This will sound more morose than I intend it to- or perhaps exactly as morose as I intend, but there are times when I’m in the back of the truck and I’m watching the cardiac monitor and it feels like I’m watching my life slip away with the patient’s. Just one beat at a time. It’s worse when there’s no chance at improvement for the patient. When I’m serving my time as a goat herder- ushering a demented little-old-lady who’s blind and deaf and requires artificial nutrition to stay alive. In those times it’s hard to feel like there’s a real purpose behind the job- that this is really a calling. Sometimes it feels more like a prison sentence. “You are hereby ordered to witness the slow death of 300 individuals per year. You will maintain what is cynically referred to as comfort measures, and extend these lives despite many good reasons not to. May God have mercy on your soul.”
I’m watching this lady’s husband tell her to stay calm, and that all of this is to help, and it just feels like a lie. Rather- it is a lie. This isn’t to help her. There is no helping her. Her brain has atrophied past the point where any meaningful interaction is possible. She’s receiving treatment for a raging UTI (her third in as many months), and we’re about to cut off her leg since her peripheral vascular disease has reached the point of no return and the skin around her foot has begun to spontaneously die. His words of assurance and calming are for himself. Convincing himself that his desire to hold on for just a bit longer is only due to love and not fear. That her case is different, and she’s about to turn the corner. That letting a surgeon cut off the lower portion of her legs is completely justified because he’ll have one more day. I know the truth: I know that this lady will in all likelihood never come off the ventilator she’ll be placed on for surgery. If she survives the procedure at all she’ll live out her few remaining days in the ICU with an endotracheal tube shoved into her airway.
We’ve arrived at the new hospital. The place (in all likelihood) that this lady will die. Far from home. Missing part of her legs. Hooked to machines, and tubes, and completely unaware of the decisions being made on her behalf. With my willing participation.
She's agitated now from the movement of transport, so I give her a little bit of Ativan. This is the life this lady gets to live in her final days. A nameless stranger who you won't remember- sedating you as you scream in the back of a vehicle taking you to a place you can't name. I don't mean to suggest that it's never worth it. I know what it is to truly save a life- to bring someone back from the very brink or even just beyond. It's just that it's so rare, and it so often feels like we're doing more harm than good. We set out to heal the world and end up just letting wounds fester into gangrene.
Tomorrow I'll go back. And I'll be in the back of the truck again, and maybe this time I'll make something positive happen. Maybe my hands will heal and revive, rather than maintain and sustain- but I truly have little faith.
Saturday, August 17, 2013
Dueling Banjos
*Editors Note: This story is about 6 years old. It's been re-edited, but remains just as true as the day it was initially written.*
When the directions to a call include "The house is a blue single-wide across from a double-wide, and should have 3 Confederate Flags hanging outside" you know you're in for an exciting experience. Yesterday was no exception.
At about 5pm we were dispatched to a hemorrhage call out in the sticks. Hemorrhage calls suck for a few reasons, but first and foremost they suck because people generally only call 911 when they're bleeding from one of two places- their ass, or their va-jay-jay. Believe me when I say this- nothing will kill your sex drive faster than some of the genitalia I see doing this job.
Sure enough, while we're enroute to the call communications radios us with the additional information they've gleaned from the caller: "Medic Unit- your patient is going to be a 42 year old female, passing clots from her vagina" It's rare for me to put on a pair of gloves before I even see a patient, but I figure this time it's justified.
Pulling up to the "house" I'm suddenly frightened for my life- I can hear the lines from Deliverance repeating over and over in my head. I wondered: Do I have a pretty mouth? What would it be like to kill a man with a bow and arrow? And where's the creepy kid with the banjo?
Oh- there he is.
Seriously. Sitting on the front porch is an blank-eyed youngster holding a banjo. Cornhole tightened, I approach the house.
As I walk toward the front door, I'm forced to shimmy, shake, and rock the stretcher past a few junked cars, through a fence gate, and up a ramp to the flimsy door of the trailer. One of the Confederate flags gets caught on the side rail of the stretcher and rips nearly in half. Apologizing to the strumming youngster, I'm just glad that neither my partner nor I are African-American. There are enough hillbillies here to pull off a lynchin'.
I start to open the front door, but pause as I'm informed that there's "No smokn in the hous". Verbatim. It's been written carefully on the front door in magic marker. At least twice. Underneath the current black letters the former iteration of this message is still visible in a more cerulean shade.
The living room of this house looks like a tornado of all that is redneck struck less than fifteen minutes ago, and since this is a mobile home that's not all that unlikely. The room is covered in naked baby pictures, and all the kids are indistinguishable from one another. They all have broad, flat, blank faces, with narrow-set blue eyes, and a gap mouthed, gap toothed smile. When the final count is in, it appears that no less than 12 people (at least 11 of them related to one another by blood... I think the black guy might've been a friend, despite the Dixie flags outside) are living in this 2 bedroom trailer.
The kids range in age from a couple of years, to somewhere in their early twenties, and all seem to share approximately the same education level. While trying to assess my patient, I got the best answers about her medical history from a child who looked to be about 11.
That reminds me- after pausing to admire the NASCAR collectible plate series displayed on top of the mantle, (I still giggle when I see Dick Trickle's name) I finally managed to get to my patient, and begin the process of figuring out just what the hell was wrong with her.
The "42 year old female who was passing clots" is lying on a hospital bed in the middle of the living room. She's lying on a plastic sheet, and is wearing nothing but a hospital gown, and a urinary catheter. She's had her right leg amputated below the knee, and just from looking in her eyes you can tell she's gorked.
Her husband is standing by the bed and furiously working the wad of tobacco in his cheek. I begin this assessment the same way I begin every assessment, asking- "What's going on today, sir?"
"Well- she bleedin 'gain"
"Ah. And how long has she been bleeding?"
"'Bout three hour"
"And is this abnormal for her, or does she normally have a menstrual period?"
"Well- she do, but this is differin. She passing big clots- 'bout fo, five, an las' time she did this, they had to give her blood an clean her on out in there."
"Okay- so when did this last happen?"
"Hmmmm- prob'ly been 'bout a year now."
"Okay- does she have any other medical problems?"
"She jus had an infection"
"What was infected sir?"
"She was."
"Ooookay. Why does she have the IV in place?"
He tells me that the hospital sent her home with an IV in place so that he (or rather, the 11 year old who understood the instructions) could administer Vancomycin everyday for 14 days. Vanc is a powerful anti-biotic used to combat very specific, and very contagious staph infections that are usually picked up in the hospital.
"Sir- has your wife always been- er- uh- Non-verbal?"
"Do what?"
"Has your wife always been unable to speak, or move?"
"Oh- no. That happened last year."
"Sir, what happened last year?"
"Oh- she had 'bout eight strokes an five- maybe six heart attacks. Doctors dunno why. But we're gettin her better here now."
Shaking my head and wondering how eight strokes and five heart attacks didn't merit a mention in response to my questions regarding "other medical problems" we move the woman over to our stretcher. Throughout this entire process she screams like the monsters from Scooby-Doo, and tries to claw anyone who touches her with her overgrown and yellowing nails.
As we pick her up to move her over, I notice an enormous decubitus ulcer (GRAPHIC!) on her buttocks, and I ask her husband about it.
"She had that oh... three, fo, months now. You can stick your fist in it!"
"Sir- have you been sticking your fist in it?"
*shuffles feet* "Naw... naw... but you could."
Throughout the entire ride to the hospital, the woman continues her monster-moans, and makes any true assessment impossible with her attempts at clawing us. I'm ecstatic when the relatively short drive is over. Wheeling the woman into the ER, we're forced to wait 30 minutes for a room since they're renovating the entire emergency department. This leaves the nurses short on beds, and shorter still on temper.
I drop off my report with the doc, and laugh as I hear him interviewing the husband:
"Sir- about this ulcer on her buttocks..."
"Yeah! You can stick your fist in it!"
"Sir- have you been sticking your fist in it?"
When the directions to a call include "The house is a blue single-wide across from a double-wide, and should have 3 Confederate Flags hanging outside" you know you're in for an exciting experience. Yesterday was no exception.
At about 5pm we were dispatched to a hemorrhage call out in the sticks. Hemorrhage calls suck for a few reasons, but first and foremost they suck because people generally only call 911 when they're bleeding from one of two places- their ass, or their va-jay-jay. Believe me when I say this- nothing will kill your sex drive faster than some of the genitalia I see doing this job.
Sure enough, while we're enroute to the call communications radios us with the additional information they've gleaned from the caller: "Medic Unit- your patient is going to be a 42 year old female, passing clots from her vagina" It's rare for me to put on a pair of gloves before I even see a patient, but I figure this time it's justified.
Pulling up to the "house" I'm suddenly frightened for my life- I can hear the lines from Deliverance repeating over and over in my head. I wondered: Do I have a pretty mouth? What would it be like to kill a man with a bow and arrow? And where's the creepy kid with the banjo?
Oh- there he is.
Seriously. Sitting on the front porch is an blank-eyed youngster holding a banjo. Cornhole tightened, I approach the house.
As I walk toward the front door, I'm forced to shimmy, shake, and rock the stretcher past a few junked cars, through a fence gate, and up a ramp to the flimsy door of the trailer. One of the Confederate flags gets caught on the side rail of the stretcher and rips nearly in half. Apologizing to the strumming youngster, I'm just glad that neither my partner nor I are African-American. There are enough hillbillies here to pull off a lynchin'.
I start to open the front door, but pause as I'm informed that there's "No smokn in the hous". Verbatim. It's been written carefully on the front door in magic marker. At least twice. Underneath the current black letters the former iteration of this message is still visible in a more cerulean shade.
The living room of this house looks like a tornado of all that is redneck struck less than fifteen minutes ago, and since this is a mobile home that's not all that unlikely. The room is covered in naked baby pictures, and all the kids are indistinguishable from one another. They all have broad, flat, blank faces, with narrow-set blue eyes, and a gap mouthed, gap toothed smile. When the final count is in, it appears that no less than 12 people (at least 11 of them related to one another by blood... I think the black guy might've been a friend, despite the Dixie flags outside) are living in this 2 bedroom trailer.
The kids range in age from a couple of years, to somewhere in their early twenties, and all seem to share approximately the same education level. While trying to assess my patient, I got the best answers about her medical history from a child who looked to be about 11.
That reminds me- after pausing to admire the NASCAR collectible plate series displayed on top of the mantle, (I still giggle when I see Dick Trickle's name) I finally managed to get to my patient, and begin the process of figuring out just what the hell was wrong with her.
The "42 year old female who was passing clots" is lying on a hospital bed in the middle of the living room. She's lying on a plastic sheet, and is wearing nothing but a hospital gown, and a urinary catheter. She's had her right leg amputated below the knee, and just from looking in her eyes you can tell she's gorked.
Her husband is standing by the bed and furiously working the wad of tobacco in his cheek. I begin this assessment the same way I begin every assessment, asking- "What's going on today, sir?"
"Well- she bleedin 'gain"
"Ah. And how long has she been bleeding?"
"'Bout three hour"
"And is this abnormal for her, or does she normally have a menstrual period?"
"Well- she do, but this is differin. She passing big clots- 'bout fo, five, an las' time she did this, they had to give her blood an clean her on out in there."
"Okay- so when did this last happen?"
"Hmmmm- prob'ly been 'bout a year now."
"Okay- does she have any other medical problems?"
"She jus had an infection"
"What was infected sir?"
"She was."
"Ooookay. Why does she have the IV in place?"
He tells me that the hospital sent her home with an IV in place so that he (or rather, the 11 year old who understood the instructions) could administer Vancomycin everyday for 14 days. Vanc is a powerful anti-biotic used to combat very specific, and very contagious staph infections that are usually picked up in the hospital.
"Sir- has your wife always been- er- uh- Non-verbal?"
"Do what?"
"Has your wife always been unable to speak, or move?"
"Oh- no. That happened last year."
"Sir, what happened last year?"
"Oh- she had 'bout eight strokes an five- maybe six heart attacks. Doctors dunno why. But we're gettin her better here now."
Shaking my head and wondering how eight strokes and five heart attacks didn't merit a mention in response to my questions regarding "other medical problems" we move the woman over to our stretcher. Throughout this entire process she screams like the monsters from Scooby-Doo, and tries to claw anyone who touches her with her overgrown and yellowing nails.
As we pick her up to move her over, I notice an enormous decubitus ulcer (GRAPHIC!) on her buttocks, and I ask her husband about it.
"She had that oh... three, fo, months now. You can stick your fist in it!"
"Sir- have you been sticking your fist in it?"
*shuffles feet* "Naw... naw... but you could."
Throughout the entire ride to the hospital, the woman continues her monster-moans, and makes any true assessment impossible with her attempts at clawing us. I'm ecstatic when the relatively short drive is over. Wheeling the woman into the ER, we're forced to wait 30 minutes for a room since they're renovating the entire emergency department. This leaves the nurses short on beds, and shorter still on temper.
I drop off my report with the doc, and laugh as I hear him interviewing the husband:
"Sir- about this ulcer on her buttocks..."
"Yeah! You can stick your fist in it!"
"Sir- have you been sticking your fist in it?"
Adventures in Not-So-Critical-Care
Television and cinema would have you believe that literally every encounter with an emergency medical professional is a OH-MY-GOD-THAT-EXPLOSION-ALMOST-KILLED-US-ALL sort of emergency that requires superhuman efforts of strength, ingenuity and dexterity to resolve. These are then typically followed by some sweet, sweet ambulance-ambiance loving. There are two real problems with this vision:
1. Ninety percent of every job in medicine, from the bottom to the top, is boring shit. By that I mean that it is both boring, and involves a large amount of feces.
2. Anyone who would ever consider copulating in the back of an ambulance hasn't spent a lot of time in one, and failed to read the first rule I just listed.
In the past 36 hours of work (that's three shifts) I've been personally responsible for the care of exactly one individual who even had an IV in place. We've probably spent a cumulative 22 hours grasping desperately for entertainment at the various hospitals we frequent (you can only read a 14 month-old copy of Time Magazine so many times before you begin to fantasize about choking Joel Stein) and most of the remainder has been nursing home discharge after nursing home discharge.
Now- I theoretically work as a critical-care paramedic. This (again, theoretically) means I spend my working hours transferring acutely ill patients from a hospital that can't take care of them to one that can. This should be the domain of intra-aortic balloon pumps, vasoactive drips- propofol and inverse-ratio ventiation! And sometimes, it is... just not lately. Lately we've been taking anemiic old ladies to Skilled-Nursing Facilities and shuttling old men back and forth to cancer treatments. I tell myyself that this doesn't matter- that the scale will balance and will swing back towards me doing something that feels like it matters again, but it's hard to maintain focus when you're sitting in yet another doctor's office with no hope of so much as an IV start in your near future.
When work-karma treats us this way, we have very few options but to entertain ourselves, and this is how we find ourselves in trouble. In keeping with the Cinema theme initially presented in this post, I give you, "Adventures with the Drive-Cam" (Note- a drive cam is a camera mounted to the windshield that activates with sudden G-force changes to the ambulance- like an impact or rollover. It's possible to set off with a hard stop, or sharp turn though. When activated it records the 15 seconds prior to the activation, and the 15 seconds after.)
The Characters: D- The Driver P- The Devastatingly Handsome Paramedic Protagonist R- The Awesome But Just-Not-As-Handsome RN Partner
Scene: After thair 3rd double BLS discharge of the day, our heroes are returning to HQ for some well-earner rest prior to the end of shift. Before disembarking from their faithful mechanical steed however, our heroes must refuel the faithful steel and aluminum beast that had so fearlessly carriied them from SNF to SNF that day. As they approach the filling station, a song wafts over the radio.
D- "Is that Journey?" *turns radio up*
P- "Shit yeah that's Journey! Crank that bitch"
All three members of the male crew proceed to sing along with the soulful stylings of Steve Perry on the perennial classic "Faithfully". There is much falsetto, and it's possible (probably even) that RN has his penlight out and is waving it slowly back forth as a poor-man's substitute Zippo. The song finishes as our crew approaches the fuel depot.
D- "Wow. That just happened."
P- "It's okay man. Everything sounds better in falsetto."
D- "We've gotta do something to de-gayify this situation." (Note- D is not homophobic, but is slightly less than politically correct.) "Let's do something DANGEROUS!"
D proceeds to jerk the wheel hard to the left, turning sharply into the fuel station, safely but dramatically in front of the pickup in the opposing lane. Simultaneously:
P- "BIG OL' BALLLLLLS!!!"
Unsure of how shouting that would "de-gayify" this situation, P looks towards his partner's in the front seats. D is now hunched towards the dash, pointing silently towards the drive cam where a green light now shines.
P- "Oh. Oh no..."
D- "I can't. I mean- Oh my God."
R- "Fuuuuuuck"
2 minutes of nearly continuous giggling begins, punctuated by occasional outbursts:
"But- It must have caught him dancing with that fucking pen light!"
"And then you were all like 'BAAAAALLLLLSSSS!'"
"You're so fired! 'Let's do something dangerous' after you go full-homophobe on camera. Don't you know you never go full homophobe?"
"Why the fuck were we all singing? This is going to be on YouTube."
"We're all fucked."
Now wheezing and with tear-stained cheeks and laughter-strained abdominals our heroes enter the gas station to find a cup of coffee, and plan their next adventure. SCENE
And that, ladies and gentlemen, is the best argument I can make for keeping your paramedics busy.
Now- I theoretically work as a critical-care paramedic. This (again, theoretically) means I spend my working hours transferring acutely ill patients from a hospital that can't take care of them to one that can. This should be the domain of intra-aortic balloon pumps, vasoactive drips- propofol and inverse-ratio ventiation! And sometimes, it is... just not lately. Lately we've been taking anemiic old ladies to Skilled-Nursing Facilities and shuttling old men back and forth to cancer treatments. I tell myyself that this doesn't matter- that the scale will balance and will swing back towards me doing something that feels like it matters again, but it's hard to maintain focus when you're sitting in yet another doctor's office with no hope of so much as an IV start in your near future.
When work-karma treats us this way, we have very few options but to entertain ourselves, and this is how we find ourselves in trouble. In keeping with the Cinema theme initially presented in this post, I give you, "Adventures with the Drive-Cam" (Note- a drive cam is a camera mounted to the windshield that activates with sudden G-force changes to the ambulance- like an impact or rollover. It's possible to set off with a hard stop, or sharp turn though. When activated it records the 15 seconds prior to the activation, and the 15 seconds after.)
The Characters: D- The Driver P- The Devastatingly Handsome Paramedic Protagonist R- The Awesome But Just-Not-As-Handsome RN Partner
Scene: After thair 3rd double BLS discharge of the day, our heroes are returning to HQ for some well-earner rest prior to the end of shift. Before disembarking from their faithful mechanical steed however, our heroes must refuel the faithful steel and aluminum beast that had so fearlessly carriied them from SNF to SNF that day. As they approach the filling station, a song wafts over the radio.
D- "Is that Journey?" *turns radio up*
P- "Shit yeah that's Journey! Crank that bitch"
All three members of the male crew proceed to sing along with the soulful stylings of Steve Perry on the perennial classic "Faithfully". There is much falsetto, and it's possible (probably even) that RN has his penlight out and is waving it slowly back forth as a poor-man's substitute Zippo. The song finishes as our crew approaches the fuel depot.
D- "Wow. That just happened."
P- "It's okay man. Everything sounds better in falsetto."
D- "We've gotta do something to de-gayify this situation." (Note- D is not homophobic, but is slightly less than politically correct.) "Let's do something DANGEROUS!"
D proceeds to jerk the wheel hard to the left, turning sharply into the fuel station, safely but dramatically in front of the pickup in the opposing lane. Simultaneously:
P- "BIG OL' BALLLLLLS!!!"
Unsure of how shouting that would "de-gayify" this situation, P looks towards his partner's in the front seats. D is now hunched towards the dash, pointing silently towards the drive cam where a green light now shines.
P- "Oh. Oh no..."
D- "I can't. I mean- Oh my God."
R- "Fuuuuuuck"
2 minutes of nearly continuous giggling begins, punctuated by occasional outbursts:
"But- It must have caught him dancing with that fucking pen light!"
"And then you were all like 'BAAAAALLLLLSSSS!'"
"You're so fired! 'Let's do something dangerous' after you go full-homophobe on camera. Don't you know you never go full homophobe?"
"Why the fuck were we all singing? This is going to be on YouTube."
"We're all fucked."
Now wheezing and with tear-stained cheeks and laughter-strained abdominals our heroes enter the gas station to find a cup of coffee, and plan their next adventure. SCENE
And that, ladies and gentlemen, is the best argument I can make for keeping your paramedics busy.
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