consciousness and her main complaint is neck and back pain. The squaddies have things well in hand so I get out of the way until the driver's out of the car.

Backboard, straps, immobilize the head, into the ambulance. Police take a report while I do a quick trauma assessment. Nothing noted but tenderness. I check the status of the area hospitals and am told by communications that the nearest hospital is open and ready to receive patients. Ok! off we go.

Unbeknownst to me, about 5 miles away was a 5-car pileup. I arrive in the ER with my patient at the end of a line of 6 other car accident victims. The nearby trauma center has been overwhelmed from previous incidents and is on re-route. Suddenly, I'm in for a long wait.

An hour later, I'm still waiting for my patient to be triaged and to hand over care. I call the Firehouse. Herself was going to meet me there to dine with us. Sure enough, she's there. I ask her to get dinner set up and start the rice. She proceeds to not only do that but to feed everyone, thereby earning the undying love and adoration of every firefighter there.

Back in the hospital, I still had a long wait before I could transfer my patient to a cot next to the nurse's station and head on out. I have to say, I was quite annoyed at the other ambulance crews that were there. One crew kept harassing the nurses for a bed for their patient when it was clear there were none. Meanwhile, one member of this crew tells me their patient has an altered mental status (AMS) so goes ahead of mine who only has pain. We're having this conversation about 15 feet away from their patient.

"AMS, Eh? When was the last time you took vitals?" asks the maddog.

"Uh, when we transported her." says the mouth-breathing dork who transported her. That would have been about an hour ago.

"Unstable patient gets vitals every 5 minutes and, unless I'm mistaken, she's still your patient." replies the maddog.

"Uh. Oh. Right!" Off dashes the mouth-breather for a stethoscope and blood pressure cuff. Meanwhile I strike up a conversation with their patient. She's doesn't have an altered mental status, she just doesn't speak English. A few sentences later, I discover she's mostly complaining because her necklace is caught in the collar and is pinching her really bad. A few adjustments later, the patient is much quieter and the crew who brought her is much meeker.

Meanwhile, my patient is becoming more agitated. She's in a lot of pain, strapped to an unforgiving and rigid backboard and unable to move anything except her hands and arms. Her head hurts. I raise her cot a bit to take some blood pressure from her head. that helps a little bit.

"I have to pee!"

"I'm sorry, Ma'am, I can't take you off the board until you've been x-rayed. We're worried about your spine and neck."

"My head hurts and I'm uncomfortable."

"Yes, I know. I'm sorry but it's for the best. I don't want you to hurt your spine." I see this isn't working so I get personal. "Ma'am, if you were my sister or mother, I would do the same thing. I'm worried that you may have injured your spine and we have to keep you from moving until we can find out what's wrong. Please don't try to move."

"This thing is uncomfortable!" She digs at the collar and tries to twist her head. Out comes my 'cop voice.'

"STOP MOVING. STOP MOVING YOUR HEAD NOW!" No shouting but firm and clear. The whole ER gets quieter. I get my face right over hers so she has no choice to look at me.

"Do not move. Do not move your head. Do not move your feet. I don't care how much it hurts. Do! Not! Move!" I stare her down.

She grows meek. "Can I hold your hand?"

"Of course you can." She does.

I find myself managing and triaging 5 patients and getting the admittance paperwork started for the nurses. All the while holding my patient's hand. As a result, things move a smidgen more quickly and I finally leave an hour and a half after I got to the hospital.

Back at the station: I manage to finish my paperwork, wave to Herself and put one spoonful of chili into a bowl when the bell rings again. 27 year old Male with Chest pains. No medics available.

Wheee!

I'll write about that one next.

--maddog

Stay Tuned? (and bring your Bean-o)

I'm filling duty tonight so I won't be with my usual duty section. I have been cooking for my duty section and the word has gotten out. I have 4.5lbs (2Kilos) of venison in my fridge and will be arriving at the firehouse with a gallon or so of venison chili.

Yum!

Hopefully, we'll have some calls that will be worth telling about. We'll certainly have some culinary stories.

--maddog

Who am I?

        
I went to a party tonight, hosted by Herself's company. They're a literary, book-selling company.

I played the part of the obligatory, entertaining husband. ... For a while, at least.

Everyone I met and spoke with was wowed by me being in EMS.

"That's so awesome!"

"I could never do that!"

"You're so strong to do that!"

Here I am, Amazed and in awe of the authors, publishers and the bigwigs of the book industry who are standing around me. Amazingly, they're all pumping me for stories about EMS.

HA!

I started out trying to talk about Herself and Herself's company. I ended up answering questions about EMS and what I do (and will be doing).

Well, that proves it. EMS ROCKS!.

--maddog

YAWN!

Not much going on. I've run a duty night or two with no calls. I'm on semester break so, no stories from clinical rotations or classes.

*Yawn!*

Sorry about that. Well, here's some upcoming things that might be interesting:

1. I'm going to try to get the following certifications this semester: Emergency Vehicle Operator (so I can drive the Bambulance), EMS instructor, through my volunteer service, and CPR instructor. The last one is offered through my shcool. The first two through my volunteer service. The thing is, they're State certifications so, if i get a job at an agency in this state, they'll look super-good on my resume.

2. I'm going to see if I can do an independent research project this semester. I'm going to look at the number of ALS (Advanced life support or paramedic) calls that have originated from within my first due (my station's primary response area) and then see if there is a need for an ALS-capable unit in my area. This includes my home town where I and my family live. Of course my motives are somewhat selfish.

Ok. I'm filling in duty this Friday night. Perhaps something interesting will come of that.

Cya!

--maddog

I'm back!

After 5 months, I have internet access at my home again! Yay!

Look for more regular updates from me (I'll try for daily). Also you'll see:

1. More specific medical and trauma musings and questions, as I have learned much and continue to do so.

2. A few soapbox rants on issues affecting EMS today.

3. Progress reports on my FINAL semester in school, including the possibility of an independent research project involving my hometown and a needs assessment for ALS service.

4. Running. I'm going to include my progress and a few thoughts as I try to prepare myself to become a 4-marathon-per-year athlete and lose some of the weight I've gained over the past couple years.

ARRRR!!!

--maddog

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