Having A Good Partner Is Very Important! · Life in Da City! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

MAST Trousers

A long, long time ago, in a galaxy not so far away….no, wait. That is not quite right.

So, TINS©, TIWFDASL©, with my partner Doug, and we caught a run for a stabbing. This was a bit out of the ordinary, inasmuch as the preferred mode of interpersonal interaction (based exclusively upon my skewed sample of EMS patients in Da City) was labeled as “a GSW”, or less cryptically, “a shooting”.

In any event, we arrived to find a gentleman who was talking, kinda sweaty, but able to tell us the chain of events that led to our meeting, along with niceties such as his allergies, medications, and previous medical history. Oh, yes: with a solitary stab wound in his chest, just left of center, and around 4-6 cm removed from his sternal margin. (Yep, that means just what you suspect that it means).

We packed him up, after Doug, thinking ahead, had laid out the MAST trousers on the cot.

So, back in the mists of time, shortly after the demise of the horse drawn ambulance (I kid! I kid!), there was this tool, based upon the fighter pilot’s “G Suit”, called the Medical Ant Shock Trousers, or MAST Trousers (Yep, that does, indeed, stand for “Medical Anti Shock Trousers Trousers”. Go figure.) The principle was thought to be that, when you inflated bladders in the legs, and overlying the lower abdomen, you would increase venous resistance, and thereby minimize the amount of blood remaining in the lower extremities, and thereby increase venous blood return to the heart. Since that would increase pre load, and preload is one component of cardiac output, the thinking was that, if we could increase preload, we could increase cardiac output, and that would increase blood pressure. Generally, within certain limits, increased blood pressure in a trauma/shocky patient is held to be A Good Thing.

We were coding merrily along to TTBTCIDC (For those of you keeping score at home, that would be “The Third Best Trauma Center In Da City”). Mr Stabee and I were having a lovely conversation, after a fashion, until he got really quiet. Concerned, I checked his pulse and breathing, finding a considerably weaker, and faster, pulse than previously, along with diminished rate of respirations.

I hollered to Doug that our new friend was circling the drain, and both more alacrity on his part, as well as a heads up to the receiving facility might be really appreciated.

I wrapped him (the patient, not Doug) up in the MAST trousers, and inflated the bladders. Now, we had a protocol of inflating the bladders to pressure “X”, re- assessing the patient, and then either holding there, or adding more pressure. In the spirit of Spinal Tap’s Derek Smalls, I bypassed the intermediate steps, and inflated the bladders, metaphorically, to 11.

To my surprise, out stabbee awakened, and began to converse, asking “What happened?”I obtained a new set of vitals, and wrote them down, as we stopped at TTBTCIDC.

We trotted our friend to the trauma room, and, as I wheeled the cot out of the room, I heard the physician order, “Take those things off of him, now!”

I started to offer our valves and suchlike, in order to wean the pressure off of the bladders, rather than precipitously deflating them, but the sound of ripping velcro was my reply.

Shortly afterward, the code was called, and everybody who had not crowded into the room, now entered.

Before we were done cleaning up the truck and restocking our medic bag, the code had been called. Unsuccessfully.

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Fun And Games · Having A Good Partner Is Very Important! · Life in Da City! · Pre Planning Your Scene

“Hey, look! I’m fine!”

Winter in Da City is a special time. The snow, late enough in the season, covers up the litter in the gutters, the layabouts tend to lay about indoors, and generally you can almost convince yourself, if you squint just so, that there is hope for, and in, Da City.

And, then you meet people. Kind of an occupational hazard of being a medic for Da City’ fire department. Most of us held to the TRUTH! Of the aphorism that “sick people suck”. Daily (or nightly- kinda depends on your shift, amirite?) we encountered folks who, well, sucked. Both as people, and at life. Because, after all, the lottery winners infrequently phoned 911 to regale our dispatchers with tales of wonderfulness. Face it: nobody calls the fire department, to gush about he/she just now met The Love Of Their Life, and how this soul brought sunshine into their every day.

So, with that thought in mind, TINS©, TIWFDASL© one lovely wintry afternoon and we (Doug and I) caught a run for a man with a broken leg. Arriving on the scene, we noted the usual choreography of the “He’s In Here!” dance, oh so very popular in Da City.

We entered to find a gentleman on the sofa, ethanol fumes emanating from his every pore. One of the (more) sober bystanders informed us that our guest had fallen while shoveling snow, and broken his leg. I turned to the named patient, and he obligingly illustrated the point by waving his (no shit, notable from across the room, articulated in an unnatural spot between his knee and ankle) leg in the air, declaiming, “Hey! Look! I’m fine! There’s nothing wrong!”

As you may have already surmised, he likely had already been well anesthetized. Then, there was the question: if he broke the shit out of his leg, as he manifestly had, how, and why, had he made his way into the house? And, what parts of this tale remained untold?

I attempted to orient him to current events. “Uh, sir? It sure appears like you have broken your leg. We would very much like to take you to the hospital, to get that fixed up for you!”

“Naw, I’m fine!” was the reply, accompanied by more broke-the-shit-out-of-it leg waggling.

The citizens on the scene were ever so helpful. Or, not so much. They contributed, “He broke his laig! Y’all cain’t leab him here!”

Thank you, Dr. Schweitzer, for your orthopedic consultation. Certainly gonna have to factor that into our clinical decision making!

I looked at Doug, and he looked at me. He handed me the handie talkie, and went to the ambulance to retrieve the cot and assorted helpful goodies. I attempted to elicit something along the lines of allergies, medication and medical history information, figuring that sort of information would be kind of mission critical to our friends in anesthesia. I was certain that a tour of the OR in the presence of the orthopedist was in his future. Oh, and vitals. Vitals would be nice.

Once Doug returned, and I noticed that he had preplanned the upcoming goat rope, including a long backboard, backboard straps, and plenty of roller gauze.

We approached out new friend, and pinned him to the sofa. Doug bandaged his arms…yeah, THAT’S the ticket! Bandaged, not restrained! Once he was hindered from “lending a hand” to the festivities, well, we rolled him onto the spine board, secured him with straps, and, laying a nice wide rigid splint between his legs, secured bandaged them as well.

The foregoing accomplished a couple of things. First, he quit flapping that grotesquely fractured leg around. Secondly, he was a considerably more stable package to carry out to the rig. Finally, all the citizenry was placated by how thoroughly their friend had been splinted. Everybody won!

Once we arrived at TSBTCIDC, and debussed Mr. Leg Fracture, well, the nursing staff couldn’t help but unsecure him, since they simply HAD to evaluate the fracture. That set off an entirely new round of protestations that he, the patient, “was just fine!”, accompanied, again, with the semaphore wig-wagging of the demonstrably unfine fractured leg.

Cool story. I finished my trip sheet, and completed and signed a “Petition for Involuntary Hospitalization”, citing my new friend’s manifest unconcern for a clearly broken leg, documenting his inability to comprehend his need for hospitalization.

All in a day’s work!

Fun And Games · Having A Good Partner Is Very Important! · Pre Planning Your Scene · Protect and Serve

The Leviathian Comes Alive!

So, one time we got dispatched to an unconscious person run on the east side. We arrived to see a number of police officers from DBCPD standing around. One of them pointed out a large slumped soul, leaning up on the steps on a rear stairway of some house.

He was not entirely flaccid, and he WAS breathing on his own, both desirable attributes from my point of view. Even so, leaving him to metabolize towards mobility appeared to be a bad plan, so Porthos and I attempted a hold-him-under-his-arms walking assist. It worked, sort of. Well, it appeared to be working well enough that we could maneuver him to the truck, and thence to TBTCIDC, where he could indeed metabolize to freedom, under the loving and watchful eyes of the TBTCIDC Emergency Department nursing staff. For bonus points, he would then not be our problem.

Porthos and I were making progress, of a sort, toward the ambulance, and the police were doing their police type stuff, when I got the bright idea that perhaps a whiff of an ammonia capsule might energize our guest.

Now, with the wisdom that comes with hindsight, THAT might have a good idea to, ya know, DISCUSS with my partner. That discussion might have elicited several beneficial outcomes, like problem solving IN ADVANCE, and anticipation of ways in which this brainstorm of mine might have turned horribly wrong, for example.

As might have become evident, I did NOT discuss this little plan of mine with my partner, and simply retrieved an ammonia cap from my pocket, snapped it, and allowed Mr. Leviathan to breathe deeply of the healing aroma.

He abruptly, and I mean RIGHT FUCKING NOW! Became considerably less stumbling, and way, way more energetic, shaking loose of my grasp on his arm, and turning on my partner.

This might be a good point in my tale to note that our guest was tall, and big, and outweighed me, as well as Porthos, by a considerable margin. If he should commence to some wrasslin’, well, whichever one of us was the object of his affections, would not enjoy being so objectified.

Porthos had noticed our guest’s reanimation, although he was a fraction of a second slower than I in so noticing, and so King King, our newly energized patient, was advancing upon my partner, hands outstretched, and backing Porthos rapidly into a corner.

I realize that things happen quickly, and it appears that time stands still, nevertheless those officers sure appeared to be statues, while this shambling wreck of a man-mountain was advancing, cornering my partner, presenting a clear and present danger of laying hands on him.

I found my Mag Light in my hand, and advanced, on my toes, behind him. My flash plan was, once he had indeed grabbed Porthos, well, I was going to go for that line drive, featuring his head as the baseball.

So, Ninja like, I was advancing upon Leviathan, Leviathan was advancing on Porthos, the cops were unmoving, and I, catlike, managed to step on his foot.

Good news: he forgot about Porthos.

Bad news: he figured that I was oh, so very much more deserving of his attention than my partner. He began to turn on me, so as to show me some love. Of some sort.

Good news: whatever was the source of his previous lethargy, it slowed his synapses, and so the insight that he would rather be thumping on me, rather than Porthos, took him a not inconsequential amount of time to process, and then to act upon.

Good news: Porthos took that opportunity to zig to Mr. Leviathan’s zag, and begin to beat feet to the truck.

Good news: I accelerated to warp speed promptly, and so managed to arrive at the ambulance about the same time as Porthos.

Good news: our officer friends were, themselves, in motion, and they converged on Mr Leviathan, and dissuaded him from pursuing any further laying-on-of-hands ceremonies.

Indeed, they were so persuasive, that they elected to transport our new friend to TBTCIDC, themselves.

Porthos and I had, well, I suppose you might consider it “a teaching moment” once we were back in service. My ears stopped burning after a couple of hours.

Fun And Games · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact

“Speck’ ah got it figgerred out!”

So, TINS©, TIWFDASL© at Rural Community Hospital ED one fine summer afternoon, nothing exciting (for me, at least: the folks who were here for sutures, or chest pain, likely thought that their dilemmas were entirely more exciting than they would otherwise desire!).

So, this fellow trotted in, carrying a crying child. He announced that the child had cut his head. Our nurse aid escorted the gentleman to one of the carts, and started to look into the problem. I tagged along.

Quick witted, she promptly determined that stapling this child’s head would likely result in a net minima of drama and caterwauling, so she plucked up a surgical stapler, and some betadine, and began to clean up the lac.

The physician arrived, and she briefed him on her findings. Me? I occupied myself trying to get vitals, allergies/meds/medical history on the child from the (clueless) dad. Doc began to perform his own assessment, as the mother arrived.

This elicited another chorus of wailing, tears, and general drama. Predominantly from the child, although the mother contributed her own share. The physician informed the parents that he was planning to staple the wound, once my friend the nurse aid had completed her task of cleaning things up.

“Is that going to hurt him?” was the mother’s question.

My bad, I answered her truthfully. “Yeah, but it will only be 4 pokes. If we stitch it, there will be 8 or more pokes to numb it, and then another 8 or so pokes to sew it up.”

Likely, it was lost when I used the word “numb”. I suspect that she stopped listening at the word “numb”, and failed to do the math. “Oh, I don’t want him to hurt! Can’t you numb him?”

The aid tried her hand. “Well, yeah, but that will require 8 needle sticks, whereas if the doctor simply staples it, there will only be 4 pokes”.

Mom had One Thing on her mind. “I don’t want him to hurt!”

The physician tried. “Ma’am, nobody wants him to hurt. In fact, if I simply staple the cut closed, he will avoid something like 12 additional punctures, and the discomfort associated with those 12 punctures.”

“Please, numb him up! I don’;t want him to hurt!”

Resigning ourselves to our fate, I collected the lidocaine, syringe and needle, and my friend the aid swaddled the child in a blanket.

The kid promptly figured out where this was going, and he wanted NO PART of this ride. So, I set up the doctor’s suture set and lido, and joined the rodeo.

The kid screamed, and he flipped, and he flopped, and he writhed, and he twisted, and he turned. He shook his head, so I was detailed to seize his head, and immobilize it. Mom, to her credit, laid across her child’s legs, and dad laid across his torso, so the doctor only had to zig and zag over roughly 30 degrees of motion as he was injecting the local anesthetic into the margins of the wound.

Did you know that lidocaine, injected into your skin, burns? Yep, burns like a sonuvabitch, for a minute or two. Now, may I watch YOU explain to an 8 year old, that the burning will go away soon, and then things will be numb? Because, he was not listening to me at all, which, of course, assumes that any earthly creature could distinguish my speech over his screams, and cries, and shrieks, and general high volume protestations. Because, I could not.

So, once the doctor had established that the process was going to be pain free (because, of course, the anesthesia had been SO! MUCH! FUN!), the child was going to lay very still for the suturing?

Totally! And, the Democrat candidates for President are not vying to convince the electorate that they, only they, will be the BEST! At providing free stuff to non citizens, as well as college graduates who find themselves in the food industry.

Of course, no. Just, NO! More rodeo nursing, more Brahma Bull On the Suture Table.

Finally, at long last, we were done. The aid unwrapped the (limp)(sweaty)(hoarse voiced) child from the blanket, and we all stepped away, so Mom could hug the child.

She looked at us all, and said, “That was awful! Ohmigawd! I should have listened to you guys!”

I bit my tongue, and shuffled off to the nursing station, to complete my charting. The aid sat down next to me, and said, “Hey! I did my best!”

“That you did.” I replied. Then, taking on a stereotypical hillbilly voice, I continued. “Hyuck, hyuck! Ah’ve bin doin’ this here ‘mergency nursin’ thang for might’ near six, mebe seven weeks now! Speck’ ah got all figgerred out!”

Fun And Games Off Duty · Having A Good Partner Is Very Important! · Pre Planning Your Scene

Car Fire

So, before Mallory and I had begun to live together, I had one of my ex partners, let’s call him Adam, as my room mate. Mallory would come over from time to time, and the three of us would chat, or share dinner, or simply hangout.

One day, she came into the house, and asked us to hurry out and see what was wrong with her car. Now, this was her baby, one she had purchased because, as she termed it, “I look so good driving that car!” It had been her very first new vehicle, ever.

So, Adam and I threw on some shoes, and trotted out to see what was the matter. She had told us that it was smoking, and once we got outside, it became clear why. The smell of burning plastic emanating from beneath the hood told the tale.

Mallory was starting to get excited, hopping around and beseeching us, “Can’t you guys do something?”

Adam looked the vehicle over, and asked her, “Do you REALLY want us to do something? If we let it burn, or call the fire department, then it will be totaled, and you can get a brand new one. If we extinguish the fire, you are gonna have to get all that burned shit replaced, and it may never be altogether right, again.”

Mallory was nigh unto break dancing by now, and simply couldn’t bear to see “her baby” burn up. Adam asked her again, simply to be certain, “Are you REALLY REALLY sure you want us to do something?Again, she pleaded with us to act. Adam looked at me, I looked at him, and we charged the garden hose, donned work gloves, and sprayed it down through the grill as well as we could. Once it had dampened down, I opened the hood, and stood aside, while he blasted it (or, at least, “blasted it” as much as one is likely to be able to, with a garden hose!). It was evidently sufficient to the task, for soon the smoke stopped, the smell abated, and we were unable to identify any further burning stuff after diligent search.

Mallory called her insurance company, they sent a wrecker, and she got a loaner.

Several weeks later, her car was returned to her. She subsequently had repeated complaints about this, that, or the other thing not performing properly. Soon, she turned to Adam, and admitted, “If I had listened to you, and let it burn, I’d be driving a new car by now!”

Fun And Games Off Duty · Having A Good Partner Is Very Important!

My Cardiac Cath Story

I once heard the aphorism that “a man who is his own attorney has a fool for a client”. It turns out that legal matters is not the only arena in which that insight is applicable. Let me tell you a story about that.

So, several years ago, The Darling Wife and I were vacationing in Georgia. There are multiple sites, preserving locations where significant battles of The War Between The States/The War of Northern Aggression (depending upon when and where you learned of such things) occurred. I wanted to walk one of the battlefields (Chickamauga), both to stretch my legs as well as to get a feel for the closeness of the opposing forces.

I was winded by the time I finished my rambling over one section of battlefield, considerably more so than I had expected. I chalked it up to “bronchitis”. (remember that thought!) This persisted as I wandered from site to site, and paused to read the explanatory tablets set here and there.

We finished our vacation, and returned home. There, my “bronchitis” persisted, until, eventually, my Long Suffering Wife asked me about my illness. I admitted that it had not improved, which was curious since I had been having this “bronchitis” for about a month by then.

“How’s your fever?”, she asked.

I did not have a fever.

“Is that common when you see a patient who has had bronchitis for several weeks?”

No, I admitted, it was not.

“So, get your shoes.”

“Why?”

“Because, if you do not, your feet will become muddy”

“Why would they get muddy?”

“When you walk to the car.”

“Why would I be walking to the car?”

“Because I’m not going to carry you there.”

“Why do I need to go to the car anyhow?”

“Because it is too far to walk.”

“Where is too far to walk?”

“Your doctor appointment.”

“I don’t have a doctor appointment!”

“Oh, yes you do! Your wife made one for you!”

“Why did you do that?”

“Because she (my PCP) is not going to come here to see you, that is why.”

“Why do I need to see her?”

“A couple of reasons. First, to get you to stop asking dumb questions. Secondly, because you are sick some kind of way, and your plan is not working. You are going to talk to your doctor, and listen to her plan. And, then, act on it.”

I went to my doctor (actually a Nurse Practitioner, with whom I had ER nursed), who did an EKG, “because you are old and all.” “Well”, she told me, “This looks pretty OK, but, your story is concerning. I’m gonna schedule you for a stress test.”

Cool story. So, I arrived the next day in my running shoes and running shorts, and proceeded to tank the stress test. I mean, I did not even finish the first stage before the physician administering the test stopped me, repeatedly took my vitals, and called cardiology.

Next week, I’m sitting in the cardiology office, and the cardiologist is admiring my EKG, and enjoying my Tale Of The Failed Stress Test. He told me, “My partner will be waiting for you, to do a cardiac cath, at 3:30 (it was now about noon).”

Okey-dokey! So, I went in to my cath, with The Darling Wife and her BFF waving me farewell.

When I awakened, it was like a family re-union. Darling Wife, her BFF, her niece, my second son, my third son, my daughter, and something like 4 or 5 other folks, family in one way or another, who I cannot recall off the top of my head. Once I had sobered up enough for The Darling Wife to brief me on the doctor’s report, her precis was sobering: “You had 95% of your main artery in your heart blocked, but they were able to open it with a balloon and a stent. The doctor said had you waited a few more days, you would have had a big, bad heart attack, and, where that blockage was located, you heart would have stopped. Missed it by That Much!”

Fun And Games Off Duty · Having A Good Partner Is Very Important! · Pre Planning Your Scene

The Great Chocolate Explosion Of 2018

So, TINS©, TIWFDASL©…. Well, alright: I wasn’t FDASL© in this story, I was in my kitchen, fixing to cook some fudge.

The women in my office (where I was a mid-level in an urgent care) had been teasing me about my domestic abilities, and so I had threatened them with offered them home cooked fudge.

The recipe I selected required that I melt baker’s chocolate and butter in a double boiler. Of course, I did not have a double boiler. Instead, I selected two pans, poured some water onto the one, and settled the other into the first, and turned on the range. I noted, in passing, that the fit seemed a bit tight, but, whatthehell, I did not act on this insight.

Remember that thought.

So, I arrayed my ingredients on the counter, and then checked on the progress of my chocolate melting. Experimentally, I wiggled the top pot. At that point I noted a seemingly tight friction fit, and told my wife, washing dishes behind me, that I was starting to be a bit concerned about that. My words were, prophetically enough, “Boy! I sure hope that this top pot doesn’t suddenly loosen from where it is stuck, here! That could be messy!”

My wife came over, gave it an experimental wiggle herself, and concurred with my assessment. “Yep, might want to turn the heat off!”

Of course, I did not. Bright idea, right there!

I diddled around in the kitchen for a few minutes, and then went back to my double boiler/pressure cooker (without release valve). I was explaining to my wife how I planned to safely extricate the top pot from the lower, when my explanation was interrupted. By the top pot ABRUPTLY separating from the lower. At speed. With force. And, with a considerable “BANG!”

The next thing I knew, I was holding the handle of the top pot, with molten chocolate running down my face. I turned from the stove, depositing the pot into the sink, and noted that more liquid was running down my face. Wiping it, I discovered that it was blood. Nice. I returned to the stove, and my wife saw the blood herself.

Ohmigawd! You’re bleeding! You’re on blood thinners! We have to take you to ER!”

Let’s turn off the stove, first, ok?”

She was fixated on my bleeding. “You have to go to urgent care! You’re bleeding!”

I was still sorting out what had happened, and what ought to be done, first, and then next, etc. “Honey? I sort of do this for a living, right? Let’s sort out what’s happening, and then decide what we indeed have to do, first, okay?”

But, you’re bleeding!”

I’ve already figured that much out, thank you. Now, let me take a second to see how badly I’m bleeding, and what else, if anything, is going on, before we panic. Once we know what’s happening, THEN we can panic, Okay?”

She hustled me into the bathroom, and handed me a towel. I sponged off the majority of the blood and chocolate, and saw a superficial appearing wound in the center of my forehead, approx 2 cm long. The blood appeared to be sluggishly dripping from it, and I did not see any other injury. Palpating, I did not feel anything suggesting a depressed skull fracture. My vision was at baseline, I had no numbness or tingling. My ears were sort of ringing (some of that was not new, some of that was readily attributable to the explosion). Otherwise, aside from chocolate EVERYWHERE, I appeared to be unscathed.

I applied some direct pressure, and the bleeding stopped after a couple of minutes.

The Darling Wife and I re entered the kitchen, and set to cleaning up the largest chunks.

A day or two later, my wife and her daughter in law were detail cleaning the kitchen, and discovered a large chocolate chunk behind the stove, and another on the top of the refrigerator. How the heck did they wind up there?