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This is a public service announcement

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Ladies and gentlemen, in EMS and Fire there is a growing trend that is very real, unavoidable, and frankly unnerving. It would appear as if mustaches have become more than a facial accessory for those of EMSosaurus and Fire Fossil generation. As a result of this observation, I’ve come to the conclusion that more attention should be given to such a hairy topic.

What exactly is the soup strainer appeal? Is it sex appeal? Is it the only accessory that men on the job can get away with? Does it have to do with paying homage to the great mustaches of yesteryear? As someone who has never possessed the ability to grow a ‘stache, I’d never given them much thought until recently. There is clearly a lot of territory to cover here.

EMS and Fire folk tend to steer clear of the full beard or goatee because of regulations concerning respirators, so the lack of other, more widely accepted and fashionable facial hair is obvious. Legend has it that firemen originally grew mustaches as a form of personal protection. According to this incredibly non-academic website and several people I asked, firemen grew long mustaches back in the days predating modern equipment to use the hair to filter out particulates in the smoky air in which they were engulfed on the job. Mustaches may have once played a role in safety on the job, but that does not explain the modern day fixation.

I’ve interviewed a fair amount of my ‘stache sporting friends and coworkers about their mustaches, and I seem to find two pervasive themes: “I’m too lazy to shave” and “I keep it because I‘ve always had it.” I don’t understand either of these concepts. First of all, being “too lazy” to shave is pretty much negated since you’re forced to shave the rest of your face. I can tell you that when I’m in, I’m all in; I have never shaved my legs with the exception of one shin. Lazy and ridiculous are not synonymous. Secondly, you haven’t “always had it.” I’m trying to picture a cherubic baby, who after being rinsed of goo and blood wears a Nascar worthy mustache. That’s not how things work, gentlemen. You would have been labeled a prophet or a demon directly; as you’re currently working with me now, you are neither.

While contemplating the topic, I called up the wise sage with whom I discuss important matters at hand. During the discussion, my mom told me, “When making out with a dude with a mustache, there’s always the one wild hair that bothers me the most. Sure, the rest of the hairs are conforming, but the one hair finds its way up my nose and tickles like hell. The mustache seemed like a good idea in the late 80s, but who wants to make out with a chick who’s sneezing? Maybe I’m just allergic to mustaches.” That’s right, boys. My mom says women are allergic to mustaches, and my mom knows all kinds of useful stuff. She’s also been known to make up things to suit her wants, but I’m going to let that slide in this case.

Ambulance Driver is the only guy I asked that boldly admitted his mustache’s intent.  “When I was 25, I wore my goatee because I thought it helped me pick up hot older chicks. Now that I’m closer to 45, and all the hot older chicks are nursing home patients with fevers, I wear my ‘stache in solidarity with my EMT brothers who are stepped on by The Man, deprived of their rights to cultivate glorious handlebar mustaches like all the firefighters.”  Far be it for me to depreciate a man’s political statement.  Damn The Man!

It was also brought to my attention by a friend that “a man is DEFINED by his facial hair,” and he also submitted this evidence. Funny, all this time I thought men were defined by their penis size.

I would have liked to take pictures of people I know with mustaches and criticize them, but they were kind enough to allow me to interview them while knowing full well I intend to make fun of them on the internet. Instead, I have provided pictures from the internet of celebrities who are accustomed to being mocked. These are the people you are emulating:

Ted Nugent

Hide yo’ kids, hide yo’ wife, and hide yo’ husband, cuz Ted Nugent rapin’ errybody out here.

Tom Selleck

Tom, you are not fooling anyone with that phone. We all know it isn’t a cell phone, and you aren’t taking a call from your beloved grandmother to display your wholesomeness. You are topless on the beach and you probably need to let your parole officer know your whereabouts.

Mario

Eventually he got the princess. However, he had to abscond several castles and defeat many-a-foe to get to her heart. When one has a mustache of that caliber, one must make up for it in various other grand gestures. Incidentally, he was probably the first human she’d seen in a long, long time. After being held captive by a dragon-turtle hybrid for a while, a lady’s mustache tolerance can only be sufficiently lessened. Princess Peach was likely thrilled merely to see someone who didn’t want to wear her skin.

Salvador Dali

I’m not going to dignify this creeper with a proper caption.

Richard Pryor

“Ladies, check out how unassuming I am in my bath of foam peanuts. There’s even a red bow to indicate I’m God’s gift to women!” FAIL.

Ron Jeremy 

Ron Jeremy got a lot of hot tail. What the previous sentence is lacking is the fact that Ron Jeremy got a lot of ass from libidinous chicks who were being paid to do naughty, naughty things with him. The beautiful women acquiesced because drugs don’t buy themselves and word on the street is Ron Jeremy has a magnificent dong.

The Village People

Wow. There’s so much to say about this montage. Let’s start counterclockwise. Leather Guy, if you come any closer to me, I will be forced to beat you with your chains. Rochelle told me the story behind the restraining order, and I’m not buying your plea. Officer, I’ve worked with a lot of policemen and have never seen anyone other than yourself in that pose. I’m not even sure what you’re trying to accomplish. Are you threatening me? I will kick you in the larynx if you so much as twitch before I’m 20 feet away. Cowboy, it’s okay to be a virgin. Embrace it. No one is going to sleep with you, so you might as well own your virginity. Have you considered joining a monastery? Stay away from the cows. I know you think they love you back, but it is illegal to love livestock like you do. Construction worker, I appreciate your gold helmet, but stop touching yourself in that lascivious manner. I will be forced to contact OSHA, who will undoubtedly not care for your fabulousness. Indian and Soldier, I have much to say about you both, but you do not pertain to my topic. (Non sequitur: You are really working the interpretative dance, Indian. Keep up the strong work!)

In the event Captain Wines of Iron Firemen finds his way to this post, I’d like to go on record saying that I in no way, shape, or form have mustache envy. My informal polls proved pretty much unanimously that women with mustaches are not well received.

Oh, no. Parapup does not rock the ‘stache.

***************************************************************************

In semi-related news, a Google search of firemen with mustaches led me to a timeline of mustache fires. Obviously, this was not my intent, but I never realized mustaches were so flammable. The mere concept got me a little giddy, but that’s primarily because I’m morbid, warped, and sleep deprived.

Posted by on March 28, 2011 • Filed under: Uncategorized • Tagged: , , , ,

High Stress, Low Class

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When the adrenaline is flowing, it is more than a challenge to keep my cool at times.  I’m not a confrontational person, but when a person interferes with my patient care, I can be a little hotheaded.  I’d love to be able to say I am the calm in the stress induced storm of an emergency, but I’d be a bold-faced liar.  I don’t know of a single person who hasn’t let their frustrations show in the heat of the moment. I’ve certainly borne the brunt of others’ rage in times of high stress on more than a few occasions.  Now that I’ve grown into the paramedic role, I’ve found that I’m no different.

Historically, I haven’t always been diplomatic when people interfere with my patient care. As it stands, I’m the only person I know who threatened to kick a police officer in the face, albeit in a joking tone, and didn’t get arrested.  I’ve doled out more than a few empty, ridiculous threats to get my point across.  I’ve said plenty of other things I’m not proud of, but I probably shouldn’t admit them publicly.

In paramedic school, we were put through the proverbial ringer of high stress situations.  We had airway obstacle courses, in which we had to perform under strobe lights and loud music.  We had impressive mock MCIs: a meth lab explosion, a train wreck with hazmat qualities, a house fire with multiple patients, multiple patient farming accidents, a building collapse with fire and trapped responders, swift water rescue, high angle rescue, and many multiple vehicle accidents.  We had complicated scenarios, in which we performed demanding tasks like CPR, controlling difficult airways, and handling multiple critical patients, while reciting acronyms and definitions.  I still recite drug dosages, classifications, indications, and contraindications while I jog out of habit.  My instructors tried their hardest to prepare us for the worst by exploiting our weakest points.  They’d make us overcome various states of equipment failure, force us to become skilled in the art of adapt and overcome, stress us out, and push us to the limit.  They even stole my equipment once because I left it unattended.  Despite all that preparation, I can sometimes feel my heart try to beat out of my chest on calls when the stakes are high.

Recently, I had my first pediatric code.  It’s no stretch of the imagination to state a child in cardiac arrest is one of the most efficient ways to induce a big, fat adrenaline rush for any emergency responder.  Everyone on scene was frazzled.  No one likes a dead kid.  I couldn’t get first responders to cooperate on even the smallest things very well, like moving the patient from a cramped bedroom into the spacious living room.

The problem wasn’t that they were bad at their job or that they were dealing with a female paramedic arriving to take control of the scene; the predicament was that the gravity of the situation was downright distracting.  I tried to be calm and collected, to keep my thoughts straight and my voice level, but when everyone else in the room is tense to the point of disruption, it is easy to become irritated.   My heart may be beating at SVT worthy rates, but I try like hell not to show it, which is not always successful.

I intubated the toddler with a small endotracheal tube and tied it down with twill tape.  A fireman was ready with the BVM to resume ventilations.  I told him to place his free hand over the child’s mouth to hold the tube in place, to keep it from dislodging.  I turned away to give a dose of epinephrine, and looked back to see he had let go of the tube and had accidentally pushed the hub of the tube to the patient’s lips.  *Gasp* My tube! Checking breath sounds, I found the tube was lodged in the right mainstem of the lungs, so I readjusted it.

I said, “It is really important that you hold the tube in place with your hand right here.  Remember the airway is paramount with pediatrics, and it is very easy to slip downward or out because there isn’t much room for error.”  I turned away to give a dose of atropine, and looked up to the same problem as before.  Holy crap!  Do not slap this man.  Good paramedics do not abuse their first responders. Again, I readjusted the tube, insuring it was in its proper position.  I tried to will myself to grow more functioning arms like a Hindu goddess, but that was unsuccessful.  Why can’t I have more arms? I said, “I really need you to hold this tube in place, because this tape isn’t working worth a crap.  You are doing a very important job, and if you need someone else to take it over, we can do that.  This tube may be this kid’s only real chance for survival.”  He said he was fine, and I believed him.  A few seconds later, I turned around to see him start to grab for something again, but he looked up at me and mouthed “Sorry.” Do not make me a murderer today, sir.

Walking to the ambulance with the stretcher, while first responders were doing CPR and ventilating, I held the tube in place at the patient’s mouth.  Within earshot of the five people surrounding the stretcher, I told the fireman in a semi-joking tone, “We’re all jazzed up here, but if you let go of my tube one more time, I’m going to kick you in the solar plexus.  If you don’t, I’ll be your best friend and send your kids birthday and Christmas presents.  If you need to switch out, tell me now.” He said he was fine; it was just his first pediatric code and he was understandably a little “freaked out.”  I didn’t tell him it was mine, too.  We loaded the patient in the ambulance, and I checked to make sure the tube was still in place before allowing him to hold it again.

On the way to the hospital, I noticed the hub of the tube was almost in the patient’s mouth, and I finally lost my cool.  I listened for breath sounds and heard nothing, but I did hear epigastric sounds.  He lost my tube. I transformed from a stressed paramedic to a pissed off megabitch in a nanosecond.

I planted my feet and took a stance I learned from playing too much Mortal Kombat in my youth.  With a punch square to the jaw, blood and two teeth flew across the ambulance.  I landed an uppercut to his chin and followed it with a right hook to the kidney when he doubled over, both solid hits.  The words “BAM!” and “POW!” appeared in the air in jagged bubbles of sound effect.  While performing CPR, the other responder in the ambulance announced in a low pitched, demanding voice, “FINISH HIM!”  One solid round house kick to the solar plexus sent him flying through the air, pushing the back doors of the ambulance open with force, and he flew out of the ambulance and onto the highway at 75 mph.  At least, that’s what happened in my head.

In reality, I took a moment to yell something that sounds an awful lot like mother trucker in addition to a string of expletives, while stomping my feet hissy fit style and grabbing a new BVM out of the cabinet, because we’d left the mask on scene.  I reassembled the intubation equipment, choosing a slightly larger endotracheal tube that I hoped like hell would fit.  I re-intubated the patient, forcing the larger tube in, as the correct sized tube was no longer useful. I said, “I don’t have the *BLEEP*ing dexterity in my toes to push drugs, so you’re going to have to hold this *BLEEP* *BLEEP* tube in place like your life depends on it. I don’t have enough *BLEEP* on this truck to intubate this kid again.”  And let go, he did not.  He even looked over at me for approval before releasing the tube in the hands of hospital staff.

Upon arrival at the hospital, the physician was “beyond impressed” that I’d managed to secure a 4.5 size ET tube.  I told him I had a little help, while glancing over at the first responder, who looked like a hurt puppy.  Afterward, I apologized to him for behaving like an asshole.  I finally told him it was my first pediatric code as a paramedic, and it took just about everything I had to hold myself together and put my training to use.  I told him I know what it’s like to be in his shoes, and while it will never get easier, he’ll have a better hold on the situation next time.  I assured him that despite the snafus, we did everything we could for the child (a mantra I had to keep repeating to myself as well).  He accepted my apology very well, and I truly hope he doesn’t hold my behavior against me, or other paramedics for that matter.  Granted, he doesn’t know that in my head, I beat the crap out of him.

For both of us, it was a horrible notch under our belts.  Perhaps next time each of us will be better prepared.  I’m certainly not the only responder who can be affected by what we encounter on the job, and I was the new EMT with the deer-in-headlights look in this very situation once upon a time.  The first time I saw a child in cardiac arrest, I was completely distracted by the one thought that kept circulating: This isn’t supposed to happen. I think we both learned a lot from that call.  I learned to trust my instincts a little better, make people trade positions when they show signs of insufficiency, and that I need to be much more civilized under pressure, while he learned paramedics can be jerks when you lose their tubes.

Posted by on March 2, 2011 • Filed under: cardiac arrest • Tagged: , , , , ,

Life Lessons Learned While Ambulancing

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On romance: The fairy tales have it wrong. True love is finding someone whose belongings (including expensive electronics) you can throw off of a three story balcony, who will in turn choke you into unconsciousness while you are 33 weeks pregnant with their child. 

On sanity: Hallucinating the devil is after you or running naked through an upper-middle class neighborhood until the police tackle you is very crazy.  As it turns out, I’m doing just fine comparatively. 

On physics: Two objects cannot occupy the same space at the same time.  Fences beware.  My ambulance is bigger than you, and I really suck at using reverse gear.

On gravity: When rolling a stretcher with a patient on it, allowing it to get off kilter is not a good idea.  It will flip, and you will probably not be able to catch it.  Your back will hurt for days from the effort.  Furthermore, it scares the crap out of the person on the stretcher.

On obesity: Fat people are fucking heavy.  My back hurts just thinking about it.

On mistaken identities: Most of the ambulances look pretty much the same; avoid getting in the wrong one at the hospital or on mass casualty incidents.  Also avoid checking off, putting your gear and belongings in, and sitting/waiting for your crew while growing irritated at their tardiness in the wrong ambulance, while your crew is in the right one, waiting for you. 

On diabetes: Keeping a tub full of cookies by your bed is not a cure for diabetes.  Who knew? 

On navigating: Sometimes, I get lost.  If I can find the nearest coffee shop or book store, I’ll find my way back on track.  

On linguistics: It is imperative to be fluent in the medical dialect of the people you treat.  Bonus points for saying “vomick” with a straight face the most times on a scene.  My partner holds the record, as I had to step outside to laugh hysterically. 

On misogyny: I’m trained to treat illnesses, perform challenging skills, think on my feet, and pick your fat ass up.  I also have ovaries.  Deal with it, as I can also restrain people if I see fit. 

On fashion: Bringing up bedazzling your turn out gear at a meeting will not impress your superiors.  Offering the ultimatum of either putting one’s name or JUICY on the rear of one’s tactical pants in rhinestones only serves to make it worse.  My superiors have opted to exchange our turnout gear for a bright yellow version, which is no consolation at all.  I continue to believe that I should be allowed to sparkle at all times. 

Also on fashion: Human feces is never an acceptable accessory, and it totally clashes with my rhinestone shades.  I may never forgive the lady that shat on me, despite the fact that she was unconscious. 

On fine dining: A slushee and a bag of white cheddar popcorn from a gas station is a pretty decent meal on a busy day.

Also on fine dining: If you get a chance to grab a meal at a soul food restaurant, the employees will likely treat you very well.  They know what they eat, and they know they’ll probably need you in the near future. 

On distorted self images: Just because one sees herself as a superheroine does not mean the rest of the world does.  They may see her as the blonde, pigtailed spaz she appears to be, despite the underlying truth. 

On great partners: Only the best partners are wise and thoughtful enough to crank up the volume on the radio when Lady Gaga is airing, so that you can simultaneously treat your patient and shake yo’ thang. 

On downtime: If a civilian calls 911 to report and complain about a paramedic shopping on shift, they should truly hope the dispatcher answering the call isn’t the very same person who is receiving freebies from the sale.  A buy three, get three free sale at Bath and Body Works IS an emergency.  Everyone knows that. 

On diversity: Stupidity knows no race, age, creed, color, religion, or social status, but it is consistent job security for me.

On kidnapping: Kidnapping and torturing your pet zombie is an entertaining, acceptable, and valuable way for your coworkers to spend their time between calls, particularly if they spend all day sending you picture messages, such as these.

 Photos courtesy of Gabe and KC.

On playing well with others:  What is the first thing you do when you arrive on scene?  Immediately decide who you will trip as bait in the event the patient turns out to be a reanimated zombie, obviously.  When, and I do say when, the zombie apocalypse comes, who do you think will be among the first wave of people attacked?  If you guessed the paramedic attempting to intubate, with their face and hands directly in the face and mouth of the “dead” guy without vital signs, you would be correct.  There’s going to be hordes of zombies somnambulating about in full paramedic, first responder, and police uniforms and turnout gear.  I don’t know about you, but I’m not going down like that.  Scene safety?  It can wait.  Need for additional resources?  I’ll let you know in a minute.  General impression of the patient?  I’ll get to it.  Zombie bait?  I’m all over that right away.  If the patient reanimates, I need to know who I’m pushing down.  The misogynistic hosedragger who refuses to look me in the eye and reports blood pressures as 120/80 without ever having touched the patient, or the fireman who pulls his weight as works with you as a team?  Easy choice.  What if zombification occurs at the hospital?  You have to choose between the mean, burnt out nurse that berates you for bringing a patient despite the fact transporting patients is pretty much what you do even if you don’t get to use any cool skills or equipment, and the tech who always smiles, helps you move a patient to the bed, and doubles as a roller derby girl in her spare time.  I think you know who I want on my team. 

I know what you’re thinking, “Um, Parapup is kind of off her rocker on this topic.”  Well, guess what you’ll be thinking once you get bit, die a painful death, and reanimate as a zombie: BRAAAAAAINS! 

Posted by on October 29, 2010 • Filed under: Uncategorized • Tagged: , , ,

Vigilante Medic Saves the Day

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My day started off with a slightly unusual call: I was sent to the aid of a young man with penile pain associated with a probable STD. Outstanding. As a heterosexual female, I have no interest in penises infected with sexually transmitted diseases, but when duty calls, I must answer, and I try to do so with grace and respect. The patient was probably not hoping to have a discussion about his penile discharge with a twenty-something year old blond female, but I honestly have no idea what goes through the minds of people who call 911 for these things. After all, the ghetto is an amazing place with a totally different definition of emergency than the rest of the world, regardless of the vehicle parked in the driveway. He had no reservations about speaking freely to me of his affliction, and after a brief consideration of making the new guy in training on our truck take a peek, I decided to wholeheartedly trust the patient’s description of his junk. Simply put, I didn’t want to look.

The patient politely asked if his “little brother” could accompany him to the hospital. I took a look at the individual, appropriately outfitted in an incredibly oversized shirt, sagging jean shorts, and an impressive swagger. He appeared to be a young teenager, and I immediately decided he was harmless. Perhaps this young one would learn a valuable lesson on the importance of the use of prophylactics. “Sure, but he’ll have to ride in the front and wear his seatbelt.” My crew and I took them both to the hospital, where the staff and I shared a laugh at the absurdity of the “emergent” situation. The day prior, I treated a man having a heart attack and a woman experiencing ventricular tachycardia, both of whom I decided would be just fine by ghetto standards.

While driving the ambulance to the hospital during the next call of the day, I was singing along to the radio, and I realized the passenger seat visor looked unusually empty. The universal garage door opener was present, but the spot where I typically clip my iPod was empty. I replayed the events of the day in my head: I came to work, be-bopped around the wash bay, and checked off the ambulance equipment listening to my “Happy” playlist. None of this was unusual. My partner, Vigilante Medic, is accustomed to finding me in the box of the ambulance shaking my thang or occasionally rocking the air guitar. I’m fairly certain he’s never seen me use the laryngoscope as a microphone, but I do tend to keep that show strictly between myself and my imaginary fans. I distinctly remembered standing on the running board of the ambulance, wrapping my headphones around the iPod, and clipping it to the passenger visor.

Upon arrival to the hospital, I immediately asked Vigilante Medic if he moved my iPod. He’s always looking out for me, I trust him completely, and it isn’t offensive or peculiar for him to get into my personal items. He told me he made sure my book bag was zipped and my Kindle (I’m a woman utterly dependent on technology) was put away before anyone entered the ambulance, but he didn’t think to look for my iPod. I scoured the ambulance, finding remnants of crews past and our belongings, but no sign of my iPod. If Vigilante Medic did not move my iPod, only one person was capable of taking it. I was enveloped in emotions of fury, horror, and personal violation, but the only thing that escaped my lips was, “That little ghetto fucker!” I personally gave this premature hoodlum permission to ride in the cab of my ambulance, which is my safe haven for 12 hour shifts, and he stole from me.

I called the hospital to which I took Penis Guy, and they told me he had been discharged with ample time to leave the premises. I called my supervisor, who has always been a wealth of wisdom, and he gave me his condolences and advised me to make a police report. I then called our communications department, who connected me to the non-emergency police line (we may be county funded, but we’re not strictly ghetto). The police department offered to send an officer to the hospital to take my report, but I declined, knowing first hand that with a growing murder rate and gang activity, our vice division has much better things to do than fuss over my stolen iPod. I had no proof that Penis Guy’s “little brother” stole from me, but I had more than reasonable suspicion. I was told I’d be contacted within ten days. Vigilante Medic found me at the ambulance with a furrowed brow and a pouting, quivering bottom lip.

Incidentally, this is not my first encounter with iPod thievery. My last iPod was stolen from my personal vehicle at my former apartment complex. I responded with a passive-aggressive note stating:

Dear Douchebag That Stole My iPod,

I hope you choke.

Love,

Tiff

Apparently, the letter I wrote, made 200 copies of, and distributed happily at that apartment complex was not well received given the response I got accusing me of threats. I moved within a week.

Vigilante Medic proposed an alternate route entirely, “If it were my iPod, I would show up with my biker friends tomorrow, and take back what’s mine.” We knew precisely where the hoodlum in question was picked up, and it was a fathomable assumption he would be there tomorrow. I tried to picture showing up in the ‘hood the next day, me leading a posse of my girlfriends each weighing in less than 140 pounds with an affinity for reading. I saw myself at the head of a group of Caucasian girls decked out in glitter shrieking, “If you don’t give me back my iPod, we’ll squeal in very high pitched tones, asshole!” We may look cute in proper lighting, but I don’t think vigilante justice suits us. I’m pretty sure I’d just injure myself if I tried to wield a gun, considering sometimes I fall down attempting to step out of the ambulance. I couldn’t conjure up a single scenario in which a situation of this caliber concluded in my favor. I’m more of the passive-aggressive letter writing type.

Inspired by the situation at hand, Vigilante Medic inquired our supervisor of potential legality issues, then called the communication department requesting a trip back to the ghetto. Communication informed him that the area was covered, but managed to assign us to the area anyway, putting an end in my mind to the age old idea that our dispatchers “aren’t looking out for us.”

I drove straight to the house where Penis Guy lives, in front of which Vigilante Medic, New Guy, and I strode out of the ambulance on a mission. We probably looked more like two dudes in uniforms with a chick looking around as if her head is on a swivel stick thinking, “Are we going to get shot today?” We were met by the father of Penis Guy, who informed us that the perpetrator was not his son, but he would be more than willing to assist us in locating him. At this point, I let Vigilante Medic do all the talking; I was stuck in the mode of thinking is the scene safe? I had one hand prepared to hit the emergency button on my radio and was constantly scanning the area for a potential gunmen or hoodlum wielding a knife. This was not an answer to a 911 call, I was completely out of my element, and I was scared.

Penis Guy’s father enlisted the help of Penis Guy, who was suddenly furious and quickly gaining my respect. Penis Guy told us he saw that exact iPod, my stolen iPod, and dialed into a cordless phone. He spoke into the telephone in a manner of incredulousness, anger, and exasperation that made me think I had judged his intellect and morality completely inaccurately. He demanded that my iPod be returned immediately, informed us of the whereabouts of the thief, and told us that it would be returned without delay or struggle.

I drove the ambulance to a gas station down the street, where we were
met by the prepubescent bandit. I saw him walking, and he was shorter and scrawnier than me. I’d barely noticed him on scene originally, but was now realizing the thug I’d built in my mind was far different from this diminutive creature. Finally, someone I can pick on. I approached him with an outstretched palm, and he reached into his right pocket, placed my iPod in my hand, and begun to walk off. I heard Vigilante Medic say, “That’s not good enough.”

The young thug turned and said, “Sorry” while looking at his feet.

I told him, “You need to look me in the eye and apologize.”

He looked up only with his eyes, “Sorry.”

“Do you understand the gravity of the situation? I was helping your friend, and you stole from me while I was doing that. I choose to have a job where I help people in distress, I don’t get paid much, and you stole directly from me. I made a police report and I’m not convinced I should call and cancel it.” I held the young crook’s gaze and tried not to lose faith in humanity. “Have you learned anything from this?”

“Yes,” he said to his feet again.

I turned and walked back to my ambulance muttering, “This little jerk hasn’t learned shit,” and thrilled that I’d regained an item I thought was indisputably lost forever. I pushed the appropriate buttons on the iPod and found that of all the angry music on my iPod, the perpetrator had been listening to, or trying to hock an iPod playing Adele. Seriously? He would have been more suited to tune into The Clash’s version of I Fought The Law and The Law Won, but in his case the lyrics would have had to been rearranged to the effect of “I Fought The Medics and The Medics won.”

Posted by on July 16, 2010 • Filed under: ems-topics, Uncategorized • Tagged: , , , ,

Zombie

7 comments

My partner and I are dispatched to a headache; this is our third headache call of the day, all of which were supremely boring. While I give my headache patients the best care I can, insuring they have no signs of an impending stroke, considering all aspects of the condition, and keeping them as comfortable as possible, I’d rounded out my previous call by looking longingly out the ambulance window, watching my coworkers wheel critical, medicated, intubated patients into the hospital, seeing my colleagues’ cheeks flushed with the excitement of their call. I want that excitement! I want to make a difference in someone’s life, but here I am on the way to another mundane headache call. What’s a girl got to do to get some neuro deficits around here?

As my partner and I pull up to an apartment complex, a first responder approaches to inform us that the patient is on the third floor, there’s no elevator, and his vitals check out fine. My partner and I roll our eyes in tandem as we mentally prepare ourselves for another monotonous experience and waste of valuable resources.

Three flights ascended, we determine the patient is stable, has no priority symptoms, and our equipment will not be necessary. In fact, the patient turns out to be such a nice person, I feel kind of like a jerk for secretly wanting to be with critical patients instead. I prepare the ambulance for a routine headache call, meticulously laying out all the things I think we might need, while my partner (who is pretty much the best paramedic on the planet and my role model) stays with the patient. I prime an IV line, turn on the oxygen tank, lay out the glucometer and blood pressure cuff, and by the time I start spying specks of dirt and spot cleaning, I realize everyone has been gone far too long. What the hell is going on up there? About the time I poke my head out of the back doors of the ambulance, a first responder comes running toward me yelling, “He passed out! We need it all!”

I scramble the equipment back together in a flash, and the first responder and I make the three story hike once again. I arrive to an unconscious, breathing patient, who has been positioned with his feet up to increase bloodflow to his brain. I quickly apply oxygen and put him on the cardiac monitor.

My partner and I simultaneously look at the monitor, look at each other, look at the patient, and look at the monitor once again, with similar blatant quizzical facial expressions. The monitor shows clear and obvious ventricular fibrillation, a non-perfusing lethal rhythm. The patient is breathing, moaning, and moving his head. We frantically double and triple check the cables, convinced there is an error. The fire department must think we’ve lost our minds. We can’t find a pulse, and we absolutely must initiate CPR. My partner prepares to shock the patient, and I perform a chest compression. The patient retorts with a clearly audible “Ow!” I have done plenty of CPR, but never on anyone who is capable of informing me that it hurts. Furthermore, I’ve never in my life seen a dead guy breathe, moan, or move on his own accord. My partner and I lock eyes, and I know we’re thinking the same thing: there’s only one explanation for this—he’s a zombie.

We actually have a cardiac arrest bag full of all kinds of goodies just for this occasion, but I didn’t think to bring it. No one thought we had a dead guy on our hands, what with all the signs of life, so we’ll have to make do with what we have. My partner sends 150 Joules of electricity into the zombie’s chest, which he clearly does not like, judging by the sound he makes. The man turns purple from the nipple line up, a textbook sign of a pulmonary embolism. I continue to perform CPR, while concurrently instructing first responders to prepare equipment.

My partner says he’s going to start an IV in a vein in the man’s neck. I have someone take over CPR, and I practically tackle my partner, which is my standard response when he’s about to do a cool procedure I’ve never done. I insert a large bore catheter in the zombie’s external jugular vein, with my partner expertly walking me through the motions.

After a few more minutes of CPR, code drugs, and defibrillation, while not being distracted by the obvious life-like state of our dead guy (for which the American Heart Association did not prepare us AT ALL), he gets a pulse back. That is to say, our zombie is now un-dead, which goes against all the comic books I devoured as a nerdy, antisocial kid. While this is obviously great for the patient, the return of spontaneous circulation also works out nicely for us, because there was no freaking way we were going to make it down three narrow flights of stairs and do CPR.

A 12 lead ECG shows the patient is also having a monster of a heart attack. So, to sum it up thus far, we have a formerly dead guy who appeared remarkably alive while dead with a possible stroke, pulmonary embolism, and big fat myocardial infarction (that’s just a fancy way of saying heart attack). This is all my fault; I pouted and wished for excitement, and the EMS gods came through with alarming alacrity.

En route to the hospital, we do the zombie-CPR-shock-drugs-un-die dance a few more times. At one point, I’m performing CPR again (I love to do CPR. There’s something thrilling about being a physically fit girl doing manual labor in a largely male dominated field, when big burly dudes say, “Need me to take over for you?” saying and honestly meaning, “No, thanks. I’m good.”) and my partner contemplates aloud, “Because he is having an MI, perhaps the epinephrine will be too much of a strain on his heart and make it worse.”

“True,” I respond, proud of the fact that I can talk and do chest compressions, “but having no pulse at all is probably the larger of the evils.”

“Good point,” he says. He pushes another round of drugs, and I get another break from CPR.

Upon arrival at the hospital, the ED staff has the delight of encountering the same bizarre circumstances as we did, and again, he regains a pulse. Doctors, nurses, and techs are all astonished, while my partner and I play the role of the experienced wise ones in this unusual scenario; after all, this is old news for us by now. The staff takes him, un-dead again, upstairs where he will undergo tests and catheterization to try to combat the zombie trifecta.

**************************************************

The next day, my partner and I take a non-critical patient to triage at the same hospital. My partner suggests we investigate the patient’s outcome, and I eagerly agree. We mosey up to the ICU, trying to give the perception that we belong here, despite the obvious contrast of our uniforms, radios, boots, and shiny badges to the hospital staff’s comfortable scrubs and tennis shoes.

We find a nurse, explain who we are and what we are looking for. The nurse tells us, “Sure! He’s doing great and he’ll probably be discharged by the end of the week. He’s awake if you want to go see him.”

He’s awake. This is far better than either of us had imagined. Honestly, we came to find out if he was dead or a vegetable, but this man is awake.

My partner knocks on the door gently, and he and I enter the patient’s room, mouths agape at the conscious man who is clearly not on life support. The patient looks at us and says, “Well, judging by the uniforms, you must be the people who saved my life. The doctors say that if you hadn’t have been there and done what you did, I wouldn’t be here.”

We stayed and chatted with a man that died in front of us the day before, which is the single greatest experience I may ever have in my career. All his faculties are intact, and he has even managed to retain his sense of hu
mor. I’m more astounded than I was when he was a zombie, but I kept that to myself.

“You know, I’m really sore from it all. I’d like to know what mammoth of a man you had doing CPR on me,” he tells us.

My partner looks at me, and I feel a girl-power grin that starts from my gut and works its way up. “For the most part, I did the CPR. You didn’t seem to like it much then, but it was better than the alternative.”

“Well, thank you both.”

The intense school, the paltry paycheck, the abusive patients, the generalized assholes, and all the crap that goes along with EMS, after seeing that man alive, was worth it.

Posted by on May 2, 2010 • Filed under: cardiac arrest, ems-topics, patient-management • Tagged: , , , ,

My Rumor Is Better Than Your Rumor

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Gossip is common in any group of people, found in every profession and every culture I’ve ever had the pleasure of encountering. In the world of emergency medicine, we could put daytime television to shame. Many of those involved in EMS tend to be thrill seekers by nature; we typically find ourselves in this line of work because we want to stare the Grim Reaper in the face and tell him to BRING IT ON. As a direct side effect of this personality type, we are an incestuous subset of society, complete with our own tales of who’s dating whom, who’s screwing whom, who’s screwed whom over, and so on. In an agency of a few hundred field personnel, ample opportunities are put forth to raise turmoil in the dreaded rumor mill. I am no exception; I dated a colleague I encountered closely in my employer funded paramedic program. Scandalous! These tales range from completely truthful, vaguely based in partial truths, and completely fictitious.

I experienced my claim to urban EMS fame with my very own rumor during paramedic school, a year and a half into employment at the agency, and a few months into the paramedic program. Until this point, I’d managed to stay under the proverbial rumor radar, largely by keeping my nose tucked safely into whatever book I’d gotten my hands on that week, with minimum fraternization with my coworkers. As a mere paramecium, I was completely engulfed in the world of learning paramedicine, and had little time or energy remaining for anything remotely indecent, however tempting.

The county my agency has the delight to serve is also provided with a fine publication called The Slammer, available primarily at superior establishments located in the hearts of our many ghettos. This may seem odd upon initial examination, but is an excellent way to keep up with the recent activities of loved and/or despised family members, cohorts, and acquaintances. I am simply giddy at the occasional glimpse of a high school classmate, although it is much more likely to catch a snapshot of the recent arrest of a frequent flier of the EMS variety.

Unbeknownst to me, The Slammer had published the latest arrest of a young lady who shares my first and last name, but is in an entirely different line of employment as myself. While not a dead ringer, Tiffany’s mugshot does not necessarily look unlike me: she’s young, Caucasian, and blond. Listed directly under the black and white photo are the allegations against her—Prostitution and Crimes Against Nature.

This particular edition of The Slammer was circulated during the opposite shift as the one I worked prior to enrolling into paramedic school. That is to say, employees of that shift were familiar with my name and had merely a vague idea of my appearance, as our paths rarely crossed. Presumably, a coworker and ardent reader of The Slammer purchased a copy, found “me,” and produced the “evidence” to the supervisor on duty, who was not particularly familiar with nor had never actually met me. The supervisor on duty then called my direct supervisor, Paramom, who was enjoying an adult beverage on her well deserved weekend off work. As I understand it, Paramom’s reaction to “my” crime was: “Are you sure? Tiff’s in paramedic school. I really don’t think she has time to hook.”

Meanwhile, “I” was cut out of that particular edition of The Slammer, and the tabloid was left at the logistics window, free to be perused by at least one member of every crew that must wait at that window for the necessary items that are required for every ambulance. While a hole in a publication that reports criminal arrests may have seemed inconspicuous to some, inclined inquiring minds had the ability to fill the void with minimum investigative efforts.

My personal rumor was brought to my attention by Paramom, who approached me during my usually anticlimactic lunch break during school. I was having a pretty fantastic day. All morning, I’d received smiles and salutations from paramedics and EMTs alike that typically ignored me or viewed me as an unobtrusive piece of the scenery. Obviously, I thought I was having an extraordinarily great hair day. Paramom casually sat at the table in the office kitchen as I shoveled in another forkful of the weekend’s leftovers, “So, did you have an exciting weekend?”

“Not really. I’m having a tough time getting all of these drug dosages down, but I think I’ll get it if I keep at it. There’s just a lot to absorb.”

Paramom asks me with a nervous laugh, “I see. So, you definitely weren’t incarcerated on your weekend off?”

When I applied at my agency, in addition to all jobs I’ve applied for in the past, I’ve been asked about the possibility of a criminal record as a formality. I’ve been subjected to standard background checks and known company policy requires full disclosure of criminal charges. I have, however, never been asked in a straightforward manner about any criminal activity, particularly when some details have been quite clearly established. It has simply never come up, and I was not entirely sure of the proper social protocol; I settled with nearly choking on my reheated pasta. “Um, no. I’m fairly certain I would have remembered that.”

Paramom proceeded to fill me in on her interesting telephone call that seemed too absurd to investigate over the weekend, but had to be addressed as a matter of course. She also informed me that she had yet to actually see the “evidence” in person. We set off to acquire our own copy of The Slammer, conveniently sold at the gas station next to our agency (we’re county funded). A few pages in, there “I” was, in all “my” mugshot glory, nestled in the middle of a section specifically dedicated to sexual crimes. Her middle name was different than mine, putting a definite end to the investigation in an official capacity on the spot. “What exactly constitutes a crime against nature?” I asked Paramom, but even in her infinite wisdom, she was dumbfounded. On the bright side, my namesake was definitely the hottest prostitute published that week.

My classmates and friends teased me with a vigor that occasionally resurfaces to this day. With Paramom’s blessing, I made no efforts to squash the rumor with the field crews. I cat walked the wash bays with my head held high and an extra swagger in my step. In an agency of a few hundred people, I had my very own rumor, which I didn’t even need to fuel with my own offensive behavior. Simply put, I had made it.

Posted by on March 8, 2010 • Filed under: ems-topics, Uncategorized • Tagged: , , , ,

The Dichotomy of Crazy

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Crazy presents itself in many forms. My own particular brand of crazy is a bizarre form of serially monogamous relationships despite my intense fear of commitment. I’m fully aware of the oxymoronic nature of myself, but self-psychoanalysis is for another time all together. I find it much more entertaining to ponder the craziness found in others than attempt to interpret and treat the psycho within. Through what I consider to be deep thought (I’m blond, it hurts, you know), I’ve come to the conclusion that the crazy I’ve encountered on the job is split into a fairly distinct dichotomy: Good (or at least not a danger to the world and its populace) Crazy and Bad Crazy.

Good Crazies and I get along very well, perhaps due to the “it takes one to know one” theory. Good Crazies and I can see eye to eye and get to the hospital without physical restraints, threats of/attempts at bodily harm, or the sudden inescapable desire to unbuckle oneself from the seatbelts on the stretcher and fling oneself out of the back of the ambulance at 55 miles per hour on the highway. We may even share a laugh, a common interest in books/music/serial killers, or a personal epiphany into the insight of mankind. People of the Good Crazy variety tend to see me, decked out in pigtails, with big blue eyes and girl-next-door freckles, as the kind and loving creature I try to portray my image to be, and immediately assess that I am not only far from a threat, but willing and able to help them. Good Crazies get my personal specialty, 50cc of love: hand holding and head patting as necessary.

Examples of Good Crazy:

Alzheimer’s Patient Who Seems To Have Developed Tourette Syndrome: This patient is almost always a delight for me. You just can’t be mad at them. You can be annoyed with the nursing home staff for calling 911 and reporting that the patient has an altered mental status, despite the fact that their normal mental status is indistinguishable from an altered one, but not at the patient. Furthermore, every time they drop the F-Bomb, it gives me the giggles like nitrous oxide. There’s just nothing like a 200 year old lady swearing like a sailor. I realize how hard this must be the patient’s family members, but if I spend much time analyzing the true misfortune of my patients, I’ll spend the rest of my life munching on serotonin reuptake inhibitors.

Mentally Handicapped, But Incorrigibly Happy Kid: I walk into the room and this kid (or technically adult as the case may be, but they always strike me as kids) just BEAMS at me with a smile that could replace the sun. I introduce myself and ask if we can be friends, and they always want to be my friend. People who want my friendship may be appealing from a person with all their mental faculties, but people who have been dealt a seriously shitty hand and have a sunny outlook are impossible not to adore. I realize that perhaps they’re incapable of knowing the nature of their illness, but I can’t force myself to care. They actually want to be my friend for no reason (perhaps this requires another self-psychoanalysis in the future, but I digress)!

The Happy Drunk: While it is obnoxious to continuously take people to an emergency room when they are clearly not having an emergency, it’s apparently unavoidable. If I must transport a drunk, I infinitely prefer The Happy Drunk, which is not to be mistaken with The Drunk That Vomited Red Wine On Me And Now I Can’t Even Smell It Anymore Without Feeling Nauseous. They may take for freakin’ ever to load into the ambulance because they feel the need to say goodbye to everyone on first response and stumble around incessantly, but they don’t throw punches or insult public safety personnel. They even laugh at their own slurring, inability to speak a clear sentence, and hiccups. The Happy Drunk is occasionally homeless, and this is his or her primary escape from the harsh reality of the world, for which I can’t really blame them. I suppose The Happy Drunk takes me back to my days in college, where I didn’t realize my EMS training had begun by taking care of my friends who frequently morphed into The Happy Drunk. In fact, I have been The Happy Drunk, just never in an ambulance.

The Schizophrenic Lady Who Puts Lipstick All Around Her Eye Like Petey The Dog, Or Other Harmless Aberrant Behavior: Bystanders only called 911 because this patient is clearly off her rocker, and they have no clue what to do. Think about it: you see someone with blatant atypical behavior, but do you really know if they’ll go off on you if you ask about it? Bystanders don’t see this patient normally, because they tend to be tucked safely away in the care of family members or mental institutions. They see someone painting their face in hot pink and babbling incoherently and have no idea what to make of it. When I show up, I compliment the color and let her know if she missed a spot. In retort, we have a peaceful ride conversing about the nice Martian she met last week.

Bad Crazy, on the other hand, is the total opposite, and even worse, they see right through my docile appearance. Bad Crazies know I’m not totally sane (who in EMS is, anyway?), and they thrive on it. They love to pick fights, force us into physically restraining them (without even acknowledging how handy I am with soft restraints! Jerks!), or make grand accusations of our intentions/races/religions/sexual preferences/possibilities of demonic nature or possession. Bad Crazies will NOT accept even my most compelling charm, which quite frankly, annoys the crap out of me. Well, that and sometimes they try to hurt me, which sucks for obvious reasons.

Examples of Bad Crazy:

The Patient Who Makes Really Ineffective Suicide Attempts Regularly: This patient either has the IQ of a fencepost or is really searching for attention, not an end to their existence as they know it. This patient only falls into the Bad Crazy category because they’re hurting the people who care about them, albeit emotionally. Cutting your finger, taking a dose of an over the counter medication that is less than the recommended dose, jumping out of a window on the first floor of a building, banging your head onto a concrete wall (but not hard enough to leave a mark), stabbing yourself in the leg with a pencil, refusing to take your vitamins, taking your prescribed medications when and as you are instructed (seriously), scratching your forearm with a dull knife, or staring at the sun will probably not kill you. These patients typically need either a stage complete with spotlights or Darwinian intervention. Better luck next time.

The Paranoid Schizophrenic Conspiracist: These people are very mentally ill, usually with a multitude of psychiatric disorders, and typically have experienced such awful things in life that their mind literally surrendered. These people know for a fact that myself, my crew, and all first responders and police officers are all minions to those orchestrating an elaborate scheme to “get” them. Granted, it doesn’t help my case that the patient was full body tackled by a police officer to get under my care in the first place, but you simply cannot run half naked, at top speed, through the back yards of a middle-upper class neighborhood; people frown on that kind of thing. Logic is of no use with these patients. My oxygen is really noxious gas, my lancet for checking glucose levels is actually a poison dart, and my blood pressure cuff is a cleverly disguised torture device. These patients are highly unpredictable and are so intensely fearful that they honestly believe I can and will hurt them. They interpret my attempt at a calm voice as a ruse and my ambulance as an embodiment of the evil that is set to destroy them. I can’t entirely blame them…if you were actually looking at a hallucination of “El Diablo,” how can you not believe higher powers are looking to destroy you? After all,
seeing is believing, right?

The Dimwitted Criminal: This particular type of patient exists largely to make me feel of superior intellect. This patient dons stylish house arrest anklet, yet led the highway patrol on a high speed chase for no apparent reason, hit the car of a passerby at an off ramp, took off on foot, got bit in the leg by a dog from the canine unit, and fails to see the irony in the fact that I forgot to put my phone on vibrate and The Clash’s “I Fought the Law, and the Law Won” rings from the pocket at my right breast. Nicely done, Dimwitted Criminal, you may have just won yourself a stay at the big house! I see the biggest injustice as the fact that these delinquents always seem to procreate; can the spawn of those responsible for keeping prison recidivism rates exceptionally high really stand a chance at success in life?

The Mean Drunk: I despise The Mean Drunk. The Mean Drunk has poured alcohol down his throat in whatever form he/she can find every waking minute of every day, regardless of the fact that the juice makes them grow horns and spit fire. The Mean Drunk knows that he or she is a raging asshole under the influence, and probably wouldn’t be such a dick if he/she quit drinking mouthwash every day, but just doesn’t care. The Mean Drunk is full of threats of violence, and occasionally acts them out. He/she flails about, swinging fists and feet, yelling threats and insults, spitting and refusing to cooperate. Really, Mean Drunk, I’m practically Aryan in appearance; it just doesn’t make much sense to call me the N-word. Also, please keep your HIV, Hepatitis, TB, or other communicable disease laced saliva to yourself. On occasion, The Mean Drunk picks me out of all the people available as his victim, which never fails to baffle me; aside from an emaciated teenaged fireman, I am likely the smallest person on a scene, and I wear my hair in pigtails regularly…PIGTAILS! “I’m gonna rearrange your pretty little face!” Yeah, Mean Drunk, you said that last week, and guess what! Face. Still. In. Tact. Seriously, Mean Drunk, this whole slowly killing your liver ordeal is for the birds; just aspirate your vomit and die already. Perhaps the most disturbing thing of all is that these people don’t actually scare me anymore. Sure, I’ll be more alert, keeping my arms constantly prepared to block a swing or ready to use four point restraints, but I’m no longer afraid. When I was a new EMT, these people scared the crap out of me; these days, I just think these patients are probably why we don’t use paralyzing drugs in my system.

I’ve barely covered the tip of the craziness ice burg in the emergency setting, but I can’t be bothered to write a novella on the experience. Besides, most of it is depressing. The comic book version of myself lifts The Good Crazies effortlessly and compassionately, delivering them to hospitals capable of curing their incurable problems. She protects the world from the Bad Crazies with speed, strength, and intelligence. Of course, the superhero within is a fantasy, so I’ll settle with not being dumbfounded and doing the best I can in whatever situation I find my patients and myself in.

Posted by on February 11, 2010 • Filed under: Uncategorized • Tagged: , , , , ,

Numero Uno

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I am a bona fide paramedic; I’ve worked hard to learn about the myriad of disastrous complications the human body can endure and ultimately, what interventions can be made on my part to keep a person alive in the face of abominable circumstances. Essentially, I was ready. Bring on the Grim Reaper-I am ready to stare him down and pull lives from his grimy, heart-stopping, possibly mummified hand! This is honestly how you feel when you’ve been a paramedic for a week: part superhero and part purist. Your heart is full of altruism, your brain is full of knowledge you’ll likely lose from lack of use, and the rest of you is petrified that you’ll kill someone. Ah, the life of a para-pup.

Then it happened: I got my first priority (read: really bad, possibly about to kick it to the next adventure, depending on your particular brand of spirituality) patient. The dispatch came over the radio, and I wasn’t necessarily anticipating anything serious in nature considering the vast majority of the people who call 911 are in no severe distress what-so-ever. The possibility still remained that this person could be in severe distress and I could swoop in and save the day with my knowledge, medications, and equipment. I can nearly see it in frames of a comic book, vibrant colors showing my hair blowing (and possibly a cape, too, for good measure) as I defibrillate the patient’s heart, stopping a lethal rhythm from claiming the life of yet another innocent soul. I intubate the patient with grace and style, protecting his or her airway from the always dreaded aspiration injury. I give life-saving medications through an intravenous line that I have managed to administer without so much as spilling a drop of blood. I can see the sparkle off my teeth as I wheel the patient into the hospital with nothing left for the doctors and nurses to do because I have saved the day. The patient, their family, and doctors and nurses thank me profusely, as they are positive that without my interventions, the patient would have inevitably experienced a harsh and painful death. On top of all that, I have never looked better in my uniform as with the added advantage of a touch of cleavage. My fantasy world quickly comes to a halt as I pull the ambulance into the parking lot of your standard ghetto-fabulous apartment complex.

True to form, the apartment itself matches the façade: smoke wafts through the air, the furniture is minimalist and cheap, untidiness is abundant, evidence of fast-food is scattered throughout the areas I see, and more people appear to live there than the fire code will likely allow. I see my patient sitting upright on a battered couch, her hands on her knees, clearly struggling to suck precious air into her lungs. Shit. Shit! SHIT! I realize two things for certain: if I don’t do something immediately, this woman will die, and I have absolutely no idea what I’m doing. Reality sucks. I can only imagine how I must have looked to my patient: a 26 year old blonde with the color drained from my face, eyes wide and unblinking, frozen. Perhaps she thought that I was fulfilling the agency’s special needs requirements for equal opportunity employment.

Luckily, I’m working today with an experienced paramedic who I would trust with my own life. She’s the real superheroine here, and I find this comforting enough to snap myself out of my stupor. Somehow, my training kicks in, and I become a woman of action, albeit a clumsy woman of action, fumbling with my equipment with shaking hands, mostly unsure of every patient care decision. I call out for the patient to be put on oxygen. Holy crap! The firemen are doing what I say and instead of looking at me like I’m speaking tongues. Well, that’s kind of cool. I listen to breath sounds, note wheezing all over and diminishment in the lower lobes of the lungs. I attach a probe to her finger that reads oxygen saturation levels: 74% and dropping with a high heart rate. The patient is unable to speak and tell me her medical history, but she is relatively young and is able to answer some yes or no questions; I just have to choose them wisely. The patient is able to nod that she has asthma and that this problem came on quickly. She shakes her head when asked if she’s allergic to any medications.

I call to my partner to set up a nebulizer with albuterol, stronger than her home version of the drug. I tell her to toss me the epinephrine, I want it readily available in my pocket. A fireman reads off medication names from a grocery bag full of medications, “albuterol, metformin, hydrochlor-I can’t say that one, but it’s a big word, lasix, and prozac.” Fantastic. Those medications indicate that she could be either having an asthma attack of the worst kind or drowning in her own blood, and if I treat her wrong, I’ll kill her.

I listen to her lungs again and there is no change, her oxygen saturation level is holding steady. We pick her up to put her on my stretcher, and as I put my hand around her left arm, I feel the swoosh of blood that indicates she has a dialysis shunt, and I briefly panic. She could potentially have toxins and fluid backing up in her bloodstream and into her lungs, and the medication I’m giving could be helping her drown if this is the case. Super. “Have you missed any dialysis appointments?” She shakes her head no, and a family member says that she went to dialysis yesterday. Here’s hoping I don’t screw this one up.

It feels like we’ve been here entirely too long, but I know it couldn’t have been more than two or three minutes. We need to get moving immediately, and I ask a fireman to drive the ambulance to the hospital, with what I like to think was politeness and urgency, but probably appeared more along the lines of frazzled bossiness.

Her blood pressure is dangerously high, making me again concerned that I’m treating my patient totally inappropriately. I reconsider and decide that this has asthma written all over it, and I make an active decision to stick to my guns and see what happens. My partner is furiously working to put together the CPAP, a machine that forces air into one’s lungs, while I’m searching for IV access. She yells out to me that the machine isn’t working as I yell that the patient has no IV access. Abandoning paramedicine in lieu of permanently living in my comic book fantasy is looking more appealing by the second. In one arm, her veins have been totally deteriorated by diabetes and high blood pressure, and in the other her veins have been altered by the surgical placement of a dialysis shunt.

I peek up at my patient to see the beginning of The Look. The Look is not a new concept for me. I’ve seen The Look as an EMT-Basic and not directly responsible for doing things like keeping people from dying. Until now, The Look meant I should say to the paramedic, “Hey, you should probably do something about that,” because The Look is typically followed by death. Now I’m the paramedic. Crap. I suggest to my partner that I think it’s time to give epinephrine, but she disagrees. My partner thinks this very strong medication could put too much strain on her heart. That’s a distinct possibility, and by doing this we could give her a heart attack. We agree to hold off on the epinephrine for now, but keep it close by.

My partner is able to rig the CPAP machine with brute force; it leaks, but it works. Good enough. The oxygen does the trick and The Look is gone for good. The patient’s oxygen levels steadily rise until they reach 100%, where they remain. We have managed to alert the hospital prior to our arrival, and as we roll the stretcher into the waiting room, the doctors and nurses immediately get to work. The room is crowded and wires and tubes seem to fling through the air as our equipment is traded out for that of the hospital’s. I manage to relay my report to the room, despite the frenzied activity, without appearing to be a complete idiot, which is no small feat. An experienced nurse is attempting to obtain IV access and I hear her say “She has absolutely no IV sites.” Well, that makes me feel a little better.

As I leave the room, my hair is matted to my head with sweat, I didn’t save the day with grace and style, and I have no tasteful cleavage. I did, however, get the patient to the hospital alive with the invaluable help of an experienced partner and an accommodating fire department. As I replay the events in my head, I remember and remark to my partner that I’m most impressed that we never got distracted by the fact that there was a midget on scene to begin with; she agrees that this is an achievement worth celebrating.

After what seemed like an eternity, I finished the bulk of my written report and documentation. I reentered the patient’s room for a little bit of early follow-up. The patient is sitting up, on continuous nebulizer treatments and finally able to talk. “Honey, did I scare you?” she asks me.

“Yes, ma’am.”

“Don’t worry. You did a good job.” Well, it isn’t people falling at my feet to appreciate my valiant efforts, but I’ll take it.

Posted by on January 26, 2010 • Filed under: ems-topics, in-the-line-of-duty • Tagged: , , , , ,