Thursday, May 19, 2011

Letter To IT Dept

To: IT Department
From: The person who sent you the fractured laptop with the mocha dripping from the fan vent
Date: Not sure, my interim computer is refusing to show me the calendar
RE: Aforementioned laptop from Hades

Dear IT guys,

Before I go into any great detail I would like to ask a question...
Why is it so blipping hard to reset passwords? I am willing to bet that a great deal of our IT guys’ time is eaten up with hand holding people through the “change the password” process, myself included. Now I am not new to computers, I have been breaking them since I was a kid. I have somewhere around 7 or 8 computers at my house that I personally have broken beyond repair by professionals. In fact they are so thoroughly broken the local garbage transfer station has refused to take any more them. I am proud of this fact. But with all of my knowledge and experience in ruining computers I find myself at a loss with the passwords for the different programs we use at work. I think this is not just workplace problem but possibly even a government conspiracy to keep us under control. Example: As long as I am worrying and dreading about that unholy little message that pops up eighteen times a day and says: “Your password expires in X days. Would you like to change it now?” I am not able to worry about anything else, like the government and how it is ran. Not to mention secretly harboring the sinking feeling that I must be as smart as a fir tree since I can’t seem to figure it out. And let me tell you having the mental capacity of a conifer is not the kind of thing you want to find out in your mid thirties. It’s like a nightmare when it pops up. I break out into a cold sweat and look for the nearest chair or something with which to crush this evil little laptop and its rotating passwords. Seriously, one password requires numbers, another requires no numbers, one has to be in caps, and one can only have some in caps. And don’t forget that they are each and every one on a different schedule of rotation for renewal. A complete series of horror movies could be written about this subject alone.
Okay, to the topic at hand. First you should know that it was an accident, I did not intentionally destroy another work computer. Second, you should be proud because I am a hero, in putting out the fire on the laptop I saved my coworkers, the building and the priceless medical equipment inside. Please do not listen to any reports from the above mentioned coworkers about the fire. They still hold a blame-placing attitude about the situation and are refusing to see how much safer they actually are because of my presence. I expect them to calm down at any moment and let me out of the bathroom without fear of bodily harm. I just wanted to fire off a quick email to you from behind the relative safety of the locked door and beg you for protective sanctuary. And also to explain the unusual circumstances before reports came in from those who do not have all the facts and are over reacting about the very minor burns they received. I blame the whole situation on the constant need to change my passwords.
So please sit back and let me try to paint a picture for you as to why, once again, my laptop is in front of you and why it smells like vanilla caramel coffee creamer and smoke.
I left the house with hot coffee and sunshine, the birds were singing, people were smiling, what a glorious morning. I got to work and had a short wrestling match with the stubborn lock on the door, both hands on the key and both feet on the wall twisting the key until my fingers bled. I still felt glad to be at work at this point, it should be noted. Once the door opened however is when my anxiety started. I encountered my first piece of technology and first password for the day, the alarm system. Now this system is, I am fairly certain, set up by a not so funny prankster at best or denizen of the abyss at worst. At any rate someone with the sole intent of making sure I am wide awake with the ol’ ticker pumping away before work started. It began to alarm the moment the door was opened warning me that I have exactly one second less than I need to make it across the room and enter the correct code before it sends the cops down on me in a blaze of gun fiery, tazing glory. Now try to keep in mind, my key was still stuck in the door lock, the same key that is attached to the lanyard around my neck. So, there I was, stretched out to my maximum possible reach plus two inches, my foot in the air and my longest finger frantically seizing against the keypad. I was acutely aware of the door slowly closing, effectively tightening the noose, er, lanyard, around my windpipe. Only as the world faded to darkness did I hear the satisfying beep of successful password entry. Whew! No cops today, I thought to myself as I gasped for breath and extricated my key from the lock. I was still happy, felt a little frayed, but ready for the day.
After I turned the lights on and sat at my little desk I hit the power button on the laptop and typed in my password. The computer loaded, slowly I might add, and there’s that little bundle of pixilated frustration. “You password will expire in....” (insert creative expletive here) I took a deep breath and a calming sip of coffee, six days and counting to D-day. Please remember that this message telling me to change my password shows up days before the actual day you MUST change it. I also would like to mention that under no circumstances will I willingly change the password early. Not when I know how every attempt at such turns out and will require me to humble myself and beg for help from you all. The anticipation and sense of impending doom gradually builds with each of the twenty six times a day that it darkens the screen of my notebook. So instead I ignored the warning and went about my merry way with this nagging reminder popping up forty two times.
I started the medical reporting software and hit ignore on the “change my password” message yet again. Everything went fine until about thirteen minutes later and I had to log in again. See, after a few minutes of inactivity the medical reporting software logs a person off, to protect patient privacy. This means that several times a day I have to log back in, triggering the password message. That was when I noticed something. It was the same day but now said four days to D-day. My heart skipped a beat and I glanced around suddenly feeling eyes on the back of my head. I will admit that my first thought was that someone from the IT department was messing with my computer in some perverse attempt at getting jollies from my fear. But in retrospect I know that none of you would do this, right?
Each time I logged in after this the number of days dropped by one. By lunch time I was no longer having fun and seriously thinking about telling the boss I was sick and checking into a psychiatric ward to hide until the whole password situation had been resolved. In fact that is a good idea, we should consider adding such a floor to our facility for employees that have had to change their passwords one time too many.
Finally, around mid afternoon it happened, the message telling me that I could no longer log in. Of course, at this time we had approximately twenty two patients in the waiting room and I was scribing for the doctor who was performing laser surgery on an eye. My blood pressure then spiked high enough that there was an audible whistle as it careened through my veins. And doctors, as a rule, are not very tolerant of audible whistling during any type of surgery, let alone one on an eye.
With a full on flight or fight response and gallons of pure adrenaline pumping through me I attempted to change my password myself, hands shaking against the keys. The staccato pop of the laser firing into an eye could be heard as I typed in my new password. What happened next started out utterly predictable and quickly progressed past that into the realm of the unbelievable.
Computer: “Your password is not accepted, your new password must be more then three characters different then your old password! Please try again.”
“You’re writing these numbers down, right?” The Doctor asked sternly, still irritated about the whistling.
“Uh, yes sir.” I stuttered.
Now I am memorizing numbers from the doctor while trying to think of my new password and calm the patient who is getting nervous about the assistant who suddenly seems to be drenched with sweat and mumbling to himself like a madman.
Computer: “Your password is not accepted, your new password must have at least one capital letter and one character! Please try again.”
The doctor gasped at me, “That is not appropriate language, are you still getting all this?”
“YES! YES I AM!” I am now surround by my own little puddle of sweat.
Computer: “Your password is not accepted, you forgot to hold the Ctrl button and stand on your head while typing it backwards! Please try again.”
“Is he okay? I know CPR.” The patient is now very dubious of having good medical help.
The doctor: “I'm not sure, he keeps twitching and mumbling cusswords...”
The laser is still popping.
I must have been a sight, sitting there shaking, typing and repeating ten sets of numbers out loud, praying the computer would give in.
It worked! “Your password has been accepted. Your computer will now reboot. I hope you saved whatever you were working on prior to starting the password changing process.” The screen light went dark.

I cannot be sure at what point the laptop got between the laser and the patient. There was too much chaos in the ensuing moments of evacuation and fire suppression. The fire department said fighting the fire with my coffee was a brilliant stroke of genius and made the room smell good as well. I suggested they not waste too much time in the investigation of the fire as sometimes accidents do happen and I was not holding our company financially responsible. (Although, I would like a reimbursement on my giant-sized, coffee mug and perhaps some new scrubs.) But that's not a problem for you guys down at IT. I'll forward the appropriate papers for that later, when there's not so much yelling and beating on the bathroom door.
So if you guys could please send the police over to help free me and send over another laptop, I will be able to leave the bathroom and give my coworkers computer back to her. Also I will require help resetting my passwords as I have forgotten what I typed in before things got so exciting.

Yours truely and thanks in advanced

Sevyrr

Saturday, January 1, 2011

The Big Picture

“Holy bat guano it's cold!” Sarah shivered at me as we literally ran from the hospital doors to our waiting rig. Jeff, my paramedic student, more slid than ran, grabbing the tailboard on his way by to stop his perilous slide on the evening ice. It was two weeks before Christmas and our area was hit with record lows, spreading ice everywhere. Thankfully it was too cold to snow. The rig was a little warmer and once we got it fired up, I asked Jeff the usually round of student questions about the last call. How do you think it went? Was there anything you missed? Anything you would do different? Why this medicine instead of that one? Do you think the chest pain was cardiac or maybe something different and why?
Jeff was good. He had been with us for over a month now and had a good solid foundation and excellent treatment modalities and he could multitask and think on his feet. The only concern I had was that we had yet to have a truly critical medical or trauma. Someone may be excellent at everything else but if they did not possess the ability to keep their head in a critical situation they might as well start looking for another career. I had been working with him on “the big picture.” The most common area that needs work on EMTs that have recently gone to medic school, is the ability to stand back and take in the whole patient and the whole scene. We teach that it is NOT the medic's job to be taking vitals. That it is not the medic's job to perform BLS interventions. Not even the medic's job to hook up the heart monitor. That's what our excellent EMTs are for. They are competent and know their job, so stand back put your hands in your pockets and ask questions and take everything in. There might be some small piece of the puzzle you uncover by doing so that will make a difference in what is done for the patient. A difference that might save their life.
Before we pulled out onto the deserted street in front of the hospital the tones alerted. Car verses pedestrian a short two miles away. Sarah flipped the overheads and I called in route. I asked Jeff what he knew about that area and what we might expect. He was right on. Forty-five miles per hour and no shoulder. The recipe for nastiness. I could see the adrenaline pumping through his shaky limbs as he described the possible injuries and safety concerns this scene would likely have.
We arrived on scene shortly to find a large, adult male sitting in the road unable to talk. There was blood on his face and he was drenched in sweat. There was several concerned bystander looking almost as dazed as the patient but they had done well by blocking traffic and shutting down the road. The truck parked in front of the patient was a very large dodge diesel with a distinctly man-shaped imprint in the grill.
Jeff got out, looked around, taking in the scene and headed straight over to the patient. Then I heard him gasp. I peeked around his shoulder, curious. The patient's right leg was sticking out at an odd angle, his pants were ripped and I could see pieces of his shattered femur laying on the road next to him. Oddly enough there was very little blood. Poor Jeff's eyes were big enough around I thought they might fall out of the sockets.
Sarah, in her usual form of excellent wisdom already had the bed and backboard coming with bystanders and was setting up our IV supplies.
Jeff kind of froze for a second. The longest second I have experienced in a while. I asked him, “What do you need?”
“Uh, dressings! Lot's of dressings, oh a splint!” Came his reply.
People were watching so I whispered, “Jeff, big picture, man, big picture!”
Then it clicked, he saw the profuse sweating despite the single digit temperature. He saw the dazed, non verbal condition of the patient. He saw the imprint in the grill.
“Oh crap! Get him on the board we need to go now!”
Jeff was amazing on that call. He properly medicated and carried out the rapid sequence intubation. He called early for a helicopter to our trauma center. He had a couple large bore IVs. I mean he did awesome. All in the two miles it took to get to the hospital with the landing pad. I gave him high marks. He went on to work for a life flight company taking calls like that all the time. All he had needed was someone to kick him a little and remind him, “Big picture, man, big picture!”
I tell this story story not because medic's out there need to be reminded of this. I tell this story because it can be applied to our daily lives, and even when not making life and death decisions on an ambulance, not seeing the big picture can be fatal.
I used to work a side job doing construction. One of my coworkers was this guy named Steve. I did not like him. Not even a little. He was rude, treated people badly and expended more energy avoiding work then it would have taken to just do it in the first place. We all know the type. We have all worked with someone like him before.
Over the course of six months though Steve got worse and worse. More mean tempered and even cussed out coworkers and customers. I mentioned this to my boss, asking why he didn't fire him. My boss was a wise man. He told me he didn't hire Steve because we needed his help. He had hired Steve because Steve needed ours. My boss was a man that could see the big picture, though at the time I thought it was the stupidest thing I had ever heard.
Things got worse and worse. Steve showed up late, frequently fell asleep on a job, and continually made mistakes I had to fix. My boss was always talking to him just out of my earshot, but he never looked angry at Steve. I would have canned his butt.
That fateful Friday we had been working on a big roofing job. There were only three of us there. My boss, Steve and I. We were working fast and hard and didn't have time for anything else and Steve was in rarer form then ever. He kept riding me and making backhanded comments at me. Critiquing my work, that was better then his, and cussing at me. About the time I had reached my boiling point I was on my way down a ladder with some tools and Steve was supposed to be holding it for me. The ladder started to slide sideways and I dumped the tools to save myself. Falling in a heap with the ladder. Luckily it was not far to the ground and I had only bruises to show for my acrobatics. Bruises and broken tools. I was livid. Steaming. I ran around the corner and found Steve sitting on the truck tailboard drinking a soda. It was too much. I let go. I yelled, I berated, I cussed, I was righteous with deserved anger. Steve just sat there looking at the ground, not saying anything. My boss just watched from the roof without expression.
The next morning, at my medic job, I was feeling a little better. A little sore but my ire had fled and I thought probably I should tell Steve I was sorry for yelling at him, even though he deserved it. Then the tones went off for the first call of the day. Possible suicide. I grimaced. I hate suicides. Weird though the address sounded familiar.
We got on scene and that's when I figured it out. It was Steve's house. I blanched, my stomach sick, suddenly full of dread. I had dropped him off here last night after work. No, please no!
I had never been in Steve's house but I was shocked by it's condition. It wasn't dirty, it was empty. There was a card table in the kitchen and one lawn chair. A cooler but no fridge. Nothing in the living room and his bed was a small mattress on the floor with one threadbare blanket. There was a note written and pinned to the wall, it was from his wife.

“I'm taking the kid's to my parent's. Don't even think about coming around until you get yourself straightened out. Lisa”

It was dated over a year ago.

The volunteers ushered me out to the garage in silence. There was Steve. My heart cried out. He had been hanging there since last night. Probably right after I dropped him off. Cold, rigored, lividity. He was long gone. I couldn't speak, shame filling my soul. Finally I understood my bosses words. “We don't need him. He needs us.” Such a simple phrase with so much meaning. With all my training in depression and psychiatric disorders, I failed to see. With all my experience in dealing with people with exactly his problems, I did not notice. With the critical indecent stress classes and debriefings I had been to, I missed this one. Heck, I have even written presentations outlining the signs of stress and mental illness to teach to our EMTs. I had gotten so wrapped up in my own irritation at his behavior. I had judged him without knowing him. I failed to step back and look at the big picture and ask myself what is really going on here. I didn't kill him. I know that, but I may have helped him on that path. If only I had taken my own advice to my paramedic student. Why was he acting like a bear just out of hibernation. I wished I'd asked myself that. I don't know that I would have made any difference in the outcome. There were a lot of factors that played into his decision to end his life I am sure. But it wouldn't have hurt to have seen the signs and tried. Now when someone exhibits less the tasteful behavior I stand back. I look at the whole scene, so to speak. I ask myself why, maybe even ask them why. Steve taught me an invaluable lesson and I will never forget him.
“Big picture, man, big picture!”

Intersecting

Life is amazing. I continue to be floored by the way people's lives intersect and have incredible impact on each other. How the events of a day sometimes unwittingly bring us into contact with others, sometimes hours later. How our decisions, meant to effect only ourselves, produce undeniable changes or surprises in ways that we could never predict or expect. Like ripples in a pond that change the course of other waves and ripples, we tread through our lives, the repercussions spreading into the world around us. I challenge you to pay attention to how what you do has an effect on other people. It can be downright intriguing to study this phenomena, sometimes the twists are better then any drama on television.

To drive this point home I would like you to meet Dave. Please understand I have never met the man. I only saw him once, on the side of the road, sitting in his car. I don't even know if his name was Dave, he just kind of looked like a Dave. But you could tell the kind of man he is. He was efficient and obviously a man that took great stock in his routine and doing the same thing, the same way everyday. He believed that if something worked so well it should be done that way everyday. If it's not broke, don't fix it.

0553 hours. The tones go off for County Medic to go on a diabetic male way up in north county. Altered mental status, blood sugar is 34. My partner Steve and I drag ourselves from bed groaning, get dressed and stumble out into the rising sun to fire up the ol' beast and head north with lights and sirens running. Bleary-eyed, bad breathed and craving coffee we start our trip staring sullenly at the road, unknowing that this call was going to change an unwitting bystander's day completely.

0600 hours. Dave's alarm goes off, slowing increasing the volume of his country music station to a decibel that brings him to consciousness. His eyes pop open and he smiles to himself. He can feel the morning sun through his window and hear the birds chirping. Perfect morning. He can hear the last few gurgles of his preset coffee pot finishing up, just waiting for him to come in and pour a cup. Life is good.

0618 hours. We arrive on scene, a little more awake. The county volunteers meet me at the ambulance to give me a short report and vitals. We get inside, the patient is minimally responsive, covered in sweat and pale. Heart rate in the 130s, blood pressure is good but the glucometer reads 28. Steve and I now end up in a wrestling match with this big sweaty patient but finally get our IV and start some IV dextrose 50%. The patient starts to blink and look around in surprise at all these people standing over his bed.

0630 hours. Dave has already had his two cups of morning java, taken a shower(putting his towel in the laundry basket, he's not the kind to leave a mess), and starting on a breakfast of eggs, bacon and toast. After all, breakfast IS the most important meal of the day. After eating and looking out his big picture window to watch deer cavort in his field, he carefully cleans his dishes and put the salt and pepper away, leaving his kitchen clean for his evening meal. It's exactly the same as yesterday, and probably the same as tomorrow. There's just no reason to change anything. He lets a very small belch of satisfaction and heads for his car keys and morning paper and that last cup of coffee.

0647 hours. After feeding the patient a peanut butter and jelly sandwich to get some carbs on board and talking to the emergency room physician we leave the patient's house. Leaving him and his family instructions to follow up with his primary care doctor and to eat frequently through the day to help level off his fluctuating sugars. We are now fully awake and really starting to anticipate hitting the mocha stand when we get to the city for shift change over. We are talking about the calls we ran last night, or maybe about our wives, I don't really remember. Just that we were talking amicably as we traveled down the canal on that beautiful sunny morning.

0655 hours. Dave reaches the end of his driveway at exactly the same time he does every morning. He turns off his car and rolls down the window to listen to the birds, open his paper and takes a long pull of the last cup of morning coffee, full and steaming in his hand. His buddy will be there in moments to pick him up for their carpool to work. He sees that his neighbor's cows across the highway seem to be doing well this morning. He does not see the big ambulance coming down the highway however.

0657 hours. Steve sees the cows. I think it is important here to explain that most EMS workers LOVE their PA system. Not many will mention this and some may even feign indifference, but having the opportunity to pick up that microphone and raise our voice several hundred decibels to project out the front of the ambulance is extremely satisfying. So like I said, Steve sees the cows and suddenly becomes very animated, eyes wide with excitement jumping up in down in the passenger seat.

“Oooo, cows! Cows! Give me the PA! Quick!” I hand it to him. Steve does not see Dave on the opposite side of the road sipping his coffee and contentedly reading his paper, window down.

Steve raises the mic to his lips, the volume cranked and lets loose his best Brahma Bull moo at sound levels that would give a Blue Angel a run for it's money. The cows jump and stare with alarm at this giant white and blue bull that moves 55 miles per hour. Steve giggles and claps with glee, like a little kid.

That's when I notice Dave. For the first and last time in my life. He appeared to be seizing inside the front seat of his car. His newspaper is in shambles. There's coffee across the windshield and dripping from the ceiling. He may have wet himself, though I couldn't be sure from the drivers seat of the ambulance. And that quick he was gone. We were past him and down the road. We never got any complaints at the office which leads me to believe he never did know what it was that disrupted his morning in such a dramatic fashion. That or he was just too good of a guy to fault a couple of immature paramedics. Steve never even saw him. Never realized that the events that started in motion early that morning made an unbelievable difference in another person's day, completely by accident. I told Steve about Dave and he just looked at me, I don't think he ever believed me. I hope Dave's doing all right.

I've always wondered if he changed his morning routine at all, to protect himself from high-speed mooing ambulances.

Saturday, May 15, 2010

Electrical Therapy for a mean nurse

If someone's heart slows down and won't speed back up we are required to fix that. Our first line treatment is a drug called atropine. Atropine decreases vagal tone, more or less taking the body's brakes away. It's not a gas pedal like epinephrine, it just takes away the feed and breed functions so to speak. If that doesn't work and the patient is symptomatic, chest pain, shortness of breath, dizziness, low blood pressure, then we have to correct this. The way we do that is by using our handy dandy heart monitor to send a small jolt of electricity through their heart 70 times a minute. Essentially we take over the heart beat, which is too slow, and tell it to beat faster with this 70 beat per minute shock therapy. So the patient sits there going. "Ow, ow, ow, ow ,ow." Every time it fires. I imagine this hurts but we give them versed to make them forget and morphine to make them comfortable. You can see their whole chest, and even neck, contracting with each little shock.

We get a page for an intrafacility transport. The city ICU to an ICU about 50 minutes away. Cardiac patient getting paced. We got there, got report, moved the patient to my machines and I took over his pacing. The patient was concious but heavily medicated and the pacer was set extraordinarily high. The doc said it was the only way they could get capture. So we loaded up and head to the big city hospital with the lights and sirens on. The trip was completely uneventful. The patient did fine and the roads were clear.

We got to the hospital ICU and met the patient's new nurse. I have to say, right from the start we did not hit it off. She was griping about this nurse and that nurse, and the secretary wasn't doing her job, she had to come off break to come get this patient, why are we here early, and on and on and on. Whatever. I don't get paid to care about her problems, only about my patient's problems. I shake my head and she jumps down my throat, "Why aren't you moving him, get him moved over now!" Really? My partner, the patient, and I all make eye contact. I kind of felt bad for the patient now.

Of course she doesn't lift a finger to help us. As she rifles through the paperwork we transfer the patient to the new bed and start moving equipment. All of the sudden she's in my face again. "Why don't you have the right paperwork!?! You are supposed to be health care professionals, you should know what paperwork you need!" Now I'm getting pissed. I asked her what she was looking for and she told me. I showed her where it was, she just missed it. Instead of being grateful she gripes some more and indicates it was my fault she missed it.

I kind of snapped and told her to get her monitor ready, we need to transfer pacing to her machine.

She looked at her monitor and the at my pads and chicken little the sky is falling! We had different machines and the pads were not interchangeable. All it means is that we would have to shut off the pacer for a minute while changing to her machine. While that can be dangerous to a patient being paced, if we timed it right it is not too big of a deal. She's now speaking acid at me. Throwing paperwork down and medical paraphernalia around. I am the devil according to her. All that's wrong in this world is my fault. I should have had the foresight to know that her machine wouldn't match mine and force my company to buy the right kind of heart monitors just prior to this transport. You may think I am embellishing here but I assure you I am not. This woman was possibly the meanest person I had ever met and she was pissed at me. The patient is now looking rather alarmed and is throwing looks my way suggesting I take him to another hospital and my partner is standing in the corner steaming.

The nurse looked at me and said "WELL!! What are you waiting for?" With that she stomped over to the patient and ripped both pacer pads off his chest violently, pulling two big patches of chest hair off the poor man. Wait! It's still on! I promise I tried to warn her but she was moving too quickly. Both pacer pads slapped together on her right hand, one on top, one on bottom. And those things are sticky. She suddenly yelped and convulsed, followed immediately by another yelp, and another. Then she screamed and began shaking her hand in front of her, rapidly hopping across the room in a very animated imitation of a rabbit on speed. She got faster and faster and louder and louder. We were stunned. Speechless. Frozen. Am I really seeing this?

After a few moments of her spasmodic break dance across the room I reached over and turned the pacer off. The nurse doubled over gasping for breath, ripped the pads off and ran from the room. The patient giggled. Then my partner giggled. I could feel the twitch of a smile and couldn't help myself. We started laughing, and laughing and then laughing some more. We were in there braying, honking snorting, eyes watering and falling over. Couldn't have happened to a better person.

I then remember the patient's not getting paced so I looked at the monitor and his heart rate was normal. I checked his pressure and that was good too. Huh. Looks like she fixed him. His color was better and he was in good humor now. A few minutes later a different nurse came in and introduced herself as the patient's new nurse and we never saw the other one again.

Thursday, May 6, 2010

A Thanksgiving to Remember

My seventh grade Thanksgiving was something to remember, more different then any before or any yet since. It started off slow, had pain and suffering through the middle, and an ending that left us full of gratitude and a house that smelled for weeks. It definitely was an occasion that I hope stays a memory and does not refresh itself with even one of the offending events. Our house full of strangers, my brother and I had cooked the whole dinner, and there was the permeating perfume of skunk everywhere. You could almost get used to it and then you would forget and inhale too deeply through your nose. Gag!

Let's go back four days. Mom was working at a ship yard and a boat had come in with several sailors with no family to go to for thanksgiving. My mother felt bad for them and decided we could use their company as much as they could ours. So she informed us that she had invited several over for Thanksgiving and that we would need to really clean the house to help to welcome them.

Count down T-Minus three days to Thanksgiving. Mom is sewing my brothers pant up, right before school, we're almost late. She get in a hurry and then lets out a yelp and holds up her finger and the needle from the sewing machine is sticking out of both side of her right index finger. She goes to the doctor and they removed it and told her she can't cook, clean, or otherwise use her finger or get it wet. My two younger brothers and I met this information without too much concern. Mom was okay and dad can cook.

Down to two days to thanksgiving. Everyone is strung tight, there's going to be a lot of people showing up, everything needs to be really nice. Me and my brothers can not seem to stop arguing. Mom is ordering us around now and trying to get us all working on something(kind of like trying to herd cats). What is that I smelled? Is that the faint odor of skunk? While doing dishes that evening my brother and I were in rare form. Fighting, yelling and otherwise being nasty to each other. My dad, finally having enough growls “That's it!” and storms towards us. The kitchen was completely soaked from top to bottom, with water dripping off the ceiling. I could immediately tell that this was not a false run, dad's really irritated. He got within range and reached up for my brother at the exact moment he stepped into water. His momentum was too great. He suddenly shot forward in a half standing, half crouching, ice skating slide across the kitchen. It would have been comical if I didn't already know he meant to teach us some sense. Then, faster then the blink of an eye his glorious first attempt at ice skating ended. He fell and broke his arm on the cabinet on the way down. He went to the doctor and they put him in a cast and told him, no cooking, cleaning, or other wise using your right hand or arm.

The day before that most remarkable Thanksgiving. Now my brothers and I are quite concerned. With both mom AND dad out of commission all the cleaning and cooking is in our less then competent hands. Not good. By now the smell of skunk is fierce and my dad's disposition is close to that of a bear just left hibernation. My brother and I are arguing while peeling apples for an apple pie when dad comes in through the sliding door and announces that there is a skunk under the house in the proximity of his bedroom. I think it should be said that he showed unbelievable restraint by keeping the growling and tearing at his cloths to a minimum. Dad called one of his friends and procured a live trap, not wanting the skunk to by killed and, well, unleash under the house as it were. I watched with deep interest as dad filled the bait bin with canned dog food and then pushed the trap under the crawl space. We crossed our fingers.

Thanksgiving morning. D-day. We all pile outside in our pajamas to check the trap. Dad and mom don rain slickers from head to toe, complete with a hat. You know, the yellow kind. Mom warned us to stay back and dad opened the crawl space and sure enough, the beady eyed monster was staring out from inside the trap. Dad grabbed a plastic bag and slowly wrestled the trap out while placing the bag around it and a lively discussion took place about what to do with this house cat sized pain. I vote on a public execution with which my father vehemently agreed. But my mom and brother decided it was too cute to kill and needed to be humanely reintroduced to the wild. My poor dad is now so unamused he is talking to himself and twitching a little. We all load up in the car and go for a drive into the woods. My dad tried to stop in several driveways to which my mother told him “No, farther out hon. Wouldn't want this to happen to anyone else.”

Finally we find the spot and we all get out to watch. I would like to point out here that I expected something very exciting from the next few minutes and I was not disappointed. Dad gets the trap out of the car and puts it on the ground. Mom and dad, still in yellow rain gear, warn us to stand back. Dad pulled the bag from the trap and used a stick to open it. The skunk didn't move. Dad, now cussing, takes a whack at the back of the trap and the skunk chose that moment to play it's ace in the hole.

Springing from the trap like a convict suddenly set free, he shot across the dirt road straight at my mom and us kids. All four of us raised to new heights of fear, rose straight up into the air and shot in random directions I even ricocheted off of my brother once or twice while trying to find a skunk free place to go and we all decided simultaneously on the family van. The skunk skidded around a tree and headed for my dad who nearly climbed out of his slickers and broke the sound barrier while fleeing around the our family van with the skunk closely behind him. After two laps around the van the skunk ran up under the van and disappeared into the under carriage. My dad by then was gnashing his teeth and hitting the ground with the stick hard enough to break it several times. In his opinion the humor had long fled the situation. My hopes increased again for a public execution. Also it suddenly didn't seem so safe in the van. Dad paced the van twice looking under it from a distance hurling Skunky expletives the whole time. Finally he yelled “Pop the hood!” and mom did. Dad yanked the hood up and shoved his head in looking down near the ground. And there was the skunk, sitting on the battery less then three inches from my dad's head. The air was shattered by my dad's ear splitting shriek and the skunk jumped straight up in the air, higher then the hood and his little legs were making three hundred mile an hour revolutions when he hit the ground and sped off into the brush. Finally having enough of this crazy family and their shenanigans.

We drove in silence back to the house. Thanksgiving dinner went off without a hitch and we had several navy men over. Only one of them had a good sense of smell or maybe less social grace. He looked at me and said “Weirdest thing. I keep thinking it smells like skunk in here.” All I could do was smile and nod when I told him “Why yes, yes it does.”

Routine Stabbing

It was 3am and I was sleeping soundly. We had been having radio tower problems with the local dispatch so sometimes our pagers didn't trip, or only one would. I woke to a persistently, irritating drumming on my bedroom door.

"What?" I rolled over facing the wall.
Sarah my partner opened the door, "I said get up, we have a stabbing, sounds bad."
I rolled over again. "Don't mess with me Sarah it's not funny." I put the pillow over my head.
She walked in the room and pulled me off the bed and said "GET UP! I'm not kidding!"
I grumbled and got up, putting my boots on, then I remember the radio problem. Maybe she's telling the truth.
"If this is a joke it's not funny." In our area we don't get a lot of stabbings.
We run out and hop in the rig and put ourselves in route with dispatch. We had a rider that day and she hopped into the back.

The radio keyed up, "District 111, and County Medic 111, you are responding to a 42y/o male reported with multiple stab wounds to chest and back. Bleeding heavily. Scene is secured by PD."

Wow. Sarah wasn't just being mean and telling me it was a stabbing when we really had an intrafacility or something like that. Please note, Sarah is not normally mean, but having me as a regular partner tends to change people's personalities. I am one of those guys that cannot sit still and often this gets me into trouble. I also have a little bit of a sadistic steak and like to play jokes on the unwitting.

Sarah lights it up and we clip off down the road. There is some confusion as to where the patient is located once we get there. Apparently the stabbing happened in one house and he ran a few blocks to another to get help.

When we got to the scene the was a long run up to the house, so I hopped out with just my stethoscope and ran up to see what we had. Just inside the front door, the patient is laying on the tile in a pool of blood gasping for breath. He's white as a sheet and profoundly diaphortic.(means he's extremely sweaty, that he's in shock). I lean out the door and yell to Sarah and the rider, "Leave the gear! Grab the bed, we need to get out of here!"

I bend over and ask the guy where he's hurt while slicing off his shirt with my trauma shears.

He looks at me incredulously and says, through his gasping, rapid respirations, "Dude!(gasp)I'm bleeding like(choke) a pig and I can't(hack) breath!"

I see four wounds in his front and one in his back, most seem superficial but the one over his upper right quadrant is right in line with his liver and diaphragm. And it is the one that is bleeding. I listened to his lungs, left was clear and right was dull and very quiet with little movement of the chest wall. Hemo/pneumo I think. A Tension Hemothorax is when the lung cavity fills with blood, collapsing the lung. It is fatal left untreated.
Sarah came in the door with the bed and I helped the guy stand to transfer to it. As soon as he stood, blood literally gushed out of the hole over his liver. Ok, gushed is not a good description. You know when you turn on the hose full blast without a nozzle? It was like that. At least a liter of blood shot out of him and splashed all over the gurney and on Sarah's legs. He looked at me and said, "You gonna stop that?"
I replied "No! Sit down!" It suddenly seemed breathing was better. I even asked him, "Hows your breathing. sir?"

"Uh, it's a lot better..."

I give him a dressing to hold at the wound and I tell him not to block the blood. There's no way my little 14g chest needle is going to make a big enough hole to compete with that big of a hemothorax. We pick him up and run for the ambulance. A volunteer EMT met us on the way and jumped in the back. Our scene time was 6 minutes. I called for an airlift to the trauma center, which is about 2 hours away by ground. In the back of the rig I had plenty of help, the rider was an EMT too. We got bilateral 14g IVs with warm saline flowing great as we tore off for the local hospital.

En route to the ER the patient exhibited increased shortness of breath again so I had him uncover the wound and stretch a little and blood again gushed out, over the patient's leg and sloshed across the floor. I had to do that 3 more times on the way in. Each time it relieved the patient's breathing. By the time Sarah opened the back doors at the ER, the blood made a macabre waterfall off the floor and back step onto the ground. Pouring out.

When we got inside the doctor started in on me. I let him off easy because it was his first day there and he didn't know the medics yet. But he argued that it wasn't a hemo, canceled airlift and stitched up the hole. I warned him to get his chest tubes out if he was going to insist on stitching the guy and he told me to leave, so I went out to write my report, a little miffed. Within a minute he came out and said "Uh, the patient's getting really short of breath, what makes you say it's a hemo." So I described it to him again(third time), and he ran back in and did an emergency chest tube, blood covering the floor of the ER room. I tried hard not to gloat. He also called airlift back and started the man on bloods.

Once at the ER we got the rest of the story, the guy had gotten drunk with a buddy and he decided to shut up his friend's wife by hitting her. His friend took exception to this and carved him up like a Christmas Turkey. The patient did well after having the hemo and his liver repaired and lived to assault another day.

Hope I don't see him again.

Tuesday, May 4, 2010

Things that go bump in the night

Most of the time EMS is fun. Sometimes it can be sad. Sometimes it can be downright dangerous. We do things to protect ourselves, like staging for law enforcement on assaults or drug ODs or if something just doesn't sound right. (Here's my hats off to the police out there, love you guys and gals, thanks for keeping us safe!) Despite our best efforts to stay out of harms way and return to our families, things can quickly move out of our control. There have been times when for my own safety I have dropped my gear and left the scene, read that as tactical withdrawal, not ran like hell. But it does happen from time to time.

The darkness shattered for the hundredth time as lightening crackled across the late night sky. Thunder drowned out the radio in the front of the rig. Trees whipped back and forth in a frenzied dance, leaves shooting across the road. It was one of those nights that evil things happen. We were assigned to the city and en route to an assault. Domestic Violence. I hate DV with passion. I nearly get enraged by the idea of some psycho beating on his wife or girlfriend. That was how I was thinking on the way to the call. Let them pick on someone their own size, or heck they could try it on me and I'm not very big. We pull up on scene and step out into the torrential downpour and a city cop leads us over to the entryway of this low income apartment complex. The lights are out in the entry hall so I use my flashlight to talk to this crying woman in the recessed area in front of the door. The cop tells us that they believe the man left the scene and that he'd stay there to keep an eye out.
The patient's face is ruined. Not from the trauma she experienced tonight, but the years of abuse etched into her features. She's shaking and flinches like a startled rabbit when I touch her arm to take a blood pressure, even though I asked her first. Her wounds on the outside aren't bad, but I'm not sure if the wounds inside will ever heal. I'm sad for her and while my partner conducts an interview I entertain thoughts of what I'd do to this guy. Oh yeah, I'd break him. I don't care how big he is. I was in old fashioned Okinawan Shoto Kan Karate for years, used to teach it. So sometimes I give myself the license to feel tough. We are there for around ten minutes, trying to get her to go in, thinking that the social workers could get to her then but she doesn't want to go. Even with as tough as I was feeling the night was wearing on me, all the thunder, the lightening, the darkness. Things were out tonight. Bad things. As I was thinking about this, lightening suddenly flashed right above us. So close that the thunder came at the same time as the flash. Hair standing on end, ground shaking, bright as daylight. No, brighter. And with that light we were able to see the door next to us, it had a window in it the full size of the door. And there, standing on the other side of the glass, was a man that looked like a giant Charles Manson. The lightening lit him up shedding ethereal light across his evil glaring visage three inches from my face!
In the sudden eye gouging, hair pulling, crazed wrestling match to be the first out of the entryway I saw my partner take two elbows from the cop and a kick to the back from the patient.
Breathing heavily, I sprinted past the patient about a block away. "That him?" I asked her on my way by. Both of us still fleeing the scene.
"Yeah, that's him." She replied through her gasping retreat.
"Well, better hurry if you're gonna tell the cop that, he's already out ran us by a full block."