tag:blogger.com,1999:blog-8502370980201183542024-03-12T17:42:16.549-07:00view from the crossroads of life & death...An NYC EMS Paramedic tells it like it is...DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.comBlogger50125tag:blogger.com,1999:blog-850237098020118354.post-42582068790574961142012-06-11T07:31:00.001-07:002012-06-12T21:02:04.234-07:00AFTER<div class="separator" style="clear: both; text-align: center;">
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A lot of my posts end with some variation of this: "And then we zipped off into the night..."<br />
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Right. That's because that tends to be the moment when our active part of the story ends. But what happens after all that frenzy? On the way, we're keeping things in order, check and rechecking things. Often we're climbing over each other, grabbing whatever hand holds we can while the bus screeches around a corner. Sometimes there's a cop back there, looking puzzled. We're taking blood pressures, making sure EKG leads are still on, squinting at monitors, maybe getting another IV. Jobs can be so dynamic: you can start with one kinda mess and wind up with a whole other one in a matter of seconds, and the body has so many ways of reacting to trauma. Sometimes a seizure is a seizure, sometimes it's a sad grasp for attention, sometimes it's the first moment of cardiac arrest. People turn so many different colors for so many different reasons.<br />
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Then we finally pull up to the bay, the beep beep back up and the bump against the tire holders. There's a final scramble to get everything disconnected and loaded onto the stretcher and then we flood inside, sometimes one riding the stretcher, pumping up and down on the guy's chest as two others guide it through the linoleum hallways into the waiting arms of trauma surgeons, interns and anesthesiologists. There's the hectic, fragile inbetween time, as the care for the patient goes passes from us to them, and their machines and protocols whirr into effect and we tit for tat back and forth, summarizing the past wild half-hour in a 30 sec soundbite (not unlike the elevator pitch, now that i think about it...)<br />
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Some doctors make a point of not giving a fuck. They talk over you, look away as you give the report, roll their eyes, ask you the same question five times. Even with EMS being what it is, still seems a hard concept for some doctors to grasp that, if we do our job right, a patient who was critical ten minutes ago is chilling by the time they show up at the ER. So sometimes we have to explain ourselves very explicitly, sometimes we do our best and then walk away shrugging. Other docs are extra EMS-happy, all up in our process, how'd it go, what was the apartment like, what did witnesses say, all that, which is great of course, more for the patient than anyone else, because some of those details can make the difference between life and death.<br />
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We step back while the hospital takes over.<br />
You get curious - put so much work into getting someone there in one piece, you wanna know what happens. But I've learned sometimes it's better to step away. I've felt that rush of frustration when you know they're not putting their all in and things go sour. Watched situations spiral out of control, and there's nothing we can do from our end. So you step away. You watch, you learn, and then you step back, smile or shake your head, finish the paperwork and go get dinner.<br />
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<br /></div>DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com2tag:blogger.com,1999:blog-850237098020118354.post-6365043227646878642012-05-20T12:47:00.000-07:002012-05-20T12:49:34.791-07:00This Week In Other People's Disasters<div class="separator" style="clear: both; text-align: center;">
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There's an ebb and a flow.<br />
months and months will pass and you'll only bring in chronic neck pain, chest colds, the occasional migraine and the same five drunks again and again. A minor MVA will seem exciting. These are the months i want to quit and never see an ambulance again in my life. Then, just when you're starting to drop your guard and accept that you're really just a glorified taxi for the inept and accident proned and chronically vaguely unwell, some real ass shit goes down.<br />
And while you're still marveling that anything worthwhile happened at all, it happens again. And then you're pivoting and splicing your way through a whole barrage of megacodes, epic disasters, medical mysteries and whatever other series of other people's misfortunes the world has to offer. Fun!<br />
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These past two weeks were in that vain. First a perfectly healthy looking fifty-year old just up and died for no apparent reason in the West 4th Street train station in the middle of the mid-afternoon rush home. So death became a spectator sport because let's be honest, who wouldn't stop and stare at such a sight: A team of firemen, EMTs and medics pumping up and down on the guy's chest, yelling commands, disagreements, possibilities, drug administration numbers, semi-coded curseouts, intubating, sticking in IVs, glancing at monitors...All that. The gapers irritate me, but the truth is i'd watch too.<br />
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He came back. And well he should've, young fellow like that, plus he dropped in public, which means everything happened fast and speed is everything in those situations. Still, you never presume someone will come through. Well, I don't. But yes, there was that bounding pulse at his neck and then we heaved him up four flights to ground level and loaded him onto the bus and lo behold, the pulse was gone. Crap. Did some shit, got things ready to move and enroute he came back, good strong pound pound and a solid blood pressure to boot and last time I checked he was still at it.<br />
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Then some dude who'd been coughing for like six weeks called from around the corner from the hospital because he was "coughing a lot."<br />
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Ok.<br />
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Then was the 40 year old that nearly passed out in a swank uptown bistro. She'd had a sudden bout of unfathomably intense abdominal pain ( did she say "unfathomably?" maybe not. But her face did. ) and when she went to the ladies room everything got bleary. She slid down the wall and we found her sobbing, holding her tummy and with no blood pressure at all. No blood pressure, unless there's a good healthy reason for it like you're an athlete or extraordinarily chill or a yoga master, is a very very bad thing. It usually means you're about to die. Your heart should be zooming at that point, to compensate, pumping as much blood as it can and if it's not you're really really about to die. So, her heart wasn't going that fast, another bad thing.<br />
Why do people have no blood pressure? Either their blood vessels have suddenly opened up wide to fight off a perceived threat, like with an infection or a allergic reaction, or the heart isn't pumping right, usually this would be a massive heart attack or someone with a cardiac problem already in the works, or you're losing blood or massively dehydrated. Since she's not febrile or breaking out in hives it's not the vessels, and she's not having chest pain or a cardiac patient so it's almost definitely not cardiogenic shock, so we're left with the fluid. She's not visibly bleeding out, she hasn't been shot, so the bleed is internal. Usually, these are in the GI tract and they eventually find their way out in the form of blackish tarlike poop. No fun. Sometimes it comes out all fresh and bri...you get the point.<br />
Anyway, ok, that's a good possibility here, but there's another piece of the puzzle to consider. The patient's last menstrual period was two months ago -- she could be pregnant. Anytime you have a hypotensive, almost passing-out woman with sudden onset lower abdominal pain and any possibility at all of being pregnant you pretty much have to assume she's having an ectopic pregnancy. This is when the egg fertilizes in the fallopian tube and then ruptures, causing massive internal bleeding. Which is exactly what happened with our lady.<br />
There's not much we can do for that prehospital. We put a huge IV in to replace as much fluid as we can as fast as we can. We throw an oxygen mask on her, we lean her back and move fast, plowing rudely through the shocked diners and whispering waiters. We haul ass to the bus and then haul ass to the hospital and let 'em know what we comin' with so they have fluids and surgeons standing by.<br />
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Then some lady called for her grandad, he was having "chest pain", even though he hasn't spoken or moved any of his extremities since 1998, still, he was having chest pain. And difficulty breathing. And he had to go to the hospital. Right.<br />
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Then a slew of drunks. All familiar.<br />
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Then an old guy laid out in his own piss, squirming, moaning, writhing. Home Health Aid epically unhelpful, but still, he's a diabetic so we just go head and check his sugar figuring that'll be that. And it's low! So low the monitor just says "LO" which is great for him, because sugar is a thing we can fix up, so we do. Except then he's still not with it. And his blood pressure's insanely high, 240/130 or somesuch disasterness. This is all very bad. It means he's having a stroke and there's absolutely nothing we can do except move fast, and even in the ER they'll be pretty helpless because with stroke treatment, timing is everything and since we can't get a straight story from the HHA, who's probably high and definitely...not bright, we don't know the onset time. So, grandpa is basically on his own as far as healing. We package him up, drop a most difficult and delicate IV in one of the meandering little slipstream veins hiding along his forearm and go go go, knowing all the while the deal is basically done.<br />
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<br />DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com2tag:blogger.com,1999:blog-850237098020118354.post-91759851883926816202012-04-01T12:49:00.001-07:002012-04-01T12:54:44.498-07:00Dead Guy In An Elevator<div class="separator" style="clear: both; text-align: center;">
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maybe I should start having more chipper names for these posts... Maybe that'd be deceitful though. I dont want people coming here thinking it's gonna be all care bears and unicorns and then getting traumatized when people keep dying. Yeah, okay. *keeps title*<br />
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ANYWAY: job comes in as "MAN ACTING WEIRD, DIZZY IN ELEVATOR" and the address is an old people home on East 128th Street. Apparently by "acting weird" they meant "dead" because when we get there there's a crowd of geris staring at an open elevator door and inside there's a guy lying there on his back, dead. Well, damn near dead, I should say, because just as we roll up he takes one, final gurgly breath (gurgley? Gurgle-y? ...whatever) and then he's really dead. </div>
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Oy. </div>
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We gently, respectfully and very quickly drag him out because when you're working up a cardiac arrest the last place you want to be is in a cramped little elevator. We park him right in front of the door and start a round of compressions.</div>
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Now normally, i think i've probably said this before a bunch of times here but there it is, normally when you have a cardiac arrest they send two units so the EMTs can pump away at CPR while we get our advanced life support on, intubation and IV meds and electricity, but here since the job came in as "acting weird" they just sent us. So, there's a lot going on. I can't even tell you the exact order of things happening, because there's a few moments in there where your hands just move in automatic pilot, compressing the chest and tearing open packages and setting up IV lines and tubes and compressing the chest more and getting the oxygen tank and tube in order. At some point the elevator door opened again and a gaggle of elders was traumatized and then the elevator door closed and we pulled the guy a little further into the lobby.</div>
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We called for backup but they were still a few minutes out. The only other person around with less than a century of living was the security guard and he was about 12 with the wispy beginnings of a 'stache just starting to make an appearance at the edges of his mouth. </div>
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I ask him if he knows CPR.</div>
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"No," he squeaks. </div>
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"Well, time for a free lesson, c'mere."</div>
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I gotta give the kid credit: he jumped in even though he was clearly boggleyed at the whole situation. </div>
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Push right here, I said, pointing to the sternum. Just like on TV.</div>
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He did some kinda timid, halfassed finger dips and I told him he had to put some back into it, which he did. The ugly truth about CPR is that usually if you're doing it right it means you're breaking some ribs, a dull crunching with a little extra give that you actually get used to pretty quickly, but probably less so when you're bar mitzvah age and have never done it before. </div>
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Cardiac arrests always feel like you're fourteen steps behind, because every second that something isn't done yet is another second that the guy is dead and not getting the oxygen or circulation he needs. Still, it's not stressful in the way paperwork or organizing concerts or meeting deadlines is. You know you can only move so fast with precision, and you move just that fast. Yes you feel behind but once you've done em for a while you also know you're never nearly as far behind as you feel. It always starts with a flurry of movement: There're so many things that needs to happen right off the bat and then as shit falls into place I always take a second to step back and say out loud what's going on. </div>
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75 year old male -- i mumble -- cardiac arrest, asystole on the monitor IV in place with cold fluids running and epi, vasopressin and dextrose on board intubated with CPR in progress for 10 minutes no change on monitor unknown history allergies meds...hmmm...</div>
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By this time the EMTs have arrived and relieved the anxious security guard just when he was getting the hang of things. I'm thinking we might have to call this one. There's no point in transporting a dead body to the hospital just so they can pronounce him there and he hasn't had any changes in his rhythm since we started. Plus he's old, and the older you are the smaller you're chances of popping back around after you code. I tell them to hold compressions and check a pulse. One of the EMTs is getting into it with the cluster of ancient onlookers, ("Keep it moving people, nothing to see here" riiiiiight...whether from Alzheimers, non-English speaking or just not giving a fuck, they all just stand there, mouths hanging open). She gives up and puts her fingers on the guy's neck and says "Oh! Pulse!"</div>
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We recheck and indeed, the man has his very own pulse and, it turns out, a halfway decent blood pressure to boot. Then things happen fast. They have to, because people don't necessarily stay back when they come back and we've already emptied half the med kit into this guy. We do a cursory wipedown/cleanup, load the guy onto the stretcher, careful not to pull out any IVs or disrupt the tube and take off in a blaze of screeches and lights. </div>
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<br /></div>DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com2Brooklyn, NY, USA40.65 -73.9540.553624 -74.1079285 40.746376 -73.7920715tag:blogger.com,1999:blog-850237098020118354.post-46977625652787441402012-02-22T16:11:00.000-08:002012-02-22T16:11:18.437-08:00MEGACODE<div class="separator" style="clear: both; text-align: center;">
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Spoiler Alert: The patient in this post does not make it. I want to get that out of the way because there's some ups and downs in how it plays out and I don't want to put y'all through the emotional manipulation of wondering if she'll get through or not.<br />
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We show up on a DIFF BREATHER call and find a 70 year old woman flat on her back with no pulse. She's a dialysis patient and has pink frothy sputum lining her mouth so it's a safe guess she went into fluid overload from kidney failure and her lungs filled up, effectively drowning her. A FDNY chief has decided by chance to show up on the job with us and she has one of the Medical Control doctors along with her, so we have a physician on scene along with the Fire Fighters helping out with CPR.<br />
This turns out to be cool and works in our favor because the Doc is actually very laid back and not trying to run shit - we're able to circumvent the annoying process of calling Online MedCon to get permission for certain medications. Sometimes, when too many authority figures and egos get on scene together there's an inevitable clusterfuck to be managed, but fortunately that wasn't the case here.<br />
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So we put our monitor on the patient to see what rhythm her heart's in. What we see looks like a regular old heart rhythm, a little slow perhaps but basically could be a perfectly healthy person. Except she has no pulse. This is called Pulseless Electrical Activity and happens because sometimes the heart has a little life left in it, just enough for the electrical impulses to keep flickering away but they're not getting capture with the actual musculature of the heart, so there's no beat, no movement to speak of, just a parade of ghost complexes marching past the monitor screen.<br />
So we start CPR, i set up the intubation kit while my partner prepares the IV and the Chief gets the woman's basic information from her son. I'm trying a new technique with intubation, just a simple adjustment on how I grip the handle of the tool we use to open up a patient's airway but it works like a charm: I can see straight down her throat and the two diagonal white lines of her vocal chords open up in front of my eyes, a perfect view. I slide the tube in, we confirm it's in place by listening to her lung sounds and my partner gets the IV as the Chief comes back in to inform us the woman is a leukemia patient, besides the kidney failure.<br />
We stop compressions, check a pulse and low behold, there it is, thumping away a little weakly but still: there. So we start setting up to transport her and are trying to check the blood pressure when she loses pulses again, we jump back into CPR, start pushing medications. When we stop the next time she's in Ventricular Fibrillation. Commonly known as v-fib, this is when the ventricles are just jiggling away uselessly, not pumping blood, not doing much at all but sending crazy wavy lines on the monitor. I charge up the paddles, an alarming wail climbing in pitch till it's a squeal, make sure everyone's clear and then shock - the patient's lifeless body jolts once and we start CPR again.<br />
It happens again- four more times in fact, till we're all looking back and forth at each other like "Really?!" because v-fib is not a rhythm that tends to stick around. When you shock your effectively jolting the heart with the intention of restarting and usually it'll either come back as some living rhythm or just flatline out and that's that.<br />
We've already pushed four different medications into her, meds to stimulate her heart, meds to preserve her tissues, meds to balance her electrolytes, meds to keep her sugar levels up, and now we push another that reduces the irritability of her cardiac cells to keep them from fibrillating. When we check again it's in an extremely rare form of v-fib called Torsades de Pointes (here's another Torsades case i had with a happier <a href="http://raval911.blogspot.com/search?q=torsades">ending</a>) which is actually quite beautiful, a spiraling double helix kind of pattern on the monitor and gets a whole other medication to try to tame it back to something healthier.<br />
Nothing works.<br />
After we shock her five times the squiggle steadies out into flat with only occasional, large messy blips. This is called idioventricular and it's the end. It means the ventricles have all but given up and are just sending a last, useless series of impulses out. We keep pumping the chest, keep squeezing oxygen into her, keep giving meds but finally the last squiggles pass by and the line is fully flat. At this point, the patient has been down over 45 minutes and we've given her every medication and treatment possible to keep her alive. It's a moment when a medic has to understand that the time has come, our resources are exhausted, we pronounce the patient and begin the careful process of undoing the past hour of messy interventions, pulling out IVs and unsticking the shock pads, finally lifting her lifeless body onto the couch and making her look as peaceful and presentable as possible for the family.<br />
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<br />DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com1tag:blogger.com,1999:blog-850237098020118354.post-81710235483045709442012-01-11T17:29:00.000-08:002012-01-11T17:32:05.752-08:00A HUGE DUDE LOSES HIS CHIN AND HIS SHIT<br />
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Apparently, this cat was talking on his cell phone and then, for no clear reason, ate pavement. According to the witness, he just dropped. When we found him, his mouth was around someone front step and there was a pool of blood and some teeth nearby. Securing his spine, we rolled him over, back boarded him, got him on the bus, took a better look. He'd somehow managed to slice his chin almost off -- it looked like the butt of a french roll of bread but it was still attached slightly so when we put the c-collar on the chin got flipped upwards and was resting on his mouth.<br />
He was still completely knocked out when PD asked if we needed them and we said no thank you and pulled off and THEN homeboy decided to wake up. I was driving, but apparently his eyes popped open and he went right for the collar around his neck, Frankenstein style. Then, and this I heard along with probably half of the East Village, he said "WHAT THE FUCK!?!"<br />
I pulled over the ambulance.<br />
<a href="http://ih2.redbubble.net/image.5264502.7935/sticker,375x360.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="191" src="http://ih2.redbubble.net/image.5264502.7935/sticker,375x360.png" width="200" /></a>The dude I was working with is solid enough but we had a student that day, more or less the intern from 30 Rock, and the patient was easily 300 lbs and pissed. He had already unstrapped his upper body and was sitting up straight, swiping at the student and yelling "REALLY? YOU GONNA DO ME LIKE THAT? THIS IS HOW YOU GONNA DO ME? REALLY?" While the student just made little cooing noises and said "no, no, that's not how we did you sir! We didn't do you like that!"<br />
The cops had been following us and when they saw me pull over they jumped out and we all rushed the back compartment. The guy had a big broken tooth grin on and he was looking back and forth at us with wide, uncomprehending eyes and giggling and repeating one of the above phrases like a damn Elmo doll on crack. <br />
"Just lie down, buddy," one of the cops said.<br />
"REALLY THOUGH? WHAT THE-"<br />
'Lie down!"<br />
You can't reason with folks when they're off the deep end like that. His chin was still flapping back and forth on his face and he was covered in blood and still grinning like an asshole.<br />
Fuck it, my partner said, unimpressed. Just roll carefully.<br />
And he was right. You're not gonna win coming at the dude, he wont' be talked into normalcy, and it'd take more than the two cops and three of us to wrastle him into any kind of submission. I rolled carefully and when we got to the ER and reeled him out he was still on that same shit, except now he was reaching into his mouth and trying to pull out shards of his own teeth.<br />
With some struggle, we got him into the ER and thru to the trauma room, where the assembled doctors asked us: What happened to this dude?<br />
I let him answer that question himself. <br />
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<br />DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com1tag:blogger.com,1999:blog-850237098020118354.post-68603031120628766222012-01-01T17:27:00.000-08:002012-01-04T10:47:46.014-08:00ON BALANCE & COMPASSION<br />
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We were held up in the ER for a while the other day, crossed the sacred 40 minute threshold that sends little alarms up and down the system computers, pissing off captains who send angry messages to lieutenants who in turn send angry and/or passive aggressive messages to us. But since we're in the ER, we don't get the messages, which come in on our onboard computer, so then heated lieutenants continue to get messages and fly over in their SUVs, full of wrath and indignation. This particular lieutenant came up on me all a-foaming and frothing as I was walking back to the unit to give an update.<br />
WHY, he demanded, HAVE YOU BEEN IN THE ER FOR SO LONG!?<br />
clearly he didn't want an answer, because no one who asks a question in all caps really expects anything but a blank stare. I presume. Because if you really wanted to know something, surely you'd ask it in a mature-type way, using your inside voice and whatnot. Surely.<br />
WHAT EXACTLY IS SO IMPORTANT THAT YOU HAVE TO BE IN THE ER FOR FORTY MINUTES?!<br />
As it happened, we'd found the patient unconscious and ODing with no blood pressure in an apartment full of men that claimed to know her but didn't have any information on her and told multiple glaring lies about how she ended up that way before disappearing completely and then locking us out as soon as we removed her to the ambulance, so we ended up spending a good chunk of time trying to explain the situation to some skeptical young doctors that didn't seem interested in such complications, and my partner was only now wrapping up the paperwork.<br />
But that wasn't an answer that would get me very far, because what does any of that matter in comparison to the almighty power of numbers? The brass in EMS, in a sickly trickle down sort of way described above, is obsessed with numbers. Numbers make the EMS wheel turn. Period. You find occasional lieutenants here and there that still hang on to some interest in what's going on with the patient or whether or not one of us is traumatized or burnt out, but when someone with a light blue shirt is getting worked up, it's usually got something to do with blipping alerts on computer screens downtown and the corresponding tirade of messages from superiors.<br />
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ARE YOU GOING TO ANSWER MY QUESTION?! OR SHOULD I JUST GO AHEAD AND WRITE YOU UP RIGHT NOW!?<br />
and honestly I was so surprised by how upset he was I really had nothing to say for a second. But then I just told him No, I didn't like his attitude or how he was addressing me and so I wouldn't be answering his questions. As he got all red and puffy another lieutenant swept in, one of the ones that seems to give a damn about a thing or two, and dismissed the first one sayin "I got this" and then the whole situation pretty much fizzled out: my partner finished his paperwork, I put us back in the system, life went on.<br />
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I said it on twitter and it stands true still, on a job with so many reasons to get worked up, I have no interest in giving time or energy to a person that can't control his temper over numbers. None at all. We who deal with actual people have to work every day to land in that delicate balance between caring too much and not caring at all. We all slide back and forth along that spectrum throughout our lives and careers and the best medics I know aren't the ones that cry for every patient (they burn out quick) or the ones that smirk and roll their eyes at every patient (they're already burnt). They're the ones that know how to measure out their compassion evenly, quietly, justly, sometimes with crass humor or a kind word, and without going overboard so they can do what they have to do and walk away at the end of each shift leaving the job and all its pettiness, hilarity and tragedy behind them when they go. <br />
<br />
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<br />DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com4tag:blogger.com,1999:blog-850237098020118354.post-60194630757152447242011-11-23T13:52:00.000-08:002011-11-24T20:24:31.151-08:00WHO HEALS THE HEALERS? Notes On Trauma & Child Sex Abuse<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.binauralbeatsonline.com/wp-content/uploads/2010/05/Cheat-at-Meditation.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://www.binauralbeatsonline.com/wp-content/uploads/2010/05/Cheat-at-Meditation.jpg" width="213" /></a></div>
<br />
<br />
* * * * Trigger Alert: This post deals with physical and sexual abuse of children. It's mostly non-specific and doesn't go into graphic details, mostly chronicling the emotional response of this first-responder to the event. * * * *<br />
<br />
Last week, for the first time in I don't know how long, the job made me feel cracked open and emptied out. I know why. Much as it hurt, I tip my hat to the somber reminder of my own humanity and keep it moving, wiser and stronger for it.<br />
<br />
I've written on this <a href="http://raval911.blogspot.com/2010/02/dancing-w-death.html">blog</a> and at <a href="http://www.therejectionist.com/2011/07/special-guest-post-daniel-jose-older.html">The Rejectionist</a> about how the action of healing, even when the patient doesn't make it, is a built-in instant form of self-care. We don't carry around the ghosts of all the horrible shit we see because we don't just see it, we work with it, throw our bodies and minds full throttle into the thick of it and become, however momentarily, part of the story. There's a cleansing that comes with taking action, even action that ultimately fails. It's as true in the larger community/world aspect as it is in the day to day grind of this job.<br />
<br />
Anyway, that's exactly what didn't happen last Tuesday and that's exactly why I struggled with it so much after that fact. My mind was already heavy with the Penn State rape tragedy. Think it was a day or two after the JoePa riots and the news was all awash with creepy justifications, including that ghastly interview with Sandusky himself, and that shit was weighing on me. They sent us to a "BURNMAJOR" job. PD had been called in on a child abuse alert and found burn marks, old ones, on the kids arm.<br />
<br />
I'm not gonna do details right now. It's all horrific, triggering type stuff and not necessary to the story. I'll just say that without anything being acutely wrong with the kid - who was running around and laughing, giving everyone high-fives - it was still the worst, most horrific job I've ever been on, for the unravelling of each nauseating detail of abuse as the detectives and my partner and I tried to understand what had been going on.<br />
<br />
And then we drove them to the hospital, dropped them off and that was that. No IV, no oxygen needed, just some highfives and smiles and a gentle ride without lights or sirens. It was the end the tour and there was paperwork to be done and supplies to be restocked and radios to be handed off to the oncoming crew. And I felt...empty. Angry and horrified and full of sorrow and wrath and disbelief and heavy with the confused imaginings of wanting to deck the bastard who did it and knowing how useless and stupid an action that was and wanting to be still and hurl curses at the sky and run and call up everyone I knew and be all alone, all at the same time. And still; horribly empty.<br />
<br />
It was raining when I walked out of the hospital and down Gun Hill Road towards the train. The Brooklyn-bound 4 was empty but thoughts of the past hour crowded in on me; the dull throbbing sorrow of nothing-you-can-do and the clenched up frustration of a hundred impossible thoughts. I let them come, mostly because I knew there was nothing I could do to stop them. And when the only action that's left to us is processing, that's what it has to be.<br />
I'm blessed to have those sacred type of people close to me that know how to be there just enough in times of need without overwhelming; people that can be light with my heaviness and prod me to go deeper when I try to fake blow it off. Over the course of the night, through sad, hilarious, challenging conversations with<br />
myself and my loved ones, I resurfaced, found my feet again, stopped feeling so empty and so began another day, full and ready for life.DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com3tag:blogger.com,1999:blog-850237098020118354.post-26494224116824416442011-11-14T16:00:00.000-08:002011-11-14T16:03:19.753-08:00NOTES ON ENABLING & A COMPLICATED EXTRACTION<div class="separator" style="clear: both; text-align: center;"><a href="http://dawn.cbcr3.com/nmc/18/18783/Images/PISSED%20LAYED%20AND%20FUCKIN%20DRUNK%20COVER.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="219" src="http://dawn.cbcr3.com/nmc/18/18783/Images/PISSED%20LAYED%20AND%20FUCKIN%20DRUNK%20COVER.jpg" width="320" /></a></div>There's a scene in the Buddhacarita where the young Buddha-to-be is sneaking out of his palace one early morning after another night of debauchery. They spend about a full chapter doing the literary equivalent of a slow-pan over all these once gorgeous women all splayed out, makeup smudged, body parts erupting from their clothes in all kinds of rude ways - a total morning after fashion catastrophe.<br />
My job is like that scene sometimes, most specifically between the hours of say 4 AM and noon, when folks that are trying to make it out home from the clubs for one reason or another don't and end up in the back of my ambulance instead. And then puke.<br />
It's not the puke or pee or, worst of all the #2s that I mind so much...Okay, no, I take that back, it is. But what adds insult to, ugh, to injury, is the sheer regularity, the predictability factor that's involved with ferrying the same, yes the same, damn drunks back and forth to the ER night after night after night. It's to the point where you start to feel like an enabler, because really, that's all you are: someone who gets these folks off the street and into a warm place so they can wander out a few hours later and do the whole thing again. And again and again. And you try, you really fucking try, not to let the regularity of all that depravity get to you and make you into some gigantic asshole. And usually you succeed. But it's really that, moreso than the death or the danger or the severed body parts or exposed intestines or whatever, it's THAT that makes this job so difficult and the burnout rates so high.<br />
<br />
ANYWAY, that's not what I'm here to talk about today.<br />
Last week, we had a patient that weighed damn near 600 pounds, couldn't get out of bed and had had her first seizure in ten years. Her husband was probably not playing with a full deck and stood WAY too close to people when he spoke. He also had the disconcerting habit of treating everyone like he knew them from waybackwhen. Not just in the buddy buddy way; he would go "Oh hey *mumbles*! How's the *mumbles* from before thingy thing? Oh yeah? Great! And anyway *mumbles* remember?"<br />
And we were like *nod nod* "No."<br />
But he was unfazed, dude just rambled along regardless.<br />
We called for Fire because they've got a special basket for removing the extremely enormous. Crazy husband wanted to know why we didn't just put her on the stretcher.<br />
"The stretcher can only hold 400 pounds."<br />
"Oh! Well she's about 475 so..." He looked at us like the explanation was obvious.<br />
We looked at him like O_O<br />
First of all, she was maybe 475 lbs at birth, but certainly not at this moment. Second of all...no. So Fire showed up, after that awesome conversation, and they'd already been there before. You could tell because as soon as they walked in they started stepping away from the Crazy Husband, who went right up waaay too close to the nearest fireman and said "Oh hey Theoihsofihdgdgjk! Remember the ohgiughdughdgd??"<br />
The Fire Captain explained that the patient didn't fit in their special basket, they'd already tried and they'd have to call Rescue, cuz they have an even specialer net system for such situations.<br />
Meanwhile, the husband still didn't understand why we couldn't just put her on our damn stretcher and be done with the whole thing. For everyone's sanity, we had to start tuning him out around this point. We'd been onscene for well over an hour, drifting in and out of the apartment as much as our noses could stand it when Rescue made an appearance. They did indeed have a complicated gladiator-style cargo net contraption that we ended up wrapping around the woman and using to lower her onto a special sled. "You alright, dear?" I asked as eight of us guided her from the bed to the sled. She nodded, said she was fine thank you very much and asked how much longer all this would take. The whole thing took about two hours, not counting decon time (she had been in that bed a loooong time) but we finally got her onto our ambulance and around the corner, literally around the corner, to the hospital.DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com1tag:blogger.com,1999:blog-850237098020118354.post-36204106077973890352011-08-14T11:05:00.000-07:002011-08-14T11:05:03.493-07:00CALM THE #%&*! DOWN<div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/_Y_GdgiQpFoA/StRasZ5jZfI/AAAAAAAAAN0/uTuBwZEOaUQ/s400/abuela.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://3.bp.blogspot.com/_Y_GdgiQpFoA/StRasZ5jZfI/AAAAAAAAAN0/uTuBwZEOaUQ/s320/abuela.jpg" width="202" /></a></div><br />
<br />
Seems the most common way for people to almost die is Acute Pulmonary Edema (APE). This, as I've blogged a lot about already, is when the heart isn't pumping adequately enough and fluid backs up into the lungs, essentially drowning the person inside herself. It can happen over the course of days, a gradually rising tide, or it can flashflood and kill someone in seconds, pink frothy sputum coming all the way up their airway and out their mouth. Usually folks show some signs as it's approaching, something called othopnea which means they can't lay all the way back without getting short of breath and is measured by how many pillows you can sleep comfortably with (six pillow orthopnea would be a very bad thing). Another sign is Paroxysmal Nocturnal Dyspnea - a fancy way of saying sudden late night breathlessness, (which now that I think about it sounds like a fancy way of saying something else altogether...)<br />
<br />
Anyway, Congestive Heart Failure is the chronic condition that causes this, but it can come from a sudden heart attack or fluid overload from kidney failure or massive hypertension, among other things, but basically, it'll kill you. By the way, i just made up the term "massive hypertension" do NOT use it if you want to impress people with your medical lingo.<br />
<br />
When a body is starved of oxygen, there's a period where it just goes batshit before it gets exhausted and starts giving up. So batshit could be described as a latesign, something foreshadowing total respiratory failure and then cardiac arrest. this is bad news because getting all worked up increases demand on an already taxed heart and makes it very difficult for us rescue folks to do complicated things to you like start IVs and put on oxygen masks. In fact, as I've said before, not tolerating an oxygen mask is almost always a sure sign someone's about to go down the tubes (unless they just broke up with their girlfriend and they're trying for attention). It means the body is SO confused, the brain is SOO starved of oxygen it can't even figure out what it needs to get better any more.<br />
This lady we had last week (betweeen the 2 arrests I blogged about previously) was already at that point when we got there.<br />
She was also a fighter, so not only would she not tolerate the mask, she was throwing old lady punches every which way to keep us back. And here we are with needles in our hand trying to be like, "Ma'am...ma'am...we're here to *ducks*...ma'am!" and my partner trying to get near enough to put the oxygen mask on...not happening.<br />
Fortunately, her daughter happened to be an EMT so she got in close and tried to calm her with a mix of loving caresses and CalmTheFuckDownCoños. Grandma didn't calm down but it distracted her long enough for me to grab her arm and put the IV in, but then of course she started flailing again, so I had to hold the arm still with everything i had to keep the catheter secure while I with one hand undid some tape and mummified that shit tight so it wouldn't go anywhere.<br />
Meanwhile, my partner wants to put her on CPAP, which is an even more intense kind of oxygen administration, basically a reverse vacuum cleaner strapped tight to your face, shoving air down your throat. It's a lot to take even if you're not panicking.<br />
She'll stab you before you get the first strap on, I mutter beneath her screeches.<br />
that may be true, he says, putting the mask down.<br />
Thing is, she does need it. Lack of oxygen is what's making her crazy and CPAP is the best way to get her lots of oxygen fast. But not if she's too busy tearing it off her face throwing it at us to get any good from it. <br />
At this point, our IVs in but I'm really looking at this lady like she's going down at any second, from the sheer amount of excitement her heart might damn well explode. Okay, not really, but it will continue to suck valuable resources from her body, and she can't maintain for long.<br />
We call for backup, on the premise that if she codes, we will need more hands to do it all right, and put some energy into calming her as we start setting up to get moving.<br />
I think it must've been the daughter's helping out, because slowly, gradually, the screaming and yelling subsides and we're able to get close enough to give some medicine. That one thing, the calming down, sets of a chain reaction of events that basically guarantees our patient will get to the hospital without indrowning or even a tube down her throat. The medicine opens up her blood vessels some, dropping her blood pressure, relieving more burden from her heart. She finally lets us put the o2 mask on her, raising her oxygen levels and calming her down even more. By the time the EMTs arrive she's so quiet I actually have to check a pulse, but then she looks up at me, still with defiance and her eyes but mercifully calm, and takes a breath.<br />
I put the daughter on keep-her-calm duty and we zip off to the hospital. DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com3tag:blogger.com,1999:blog-850237098020118354.post-76695194077953690322011-08-08T08:24:00.000-07:002011-08-08T08:24:49.102-07:00THIS WEEK IN DEAD PEOPLE<div class="separator" style="clear: both; text-align: center;"><a href="http://www.symptomsearch.net/images/ekg.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="266" src="http://www.symptomsearch.net/images/ekg.gif" width="400" /></a></div>Lord my blog is morbid! i forget sometimes, because it all's become a pretty harmonious aspect part of my everyday life, but then I scroll down the past bunch of entries and make boggly eyes at some of the shit that's come up. Anyway, for an ongoing collection of stories that are so much about death, the thruline really is Life: sustaining life, living life amidst death, letting go of life when the time is right. Alladat.<br />
aaaand, this week is no different. It was a morbid ass week, i won't lie, but only in that tumultuous, joyful, challenging way that it so often is in my job.<br />
<br />
Started with The Stench. Never a good job to get. I think PD gets it as the FOUL ODOR, for us it's a CARDIAC ARREST because if something smells SO bad you have to call 911, it's probably dead. Fire trying to get themselves canceled the second they get there- "Um, you really gonna need us? It says Possible DOA in the job descrip..." which is an absurd excuse to leave because "possible DOA" can mean anything from dude taking a nap to...well, to what we ended up finding. So i tell Fire no, y'all comin up there with us, possible DOA or not. As I've said before, the main thing you need on a Cardiac Arrest is enough hands to have CPR ongoing while we do the other stuff, and I wasn't about to be the jackass that cancels Fire only to have a just-died dude on his hands and no one to pump the chest.<br />
<br />
When the elevator door opened on the third floor, the whole Fire crew literally took 1 step into the hallway, did an about face and went poof. And at that point, I couldn't blame 'em. The smell of human decay is singular, unmistakable, unshakable. Some EMT showed up out of nowhere acting all cocky and loudmouthed about something, I don't remember what, so we let him go in first. He opened the apartment door and then we all had to move out of the way while he ran retching in the other direction and then was never heard from again. Poked my head into the apartment, not breathing through my nose at all. Didn't see anybody, just a dingy old onebedroom, cluttered with old magazines and piles of clothes. I peeked alittle further in, but the door was one of those swings shut quick behind you joints so I kept one foot blocking it. The air was thick and nasty and ahhhhh yes, there on the couch was the gentleman, lying peacefully on his back in a state of total Indiana Jones style decay/damn-near mumification. I hadn't noticed him because he was so perfectly still, obviously, and so many different colors that a human being should never be. <br />
It's possible that I said "Where's the dead guy? Oh." But I can't confirm that.<br />
Anyway, we made a quick retreat, ganked PD's paperwork so we could write the guy's info down from the safety of our air conditioned ambulance and then went out to breakfast.<br />
<br />
The next night we started out with a 55 year-old dementia patient who'd turned up dead on the floor of his nursing home room. He was on the young side, but otherwise, it was the same nursing home "we just saw him alive 5 minutes ago" routine, when clearly he'd been down much longer. It's maybe one of the saddest parts of my job that I've come to expect that kind of utter-incompetency and negligence from nursing homes, but that's what it is. He probably didn't have a chance but we did what we could. The family showed up halfway through, and we tried to have them stand outside but the son, a tall cat in his late 20s who was fasting for Ramadan and had been an EMT for a few years, just stood there shaking his head and saying he'd seen it all before. Family reactions are hardest when the death comes out of the blue, there's no time to brace for the impact and it just seems to sweep people up and knock them over like some angry wind. The son stood there solidly while the patient's wife bawled on his shoulder. I don't like prolonging the uncertainty. As long as we're working on him, all that maybe maybe shit gets drawn out, when really, it's not a maybe maybe situation. So i call, get a time of death and that's that. The son thanked us and then swooped around his mom like a big bird and the true mourning commenced.<br />
<br />
Then some lady called us because her back had been hurting for like 18 years and she just couldn't take it anymore.<br />
<br />
At six or so that morning, an asthmatic woke up barely able to breathe. He told his brother to call 911, put himself on a treatment and died. We got it as a DIFFBREATHER first, "...unable to speak in full sentences..." (never good) and then as we approached it became a CARDIAC ARREST. The brother had started CPR right away, and the EMTs were doing those real good ribcracking compressions, and the guy was only fifty-something, so everything was basically in place for him to pop back around, but still, he was flatlined, which is the deadest rhythm your heart can possibly be in, and he didn't change in the first 20 minutes of working on him. I did a round of compressions, felt the crunching of breaking ribs beneath my hands, then handed it off to fireman and stepped out the room to call Medical Control.<br />
Passed the guy's ancestor shrine on the way down the hall. I was on hold with telemetry, so I just gave them a nod and mumbled 'go take care your homeboy,' and then the doctor picked up. Laid the presentation out to him, got a few more medications to give and came back in the room. The EMTs are still pumping on his chest. I push the meds, we do some more CPR and then stop to check a pulse.<br />
"Pulse!" the EMT yells. "Strong one!"<br />
Indeed it is - a good solid pounding up his carotid artery. His blood pressure's a healthy 148/72, his heart's a little fast, but that's to be expected considering everything. Okay. now we have to move. People that come back like that can look really really good until all the sudden they're not, and then there's a tiny window when you might be able to get 'em back stable but it's real touchy, and really, they need an ER at this point. So we scoop him up, gather our shit, carefully carefully lift him on the board, because if we dislodge the tube right now it's a wrap, and bustle him off to the ambulance. Downstairs we recheck everything: his heart rate is still good but his pressure's diving. The recently-undead can be so finicky and unpredictable with their blood pressures! It's not low enough to intervene yet, and given said finickiness I tend to be a little tentative about putting major gamechanging medications on board prophylactically, which is what the lieutenant on scene thinks we should do.<br />
So i hold back on the dopamine, and sure enough when we get him in the ER and they take his pressure it's through the roof high, 180/100 or something, and any kind of intervention would've skyrocketed it into guaranteed stroke territory. We give the report, the doctors are always a little wideeyed that such things happen outside of hospitals, and they take over. Before the shift ended we check on him up in the CCU and he was in an induced coma, his body being inundated with cold fluids to preserve the tissue, but he was still alive.<br />
<br />
<br />
DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com2tag:blogger.com,1999:blog-850237098020118354.post-4055138041854182162011-07-08T16:01:00.000-07:002011-07-08T16:01:30.709-07:00STAKING OUT A POTENTIALLY DEAD GUY'S DOOR<div class="separator" style="clear: both; text-align: center;"><a href="http://farm3.static.flickr.com/2194/2435212284_364fb5848d.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="206" src="http://farm3.static.flickr.com/2194/2435212284_364fb5848d.jpg" width="320" /></a></div><br />
Last night they sent us to some vagueness at Tracy Towers. By vagueness i mean the job just said "MALE DIFFBREATHER" and not much else. Gave an apartment number but the dispatcher came up to let us know the patient would meet us downstairs. Fine, that's always more pleasant than lugging 40 lbs of equipment up to some stuffy apartment. Thing is, Tracy Towers is this monstrosity of a project made up of many unmanageable somewhat connected ginormous buildings. There's ramps, tunnels, construction areas, elevators that only go to some floors, cross over bridges to nowhere. All the post-apocalyptic Wonderland features of PJs that make it hard to find anybody. So when we finally find the building we need, which involved going the wrong way up a windy-ass ramp and through a cloud of pot smoke, the dude's not there. A few cats are throwing dice in the parking lot, some ladies are smoking menthols on a bench and coughlaughing about the dudes throwing dice. A couple security guards are walking around looking more lost than we are.<br />
<br />
We ask dispatch for a callback. There's some confusion. Fire gets called to take down a door that we haven't knocked on yet. The apartment might be A and it might be H, no one's sure. We shrug and hang around with the dicethrowers waiting for someone to make sense of this mess. Somehow, Fire gets on scene and up to the apartment without going past us, surely by going up another series of MC Escher stairwells, and when we show up at the apartment they're all irritated.<br />
-We knocked on Apahtment A and they said they didn't call.<br />
Okay, I say, well we have to...<br />
but they're already in the elevator and gone before I can finish. Thing is, if someone might be sick or dead in apartment H, we can't leave. So we put in a call for the grumpy Fire guys to come back, which surely pisses them off even more and causes them to fake mechanical troubles or whatever, because what happens next is we wait. And wait. And wait some mo'.<br />
<br />
A lieutenant shows up. Makes angry gestures and mumbles about Fire. Puts down his stuff and commences pacing with us after he makes some phone calls. Ominously, there's a tv blaring inside apt H but no one answering our incessant pounding. Stakeout the possible-dead guy's door time always becomes storytime, so we recount our other mishaps and victories, like the time some cop decided not to take a door in and they found a dude with his throat slashed in there the next morning.<br />
<br />
We wait some more.<br />
<br />
Eventually, Fire comes back and it is, predictably, a different crew. They take the door and inside we find an apartment that is almost completely empty except each room has a large screen TV blasting infomercials and Glen Beck at full volume. And the windows are open, a draft blowing the curtains around, givin the place a chilly, semi-alive feel. No body though, so we pack up our crap and begin to work our way back through the serpentine impossibleness of Tracy Towers.DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com2tag:blogger.com,1999:blog-850237098020118354.post-85858907194720486352011-07-05T22:06:00.000-07:002011-07-05T22:06:13.497-07:00GUEST BLOG!Was so honored to be asked to write a guest post for The Rejectionist's blog, which i have been reading and enjoying for a while now. Here's a link: <a href="http://www.therejectionist.com/2011/07/special-guest-post-daniel-jose-older.html">http://www.therejectionist.com/2011/07/special-guest-post-daniel-jose-older.html</a> drop by and leave a comment! :)DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com0tag:blogger.com,1999:blog-850237098020118354.post-73803083110179360422011-06-11T18:56:00.000-07:002011-06-11T18:56:52.598-07:003RD PARTY CALLER NOT ONSCENEI was sleeping on the stretcher early this morning and the rain was falling in sheets on the roof of the ambulance. The job they woke us up for, sometime before dawn, sounded like either nonsense or a complete mess: "FEMALE 80 DIFFBREATHER 3RD PARTY CALLER NOT ONSCENE." that usually means someone somewhere doesn't know what to do with their grandma so they call EMS and say she's having trouble breathing and let us handle whatever family crisis was going down. Usually.<br />
In this case though, the patient had called her daughter, gasped "I can't breathe!" and hung up. The daughter was on the way but when we got there it was 4:30 am and no one was answering the door. We buzz, call dispatch for a callback, buzz some more, wait. Nothing. Finally, the daughter shows up, lets us in and there's her mom, laying facedown on the kitchen floor. You can tell right away when a body's a corpse. It's not just that they're not breathing, there's something else; a total inanimate quality to a dead person that even the comatose don't have. She was quite dead, but had been alive at least 15 minutes earlier, so we brought her into the front room (because there wasn't enough space to work her up in the kitchen) and began CPR.<br />
<br />
If you're gonna work up a cardiac arrest, the thing you really need that'll let you do your job is more hands. This is because CPR has to be going on throughout, and meanwhile you have to be starting IVs and intubating and pushing medications and all that, so really it takes at least 4 people to do it right, but preferably more. Since this job came over as a DIFFBREATHER and not an ARREST, it was just us. I come up on the radio to call for our backup, as I'm pumping up and down on this woman's chest, and nothing happens. No staticy reply, no other units chattering. Nada. My partner tries too and gets nothing. One radio keeps shutting off and the other gets no signal whatsoever.<br />
Mumbling and grumbling and still pumping up and down while my partner gives ventilations, I call the dispatcher, but of course, the number i have in my phone still goes to the Brooklyn desk, and for whatever stupid reason they won't transfer me.<br />
-i can give you the last four digits of the number you need, the dispatcher tells me helpfully.<br />
How bout you go ahead and give me all ten?<br />
-Oh, I don't know them.<br />
There was a pause then as a million unfathomable curses swung through my head.<br />
Meanwhile, I'm panting, and the phone is cradled in my shoulder and I'm trying not to let it slip and fall onto the patient and the daughter is watching from the kitchen, trying not to burst into tears.<br />
-But I can tell you the first six numbers are the same as the ones you just called for the Brooklyn board.<br />
what. numbers. are. they?<br />
-Oh! I don't know. Whatever you called!<br />
I think I growled at that point. Fortunately I had been repeating everything back to her throughout the whole conversation, including the last 4 digits that we needed, so my partner took out his phone and put everything together.<br />
"We have a cardiac arrest and we need backup..."<br />
In the meantime, I get busy with the IV, which involves doing a whole bunch of chest compressions, stopping to put on the tourniquet, a whole bunch of compressions, finding the vein, which is all the harder when someone doesn't have blood pumping through them, compressions, swabbing the site with alcohol, mad compressions, tearing open the plastic wrappers on the saline lock and the syringe, pushing saline into the lock and unwrapping the catheter, mad compressions, and finally putting in the line, compressions, and securing it down with tape. Whew. Fortunately, backup showed up right around then so I was able to go head and push the first line of medications without stopping every five seconds. <br />
<br />
Amidst all this, I'm trying to explain, without being too grim or falsely hopeful, to the daughter that her mother is in cardiac arrest and what exactly that means. I do this because all too often, people believe the crap they see on TV with dead folks popping back alive every time someone bounces on their chest for a few seconds. Without obliterating all hope, I want the family members to understand the gravity of what's going on. It can get even messier when we're forced to transport the patient, for one reason or another, and then people really believe they're going to make it, when in reality they so rarely do. So, I'm panting away, holding the calmness in my voice, and the daughter is taking it really well, nods, seems to get it, although I do see the moment of painful realization flash across her face and for a second she looks like she's going to break but then she pulls it all together.<br />
<br />
I start running the cold fluids, part of the new hypothermia protocol we do for cardiac arrests patients now that lowers the core body temperature with a flush of near frozen saline to preserve the tissues. But when my partner goes to intubate he finds the airway full of pink, frothy sputum. The patient had been in pulmonary edema, a fluid overload in the lungs. Pumping more into her at this point will only aggravate the situation that caused her death so we discontinue and move on to the other medications. <br />
<br />
At some point the daughter remembers there's a Living Will that specifies the patient doens't want to be resuscitated. Technically, we can only accept a true Do No Resuscitate order, but at this point we've already pushed all the first line meds and are ready to call the online telemetry doctors for a consult anyway, so I make the call, give the presentation and then let the doc know about the will.<br />
The patient's been flatline the whole time, hasn't shown any change towards making a comeback and the will speaks for itself, so when the doctor asks if I'm comfortable pronouncing I tell him I am and he gives me a time of death.<br />
And that's that.<br />
We extubate, pull out the IV, slide a sheet under her and heave her onto the daybed in an adjacent room. One of her cats comes out to see what all the fuss is about and then somberly walks away. We close her eyes, tuck her in and leave her be.<br />
<br />
It takes a while for PD to show up, again because the job didn't initially come over as a cardiac arrest, so I end up sitting at the kitchen table with the daughter, sipping water and chatting about life, death and cats. She's calmed down a lot, made a quick peace with it, perhaps to grieve later. Her husband showed up and took on the grim task of alerting her estranged sisters about the death of their mother. Outside the rain is still coming down and the sun is just beginning to rise.DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com2tag:blogger.com,1999:blog-850237098020118354.post-19024002599758285802011-04-17T21:29:00.000-07:002011-04-17T21:33:27.354-07:00GO TO PRISON OR DON'T SAVE YOUR BUDDY<div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-9ep7QGLQ8QA/Tau9criyhRI/AAAAAAAAAGI/Ko4w0sw3jDs/s1600/syringe_hypodermic_set_c._1880._1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="287" src="http://2.bp.blogspot.com/-9ep7QGLQ8QA/Tau9criyhRI/AAAAAAAAAGI/Ko4w0sw3jDs/s320/syringe_hypodermic_set_c._1880._1.jpg" width="320" /></a></div>Ok, that's not a real choice anyone should ever have to make.<br />
I just liked the title and I chose it because people seem to think that's the deal. I'm here to dispel that myth.<br />
Let me explain:<br />
I was speaking on a panel this weekend for the <a href="http://www.alp.org/">Audre Lorde Project's</a> summit on keeping Brooklyn safe for LGBTQ folks and it was pointed out that a lot of people have trouble figuring out who's the cops and who's not. This is very true- we all wear the same navy blue uniforms with many pocketed pants and have blaring radios and that self-important strut. It can be a lethal mistake though, because, as happened the other day, people are less than willing to speak to cops about things they really do need to be telling paramedics.<br />
<br />
At daybreak we found ourselves in a shwank lower-east side condo looking down at a middle-aged hipster who was literally blue. When you're upset and trying to pretend you can't breathe to get back at your girlfriend or whatever, you turn red. When you actually can't breathe and are about to die or already did, you're blue. Elmo vs. Grover. This dude was blue, not breathing, out. While we start getting set up to put some air in him I yell over to his buddies: "What'd he take last night?"<br />
<br />
Now look- it was kind of a formality, i admit. There's really only so many things that'll do that to you and most of them are heroine or some family of it. His pinpoint-ass pupils confirm that it's some opiate involved, but whatever, it's always good to ask.<br />
"Uh," the friend yammers. "I mean, some beer and some weed, that's like it really."<br />
The thing about a heroine OD that's awesome is we have this drug narcan that I've already blogged quite a bit <a href="http://raval911.blogspot.com/2009/03/ungrateful-suicide.html">about</a> and it whups you out of that high so quick you don't know what hit you and go into withdrawal in the blink of an eye. It's not fun, but still better than respiratory arrest and death.<br />
So, I'd like to think most medics would give that Narcan shot regardless of what dude's dumbass friends said, but the friends don't know that. For all they know, we'll swallow whatever dumb story they invent and be on our merry way while homeboy codes in the back of the ambulance. Of course they were all high as hell too and surely we were interrupting their pleasurable afterparty. As it happened, another medic on the scene DID go for their story (he was pretty new) but we talked him out of it and of course we gave the shot and the dude came back all irritable and groggy and 'Oh my god I just died' and all the friends gawked and we hauled the dude out and that was that.<br />
<br />
The point is, EMS is not PD. Patient confidentiality laws prohibit us from telling cops anything pertinent about the patient, including what drugs they did to make them that way. If anything, you can usually take one of us aside, away from all the po-pos and have a word in private. Do that, because the alternative, letting your friend drop dead because you don't want to face too many questions, is much much worse.DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com1tag:blogger.com,1999:blog-850237098020118354.post-22302142773205678732011-04-12T10:32:00.000-07:002011-04-12T10:32:06.832-07:00TO TUBE OR NOT TO TUBE<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-G3ZK4Cf9ilY/TaSMeyPrJfI/AAAAAAAAAGE/EG38VhlK31g/s1600/FI00035_96472_1_Endotracheal+and+Nasogastric+Tube+Insertion.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="205" src="http://1.bp.blogspot.com/-G3ZK4Cf9ilY/TaSMeyPrJfI/AAAAAAAAAGE/EG38VhlK31g/s320/FI00035_96472_1_Endotracheal+and+Nasogastric+Tube+Insertion.jpg" width="320" /></a></div><br />
<br />
The guy's ancient, all flaky skin and withered bones, body permanently contorted like a gnarly tree. Plus, he's in a nursing home, and quite frankly when we get any job in a nursing home we're surprised to find the patient alive at all. This fellow is indeed alive, but only barely. His lungs are gunked up with pneumonia, his blood pressure's low, his temp is high and his heartrate is all over the map. He's septic and probably has been for a while. Sepsis becomes lethal when the body feels so threatened that it opens the entire vasculature up nice and wide in an attempt to flush out whatever nastiness has entered. The blood pressure drops and the heart eventually gives up when it can't find anything to pump. It's similar to an allergic reaction but the patient's already in a weakened state and becomes febrile and lethargic. <br />
<br />
To top it off, our guy had almost no oxygen saturation. That means the percent of o2 getting to his blood stream, which in a healthy person is upwards of 96%, was down around 82%. This number is complicated by the fact that he suffered from chronic lung disease, which keeps your sat numbers down even when you're not acutely ill. He's moving air, although not much, and his mental status is impossible to really gauge because according to the staff he's either agitated or vegetative but never makes sense. Right now, he's agitated and makes no sense.<br />
<br />
So what we have is a decompensating patient. We have a few things we can do for him to keep him from checking out on the way to the hospital but really he needs lots of antibiotics and to have his position in bed changed more than once every couple days. To keep his pressure from bottoming out, we put two of the biggest IVs we can on him and start dumping fluid through them. This helps fill those wide open vessels and gives the heart something to pump.<br />
<br />
His breathing though, is another matter. Even with a mask blowing high-concentration oxygen straight into his face, that sat is still hovering in the mid eighties. By some standards, that number alone would get the guy intubated but most medics know better than to treat a patient by numbers or monitor readings. The problem is this: intubation is an invasive, complicated procedure. When you do it on a live patient it often requires sedation, which means further depressing his respiratory drive and mental status. If he's far enough gone to be intubated without sedation, you still need to lay him supine, which is a bad position for patients struggling to breath, open his airway enough to see those vocal cords, wait for them to open when he takes a breath and then put a tube between them, all the while depriving him of oxygen. Either way, you risk stimulating the all important <a href="http://raval911.blogspot.com/2010/02/wanderer.html">vagus nerve</a>, which runs behind the throat and slows the heart rate. In such an unstable patient, vagal stimulation could easily spiral them into bradycardia and then death. Also, intubation comes with added risk of infection, especially in the pre-hospital setting.<br />
<br />
Of course, a tube means a secure airway, and this patient's breathing is far from stable. Once the tube is in your pumping oxygen directly into the lungs. The question then becomes: is his situation unstable enough that it's worth risking tipping things even further with intubation or will he hold out to the more stable environment of the ER, where they have paralytics, other airway options, bright lights, non-swerving through traffic surroundings, etc etc...? Of course, it's case by case, there's no one answer.<br />
I try to gauge how acute a situation is based on how the patient responds to our lesser invasive treatments, how the pathology changes in the short time we're one scene. A lot can happen in 10 or 20 minutes. Someone in Acute Pulmonary Edema, for example, can go from mild distress to having fluid filling up to the top of their lungs and coming out their mouth in a matter of seconds. Or it can take hours, days even. With septic patients, especially in nursing homes, it's particularly hard to get a good history because they're often not with it enough to tell you (and neither is the staff).<br />
So you look at what you have. If I've been on scene for half an hour and the patient hasn't declined sharply I tend to cautiously put more aggressive treatments to the side. I say cautiously because an unstable patient is an unstable patient, so the tube kit is never far from my grasp.<br />
<br />
My partner wanted to intubate this one. I see where he was coming from but to me, it was an unnecessary risk. I've seen medics go to tube very similarly situated patients and ended up pumping on their chest. We went back and forth a few times in that respectful, quiet way that you have to use when you're on scene and there's other people around. I had a sense that the patient wouldn't put up with much tinkering around since he kept pulling the oxygen mask off; we agreed my partner'd take a look and see how it went but not push it. When he went to open the airway, the guy slapped him across the face. Sometimes, the patient will tell you all you need to know about a situation. If they're messed up enough to consider tubing but strong enough to deck you, they'll probably make it to the hospital, which this dude did.DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com0tag:blogger.com,1999:blog-850237098020118354.post-55170826946644528532011-03-08T12:03:00.000-08:002011-03-16T13:22:11.250-07:00BEYOND MANNING UP: An NYC Paramedic Speaks Out About Men's Violence Against WomenWhen I first started in EMS, I was struck by how many domestic violence calls we got. Within weeks, it became a regular part of the night, just another bloody dispute amongst the asthma attacks, strokes, shootings etc... I'd like to say there was a moment that shook me out of complacency - the woman whose father had beat her so badly she couldn't open her eyes but she still wouldn't go to the hospital or press charges, the decayed body of a nameless girl we found wrapped in trash bags in the backstreets of East New York - but revelations don't usually come in single sudden bursts. It was a slow and painful movement towards recognizing that the everydayness of men's violence against women, the sheer normalcy of it, is the most insidious, dehumanizing part. That something must change.<br />
<br />
They say that understanding privilege is a process much like accepting death - you cycle through a haze of stages from Denial to Bargaining to Blame and finally Acceptance. But of course, nothing's ever that linear. As the ugly truth about what men do played out in my ambulance night after night I got angry, I tried to separate myself from all that mess by holding tight to some concept of being a "good man," I tried to invent some perspective that would make it all a little more okay, make it make sense, rationalize it. My social scientist side kicked in and tried to fit it into some theories that'd water down all that blood but I kept going in circles, bouncing between all the stages, overlapping a few at once and getting nowhere.<br />
<br />
Acceptance came when I finally shut up and listened to what women around me were saying, what they'd always been saying, what my own life was telling me: that the physical, mental, spiritual violence that men commit against women is so wrapped in the fabric of society that it seeps into our subconscious, poisons our relationships to each other and ourselves. It's a matter of life and death, not just because of the enormous amount of men that kill women every year but because of the lethal fallout of the patriarchal mindset, which asks us to make insanely unhealthy choices in the name of 'manning up.'<br />
<br />
Even though it's the last stage, Acceptance is only the beginning of the struggle. I finally got to a point where I could put words to my process, make some more sense of privilege and responsibility than just being speechless or awkward, move forward. Fell into a collective of like-minded people of color working on intersecting oppressions - true, brave hearted people that I learned along side, laughed with and argued with and stayed up all night unfurling crazy plans with - and we started doing workshops in schools, churches and community organizations around Brooklyn.<br />
<br />
We used the Gender Box exercise that they outline in Beyond Beats and Rhymes, which looks at the way we play out stereotypes even today and what forces keep us in those boxes. We broke down how male privilege plays out on institutional and interpersonal levels and how white power plays on images of manhood to turn us against ourselves. We taught in Riker's Island and the District Attorney's office, spoke with judges, doctors, business people, priests and gangmembers, but mostly we worked with young black and brown kids, and this is what i learned: <br />
<br />
Despite what we're told, people are hungry to talk about how privilege and power keeps us apart and holds us back. Young men know what's going on, feel the strain of what they're supposed to be, but our institutions won't give them the language of how to talk about it, how to make sense of it, how to survive. What we're left with is locker room banter and bad tv, an epidemic of crap media culture telling us how to be who we are.<br />
This is what I believe: in our heart of hearts, men are not the monsters we've allowed media to make us. We are infinitely wiser, more compassionate and more complex than that. Fighting against gender violence really means ending patriarchy, which for men means finding that place beyond what we're told we're supposed to be, beyond "manning up," and becoming what we really are.DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com2tag:blogger.com,1999:blog-850237098020118354.post-21824174225556241872011-02-15T22:32:00.000-08:002011-02-15T22:32:14.760-08:00¡ECLAMPSIA!<div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-CdHKA1boZro/TVtvYF_F7WI/AAAAAAAAAGA/O6DVH19-At8/s1600/black-woman-pregnant-belly.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="197" src="http://3.bp.blogspot.com/-CdHKA1boZro/TVtvYF_F7WI/AAAAAAAAAGA/O6DVH19-At8/s320/black-woman-pregnant-belly.jpg" width="320" /></a></div>I was working BLS this weekend, which basically means I'm lugging 30 lbs less equipment and they send us the stupid nonsense calls on purpose instead of by mistake. Except this one: comes over as your average boringass 'SICK' call, which can be anything from 'My nose hurts' to 'I'm upset.' This one was 23 year old female with headache. No further information. Fine. When we get there a dude's flagging us down from outside the building looking real urgent. "She's having a stroke or a seizure or something! Come quickly! Please!"<br />
<br />
I've already mentioned that people love to hurry us along for even the lonliest little toothache or whatever, but as time goes by you can kinda distinguish between the guy that is just wants to someone around and the person who really and truly fears for their loved one's life. This guy was definitely the second. Then he mentioned, as we hustled through an outer open area and up some stairs, that his wife had just delivered a baby five days ago.<br />
<br />
Now here's where any medic or EMT worth their salt should have the word 'eclampsia' dancing through their mind. Not as a definite, cuz we gotta wait till we see the patient and all that, but between the call information and the husband's story, you have a pretty textbook eclamptic patient. What it is is an obstetrics disorder where the blood pressure shoots through the roof causing blurred vision, massive headaches, edema in the extremities and sometimes blood backing up in the lungs. All that is pre-eclampsia, when the patient actually goes into a full tonic-clonic seizure it becomes eclampsia proper, which is gets its name from the Greek word meaning "shining forth." It's rare we see even a pre-eclampsia in the field and rarer still to see a fully seizing pregnant woman, but sure enough when we walk in we find the patient just finishing her last convulsion and settling into a postictal stupor complete with snoring respirations, drooling, rolling eyes and occasional tremors. (I've heard varying reports but apparently it can happen up to 4 weeks after delivery.)<br />
<br />
So, like I said, I'm BLS and don't have any medicines with me and really there's nothing worse than being at the scene of some magnanimous disaster and utterly helpless to do anything about it (See previous posting for more on that...) The family is going through all the motions of utter freakout, from screaming that she's going to die (her mom) to trying to shut the gloomy screaming lady up (her husband) to bawling and pointing (her nieces and nephews). The pregnancy wasn't high-risk, plus it's over, and she has no medical problems so you can see they were all taken totally off guard when she suddenly seized after complaining of headaches and blurred vision all day. I call for a medic bus to back us up and my partner and I start getting her ready to go. Baby's sleeping quietly in her crib the whole time.<br />
<br />
The medics are waiting for us downstairs. I give the story as I'm fighting the stairchair with the lady in it over some bumpy pavement, praying she doesn't seize again and topple. We're on the bus and let me tell you, when I'm working BLS and medics show up I generally make it my business to be quiet and stay out the way, mostly because the worst thing in an emergency is three alpha medics yelling three different things. Plus, the guy working was a friend of mine and knows what he's doing. HOWEVER, just when it seems like we've fallen into the whole swing of the job and everything's moving along smoothly, he goes for an utterly different medication, Dextrose in fact, which would infer a treatment modality for a whole other situation than what we're dealing with.<br />
"Wait!"<br />
I really don't like doing that, especially when there's a student, another medic and an EMT all right there. The guy looked at me cock-eyed. I ran down the list of symptoms and watched it dawn on him. "Why didn't you say all that when we got here?"<br />
"I did!" I had!<br />
"Oh! I didn't hear you. And I figured my partner'da given me the story." She hadn't.<br />
A moment went by where we all kinda looked at each other. Then I don't know if anyone said anything or what but we all just fell back into the business of treating the patient, now truly on the same page. Magnesium Sulfate relaxes the smooth muscles and can ease/prevent the eclamptic seizures. We also treat asthma with it and a rare form of v-fib called Torsades de Pointes. You have to mix 2 gms of it up in a 50 ml bag of saline and set the drip rate to deliver it over 10 minutes, which is a little project unto itself, so while the other medic is doing that I get on the phone with our telemetry doctor to get clearance to give the medicine.<br />
Talking to telemetry can be an outrageous experience. There's a medic that you have to get through to actually speak to the doctor and he's always angry about the fact that he's wasting away in an office while you're out there having fun in the street and he always manages to find something to pick a fight over. I brush through him as quickly as I can, doing everything possible not to take the bait of his irritability. Then some absurd pop song comes on, because I'm on *&*&#^#*! hold of all things and finally the doctor gets on. I spit the situation out quick to him and make it very clear with my tone that I know what I'm doing, because certain doctors enjoy verbally shredding medics when they smell uncertainty. "Alright give the mag," he mumbles, hangsup and returns to his cave.<br />
When I get back in the bus I see the medic has asked the student to draw up the 2 gms of Mag, which he's done, but now he's got the syringe full of medicine and is reaching for the patient's IV, about to mainline it. I can't say for sure that his would kill her, but anytime you dilute a medicine in saline and drip it over 10 minutes it's for a reason. Both me and the other medic yell "NO!" and lunge at the student who realizes his mistake and cringes. We gank the syringe from him. "Sit down," the medic says.<br />
"But..."<br />
SIT.<br />
he does.<br />
We put the mag in the bag and I hop in the driver's seat while they set the drip rate. Get on the mic to give our notification as I peel off into traffic. She saves her last seizure for when we roll up into the ER bay, which makes getting her out of the bus and into hospital but we eventually manage and the doctors swirl in on her as we yell out the story once again. After some messiness, they break the seizures and she's sleeping quietly when I leave, her worried husband holding her hand and shaking his head.DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com4tag:blogger.com,1999:blog-850237098020118354.post-83805309978625285662011-01-26T21:38:00.000-08:002011-01-27T07:25:53.296-08:00STUCK: A Long Night In The Ambulance During Snowpocalypse 2011<div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/_3wre_U3jwBs/TUEF1DSVRQI/AAAAAAAAAFw/MLdQU4SkVOE/s1600/images.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="260" src="http://4.bp.blogspot.com/_3wre_U3jwBs/TUEF1DSVRQI/AAAAAAAAAFw/MLdQU4SkVOE/s400/images.jpg" width="400" /></a></div><br />
Since the snow is once again billowing down on NYC I thought I'd take a second to recall my lovely experience during the original Snowpocalypse 2011.<br />
<br />
It started coming down heavy midafternoon and Brooklyn was already completely blanketed head-to-toe in white (omit gentrification joke) by the time I got to work at 6. There were no plows out, barely any buses or cars and only a few scattered people here and there. Our first job took us from Brooklyn Hospital to Fulton and Kingston, which on a normal day isn't bad but during the arctic death blast turned out to be quite a trek- didn't want to drive too fast because it took me about 3 blocks to come to a full stop, but I didn't want to stop either because that meant maybe never starting again. PLUS every three to five minutes the back of the bus would jacknife around and try to pass the front. When we get there, a solid twenty minutes later, the radio's crackling with units responding two a double shooting not far away, one of the victims is dead and the other's critical. Our patient though is upset because every time the wind blows in her face she becomes short of breath.<br />
Are you short of breath now?<br />
No! Ze wind she is not blowing!<br />
Do you want to go to the hospital?<br />
But of course! I could not breathe!<br />
The hospital, mind you, was around the corner, but she wanted to go to another swankier one across town. That didn't happen. When we dropped her off at the crummy around the corner hospital the shot guy's homeboys were just getting there and running rampant around the ER looking for their friend, who was resting in peace under a sheet in the resus room. When they found him they erupted into a barrage of curseouts and revenge promises and we left outta there, turned onto the completely snowed in Atlantic Ave and immediately almost got stuck. But we didn't, barely, and made it back to Brooklyn Hospital.<br />
<a href="http://1.bp.blogspot.com/_3wre_U3jwBs/TUECW_XuCsI/AAAAAAAAAFs/apcO1iD8YPQ/s1600/PLOW5-popup.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="214" src="http://1.bp.blogspot.com/_3wre_U3jwBs/TUECW_XuCsI/AAAAAAAAAFs/apcO1iD8YPQ/s320/PLOW5-popup.jpg" width="320" /></a>Meanwhile- the radio is nonstop with units getting stuck. I mean- EVERYONE was in a snowbank somewhere, completely snowed in and once they came up on the air to report getting free it was usually on a few minutes before they were stuck again. This meant, besides the huge backlog of jobs building, that paramedic units were getting assigned lower priority jobs and EMT units higher priority jobs, just because the dispatcher was forced to hand out jobs to whoever might be available at the moment. Total disaster, in other words. Meanwhile, not a plow in sight.<br />
We got stuck on Fulton and St Felix for like ten minutes, dug out, got stuck again a block further, dug out, got another job, took us about twenty-five minutes to get five blocks away for a kid that bumped her head in the PJs and thennnnnn lord have mercy they sent us to Red Hook.<br />
Now, for those of you that don't know Brooklyn, if downtown Brooklyn is on some Day After Tomorrow Code Three disaster status you KNOW a backalley boondocky spot like Red Hook is gonna be all the worse. We got detoured by a jacknifed tractor trailor and ended up winding along Van Brunt Street, which runs by the dockyards. Then we hit a non-moving line of cars, tried to turn off down a sidestreet and got really really really stuck. A couple neighbors came out to help us dig snow along with a happy little Pakistani guy who was stuck behind us and an ornery Mexican that came down the wrong way and got stuck in front of us. Finally we dug out, backed back onto Van Brunt and got stuck again. This is when the wind picked up and started bullwhipping icy snow into our faces, thank you very much.<br />
My partner, who was in the back doing her hair while I jolted the bus back and forth trying to lurch us out, puked. Then she cursed out almost every element in the natural world and went back to doing her hair. <br />
It was getting on towards midnight. The radio was still crackling with units getting stuck. I added our names to the list and gave up. We'd moved a half a block in two hours and were only deeper entrenched than before. I had some cold coffee and two chicken wings and three quarters of a tank of gas. The snow was up to the doors. I tweeted. I gchatted. I laughed. My partner woke up around 3 and started cursing again and went back to sleep.<br />
<br />
The radio never stopped chattering with units and they're stuckness except now none of them were getting unstuck, they were just holing up like we were. For a while people were updating, cuz EMS is really update-retentive about crap, you always gotta account for yourself if you're somewhere too long or they start coming for your wig. But during snowpocalypse it just got relentless and the dispatcher started coming up on the air with this whole "OK, Units, I know you're stuck. If you're still stuck, don't update, I know it. Just be quiet. If you get unstuck just hit your button. I don't need the updates. Thank you." And then it'd get real quiet, cuz frankly that's all that was happening. Then of course every couple hours some horrific exchange would go down- a unit would get to an Abdominal Pain and find someone lying dead in the street instead and then all the units trying to back them up would get stuck on the way and then they'd get stuck and be screaming on the air like some horror show... it was not fun.<br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/_3wre_U3jwBs/TUEF3puaBCI/AAAAAAAAAF0/diDDXNOf8MM/s1600/s-AMBULANCE-large.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/_3wre_U3jwBs/TUEF3puaBCI/AAAAAAAAAF0/diDDXNOf8MM/s1600/s-AMBULANCE-large.jpg" /></a></div><br />
I think the first time I saw a plow it was after midnight, and- surprise surprise, it was stuck.<br />
I slept from dawn till 8 when some firefighters trudged up to our happy little embankment and informed us that we were stuck.<br />
Oh crap really?<br />
Looks like it.<br />
Well gee.<br />
You got a supervisor you can call or somethin'?<br />
...<br />
We trudged the five blocks to their rig and they gave us a ride back to our base where we dried off, coffeed up and then i jumped into an SUV with this old Jamaican cat that was going to help out our other unit.<br />
Basically nothing was plowed that morning except Atlantic Avenue, some of Fourth Avenue and a few of the major throughway streets in Bed-Stuy. A few. We were lucky enough to fall in behind a jeep full of Mexicans with shovels who happily jumped out every time a car got stuck in front of us and dig them out and then whizzed past them laughing. That's the only reason I made it home at all.<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/_3wre_U3jwBs/TUEF6f8h2QI/AAAAAAAAAF4/fbVyeUhJ_c4/s1600/images-1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://4.bp.blogspot.com/_3wre_U3jwBs/TUEF6f8h2QI/AAAAAAAAAF4/fbVyeUhJ_c4/s1600/images-1.jpg" /></a></div>Made it to bed sometime that afternoon and woke up to hear the Mayor blaming EMS for our shoddy response time.DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com3tag:blogger.com,1999:blog-850237098020118354.post-85740564043131809112011-01-24T19:23:00.000-08:002011-01-24T19:23:50.284-08:00OFF DUTY<div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/_3wre_U3jwBs/TT5CNDQX1xI/AAAAAAAAAFo/yB5EN8WoYhA/s1600/6a00d83451e7a169e20120a5865e70970b-pi.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/_3wre_U3jwBs/TT5CNDQX1xI/AAAAAAAAAFo/yB5EN8WoYhA/s1600/6a00d83451e7a169e20120a5865e70970b-pi.jpg" /></a></div> It was daybreak and the daytour was giving me a ride home. We were just pulling off from the ER bay when a dude came running up to the ambulance. Now...when people come running up to ambulances about 90% of the time it's to either ask directions or tell us about how their friend's like sooo totally drunk could you just like take her blood pressure or whatever. So, excuse us if we don't get really excited when folks come tapping on the window. Anyway, it was still dark out and we couldnt quite tell which of the 2 this guy was until he said "Yo, some old dude just got fucked up over there!" Still...this could mean sooo many things, but we rush on over and sure enough, there's a car sticking out of a building and an old dude crumpled on the curb next to it. And yeah, he was pretty bad, because as we were approaching I first thought he was just a pile of random debris, so still was that old dude. Usually when you mistake people for inanimate objects it's because they're dead, but this guy actually took a breath just as we started going to work on him. So he wasn't dead, but he was an absolute complete damn mess. The bystander's description actually turned out to be pretty accurate. I'd thought he had been in the car and either been ejected or stumbled out when it crashed. Usually when people are ejected though they're like, across the street or in a tree somewhere, not right right there. What actually happened was the guy'd been on the far adjacent corner, minding his, when a carload of drunken patygirls barreled on through, clipped him and sent him in a massive acrobatic airborn spin across the street and onto the curb. To hear the witness tell it, the guy'd done like three pirouettes and a butterfly kick on the way ("Yo, his legs went up like this and they kinda did one a these and then he rolled up and over" like it was all in slowmo...).<br />
Anyway, then the car had swerved and smashed into the wall, the gaggle of hoochie mammas all hopped out at once, clucking away apparently, took one look at the patient and screamed, simultaneously "YOU KILLED HIM!" and clackity-clacked off towards Flatbush in a perfume flavored huff. The driver, a really irritated looking dude, was standing there talking to 911 on his cellphone when we rolled up, trying to make it sound as little his fault as possible ("No, the guy musta been drunk! Walked right into my car!")<br />
<br />
We call for backup, put the patient in the back and take a look at what we got. The left tibia is pretty much shattered, his left arm is pretzeled and there's an open wound where the bone broke, and he's got more than a few ribs that are in many many pieces. Also, he's got a buncha little cuts and bruises and whoknowswhats going on with his head. We have him boarded and collared and nothing seems to be actively bleeding anywhere, although there's blood EVERYWHERE. <br />
He's coming around, which is wretched for him in the short term but ultimately is a pretty good sign. What's not good is that as we're getting ready to go the genius that hit him decides he has neck and back pain and needs to go to the hospital too. I've been in this situation before, and it sucks. Since there was no other ambulance on scene, it means we can't leave without technically abandoning a patient and opening ourselves up to colossal lawsuits, getting fired, all kindsa stupidness.<br />
We come up on the air, tryna express the urgency of the situation without cursing, and then get back to caring for the patient while we wait for another unit to show up.<br />
At this point i remember I'm off duty. Not only off duty, I'm wearing some a spiffy all white suit (for a change) that miraculously has remained bloodstain free up to this point. I've always said if some mess goes down while I'm not on the bus you probably won't be seeing me leaping across the street to stick my fingers in the muck. It's not that I don't care about my fellow humans- I wouldn't be doing the job if that were the case- it's just that without any equipment there's really not much I can do for you. CPR...that's about it. Anyway, here I was in my civies, off the clock, and yet I had a bus full of medic goodies to play with. What struck me though, as I was reaching over the crumpled up old guy to put an IV in, was how different it felt, being out of uniform and dealing with all this mess...It seems like a small thing, or it did, but the mental space that wearing those techpants and button shirt and having that heavy belt on put you in is thoroughly somewhere else from the I'm-just-walking-down-the-street-in-my-nice-white-suit mental space. Like, a whole other planet. The physical act of gearing up, clocking in, checking out the ambulance, carrying around that chattery little radio...it all serves to ground us into that realm of service- a singlemindedness that I've spoken of before that can be so cleansing when it climaxes in the thick of a brutal job.<br />
Without all that, i felt naked. <br />
The other unit finally skidds up and we speed off. The dude's talking and conscious by the time we roll into Belleview. The sun rises. I help the daycrew clean out the back of the bus. scrubbing away blood, picking up shredded clothing and bandage wrappers. I wonder, as we made our way back to Brooklyn along the East River, what life will be like when I'm done with this job for good and no longer spending half my week intimately wrapped in the ridiculous and tragic beating heart of the city around me. I think I'll miss it.DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com3tag:blogger.com,1999:blog-850237098020118354.post-9694239667079716022010-12-15T08:06:00.000-08:002011-02-15T22:37:16.531-08:00STAT EP<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/_3wre_U3jwBs/TQjnay1q3_I/AAAAAAAAAFg/_5KIvzhZKOQ/s1600/epilepsy_image_inside.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/_3wre_U3jwBs/TQjnay1q3_I/AAAAAAAAAFg/_5KIvzhZKOQ/s1600/epilepsy_image_inside.jpg" /></a></div>Seizures suck.<br />
Now that we've got that important announcement out of the way, lemme clarify some things bout EMS and seziures: If you call 911 right after someone seizes, the call type is just "Seizure" and they send EMTs. If you call while someone is having a seizure, they presume it's been going on for long enough to qualify as status epilepticus, which is a prolonged series of seizures without a lucid interval inbetween, and the job becomes a "Stat Ep," and they send paramedics. Also, if you call 911 and say "Yo, I'm abouta catch a seizure son!" they make the job a "Stat Ep" and send medics, unfortunately. This happens more often than anyone would care to know about. (More on the difference btwn EMTs and Paramedics<a href="http://raval911.blogspot.com/search/label/FAQ"> here.</a>)<br />
<br />
Anyway, there's a couple reasons one might catch a seizure. Most common is epilepsy, which really just means you're prone to seize, but there's also hypoxic seizures which you get from lack of oxygen and usually precede death by a couple seconds, withdrawal seizures, including delerium tremens, and seizures resulting from traumatic brain injury. But by far the most common seizure call I've ever done is this one guy, we'll call him Fred, that we always find blasted out his mind and writhing in a puddle of his own pee on the last stop of the cross town bus in Harlem. This dude, every----night gets obliterated, on what Fred?<br />
"ABTHOLUTELY!!"<br />
The Vodka?<br />
"YETH!"<br />
Are you sure?<br />
"ABTHOLUTELY!!"<br />
Ok.<br />
And winds up cursing out everyone around and screaming that he's having a seizure (so it's a Stat Ep). Or sometimes chest pain ("The Cardiac"). Then we lug his pee-covered ass to the hospital and by some unknown bum magic Fred always emerges the next day at dawn, not only sober and with a British accent but wearing pressed pants and alligator shoes, all dapper and ready for another day of getting blitzed and writhing round in his pee. <br />
<br />
True seizure patients are usually really out of it for a while after they come around, sometimes get violent and wanna pound you for taking them to the hospital, sometimes they do not under any circumstances want to be bothered by anyone and often act like a teenager not getting up for school in the morning. Also they're confused, cuz last they remembered they were sitting at the table or whatever and suddenly they're across the room with a fat lip looking up at me and I'm holding a big needle. Or, in what might a worst case scenario we had a while back, they wake up butt naked in the basement of an HIV shelter covered in their own feces. I'm still not sure how the dude got down there. I mean, he was a resident of the place, but still- damn. The security guard was ornery and couldn't give us much of a story. I tossed the dude a sheet and he kinda cleaned off best he could, mumbled something about 'yeah this happens sometimes' (o.O) and walked out to the ambulance. Well...hobbled kinda.<br />
When we got to the hospital he insisted on walking in, even though we realllllly dont recommend it cuz if you seized once you might damn well seize again. But dude wanted to walk and wouldn't be dissuaded.<br />
Halfway between the bus and the door he turns the wrong direction and takes two steps. I open my mouth to say "No it's over..." and then realize what's happening. I break into a mad dash towards him as his body goes rigid and he starts to keel over backwards, get there just in time to stop his head from exploding on the concrete and lower him down gently as his whole body rocks into a grand mal seizure. My partner that night, a confirmed jackass, pokes his head around the corner.<br />
"What's wrong?"<br />
I'm holding this 300 lb seizing man's face away from the gravel in an ER bay. What the *#&(@*%)#@*#*Q@ do you think is wrong?! "Get me the stretcher!"<br />
"What happened?"<br />
"STRETCHER!! NOW!!"<br />
Partner disappears and shows up not with the stretcher but with...an oxygen tank.<br />
Lemme tell you something: yes, by the guidelines and protocols, a seizure patient gets oxygen. Yes. This is true. But what this one in particular needed was to not be seizing on pavement. And what this paramedic needed was not be holding him up. I think I cursed out my partner. I'm not totally sure, cuz it all happened very fast, but eventually he made the stretcher happen, after some grumbling. It's probably a good thing my hands were busy. By the time we got dude on the stretcher he'd wrapped up the shaking and fallen into that deep sleep. At least he woke up in better circumstances the second time.DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com0tag:blogger.com,1999:blog-850237098020118354.post-83672926751361072422010-10-18T19:53:00.000-07:002012-03-08T18:51:42.996-08:00WEIRD LITTLE RUNNING GUY RUNS OFF<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/_3wre_U3jwBs/TL0H2JereRI/AAAAAAAAAFc/FdmnJJ4wCRg/s1600/running-man.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="http://4.bp.blogspot.com/_3wre_U3jwBs/TL0H2JereRI/AAAAAAAAAFc/FdmnJJ4wCRg/s320/running-man.jpg" width="189" /></a></div>
I know this job is gonna be ignorant the second it comes over because the text is telling me to go to a psyche facility to pick up a patient acting mentally unstable. I'm already deeply unimpressed and we haven't even got on scene. However, I'm also happy: psych patients usually walk all by themselves and provide for good conversation to boot. This one, as if to prove my point. disappears up a flight and is gone the second we arrive. The guy running the place comes over looking exhausted. <br />
"This guy's acting fucking crazy!"<br />
"Sir...this is a psychiatric facility, correct?"<br />
(I shouldn't even need to have this conversation)<br />
"Yes, but he's really acting bonkers man! He might set the place on fire or something."<br />
It's amazing how two people can create total chaos all by themselves.<br />
"We don't chase people," I say, putting down my bags and sitting my Cuban ass in a chair.<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
Usually PD is all over a job like this. They love gettn all hunkered down in their gear and tasering people or putting them in the slug outfit or whatever. But perhaps they gleamed from the job text how utterly ridiculous this was gonna be and didn't bother. I get on the radio and ask for a squad car. Jumping on people is their job, not mine.<br />
"I think he took too much of his meds," the stressed out guy in charge tells me.<br />
"You don't mean too few?"<br />
"No! Too many!" (maybe he's not the only one?) "He was sitting right there and then he just started rolling around the floor! It was...crazy!"<br />
Again...ah forget it.<br />
Then the guy comes running past. He's little, filthy, mustached. Wearing an Aerosmith shirt from circa 1976. And he's fast! I barely realize he's there before he's out the door and off into the night.<br />
"There goes your guy," I tell the supervisor. He turns around and runs out the door too. I put some gum in my mouth.<br />
Supervisor comes back in a minute later. Tells me PD showed up and took off after the guy down the block. My partner and i saunter outside, see PD reversing in a fury toward Fulton Street as homeboy cuts a hard left and disappears. We saunter into ambulance and at a saunterly pace roll around the block.<br />
<br />
PD is having an extended negotiation with the dude when we show up, which is amusing mostly because they don't speak Spanish and he barely speaks English. He's carrying on about someone ganking his dinero, they're all: 'Sir, you're gonna havta calm down. Sir."<br />
I tell him in Spanish he gotta go to the hospital, get on the ambulance right now.<br />
He curses out all of us, all our mothers, all our sisters, all that we hold sacred but sheepishly complies.<br />
In the ambulance, I notice he's utterly wasted and won't stop chewing. Not in the gum kinda way. In the way old people do all the time. Might be the Parkinson's like effects of certain anti-pyschotic meds, or perhaps it's just him being high. It doesn't matter toooo much, and we roll of the hospital. When we get in the ER first thing he does is spit a walnut on the ground. Everyone groans. <br />
I hate it when my patients are rude to the ER staff and I tell him. He looks at me like, meh? and he's still chewing. Ugh. "Ju my frien'," he informs me. "Ju too," he tells my partner. Terrrrrific. While they're taking his vital signs he produces an EKG electrode from somewhere in that mouth of his, regards it for a second and then puts it back in his mouth. I think me, my partner, the nurse and the registration lady all facepalmed at exactly the same moment.DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com2tag:blogger.com,1999:blog-850237098020118354.post-14814102329050101482010-07-20T14:44:00.000-07:002010-07-20T14:44:27.847-07:00NOTSOMUCH: The Truth About Black On White CrimeI took this little hipster dude to the hospital seven years ago; he'd left his apartment door unlocked and then got pistol whipped when he came home to find someone going through his stuff. Now why would I so clearly remember a minor injury from ages ago? Because in my eight years working EMS in Bed-Stuy, East New York, Harlem and the Bronx, that was the singular, solitary white patient I've had who was a victim of violence at the hands of a person of color. I remember sitting in the Woodhull ER with him. He was holding an ice pack to his little forehead gash and going "God! I can't believe I got pistol whipped! It's like...it's like a movie!" At that point I had already given up checking the newspapers in the morning to see if any of my crazy jobs from the night before would show up. They never do; the patients are all black and brown and their tragedies, no matter how gruesome, are automatically deemed run-of-the-mill and unworthy for news attention. <br />
<br />
In general, the white patients we get are either little old ladies, drunk Polacks who tried to play frogger across McGuinnes Boulevard, college kid anxiety attacks and overdoses. We also get the occasional "All these Black people are trying to rape and kill me so I can't leave my apartment!!" and sometimes "I stopped taking my meds and I'm about to do something really really bad."<br />
<br />
All this is to say that the amount of time and energy that white culture puts into being afraid of the crimes that will be committed against them in the ghetto could be better spent thinking about something that actually happens.<br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/_3wre_U3jwBs/TEYYim_eJLI/AAAAAAAAAFM/1yTJoUtw-FY/s1600/cop.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="http://1.bp.blogspot.com/_3wre_U3jwBs/TEYYim_eJLI/AAAAAAAAAFM/1yTJoUtw-FY/s200/cop.jpg" width="200" /></a></div><br />
For instance, white on black crime, which we see faaaar more frequently. A lawyer was interviewing me the other day for a case they wanted me to testify in. A patient I'd had who'd also been pistol whipped, also seven years ago, this time by cops, was suing the NYPD and this lawyer was trying to take apart the guy's story. He showed me a picture of a middle aged black man with a swollen lip and busted eye and asked me if I remembered him. I had to laugh. "Do you have any idea how many times a week I go to the precinct to take care of black men who've been beaten by cops? Plenty. Times fifty-two times eight. No I don't remember that dude." Or the kid I met last night, who'd been cardoored by a police cruiser and then arrested before he could get up, all for riding his bike on the sidewalk. Or <a href="http://www.nytimes.com/2008/09/25/nyregion/25tased.html">Iman Morales</a>, who was naked on a fire escape in Bed-Stuy having a psychotic fit when PD tasered him, causing him to fall to his death. Or Sean Bell. Or Oscar Grant.<br />
And then there's the entire 81st Precinct, who's institutionalized racism was recently unveiled by a defecting whistleblower and thoroughly detailed <a href="http://www.villagevoice.com/2010-05-04/news/the-nypd-tapes-inside-bed-stuy-s-81st-precinct/%20">here</a>.<br />
<br />
Most white on black crime happens without the majority of whites having to perpetrate a single violent act. Another unspoken benefit of white privilege is the ability to win without even having to fight. Gentrification, and the uprooting of communities that it entails, will happen regardless of how the incoming hipsters feel about their neighbors; the pieces are already in place, the gears turning. 911 doesn't get called- it's a slow motion race riot, which history has proven can be the most devastating kind.DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com6tag:blogger.com,1999:blog-850237098020118354.post-3421368496153804122010-07-15T22:39:00.000-07:002010-07-15T22:39:04.672-07:00ON EFFING UPOne time, when I was a brand new medic my partner and I gave the wrong medicine to a patient. It saved her life anyway but both meds in question were narcotics, the most regulated drugs ever, so we ended up getting dragged downtown to explain ourselves.<br />
The lady was succumbing to a bout of Acute Pulmonary Edema- a situation I've talked about a few times on this blog that involves the failing heart backing up fluid into the lungs, essentially drowning a person inside themselves. You can have it just a little bit- your lungs sound like a straw sucking out the last bits of soda around wet ice cubes- but it can also flash flood and pinkish fluid will gush up your airway and asphyxiate you. Plus, if you're old, even having a mild amount of fluid can cause so much respiratory distress that the body will quickly exhaust itself with the effort of each breath and give up. This lady was a few minutes away from crashing. The fluid was at the top of her chest and would come pouring out her mouth any moment. Her eyes weren't focused, her body was doing that spiraling down the toilet bowl swirl that I tell my students to watch out for. <br />
My partner and I had spent the day having a friendly debate about Morphine, cuz that's what bored medics do. We use Morphine in that situation to help open the veins up and lower the blood pressure, which is usually through the roof in APEs. It also has the added benefit of sedation, which allows you to intubate, which is what this lady needed because she was about to stop breathing completely and a tube down her throat'd be the only thing that'd keep her alive. When my partner called up the Online Medical Control people to get permission to use narcotics, he asked for Valium and they gave it to him. Valium is a sedative used specifically for the purpose of knocking someone out so you can tube 'em. But Morphine musta still been on his mind, cuz that's what he handed me and that's what I gave the patient, although neither of us realized the mistake until after everything calmed down.<br />
The thing about knocking someone out to tube them is that then you HAVTA tube them, cuz you kill their respiratory drive too and that's already low. And the thing about tubing a living person is you can see the weird little inner mouth that the vocal cords form and watch them open with every troubled breath the patient takes. And you wanna open up that airway, see the cords and then sit there poised with the tube ready to stick down there at just the right moment. It's like some creepy Indiana Jones/William Burroughs insanity, but we love that mess as I'm sure you've realized by now.<br />
Anyway, I opened her mouth, took out her dentures, got all up in her airway with the tube ready, holding her tongue out of the way with a metal blade, and watched the cords open, close...open...close...open and I pushed the tube through and secured it in place. It was in, confirmed, solid, %100 and we triumphantly zoomed off to the hospital all happy happy that we'd saved another life.<br />
<br />
Until we realized we'd given the wrong sedative.<br />
Anyway, like i said, we ended up downtown at EMS headquarters to explain what we'd done. My partner was the senior medic and he did most of the talking. He said- Look, we did mess up and give the wrong med, it was a very hectic scene, the lady was crashing and we were under pressure and we messed up. That's it.<br />
There's always one EMS lieutenant they bring to be a total dick and then a doctor who's mad coool (that was the only time I've been but everyone tells the same story)- the Lieutenant basically was like "Well, you're job is to deal with stressful situations and not mess up. So that's no excuse at all."<br />
<br />
And, much as I hate hate hate to agree with a lieutenant, the dude had a point. First of all, we deal with all kindsa situations and an old lady dying in front of us was really not the peak of insanity. She was on the bus, so it was a controlled atmosphere. Plenty of times it'll be the same thing but there'll be children crying for us to make mommy breath again, fire men crapping themsevles, angry husbands cursing us out, threatening our lives, crazy frothing dogs, cocaroaches, mice scurrying around, gettin in our equipment, endlessly cluttered apartments with no room to move in, let alone spread out and work up a cardiac arrest. PLUS, dirty needles, electrical volts, freakazoid partners, white supremacy and patriarchy...anyway, you get the point. We deal with stressful situations. It's what we signed up for. It's what we joke and carry on about at the bar after work. It's part of what we love and hate about the job. And we all will and have made mistakes, it's also a part of the job, we're not super humans, but to ask for an out because the situation was hectic is to ask to be told: That's your job. Do it.<br />
<br />
I say all that because EVERY time, every DAMN time, a cop effs up and shoots an unarmed man of color, you get the mayor, the police chief and a hundred different union reps and apologists screaming and crying about the line of duty and you don't understand what it's like to possibly have a gun pointed at you. (or a wallet). And it's true, I don't. Nor do I want to. That's why I chose the job I chose. But for someone who chose to be a cop, they've taken on the responsibility of living in the cross hairs and having the power of death at the whim of their trigger finger. That you were in a stressful situation doesn't get you a pass; it's not the go ahead to go buck wild. Especially because it's probably those same stressful situations that you go bragging about at the bar, that you roll your eyes and shrug off about at parties when someone asks you about the craziest mess you've had to deal with.... For both PD and EMS it's those challenging moments of the job that makes us love it, which means we don't get to run back and hide underneath them when things don't go our way.<br />
<br />
End rant. DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com3tag:blogger.com,1999:blog-850237098020118354.post-44505597130190071112010-06-30T23:17:00.000-07:002010-06-30T23:17:23.524-07:00THE MOST SKEEVED OUT I'VE EVER BEENI was gonna write about death again- but I do that (...reading back over old posts..) A LOT o_O<br />
so instead I'll talk about um...oh crap this ones about death too but whatever...THE MOST SKEEVED OUT I'VE EVER BEEN.<br />
<br />
it wasn't on the evisceration, or the lady who's leg was hanging off or any of the crazy shootings stabbings rectal bleeds or other bloody disasters I've been on. This might even come as kind of a let down, cuz people at parties are always asking me: What's like the CRAZIEST ISHT You've EVER seeeen? And this definitely was not it. But it skeeved me to the bone none the less.<br />
We were riding with this Hasidic kid that night, a student, and some of his boys were on the Hatzolah truck that works nearby- Haztolah is the all Hasidic ambulance group- and somehow they'd gotten a call for a jumper down- it was one of their guys and I guess he'd gone from the roof of one of the all Jewish projects on the Williamsburg/BedStuy border (yes there are Jewish projects). We were nearby and the kid wanted to meet them at the hospital and lend a hand, whatever, see what they'd done, learn something i suppose, so I rode over to let him take a peek.<br />
Hatzolah is famous for rolling deep. They call it the clown car cuz the bus rolls up and nojoke like eight little bearded EMTs will pop out, all muttering at each other in Yiddish and usually dressed in tshirts and sneakers. But for some reason, that night, there was no one there, they all musta hopped out and scattered, or maybe they all decided to go in and notify the hospital together, the way girls flock to the bathroom. Either way, it was just this one little sad yarmulka'd fellow left to bring in the patient. Even my student was nowhere to be found.<br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/_3wre_U3jwBs/TCwx-nzKLcI/AAAAAAAAAFE/DT-_rlYgkYU/s1600/3200442710_dbf0a6136e.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="http://3.bp.blogspot.com/_3wre_U3jwBs/TCwx-nzKLcI/AAAAAAAAAFE/DT-_rlYgkYU/s320/3200442710_dbf0a6136e.jpg" width="320" /></a></div><br />
I really don't like to get involved in other people's jobs. It's wrong for so many reasons but you can't roll into the hospital with a traumatic cardiac arrest and no one's doing CPR, no one's giving ventilations... It's not because the guy might make it- that was definitely not going to happen- it's just a really bad look. it's like showing up to play baseball wearing a tutu. You dont do it. So like a idiot I gloved up and positioned myself on the stretcher to start pumping the guy's chest.<br />
Considering that he'd come down from a PJ, i was surprised that the dude wasn't splattered. He was white- literally white not just racial construct white- pale as a piece of paper, probably his internal organs had exploded and the blood was scattered inside somewhere, and his feet were pointing in all the wrong directions, surely from having been landed on. They said he'd just gotten out of woodhull's psych ward and that Jews who suicided weren't allowed to be buried in Jewish cemeteries but since no one had seen him jump, he might've been pushed or it might've been a freak accident and he'd get the benefit of the doubt.<br />
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<div class="separator" style="clear: both; text-align: center;"></div>Anyway, on my third or so compression, one of the man's chest hairs caught me right where the glove stops and my wrist begins- that tendon right there? YO. It was like the long finger of Father Death tickling my soul and NOT in a good way. I can't tell you what it was that eeeked me so much about that all i know is within 2.7 seconds I was off that stretcher and halfway across the street yelling "OH HELL NO!!" and making all kindsa faces. By that time, some other Hasids had materialized and took over but I couldt've cared less to be honest with you, I was DONE.DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com2tag:blogger.com,1999:blog-850237098020118354.post-26320591982241126202010-06-23T18:23:00.000-07:002010-06-23T18:23:21.023-07:00WE ALMOST LOSE A KID<div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/_3wre_U3jwBs/TCKzWBYbP3I/AAAAAAAAAE8/wNnpFDBYgOk/s1600/asthma-athlete.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://4.bp.blogspot.com/_3wre_U3jwBs/TCKzWBYbP3I/AAAAAAAAAE8/wNnpFDBYgOk/s320/asthma-athlete.jpg" width="301" /></a></div>One of the biggest decisions a medic has to make is Grab-n-Go or Stay-n-Play.<br />
Most of the time it's relatively simple- trauma's are always grabngo as I've talked about before, because trauma patients really need a surgeon to help them, so whatever we do to 'em we do it enroute to the hospital, ideally. Most medical situations are the opposite: we 're equipped to do for an asthma or heart attack what any ER would do in the first line of treatment anyway, so it's worth taking the time onscene to get the IV, the EKG, do the full workup.<br />
Kids can seem like they fall into the inbetween category. When a kid is critically ill it feels like a trauma job because people are freaking out, tensions are high, there's a certain element of chaos that makes you wanna go go go and be gone no matter what. Adding to that tension is the high compensation/sudden plummet thing that kids do. Unlike adults, who will spend hours sometimes circling the drain, kids tend to compensate and compensate and compensate- sure they're struggling but they look okay, right? and then suddenly they'll just turn blue and crash completely and die in a matter of seconds. A good medic knows that, and it makes us anxious to pass the potato, but we also know that what happens in those fleeting moments between life and death determines whether a patient makes it or not.<br />
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So this kid was big for 13. A hundred and seventy-five pounds actually and foulmouthed to boot, and he was standing outside his house at 3AM flagging frantically at us. He stumbles over to the ambulance as we roll up, his pants falling down. "I'm gonna fuckin' die!" he screams and jumps in the bus, crapping himself as he goes. Now, people saying they're gonna die- you know that's neither here nor there. You get the people that say it over a fight with their ex and then you get the people that look fine, say they're gonna die and then do exactly that, which yes is creepy as hell. But you can't fake crapping your pants- it's always a bad sign whether asthma attack, heart attack or trauma, it means the body is giving up less essential functions to concentrate on the only ones that matter. The mom came running up a second later. The boy laid out on the stretcher, gasping and started turning blue. I mean, the kid literally used his last drip drops of life force to make it to us and then everything started giving out.<br />
<br />
Moments like that, the world goes into slow-mo. Actually, we were moving pretty fast, but it felt like hours as I moved across the bus and pulled open our medicine kit to find a syringe and the epinephrine. My partner was dealing with the oxygen, setting up an albuterol treatment, and I'm wondering if the kid'll even be breathing by the time we get it to him, but I can still hear his tight little gasps and his mom sobbing for us to help him. <br />
The stupid epi comes in stupid little vials that you have to crack open and extract the liquid from painfully carefully with a needle. It sucks. drip drip drip. 0.1 mgs and I need 0.3. Drip drip drip. Gasp...gasp...gasp. "Please, he's turning blue! Help him!" I hear the shushhhh of the oxygen (Finally...only seconds later though...) and Mike straps the mask onto the kid's face as the treatment seeps out in a little cloud. It's a start, but epi is the real turnaround medication. Finally I hit 0.3 mgs, grumbling, and I stab the kid in the arm and push the meds in and exhale.<br />
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But he's looking worse. "I think we're gonna haveta tube," Mike says. I nod, throwing the defibrilator pads on the boys chest so we can get a read out on the monitor and shock if we have to. A tube is a last ditch effort for someone in respiratory failure. It's for when the body simply can't breath for its self anymore and so it allows us to do the breathing for the person. His heart rate turns out not to be so bad- it's 110, which is about normal for someone having an asthma attack. (Kinda bad woulda been much much faster that, 140 or 160 but really really bad woulda been slow, anything below 70 would signal him sliding straight down the drain at any second.) His oxygen saturation is crap though. That's the percent of o2 that's gettin to his blood. It's normally %97-%100. Someone struggling to breath might be down to %80something and we'd be pretty concerned. This kid's is %54.<br />
<br />
Mike opens his mouth to intubate but the boy is clenched up. It means he still has some fight in him, but still...I take a quick look to see if there's an IV to be gotten, but he's large and nothing popping up. The moment to move has come. The first lines of medicine are onboard, the oxygen is flowing. Stay and play is over. I put on the machine gun scatter siren and blast off to St Johns, giving the notification breahtlessly as I go ("13 year old...male...(pant pant)...imminent respiratory arrest...(pant pant)...vital signs are as follow...(pant pant)) and make it there in 2 minutes flat. Mike has popped an IV and some more meds in on the way, bless his soul. I can tell the epi has done its thing before i even get out of the driver's seat- the kid is coughing and crying. People who are about to code don't cry. He's moving air. I hop out and by the time we roll him inside Little Big Man is actually talking, almost in complete sentences. "Jesus Christ!" he pants. "I almost fuckin' died!!"DanielJosehttp://www.blogger.com/profile/16558473147204256350noreply@blogger.com1