DAPPER OLD DUDES GET DRESSED

Seems weeks run in themes. This week, for whatever twitch in the grand scheme a things, was the week of little ol’ dapper dudes. All three were more concerned with lookin’ slick than whatever medical issue may or may not’ve been goin on w/ em, but u know what? I really wasn’t mad at it. How could I be? After being around a swath of young people complaining about shit that wasn’t really all that bad or mommas worried about babybutt’s sniffly nose, a slowasmolasses geriatric dude with a wizened chuckle and mischievous glint in his eye is a welcome change of pace. Plus, old dudes like their apartments extra saunarific hot, so that extra 40 min on scene each time was like a freakin’ vacation from the brisk December wind.
One was tryinta make like he had something going on but really it was all about his appointment in the morning, and he was too old to be bothered with public transportation. He basically said as much 20 min into the job when we were all hangin’ out so he could put his jewelry on and get proper. While he inch by inched his way around the little one-bedroom on Lenox Ave, he explained that he’d tried to call the phone company to get his number changed cuz it had 666 in it (they refused) and how (oh wait, lemme just get my keys…) he’d lived in Harlem for 50 years and oh (hang on, not this vest, the other one, get me the red one…yeah) Daniel like from the lion’s den? Alright alright.
I blasted the old jazz station on the way to the hospital. I actually play it all the time anyway, but I played it extra loud so old dude could hear it in the back too, and he bopped his head and smiled his big smile all the way there. Of course, Mt Sinai gave him the grand welcome upon arrival: “Hey hey, Mr B, whats good?” “Whadup Mr B!” “He’s ba-a-ack!” Not even bothering to ask what was wrong this time, because obviously, like every other time, he was chillin.
Then there was Ol’ Joe, half dressed and aggravated in his swank Park Slope apartment. An ancient lady in a bathrobe let us in and then said, “Aight, Imma tellya whatall goin’on. Joe here and I been friends for damn near 40 years, and Imma tellya: Joe been prostitutin’ hiself again.”
“Uh…”
“Shaddup Margaret! It ‘aint true…”
“It is. I know it’s true. And thas why u can’t breath. Prostitutin’.”
“Um…can we focus on what’s wrong medically with Joe?”
“I’m just saying…”
“Quit yer sayin and help me put dese pants on!”
People: I honestly don’t know what the fuck was going on in there. And I wanted to find out, but Joe was gettn riled up with all the talk of his whoring ways. I think she meant he was going TO the prostitutes, rather than actually selling his own body, because, well… he was pretty frail, could barely make it across the room to put on his swank dress jacket and leather shoes, let alone earn his keep in a brothel. Anyway, we took his ass to the hospital and that was that.
Finally, there was the noise complaint dude. Said his upstairs neighbors call in a noise complaint on him every week, which I suspect may’ve been some kinda kick out the old play outta the gentrification handbook, cuz there was nothing in that aprtment to make any noise with. “I don’t see no drums,” I told him. “How you making all that ruckus?”
“I aint!” he said. “But I usedta play drums for Tito Puente, Joe Cuba, all the greats. Then I stopped.”
His walls were lined with photos of himself dapped up in slickass suits with pinky rings. Once he finished having his anxiety attack he was pretty cheerful and we hung out chatting for a while. The two female cops who’d shown up were yukking it up with us, and as we left Old Dude turned to the fine young one with big eyes and said, “Yo, ma, lemme getchya phone numba.”
We left before she answered, but she looked like she was seriously considering it.

GRAVEYARD WALTZ

Hey everyone- just published a short fiction piece about ghosts, graveyards and gentrification on this groundbreaking web journal, The Freezine of Fantasy and Science Fiction! Here's the link:

http://tinyurl.com/yact6yy

BUSY WEEK ON THE BUS

MOOD: slightly tipsy, it’s true

MUSIC: Erykah Badu

She was pregnant and lying in a pool of blood. There were 2 others, deeper in the deli, but a quick glance letme know they weren’t nearly as bad. The project across the street was already emptying out, folks screaming and yelling, breaking towards us at a run as PD scrambled to control the scene. Bright lights bouncing across the brick buildings. Utter chaos.

While my partner and an EMT strapped the patient to the long board, I set up an IV and liter bag of saline fluid so everything would be ready when they loaded her in.

The thing about most shootings: they’re a) usually not THAT bad- a in and out tib/fib shot or a hand, and b) the patients are rarely surprised to have been shot. Always wanna act like they saw it coming, like it’s just some of run of the mill shit, bla dee bla. Or like the guy two months ago who wanted us to take a picture of him for the cover of his album (Sweartogod). But this lady was both very near death and very afraid. She had no blood pressure, because she barely had any blood- what she hadn’t left on the corner store floor was quickly soaking through the bandages, and she kept teetering in and out of consciousness.

My partner put one IV in and I yelled to the driver to go, but not go crazy – cuz mofo’s will drive like hotholy hell on jobs like these and make things much worse- and we speed off. There’s no trauma center in North Brooklyn. If we’re any further up than we were we usually haul ass over the Williamsburg Bridge to Belleview but were slightly closer to Kings County, so off we went, slipping along through the rainy night towards Atlantic Ave, then Eastern Parkway. She had a juicy vein along her forearm, so we dropped the second IV there, bouncing along with the Brooklyn potholes and stubborn, non-clearing stopngo early evening traffic.

She wakes up some with the fluids flowing through and wants to know if she’s going to die, if her baby will make it.  The truth is, it’s looking good for her but there’s no certainties with jobs like this. I tell her as much, but with a more positive spin, and give as clear and update as I can while I try to staunch the bleeding and not fly across the ambulance. We screech around a corner, the cop in the back with us looks like he might lose his lunch at any moment, and then we roll up the hill into the County ER bay.

The other two victims roll in soon after us, one in handcuffs from a previous warrant---dang imagine gettin’ shot and arrested in 5 minutes for separate shit… And the hospital staff jump into their frantic dance.  When we leave, I’m happy to say, our patient is stable and the baby is out of danger.

Later that night, we’re in the train station, looking at an elfish Puerto Rican pothead who’s pretending to have chest pain. When we get him away from the cops I raise an eyebrow at him: Really, dude?

He sighs. “No, I just smoked A LOT of herb.”

How much?

“No, bro, I can’t even. No. Too mothafuckn much.”

I won’t write it down on the paperwork, I swear.

“Well,” he laughs hysterically for a few minutes and we wait for him to collect himself. “Three grams. Plus I tripled up on my antipsych meds. Hehehe…”

Damn.

“Yeah, son.”

Hungry?

“You have no idea.”

Chest pain?

“Nah. I was just…you know.”

You just want somewhere to take a nap.

“Basically.”

No problem.

Then, two nights later, we’re chilling in Marcus Garvey Park, whiling away the night, when the cardiac arrest comes over. Everything happens fast and efficiently: we’re there in two minutes along w/ the BLS, the dude is 41 with no medical problems lying dead on his bedroom floor. Wife and 3 kids looking stunned, staring in at us from the doorway as we setup our shit. I pass my partner and the student the tube kit and they get to work putting an airway in him. The EMTs start chest compressions and pull out the oxygen. I throw the EKG pads on and take a look.

Quick cardiology lesson for those that don’t know: when you’re heart stops beating, it doesn’t necessarily mean all the electrical activity stopped. When that happens, you get the flatline. But sometimes there’s still a ridiculous little floppy line of current running through- it’s called ventricular fibrillation. It’s rare and usually fleeting but if you catch it you can sometimes shock it back into a nice normal working rhythm.

When they stop compressions so I can get a look, I see our guy’s in a rare form of v-fib called Torsades de Pointes. It’s pretty, a windy, spiraling squiggle. “Clear away from the patient,” I say, charging up the monitor. Everyone takes a few steps back, I hit the button and the patient flops up in the air, his inanimate limbs jolting around eerily. When he lands, we do another round of compressions and check again. A  few gimpy complexes float past on the monitor before it settles into a nice steady regular rhythm. We check a pulse and voila- miracle of miracles the man has a beating heart. The tube is in, we drop an IV and begin setting up for transport. We’re exchanging glances but trying not to get all excited cuz the shit could fall apart at any given second and usually does.  Even in the rare case that folks DO come back, they almost never come back to be anything beyond total vegetable.  But there’s always a chance.

Our guy stays quite stable throughout transport.

He coded and was revived twice more in the hospital (where a tox screen revealed large amounts of cocaine in his bloodstream) and at last check was still comatose but expected to pull through.

THE SINGING HEART ATTACK

Fire men were standing in their usual confused huddle around a bench outside the Myrtle Ave projects. One of them came and met us on the walkway. “Um, he’s having chest pain, we think and he had a…seizure…maybe…”
And?
He looked nervous. “And he’s…singing.”
Indeed, the slurred, drunken strains of I’ll Be There were wafting out from the center of the firemen’s circle and we knew it was Singin’ Joe.
This dude calls every couple days when he’s lonely or cold or just too drunk to get home. He was sitting jauntily on the bench, looking back and forth at the confused FDNY dudes, singing at the top of his lungs thru his oxygen mask and punctuating his song with the occasional scream of “OH MY HEART!! OW! OW!...I’ll be thaayayare!!”
“Whatsa matter Singing Joe?”
“Oh I was at dis ol party on the second flo’ and I caught a heart atta- no wait I caught seizure. I caught a seizure. JUST REMEMBER…Yeah!”
“So you came down stairs?”
“Uh huh, I’ll be thaaaayaaaree!”
I wave at Fire. “You can take that oxygen mask off.”
One of the boys goes to pull off the little plastic piece and Joe rolls his eyes back and starts twitching, his great big fro waving back and forth like a peacock tail. The fireman jumps back, horrified. “I’m ca-a-a-tchin a see-e-e-e-iz-ure a-a-a-aga-a-a-ai-n!!! Oh my chest, FUCK!”
I’m biting my finger not to laugh. “Just get on my stretcher, Joe. Seriously. You can finish your seizure on the bus.”
He obligingly brings his shaking to a dramatic close and climbs up onto our stretcher (Singing Joe is fucking tiny, by the way- more fro than dude.)

All the ER nurses turn and smile when we wheel Joe in. He’s crooning at the top of his lungs again, waving at his adoring fans like the drunken king of Brooklyn.

THE GREAT ACID RAIN STINK BALL of 1995

It was 5:40 am and we get off at 6. They wanted us to go get a “DIFFBREATHER” on Nostrand and Lexington and I wasn’t mad at it cuz it was on the corner and corner jobs are usually grabngo.
As we roll up a little Mexican dude and wiley haired black guy are waving to us frantically. They both look happily trashed, neither is strugglin’ to breath, (no surprise there).
-You guys are heroes, the Mexican tells me in Spanish.
-Gracias, I say. Why are we here?
He points to the other dude, who’s either completely fucking Blitzed or completely fucking nuts.
-He came into my corner store, he tells me as if that explained it all.
-And?
-He looked…well, look at heem.
Whatever. We put the dude in the truck and the Mexican told us we were heroes again and went on his merry drunk way.

My partner Mr. C was lookin edgy but I didn’t know why cuz I was standing outside the ambulance on the bumper.
-Whats the problem today, sir?
-Where you in New York City in 1995? The guys asks Mr. C.
-Uh…no.
He looks at me. –What about you? New York City, 1995?
-nope.
The dude looked crestfallen.
-Why you wanna know?
-Acid rain.
That’s when I stepped into the ambulance and it hit me: a thick wave of the WORST most stankiest foulest most nastiest stanky stink E V E R was hovering like a brown cloud of shitstain. The guy smelled like the asshole of an armpit. I steadied myself with one hand.
-Alright what hospital you go to?
-He goes to the hospital we can get to fastest, Mr. C said.
I concurred and literally jumped out the back the ambulance. The dude picked something out of his ear and looked at nothing in particular with those big boggly eyes.

I was feelin kinda bad about leaving Mr C back there but then i hopped up front and realized the smell was not contained to the back cabinet. The foulness fucking surrounded me, demolished my whole sense of self for a few seconds until I cleared my head. I looked down and watched the milk in my coffee curdle (Ok, that’s not true- i never put milk in my coffee…)
All the windows on the ambulance rolled down simultaneously. I switched my heavy duty lights and get-the-fuck-out-my-way sirens on, hung my head out the drivers side window and hauled ass to the hospital past wilting flowers and dying squirrels. Made it there at 5:51, panting, and spent the last nine minutes of tour airing out ambulance.

ON WRITING 1: Just Tell The eFfin' Story

It's funny because it was blogging bout the ambulance messes that re-opened up the writing part of me. Spittin out these weird little vignettes that I'd throw together from memory in 20 min btwn calls reminded me of a simple rule of writing: just tell the fucking story.

Seems so obvious but I see how not remembering that caused some real blockage in my creative output over the years. Get so damn caught up in angles and analysis and voice---nothing happens. My big overeducated head a dang boulder on the path.

So it makes sense that I'd start throwing in some thoughts on the craft of writing among these twisted true life tidbits. The ambulance work feeds me, literally and literarily, because what better fodder for a writer than night after night of humanity's tiny disasters? Even the boring shit's a nice little packaged short story (repeating again and again...) and rather than falling in 2 the cliched role of passive observer that we writers are prone to, the medic is unavoidably, irrefutably and literally arm deep in the shit.

So these notes on writing won't b as gory or ridiculous as the ambulance ones but they will b curse-laden and spiritually engaging. Yes, spiritually.  And they'll be clearly marked so u gorehounds can disregard @ will...

So Today’s Topic: Just Tell the eFfin' Story. Much as I believe in the other timeless wrtier's rule: Ass In Chair, I’ve logged many a-blank stared hour in this chair and wound up with blank pages. Or the inverse: pushed hard and cranked out pages and pages of utter uselessness. I believe in freewrites something fierce- it’s the best way 2 dislodge that thought-fraught brain and clear writer’s block. But for me, thrusting forward towards a word or page goal isn’t the way 2 go.  (For other writers, wordcounts are the beesknees: http://thewordsofawriter.blogspot.com/2009/10/i-love-goals-for-writing.html )

I am though, a big fan of the Outline.  Right behind me, winding across my wall in a serpent of post-it notes, is the outline of the novel I’m deep into. (A sample: http://tidepoolfiction.wordpress.com/2009/10/01/flatbush-spirit-dance/)  Actually, there’s two intertwined strands, one a completed work and the other a completely different strand of that forking off at page 30. It’s a roadmap- guarantees that each time I sit down to write, I’ll know where I’m going, where I am and where I been. That way, the work on the story itself happens all the time, on the train, in the ambulance, in the shower, while I’m treating a patient- whatever, and gets scratched into my handy blackberry, spat onto my wall and then the writing time allows me to throw away all other concerns and Just Tell the Fucking Story.

Which is what writing is all about.

TOO LITTLE TOO LATE

It’s amazing how many calls we get for old men that wanna complain about the “tiny little guys” running around their apartments. There must be an infestation of freaky leprechauns in the city. I know it’s gonna turn up in 1 of my short stories soon…

But anyway, that’s not today’s topic. Today’s we’re here to discuss the little dude that makes sandwhiches at one of the delis of 125^th St in Harlem. He called because he was having pain all up and down his left side (came over as a CARDIAC job, because they included the chest in “all over”…smh). So he’s 32 years old, no medical problems, no medications and he’s basically rocking back and forth and going “OOOh it feels so WEIRD! It feels SO Weird!”

what’s weird?

My whole left side of my body!

Does it hurt?

No! I can’t feel it! Or it’s like pins and needles! Aiiiii!

How long it’s been going on?

Since the day before yesterday…

Anything else wrong?

Yeah, when I poop: blood comes out…

Oh boy…how long THAT been going on??

Since about…well, matterafact since the day before yesterday!

What the hell happened the day before yesterday?

I fell down the stairs.

How many stairs you fell down?

Shit…all of ‘em.

…And you’ve been shitting blood ever since?

Yep.

And you can’t feel half your body?

Uh huh. You think Imma be alright?

NO I DON’T THINK YER GONNA BE ALRIGHT! …jeeeeeze…(aside: do you really need me to tell you that?)

So you think I should go to the hospital?

No, I think you should’ve gone to the hospital 2 days ago when you ruptured your internal organs and severed your damn spinal cord but now u HAVE to go to the hospital…

Sigh….okay let’s go…

That is all.

2 CRAZY GERIS

TWO CRAZY GERIS

One of the crappiest parts about this job is the fact that no matter how fucked up your night was, no matter how tired you are, how many chests you pumped on or IVs you started or whining buttheads you dragged 2 the hospital, you can still get hit with an assignment right up until the minute you get off. So at 6:59 am, after a 12 hour tour, we can end up driving all the way up town for some nonsense. And the rule seems to be that those late jobs are always one form of clusterfuck or another- like, somehow, something always goes wrong.

Okay, not always. Sometimes we do a grab n go:

:::ambulance screeches up to Slightly Intoxicated Mexican dude with no shirt on:::

Me: Get in!

SIM: My neck feels funny…

Me: Get in the bus. We talk inside.

::::he gets in::::

Me: What hurts?

SIM: My neck, it doesn’t hurt but it feels funny.

Me: for how long?

SIM: Like, 2 weeks, guey.

Me (to my partner): Go go go!

:::ambulance screeches off::::

And then, sometimes we actually get home on time.

Last month, we got the job for the UNCONCIOUS at 6:30, which could’ve been a quickie but it was a old lady up in a apartment, so you know it’s gonna be slow. Most of the time, theyre really not unconscious, they’re either napping or felt a little woozy, unless they’re in a nursing home and then they’re usually dead.

This lady wasn’t in a nursing home and she wasn’t unconscious, in fact, she wouldn’t shut up. We heard her yelling from down the hall and us comin inside only made it worse.

“Me not going to the hospital! Just wanna drink me tea! Leave me ‘lone I tell you!”

It was one of these get gramma out the house for whatever reason things, probably cuz she’s won’t stop yelling, so call 911 and have us deal with her. We get that a lot towards the weekends…

Anyway, she also kinda had to go anyway, cuz she had like fourteen billion medical problems, was borderline insane and her toes were rotting off.

But she wasn’t having it. Her poor husband was actually dying of cancer in the other room, but I think he really just needed a good nights sleep. Then the daughter showed up and started cursing out the old lady “Just go with the goddamn ambulance people, ma, you always do this, ma, seriously, we go through this every FucKING WEEK!” and then to us: “I’m so sorry, boys, really…”

But without her tea it was a no go.

We sent someone to put the kettle on, but really it was a battle of wills. You could tell she was starting to cave when she got pouty and stopped yelling and carrying on- the non-logic of tea over amputated feet had been barreled over by the sheer strength of her daughter’s curseout.

“But I can get up me own self,” she insisted after finally relenting. “If I can make it to bathroom on me self and make it to kitchen to make me tea, why you think me can’t go to ambulance me self?”

Far be it for me to tell someone that I don’t have to carry their ass- I’m usually the first to agree. Unfortunately for everyone though, grammy’s feet were wrapped in leaking, yellow stained bandages that hadn’t been changed in…weeks at least. Damn near had to wrestle her onto the chair and she actually took a swipe at me as we carted her out, but all in all, granma made it to hosp and everyone else breathed a sigh of relief.

Then last week- we came for the DIFFBREATHER on top of one of those pjs along marcus garvey. The man was ancient! Skin like crinkled up paper, long boney legs bent into an antique wheelchair.

“did you ask for the police to come to?” he wanted to know when we came in. I put a message over the radio for them.

-what’s wrong today sir? You feel okay?

…yes. Yes feel alright.

The apartment was dusty and mostly empty.

-Do you wanna go to the hospital?

-Yes…Yes I think I do.

Ok…Any pain anywhere? Any trouble breathing?

No. None at all.

That’s nice. Why did you, ah…call…911…today…sir?

Lemme get back to talkin’ to my daughter for as sec, he says, indicating an empty corner behind him.

I was about to be able to explain the whole weird episode away as a oh he’s bonkers but then i saw the phone sitting there off the hook. I passed him the receiver.

No- he says- no, dear, it’s just something i have to do. I can’t stand him being here anymore. No, he’s out now. No…I know…It’s just the way it’s gotta be. Okay…alright.

He passed me the phone to hangup.

Popo couldn’t get much more outta him than we could.

Basically, the cop says, you just wanna go to the hospital but nothings wrong?

That was the gist of it. When I went to help him up from his wheel chair and into ours, he reached one long arm into the pillow behind his back, retrieved a 10” butcher knife and handed it nonchalantly to my partner with a curt: hold this for me.

“Uh…ok…” she gingerly placed on the dust covered kitchen table and we wheeled him the fuck out the door.

BLEED IN BLEED OUT

When the word INBLEED pops up on our screens as a call type it inevitably means the next hour of life is gonna be either messy and stupid or boring and stupid. This is because INBLEED is the kind of call you become when you tell 911 you’re bleeding out yer butt, so the range is from “I have hemorrhoids” to lying dead in a lake of blood. That was actually a job I had a couple years ago- start as a INBLEED, turned into an UNCONSCIOUS while we were on the way and then a CARDIACARREST when we rolled up. Sure enough, the landlord met us at the door with the delightful words: “He has HIV and Hepatitis and he just vomited up all the blood in his body and died.” Sure enough, the damn room was painted, floor to ceiling with bright red blood (bright red means it’s recent, dark coffeeground blood means it’s old. For what it’s worth) and there was a dead guy lying in the middle of it all.

Anyway, you basically treat a true internally bleeding patient as if they were a trauma: they need a big IV with lots of fluid going through it and they need to get to a surgeon ASAP, no time to play. But that’s really the very rare exception that shit turns out so dramatic. Most, like 90% of em turn out as

“yeah I found a streak of blood in my stool, wanna see?”

nope.

or “I just vomited and there’s some red in it.”

What were you eating?

“Cherry ice cream with beets and ketchup.”

Hmmmm.

BUT anyway, by whatever odd logic of the EMS gods was at work last Monday, we ended with 3 inbleeds in a row, spanning the whole range of madness. The first was a chick from a shelter who’d just had a little dab a blood here and there whenever she did a number 2 for the past three weeks. Ok, doo dee doo, let’s go. Second was basically the same thing but the guy tried to fake a seizure on the way out cuz he didn’t think we were paying him enough attention. Then the last guy- he made like he was alright, even convinced himself he was I think. He’d had a near syncopal episode (almost fainted) coming back from the bathroom and while he didn’t have any active bleeding, he’d been diagnosed with a bleeding tumor and a stomach ulcer. But the dude wasn’t showing any signs of crashing or even being shocky at all, no dizziness, wasn’t pale, wasn’t weak, his blood pressure was fine, heart wasn’t racing. Did you know when your bloodpressure drops your body realizes it and makes you thirsty so you can compensate the fluid loss? That’s why so many trauma patients’ last words are “can I have some water?” and then they die.

Anyway, this dude had none of that, and he wanted to walk, so we said alright, but kept a sharp eye on him as he stood. Halfway to the door, right in the narrowest part of the hallway, he went gray, flung his arms out to either side, rolled his eyes back and collapsed. Man…

The boyfriend starts yelling about how he always does this (!?) and why he have to be so macho, then their cat starts hollering and carrying on too, and meanwhile my partner’s passing me the IV line and needles while I’m making sure dude isn’t in arrest. It’s tight in here, mind you, like one person at a time tight, and the patient’s large and in charge, but fortunately, not dead. He still needs an iv though, so I wrap the rubber cord round his big ol’ arm and start feeling round for a plump vein, but there’s NOTHING, not a damn thing. He’s waking up now, talking bout –oh I feel better now I can walk? and his man’s like –oh HELL no, boo! And I’m like, dude- where’s your veins? But like I said, he’s fat and probably bleeding out somewhere deep inside, which depresses already hiding vessels. Grrr. Then to top it off, it turns out when I do take a stab at something, his skin is alligator thick. Like, you have 2 put shoulder into it to get the needle through, which sucks for everyone. So he’s screaming and yelling, the bf’s like “man up” in a startling about face from his earlier position, and my partner’s peering over my shoulder tryingto see if my IV any good or not. I push hard, break skin but get no flashback, no love whatsoever from those escondido mothafuckas. We try twice more but with no luck.

He still wants to walk, which is generous to our backs but unfortunately, not even remotely possible. Just sittin up he gets dizzy again, so we call for a backup truck, pull out the scoop and ease him onto it. Takes some serious heave ho’ing but eventually we get him hoisted up, down the skinny ass hallway and into the ambulance and then carted safely and happily off to the hospital.

STAND UP SIT DOWN LIE DOWN DIE

The next night, after lots of ridiculous little jobs (“my elbow hurts” and “I can’t find my psych meds!”) I was workin with newguy and we walk into a fancy Spanish Harlem apartment to find a little old guy, surrounded by gawking firemen, about to die. Dude was pale as shit, gasping for air, flailing his arms around like he was drowning and couldn’t get more than a word or two out. He definitely had fluid in his lungs, you could hear that raspy gurgling from across the street- the real question was his blood pressure. If you have fluid in your lungs and your pressure’s skyhigh, which is usually the case, it’s very bad- your veins are clenched up tight, you’re heart failing miserably and you’ll eventually drown in yourself. But if you’re ful of fluid and your pressure’s low: you’re fucked. Unless someone puts some dopamine in you quick it’s all over. It’s called cardiogenic shock. That was this guy. To top it off, there was no way for us to give him the dopamine, which tightens up your vessels enough to keep your heart pumping and your pressure up, because the guy had no veins at allll. Nada. I took one look and knew it wasn’t even worth trying.

Here’s the quandary with this situation: no blood pressure means you can’t sit up- any fluid you got needs to be pooled at your upper body, vital organs, so if you sit up it’ll drop to your lower extremities and you’ll die. That’s why people in that situation, including trauma patients who’ve bled out and internal bleeders, all get transported with their feet up, lying flat on their back. On the other hand, people with fluid backing up in their lungs can’t breath, and the last thing you want to do if you can’t breath is lay back- the fluid floods right up your airway and drowns you. That’s why asthma attacks and pulmonary edema patients lean forward in what’s called tripod position.

So here we have a dude with both: no blood pressure- it was like 80 over 50, and can’t breath, and he’s anxious, freaking out, won’t tolerate even the oxygen mask that he so badly needs. So we have the scoop to lay him down in and the chair to wheel him out in but it’s a no win situation either way. He was in a sitting slouch when we got there, so I watch him sit up some and ease onto the chair. He doesn’t look much worse for it and I can tell that laying back further is increasing his agitation, and him getting more upset means his poor failing heart has to work even harder and will sooner collapse. I decide to chair it but have the fireguys walk along side with the scoop just in case he codes and we have to start doing cpr.

He’s spiraling down in the elevator, arms flailing madly like he might take off at any second, water rising higher and higher up in his lungs and everything seems to be going in slow mo, but not in the badass matrix way, only in the whytheFUCKthistakingsolong kinda way. Finally we outside, I toss partner my keys so he can set up the stretcher while I cart homeboy out. Firefighters are scurrying all around me in a frantic escort as I heave ho thru two sets of project doorways and out into the street. We do a quick 1,2,3 evaluation: dude’s still fucked, and then I jump into drivers seat and come up on the air to give the notification: 12xray (that’s our unit number) with a note to Saint Lukes.

I’m throwing into drive, restraining a hot seething curseout as the firetruck that’s blocking us in takes a few milliseconds longer than I want it to to get the f out my f’ing way.

-Go head with your notification, 12xray.

-we have a sixty three year old male, eminent cardiac arrest second to cardiogenic shock, blood pressure 80/50 heart rate 120 respirations 28 be there in 2 minutes.

In my rearview, I see my partner flittering around like a desperate little toothfairy in the back. He’s brandnew and truthbetold, I don’t think the patients gonna make it through the night, but I know the best I can do is get him to the hospital fast as humanly possible so he doesn’t have to get worked up by brandnew dude all by himself.

The *%#*&&#?!! Firetruck has pulled off now and I’m airborne through the windy upper west side streets, winding round the park, hauling ass along 110^th and screeching around onto Amsterdam. My sirens are having a temper tantrum, my lights playing rude games in red and white along the Chinese restaurants, coffee shops and saint johns cathedral and then we’re there, breathless, weary, but the dude’s still alive, if only barely.

He didn’t make it through the night tho.

KER-SPLAT

I was laughing cuz my partner was moody and not in the mood for trauma, but we had a student, and it was Sunday night in Harlem, so even without riding all over town trying to pick it up, the shit was flying our way. We’d already done a pretty low key shooting, no kinda clusterfuck just a straight forward once in the leg, dude was pretty much chilling in the doorway waiting for us and then we were sitting in Garvey Park, enjoying the firefly show when they sent us solo for a cardiac arrest on 110 and Lenox. Text said, MAN FELL OFFA BLDNG NOT BRTHNG NOT MOVING.

Now, lemme say that even when a cardiac arrest is just your regular everyday 200 year old in the nursing home type of thing, you still automatically get EMTs backing you up AND a slew of firemen and a conditions boss. This is because arrests take a lotta grunt work to deal with. It’s like any job but someone has to be doing CPR the whole damn time, and real CPR takes two people minimum to do. Then add into equation that the patients probably gonna be humongous and humongoloids as a rule only live on the top floor of buildings with no or broken elevators- it’s a production.

But even with this patient being skinny and obviously not on the top floor, another seta hands woulda really helped.

When we rolled up the fire dudes were there running around with the general melee of the building, which had emptied out for the spectacle. People were pointing and yelling- He on the awning, yo!, so we walked in the building, up a flight of stairs, down a windy hallway, through someone’s bedroom and out a window to the cement awning where we found our guy.

He had landed Wiley Coyote-style, face first, arms and legs sprawled out at impossible angles all around him. He was also about 60, skinny and frail and, most surprisingly of all, alive. Not only was he alive, he was talking, or groaning anyway. Mostly all he said was “ow” the whole time, but for an older dude who’d just eaten pavement from five stories up that’s not bad. Most guys like that we just put a sheet over.

Anyway, the bucketheads had brought their backboard up but we had a problem: the guy was facedown and had to be rolled to be placed supine on the board, but both his arms were shattered, loose like spaghetti, one of em with an open fracture, bone and everything out for all the world to see. To roll him like we usually do would’ve rolled his arm over and over underneath him like dough. Fortunately, he was slender and light, so we adjusted the arm, grabbed him all along his mangled body, supported his head and lifted him over his own arm and onto the board.

“ow.”

Then I climbed back through the window and we passed the board and dude through the window and out into the hallway. With firemen helping my partner get the guy out, i rushed ahead to the ambulance and set up our equipment. He was a trauma, so he’d need big IV lines and big bags of fluid. Because of the mechanism of injury he was likely to check out at any dang moment, so I opened up the tube kit and laid out on the little shelf next to where the patients head would be.

The door swung open and they loaded our guy in, sill moaning. He turned out to have a decent blood pressure- 130/70, and a heartrate of 70- that’s ridiculous. No one falls off a building and has perfectly normal vital signs, but who am I to complain? Either way he was still broken everywhere, and crush injuries like that can maintain and look normal right up util they don’t, and then the guy will just die.

So we lurch into motion towards Saint Lukes and find two surprisingly bulgy veins to put two bigass needles in and lots and lots of fluid and our man rolls into the hospital in the same vaguely shocked and irritated, broke ass way we found him.

THE MISSING BULLET

But first:

ME: What’s the trouble today young lady?

PT: I’m bleeding…from my vagina.

ME: Um…this has happened before ever?

PT: Yes! A month ago actually!

…

True story.


ANYWAY:

PD started getting excited on their radios cuz a car accident came over and it was right at their favorite bar. Then a shooting came over at the same location. Then it turned out to be one in the same and you could hear all hell breaking loose. “It’s an MVA! It’s a shot! It’s both! Blaaah!” I was around the corner in Garvey Park so I just kinda started easing over that direction nice an’ chill like. When you’re medics, you don’t wanna get on a trauma before everyone else. Better to let the EMTs get there first, deal with all the annoying putting the dude on the backboard/getting him out of the car etc. and then you get to do the fun stuff- starting the IV, intubation, whathaveyou. So I sat on 121 and Park and listened to sirens come screaming towards me from all around the city. Emergency Services flew past- those are like the NYPD’s swat guys. Then some EMTs zipped by and we fell into place behind ‘em, bee-lining towards the sea of flashing lights.

They were pulling the dude out of his escalade. He was 60, 300 lbs and dead. There was a gunshot wound in the back of his head and no other visible injuries. His escalade was mashed into the brick wall of the cop bar. A kind of controlled chaos was hanging in the air as everyone swarmed about our business. Eerily, the guy’s cellphone won’t stop ringing.

A word about being dead: as Billy Crystal said in The Princess Bride, there’s dead and then there’s MOSTLY dead. According to our rules- you’re only truly dead if you fit certain criteria: rigor mortis- which is you know when you’re all stiff, dependent lividity- which means you’re so dead all the fluids are pooling at the lowest point in your body (yes, it’s gross), decomposition- which is self explanatory, you’re rotting and then the wonderful catchall: Obvious Death. That includes everything from beheading to burnt-to-a-crisp. Usually if brain matter is involved, it’s Obvious Death (unless the person’s still squirming). If you fit into any of those categories or have a DNR, we put a sheet over you and call it a night. Otherwise, it’s the whole rigamaroll.

This dude wasn’t quite obviously dead enough to be Obviously Dead, plus they’d already gone to work on him when we got there and it’s a whole other rigamaroll to stop a workup in progress. So we did our thing: got him on the EMT’s ambulance, I set up a fatbag o’ fluid and prepared my iv, my partner took out the laryngescope- a metal scythe shaped tool with a flashlight on the end that we use to look all the way into people’s throats so we can stick a tube down there. Meanwhile, I tossed my keys to the other EMT so he could drive our bus and yelled to the driver to start rolling.

The best way to find a good vein to poke isn’t by looking, it’s by feeling. Sometimes you’re better off not looking- you just roll your finger gently along the area where you know the juicy ones hide until you feel that bouncy vessel poking up. Then you trace it, see which direction it leads, and sink your needle just below it. When the needle finds its mark, blood pours into a little filling chamber. You push the plastic catheter forward while pulling the needle out and then attach the iv line to the hub left behind. All this happens while the EMT is frantically barreling down the street and around corners because he’s new and never been on a shooting before, let alone a crazyass car crash head shot traumatic arrest. Just as we're ripping off scene though, the ambulance stops short.
What’s the problem? I yell from the back.
There’s a Captain onscene, the EMT reports.
So what? I ask. They’ve been getting real uptight about certain things and apparently this one wants to check on us. But really- now is not the time.
He’s blocking the bus, the EMT says.
Drive around him, I holler. Both my hands are busy trying to keep the IV bag from swinging into my partner’s face while he sticks the tube in.
We drive around the captain.

The line is in and so is the tube when we swing into the ER bay a few blocks away. Since we made patient contact, eight minutes have gone by. The energy is coursing through my body- it’s more than adrenaline- it’s the glow of total focus and purposefulness of action and it feels amazing.

At the hospital, they pronounce the dude pretty quickly, but when they x-ray his head there’s no bullet there. Now we have a riddle: there’s only one hole, so where’s the damn bullet? I ask my partner what he saw when he went to intubate. –Just a lot of blood, he says, couldn’t see much. The doctor in charge gets his suction and a light and after some cluttering around in the dead man’s mouth announces he has found the other hole. The entrance wound. Turns out our guy was a suicide. A general murmur flutters around the detectives. Apparently he was talking on the phone with his girlfriend, had been depressed for a few days, crashed the escalade and did the deed, gf still on the line. That’s why she kept calling back.
The doctor puts a sheet over him and I head outside to clean off the equipment.

CLUSTERFUCK 1

MAKE MY FUNK THE…

Last Saturday:This dude was 60 and totally out- speaking garbly gook like he might have a head bleed but the also kinda had that o.d. look to him. Or maybe his sugar dropped. The thing is, for a medic, the most useful skill we have is our ability to get the story. The best ones are like medical Sherlock Holmeses- can figure out the whole damn scenario from getting the history. New guys always gush about the skills: can u get an iv, how many tubes have you done, etc etc but bottom line is that if you don’t know what to do with that iv when you got it, it aint worth shit. But then there’s dudes like this, who can’t tell you what’s going on cuz they’re just going: Blarga blarga blarga and the cracked out middle age ladies who were with him were either clueless or withholding info.
All they would tell us is: he’s hopped up on p-funk.
What’s p-funk?
They didn’t know. His pressure wasn’t high enough to really look like a stroke and he didn’t respond when we put an amp of sugar in him, which he would’ve if he was hypoglycemic. He doesn’t look much like a standard narcotic OD either- pupils aren’t pinpoint and he’s not in respiratory depression, but he could have any number of things on board, so we push a judicious little squirt of narcan in him to see how it settles.
Full body seizure. Not even a fake one.
This’ll happens sometimes with addicts, because the narcan puts them into such immediate withdrawal their body rebels. But this wasn’t enough to do that and it seemed unlikely that he was that far in anyway. He came out of it on his own as we sped off to the hospital, where we found out from google that p-funk is a saucy mix of powdered heroin and crack-cocaine…. Which makes me think the seizure happened when the narcan zapped the heroin out of the equation and left him suddenly full of pure crack.
Sometimes all you can do is shake yer head and sigh…



CLUSTERFUCK #1


Yesyes, clusterfuck, but first, this:
It’s pouring rain in that weird semi-suburban part of East New York where the mafia used to put all their dead. We’re backing up a BLS unit on another nonsense DIFFBREATHER. You can tell it’s gonna be no big thing from the call description on the monitor: FEMALE, 48, UPSET, NO MED HIST, DIFFBRTHR… and the EMTs are already inside so I tell my partner to wait in the bus, I’ll just take a quick looksee. When I open the door to the little ramshackle house I find a lake in the living room. The water is easily knee deep. A little electric pump is at the entrance, frantically scooping water up, but it’s facing the wrong way so all the waters’ splashing back into the house. An old blind guy is sitting on a mattress that’s floating in the middle of the room. He’s propped up on his elbows, looking around curiously.
Uh- sir? I say.
Eh?
Sir? Someone called EMS for trouble breathing?
Eh?
I gingerly wade thru the domestic tide pool to a back room, where the EMTs are chatting with a crying lady.
What’s wrong?
She didn’t take her psych meds for three days, the EMT reports
She’s not upset about…, I nod my head towards the disaster area behind me.
The EMT shrugs and the lady sobs.
Any chest pain, ma?
She shakes her head.
Any medical problems besides the psych stuff?
Another shake.
I make my “you good?” face at the EMTs and they nod (because EDPs get EMTs). I slosh back out into the living room, past the little floating old guy who says “eh” and out into the rainy Brooklyn night.


Ok now the story, and this people, is 1 of the ones that comes to mind when people go 'Oh what's the most fucked up shit you been in on the job?':

Big T was grumpy that night, which usually meant that any little thing could ignite a rambling curseladen monologue that would eventually lead back to his wife. Always amusing, once you got past the fear that he might stab you up. But still- one of my all time favorite partners.
You can tell a shot is gonna be legit when it comes in a whole bunch of times in a whole bunch of different ways. This job came in on three different corners, once or twice as a shooting, once a stab. It’s not because there’s so many patients (usually), but more a hint of the clusterfuck that awaits us: shit is so chaotic and everyone is going batshit so everyone calls 911 with a different batshit story. As we start heading in the job becomes a CARDIAC ARREST, which doesn’t even mean he’s dead, just means more insanity. Now an arrest by its very nature requires two units, an ALS and a BLS, so the EMTs can do CPR while we start the ivs and intubate and shock and all that. But tonight, all the east new york EMTs were busy taking stuffy noses and stubbed toes to the hospital, so they had to send a unit from Crown Heights to back us up.

The night was thick with chaos. Even before we get to the job someone’s trying to flag us down cuz he’s getting his ass kicked over some petty robbery shit. Cops are flying around in all directions like dogs chasing their tails. It’s hot as shit out. We have to park at the top of the block because the whole thing is covered covered covered in people who spilled out of a houseparty whn the shooting went down. Everyone already wants to kick our assses the second we get there, and the only back up we have is a bunch of surly Long Island firefighters, who aren’t world renowned for easing the community’s aggression. They do help us cleave a path through the crowd though, and we finally get to our man.

BUT- there’s a chick clinging to him. They’re both covered in blood, who knows whose, and she’s screaming for us to help him but won’t get the f out of the way.
We erupt into a chorus of: lady, you gotta get off the dude so we can help him, lady, miss, seriously, now, lady, get off the dude NOW RIGHT NOW YOU’RE NOT HELPING.
And she’s screaming: HELP HIM MY GOD PLEASE OH HELP HIM PLEASE…
And believe me people, I wanted to physically detach her myself but i already had a large angry crowd looking for a reason to whup my ass and touching the screaming lady was not about to 2 be that reason. Meanwhile, we still have no BLS to back us up and the Fire dudes are looking pretty iffy about the whole thing.
Lady: HELP HIM! SAVE HIM! PLEASE!
Us: Get…OFF…THE SHOT DUDE…NOW!
And the guys barely moving at all.
It takes FD, PD and us to convincer her to get the f off him AND THEN: (and i don’t even like using capital letter but if i was telling u this in person I would be raising voice plenty, because although this happened a few years back when i was a new medic, the trauma of the night lingers. In a healthy way) Aaaaanyway: AND THEN: it turns out the lady didn’t even know our guy. Did…not…even…know…the dude….Damn. Just rolled up on the scene and jumped right into the action. Covered herself in his blood, delayed his medical care- which in any other circumstance would land yer ass in central booking, and he a total stranger. Well…sometimes you just have to move on.



EMTs showed up and I swear I’ve never been so happy to see them. Situations like this- you need as many hands as you can get. When we get him on the bus they get a blood pressure and cut off his clothes while i set up an iv and my partner does a full body super fast assessment. He’s got one thru the hand, one in the left chest and one in the gut. The chest one turns out to be a problem because it’s pierced his lung, collapsing it- that’s why he’s not talking. This is the most pressing issue he’s got, will kill him quickest. Second most pressing is the gut shot, because you can easily bleed out and/or later on, toxify your system from that. Those are eerie because you may not even see a drop of blood, but it’s all gathering in the abdomen somewhere and then they’ll suddenly have no blood pressure and crash, just like that.

For his bleeding out gut, we have a big bag of saline, attached through a drip set which is attached to HUGE ASS IV that I stick into his arm. The collapsed lung is more complicated: I pass my partner an equally hugeass needle, which he inserts into the third intercostals space, meaning between the second and third rib. With the needle removed, the open catheter allows the extra air that’s built up in the chest cavity to escape so that the lung can reinflate. It did and the guy started talking and looking a little more alive as we rolled into the er bay.

Unfortunately, that’s when things started getting really ugly.
We musta caught em off guard, cuz it was a hosp i’ve seen work miracles in some f’ed up situations. We definitely told the dispatcher to let them know what we were coming in with, but maybe they never got the message. Either way, they weren’t ready for us, which led to chaos: nurses and doctors running around, paging trauma teams, screaming back and forth. You know things aren’t going well when you have to repeat the presentation like five times to different people. In the midst of this, homeboy’s lung recollapsed right in front of me, so I re-decompressed him, using my partner’s needle hole as a marker. Then someone pulled out that fat iv i’d worked so hard to get, and a scramble commenced to get another. Then suddenly everyone disappeared for a haunted few seconds, but not for an x-ray, maybe just to huddle and try a new approach, cuz then they were all back with renewed chaos. I should’ve known just to do my job and back away, but like i said, i was new, and we’d worked so damn hard on this guy, i wanted to see what happened. He could see things weren’t going well, was yelling and screaming for them to help him and then finally, out of breathless and hopeless, just looked at me, dead in the eye actually, and said goodbye. Then he dropped his head back on the stretcher. They tubed him but didn’t have a oxygen ready to push into the tube, and by the time they got it his pressure was bottoming out and they whisked him away to surgery, where he died.

A Dream, A Drunk, and A Few Things You Do When You Die

Before I begin- before I forget, lemme let out something I been meaning to mention since i started this blog: if you and me are walking down the street one day and- god forbid- some nice little old lady gets steamrolled by a mack truck, or some dude decides to check out off a building ledge or any of the other imaginative-ass ways people find to get themselves collected into the underworld takes place- it’s not gonna be a whole heroic rushing to the rescue situation. Music won’t swell. I won’t be pulling any granny’s from flaming cars and I definitely won’t be sticking pins into people’s throats and breathing for them. Probably, I’ll tip my hat and walk away, because without a bag of equipment and some gloves, I’m just another dude on the street except I would be able to imagine what I would do and not be able to do it. Which would suck. For me and the unfortunate patient.

Having said that, there are 2 exceptions. The first is non traumatic cardiac arrest- cardiac arrest because CPR only requires hands- (the American Heart Association recently took mouth to mouth out of the equation cuz no one wanted to do it and compressions work well on their own. holla. ) and non traumatic because traumatic cardiac arrests usually involve lots of blood, and I love humanity and all but not enough to catch something nasty from some stranger. Aaaand traumatic cardiac arrests rrrrarely make it anyway.
The second exception would be the choke and by choke I don’t mean the guy holding his hands to his throat going Oh my god I’m…I’m choking! I’m choking dammnit! Because someone who tells you they’re choking is like someone telling you they’re in cardiac arrest- it means they’re not. Real chokes don’t talk, they’re too busy turning blue and coding and I’m too busy getting my forceps out and putting em down their throat. They don’t turn red. They don’t cry and moan. And usually, they were eating right before it happened, not talking on the phone with their ex like most CHOKE calls we get. But yes, for the real legit, bluefaced not talking not demand making not EDP or recently dumped choke, the good old heave ho on the tummy will do the trick most of the time and make all the difference.
So there you have it.
Now on to the subject of tonight’s pleasant/gruesome chat.

1.
I was pleasurably napping on my couch yesterday when all the sudden I was downstairs in a strange duplex and people were filing out of some meeting on the second floor. An old scruffy fellow with a beard came up to me and sort of collapsed onto me, getting his drool all over my shirt. I lifted him up and he puked on the floor and looked like he was about to check out as I was waking up.
Damnit- I thought, back to work already…

2.
Later that night:
You can tell this job’s gonna be retarded from the way it comes over on the screen. It’s an UNCONCIOUS and the text says “FEMALE CALLER STATES MAY HAVE LO BLOOD SUGAR” so you already know the lady is not unconscious at all, but lucid enough to be already trying to rationalize Why she called 911 and told the operator she wasn’t conscious. And it’s at a bar. Any UNCONSCIOUS at a bar sucks on principle cuz it automatically means the patient’s having more fun than we are.

When Mr C and I pull up outside 1 of these new trendy spots on Myrtle, a short white guy approaches the bus. He has thick glasses and a little hair left and carries himself like he owns the place but doesn’t want to throw it in your face but wants to make sure you know but doesn’t want any trouble either. The creases on his forehead say that he’s gonna try to maintain calm and keep control even though he’s very fucking concerned about how this looks for the business. He immediately irritates the shit outta me so I open the window just a quarter of the way. He wraps his anxious little fingers around the edge of the window and gets up on tippytoes to peer in at us.
Um- excuse me…
Yes, can we help you?
Yes, um, there is a lady inside, she was shaking, and she said that um, her sugar might be low, and um so now though she’s like, unconscious and so we you know called and she’s inside so maybe you could you know…um. Yeah.
Okay.
I roll up the window.

The bar is all wide eyes and whispers. The unconscious lady has decided to stay in the back area and she’s moaning and carrying on, waving her hands in the air in the midst of a small crowd of onlookers. She’s middle aged and fattish with an indigo girls haircut leftover from 1992. Predictably, she’s trashed.
Oh god! She’s yelling in a thick british accent. God, this is- this is so Not Me! I just- I don’t know what’s wrong with me, it’s like…I’m like…It’s like I’m perhaps I’m or my sugar is low!
Are you a diabetic? Mr C asks.
No, but I mean, oh it’s crazy, I’m so, I’m so embarrassed. I mean…
Ma’am, could you hold still a second?
I mean, I’m so- this is so not me. I can’t even, oh godddddd
Ma’am, stop writhing please and sit in this nice orange chair.
(Patience waning, waning away)
It’s like…oh! I’m so embarrassed. Perhaps it’s you know, something menopausal, you know, like I don’t know, I feel so weird, perhaps it’s something with menopause…
Perhaps, I suggested, it’s that you’re drunk.
At this point her friend chimes in helpfully- Oh, she wasn’t drinking tonight!
Mostly without meaning to, both me and my partners’ eyebrows raise with wonder.
I say that I think maybe she was, just a little.
Just three vodka tonics, says the patient, but that can’t be it…

Everyone stares as we wheel her out, which usually bothers me, but this one’s still moaning and carrying on so much it’s hard not to think that she’s feeding on the attention. When we load her into the bus she enters the apologizing drunk lady phase, starting with a thick round of Oh god, I’m so sorry boys, I’m really really really really- uh sorry. Oh, I think I’m gonna be sick again, oh my god- like, i”m really really sorry, guys. I’m really embarrassed and I really think this is the menopause, you know, and maybe my sugar.
Must be some combination, dear, -the friend offers reassuringly. Some combination of chemicals, you know, in your body. Reacting to each other, you know? Not to worry- this isn’t you, darling, this isn’t you, just some combination of chemicals.
Yes, I think: alcohol and blood.

Drunk people l o v e to repeat shit, just in case in the retelling some new detail will emerge that makes it all make sense in that satisfying drunk way. And when you add a mostly drunk person to a completely drunk person, they usually end up repeating themselves and egging each other on to repeat things even more, ad nauseum (literally). So I was happy to be driving last night, and not sitting in the back listening to the pissfaced brit fest skip back to the beginning of the monologue again and again.

At Brooklyn Hospital, she decided that she needed a cool room please, and a clean bucket to be sick in, and that perhaps it was actually, you know, food poisoning.
Perhaps, my partner said, it was alcohol poisoning but she’d already cycled back to the low blood sugar theory and her friend was nodding enthusiastically.

some douche bag took this photo in Cali. Im not for this voyeuristic crap but im not against ripping it for my blog, especially when it's SO exactly what im talking about. Notice how the new guy looks like he's thinking about maybe treating her and the old dude in back is like "Don't even fucking consider it, a-hole." Classic. And that chair is HUGE.

3.
Even later that night:
Our EMTs are dealing with a drunken head trauma when another guy approaches them to say he’s having trouble breathing. So they call us to come handle it while they continue longboarding and collaring their guy. Our guy is outside on the stoop, puking and yelling that he can’t breath. It’s dark, so we don’t really get a good look at him till we’re inside the ambulance and starting the workup. He’s 59, a diabetic and has just been having shortness of breath all day but no chest pain, no bleeding, nothing else unusual at all. When he takes a breath you can hear the rustling of excess fluid frothing in his lungs. It sounds like someone sucking the last bits of soda out of a cup of ice and it means his heart’s failing.

There’s a few things I tell my students to look for when they’re trying to assess whether a respiratory distress patient is about to check out. They’re not medically proven and you won’t find them text books, but as someone who sees people on that gray breathless line between alive and dead fairly regularly, i can tell you they are almost without fail warning signs of someone looking to not make it.

The first is Non-Tolerance of Oxygen.
I can’t breath I can’t breath!
Ok, Here’s some oxygen, this’ll help.
No! I said I can’t breath damnit! Ah!
When someone’s so deep in their hypoxic stupor that they can’t even bear to have the O2 mask strapped to their face, I start looking at my tube kit.

The second sign of imminent respiratory and then cardiac arrest is the Toilet Spin- they start making crazy circles with their upper body like someone just flushed them down the big linoleum bowl of death. Their eyes stop looking at anything at all because the patient’s too busy trying to breath to bother seeing. It may be why we call it crapping out.

Finally, Everything That Once Was Fast Gets Slow, real slow. That fast thing is how the body compensates: They can’t breath, so the heart beats faster to pump more blood to the lungs and other vital organs. The respirations speed up to try and get more air in, but adds to the hypoxia and franticness. Sometimes a patient can keep going like this for a long time, their chest muscles flexing in and out in a desperate attempt to keep breathing, but eventually, exhaustion will kick in from all that hard work, and that’s when Everything That Once Was Fast Gets Slow. They’ll go from “OhmygodhelpmeIcan’tbreath

pleasedosomething” to “…uh…” and from gaspgaspgaspgaspgaspgaspgasp to gasp……………….gasp………………….gasp…………………gasp……………………………gasp.
That’s endgame.

This fellow had all that going on within minutes of getting on our ambulance. AND he had no veins for me to put an iv into. AND his lungs were quickly filling up with backedup fluid from his failing heart, so he was literally drowning inside himself, which is only a deep concept when you’re not watching it happen to someone right in front of you. Now, usually folks in this condition, it’s called Acute Pulmonary Edema, have extremely high blood pressure, which sucks a lot for them and could quickly kill them, but suck tho it may, it’s still much better than the ones with fluid filling up their lungs and NO blood pressure at all. Those guys are in whatscalled Cardiogenic Shock, and they’re fucked. That was this guy. He was cold to the touch. No one could find his blood pressure. His veins were collapsed. It was the kinda guy that you keep looking up at to make sure he hasn’t coded yet, even if he’s talking to you.

And he was talking away at first, while we were digging around in his hands for that lucky little flash of blood to tell us we had IV access and could get some life-saving meds in him. Then he got agitated, and started taking off his O2 mask, and me and Mr C exchanged a glance. Then we still couldn’t get a blood pressure or an IV and he started getting quiet, which is when I said “Imna start rolling.” As I hopped out of the back I saw him make a little sightless spin with his upper body.

When you’re a paramedic and the man you’ve been assigned to keep alive is about to die and you don’t have an IV, all you have left is you’re lights and sirens (this is why I don’t mess with patients when I aint working). I fucking flew to the hospital, my siren turned up to an ear shattering, frantic splatter that makes yuppy scum jump the fuck out the way and then look on irritably. Made it there in a minute and a half and by the time I opened up the back our man was in cardiac arrest, intubated and lifeless. Can’t say I was surprised. The only thing that didn’t fully add up about the situation was no chest pain- for someone to be in as much cardiac distress as he must’ve been, judging from his EKG and symptoms, he shoulda felt it, but diabetics are known to have whats called silent heart attacks, meaning you can catch and not know it.

In the hospital they put a central line in and got him back for about ten seconds before he coded again. They shocked him more than a few times, brought him back again, lost him again and last I checked he’d coded and revived a total of five times but was still alive and ticking all by himself.
What’s the story with this guy? The doctor wanted to know.
No history, I said, except the diabetes. No chest pain, he was just sitting on his stoop vomiting and looking like he was about to check out.
Then I remember my dream.

5 Flights or Patriarchal Dumbassery Claims Another Victim

A five story walk-up on the Grand Concourse. Why do folks who need to be carried always live on the fifth floor or higher with no elevator? The patient’s wife opens the door and she looks like she’s not sure whether to be irritated or worried. (Strange to have our own expressions mirrored back to us for once.) She leads us inside where we find a pale, sweaty, agitated, half-drunk 40 year old with bags under his eyes, clutching his chest and yelling that he’s fine and he doesn’t need to go to the hospital so dejame en paz, carajo!...

We finally coax him to calm down and sit down and usher his teenage daughter and five year old son into another room. Turns out, the doctor told him that he ever drank again he’d have another heart attack.
And?
And I jus had a drink.
And?
And I’m fine. I’m- AAAAH MY CHEST!!! (Sweat sweat, clutch clutch…) But is not that bad, I swear!

It’s funny because…wait a minute, in writing that I realize that a lot of you might not find anything funny about a man having a heart attack in front of his whole family. And you’d be right not to. But in reading ahead i would encourage you to let go of preconceived notions and all that right/wrong junk and just appreciate what a pleasurable thrill the twisted disasters of life and death bring. That’s all. People die in horrible and ridiculous ways day after day and when you’re there to see it, well, sometimes all you can do is laugh- once all the busy work is done of course, and you’re having a cup of strong black coffee at the Lechoneria around the corner with your partner. It’s not that if you don’t laugh you’ll cry, it’s that if you don’t laugh you’ll become a fucking shell of a person who can’t function.

AAAAaaaaaaaaaaaaanyway, it’s funny because we spend SO Much time, Most of our Time, dealing with people that have no business at all calling 911, or even 311 for that matter, but really just want a little human touch. Okay, I’m full of sidetracks tonight, but I’m restless so bare with me- like the lady last week who said: “I was opening a window and I think I pulled a muscle and then my whole left side of my body went numb.”
And then what happened? (because you could tell there was more coming..)
So then I took my asthma pump and…
Wait, why’d you….nevermind
And it worked!
It did?!
Yeah, I can feel my left side again. But my pulled muscle is still kinda bothering me.
You wann go hospital?
Yeah!
(Later in the elevator)
By the way, ma’am, how long ago was it that you tried to open the window, an hour or two?
No, it was like three, no four day ago.
…

I really enjoyed that call, actually, because it really truly had me laughing. Like LMAO kinda laughing, not just a sardonic chuckle.

AAAaaanannnnnyyywayyyy again- back to the story at hand:
Where was I? Ah yeah- it’s funny Because: we spend all this time with folks that truly don’t need us, or our 40 pounds of equipment, and then here we have what turns out on the EKG, the 12 Lead and in every possible way to be a bonafide Myochardial Infarction AKA The Big One AKA a fricken heart attack- and homeboy has no intention of letting us treat him. We practically have to beg him to let us put an iv in, and all the while:
I’m fine, I’m fine, I’m fucking AAHAHAHAHA MY FUCKIN CHEST OH CONO CARAJO MY CHEST JESUS MARY AND JOSEPH!!!

When we finally convince him to come with us to the hospital and not commit suicide by stupidity in front of his family, he want s to walk down the 5 flights. Now, believe me- just about any other patient I would’ve actually hid the stair chair from so they didn’t get any dumb ideas about being carried, but the Llaaaast thng you wanna let someone having a heart attack do is walk down 5 flights of stairs. BUT- one the other hand, the last thing our patient wanted to do was get paraded out in front of his whole building looking weak and being carried in a gimpy EMS chair by another man. So we were at a standstill.

My partner and I wasted many graphic explanations of how the heart crinkles up and dies without oxygen and what it feels like when you’re lungs fill up with fluid and you drown inside yourself (more on that in some other posting, I’m sure…) trying to reason with our dude but it was no use. He didn’t even seem to be listening, mostly just sat there sweating and clutching his chest and whining that he was okay leave me alone, papa, estoy fucking …bien… (ow! Shit!...ow!)

Finally, I lost my patience, my temper and my cool all at once and launched into a satisfying, curse-laden tangent, (any of you who’ve seen my do a workshop…like that, but without the stupid smile…)…(why should patients be the only one’s who get to curse?)…

DUDE, I said, yer gonna die. In fact yer gonna fucking die, more than likely, on this staircase, in front of your family and it’s gonna suck AND me and my partner gonna haveta stick a tube down yer throat and pump on yer chest. . It won’t be poetic, it’ll just be ridiculous. I don’t like carrying people down 5 flights of stairs, but for you it’s how it has to be. Sit in my chair. Put this sheet over your head. And stop screaming in pain and saying you’re okay, cuz you’re not. Then, we go to the hospital. Okay?

I knew he would concede when he looked at me the way I look at some EDP’s (like the one hiding the rock in his sock). It’s a look that says: Are you gonna kill me or am I gonna kill you? Or are we just gonna fucking pretend to be friends and go to the hospital without a problem?

BUT…oh, the but.
Before he could go, he had to have a pep talk with his successor. And this…really, this was one of those moments that I could kinda feel civilization crashing around me.
Before I go, he said, Bring me my boy.
Someone brought the boy (age 5 remember).
Boy- he said. He said, Papi’s going away for a little while. You da man of the house now, hear? You in charge.
His grown ass wife and mostly grown ass daughter looking on, traces of embarrassment plain to see.
You running things round here, he continued. You the boss. Okay?
The boy nodded but his face said WHAT THE FUCK IS WRONG WITH YOU DAD?

And with that, we draped the sheet of shame over his head and carried his ass down the five flights to the ambulance.

EMS WTF FAQ

Okay people- I realize as I’m scratching out all these stories that a lot of folks don’t have much idea what the this whole EMS thing is all about. So here’s a primer for those that’re interested.

Q: What the hell is EMS anyway?

A: EMS is the Emergency Medical Services. That’s the whole system. There’s the transport side, which is mostly when nursing homes, dialysis centers, etc have contracts with private companies and call an ambulance to get their clients towed back and forth inbetween, and then there’s 911- which is when you call 911 and someone at 9 Metrotech in downtown Brooklyn directs your call to EMS and a GPS system tells them which 911 ambulance is closer. 911 has private ambulance companies, hospital ambulances and FDNY ambulances in it, all doing the same job and each claiming the other is full of useless skells and lowlifes.

Q: What are you- EMT? Paramedic? What’s the difference?

A: There’s Basic Life Support and Advanced Life Support. EMT means Emergency Medical Technicians; they do BLS, which includes bandaging, immobilizing, bleeding management, delivery of oxygen and a few medications and transportation to the hospital. Paramedics (that’s me) do ALS, which involves more invasive procedures like giving IVs, intubation, needle cricothryoidotomy (putting a HUGE ass needle right below someone’s adam’s apple when they have an airway obstruction) and chest decompression (putting that same hugeass needle inbetween someone’s ribs to let the air out of their chest cavity when their lung collapses.) We also give medications, about 50 of them from Adenosine to Vasopressin, and are equipped to do for an asthma or heart attack what any Emergency Room would do in the first hour of treatment. If you call 911 and say you stubbed your toe they’ll send you EMTs. If you say you stubbed your toe and your chest hurts, you’ll probably get medics. If you tell them you stubbed your toe and now you’re dead, they’ll send both. It’s happened. Sometimes EMTs will get called for the sick and get there and find a heart attack, so they can call for us. You get shot, it’s EMTs unless you get so shot up your unconscious or dead. That’s why sometimes we medics keep an ear to PD radio and take a quick ride over when there’s a shooting. If you “feel weird” you get EMTs unless you’re especially old or diabetic, then you get us. It’s all a little ridiculous but also there’sa weird logic to it. I’ll just say, when the man called the other night to tell 911 that he was unconscious, they made the job an “UNCONSCIOUS” and sent us. If you just had a seizure it’s EMTs but if you’re having one, even if you’re the one saying you’re having one, it’s a “STAT EP” (status epilepticus) and it’s medics. Even the guy that calls every other weekend because he feels like he’s about to have a seizure, but never actually does, even he gets medics, even though he’s actually an EDP and EDPs get EMTs.

Q: What’s an EDP?

A: Emotionally Disturbed Person. Aaah we could go on for hours about the many wondrous events that happen when folks don’t take their psych meds or lose their shit for one reason or another. Any of us could go EDP at any given moment, far as I can tell, cuz they range the range across all borders. Many jobs will start as DIFF BREATHER and end up as EDP when we get there and patient says something like “I haven’t been able to exhale for like three days,” or “I haven’t taken my psyche meds and I want to fucking kill somebody.” Sometimes EDPs hide behind locked doors, which makes them BARRICADED EDPs, or hide weapons places (“that’s just my rock…i keep him in a sock…” which makes them VIOLENT EDPs. They can also stand up on high places, when they become the JUMPERUP, and then fall, when they become JUMPERDOWN.

NYPD is always getting into a hot mess over EDPs and then having to get retrained on how to deal with them. Usually its cuz they get confrontational with em, and the last person you need to argue with is someone who’s completely disengaged from reality (“Sir, you need to go to the hospital.” “I am in the hospital…” “uh…”). It’s like arguing with the last drunk guy at the party. (most recently see: Iman Morales, who was screaming naked on a Bed Stuy fire escape before PD tasered him, causing him to fall to his death.)

Q: Do you really drive the ambulance?

A: We do and yes it’s really cool but blowing lights and parting traffic jams like the red sea is really not nearly as cool as some of the shit that happens in the back of the ambulance. But people are usually more excited about the woop-woop.

Q: What’s like the craziest shit you’ve ever seen?

A: Why do people always ask that like they’re the first person to think of asking it? I dunno, depends on when you ask I guess. I’ll probably blog about it sometime…

Q: Do people really call for stubbed toes?

A: Stubbed toes, runny noses, burning genitalia, crying babies. “I feel: tired, sick, lonely, strange, different, okay, weird…” “I have an appointment at the hospital.” “I just needed to get out of my house for a while.” “I was bored.” “I hate my husband.” “Can you look at this huge cyst I have on my nuts?” “My tooth hurts since like, three weeks ago.” “I don’t want to talk about it.” “I’m bleeding from vagina, same as i was about a month ago.” “i can’t get out of my chair but i don’t want to got to the hospital, just help me…get…unstuck…”

Those are really the vast majority of our calls. About 80% let’s say is freakish dumbshit and then 15% is like mildly important medical situations and the last 5 is really good urgent crazy shit. Depends on the week though.

Finally, I’ll end with this one:
We were called for the CARDIAC- 78 year old with chest pain. We arrive to find a dapper little elderly gentleman sitting calmly in his East New York apartment.
Whats the trouble today sir?
My heart is broken.
Excuse me?
It’s broken I say.
Does it…hurt?
It hurts a lot.
How…long has it been going on?
Oh quite a few years now.
You want to…go to the emergency room?
Yes please.

And away we went.

THE BABALU AYE SPECIAL EDITION: 2 BACK FROM THE DEAD STORIES (sorta)

Well: I was really planning on the next piece i wrote being about all the mundane bullshit we do, which is like 90% of the job, especially cuz now i got fricken jud and saraivy telling me how i’m just trying to show off on facebook with all the gory shit we do…BUT, f them- cuz this week was Babalu’s day, and in his catholic form, Babalu was Lazarus, who Jesus famously raised from the dead, and in honor of this I somehow ended up with 2 Babalu-relevant jobs, and I’m sitting here bored out my skull so I will now share them with you.


1.
There’s this crackhead motel on 125 and Park. Everytime we go there it’s some scene out of The Wire or Pulp Fiction. Job comes in as first DIFFBREATHER, then UNCONCSCIOUS and then, inevitably, ARREST. Means the guy’s supposedly dead. We get there, walk up the rickety stairs and our dude is laid out doing a very loose impression of a dead person, surrounded by a swath of mortified and confused cops and fire fighters.

On a sidenote: this is a classic firefighter maneuver called The Circle Of Death: it’s when they get there first and form into a small circle of curious white faces looking down at the patient. It’s FDNY sign language for ‘what the fu-u-ck?’ Many a time we roll up on scene to find this peculiar huddle and it’s usually not a good sign.

Anyway, if you’re any kind of medical personnel you get good quick at knowing the difference between a true cardiac arrest and a guy that wants attention (the best are the fake seizures, when they go “I’m having a seizure!” and squirm awkwardly till they realize you’re not buying it). But firefighters and cops are not trained in this art, so they really were convinced. O and I took one look at the man and O set up the stair chair and i said “Get…up!”

First he squirmed and moaned and the firefighters all gasped. “Get up and get in my chair,” and reluctantly, he struggled to his feet and planted himself in our chair as the room fell completely silent.

We had ourselves a good chuckle driving back to our spot when it was all over. Not so much at the fireguys’ expense (a little though…) if not at the whole situation in general: here we are again in the midst of this whole huge bureaucratic clusterfuck, dozens of different agencies and crossed lines and legalities and so much work done covering ass and so little done treating patients, between dispatchers and insurance companies and godknows what kind of existential spiritual lifendeath tug-of-war, and right smack at the center of it all is five guys with helmets standing in a circle around one old bobo trying his best to look dead so he can get a night of sleep away from the other crackheads.

2.
That was Wednesday, December 17, sacred to San Lazaro, who shocked everyone by

emerging out of his grave on Jesus’ request and hobbles around town with his crutches and pack of dogs. On Saturday, the night of the annual Babalu cleaning ceremony, we had two back to back cardiac arrests.
The first was a 96 year old lady who was clearly well past gone, but when we walk in the fire guys go “oh! She was up and talking just before you walked in!” like it’s all our fault. This is pretty standard procedure especially when it comes to nursing homes- we get there, the patient’s rock solid with rigor mortis and the staff is talking bout how she was laughing and chatting not seconds before and how they can’t believe it, in fact she was walking around, walking I tell you! Playing freeze tag even! Lord- look how quick she went!
This lady was, as i said, gone but she didn’t fit the criteria for us to leave her in peace (rigor mortis, decomposition, dependent lividity-which is the pooling of fluids at the lowest point in your body, or a grim catch all called Obvious Death, which is for those guys that are just DEFINITELY not coming back, i.e. decapitated) . So we went ahead and started working her up. It ended up messy, firstly cuz she was old and must’ve had a terrible case of osteoporosis, because literally all of her ribs collapsed on my first round of cpr. Secondly, she had zero veins for iv access, (and we tried plenty) except as it turned out, a nice solid 1 going right down the center of her forehead, and that is exactly where the iv ended up. It seems crude, it is crude, i guess, but this is what it is: if you’re in or about to be in cardiac arrest, having a little saline-lock antenna popping out your head is not what matters, all that matters is that you have one. In that iv goes all the good medicine that we carry around that will bring you back, directly into your bloodstream and all across your body. So in retrospect, or from the comfort of all of our not-imminently-to-die selves it’s easy to squirm at the thought of all these gruesome details and invasions, but I’m telling you them precisely because that is the very heart and soul of emergency care. It’s by definition a sticky mess of bloodied gauze, discarded syringes and stained suction tubes matched only by the colliding and collapsing human disaster zones that it’s created to revive.

Which brings us to the second cardiac arrest of the night.
No wait, first, another sidenote:
Approximately 100% of the recently dead on tv and movies who are treated with a touch of poorly performed CPR come springing right back to life and go back to killing bad guys. Most notably, James Bond, who just one movie ago defibrillated himself back from the beyond and then went on playing poker straight away.
Yeah- that’s not how it works. First of all, it’s literally about 1-2% of people we get in arrest ever get a pulse back at all. In my five year career I’ve gotten 2 maybe 3 pulses back total. Second of all, and maybe most importantly, of those few the vast vast majority of them are total vegetable matter from then on out. You just can’t deprive a brain of oxygen for that long and pop back around like nothing happened, it doesn’t work that way. In NY the situation’s complicated even more by tall buildings, projects, traffic and numerous other obstacles delaying patient contact.

So, so so so, that means when it’s your time it’s your time, and most guys that’ve been working the field long enough know better than to walk into every arrest that comes over and raise the dead.

I was particularly feeling that way on Saturday, not just cuz of the first messy arrest, but because i was working with, oh let’s call him Gerk- a certain medic that I just wouldn’t trust giving treatment to anyone i knew or cared about or had ever met. At all. I mean- well his name says it all. And then I was even less thrilled, you can imagine (maybe…) when the second arrest of the night came over not long after we finished cleaning up the first one. Oh lord, i said to myself, this poor whomever, wrong night to flatline…

Whomever turns out to be a 72 year old Indian gentleman lying flat on his back in his underpants with a bright red flare of blood at his lips and nostrils and a burly EMT thumping up and down on his chest,. He has no signs of trauma and appears to be in good health except for a large unsightly triple bypass scar stretching across his chest (and the fact that he’s dead).

Our monitor says he’s flatline, so there’s no movement at all in the electricity of his heart, nothing to shock in other words, so I start looking for a place to put my iv while Gerk prepares his tube kit to get an airway. This guy has only slightly better veins than the last lady, and having no heartbeat doesn’t help, but i manage to sneak one in right along the top of his left hand. Gerk’s having trouble with the tube, to his credit the blood in the airway means he’s just staring into a dark tunnel of fluid, with surely no vocal chords in sight to pass the tube through. Eventually, we do get it though, and just when I’m thinking the EMT is gonna have his own cardiac incident from how hard he’s pumping and sweating, someone announces that they felt a pulse.

No shit, i think, but there it is- a vigorous thump-thumping along his carotid artery. There’s some excitement now as the crew shifts course, one EMT running off to get the stretcher, the other taking the blood pressure, Gerk on the phone with our on-line medical control to get more meds, me and the lieutenant prepping the patient for transport.
The family’s all there screaming and praying as we load up our post-arrest patient and stick him in the ambulance, and though I’m trying to be pessimistic I’m feeling good about this one right up until he arrests again as we’re flying along to the hospital. He’d come back strong with a solid blood pressure and the pulse way up in the high 140’s but halfway to Wyckoff his heart dropped back down to the 60’s, then 30’s, and while we’re frantically working on him he loses pulses again completely and we’re back to thumping his chest while trying to keep balance amidst the tossing and turning of Brooklyn streets.

As we pull up I check again and miracle of miracles, there it is, that rhythmic murmur of pressure against my finger… In the ER bay they do their usual half-joking complaining about how we have all the fun and get right to work on him, setting up a dopamine drip, getting a ventilator set up, etc. I can’t help but feel good, and I’m literally typing the first words of a jubilant text message to Gabi when I see all the nurses run over and a doctor start compressions again.
Crap! I shut the phone right quick and walk over cringing. For a third time though, our man decides to live that night, and this time he stays for good. When we leave the hospital he’s pumping away all by himself, but he's still, and maybe always will be, a vegetable.