Drinking in the Heat

When my boys were young teens, they were scouts. I was the assistant scoutmaster, and the troop required two adults to accompany the boys to camp. Since I worked weekends and off shifts, I could finagle a string of days off, and, therefore, I could take the time off for scout camp.

Being of the medical bent, I was de facto medical officer. Therefore, the scoutmaster and I (the only fellow, ever, who was more conservative, politically, than I!) got up early the first day, and, observing the hot, humid nature of the morning, and the weather forecast promising even more of the same for the day, assembled the boys for the morning briefing.

I observed that it was hot and humid. (for am I not, after all, a man gifted with a firm grasp of the obvious?) I next observed that this provided an opportunity for some preventative medicine, to whit: DRINK! DRINK! DRINK! If you (the scouts) are under the misapprehension that you are drinking enough water, you are wrong! When you stop, drink water. When you are moving, drink water. If you are wondering if you might be drinking too much water, drink water.

There appeared, among the boys, some skeptical looks. The Scoutmaster, Tom Swift, admonished the troop, that I had schooled my self for a long time, and delved ever so deeply into the mysteries of the functioning of the human body. Therefore, I likely I knew whereof I spake, and they ought to attend to my counsel.

We broke up for the day’s activities. I lingered in camp, being “on vacation”, until I roused myself to wander the camp. I eventually caught up with my partner Tom, and the gaggle of our scouts. One of these worthies appeared unfocused, with a bit of a bobble to his walk. One of the scouts took note, and directed my attention his way. I poured this scout a tall glass of ice water, and commanded him, “Drink up!”

He demurred, reporting that he was not thirsty.

“I do not recall asking if you were thirsty or not. Drink up!”

He did so. As I poured him another glass, I asked him, “How much have you had to drink since breakfast today?”

“Uh, not much?” Another scout, who had followed this scout’s schedule, chimed in, “I did not see him drink anything today!”

Finishing the glass, another poured. “Drink!”

He had just about polished off an entire liter at that sitting, and Scoutmaster Tom and I conferred. Our scout still appeared unfocused, and so we elected to change venues to the first aid cabin, wherein he could benefit from air conditioning, as well as a place to lay down.

As an oasis, the first aid cabin certainly fit the bill. Kevin, the tottering scout, appeared to like it, and slurped down several popsicles under the camp nurse’s supervision. An hour of hydration as well as temperate environmental conditions certainly seemed to perk him up.

That evening, we held a review of Heat Injuries, And The Scout Population. Using Kevin as an object lesson, for some reason the boys appeared considerably less skeptical than they had that morning.

Weird.

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Dumpster Diving

This one schedule, Doug had elected to rotate onto day shift. Likely something about a wife, family, and wanting to spend some time with That Bright Thing all up in the sky, while he was awake, might have figured into his calculations. In any event, TINS©, TIWFDASL© on night shift at Medic 14 (let us say). I was partnered up with Johnny Wadd (not his real name), who was, even among the collection of characters that made up the crews of EMS in those halcyon days, a character. He was book smart, street wise, quick on the uptake, head on a swivel, and, despite a very crusty persona, good hearted.

So, this one time, at band camp….uh, wrong story. So this one night we were cruising around between runs, and, as commonly happens in my “sea stories”, well, we caught a run. In the misty distance of all these years, I cannot tell you what the nominal nature of this run was. I do, however, remember (a) that the police were NOT dispatched to this run, and (b) once we arrived, and began to understand what the happs were, well, item “a” began to appear to be a big, big mistake.

So, we arrived on the scene to discover not a light on in the alleged address. Calling on the scene, we verified that the house number on the house before us, was, indeed, the address dispatch wanted us to report to. Check!

I knocked upon the door, while Johnny looked around the front of the house. As he reached the edge of the house adjoining the driveway, he heard something from the back that caught his attention. We meandered back to see what was up (notifying dispatch, on the way, of our explorations).

The sounds Johnny had heard were moans, and they were emanating from a wheeled trash bin. That made sense, as my flashlight illuminated two legs protruding from the top thereof. Johnny peered inside, and beheld a gentleman curled up inside, much the worse for wear.

We figured that any conversation to be had, would be had with greater clarity should our new friend be extricated from the trash bin, and so we began to attempt to lift him by his legs.

BAD PLAN! At least, in his view. He screamed, convincing us that this was NOT the course of action we desired to pursue. I ran to the truck, and retrieved the cot, a backboard, and backboard straps. Johnny and I then slowly levered the bin onto it’s side, and tried to gently place Mr. Trash Bin onto the backboard so as to remove him from his nest with minimal discomfort (to him) as we could manage. In his opinion, we were not particularly successful.

Once he was out in the light, such as it was (MagLite light, it was!), we could discern from the angulation of his thighs that he had sustained two fractured femurs. Further evaluation revealed a couple of gunshot wounds, as well as several stabbing wounds.

We determined that further time on the scene, with our basic life support asses, would be unprofitable, and so secured our guest onto the board, strapped him onto the cot, loaded him up into the truck, and coded our happy way to TBTCIDC.

Once we had turned him over to the ED crew, and they were poking, prodding, needling, radiating, IV-ing, and generally getting to know him far, far better than anyone else in his life ever had, we cleaned up and restocked the truck. Johnny turned to me, reflection written deeply in his eyes.

“Ya know, Reltney, I wonder if someone, somehow, got a little angry at our guy there! Somebody does not seem to have had his very best interests in their heart!”

Night shift lost the medic bag, a fact we discovered *AFTER* we caught a run!

So, TINS©, TIW©, all psyched up to FDASL©, chatting with the off-going crew, with my partner Doug. I had just about completed dropping my bookbag full of nursing school homework on the desk, when the phone rang with a run. Unaccustomedly, we were on day-shift, this being summer and my class load being light.

Of course, our very first run of the morning was Not a “sick person”, was not a “stomach pain”, no, indeed, it was an arrest.

It was Doug’s day to drive, so I settled into the passenger seat, buckled up, and we were away.

It was the custom, in those dark days of antiquity, to gather our immediate aid materials in a “mussette bag”, generally mil surp, olive drab, canvas. With a capacity of around six liters, we could carry several roller gauze bandages, a dozen or more sterile 4 x 4 dressings, several 5 x 9 ABDs (variously translated out of acronym into English as Army Battle Dressings, or ABDominal Pads), tongue blades, plastic oral airways (NOT endotracheal tubes: in those days, we were running an entirely basic life support operation), and, most relevant to Today’s Lesson in Life In Da City, a bag-valve-mask resuscitator.

Mostly, Da City bought the Laerdal brand of bag-mask, branded as Ambu, Therefore, of course, we referred to these as “the ‘Bu”.

You may wonder why I am assaulting y’all with these details of my far gone workaday life, amirite? Well, ya see, on this particular day, on this particular “cardiac arrest” run, as I settled my bony ass into the passenger seat, I did NOT have to step around the green bag. This caused me to look around, as we sped to the run, and NOT find the bag. I twisted around, and gazed into the module from my seat, and, again, did NOT! See our bag.

This was not encouraging.

Shortly, we arrived on scene, and, fortunately (for certain narrowly defined values of “fortunately”), our named patient was not only arrested, but, also, in rigor mortis.

Please recall that “narrowly defined values of ‘fortunately’” thing, cited above.

This soul was not going to benefit in any manner from CPR, ventilation or any other intervention in our (missing) bag of tricks. Therefore, we pronounced him on the scene, called dispatch for a scout car to take report, and went in service.

Returning to the firehouse, we examined the log entries from night shift, listed several likely locations of our errant bag (and I retrieved my personal bag from my vehicle, so, in the interval, we would not face performing mouth-to-mouth on some unlucky stranger). Then, we went visiting.

On our second or third stop, a pleasant lady answered the door. “I was wondering when you fellas were going to come back. Them nice fellas last night were in such a hurry that they left this on our living room floor!” And she handed us our bag.

I asked how her husband was doing, he being the subject of night crew’s visit last night. “Oh, he’s staying in the hospital. The doctors said his belly pain was from his appendix, and he’s gonna have an operation today, but they say he’ll be fine!”

Doug and I applauded this news, thanked her for holding our equipment for us, and bade her farewell.

And, boys and girls, THAT is why I forever afterward placed my own green bag in the ambulance, for the duration of my days on EMS!

A different view on policing, from the prevailing media narrative

Against my will, I have been aware of the news reports of many, many protests over the circumstances surrounding death of George Floyd.
Against my will, I have been subjected to the noxious virtue signaling malarkey from many quarters, braying about how anti racist they are (“acta, non verba!”).
Again, against my will, I have been subjected to the chant of racist, violent police being The! Single! Greatest! Threat! to black men, In! Da! World! (notwithstanding the 24 fatal shootings in Chicago just the weekend of May 30-31)
( see https://chicago.suntimes.com/2020/6/1/21275944/chicago-weekend-shootings-most-violent-weekend-2020-may-29-june-1)

I request that we all keep in mind that we are all fallen, all imperfect, all in need of improvement. Police are part of that set. And, like some of our neighbors, some officers do felonious things. Mr. Chauvin appears due to get his day in court, which, should things work out as they are supposed to, will bring to light evidence supporting, or refuting, the cloud of assertions surrounding these events.

Tl: DR summary: Lotsa heat, little light, Facts will come out, and theories and bullshit will be tamped down.

Now, that I have stepped off of my soapbox, let’s hear a story of “Protect And Serve Policing”, of the sort that I have seen repeatedly myself.

Observant readers will note that this is a re-run.

Patient Care Is Everywhere!  (small town life)

I had the opportunity, a couple of years ago, to speak with an police officer who personified the
 “Protect and Serve” mindset. An elderly, very confused gentleman, with a baseline mentation 
deficit, was brought in to the hospital at the instigation of the officer. Having been dispatched 
for a "welfare check", he found this soul confused, and in the officer's estimation, "looked sick."
 We evaluated the patient, and tried to (start to) fix his medical issues.  While waiting for the lab
 results, the officer and I chatted. The officer related to me that he was an officer, “not for the 
attorney with a 150,000 dollar car and a nice house: he doesn’t need me. That guy, over there: 
he depends on me to do the right thing. He is why I took that oath.” 

Once we had finished caring for the gentleman, and were ready to discharge him, another 
officer from this same (yeah, rural) department came and took him home, seeing him safely 
into his apartment.

Another occasion, same rural police department, same officer. This time he  accompanied an 
EMS transport. This soul was in custody, so the officer parked himself outside the room, to 
keep an eye on his charge. During their stay, in the room across the hallway, was a child, who 
was very dubious about the entire "going to the hospital" thing. This officer was approached by 
the fearful child, who momentarily had his fears overcome with curiosity about a live-and-in-
person police officer. This officer was very engaged with the child, producing wide eyes 
interest as the boy lectured the officer on the ins and outs of frogs, and minutiae of their lives in 
the wild. He (the officer) offered a few frog insights of his own, and the two of them had an 
animated conversation there in my ED hallway. 

The rest of my encounter with the boy was made considerably smoother, when the officer 
asked the boy, "Are you behaving for my friend Reltney?  Yeah, he may be a doctor (well, a PA
 at this point, but, ya know...), but he's pretty nice.  Give him a chance, wontcha?"

My point? There has been come conversation of “Officer as social worker” becoming part of the
 police toolbox. This theme is not new, although it used to be called "walking the beat, and 
knowing your beat". Some officers, who are each a credit to their profession, have been 
employing that tool for a long time. And, in some regards, to steal a phrase from the American 
Nurses' Association, "Patient Care is Everywhere!"  Some of the practitioners are not formally 
licensed in health professions. And, some of us simply see it as being a good neighbor. 

Bradycardia and The Cough

TINS©, TIWFDASL©, nursing in the ED of this community hospital in Northern The Un-Named Flyover State. A gentleman arrived, somewhere in his forties, and he told his tale of chest pain. He shortly thereafter sported the latest fashions in IVs, EKG monitoring, oxygen, and much blood drawn and sent to lab for analysis.

Two things you should know about me. I am a bottomless well of generally useless trivia, for one. For example, the relevance of which will become apparent shortly, I read a bunch of stuff, including a report, years and years and years ago which asserted that individuals undergoing a cardiac catheterization would be instructed that, should they be commanded to do so, they should cough vigorously and repeatedly. This would, or so the article asserted, increase pressure inside the chest, compress the heart, and thereby expel blood from the heart. This was important because occasionally the catheter, introduced into the heart, could produce irritation sufficient to produce fibrillation. (an uncoordinated trembling of the heart, which produces no blood flow. A Bad Thing.)

Once they drew in another breath preparatory to coughing once again, the negative pressure inside their chest so produced would encourage their heart to again fill with blood, which would be expelled with the next cough. This could temporarily produce enough blood pressure to keep things idling along, until the cath lab staff could intervene and set things right.

The other thing about me, is that I am somewhat chatty. (“No! Say it isn’t so!”). Okay, very chatty. So, there I was, chatting with this gentleman, and noting his cardiac rhythm and heart rate as displayed upon his cardiac monitor.

I noticed that his heart rate, originally in the 90’s, was trending downward. (normal is around 60-80). Once it dropped below 55, I stopped congratulating myself on wonderful patient care, and began to worry.

He began to report feeling dizzy and weak. I directed him, “When I tell you to cough, do not ask any questions, simply do it!”

He, of course, asked me why, but at that point his heart rate had dropped below 30 (Very Not So Good!), and I was a bit terse. “Stop talking, and cough!…Cough!…..Cough!….”

I repeated myself at about one second intervals. Now, I am sure that the other nurses heard me, and wondered what variety of insanity had afflicted me. Once they came in to investigate, and I waved my hand at the monitor, continuing my coxswain like commands of “Cough!….Cough!….Cough!….”, they noted his very, very slow intrinsic heart rate. That, coupled with this guy, eyes fixed upon me, coughing every time I commanded him to do so, told them everything that they needed to know, and things got considerably more active in short order.

He soon received a temporary external pacemaker and and an ICU admit.

And we all lived happily ever after!