Life in Da City! · Pre Planning Your Scene

Stairway To The Bathroom

 

So, once upon an EMS, I was working a medic unit in the center of the city. We caught a run to the near west side, and so, off we went. It was late on a lovely July afternoon. I remember the leaves shading the yard of the house we were called to. We walked up the steps, up the porch that ran along the side of the house, and knocked upon the door.

An excited gentleman answered our knock, and directed us into the home. There, a turn into the bathroom revealed our patient. He had, or so we were told, stumbled while descending the stairs, had fallen down those selfsame stairs, and, since the stairs terminated in the bathroom in which we were standing, when he came to a stop, he did so abruptly, having struck his head upon the bathtub. He seized, and our correspondents thought that this was a bad thing. Their opinions were not changed by the fact that our new friend had not awakened at all since the fall and seizure.

My partner at this point, who we can think of as Heinrich Hobson, was a veteran of the streets, and schooled in the ways of Da City. So, of course, once he left for the ambulance to retrieve the cot, backboard, and suchlike so we could transport our patient, well, THAT is when the excitement began.

So there were two ambulatory men, and one huge woman, on our scene, in addition to our unconscious patient. This woman was carrying an enormous purse, and began to exchange (heated) words with one of the gentlemen. The shouting escalated, and Mrs Large Purse decided that it was time for Show and Tell, and therefore Showed us all her nickel plated semi automatic pistol, all while Telling us how, in her words, “Alright, m0th3rf4ck3r, now you gonna DIE!”

It was not immediately clear which “m0th3rf4ck3r” was “gonna die”, or whether this was a particular prediction, or applied to all of us in the room. Since I kinda stood out, being (a) in uniform, and (b) the only paleface present, I felt as if I were a lightning rod awaiting that thunderstorm, and wondered, to myself, if there was not someplace I ought to be. Like, anyplace but that house.

I began to sidle my happy little way out of the room, and onto the porch. Once on the porch, the voices in my head held a debate regarding the proper way to unass the fatal funnel that the porch presented. One chorus encouraged, nay, DEMANDED, that I “RUN!”. The other viewpoint was that, in running, I would both attract (more) attention, and likely would elicit the predator-prey response in the nice lady with the pistol. I was not altogether certain that I really would enjoy the starring role of “Prey” in this production, and so, while the voices in my head held their debate, and then broke out for focus group discussions, I longstepped my way down the porch, and into the street.

Heinrich was collecting the straps, board, sheets, blanket and whatnot useful in comfortably transporting our patient, and I walked right up to him, and in the scholarly, educated, calm, thoughtful manner of speech for which I have become justly famous, brought him up to date on events within the domicile. What I said was, and I quote directly, “G! G! Guh! Guh! Biigggg! Biggg, guh!” Several choruses of that gibberish followed, until The Nice Lady With The Gun appeared on the porch, and I finally orchestrated a semi coherent thought. “We go now!?”

Of course, calm as could be, Heinrich grasped the handie-talkie, and began to bring Dispatch up to speed.

Dispatch, Medic 8. We need police here, my partner reports that there is a woman with a gun inside on our scene.”

Dispatch did not require a lot of time to process this. “Medic 8, have you cleared the scene?”

Negative, our patient is still inside.”

Dispatch’s opinion of that plan? “Medic 8, clear the scene! Immediately!  Police are on the way!  Repeat, CLEAR THE SCENE!” 

At this point I was in the passenger seat, listening to all the wisdom Our Friends At Dispatch were sharing with Heinrich, and wordlessly testifying to their TRUTH! Heinrich debated the ethics of unassing the scene wherein our patient lay, vs returning to save lives another day (the latter course of action I enthusiastically supported), with dispatch, articulating the position that we could not leave our patient.

I had my own thoughts on that matter, mostly along the lines of WHY THE F4CK WERE WE NOT IN THE NEXT PRECINCT BY NOW?! While this conversation continued, and I slunk down in my seat, thinking invisible thoughts, one of the gentlemen from the scene, he of the “Alright, m0th3rf4ck3r, now you gonna DIE!” insight, came to MY side of the truck, grasped the sill of the door, and asked, “You all ain’t gonna leave me here, are you?”

I started to roll up the window as fast as I could (no, I do not know why), and told him, “Mister, if you do not pull your fingers back right quick, I ain’t gonna leave ALL of you here!”

So, as it happens, if you really feel a burning need to know just how many officers DBCPD has on duty, and with access to a car, at any given time, I recommend that you find a seat across the street from a scene wherein an EMS crew has just called “Medic in Trouble!” Let me tell you, it made me feel all warm and fuzzy inside, as car after car squealed to a stop, and officer after officer piled out ready to kick ass and take names. Fortunately, by this time, Ms. Gottagun had strolled down the street and into another house altogether, and the officers declared the scene secure. Our friend of the tub-strike (remember him?) got bundled onto a spine board, and trucked off the TLHTTIC.

No medics were harmed in the telling of this tale. For some of them, however, their foundation garments will never be quite the same shade of not-brown.

Life in Da City!

Doberman Overdose

 

So, I was working Medic Seven with Doug. We caught a run for an overdose, and proceeded to the call. Calling dispatch to announce our arrival on the scene, we stepped into the autumn evening.

So, there was (and, likely, still is) a considerable, amorphous, body of knowledge, that might be termed “street smarts”. For example, there is what we called “Decker’s Law”, which opined that, should you be on a block, and you were sure your call was at one house on that block, but, of course, there were no house numbers, you should knock upon the door of the house that appeared most likely to be a heap of rubble by the time you went back in service. Your patient awaited therein. Or, Ciaramataro’s corrolary: the house with the steel window and door bars was your scene. Or Ivan’s Axiom: the house with the “ghetto gates” had nothing within it worth stealing. And, those folks likely knew who was doing all the B & E’s in the neighborhood, because they were likely the ones performing them.

Other insights were more what might be called stagecraft. As in, do not have your back to residents of the scene. Or, know two (or more) exits from every scene. Or, do not stand directly in front of the door. Or, and relevant to this tale, plant your boot in front of an outward opening door, because you just might not really want whatever is inside, to abruptly come outside to play. With you. Or your partner.

So, TINS©, TIWFDASL©, with Doug on one side of the door, and myself on the other. Doug was on the handle side of the screen door, and I was on the hinge side. I knocked, and announced our presence in the immortal words of yore: “Fire Department!”

The occupant came to the door, and we heard his dogs enthusiastically greeting us before the door opened. Doug, thoughtfully placing his boot before the door, allowed said occupant to uselessly push against the door as the dogs leapt, barked, and slathered their greetings. This gentleman was exhorting us, “C’mon, c’mon, c’mon! He could be dying in here!”

We suggested, “Sir, if you will secure your dogs, we will be right in!”

He responded, “C’mon, c’mon, c’mon! Dude’s dying in here, and you all be fucking around!”

Again, Doug suggested, “Sir, you have to put your dogs up, or we aren’t coming inside! We aren’t going to get bitten by your dogs!”

Our Host again responded, “I ain’t putting my dogs up! Y’all get in here! He could be dying!”

I looked at Doug, and he looked at me. “You need to hear anything more?” Doug asked me.

“Nope, heard everything I need to hear.” Doug nodded, and said, “Let’s go!”

We got. Once in the truck, and around the corner, we went a couple of additional blocks, and called dispatch. “When you get another call to this location, send police. The resident has a couple of big dobermans, they are aggressive, and he refuses to secure them.”

I finished the run sheet, and prepped the next one. Dispatch did not disappoint.

“Medic Seven, you still near you last run?”

“Affirmative.”

“Respond to that scene, run number (number), address (address). Scout car has been dispatched. “

“Medic Seven on scene, around the corner, waiting for scout.”

The police car soon pulled up, we regaled them with the above story, and off we went. This time, the offices stood at the door, their boots were on the door, and we stood back to admire things.

The same gentleman opened the door, the same dogs danced and growled, and the same dialog. “C’mon, c’mon, c’mon! He could be dying!”

One officer said, “Sir, secure your dogs.”

Our Host had considered his response. “I ain’t locking up my dogs!”

The officer asked him, “Did you just tell me somebody inside there is dying?”

“Yep, and you all are fucking around on this porch!”

The holster snaps were released. “Sir, we’re coming inside in 3 seconds. Those dogs will be secured, one way or the other. You need to lock them up, right now!”

Our Host began to protest, as the other officer placed his hand on the grip of his sidearm, and began to count. “Three! Two! ….”

Somehow, it appeared, the dogs levitated, and disappeared with a “whoosh!”. Seconds later the gentleman announced, “They’re locked up, in the bathroom!”

The officers unholstered their pistols, and led us into the house. One officer, locating the closed door, presumably the bathroom, behind which the barking continued, ensured that it was latched, and waved us past. We moved on, and found an inert soul, unbreathing and pulseless. We started CPR, transported him to TSBTCIDC, and they pronounced him.

Yeah, some runs you remember, even after the better part of forty years.

Life in Da City!

Another use for a leg abscess

 

So, I spent some time pulling calls in and around “Da Corridor”. One schedule, early in my time on da street, I was working days at Medic Eight, and found that we had what might be described as “frequent fliers”. One such soul was a young woman who evidently worked what might be termed “The Entertainment Industry”. The first time I met her, I was amazed at the abscess on her right thigh, which appeared to be as big around as my fist, and a couple of inches deep. For all the hugeness of the wound, it appeared remarkably clean. No redness, no pus, simply pink moist tissue in the wound depths. It looked like a pink crater in her leg.

A convenience sample, with no rigor to the study whatsoever, suggested that IV drug use was really, really common among these folks.

We transported her for whatever the malady-du-jour was, and went back in service. I was surprised when the same woman was in my ambulance several weeks later, crater still there, still appearing uninfected, for some other illness. I asked her, “What have you been doing for that wound? How come it isn’t healing?” She rattled off some answer, and I let it go. Report to nurse, patient on cart, inservice, and away!

Yet again, the same woman several weeks later yet, another not-persistent-leg-ulcer-related nature of call. Yet again, same ulcer, same tremendous size, same did-not-look-infected appearance. I asked her, again, what was up with the persistence of the wound.

Her answer was astonishing. “Well, when I go to do my do (administer my heroin), I can just sprinkle it in my sore, here, wrap it up in saran wrap, and I get my fix. It’s about as good a rush as shooting up, and no needles!”

Life Lesson: Ostensibly poor life choices do not necessarily map directly onto “stupid”.

Life in Da City!

Baby Huey’s Theory of Stress Management

So, my good times with Baby Huey did not end with the gentleman seeking to fall from the stretcher. Nosiree! I worked the rest of that schedule with him, and Cletus. So, TINS ©,TIWFDASL ©, when we caught a run in “The Corridor”. This was a section of Da City that was south of Da University, and renowned as a hotbed of drugs, prostitution, alcoholism, a veritable wretched hive of scum and villainy. Indeed, the fire house serving this area had so many working fire calls, that the house was known among the firefighters as “Fire Island”. Or, it was, until some wag noted that New York’s Fire Island was a noted vacation spot among the “Faaaabbulous!” of Manhattan. With that insight, the cachet of the nickname seemed to fade.

So, as it turned out, we were dispatched for “difficulty breathing”, or some such bullshit. Therefore, the three of us, Cletus, Baby Huey, and The Stretcher Ape, arrived without the police. This was not usually a problem, both because EMS was sort of cloaked in invisibility with regards to the citizen antipathy towards other uniformed services, and, even if things were jakey, there were few problems that could not be solved by transport. Prompt transport.

We found ourselves outside some bar, door open, in the warm May sunshine, and (curiously) nobody about. (THAT should have been a clue!). Cautiously, we entered. There was nobody inside, if you ignored the woman halfway slumped against the bar.

She appeared to be around a suburban sixty years of age. That would place her somewhere like a corridor forty or so. It was difficult to eyeball estimate folks’ ages, because, as a later partner would put it, “Life is tough in the ‘To” (as in “ghetto”). In any event, it became clear, both, that she was our named patient, and why she might have “difficulty breathing”. There were six red holes angling diagonally up her torso, and she appeared to have no notice of our arrival. In the course of her fall, her dentures had been halfway knocked from her mouth.

On this day, Cletus was driving, and so he rapidly assessed the situation, and pivoted to hotfoot it to the truck and retrieve the cot. Baby Huey knelt at the patient’s side, and began to wave his hands over her, just as if he were warming his chilly fingers in the (fading) warmth of her inner fire. I was fumbling with the straps of the medic bag, since I very much wanted the BVM in my hands, and similarly wanted to commence to resuscitatin’. While I was fumbling, and Huey was waving, he was saying “Relax! Relax! Relax!”

I was puzzled. Not puzzled enough to stop retrieving the ‘Bu, but puzzled nonetheless. My snap assessment of this woman was that, among her multiple medical and surgical issues, stress and tension were not prominently featured in my differential diagnosis. I shared this with Baby Huey.

“So, how about laying her down on the floor, removing her dentures, and we can start some CPR?”

I know I spoke. I heard myself. Baby Huey, however, continued his invocation, evidently seeking to exorcise her of the demons of stress. It occurred to me that just a LEEETLE more tension among her rescuers might be a bit more helpful, and I shared this new insight.

“Uh, lay her down and clear her airway, OK?”

No change. She still wasn’t breathing, he was still hypnotically entrancing her, working feverishly to allay her nervousness. AHA! BVM finally in hand, I moved to her side. I repeated myself to Baby Huey.

“Lay her the fuck down, get the god-damned false teeth out of her mouth, and then get the fuck out of my way!”

Evidently, I simply had to enunciate my thoughts in terms that he could comprehend. He stopped with the hand-waving, he ceased the incantation, dentures magically moved from her mouth, and, Viola!, she was supine on the floor. I extended her head, sealed the mask on her face, and set to ventilatin’. Baby Huey, finally struck by the Clue Bat with sufficient vigor, lined up, located her xyphoid, and set to chest compressions.

Cletus arrived right about that point in our festivities, and so Ms. Beenshot was loaded up, and trotted to the rig, whereupon Cletus skeedadled us the 4 blocks to TBTCIDC, where she expired.

No, I am not making this shit up. True story, near as I can recall it from around 40 years ago.

Life in Da City!

Baby Huey And The Guy in the Gutter

 

Welcome back. Now TINS©, TIWFDASL ©, and we came across a figure in the gutter. Ok, we weren’t FDASL*, really. In fact, we were cruising. Now, “cruising” was verboten. It reeked of spending Da City’s hard earned fuel to lollygag about, on da streets of Da City. No, Da City, in it’s wisdom, would much rather we lollygag in quarters. But, THAT is a tale for another time.

So, this one time, we were “Touring Our District”. (There, doesn’t that sound so much better?) Indeed, our sole mission was to improve our understanding of the streets of our primary response district, in order to hasten responses, and avoid potential delays in lifesaving care!

Yeah, That’s it! That’s the ticket! We were “touring the district”! Absolutely!

So, in the course of familiarizing ourselves with the streets of Medic 8’s district (conveniently enough, we were working at Medic 8, myself, Baby Huey, and Cletus, Da Genius), we happened across a figure in, TINS ©, da gutter of Turnbuckle Avenue. Curious as to how this might have happened, we stopped, and advised dispatch of this interruption to our night.

So the night in question was raining, and therefore, unsurprisingly, our new friend was wet, muddy, and, simply to make everything just nice, intoxicated as hell. We bundled him up, in our nice, warm, and dry truck, and proceeded to The Little hospital That Thought It Could (TLHTTIC). En route, I attempted to elicit any sort of helpful information, such as allergies, medications, medical history, name, address, phone number we could call for somebody to pick his soggy self up from TLHTTIC, but he wasn’t in much of a mood for conversation. (remember THAT thought.)

I tried chafing his wrists, I tried tapping his cheeks, I tried the tried and tested “Annie! Annie! Are you all right?”, but he was not having any of it. I contented myself with vitals, and idly admiring our ceiling, en route to TLHTTIC.

Once we arrived, the ED staff informed us that they had no vacant stretchers, and we would have to wait. Cletus Da Genius set off in search of a vacant stretcher. So, there I was, Baby Huey, Mr Soggy Intoxicated, and me, with Mr. Intoxicated on an ambulance cart fully elevated.

Now, potential energy is a funny thing. Different heights allow for different durations within which gravity (“It’s not just a good idea! It’s the LAW!”) can act upon a body in flight. Given the formula v=AT, well, a falling body from, let’s say, 3 ½ feet in the air, can achieve enough velocity that, suddenly stopping on a concrete floor covered with tile,  fracture something will fracture. Hips are popular in the falling populace, and among orthopedic surgeons who have children in expensive colleges, as well. So our new friend was at “The Orthopedic Height”.

With this in mind, our new friend decides to awaken. Whatever my other failings, I am not a fan of added injuries to folks who are, however briefly, my patients. So, I attempted to stop Mr. Intoxicated from launching himself over the side of the cart, and into a consult with orthopedic surgery.

At this point in my life, I was a union steward in our union. I was also an RN, having finished school and passed the boards a couple of years before. I’m not the smartest SOB, but I generally can recognize really, really dumb stuff, and avoid it.

So, OF COURSE, NOW Baby Huey bestirs himself from his coma, to provide me with an extemporaneous lecture on the medico-legal niceties and particulars of patient restraint. I had some familiarity with said niceties, and, as I tried to explain to my newly legal-beagle partner, if my choices were to “illegally”restrain this guy, or watch him fracture his hip, I wanted to be explaining my actions taken to protect the patient from harm. Baby Huey was unmoved, repeating, “Da man wants to go, you got to let him go!”

Several things passed through my mind. Foremost, I hated-truly LOATHED-rolling around in close contact with unwashed, smelly, halitosis ridden children of God. Secondly, I wondered where TLHTTIC got all those nurse-statues, because they sure as hell weren’t moving. Thirdly, where was Cletus Da Genius?

A couple of minutes of wrestling later Cletus arrived with a stretcher. Cletus, in contrast to Huey (in his newfound persona of Legal Authority on All Matters Relating to False Imprisonment and Illegal Restraint), did take direction, serenaded by Huey’s Moot Court exposition. Cletus and I managed to pivot our new friend, writhing as he now was, onto TLHTTIC’s cart, lower it to the laceration height, and secure all siderails up. As I turned to escape this clown show, I noticed said friend start to inch-worm himself to the head end of the cart, and there, I predicted, tumble headfirst onto the cement floor. Didn’t seem all that good of a plan to me, so I watched him. The nurse-statues remained immobile, and so, once I figured his center of gravity was approaching the tipping point, I slid next to him, reached beneath his arms, and controlled his descent to the floor. I then turned and moved smartly to the door. I figured that, by the time he found someplace to fall to, from the floor, I would be happily somewhere else.

Huey had apparently concluded his summation, and decided that he needed to follow me out to the truck. I was really over him and his stupid, pretentious, pompous nonsensical bullshit, but, since he was about 4 inches taller than me, and 80 pounds more obese, I didn’t figure that any conversation he and I would have, would end well for me. I tossed the cart into the back of the truck, and hit the bathroom, figuring he’d leave me in peace to do my business.

I figured wrong.

Huey had, it seemed, figured out, all by himself, that I was irritated. With this insight, he decided that this was a good time to become confrontational. Well, I did not really have to go to the bathroom all that badly, and, besides, I wanted witnesses if I had to knife him in self defense. I exited the bathroom, and went to the counter of the nurse’s station, to finish the run sheet. With how wonderful this run had been, I was gonna be writing the Great American Novel, with footnotes, illustrations, bibliography, and annotated commentary by both Johnny Gage as well as Roy DeSoto. (Foreword by Dr. Eugene Nagel).

Huey, not the smartest representative of Australopithecus, decided that he needed to know if I wanted a supervisor. Indeed, ignoring him was unhelpful, and he got louder, and closer to my personal space (and approaching the “Let’s find out what you have hiding in your peritoneum” range), bellowing, “Do you want a supervisor, Mr. StretcherApe? Well, do you?”

I paused, putting the pen on the counter, and reflected. I asked the nurse-statue posed behind the counter if I could please, borrow her phone for a moment? She said yes. I placed it upon the counter, smiled my best “The voices told me I really don’t need to take my medication every single day” smile, and sweetly invited him, “Great idea! Would you please call dispatch, and ask that they invite the shift captain to meet the on duty union steward, right stat like**, at TLHTTIC? Right about now would work just fine for me! Oh, thank you so very, very much!”

I turned back to my documentation, only to have a nurse-statue develop the powers of speech, finally.

You know, I need your name and unit number for my incident report!”

I responded, “Of course you do. And, I’ll need the names of every staff member on duty, now, for my incident report.”

She did a double take. “What are you going to be writing an incident report about?”

Well, besides the obvious, there is the matter of your personnel admiring my patient’s efforts to fracture his hip, without moving to stop him. That’s pretty remarkable, right there!”

You cannot write us up in an incident report!”

I’ll be sure to mention that. In my incident report.”

I had thought that the demons of pre hospital care could not possibly bedevil me any more. It was a nightmare shift, with nightmare “partners”, and my life truly sucked stool. Doug was off at another house, working start of the week days, and therefore soaking up sunshine and living the good life, while I was on nights, in EMS hell with Cletus and Baby Huey. Once again, I thought wrong.

So, a couple of weeks later I went up to headquarters to pick up my paycheck. Captain Raconteur was the administrative captain this schedule, and when I signed for my check, he asked, as if it was just another casual conversation, “So, you beaten up any patients lately?”

What the fuck? “Uh, pardon me, Captain?”

I asked if you had beaten up any patients lately?”

Uh, well, you know, I haven’t beaten anybody up at all, any time, anywhere. So, what prompts this question?”

Well, your partner wrote a letter reporting that you had beaten a patient, and that he was so distraught that he could not keep what he had seen to himself.”

Doug? Doug wrote a letter?”

Oh, hell no! It was Baby Huey. He wrote a letter about you beating some poor schmuck.”

Are you kidding? Were you gonna give me a chance to respond?”

Do you want to respond?”

Hell, Yes!”

Ok, let me dig it out of the file I placed it in.” So saying, Captain Raconteur poured his trash can onto the floor, and started to pick through the papers therein.

Did you really shitcan a letter reporting that I had struck a patient?”

Hell, yeah! Everybody knows Baby Huey is an idiot. You, well, you’re an RN, the union steward, and never had a single charge against you. Hell, I know you, and how you operate. If, in fact, you had smacked some fool, you would submit a lengthy letter, with names, addresses, phone numbers, and shoe sizes of a dozen honest citizens who will all testify that not only did this fool need smacking, if they had been the ones doing the smacking, they would have smacked him harder, and longer than you did. You did not submit any such letter, so therefore, Baby Huey is full of shit.” Captain Raconteur looked into the distance. “If I could buy Baby Huey for what he is in fact worth, and find somebody to buy him for what he thinks he is worth, I could retire tomorrow!”

I later crossed paths with Doug, and told him the tale. He stopped me. “Baby Huey has been running his mouth, about how he got you in trouble. Nobody, yet, has asked him how it’s clever to monumentally piss off your shift steward. We have a pool going, on when he’ll go up on charges, and see your smiling face, sitting there to represent him!”

*FDASL: Fighting Disease and Saving Lives

** “Right stat like” = “stat”, which means immediately. In medicalese, this means that there is nothing else you really need to be doing, other than this thing, and you must NOT be distracted from doing it until it is fully done.

And, to review: TINS=This is no Shit

TIWFDASL=There I was, Fighting Disease and Saving Lives