view from the crossroads of life & death

A HUGE DUDE LOSES HIS CHIN AND HIS SHIT

2012-01-11T17:29:00.000-08:00

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.
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!?!"
I pulled over the ambulance.
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!"
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.
"Just lie down, buddy," one of the cops said.
"REALLY THOUGH? WHAT THE-"
'Lie down!"
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.
Fuck it, my partner said, unimpressed. Just roll carefully.
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.
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?
I let him answer that question himself.

ON BALANCE & COMPASSION

2012-01-01T17:27:00.000-08:00

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.
WHY, he demanded, HAVE YOU BEEN IN THE ER FOR SO LONG!?
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.
WHAT EXACTLY IS SO IMPORTANT THAT YOU HAVE TO BE IN THE ER FOR FORTY MINUTES?!
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.
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.

ARE YOU GOING TO ANSWER MY QUESTION?! OR SHOULD I JUST GO AHEAD AND WRITE YOU UP RIGHT NOW!?
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.

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.

WHO HEALS THE HEALERS? Notes On Trauma & Child Sex Abuse

2011-11-23T13:52:00.000-08:00

* * * * 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. * * * *

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.

I've written on this blog and at The Rejectionist 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.

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.

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.

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.

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.
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
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.

NOTES ON ENABLING & A COMPLICATED EXTRACTION

2011-11-14T16:00:00.000-08:00

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.
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.
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.

ANYWAY, that's not what I'm here to talk about today.
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?"
And we were like *nod nod* "No."
But he was unfazed, dude just rambled along regardless.
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.
"The stretcher can only hold 400 pounds."
"Oh! Well she's about 475 so..." He looked at us like the explanation was obvious.
We looked at him like O_O
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??"
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.
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.

CALM THE #%&*! DOWN

2011-08-14T11:05:00.000-07:00

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...)

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.

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.
This lady we had last week (betweeen the 2 arrests I blogged about previously) was already at that point when we got there.
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.
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.
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.
She'll stab you before you get the first strap on, I mutter beneath her screeches.
that may be true, he says, putting the mask down.
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.
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.
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.
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.
I put the daughter on keep-her-calm duty and we zip off to the hospital.

THIS WEEK IN DEAD PEOPLE

2011-08-08T08:24:00.000-07:00

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.
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.

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.

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.
It's possible that I said "Where's the dead guy? Oh." But I can't confirm that.
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.

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.

Then some lady called us because her back had been hurting for like 18 years and she just couldn't take it anymore.

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.
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.
"Pulse!" the EMT yells. "Strong one!"
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.
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.

STAKING OUT A POTENTIALLY DEAD GUY'S DOOR

2011-07-08T16:01:00.000-07:00

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.

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.
-We knocked on Apahtment A and they said they didn't call.
Okay, I say, well we have to...
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'.

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.

We wait some more.

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.

GUEST BLOG!

2011-07-05T22:06:00.000-07:00

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: http://www.therejectionist.com/2011/07/special-guest-post-daniel-jose-older.html drop by and leave a comment! :)

3RD PARTY CALLER NOT ONSCENE

2011-06-11T18:56:00.000-07:00

I 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.
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.

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.
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.
-i can give you the last four digits of the number you need, the dispatcher tells me helpfully.
How bout you go ahead and give me all ten?
-Oh, I don't know them.
There was a pause then as a million unfathomable curses swung through my head.
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.
-But I can tell you the first six numbers are the same as the ones you just called for the Brooklyn board.
what. numbers. are. they?
-Oh! I don't know. Whatever you called!
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.
"We have a cardiac arrest and we need backup..."
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.

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.

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.

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.
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.
And that's that.
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.

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.

GO TO PRISON OR DON'T SAVE YOUR BUDDY

2011-04-17T21:29:00.000-07:00

Ok, that's not a real choice anyone should ever have to make.
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.
Let me explain:
I was speaking on a panel this weekend for the Audre Lorde Project's 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.

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?"

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.
"Uh," the friend yammers. "I mean, some beer and some weed, that's like it really."
The thing about a heroine OD that's awesome is we have this drug narcan that I've already blogged quite a bit about 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.
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.

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.

TO TUBE OR NOT TO TUBE

2011-04-12T10:32:00.000-07:00

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.

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.

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.

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 vagus nerve, 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.

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.
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).
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.

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.

BEYOND MANNING UP: An NYC Paramedic Speaks Out About Men's Violence Against Women

2011-03-08T12:03:00.000-08:00

When 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.

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.

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.'

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.

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:

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.
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.

¡ECLAMPSIA!

2011-02-15T22:32:00.000-08:00

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!"

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.

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.)

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.

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.
"Wait!"
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?"
"I did!" I had!
"Oh! I didn't hear you. And I figured my partner'da given me the story." She hadn't.
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.
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.
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.
"But..."
SIT.
he does.
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.

STUCK: A Long Night In The Ambulance During Snowpocalypse 2011

2011-01-26T21:38:00.000-08:00

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.

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.
Are you short of breath now?
No! Ze wind she is not blowing!
Do you want to go to the hospital?
But of course! I could not breathe!
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.
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.
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.
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.
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.
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.

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.

I think the first time I saw a plow it was after midnight, and- surprise surprise, it was stuck.
I slept from dawn till 8 when some firefighters trudged up to our happy little embankment and informed us that we were stuck.
Oh crap really?
Looks like it.
Well gee.
You got a supervisor you can call or somethin'?
...
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.
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.

Made it to bed sometime that afternoon and woke up to hear the Mayor blaming EMS for our shoddy response time.

OFF DUTY

2011-01-24T19:23:00.000-08:00

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...).
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!")

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.
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.
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.
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.
Without all that, i felt naked.
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.

STAT EP

2010-12-15T08:06:00.000-08:00

Seizures suck.
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 here.)

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?
"ABTHOLUTELY!!"
The Vodka?
"YETH!"
Are you sure?
"ABTHOLUTELY!!"
Ok.
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.

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.
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.
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.
"What's wrong?"
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!"
"What happened?"
"STRETCHER!! NOW!!"
Partner disappears and shows up not with the stretcher but with...an oxygen tank.
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.

WEIRD LITTLE RUNNING GUY RUNS OFF

2010-10-18T19:53:00.000-07:00

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, when we arrive, runs up a flight and is gone the second we arrive. The guy running the place comes over looking exhausted.
"This guys acting fucking crazy!"
"Sir...this is a psychiatric facility, correct?"
(I shouldn't even need to have this conversation)
"Yes, but he's really acting bonkers man! He might set the place on fire or something."
It's amazing how two people can create total chaos all by themselves.
"We don't chase people," I say, putting down my bags and sitting my Cuban ass in a chair.

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.
"I think he took too much of his meds," the stressed out guy in charge tells me.
"You don't mean too few?"
"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!"
Again...ah forget it.
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.
"There goes your guy," I tell the supervisor. He turns around and runs out the door too. I put some gum in my mouth.
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.

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."
I tell him in Spanish he gotta go to the hospital, get on the ambulance right now.
He curses out all of us, all our mothers, all our sisters, all that we hold sacred but sheepishly complies.
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.
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.

NOTSOMUCH: The Truth About Black On White Crime

2010-07-20T14:44:00.000-07:00

I 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.

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."

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.

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 Iman Morales, 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.
And then there's the entire 81st Precinct, who's institutionalized racism was recently unveiled by a defecting whistleblower and thoroughly detailed here.

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.

ON EFFING UP

2010-07-15T22:39:00.000-07:00

One 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.
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.
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.
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.
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.

Until we realized we'd given the wrong sedative.
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.
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."

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.

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.

End rant.

THE MOST SKEEVED OUT I'VE EVER BEEN

2010-06-30T23:17:00.000-07:00

I was gonna write about death again- but I do that (...reading back over old posts..) A LOT o_O
so instead I'll talk about um...oh crap this ones about death too but whatever...THE MOST SKEEVED OUT I'VE EVER BEEN.

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.
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.
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.

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.
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.

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.

WE ALMOST LOSE A KID

2010-06-23T18:23:00.000-07:00

One of the biggest decisions a medic has to make is Grab-n-Go or Stay-n-Play.
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.
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.

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.

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.
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.

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.

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!!"

LEMME JUST TAKE THIS CALL

2010-06-22T13:43:00.000-07:00

I guess if I'd been shot twice in the face there'd be some people I'd like to call too, but if the paramedic told me to lay down and stop moving that's what I'd do. Not this dude. This dude is too busy cursing someone out on the other line and swatting off the EMTs while they try and fit a c-collar on him.
I hop on the bus and put on my I'm-not-kidding voice: "Sir, you have 3 bullet holes in your face. That means 2 went in and only 1 came out, so there's a bullet rattling around somewhere and if you move too much it very well might dislodge and end up in your brain."
"But..."
"And then you'll be dead."
He relents and lays onto the board, lookng irritated at me . (I'm not the one that shot him...whatever...) the emts collar him up and strap him down and I yell to the driver to take a not-2-crazy ride to King's County. If you don't say that you end up hitting a bump at mach 7 and all kindsa mess can ensue. Especially because when the ambulance roars off me and my partner grab the biggest needles we can find and start poking the patient with 'em. To get the IV of course- not cuz he's being difficult.

The first bullet entered the ridge of his cheek bone just below the eye, transversed his face somewhere between his eyes and nose and exited through the opposite cheek. The second bullet entered slightly lower than the first and is who-knows-where. Miraculously, the dude's vital signs are all stable, he's mentating perfectly well and the only bleeding is a little clottiness around his nose. Still...trauma patients and kids (see next post) can look perfectly fine one second and die the next, so we keep a steady eye on him.
Before we get to County he swears he doesn't know who shot him, gives a false name and fields two more curse-laden phone calls.

In 2 Ze Bone!

2010-05-28T22:52:00.000-07:00

Been on a little blog vacation- ok a bigass 1 actually- while i concentrate on some fiction but it's a slow ass night 2night and may actually have a second to knock 1 out.

I can't remember if I've been over the criteria for True Death on here yet, but anyway it bares repeating cuz it's morbidly fascinating and that is the theme of this blog.
If you die, the job gets entered into the system as a CARDIAC ARREST, which just means your heart stopped. Doens't matter if it happened today, yesterday or 12 years ago, you still have to get evaluated and pronounced and/or worked up by EMS. The other day we had a dude that died in a shelter, got pronounced by EMS cuz he was QUITE dead but never got picked up by the morgue so 3 hrs later they put the job back in the system hoping to get the ME guys 2 show up and take the body but got us instead. The bunk room was cleared out, all the guy's roomates standin irritably off to the side waiting to get back to bed, and lo and behold the dude was still dead- it was a guy I've had several times as a patient actually, a real ornery cat that always refused 2 go to the hospital no matter how messed up he was. There was nothing to do, because we don't take bodies to the morgue (usedto though) so we got back in the truck and went our way, much to everyone's disappointment.

Anyway, what is the criteria for being SO completely dead that we don't even go through the motions of trying to bring you back? There's 5:
Rigor Mortis, which is when the body becomes rigid, usually several hours after death.
Dependent Lividity, which is the pooling of the blood at the lowest point of your body and basically looks like a huge grimy stain.
Decomposition, which is....gross. And you can usually smell from a block away.
Obvious Death, which covers everything from splattered across the pavement to decapitation.
And having a Do Not Resuscitate Order, which doesn't happen nearly enough, in this medics opinion.

If you don't meet any of those criteria, we're gonna be intubting you, putting an IV in with load of medications and possibly shocking you and dragging you to a hospital while some grumpy fireman pumps on your chest. This lady we had the other day didn't fit any of the criteria BUT she was quite large and didn't have any available IV access. When you have a cardiac arrest with no kinda veins to put your meds in2 there is now one other option: the bone.

Right below the knee cap there is a flat plateau along the humerus. I place my fingers along it, pushing through layers of fat and muscle until I'm sure I have the spot. Lather it up with an alcohol swab and place the tip of a largeass needle against it, my hand gripping the blue plastic handle. Around me, the typical cardiac arrest chaos is swirling- partner intubating, EMTs sweating as they bounce up and down on that chest, nursing home attendants blabbering about how they just saw the patient a few minutes ago and everything was fine, lieutenant gazing at the lovely trees outside the window... I push the needle into the flesh, twisting in a screwdriver motion as I go. It slides in without much resistance till i reach the bone, then i have to push harder, put some back in2 it before the satisfying (yes I said satisfying) POP! comes and I know I'm in. The needle has entered the marrow. I pull out the needle, leaving the catheter in place and attach up the IV line, adjusting the flush to gush full blast, which will push fluid through to the bloodstream and give us the access we need to get medications on board.

We push our meds and when there's no response from the patient make a phonecall to our medical control doctors to get a Time of Death. We're wheeling the empty stretcher out towards the elevators when the lieutenant looks up from her window gazing: "You guys think that tree out there is fake? It's so pretty!"

DANCING W/ DEATH

2010-02-19T00:47:00.000-08:00

I'm a little tipsy right now, which seems like the best time 2 write a blog about death.
Imma also tryn write this as quickly as humanly possible with minimal thinking involved cuz i suspect that if I even slightly overthink it, the shit'll come out all crapademic and corny.

Death isn't the tragedy, from where we stand, its the perpetual slow state of constantly dying that really sucks. I'll tryn explain:
I usedta work Transports- that's as opposed to 911. Transports means ur bussing the same sick and dying folks back and forth day in and day out btwn nursing homes, dialysis centers, crappy little apartments, ICU units...watching limbs rot off one by one, mental statuses decrease into total vegetation. THAT shit, is depressing.
It's also the polar opposite of 'Emergency,' which is why most of us got in2 the field, to deal w/ emergencies, right? Right.
We're good w/ the acute: u about having a heartattack? we got nitro to spread those veins open and keep the blood flowing. Not breathing? Here's a tube and some oxygen to keep things moving.
In 911, things move fast. Within a 45 min job, a patient can go from about to die to dead to back alive and kicking to dead again. Or vice versa. And that's when we are most alive, jumping in and out of protocols, stepping back to assess and reassess, checking in w/ each other, staying light on our feet, planning thinking moving working...
What it comes down 2 is this: Trauma lives in the body. They say it again and again in all the books and lectures, but what does that really mean? It means that when your body is all up in that trauma, when you are literally entwined with the heart and lungs of the patient, connecting IVs to veins and plotting exit strategies and busting ass to hospitals, the experience of someone else's effed up situation is completely different than when u are walking by, helplessly witnessing it.

This is why we sleep at night. Because whether the patient makes it thru ok, ends up a vegetable for life or dies completely, we have played our part, added our small piece to the puzzle of their survival, with the knowledge that we do what we do and the rest is in God's hands.

THE WANDERER

2010-02-09T20:22:00.000-08:00

She’s 42, passed out on the floor in her own vomit and barely breathing.
Damn seems like all my blogs start this way…I have one about to happen about dealing w/ trauma and death on the job but interesting shit keeps happening, so that’ll be next weeks…
Annnnyway: she’s 42, etc etc etc has no medical problems and no signs of trauma. According to her husband, she just took a pain medication from the Dominican Republic- some ish I never heard of- felt itchy, groggy, puked, passed out. The itchiness speaks to an allergic reaction and the pain meds speak to a possible overdose; both could cause vomiting, syncope and respiratory arrest, but neither is a sure shot answer. First of all she’s not covered in hives, in fact there’s none at all to be seen. It doesn’t sound like she took enough to OD though, unless she had something else on board, which the husband swears up and down that she doesn’t. So, the EMTs are giving her ventilations, my partner sets up his tube and I get the IV ready. On our EKG monitor she’s a normal rhythm at a healthy 60 beats a minute, she’s breathing intermittently, only barely, and occasionally moaning and writhing.
You don’t see the best veins for sticking a needle in, you feel them. They bounce gently against your finger in a way normal skin doesn’t. When you have a somewhat plump arm that’s not showing you anything vein-wise, you’re usually better off going by touch. If you know the body you know where to look: usually at the little depressed area along the wrist, just below the thumb or on the reverse side of the elbow are the best spots. On a really tough one, sometimes you can get lucky with a little veins swirling around the knuckles. This lady’s got some flesh to her, but my finger bounces off a nice one running along her forearm and the needle goes in with no trouble.
I push 2 mg of narcan, which will block her opiate receptors and break her out of an OD. The EMT tells us he can’t hear her blood pressure so I hang a large bag of fluid, run the line through and attach it to her IV. At this point, my partner decides to intubate. I’ll be honest, it wasn’t the move I woulda made. It wasn’t wrong either- she was only barely breathing and she had vomited so her airway was definitely compromised, and the best way to secure a compromised airway is to put a tube in it. On the other hand, the EMTs were moving pretty good air into her with the ventilations and most of all, when they tried to put in the plastic piece that slides into your throat to help the air in, the patient gagged. If she gagged on a little piece of plastic at the base of her tongue she was def gonna gag at a tube reaching all the way into her lungs. Also, if she was an OD, the narcan will bounce her out, and the last thing you want to do is wake up in withdrawal, puking and with a tube down your throat.
She gags on the tube, pukes again and then her heart rate drops from 60 to 50 to 40.
“Shit.”
The EMTs go back to giving ventilations. Her oxygen saturation is fairly high but she still has no pressure and now her heart is waaaaaay too slow. I push an amp of pure sugar into her, just in case she’s a secret diabetic or somehow dropped her glucose level, and then some more narcan. Nothing’s working. Generally, when young, healthy people’s heart rate’s start spiraling down its because of a respiratory issue, but also from stimulation of certain nerves, which I’ll get into in a minute. As long as there’s no underlying situation keeping their rate low, a few minutes of good solid ventilations should bring them up to speed, with or without a tube.

We start packaging to get moving, keeping an eye on the monitor. She slips up to 48, 52 and then falls back to 44. We musta looked like we were watching a sports game, the way our eyes followed those numbers on the EKG. My partner and the Lt on scene wanted to push atropine, a drug that suppresses the body’s ability to slow its heart but I wanted to give another minute or two to let her resolve herself before we shoved any more drugs in her. Atropine’s no joke, and if you give it too slowly it can actually do the reverse of what it’s supposed to and drop her heartrate even further, which would definitely kill her. I drew up the medication to have it ready, we lifted her up to the stretcher, explained the situation to the husband, sent someone to call the elevator up for us so everything was ready.
Her rate evened out at 42. I pushed .5 mg of atropine (quickly) and stepped back. Nothing happened. Then it went up to 50. Then 54. Long as it stays over 60 its ok w/ me. 58. Then 64. We all let out a sigh of relief and start wheeling her out. 68. In the elevator, the rate stays a steady 70 and our lady opens her eyes and pushes the oxygen mask out of her face irritably. In the bus, she tells us her name. By the time we in the ER she’s more concerned with how her husband will get home from St Lukes then the fact that she just basically died and came back.
“I was with it the whole time,” she tells me. “Praying. I could hear everything you were saying. I just couldn’t speak. I just prayed to the Holy Spirit to keep me around.”
So: wtf happened? I’ll tell you what I think.
There’s this nerve that runs from your brain down behind your eyes, past the back of your throat and into your heart. Because of its long, winding path, they call it the vagus nerve (as in vagabond, wanderer, vague, vagrant) . The vagus nerve slows your shit down. When you yawn you stimulate it, but most notably, and this usually happens to the elderly, when you bear down, like when dropping a deuce, you stimulate that thing like crazy. It’s called a vaso-vagal response and is responsible 99% of old people that we find unconscious on the can- they bare down, trigger the vagus nerve, slow their heart which drops their blood pressure and they pass out.
Probably, our lady had a mild allergic reaction to the painkiller, which caused the itchiness and nausea. She vomited, vaso-vagaling herself out. When the EMTs arrived and put the plastic piece in to keep her airway open, she gagged, stimulating the vagus even more. Then the tube added insult to injury, PLUS the painkiller may have already been boosting her parasympathetic system, which keeps everything depressed. The result: respiratory arrest, no blood pressure, unconsciousness, low heart rate.
Of course, it’s easy after the fact, when husbands and lieutenants aren’t running around screaming and women aren’t not-breathing on the ground in puke, to see all that clearly. What the job presented, much like the dude last week who coded, was a fluid, ever-changing situation. As a medic you’re constantly weighing what your options are, what the consequences of each one is vs the consequences of inaction. There’s a million different subtleties in between over-aggressive treatment and doing nothing, and somewhere in there is the path to reversing an imminent cardiac arrest. In situations like these, when there’s no one clear pathology or treatment plan, it takes a cautious trial and error to proceed, which sounds iffy from the outside but ultimately saved this woman’s life.

SUDDEN DEATH

2010-01-29T22:50:00.000-08:00

The guy is almost fifty, skinny and white, tatted up w/ Buddhas and Asian letters and all in all has the general affect of an angry teenage hipster. He’s squirming and whining, and I’ll be honest, truly irritating the shit outta me and my partner. There’s a younger Asian girl there that he’s bossing around and that’s grating me even more. Also: there’s nothing apparently wrong with him. His pressure’s 158/90 his pulse is 70, he’s breathing regular, has no chest pain, no signs of trauma, hasn’t been pissing blood or puking excessively. Nothing. That much is fine, we get patients w/ nothing wrong with em all the time. But this dude won’t sit up. Then when he does he’s slouched over so we can’t get the EKG on him properly. Then he wants to put his feet up even tho he’s in a chair and clearly can’t.
We being calm, mind you. The curseout I had waiting in the wings remained lodged in the back of my throat, even when the guy decides to lay down on the floor and starts grabbing my partner’s arm and screaming “Why won’t you give my something for my legs!? My legs are tingly! I don’t understand why you won’t help me!”

I was sharp w/ him, as I pried his hand from Mr. C, but I kept it basically cool. We lift him up, put him on our chair and cart him out. The Asian chick looks anxiously after us but doesn’t come with.

Ok. Reassessing as we wait for the elevator: he has no medical problems, no allergies, takes no meds. Has no complaint of pain beyond his legs feeling funny, but he clearly feels it when we pinch him to make sure there’s no nerve damage. He’s moaning still. When we told him we don’t give anything for funny leg feelings he apparently ignored us, cause he’s still asking for something. He denies any drug use, not sure if I believe him or not, but he’s alert, oriented to where and who he is, knows his birthday, etc and his pupils are normal.

Something happens between the elevator and the ambulance. It’s a subtle thing, very hard to describe if you’ve never seen it, but at some point, a small change in his body motion sets off little alarms in me. I can tell Mr. C sees it too, the way he eyeing the patient and then looking back at me. The guy’s still talking but his motion is more sporadic. His arms just flop loosely up in the air every couple seconds like he’s a marionette being jerked around by some sadistic puppeteer.

When we lift him from chair to stretcher there’s no question something’s wrong. He has enough energy to grab my arm and make it more difficult to move him, but that’s about it. And he’s talking less. When people who won’t shut up suddenly shut up you need to pay attention- (unlike the non-asthma attack having lady who was so busy cursing us out we couldn’t listen to her lungs, but we didn’t have2 anyway, cuz if you can curse us out w/out taking a breath for five min straight you aint having an asthma attack…)

At this point, I’m thinking hemorrhagic stroke and I’ll tell you why: The typical stroke, the one they tell you about in all those PSAs with the droopy one side of your face and slurred speech and can’t raise one hand- that presentation is more commonly for what’s called an ischemic stroke . Basically, a bloodclot is cutting off flow to one part of the brain, much like the way a heart attack works. But when the blood vessel bursts, either from trauma or high pressure or whathaveyou, its called a hemorrhagic stroke and you’re head fills up with fluid, increasing your intcranial pressure sometimes to the point that the brain tries to escape through the hole at the bottom of your skull. These kinda strokes don’t often look like the other kind: the pressure doesn’t neccesarily go as high until later on, there isn’t always one sided weakness and one thing I’ve noticed time and again with these, the patient won’t slur their speech so much as speak in tongues. It’s like the way a baby will talk utter gibberish but with total conviction, and they look like they think they really saying something that makes sense, but they just saying “Blarga blarga blorp blaa! Blarg! Blegh!” and so on. And they get irritable. Now this isn’t all that different from the way certain people look when they drunk or hopped up on some bullshit, mind you, and so it’s easy to miss. (Diabetics when their sugar drops tend to moan more and are usually sweaty and cool to the touch.) The only difference is that certain something, a kind of lethargy that takes over that is really a grim late sign- the body is giving up.

When we load him into the ambulance he’s pale as shit, still mumbling and squirming but looking otherwise very corpselike. I take a blood pressure while Mr C drops a line. Well- I try- but there’s nothing to hear. A very late sign. The last thing I notice before I slam the back doors closed is his respirtations- his body can’t be troubled to open his mouth any more, so they come out in a rude snoring kind of way, all spittely and loud.

I jump in the front, let the hospital know we comin and blast off down Dekalb. When I open the back in the ER bay Mr C says: How fast can you set up my tube? And indeed, I see the patient has stopped breathing. His heart rate has dropped down to 40. I jump in the back, pull out the tube kit, throw him the laryngescope, which he uses to hold open the guy’s jaw and get a look at those vocal cords. I screw the syringe onto the little attachment on the tube and pass that over as the heart rate dips down to 20.

“Uh…tube quick he’s checking out.”

But Mr. C is no fucking joke with a tube, before I can count to 10 he’s slid the thing in, confirmed it with the stethoscope and I’m passing him the platic device that holds it in place. The heartrate slides back up to 50, then 70. “Ok, we straight,” he says, but then the lines on the EKG go all squiggly. “He’s in V-fib,” I say, going for the pads and thinking if this dude takes one more damn turn for the worse… Before I get a chance to put the pads on the rhythm straightens out back to 50 and then starts dropping.

We load him out the bus and hustle him into the ER, yelling out the presentation to the docs as we go. His heart’s at 20 when we wheel him in and stops completely as we reach the crash room, where they work him up for another half hour before pronouncing him dead.

Ok, a couple things w/ this job:

It startled the shit outta me. I’ll be honest- it didn’t really bother me so much as it just caught us off guard. In the end we moved with what happened, didn’t get caught up in the tunnel vision and what it started out as vs what it became. It was definitely a solid reminder to stay flexible: even when something looks, smells and sounds in every way like a basic bs anxiety attack, some real shit can be lurking.

Was there anything we could’ve done to stop what happened? Nope not at all. What this dude had going on was beyond anyone’s capacity to stop. He didn’t show any hints to what might’ve been going on before he started crashing and once he did it was waaaay to late to stop. Plus, we have nothing with us that would’ve stopped it.

Sometime I’ll blog about dealing with death on this job, but that’s for another day.

A FAT GUY DAMN NEAR DIES

2010-01-02T20:32:00.000-08:00

Some jobs you walk in and know exactly whats goinon and what’s gonna happen next and all the things you’re gonna haveta do etc etc. You can see the whole thing wind out in front of you like a damn roadmap, and you quickly fall into the rhythm and BAM it’s over before you know it.
This wasn’t one of those jobs.
A bigass dude, and I don’t mean big boned (all though he was that too) but Large and In Charge, looking a little worried and breathing kinda heavy. Our guy’s sitting on his bed in what’s called tripod position, leaning forward with his hands on his knees, puffing in and out like he just spent 20 minutes underwater. Still, I’ve seen much worse and he’s not blue, not lethargic, not gasping. At this point, could be a anxiety attack, a mellow dramatic head cold or a bad breakup.
He’s only 34 but has an enlarged heart- damn near the size of my head, the x ray later reveals- and i literally coulda crawled into his belly and taken a nap it was so effin huge, probably from the excess fluid buildup from his backed up heart.
When your ventricles are that gigantoid, they don’t work right. Sometimes they work so asscrappily that the blood doesn’t fully make it out and stays backed up, which causes the bodywide puffiness. That’s when the right ventricle backs up. When the left one goes the fluid ends up in your lungs, and that’s when you start drowning in yourself.
Neither of this dude’s ventricles were working well. You could hear the excess blood lapping up against his lungwalls, a rising inner tide.

Jumped into action. Checked his ekg (predictably fast but otherwise ok), found a vein and put an IV in. Put some nitroglycerin under his tongue to open up those tightly clenched blood vessels, lower that pressure some and get the blood flowing. Got ready to move.
Now there’s something bout moving patients that completely fucks em up. Even a relatively stable patient that we’re literally lifting up to put on the chair and carrying the whole way, no exertion whatsoever, can still end up like 5 degrees more effed up by the time you get em on the ambulance. It’s just the stress of moving, being moved, I suppose, plus the sudden rush of cold air when they get outside never helps. But it’s something you count on, so especially when it’s a dude like this, you treat a little aggressive before you move just to pre-empt the inevitable decline.
The problem was, this dude was getting worse and worse even before we started moving him. His mild discomfort had blossomed into a full blown freak out, which was causing him to stress his already taxed heart even more. The fluid was rising steadily higher and higher with each passing moment. My partner and i were doing the everything’s cool routine, without lying to him about what ws going on mind you, I’m just sayin we weren’t panicked, but there was no mistaking how fast we were moving. Dude was agitated.
So we get em on the chair but when I tell you I was eyeing it to see if it’d give out…Anyway, the other problem was that he lived DOWNstairs, which meant we were gonna havta heave him UP ‘em to get out. Plus he was in some weird basement complex, so we had 2 wind our way through a weird atrium, back into a building, over cracks and bumps and through a little tunnel b4 reaching the stairwell. And lemme tell you: the only thing worse than lugging hugeness is lugging hugeness that is freaking the fuck out and about to code. By the Grace of God we got to the stairs and then I swear it was like some serious epic shit, every single step. I was on the top part, yelling in Spanish at the patient “Tranquilo, papa, ¡calmate coño!” and a cop had the bottom bar, and he was just lookn copconfused and sweating. We heavehoe’d each step, letting out some real Neanderthal-ass grunts and there was a couple times i really didn’t think it was gonna happen but it did and we loaded him up in the bus and reassessed.
He was still bad, flopping and flailing bad, but not quite as bad as he coulda been. We’d pushed lasix earlier, which drains you out and makes you haveta pee something mean, and a few more nitros were working their way thru his system. My guess was that he’d make it (he did). Hopped in front, came up on the radio to let the hospital know were coming and what we had, drove the fuck off in a blur of blasting sirens and flashing lights.

DAPPER OLD DUDES GET DRESSED

2009-12-16T01:28:00.000-08:00

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

GRAVEYARD WALTZ

2009-11-30T12:31:00.000-08:00

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

http://tinyurl.com/yact6yy

BUSY WEEK ON THE BUS

2009-11-19T11:56:00.001-08:00

MOOD: slightly tipsy, it’s true

MUSIC: Erykah Badu

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

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

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

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

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

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

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

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

How much?

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

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

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

Damn.

“Yeah, son.”

Hungry?

“You have no idea.”

Chest pain?

“Nah. I was just…you know.”

You just want somewhere to take a nap.

“Basically.”

No problem.

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

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

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

Our guy stays quite stable throughout transport.

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

THE SINGING HEART ATTACK

2009-11-07T20:44:00.001-08:00

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

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

THE GREAT ACID RAIN STINK BALL of 1995

2009-11-01T01:15:00.000-07:00

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

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

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

ON WRITING 1: Just Tell The eFfin' Story

2009-10-21T20:34:00.001-07:00

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

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

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

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

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

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

Which is what writing is all about.

TOO LITTLE TOO LATE

2009-10-10T18:12:00.000-07:00

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

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

what’s weird?

My whole left side of my body!

Does it hurt?

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

How long it’s been going on?

Since the day before yesterday…

Anything else wrong?

Yeah, when I poop: blood comes out…

Oh boy…how long THAT been going on??

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

What the hell happened the day before yesterday?

I fell down the stairs.

How many stairs you fell down?

Shit…all of ‘em.

…And you’ve been shitting blood ever since?

Yep.

And you can’t feel half your body?

Uh huh. You think Imma be alright?

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

So you think I should go to the hospital?

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

Sigh….okay let’s go…

That is all.

2 CRAZY GERIS

2009-10-04T21:07:00.000-07:00

TWO CRAZY GERIS

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

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

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

Me: Get in!

SIM: My neck feels funny…

Me: Get in the bus. We talk inside.

::::he gets in::::

Me: What hurts?

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

Me: for how long?

SIM: Like, 2 weeks, guey.

Me (to my partner): Go go go!

:::ambulance screeches off::::

And then, sometimes we actually get home on time.

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

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

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

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

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

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

But without her tea it was a no go.

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

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

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

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

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

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

…yes. Yes feel alright.

The apartment was dusty and mostly empty.

-Do you wanna go to the hospital?

-Yes…Yes I think I do.

Ok…Any pain anywhere? Any trouble breathing?

No. None at all.

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

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

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

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

He passed me the phone to hangup.

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

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

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

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

BLEED IN BLEED OUT

2009-09-12T19:36:00.000-07:00

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

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

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

nope.

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

What were you eating?

“Cherry ice cream with beets and ketchup.”

Hmmmm.

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

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

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

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

STAND UP SIT DOWN LIE DOWN DIE

2009-09-08T22:13:00.000-07:00

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

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

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

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

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

-Go head with your notification, 12xray.

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

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

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

He didn’t make it through the night tho.

KER-SPLAT

2009-09-05T18:33:00.001-07:00

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

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

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

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

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

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

“ow.”

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

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

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

THE MISSING BULLET

2009-08-29T18:42:00.001-07:00

But first:

ME: What’s the trouble today young lady?

PT: I’m bleeding…from my vagina.

ME: Um…this has happened before ever?

PT: Yes! A month ago actually!

…

True story.

ANYWAY:

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

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

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

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

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

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

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

CLUSTERFUCK 1

2009-06-09T21:52:00.000-07:00

MAKE MY FUNK THE…

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

CLUSTERFUCK #1

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

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

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

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

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

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

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

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

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

2009-03-31T20:58:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

5 Flights or Patriarchal Dumbassery Claims Another Victim

2009-03-31T20:57:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

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

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

EMS WTF FAQ

2009-03-31T20:55:00.000-07:00

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

Q: What the hell is EMS anyway?

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

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

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

Q: What’s an EDP?

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

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

Q: Do you really drive the ambulance?

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

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

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

Q: Do people really call for stubbed toes?

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

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

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

And away we went.

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

2009-03-31T20:52:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Ungrateful Suicide

2009-03-31T20:51:00.000-07:00

Saturday Night. Gentrification has created these weird pockets of extreme wealth in that ambiguous part of town where Bed-Stuy and Prospect Heights overlap. Me and C wind our way through the corridors of some converted warehouse. It’s dim and dank and smells funny until we step suddenly into an ornately decorated apartment with frilly columns, oriental rugs and wall-to-wall theater memorabilia. A distraught, exhausted middle-aged woman ushers us into the bedroom where we find cops and volunteer EMTs swarming around a fat white male, obtunded like a goddamn beached whale and not breathing on the floor beside his king-sized bed.

My partner C was here last time this guy tried this, and he’s asking the wife what our patient took tonight but she won’t say. The EMTs get the bag-valve mask on to giving him respirations and I’m driving tonight, so i set up the IV while C gets down to where the patient is and starts looking for a vein. The guy’s teenage son is coming in and out, I’m trying to get a coherent story while squeezing saline into lines and ripping open plastic bags, but all we can get is that the guy was drinking all night, has been depressed, has tried this before, etc etc. There’s a not that says “Dear so-n-so i love you and i’m sorry’ and then it’s all garbly chicken scratch. PD was here a few months back cuz our man locked himself in a room with a gun (a BARRICADED EDP- more on that some other time…). He’s h e a v y like you wouldn’t believe and out like a pile a rocks. I pass C the tourniquet, then the catheter (a smallish one, cuz the fellow’s fat so he’s a tougher stick and there’s no reason for anything big), and when he reports that he’s in i hand over the iv lock and a flush of saline water along with the stickies to hold it on.

The pupils are pinpoint and his respirations are still almost none, so we have good reason to suspect a narcotics overdose. I pass C a needle with 2 mg of narcan- a medication so notorious in the heroin circles all you have to do is mention it and many addicts will come jumping out of their stupor just to beg you not to give it. Basically, it blocks all the opiate receptors in your body and completely and utterly deprives of you of any possible high you mighta had. Then, you go into instant withdrawal which can mean anything from extreme irritability to severe hibijibis to simultaneous shitting and vomiting to seizures. That’s why, to avoid prolonged cleanup/resuscitation sessions, narcan is best given a) in small polite doses and b) no more than two seconds before the patient gets moved out of the ambulance and into the er.

The Dreaded Narcan...

But a suicide is a horse of a slightly different color than a typical addict OD, especially when the guy is HUGE, has taken unknown mountains of unknown narcs and is already pretty far gone. So we drop in the two mgs, enough to make your average user do the shitnpuke right quick, and it doesn’t even touch him. Practically bounces off the guy. He’s still pinpoint, obtunded, not-breathing. A hot mess. And we’re all still wedged into this awkward space between the bed and the wall. I pass C an amp of dextrose, sugar water, in case on top of everything else he happens to be diabetic and hypoglycemic as well, and then another 2 mg of narcan. Then we start packaging to go, cuz he’s still not responding and we’re reaching our limit of options. It takes about five of us to get him, strap him to a board and get him moving. We’ve all carried some fatties, but this guy is solid, dead weight and managed to collapse into a particularly un-reachable corner of the master bedroom. So we heave and ho and finally begin carting him through the windy passage ways back towards the street.

Just before we make it back out I see his arm start to raise up, and slowly he blinks back into consciousness. He looks around groggily. His hands are taped together to keep them from flopping out of the stretcher. He has an iv in him. He’s surrounded by cops and medics. He looks each of us in the eye and says:
”Fuck you guys, why didn’t you leave me the fuck alone…” and then falls grumpily back into his stupor. Then he wakes up again as we loading him up. “Damn you. Damn you all. Motherfuckers…”

What do you say to a dude like this? I mean, none of us are really in it for the thank yous, but shiet- if yer gonna be hufuckingmongous and a big a-hole to boot, yer ass can walk to the ambulance or just keep it to yerself. But in the end, you say nothing. You chuckle. Brush it off and take homeboy to the hospital, where he proceeds to curse out each and every one of the nurses, security guards and techs and then falls back asleep.
And then you go get dinner.

Breaking The Rhythm

2009-03-31T20:46:00.000-07:00

Well- most of you know I spend my nights picking up busted up bronx and brooklynites and taking em to the hospital, but few of you really know what this job is like beyond the stupid stories i tell when drunk, so i thought i'd use this space to give you some idea of the day to day of the job.

Although, as i often say, this work is hardest cuz of just how much junk and non-emergency shit we deal with, really like %90 is total nonsense (from nosebleeds to stubbed toes- possibly the title of my memoir?...nope) but last night, amidst allllll that bullshit, my partner and i caught one of those few calls where we paramedics really get to actually do something that makes a damn difference to someone.

It was 530 am, a rainy dawn in Harlem. Call came in as a "diffbreather," i was sleeping in the stretcher (sooo comfortable...really, and not the bad dream factory you would imagine) and Ortiz was passed out in front, having exhausted all possibilities of online poker. Bleary eyed, we zipped over to an apartment complex on 130th by the FDR, lugged our 40 lbs of equip out the bus and headed up a few flights of stairs.

The dude was about 40, sweating profusely, clutching his chest and struggling to breath. He said this has happened before, his heart goes too fast, he can feel it pounding away in his chest. Far as calls go, this is fairly serious- meaning if left like this, yeah he'll drop in not too long, but probably won't go down in the next 10 seconds. Probably won't, but easily could.

Ortiz is the kinda partner that you can jump into action with and know he's taking care of his end of things without anyone having to speak. I'm taking the blood pressure, he's putting the guy on the monitor for an ekg. Sure enough, the dude's tachying away at 208 times a minute, whereas your heart really should be going between 60 and 100. Going this fast, his heart is not pumping effectively, the chambers aren't filling up fully, system's backing up, oxygen not being distributed well, etc etc until he's dead. And as his heart continues to become hypoxic (oxygen deprived) it can easily jump into any number of even more killuquick rhythms and make ass him out right quick.

Now, I'm getting an IV while Ortiz getting down all the guys info, past medical history, meds, etc.

But first a quick note about Adenosine: that's the drug we gotta use to bring this heart back into normal working order but it's a hardcore mess of a drug- the half life is about 10 seconds, meaning it needs to get where it's going, the heart, QUICK or it won't work at all. This means u gotta get a big needle into a big vein that's as close up the arm and towards the chest as possible and you gotta push the drug in fast and follow it with a big shot of saline to get it all the way thru.

This dude's veins are not big, in fact they're hiding. I finally find a juicy one, pop in the needle but there's no flash back, nothing to tell me i'm in, just empty catheter. And here's one of those cases where u really need that iv in there, not just some just-in-case c.y.a. nonsense. I dig a little, the guy doesn't mind cuz he's really more worried about his crashing heart, prod where the vein once was with my gloved finger, turn to the left a little then right and finally see a dot of dark blood in the chamber, followed by a small flood to confirm it's in. I advance the catheter, pop off the turniquet and connect up the line as Ortiz passes me a bag of saline to link it up with (see what I mean about him- the guy's on point!)

So now we're good, IV in, ready to go, but we still gotta push the shit, hope it works and it feels like everything's taking too long. All the while the guy's moaning in the background as his heart is racing along on the ekg.

I put the syringe of adenosine in the port, give Ortiz a flush of saline that he puts in beside mine. I count to 3, push the shit and he immediately pushes his. Then we step back and watch.

Now the crazy thing about Adenosine is that to work it actually stops your heart and restarts it again. I mean literally, you can watch it on the monitor, and the patient always goes "Oh...oh oh oh oh...ooooooo....uhhh" in some kind of painful/orgasmic dance with death and then let out a big sigh as their heart comes back at a reasonable rate. If it comes back at all... So when we give it we always step back and just kind of watch, ready to either jump into fevered action or grin and chuckle with the dude.

We watch. Still at 208, now 210, 206... he's still hurting. A minute passes with no change. We set up the next dose, 12 mg this time, grumbling slightly to ourselves and wondering if we're gonna end up tubing the dude.
When we're in position I count 3 again and we both push, flushing all that good stuff right down into his troubled heart. For about 30 seconds (seems like forever) he's the same and then:

Supraventricular Tachycardia, a pause, and back to normal...

A pause. He throws a couple ugly looking PVCs, which means the hearts irritable, then it stops dead for a second or two, (dude: "oh...oh oh oh ...uh...) and (sigh...) come back at a very reasonable 124 beats a minute. And he's smiling now. So am I. So is Ortiz, although there's certainly a little edge to both our grins as we pack up our stuff and plop the guy on our stairchair to bring him out.

Dawn's breaking over the east river outside. The morning commute is chugging along the FDR and two trains crisscross on the bridge above. A light rain is falling.

With the vague tingling thrill that comes from finally doing something tremendous and worthwhile after so much crap, we cart our now jovial patient off to our ambulance and away...