The call goes out as "Trouble Breathing"
CC-Rider and I are together again. Our driver, SmokeyJoe, is a recent Paramedic who's still getting his ride time in. He left the USMC and started paramedic school when he was 32. (Sound familiar?)
CC-Rider says to the both of us, "This is your call! I'm driving!" She clearly has much faith in us.
The "trouble breathing" is a woman sitting on the floor in the open front door of her house when we arrive. Her face, lips and neck are about twice the size they should be and she speaks to us in a pattern like this:
"I...GASP...ate...GASP...a...GASP...pistachio...GASP..." (you get the picture).
"Ma'am, are you allergic to anything?"
"Yes...GASP..nuts...GASP!"
I look at SmokeyJoe over the top of my glasses and see his eyebrows do their best to meet his hairline.
Ooooookay! it's GO TIME!
I don't need my stethoscope to tell me that she's closing up. From a foot away I can hear a noise like "HeeeeEEEEEEP!" every time she breathes in. My stethoscope does tell me that she's not moving any air in her lungs other than the very center of her chest. Basically, this means that her allergic reaction is causing the muscles around her bronchioles (the smaller pipes that lead from your windpipe, or bronchia, to the business parts of your lungs) have all squeezed down really hard and are blocking any air from getting to the parts of her lungs that will enable her to get oxygen into her body and carbon dioxide out.
This is what we call, "bad."
Her husband hovers nervously in the foyer. SmokeyJoe and I waste no time. We practically fling her onto our cot, dash the 10 yards to the medic unit and load her up. CC-Rider is already there and bobs her eyebrows at me, asking what to do.
"Epi, IM." I tell her, indicating her to inject 0.3mg of epinephrine into my patient's arm muscle. This is a pretty cool drug. The paramedics in the UK accurately call this drug adrenaline. That's what it is. It's the thing that makes your lungs open up, heart race, blood vessels constrict and dries up any secretions in your mucous membranes. (Pseudo-ephedrine, or sinus medications is a form of this). The dose we give people having allergic reactions (anaphylaxis) is, for the human body, HUGE!
It works quickly and very well, however, it just buys us time. It'll probably wear off before she's done having an allergic reaction. SmokeyJoe tries and fails to get an IV line on twice. I tell him to start a neb of albuterol. This is a drug that acts directly on the aforementioned bronchioles and cause them to open up. We deliver it by nebulizing it so the patient breathes it directly into the lungs (quickest way to get it where it's needed).
Meanwhile, I drop the IV perfectly into the patient's left arm. This is significant in that it's my first successful IV in over a year (not a lot of chances to start one when you're a teacher) and I was nervous that I had "lost" my skills. CC-Rider jumps in the driver's seat and we roll. Our patient is breathing easily and has the hyper, nervous laugh that comes with getting jacked up with more adrenaline than your body can make in an hour.
She's not the only one breathing easier. SmokeyJoe and I are already confident in the fact we had a "save."
What I mean is, had we not arrived (or arrived late) this one would have closed up and suffocated. She'd be dead at age 33 and her husband would be a lost and confused man, having watched his young wife die before his eyes.
We turn her over to the friendly staff at the local hospital and in the part of my paperwork that says, "Condition of Patient Upon Arrival at Destination:" I gladly choose "Alive:Improved."
Life? It's good.
--maddog
Epiloge: I saw her a few hours later when we brought another patient at the same hospital. The sight of her happy (normally sized) face made up for the "died-despite-all-we-did-and-we-did-it-right" condition of my current patient.
11.08.2008
10.13.2008
Second Guessing.
I'm in a unique place.
One of my students is also a member at my volunteer firehouse (where I am the EMS Sergeant). She has another four months until she becomes my student (begins field clinicals) but she's still "one of mine."
She came to me with a rather prescient question today. She had been the primary provider on an accident. She was riding the ambulance and the fire engine (with our station officer on board) had been dispatched on the call too.
It was an auto accident with very minimal car damage. There was a "star" on the windshield but not in the typical place for head impact. Relevant too, was the fact that the driver (my student's patient) was seatbelted. No airbags installed on his car.
He was also "altered." This means the person driving the car was in an altered mental status, or was so out of it that he did not remember the question that was asked of him 2 minutes before.
My student said, "Off to the trauma center you go!!!" In fact, as she arrived on scene, she asked for the status of the local trauma center.
The officer, however (someone who is primarily involved in fire suppression), said, "No, you should go to XXX hospital" (the closest but NOT a Trauma center).
60 hours later, she catches me in the Chief's office and asks me if she made the right decision.
Now, understand that these "questions" are never asked. They are always prefaced by a story. She's telling me the story and when she gets to the part about "star on the windshield + altered mental status" I interrupt and say, "Trauma Center!"
She counters with, "What if it's a seizure or EToH?"
I respond with, "Look, If its a seizure, EToH or a stroke, the local trauma center can handle that. If it's an altered mental status due to a stroke or an epidural bleed, for example, then the local "community" hospital is going to transfer them to the trauma or the stroke center (both in the same place) and that will delay care.
I tell her, "I would have made the same decision. Fire donkeys and cranky nurses be damned."
She sighs her relief.
I asked her if that's where her patient went. (To the Trauma Center) Yes, but she feels bad about "second guessing" the officer on the call.
I ask her, "Who's in charge of patient care?"
Her shoulders drop and I can visibly see the stress fall away...."Me!"
"Then it's your call and you made the right one."
"Thanks, Sarge!" A flip of a wave and a spring in her step and she's gone.
She's ready for the next one.
-maddog
One of my students is also a member at my volunteer firehouse (where I am the EMS Sergeant). She has another four months until she becomes my student (begins field clinicals) but she's still "one of mine."
She came to me with a rather prescient question today. She had been the primary provider on an accident. She was riding the ambulance and the fire engine (with our station officer on board) had been dispatched on the call too.
It was an auto accident with very minimal car damage. There was a "star" on the windshield but not in the typical place for head impact. Relevant too, was the fact that the driver (my student's patient) was seatbelted. No airbags installed on his car.
He was also "altered." This means the person driving the car was in an altered mental status, or was so out of it that he did not remember the question that was asked of him 2 minutes before.
My student said, "Off to the trauma center you go!!!" In fact, as she arrived on scene, she asked for the status of the local trauma center.
The officer, however (someone who is primarily involved in fire suppression), said, "No, you should go to XXX hospital" (the closest but NOT a Trauma center).
60 hours later, she catches me in the Chief's office and asks me if she made the right decision.
Now, understand that these "questions" are never asked. They are always prefaced by a story. She's telling me the story and when she gets to the part about "star on the windshield + altered mental status" I interrupt and say, "Trauma Center!"
She counters with, "What if it's a seizure or EToH?"
I respond with, "Look, If its a seizure, EToH or a stroke, the local trauma center can handle that. If it's an altered mental status due to a stroke or an epidural bleed, for example, then the local "community" hospital is going to transfer them to the trauma or the stroke center (both in the same place) and that will delay care.
I tell her, "I would have made the same decision. Fire donkeys and cranky nurses be damned."
She sighs her relief.
I asked her if that's where her patient went. (To the Trauma Center) Yes, but she feels bad about "second guessing" the officer on the call.
I ask her, "Who's in charge of patient care?"
Her shoulders drop and I can visibly see the stress fall away...."Me!"
"Then it's your call and you made the right one."
"Thanks, Sarge!" A flip of a wave and a spring in her step and she's gone.
She's ready for the next one.
-maddog
9.14.2008
Please don't eat before you die!!!
Well, yes, I told you "More to Come" and here it is!
We get called to a townhouse for one having trouble breathing. Dispatch has done a great job of getting information and we know that, even though she's 42 years old, she's already had a heart attack, suffered from congestive heart failure (CHF), and has an extensive history with a LOT of drugs.
In the door & up one flight of carpeted stairs.
This place smells horrible.
There are a lot of concerned people standing around who, I assume, are family.
Another flight of stairs. (Why is this so common!???)
Into the bedroom where she's lived for the past couple years (we can tell that walking in).
She's on a big recliner. She's got all the signs of a lifetime of being unkind to her heart. I see all this and I see her chin on her chest (not natural). Right away, I can see that "trouble breathing" is now "NO breathing!"
ZIP! I slide in and check a pulse while moving her head up to open her airway.
"I got nuthin!"
This galvanizes the other two medics I'm working with. Mind you, this is my second shift with them. The last one was exciting as well.
It's game time!
CC-Rider and I quickly move our patient from the recliner to the floor. MedicToMyRight (who, strangely enough, is again to my right) dives in to help. We also have some well-meaning, enthusiastic volunteer firefighters too.
The room is suddenly crowded.
As my patient's head is wedged between the recliner and the wall, I can't immediately get a quick assessment of her airway other than getting a basic airway (OPA, or OroPharengyalAirway) in her mouth.
I roll it in and she doesn't gag. This means that the airway is "tolerated." This also means that the patient is in a bad way. The control of the gag reflex comes off the brain directly and if there is no gag reflex, that can be pretty bad.
At this point, Volunteer Firefigthers are "bagging" (pushing oxygen via a special bag) into this woman. There's a lot of gurgling. We're having a tough time getting air into her lungs versus her stomach. (Can't breath through your stomach so, that's bad.)
I check again for a pulse and find none. I start chest compressions. All my paramedic training and the most important thing I can do for this woman (Really!!!) is something I learned about 12 years ago (CPR!).
Now, let me take a moment to tell you about OPAs. They are merely a piece of plastic curved in a way to keep your tongue from falling back in your throat. The more modern ones are very much like a curve plastic stick that does the job while allowing air to move around it. The older ones, however, are more like curved TUBES that, essentially do the same thing but are a pipe going into the back of the throat.
Neither one, however, does a dang thing to keep air from going into the stomach, versus the lungs. (two pipes down there, remember!)
The OPA that I grabbed from the bag was the old style. As I started to slam down on her chest with all my might, the pressure of the air in her stomach, combined with the full meal she just ate contrived to make a geyser.
Each time I pumped on her chest, we got a bit of vomit shooting 12 to 18 inches up in the air.
The Vomit Comet rides again!!!!
It's at this point that CC-Rider and MedicToMyRight look at me. They shake their heads. Last shift we had a code and this is looking to be the same way.
Down 2 flights of narrow stairs, through the living room and into the medic unit we go.
We intubate, hook her up to a monitor and give her a TON of ACLS drugs.
All the while we're being driven by a volunteer firefighter who's wearing a full stetson hat, a torn t-shirt and his bunker pants.
He hits every bump and curve at 65MPH.
We all get puked on as we bounce around the back of the ambulance like ping-pong balls in a tornado.
...and he gets lost on his way to the hospital.
Basically, he exemplifies every un-professional characteristic of our volunteer service (keep in mind that I'm a volunteer and riding as one during this call).
What a donkey!!!!
After the call, as we're cleaning up, I pull him aside.
"Hey, man, Howareya?"
"..Um...Ok"
"Great..thanks..listen,...can I ask you a favor????"
"...Um...Ok.."
"Yeah,....great...Listen, Um...Don't ever drive a medic unit agin..Ok?"
He's gettign defensive at this point...."What?"
We've walked away, out of earshot of everyone else, by this point. I put both hands on his shoulders.
I look him right in the eye.
With the most firm and benevolent, fatherly look I can put on my face. I say:
"It would be bad."
I keep looking at him.
He's thinking this is some kind of man-fight and gives me a defiant look.
I keep looking at him.
"What?....Welll...Sh**........"
I keep looking at him.
His shoulders hunch and I can feel him getting tense. He tries again to be tough...
I keep looking at him.
"F*** you!"
I keep looking at him.
"F*** it, I hate the ambulance!" He says with a flame in his eye.
Success..
--maddog
We get called to a townhouse for one having trouble breathing. Dispatch has done a great job of getting information and we know that, even though she's 42 years old, she's already had a heart attack, suffered from congestive heart failure (CHF), and has an extensive history with a LOT of drugs.
In the door & up one flight of carpeted stairs.
This place smells horrible.
There are a lot of concerned people standing around who, I assume, are family.
Another flight of stairs. (Why is this so common!???)
Into the bedroom where she's lived for the past couple years (we can tell that walking in).
She's on a big recliner. She's got all the signs of a lifetime of being unkind to her heart. I see all this and I see her chin on her chest (not natural). Right away, I can see that "trouble breathing" is now "NO breathing!"
ZIP! I slide in and check a pulse while moving her head up to open her airway.
"I got nuthin!"
This galvanizes the other two medics I'm working with. Mind you, this is my second shift with them. The last one was exciting as well.
It's game time!
CC-Rider and I quickly move our patient from the recliner to the floor. MedicToMyRight (who, strangely enough, is again to my right) dives in to help. We also have some well-meaning, enthusiastic volunteer firefighters too.
The room is suddenly crowded.
As my patient's head is wedged between the recliner and the wall, I can't immediately get a quick assessment of her airway other than getting a basic airway (OPA, or OroPharengyalAirway) in her mouth.
I roll it in and she doesn't gag. This means that the airway is "tolerated." This also means that the patient is in a bad way. The control of the gag reflex comes off the brain directly and if there is no gag reflex, that can be pretty bad.
At this point, Volunteer Firefigthers are "bagging" (pushing oxygen via a special bag) into this woman. There's a lot of gurgling. We're having a tough time getting air into her lungs versus her stomach. (Can't breath through your stomach so, that's bad.)
I check again for a pulse and find none. I start chest compressions. All my paramedic training and the most important thing I can do for this woman (Really!!!) is something I learned about 12 years ago (CPR!).
Now, let me take a moment to tell you about OPAs. They are merely a piece of plastic curved in a way to keep your tongue from falling back in your throat. The more modern ones are very much like a curve plastic stick that does the job while allowing air to move around it. The older ones, however, are more like curved TUBES that, essentially do the same thing but are a pipe going into the back of the throat.
Neither one, however, does a dang thing to keep air from going into the stomach, versus the lungs. (two pipes down there, remember!)
The OPA that I grabbed from the bag was the old style. As I started to slam down on her chest with all my might, the pressure of the air in her stomach, combined with the full meal she just ate contrived to make a geyser.
Each time I pumped on her chest, we got a bit of vomit shooting 12 to 18 inches up in the air.
The Vomit Comet rides again!!!!
It's at this point that CC-Rider and MedicToMyRight look at me. They shake their heads. Last shift we had a code and this is looking to be the same way.
Down 2 flights of narrow stairs, through the living room and into the medic unit we go.
We intubate, hook her up to a monitor and give her a TON of ACLS drugs.
All the while we're being driven by a volunteer firefighter who's wearing a full stetson hat, a torn t-shirt and his bunker pants.
He hits every bump and curve at 65MPH.
We all get puked on as we bounce around the back of the ambulance like ping-pong balls in a tornado.
...and he gets lost on his way to the hospital.
Basically, he exemplifies every un-professional characteristic of our volunteer service (keep in mind that I'm a volunteer and riding as one during this call).
What a donkey!!!!
After the call, as we're cleaning up, I pull him aside.
"Hey, man, Howareya?"
"..Um...Ok"
"Great..thanks..listen,...can I ask you a favor????"
"...Um...Ok.."
"Yeah,....great...Listen, Um...Don't ever drive a medic unit agin..Ok?"
He's gettign defensive at this point...."What?"
We've walked away, out of earshot of everyone else, by this point. I put both hands on his shoulders.
I look him right in the eye.
With the most firm and benevolent, fatherly look I can put on my face. I say:
"It would be bad."
I keep looking at him.
He's thinking this is some kind of man-fight and gives me a defiant look.
I keep looking at him.
"What?....Welll...Sh**........"
I keep looking at him.
His shoulders hunch and I can feel him getting tense. He tries again to be tough...
I keep looking at him.
"F*** you!"
I keep looking at him.
"F*** it, I hate the ambulance!" He says with a flame in his eye.
Success..
--maddog
9.10.2008
Smoova!
38 year old male. Bleeding from the head after an assault. We arrive about 2 minutes after the engine crew does. We were all called here by the police. They've got the scene safe enough for me to enter the house.
I find a guy sitting on the couch, holding a bloody towel to his head. He looks right at me as I come in the door and answers all my questions appropriately.
He's got a 3-5 inch gash on the side of his head.
"Sir, what happened?" I like open-ended questions sometimes, I can get a lot more information that way.
"I come in 'da house. 'Dat ***** went upside my head wiv a smoova!"
Now, being from where I'm from, I know what "upside the head" means. I can see it in my mind's eye. Someone took a big wide swing and hit him in the temporal area (above the ear between the forehead and the back of the skull).
But what the heck is a "smoova?" So I ask him.
"A 'Smoova'?"
"Yeah! A Smoova!"
I look to the firefighters standing around me. They look as puzzled as I do.
"Sir? What's a 'Smoova'?"
"A Smoova!! Y'know! For you clothes!" he makes an arm gesture like he's ironing a shirt.
A "smoother." An iron.
Ok! OW! That must have hurt!
I love my work!
--maddog
I find a guy sitting on the couch, holding a bloody towel to his head. He looks right at me as I come in the door and answers all my questions appropriately.
He's got a 3-5 inch gash on the side of his head.
"Sir, what happened?" I like open-ended questions sometimes, I can get a lot more information that way.
"I come in 'da house. 'Dat ***** went upside my head wiv a smoova!"
Now, being from where I'm from, I know what "upside the head" means. I can see it in my mind's eye. Someone took a big wide swing and hit him in the temporal area (above the ear between the forehead and the back of the skull).
But what the heck is a "smoova?" So I ask him.
"A 'Smoova'?"
"Yeah! A Smoova!"
I look to the firefighters standing around me. They look as puzzled as I do.
"Sir? What's a 'Smoova'?"
"A Smoova!! Y'know! For you clothes!" he makes an arm gesture like he's ironing a shirt.
A "smoother." An iron.
Ok! OW! That must have hurt!
I love my work!
--maddog
8.29.2008
Pacemaker + Fail = Pump and Blow, Load and Go!
The call is for "trouble breathing" but by the time we get there, it's something else. A community swimming pool and it's a guy in his late 60s. He started having trouble catching his breath in the pool.
The BLS (Basic Life Support) crew is strapping him to their cot. I have the luxury of doing nothing but looking at him (many hands).
"Um...I don't see breathing." I feel like the kid who said the emperor has no clothes. My words galvanize a group of people into action.
BVM, Cot to the medic unit, IV, EKG. Go go go go.
Nope, he's not breathing and his pulse is fading fast. I'm on his chest so I look to my right and say to the medic I just met 3 hours before, "You've got airway and breathing. Get me a good tube. you're second line for ACLS drugs. Got it?"
I'm the new guy but she nods at me as if I was there every day for 20 years.
I look to my left where CC-Rider, my new pal and best friend, has already pulled out the combi-pads (sticky things that allow us to shock someone's heart) and EKG leads (more sticky things that allow us to analyze what the heart is doing).
"IV and meds, Please."
That earns me a wink and a nod.
I dial up the EKG and see that this guy is in a ventricular escape rhythm (the lower 2/3 of his heart is trying to beat) but it's way too fast (about 70/minute). CC-Rider and I realize that we can't put the combi-pads in the usual place because he's got a big, metal square under his skin just inside his left shoulder.
Can you say "Pacemaker?"
I can...and i did.
OOOKay. Well. pacemaker or not we treat this patient. I see no pacemaker "spikes" on the monitor.
Can you say, "Pacemaker FAIL?"
I can and do.
MedicToMyRight drops a perfect tube and we get a capnography wave that is good but the CO2 level does not get above 17 mm of Hg and is dropping (this tells us how much air is getting through the lungs into the blood by measuring the return Carbon Dioxide). I'm looking for a nice wave and a level above 28.
That's when I see pink foam surging up the airway tube on every exhale.
Pulmonary edema.
Deep suction takes out a LOT of the "juice" and we get a capnography reading of 30. Lovely!
I'm doing chest compressions by this point because there is no pulse that any of us can feel anywhere.
IV is in.
Pump and blow
Epinepherine, 1mg. BAM!
Pump and blow.
Check the monitor:
Asystole. (flatline) No heart activity.
I'm not giving up!
Pump and blow.
Capnography says 15mm of Hg and dropping.
Crap! Suction again!! It climbs to 25. Good enough!
Atropine: 1mg
Pump and blow.
Epinepherine: 1mg
Pump and blow
EKG is a flat line with occasional, weak attempts by the heart to do something.
Diesel Thereapy!! (Drive fast!)
Perhaps a bit too fast. The firefighter who jumped in the driver's seat of our Medic unit made a traffic decision that lead us onto a Hella-bumpy road.
Only my experience in the Coast Guard on small boats in high seas keeps me upright. CC-Rider and MedicToMyRight are both on their butts on the floor.
We arrive at the hospital a bit frazzled but with a completely worked patient. I'm standing on the carriage of the cot so I can continue chest compressions without having to walk. All the while, I'm directing the 3rd round of ACLS drugs and getting the BLS provider to work with MedicToMyRight to check that we haven't lost the tube and we're still suctioning the HUGE amount of fluid infiltrating this guy's lungs.
Like usual, we seamlessly merge with the resuscitation team and I find myself moving to airway with bagging and then drawing up more drugs.
By the time I have a chance to step back and wash my hands. It's over.
The doctor declares this one dead. Ah, fooey.
Not that we didn't see that one coming. This guy had a pacemaker that kept his heart beating well. He also was doing all he could to keep that working right. According to the staff at the fitness center, he was a regular. Swam a mile every day.
Unfortunately, his pacemaker failed. It failed while he was in the middle of his swim. As a result, his heart was not able to crank out enough pressure to his body and then the pressure in the blood going to his lungs began to rise. It got to the point where the pressure of the blood going to his lungs started to push the water in his blood into the breathing space of his lungs.
Pulmonary edema.
Acute congestive heart failure.
CC-Rider, MedicToMyRight and I were cleaning up and getting ready to talk about the call. In my head, I'm thinking about what went well, what went wrong and what I could have done better.
We all agree that by the time we got to the patient, there was not much more we could do. His heart had stopped working properly and he had stopped breathing. We did what we were trained to do and, we did it exeedingly well. We all worked together as if we were the same person.
As this was the first time I worked with CC-Rider and MedicToMyRight (the first call, in fact), I asked how I did.
"Maddog, You're in charge!"
"That was awesome. You knew exactly what to do and you told us when to do it."
"You 'da man!"
Golly! *cue maddog blushing*
But wait! We did this again and again!!!
...more to come...
--maddog
The BLS (Basic Life Support) crew is strapping him to their cot. I have the luxury of doing nothing but looking at him (many hands).
"Um...I don't see breathing." I feel like the kid who said the emperor has no clothes. My words galvanize a group of people into action.
BVM, Cot to the medic unit, IV, EKG. Go go go go.
Nope, he's not breathing and his pulse is fading fast. I'm on his chest so I look to my right and say to the medic I just met 3 hours before, "You've got airway and breathing. Get me a good tube. you're second line for ACLS drugs. Got it?"
I'm the new guy but she nods at me as if I was there every day for 20 years.
I look to my left where CC-Rider, my new pal and best friend, has already pulled out the combi-pads (sticky things that allow us to shock someone's heart) and EKG leads (more sticky things that allow us to analyze what the heart is doing).
"IV and meds, Please."
That earns me a wink and a nod.
I dial up the EKG and see that this guy is in a ventricular escape rhythm (the lower 2/3 of his heart is trying to beat) but it's way too fast (about 70/minute). CC-Rider and I realize that we can't put the combi-pads in the usual place because he's got a big, metal square under his skin just inside his left shoulder.
Can you say "Pacemaker?"
I can...and i did.
OOOKay. Well. pacemaker or not we treat this patient. I see no pacemaker "spikes" on the monitor.
Can you say, "Pacemaker FAIL?"
I can and do.
MedicToMyRight drops a perfect tube and we get a capnography wave that is good but the CO2 level does not get above 17 mm of Hg and is dropping (this tells us how much air is getting through the lungs into the blood by measuring the return Carbon Dioxide). I'm looking for a nice wave and a level above 28.
That's when I see pink foam surging up the airway tube on every exhale.
Pulmonary edema.
Deep suction takes out a LOT of the "juice" and we get a capnography reading of 30. Lovely!
I'm doing chest compressions by this point because there is no pulse that any of us can feel anywhere.
IV is in.
Pump and blow
Epinepherine, 1mg. BAM!
Pump and blow.
Check the monitor:
Asystole. (flatline) No heart activity.
I'm not giving up!
Pump and blow.
Capnography says 15mm of Hg and dropping.
Crap! Suction again!! It climbs to 25. Good enough!
Atropine: 1mg
Pump and blow.
Epinepherine: 1mg
Pump and blow
EKG is a flat line with occasional, weak attempts by the heart to do something.
Diesel Thereapy!! (Drive fast!)
Perhaps a bit too fast. The firefighter who jumped in the driver's seat of our Medic unit made a traffic decision that lead us onto a Hella-bumpy road.
Only my experience in the Coast Guard on small boats in high seas keeps me upright. CC-Rider and MedicToMyRight are both on their butts on the floor.
We arrive at the hospital a bit frazzled but with a completely worked patient. I'm standing on the carriage of the cot so I can continue chest compressions without having to walk. All the while, I'm directing the 3rd round of ACLS drugs and getting the BLS provider to work with MedicToMyRight to check that we haven't lost the tube and we're still suctioning the HUGE amount of fluid infiltrating this guy's lungs.
Like usual, we seamlessly merge with the resuscitation team and I find myself moving to airway with bagging and then drawing up more drugs.
By the time I have a chance to step back and wash my hands. It's over.
The doctor declares this one dead. Ah, fooey.
Not that we didn't see that one coming. This guy had a pacemaker that kept his heart beating well. He also was doing all he could to keep that working right. According to the staff at the fitness center, he was a regular. Swam a mile every day.
Unfortunately, his pacemaker failed. It failed while he was in the middle of his swim. As a result, his heart was not able to crank out enough pressure to his body and then the pressure in the blood going to his lungs began to rise. It got to the point where the pressure of the blood going to his lungs started to push the water in his blood into the breathing space of his lungs.
Pulmonary edema.
Acute congestive heart failure.
CC-Rider, MedicToMyRight and I were cleaning up and getting ready to talk about the call. In my head, I'm thinking about what went well, what went wrong and what I could have done better.
We all agree that by the time we got to the patient, there was not much more we could do. His heart had stopped working properly and he had stopped breathing. We did what we were trained to do and, we did it exeedingly well. We all worked together as if we were the same person.
As this was the first time I worked with CC-Rider and MedicToMyRight (the first call, in fact), I asked how I did.
"Maddog, You're in charge!"
"That was awesome. You knew exactly what to do and you told us when to do it."
"You 'da man!"
Golly! *cue maddog blushing*
But wait! We did this again and again!!!
...more to come...
--maddog
8.18.2008
Scared?
I got "pinged" by a reader. She's a regular and she hadn't seen me post in a while. So she sent me an email asking how I was doing.
Somehow, coming from a stranger, that meant a lot to me.
I've been busy with family death and my own non-blogging obligations. Yet, there's more than that.
You see, I'm a fundamentally broken man. I feel that I don't fit into where I am. There are parts of me that don't fit into how the rest of the world lives. I'm working really hard to make myself fit but I see the reminders of how I don't and it's a powerful thing. I'm reminded all the time of what an outsider I am.
I try and I try but, really, I'm not like anyone around me. We all live as if we will never die, or, if we do, it'll be a thing we're all ready for. We will all die. Many of us will do so unexpectedly.
That sucks. Big Time.
I'm aware of that all the time.
(Here's the really scary part:)
I know my father will die. I'll likely be there
I know my mother will die, I hope I will be there.
I know Herself will surely die and I will surely be there.
EVERYONE will die (even me!!!).
But many of us live comfortably because the frailty of life is not in our face. We assume that so-and-so will be there tomorrow. We operate under the assumption that we will all have friends and family around us tomorrow as we did today.
Am I the only one who feels in his guts that this is SO not true?
I'm scared all the time.
Am I allowed to be scared?
--maddog
Somehow, coming from a stranger, that meant a lot to me.
I've been busy with family death and my own non-blogging obligations. Yet, there's more than that.
You see, I'm a fundamentally broken man. I feel that I don't fit into where I am. There are parts of me that don't fit into how the rest of the world lives. I'm working really hard to make myself fit but I see the reminders of how I don't and it's a powerful thing. I'm reminded all the time of what an outsider I am.
I try and I try but, really, I'm not like anyone around me. We all live as if we will never die, or, if we do, it'll be a thing we're all ready for. We will all die. Many of us will do so unexpectedly.
That sucks. Big Time.
I'm aware of that all the time.
(Here's the really scary part:)
I know my father will die. I'll likely be there
I know my mother will die, I hope I will be there.
I know Herself will surely die and I will surely be there.
EVERYONE will die (even me!!!).
But many of us live comfortably because the frailty of life is not in our face. We assume that so-and-so will be there tomorrow. We operate under the assumption that we will all have friends and family around us tomorrow as we did today.
Am I the only one who feels in his guts that this is SO not true?
I'm scared all the time.
Am I allowed to be scared?
--maddog
7.19.2008
What would YOU do???
We, who do what we do, live with the persistent knowledge of what we have done.
It's so very easy for those who have not done what we have done to dissect our actions.
"Yeah, maddog, but I would have done THIS. "
All I know is that I came on scene and there were people, and blood, and gunk, and a big mess.
I put tubes where they should go. I pushed on the things that needed pushing and I gave the drugs that needed giving.
The whole time I'm sweating how well or how poorly I'm doing. It's not about me, It's about my patient.
You can sit back in your "armchair" all you want but, it was ME that was doing CPR, Intubating, pushing the drugs and otherwise making the decisions that helped the family know we had done all we could.
You will never be the medic that I was at that exact moment.
Me? I'll spend the rest of my life thinking about what I could have done. I don't need you to ask me stupid questions.
--maddog
EDIT: This post was written in response to the casual comments by a less-than-professional jerk after a particularly difficult call. It is NOT directed at you, my dear and loyal readers! Thanks for reading.
It's so very easy for those who have not done what we have done to dissect our actions.
"Yeah, maddog, but I would have done THIS. "
All I know is that I came on scene and there were people, and blood, and gunk, and a big mess.
I put tubes where they should go. I pushed on the things that needed pushing and I gave the drugs that needed giving.
The whole time I'm sweating how well or how poorly I'm doing. It's not about me, It's about my patient.
You can sit back in your "armchair" all you want but, it was ME that was doing CPR, Intubating, pushing the drugs and otherwise making the decisions that helped the family know we had done all we could.
You will never be the medic that I was at that exact moment.
Me? I'll spend the rest of my life thinking about what I could have done. I don't need you to ask me stupid questions.
--maddog
EDIT: This post was written in response to the casual comments by a less-than-professional jerk after a particularly difficult call. It is NOT directed at you, my dear and loyal readers! Thanks for reading.
7.07.2008
Cocktail Parties
An earnest young student asks me a serious question:
"What's the hardest part about being a paramedic?"
I look her right in the eye.
"Cocktail parties."
I say this with all seriousness.
She leans back in her chair, blinking her disbelief.
It's the social that's the most difficult.
Here I am, out with a bunch of people who have no idea what they'd do if someone died right in front of them.
I, on the other hand, know exacttly what I'd do!!!.......Pump and blow, Load and go!!!
(If the preceding phrase has no meaning for you, then you're definitely not an EMT. )
We, who do what I do, live with the persistent knowledge of how easily and how frequently people die.
We also live with the constant assurance of our role in that process. We know what we are to do and when we are to do it.
I find that I alternate between the responsibility of being guardian of all life around me and the honor of being the shepherd of the passing of life around me.
At times, it makes me dizzy.
At cocktail parties, it's awkward.
--maddog
7.06.2008
How to make a nurse laugh....
Roll into the ER at 0500?
No.
Have a perfectly healthy, whiny patient with abdominal pains?
No.
Tape a "falling hazard" warning sign to your shirt and stagger around the ER saying "Coffeeeee.....""
BIG YES!!!
--maddog
6.09.2008
Sometimes, we win.
I did an amazing thing, apparently.
Duty Night. Chillin' in the lounge chairs, watching a movie I've seen before and don't mind seeing again. Earlier that day, I had played in a kickball game with some other folks from the Firehouse. Good times. No beer for me as I was heading directly to the Firehouse afterwards.
Roswell pops his head into the lounge, "Hey, maddog, can I see you?" He tilts his head in a way that tells me he need to talk to me RIGHT NOW.
"Sure!" Off I go. He leads me back to one of the dorm rooms where his girlfriend, JLB, who's also a firefighter/EMT, is lying on the bed. They've been drinking steadily for the previous 7 hours (they started at the kickball game). She's lying on her side, breathing at a rate of 60 breaths per minute.
OoooooooKay! Pulse is 92, BP is 130/82 and her blood is 99% saturated with oxygen (SpO2=99). These are all good. Oh, yeah. She also smells boozy to the max!!! The thing is, I can't rouse her at all. I do exceedingly painful things to her but she doesn't respond. That is bad. However, considering her blood pressure and pulse are reasonably OK, I'm willing to adopt a "wait and see" attitude and see how long it takes her to sleep off her drunk. Roswell and I roll her onto her left side and make sure she's got a clear "vomit path" in case she barfs. We're trying to ensure she doesn't breathe in, or aspirate, anything she pukes up.
I'm standing next to the bed, discussing with Roswell what we should do. We were just deciding to check on her ever hour when her noisy breathing stops.
We look at each other.
We look at her.
We look at each other again.
This is the first time I've ever seen Roswell scared. Strangely enough, and totally out of context, I realize that, despite the ups and downs of their relationship over the past 2 years, Roswell really loves JLB!!
I roll JLB on her back. I move her head back to ensure her airway is open.
She's still not breathing.
I check her pulses on her neck (carotid) and her arm (radial). What had earlier been a steady "THUMPTHUMPTHUMP" is now a, "THumpthumpth...tu..th.......th......t...t....p....p................"
Everything is now bad.
"Hey, Roswell?" I say in my calmest voice, "I think we need to start a medic unit, OK?"
In a flash, he's gone.
I try again to get JLB's airway open and, again, try to rouse her with painful stimulus.
Still no breathing.
Check the pulse again. I can barely feel it. It's beginning to dawn on me that I may have to do CPR on a woman who I consider a family member. I guess I better get her off the bed and onto the floor!
I cradle her like a child and move her to the floor. She's as limp as a rag doll (or the newly dead). By this time RockSteady has shown up. He was a Paramedic back in "Joisey" before he came down here to be a financial planner. He runs at the Firehouse because, deep down inside, he misses it.
"What do you need?" he asks me. As calm as could be.
"AED, O2, BVM, a medic unit and wake everyone up." I reply in a tone that I hope sounds as calm as RockSteady.
Brooklyn shows up with the "Go" bag and the O2 Kit. This kid has learned much from the maddog. I drop a 22fr Nasopharengeal airway in JLB. Her jaw's pretty tightly clenched so I know I'm not getting anything in her mouth. At least I can help a bit with a flexible tube down her nose to help get oxygen into her lungs. I get out the Bag-Valve-Mask (BVM). This is a device that allows me to put a mask over your nose and mouth and squeeze air, via a specially built bag, into your lungs. I'm trying to breathe for JLB. By this time, Brooklyn has left to go get the stretcher. I check JLB's pulse again.
Nothing.
I check it AGAIN!
No, Really, I mean NOTHING!
"Crapcrapcrapcrapcrapcrap!" I'm saying to myself.
Weed has slid into the room at this time. She's still half asleep. I've never worked a bad patient with her but she and I work together as one.
"I got nothing" She says to me. She's feeling for a pulse too.
"Right!" I say. Weed hands me the scissors and In about 1 second, I've got JLB's shirt and bra cut off. Weed takes over the ventilations.
At this point, part of my mind is remembering how many times JLB and I have joked about getting "Trauma Naked" by cutting someone's clothes off. We say that this is a real possibility when someone dates a paramedic. Now, here she is, "trauma naked."
I start shoving on her chest with all my weight. I'm forcibly and mechanically taking over for her heart. I'm slamming it flat to force the blood in it to go out to her body and lungs and then springing up suddenly to allow it to fill up with blood to, again, be forced out to her body by the next compression of my body weight on her chest. It's not elegant but it IS effective.
I do about 2 rounds of 30 compressions when the AED arrives with Brooklyn, Ninja and RockSteady. We slap the pads on her and stop CPR long enough to have the machine tell me that no shock is advised. I go right back to CPR.
Here's the freaky bit:
I finish my 3rd or 4th cycle of chest compressions when JLB's eyes snap open and she takes a deep, ragged breath.
Woah!
Did I just do that?
"Hey, darlin'! Glad you've decided to come back and join us!" I say in a voice I hope sounds lighthearted and calm. Her eyes orient towards me and she makes eye contact. Well! This is Very Good!!!
She fades in and out. Her respiratory rate never gets above about 6-8 per minute so, I keep assisting her ventilations with the BVM and a full dose of Oxygen.
Brooklyn, Ninja, Weed, RockSteady and I get JLB moved out on a Reeves stretcher. This is a nice tool for getting people out of tight spots without jerking them around too much. As we load her onto the stretcher/cot in the engine bay, we hear the Medic unit pulling up out front.
Smooth and easy we move her into the medic unit. Weed and I stay in the back to help out and Ninja jumps in the driver's seat. Off we go. The medics hook JLB up to the EKG, check her Carbon Dioxide output (Capnography), her blood pressure and other vitals as well as starting an IV in her left arm (after an attempt in her right arm and her external jugular vein with no success). All the while, JLB is alternating between lucid periods where she's looking at me and asking where Roswell is and complete unconsciousness with a respiratory rate of around 4-6 breaths per minute.
The two medics, Weed and I work together like we were cogs made for the same machine. Medic #1 calls the hospital on her cellpone and gives them a good, solid report so they know exactly what's coming in the door when we arrive. It pays off too. We roll right into a critical care resuscitation room and are swamped by nurses, techs and doctors.
As soon as we arrive at the hospital, we're swarmed by other firefighters, JLB's family and a few cops too. It's a circus. I hand off ventilations to a tech and clear out of there. I wash my hands and find a spot out of the way to wait and see what happens.
20 minutes and 2 liters of intravenous fluid later, JLB is answering questions and completely alert. 1 Hour later, all of the people involved are having a CISM debrief in a conference room in the hospital. 2 hours later, JLB is going through a battery of tests, EKG, 12 lead, Blood work, etc., etc.. I'm back at the station, filling out my reports and restocking my gear.
They keep JLB at the hospital for a while to do a full workup. By the time she slides into CAT scan, I'm dead to the world asleep.
I did everything as I should and made no mistakes. Clinically, I'm pleased and satisfied. 14 hours later, telling the story to someone who's not a firefighter, I can't stop myself from crying. No sobbing of loss of control. I simply cannot stop the tears from flowing out of my eyes.
She woke up. Her eyes opened and she looked right at me. I'm beating on her little body hoping to push enough blood around to keep her brain from dying and she opens her eyes and looks AT ME.
Somehow, this is the part the overwhelms me.
-'Medic
Duty Night. Chillin' in the lounge chairs, watching a movie I've seen before and don't mind seeing again. Earlier that day, I had played in a kickball game with some other folks from the Firehouse. Good times. No beer for me as I was heading directly to the Firehouse afterwards.
Roswell pops his head into the lounge, "Hey, maddog, can I see you?" He tilts his head in a way that tells me he need to talk to me RIGHT NOW.
"Sure!" Off I go. He leads me back to one of the dorm rooms where his girlfriend, JLB, who's also a firefighter/EMT, is lying on the bed. They've been drinking steadily for the previous 7 hours (they started at the kickball game). She's lying on her side, breathing at a rate of 60 breaths per minute.
OoooooooKay! Pulse is 92, BP is 130/82 and her blood is 99% saturated with oxygen (SpO2=99). These are all good. Oh, yeah. She also smells boozy to the max!!! The thing is, I can't rouse her at all. I do exceedingly painful things to her but she doesn't respond. That is bad. However, considering her blood pressure and pulse are reasonably OK, I'm willing to adopt a "wait and see" attitude and see how long it takes her to sleep off her drunk. Roswell and I roll her onto her left side and make sure she's got a clear "vomit path" in case she barfs. We're trying to ensure she doesn't breathe in, or aspirate, anything she pukes up.
I'm standing next to the bed, discussing with Roswell what we should do. We were just deciding to check on her ever hour when her noisy breathing stops.
We look at each other.
We look at her.
We look at each other again.
This is the first time I've ever seen Roswell scared. Strangely enough, and totally out of context, I realize that, despite the ups and downs of their relationship over the past 2 years, Roswell really loves JLB!!
I roll JLB on her back. I move her head back to ensure her airway is open.
She's still not breathing.
I check her pulses on her neck (carotid) and her arm (radial). What had earlier been a steady "THUMPTHUMPTHUMP" is now a, "THumpthumpth...tu..th.......th......t...t....p....p................"
Everything is now bad.
"Hey, Roswell?" I say in my calmest voice, "I think we need to start a medic unit, OK?"
In a flash, he's gone.
I try again to get JLB's airway open and, again, try to rouse her with painful stimulus.
Still no breathing.
Check the pulse again. I can barely feel it. It's beginning to dawn on me that I may have to do CPR on a woman who I consider a family member. I guess I better get her off the bed and onto the floor!
I cradle her like a child and move her to the floor. She's as limp as a rag doll (or the newly dead). By this time RockSteady has shown up. He was a Paramedic back in "Joisey" before he came down here to be a financial planner. He runs at the Firehouse because, deep down inside, he misses it.
"What do you need?" he asks me. As calm as could be.
"AED, O2, BVM, a medic unit and wake everyone up." I reply in a tone that I hope sounds as calm as RockSteady.
Brooklyn shows up with the "Go" bag and the O2 Kit. This kid has learned much from the maddog. I drop a 22fr Nasopharengeal airway in JLB. Her jaw's pretty tightly clenched so I know I'm not getting anything in her mouth. At least I can help a bit with a flexible tube down her nose to help get oxygen into her lungs. I get out the Bag-Valve-Mask (BVM). This is a device that allows me to put a mask over your nose and mouth and squeeze air, via a specially built bag, into your lungs. I'm trying to breathe for JLB. By this time, Brooklyn has left to go get the stretcher. I check JLB's pulse again.
Nothing.
I check it AGAIN!
No, Really, I mean NOTHING!
"Crapcrapcrapcrapcrapcrap!" I'm saying to myself.
Weed has slid into the room at this time. She's still half asleep. I've never worked a bad patient with her but she and I work together as one.
"I got nothing" She says to me. She's feeling for a pulse too.
"Right!" I say. Weed hands me the scissors and In about 1 second, I've got JLB's shirt and bra cut off. Weed takes over the ventilations.
At this point, part of my mind is remembering how many times JLB and I have joked about getting "Trauma Naked" by cutting someone's clothes off. We say that this is a real possibility when someone dates a paramedic. Now, here she is, "trauma naked."
I start shoving on her chest with all my weight. I'm forcibly and mechanically taking over for her heart. I'm slamming it flat to force the blood in it to go out to her body and lungs and then springing up suddenly to allow it to fill up with blood to, again, be forced out to her body by the next compression of my body weight on her chest. It's not elegant but it IS effective.
I do about 2 rounds of 30 compressions when the AED arrives with Brooklyn, Ninja and RockSteady. We slap the pads on her and stop CPR long enough to have the machine tell me that no shock is advised. I go right back to CPR.
Here's the freaky bit:
I finish my 3rd or 4th cycle of chest compressions when JLB's eyes snap open and she takes a deep, ragged breath.
Woah!
Did I just do that?
"Hey, darlin'! Glad you've decided to come back and join us!" I say in a voice I hope sounds lighthearted and calm. Her eyes orient towards me and she makes eye contact. Well! This is Very Good!!!
She fades in and out. Her respiratory rate never gets above about 6-8 per minute so, I keep assisting her ventilations with the BVM and a full dose of Oxygen.
Brooklyn, Ninja, Weed, RockSteady and I get JLB moved out on a Reeves stretcher. This is a nice tool for getting people out of tight spots without jerking them around too much. As we load her onto the stretcher/cot in the engine bay, we hear the Medic unit pulling up out front.
Smooth and easy we move her into the medic unit. Weed and I stay in the back to help out and Ninja jumps in the driver's seat. Off we go. The medics hook JLB up to the EKG, check her Carbon Dioxide output (Capnography), her blood pressure and other vitals as well as starting an IV in her left arm (after an attempt in her right arm and her external jugular vein with no success). All the while, JLB is alternating between lucid periods where she's looking at me and asking where Roswell is and complete unconsciousness with a respiratory rate of around 4-6 breaths per minute.
The two medics, Weed and I work together like we were cogs made for the same machine. Medic #1 calls the hospital on her cellpone and gives them a good, solid report so they know exactly what's coming in the door when we arrive. It pays off too. We roll right into a critical care resuscitation room and are swamped by nurses, techs and doctors.
As soon as we arrive at the hospital, we're swarmed by other firefighters, JLB's family and a few cops too. It's a circus. I hand off ventilations to a tech and clear out of there. I wash my hands and find a spot out of the way to wait and see what happens.
20 minutes and 2 liters of intravenous fluid later, JLB is answering questions and completely alert. 1 Hour later, all of the people involved are having a CISM debrief in a conference room in the hospital. 2 hours later, JLB is going through a battery of tests, EKG, 12 lead, Blood work, etc., etc.. I'm back at the station, filling out my reports and restocking my gear.
They keep JLB at the hospital for a while to do a full workup. By the time she slides into CAT scan, I'm dead to the world asleep.
I did everything as I should and made no mistakes. Clinically, I'm pleased and satisfied. 14 hours later, telling the story to someone who's not a firefighter, I can't stop myself from crying. No sobbing of loss of control. I simply cannot stop the tears from flowing out of my eyes.
She woke up. Her eyes opened and she looked right at me. I'm beating on her little body hoping to push enough blood around to keep her brain from dying and she opens her eyes and looks AT ME.
Somehow, this is the part the overwhelms me.
-'Medic
5.27.2008
Indy 500.
Yes, I was there.
Every year, my brothers and I go somewhere awesome with our father for Father's day. Though it was a bit early, we went to theIndy 500 this year.
This pretty much sums it up:
Brreeeeeoooowwwwww!!!!
-maddog
Every year, my brothers and I go somewhere awesome with our father for Father's day. Though it was a bit early, we went to the
This pretty much sums it up:
Brreeeeeoooowwwwww!!!!
-maddog
5.12.2008
Nothin' Doin'
It's a fill-in night at the firehouse. I've asked Helga to cover for me in the past and I'm paying her back now.
There's this kid. Her mom and my Mom went to Nursing school together. Her older sister is a doctor and she's thinking the same thing.
In the interim, she's decided that being an EMT-B is a good idea as a start on her road to her MD. An application, background check and a physical exam (Ironic?) later, she's a member.
Now, she's my problem.
The only time we roll the ambulance tonight is to go get ice cream at 11:00 at night.
Exciting times, no?
She fits in so well that I feel she's been here all along. This is one of those cases where someone is well suited to be here contrary to all assumptions.
I don't have a blog-name for her yet. She plays it too close to the vest for that at this point. For now, we shall call her, "Sis." She is more like a sister to me than anyone I've ever known at the firehouse. She's beautiful, confident and capable.
I have great hopes for her.
Tonight, she joked with us, commented on bad movies with us, made a senior member blush and was first on the engine when it got toned out for a fire. I watch this person for 4 hours and realize that nothing will stop her and she will do well in all she puts her mind to.
That's some powerful stuff.
'Go, Sis, GO!'
--maddog
There's this kid. Her mom and my Mom went to Nursing school together. Her older sister is a doctor and she's thinking the same thing.
In the interim, she's decided that being an EMT-B is a good idea as a start on her road to her MD. An application, background check and a physical exam (Ironic?) later, she's a member.
Now, she's my problem.
The only time we roll the ambulance tonight is to go get ice cream at 11:00 at night.
Exciting times, no?
She fits in so well that I feel she's been here all along. This is one of those cases where someone is well suited to be here contrary to all assumptions.
I don't have a blog-name for her yet. She plays it too close to the vest for that at this point. For now, we shall call her, "Sis." She is more like a sister to me than anyone I've ever known at the firehouse. She's beautiful, confident and capable.
I have great hopes for her.
Tonight, she joked with us, commented on bad movies with us, made a senior member blush and was first on the engine when it got toned out for a fire. I watch this person for 4 hours and realize that nothing will stop her and she will do well in all she puts her mind to.
That's some powerful stuff.
'Go, Sis, GO!'
--maddog
4.19.2008
Sunny Day
It's the first beautiful day of Spring. temperatures creeping into the 80s. Lovely.
Around 11 am, he puts his favorite lawn chair in a sunny spot, grabs a cup of coffee and has a seat in the sun. He's 93 years old.
It's a beautiful day.
Nine and a half hours later, we find him. Still sitting in the char, still holding his (now empty) coffee cup. From a distance, it looks like he just rested his chin on his chest and went to sleep. Up close, I see the signs.
For him, I think this beautiful day never ended.
For us on the engine and ambulance crews, we smile quietly and look inward. Passing is sad but, somehow, this one seems to fit.
Not a bad way to go.
-maddog
Around 11 am, he puts his favorite lawn chair in a sunny spot, grabs a cup of coffee and has a seat in the sun. He's 93 years old.
It's a beautiful day.
Nine and a half hours later, we find him. Still sitting in the char, still holding his (now empty) coffee cup. From a distance, it looks like he just rested his chin on his chest and went to sleep. Up close, I see the signs.
For him, I think this beautiful day never ended.
For us on the engine and ambulance crews, we smile quietly and look inward. Passing is sad but, somehow, this one seems to fit.
Not a bad way to go.
-maddog
3.26.2008
There are smells...
I am driving south on a major highway. An interstate, in fact.
There are smells leaking in to the confines of the vehicle I drive. They are smells like any other.
It all comes down to context.
There is a smell I call "vaporized rubber." Its the smell of locked wheels sliding across tar pavement. Some of that black tire material becomes a vapor and gets into my nose. I have smelled the remnants of this as I pull up and survey the scene of someone's bad decisions
"Diesel urgency" is a smell that exists in many areas. Chemically, it's the smell of insufficiently burned diesel fuel. This can happen when a diesel engine is accelerating excessively (Go faster! She's fading fast!)or when one is desperately trying do decelerate(Oh Crap! Oh Crap! Oh Crap! *BANG*). It is also the smell equated with spilt diesel fuel hitting a hot surface (Get 'em out now!!).
This, too, is a smell I equate with highway calamity.
I, however, am not driving an ambulance tonight. I'm merely driving home from work. These smells leach into my nose and brain via the ventilation system of my car.
Around me, the day to day catastrophe of an interstate occurs. I am just another commuter.
The smells remind me.
--maddog
There are smells leaking in to the confines of the vehicle I drive. They are smells like any other.
It all comes down to context.
There is a smell I call "vaporized rubber." Its the smell of locked wheels sliding across tar pavement. Some of that black tire material becomes a vapor and gets into my nose. I have smelled the remnants of this as I pull up and survey the scene of someone's bad decisions
"Diesel urgency" is a smell that exists in many areas. Chemically, it's the smell of insufficiently burned diesel fuel. This can happen when a diesel engine is accelerating excessively (Go faster! She's fading fast!)or when one is desperately trying do decelerate(Oh Crap! Oh Crap! Oh Crap! *BANG*). It is also the smell equated with spilt diesel fuel hitting a hot surface (Get 'em out now!!).
This, too, is a smell I equate with highway calamity.
I, however, am not driving an ambulance tonight. I'm merely driving home from work. These smells leach into my nose and brain via the ventilation system of my car.
Around me, the day to day catastrophe of an interstate occurs. I am just another commuter.
The smells remind me.
--maddog
Subscribe to:
Posts (Atom)