Vehicular Extrication

Long ago and far away, I spent my salad days as a street medic in Da City’s EMS. I know, right? Startlement abounds, amirite? Anyhow, this one time, we caught a run. We arrived to find an intoxicated gentleman seated in the rear seat of a four door sedan. Interestingly enough, he was seated upon the floor thereof, with his legs extended beneath the front seat.

We figured that extricating him from the vehicle would facilitate assessment (eg, WTF was his primary malfunction, and what, if any, would be our role in addressing it?). Therefore we started to attempt to move his legs so that he could return to being seated upon the rear seat, and exit the vehicle from there. No joy.

It tuns out that highly intoxicated folks, like our friend here, were not so very good at listening to and following directions. Our entreaties that he fold one leg, and remove it from beneath the seat, seemed overly complex, as he did not successfully implement step one of our process.

So, we tried to move the seat forward, thinking that this would afford our patient enough maneuvering room so as to fold leg “A”, move it laterally, extend it, and repeat the process with leg “B”, and thereby achieve freedom.

Nope. As the seat moved, he shrieked as if we were removing the leg, likely anticipating reattachment on the sidewalk. So, that avenue of approach was foreclosed.

Doug and I consulted with the vehicle’s owner, who had been pacing about, intent that we not damage his baby. Or the patient, I suppose. Doug and I were fresh out of ideas, and figured that our friends in the firefighting division, with halligan bars, K-12 gasoline powered saws with metal cutting blades, hydraulic extrication tools, and similar toys for fun and games, likely could devise several new plans to remove this gentleman from the floor of the back seat.

I shared this thought with dispatch, noting that our patient appeared in no immediate life threat, and perhaps a “Code Three” (aka “Priority Three”, or no red lights no siren) response might be appropriate.

Dispatch acknowledged our request, told us that a squad would be on the way, and “Firefighters never respond ‘Code Three’, always ‘Code One’”.

Alrighty, then.

The vehicle owner overheard all this, and appeared to become considerably more excited. “You called the mother-f*@$ing firemen! They will f*@$ up my car!”

Doug and I agreed with him, that likely there would be some damage once the firefighters had extricated Mr. Drunk And Boneless from his car.

Mr. Drunk And Boneless thereupon became the recipient of a loud, profane, creative, and enthusiastic exhortation that he remove himself from the vehicle so as to greet the firefighters while sanding upon his own two feet, on the sidewalk, rather than seated upon the floor of the exhortor’s car. (Paraphrased). This was accompanied by pulling, pushing, tugging and bending, as the narrator demonstrated the contortions that he believed would facilitate the exit of the drunk and boneless fellow from the narrator’s vehicle.

And it came to pass that, once the squad had arrived on our scene, Mr. Drunk And Boneless was seated, relatively happily and nearly uninjured, upon somebody’s lawn, rather than enmeshed in the seat of the vehicle that had held him securely within it’s embrace.

The squad looked the scene over, returned to service, and our patient told us to bugger off, as he simply wanted to sleep.

Well, bye!

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Thanksgiving

This is, fundamentally, a repost of a blog entry from 13 Dec 2019.

Several years ago, TDW-Mark 2, Second Son Charlie, and his wife and I were out to dinner one night. Charlie had asked me how work was going, and I fell into my reflexive recitation of complaints about my employer. Yada, yada, yada, bitch, moan, and complain.

After a couple of minutes, I stopped to take a breath. Charlie looked at me, contemplatively, and asked me, “Dad? Can I ask you a question?”

“Sure. Lay it on me!”

“Do you suppose that, say, Cuban refugees, having entrusted their families, and their own, lives to rafts made, oh, out of a pickup truck and old water bottles, stagger onto the Florida shore, join hands, and ask each other, ‘Doesn’t McFee’s life really suck?’”

I considered my son’s question. “Really, I doubt that they spend an entire second on that concern.”

He smiled upon me, as if a Jedi Master upon a Paduan. “Yep, Dad. First World problems!”

Today’s deliberation is that, while there are, indeed, problems galore in America, please let us all consider the fact that, in most of the rest of the world, those things that we consider “problems”, are counted as blessings. It is like a real world experience of Bill Cosby’s bit about growing up poor in Philadelphia,

“Man, I got to share a bed with my brother! It is awful!”

“Man, YOU have a bed?”

“And, I get hand-me-down shoes, also! The worst!”

“Say what? YOU have SHOES?!?”

Etcetera. Sort of a reverse “The Dozens”.

May all of you have a pleasant, peaceful, tranquil, thankful, Thanksgiving Day.

BEFORE GOOGLE

Gather ’round, my children, and listen to a tale of long ago, and far away! In those far away, long ago times, there was electricity, yes, and telephones as well (although they were anchored to the walls of our homes, by “wires”). Why, indeed, we even had the Goddam Noisy Box, which you young ‘uns call “TV”.

Once upon a time, I was volunteering at a free clinic, serving as a nurse therein. The volunteer physician would interview, and examine the patient, and then provide orders for the treatment indicated. In those days, should one have symptoms of gonorrhea, the therapy was two injections of procaine penicillin g.

This turned out to be around 3 cc each, of a very, very viscous fluid, made particularly slow flowing because it was kept in the refrigerator.

At this point, I had been an RN for several years, working full time in ER. I had administered many, many, many injections intramuscularly as well as intravenously. I was familiar with injections, as well as strategies to mitigate patient discomfort while they were administered.

So, one gentleman was diagnosed with gonorrhea, and I received an order to administer two injections of 2.4 million units, each, of procaine penicillin g. I secured the medication, verified it’s outdate as well as the order, and made sure that the other medications the patient took, as well as his allergies, did not contraindicate this treatment.

I entered the room, and checked that the patient had been told of our plan of care. His reply? “Doc, doc, just shoot it on in!”

I informed him that he did NOT want me to “just shoot it on in”, and he would very much not enjoy the result of my doing so.

He reiterated his demand. I told him,” Sir? You are going to get two of these shots. You do not want me to simply ‘shoot it on in” because you will find it to be way, way more uncomfortable than it needs to be.”

Unmoved, he repeated his demand.

“Sir, how about I do as you insist, for the first injection. Then we can talk, and see if you would like to try it my way for your second shot, okay?”

He stated that he would not change his mind. I injected the first syringe of medication, rapidly, as he had insisted. It took some effort, because the penicillin was very thick, and did not want to flow through the needle at all rapidly.

My patient was very, very impressed by his first injection. Not at all favorably.

He stood up, once I had removed the needle, and commenced to hopping around and swearing. “Goddam! That really, really hurt! Shit, shit, shit! Doc, let me cool myself for a while!”

I corrected him. “Sir, I am an RN, not a physician. Once you calm yourself, you have another injection coming. Why don’t you allow me to administer it in the way that I know I ought to, and you can tell me how it is compared to the first one?”

He soon calmed himself, and I administered the second injection, steadily and slowly. The advantage of doing so correctly, oddly enough, is that the deliberate pace of administration allows the medication to spread out, rather than remaining a single, irritating ball of foreign material in the muscle, eliciting a cramp and muscle spasm. A cramp about which my patient had testified loudly.

Once I was done with the second injection, he stood, adjusted his clothing, and rubbed the second injection site. “Ya know, doc, that second one was not anywhere near as painful as the first one!”

Gooll-llee, Sergeant Carter! Just as if I had gone to school for this stuff, or something!

Serendipity

One evening, I was eagerly anticipating the prospect of departing work on time. We had not turned a metaphorical wheel for something like 45 minutes, and the clock on “the clubhouse wall” promised us only 20 more minutes until we recreated a LeMans start, jetting off into the night.

So, of course, somebody wandered in. She got registered, and my MA roomed her, interviewed her, vitaled her, and got some pee to analyze for indicators of a urinary tract infection, as such were her reported symptoms.

I reviewed the vitals, allergies, meds, and past medical history, as the urinalysis machine deliberated, finally printing out it’s findings. Surprisingly, given Miss Lady’s report of frequent, urgent, uncomfortable urination, there were no white blood cells nor nitrate (indicators of bacterial source of her discomfort). What there was, was an abundance of glucose (sugar). Indeed, the machine indicated something like 1,000 mg of glucose per decaliter (100 ml, or 1/10 of a liter). That’s a lot of glucose. I requested a finger stick blood glucose test.

That read “High”, as in, too much glucose in the drop of blood tested, for the machine to measure it. The machine will register blood sugar levels as high as 600 mg/dl.

I entered the room, introduced myself, and asked, what prompted her visit tonight.

She recounted the urgency, frequency, and discomfort with urination. “I feel like I have a bladder infection!”, she declared.

“Well, ma’am, there are no indications of infection in your urine. There is, however, an abundance of sugar in your urine. This is present, as well, in your blood. Are you a diabetic?”

“No.”

“Well, ma’am, you have more sugar per ml of your blood, than is present in a similar volume of sugary soda pop. You are, indeed, a diabetic. You need to go to emergency right now, so that they can get you started on managing your diabetes. Give me a minute, and I will print out your chart so you can show the folks in ER what I have found.”

Retail Pharmacy, So To Speak

A long, long time ago, in an ER very far away, I was a night shift ER nurse.

Surprise!

So, TINS, TIWFDASL, well, uh, not so much. I and the other nurses were capitalizing upon a slow moment and gabbing away at the nursing station, when one of our security officers ran in (literally!) and announced that “We got a shooting in the driveway!”

Having heard no loud noises, I was puzzled, but, these officers were not prone to overstatement, so I asked a couple of the other nurses to grab a cart, I grabbed some gloves, and off we went to the ambulance entrance.

Now, by way of background, this was in the early days of the crack cocaine epidemic (although, how one contracted “crack cocaine” from another person without active, willful action on one’s own part is unclear to me). A couple of blocks away was what might be considered to be an open air drug market. Folks (commonly suburbanites) would drive up, engage a soul in conversation and arrange a transaction, another confederate would be summoned and the exchange would take place, money from the buyer, drugs from the vendor.

We were told that in this particular transaction, the named patient, seated in the back seat of this two door vehicle, appeared to believe that he was the designated quality control inspector. Indeed, the tale appeared to paint this fellow as believing that he ought to remonstrate with the vendor regarding the unsatisfactory nature of the product that had been delivered.

As the History Of Present Illness unraveled, the vendor did not seem to have fully committed to a “Zero Product Defect”, nor a “Every Customer Fully Satisfied, Every-time” merchandising philosophy, as, when the shootee indicated that he, the shootee, intended to enforce his product quality complaint by with holding payment, he, the vendor, is reported to have produced a handgun, and shot the shootee.

Bad times ensued. The driver, unsurprisingly, panicked, and sped away. A few blocks later, he, the driver, noticed our bright “Emergency” sign, and pulled in, bellowing an incomprehensible narrative.

So, security cleared the car of the terrorized goslings, and I (and security, and my nursing partners) tried to extricate Mr. Beenshot’s inert form out of the rear seat of a coupe, indeed, a compact coupe.

It only closely resembled a cluster fuck. For a while.

We maneuvered Mr. Beenshot into our code room, and commenced to resuscitating. Before things had progressed very far, our doc had determined that this guy had a “STAT!” transfer in his very near future, and so the nursing supervisor, who had come at a run upon our paging a Code Blue overhead, peeled off to arrange with our transfer ambulance service that they produce a crew and truck RFQ (Right F*%king Quick), and then phoned TBTCIDC to provide them a heads up.

We eventually got him stabilized (kind of, sort of), and the physician had a detailed chat with TBTCIDC senior physician. Off Mr. Beenshot went, and we sought out the entourage, intending to elicit more history, more circumstances leading up to the shooting, more pretty nearly anything, so we could provide that information to TBTCIDC, as well as, well, notify next of kin.

Alas, the posse had unassed our waiting room sometime while we were distracted, trying to save the life of their friend, I mean, co conspirator.