Life in Da City! · Uncategorized

In Review….

I’m an old stretcher ape. Started in EMS a long, long time ago, working in, and for Da Big City. Worked my way through nursing school, and eventually went to grad school, in my capacity of Official Old Fart. I’m chock full of stories, all of which begin with the obligatory disclaimer, followed by the Mark One, Mod Ø preamble: “This is no shit! There I was, fighting disease and saving lives….”

Abbreviations, Acronyms, and Terms Of Art: I tried to assemble all the esoterica in one place, for ready reference/translation to the non-medical readers. Somebody suggested that the link/page of this stuff was inaccessible for one reason or another. Here’s another go at it!

I’ll try to collect all the unusual, non-standard-English phrases and suchlike here, for easy translation.

  • BVM: bag-valve-mask. A device for introducing room air into the lungs of a     nonbreathing person, by compressing a bag, pushing the air from that bag through a one way valve into the mouth (and therefore airway) of said person via a mask. Releasing the bag allows it to self inflate, and the patient to exhale, so you can repeat the whole process again. And again. And again…
  • Carotid pulse/Artery. Large bore neck artery, main pathway for blood to travel to the brain from the heart. One on each side of the (kinda) front of the neck. High pressure. Lotsa blood flow.
  • CLOVER: (from The Urban Dictionary): Clovers believe that they are always doing the right thing, and therefore everyone should wait on them, or are basically oblivious to others’ needs.  Clovers generally believe that if someone does something that irritates them in some way that a law should be made to correct the problem – “There ought to be a law”. A Clover will always side with the police or the government no matter what egregious evil they have committed.
  • “da corridor”: the district immediately south of Da University, a sort of wrong-side-of-the-tracks “entertainment” district. An environment rich in overdoses,alcoholism, prostitution and assorted pathology. Commonly, in the spring you would notice new, young, generally female faces among the inhabitants. Towards autumn, most of those faces were absent (Ghawd, I hope that they went home!), and the ones remaining were in no way as fresh, bright eyed, or as healthy looking as they had been around 5 months previously.
  • DBCPD (Da Big City police Department)
  • HEARN: Hospital Emergency Alert Radio Network, a  VHF. radio channel employed for (surprisingly enough) alerting the hospital of pending arrival, particularly of a priority patient. 
  • Kel-Lite: heavy duty, police-style flashlights, useful for illumination, or as a bludgeon
  • RFN: Right Fucking Now
  • SBTHIDC/SBTCIDC: Second Best Trauma Hospital/Center In Da City.
  • “Stat”, “Stat-like”, or “right Stat like”, all equate to “IMMEDIATELY!”
  • TBTCIDC: The Best Trauma Center In Da City
  • TINS: This is no Shit
  • TIWFDASL: There I was, fighting disease and saving lives….
  • TLHTTIC: The Little Hospital That Thought It Could
  • “To”: (pronounced “toe”, like the digit) short for “ghetto”, as in “Life is tough in the ‘to”
  • “Wheedle-Deedle”. The sounds made by an electronic siren. See Also, “Most weird Noises From An Electronic Siren

Fun With Suits! · Life in Da City! · Pains in my Fifth Point of Contact

Accident Letter

So, TINS, TIWFDASL, and responding to some sort of emergency or other. It was my day to drive, and I was merrily coding along. Approaching The Major North Bound Thoroughfare as I headed west bound, light and siren flashing and a-wailing, I slowed and observed cross traffic (who had the green light), stop on the rain slicked street.

That appeared encouraging. I began to accelerate through the intersection, when, lo and behold!, I beheld a driver swing into the center lane, pass all the stopped traffic, and proceed to strike the ambulance aft of the driver side dual rear wheels.

He had built up to fair clip, because he rocked the modular ambulance pretty good. Indeed, given my own momentum, the aft of the rig slewed to the right, and we entered a skid.

I corrected, steering into the skid, and noted in passing a pedestrian on the northwest corner determine that he did NOT want to remain standing where it appeared I was going to roll over, and so he started stepping lively toward the south.

Remember that “I corrected my skid” thing? Yeah, about that. It turns out that correcting a skid, in a, oh, let’s guess 5 ton truck, is not a fact, it is a process. So, when I had corrected our slewing-sideways-towards-the-northeast skid, we NOW had a slewing-sideways-towards-the-west-southwest skid. Less off axis, so there was that as an improvement, but our friend the pedestrian (remember him?), last seen high stepping to the south, did not think much of this as it portended his own immediate future. He demonstrated this understanding, as well as outstanding situational awareness, as he skidded to his own stop, about faced, and accelerated north.

I had noticed that we were skidding kinda sideways, in a west-southwesterly direction, and so, once again, I corrected, steering into the skid. Once that had been accomplished, we were merely proceeding catty-wampus, in a more or less northwesterly direction, and, it appeared, tracking our poor increasingly frazzled pedestrian friend as if we were a pedestrian seeking missile. With target lock.

Fortunately on several levels, all these gyrations had bled off considerable speed, and I was able to come to a complete, and rather abrupt, stop, short of squashing the pedestrian.

My partners were uninjured, as we had vicariously experienced many, many motor vehicle collisions, and had scant desire to recreate the experimental results we had witnessed. We were all buckled up.

While I was attempting to determine if my SVT (supraventricular tachycardia: an accelerated heart rate running around 150-200 beats per minute) was self limiting, or my new normal, Doug figured that (a) we were not completing this run, and (b) this might be a nice thing to share with dispatch. He did so.

We checked the other driver (who was fine), and awaited the police, city wrecker, and the inevitable chat with The Lieutenant. Fun times ahead, indeed.

The officer taking the report only had about 7,000 questions, and, once he was done, dropped us off at apparatus. There, we got to switch from our rig, into a back up rig. Back up rigs were too rickety to be in front line service, but not so obviously rattletraps that they could not serve as interim ambulances until our rig was repaired. Which in our case was likely to be sometime around the heat death of the universe.

We returned to quarters (with Doug driving!), where we awaited Lt. Evans. Once he had arrived, he directed me to write a letter (standard practice) detailing the events that had led up to our nice new truck getting bent up.

At this point I was the union’s chief steward, and was familiar with the contract. One of the provisions thereof was that any member, facing potential discipline, had the right to consult with a steward prior to making any official statement. I figured that, hashing this out with another steward might allow me to avoid talking myself into (harsher) charges (than I already faced for the collision).

Another peculiarity of Da City’s system, was that it appeared that the algorithm for assessing fault ran as follows. (each yes answer advanced you one more round) “Were you driving?” (Y/N) “Were you driving a city vehicle?” (Y/N) “Was that vehicle involved in a collision of any sort?” (Y/N)

“GUILTY! GUILTY! GUILTY!”

No shit: on one call, I had parked the ambulance in the street, four way flashers flashing, beacons in operation, I and my partner were IN THE REAR OF THE AMBULANCE, when some jackhole decided that, as IMPORTANT as he obviously was, he could not wait for us to roll off, and had to depart NOW! In the course of snaking his way out of the parking spot right next to us, he nudged the ambulance bumper, causing the vehicle to rock on it’s springs.

Like a dummy, I reported it. To my astonishment, it took the Accident Review Board SIX FREAKING WEEKS to ascertain that I was NOT at fault.

So, with these lessons in mind, I was reluctant to make any sort of official statement without at least having another steward tell me I was doing it wrong. I said so the Lt. Evans, and said, “So, sir, I officially request that I be allowed to speak with a steward prior to making an official statement, as guaranteed in our contract.”

He gave me the stink eye. “You’re the chief steward, right?”

“Yes, sir.”

“So, go chat with yourself , and write my damned letter. Now would be good.”

“Uh, sir…?” I began.

“Mr. McFee, I am making that an order. Do so, at once!”

“Yes, sir!”

I therefore drew up a piece of Fire Department letterhead, and composed the following letter:

“TO: Superintendent of EMS

From: Reltney McFee, EMT

Subject: Collision involving Medic 23 this date

Date (date)

Sir: Lt. Evans ordered me to write a letter regarding Medic 23’s collision this date. I requested the opportunity to speak with a union steward prior to making any official statement, and Lt. Evans ordered me to write you a letter at once.

This is that letter.


Respectfully, Reltney McFee EMT, Medic 23”

I pulled it out of the typewriter, placed my carbon copy in the desk, and handed it to Lt. Evans. “Here’s your letter, Lieutenant!”

He looked at it for a minute, and glared at me. “McFee, this is unsatisfactory. Write this letter, all over again, and this time do it right!”

“Yes, sir!”

I assembled another set of letterhead and carbon paper, and captioned the next letter as before.

My opening line was as above. I asked the Lieutenant, “Sir? What do you want me to write now?”

He said, “McFee, I’m not going to tell you what to write!”

I typed in, “Lt Evans told me to write, “ ‘McFee, I’m not going to tell you what to write!’ “

“What’s next, sir?”

“Goddammit! Stop that! Just write what happened in your accident!”

My next line of text was, “ ‘Goddammit! Stop that! Just write what happened in your accident!’ “

“Yes, sir? What is next?”

He glared at me. Again. “McFee, get up from that chair. Do not type another word!”

I stood. He asked me, “McFee, what do you think you are doing.”

“Well, sir, you ordered me to write a letter about an accident prior to my having the opportunity to speak to a steward about a matter that might result in my being disciplined. I complied with that order, and wrote a letter citing everything that I was willing to say at this moment. You did not find that satisfactory, and ordered me to re do it. I was rewriting it to your specification, when you abruptly stopped providing me directions. Sir.”

Again, with the glare. “It is now 1300 hours. You will have that letter, and I mean the letter that you KNOW you have to write, in my hands no later than 1700 hours today, without fail! Am I making my self clear?”

“Perfectly, sir!”

He stormed out.

I got his letter to him, after a phone consult with another steward.

Oh, yes, And I got a written reprimand for my role in the collision.

Fun And Games · Life in Da City!

Suburban Community Hospital (or) Be Careful What You Ask For!

Another time, with dispatch whimsically sending us on a scavenger hunt all over Da East Side of Da City, we had occasion to transport sumdood to Suburban Community Hospital. This was a fairly sizable establishment, even by the standards of the day, and the ED was pretty busy upon our arrival.

We handed Mr. Dood over to the nurses, gave report, and began to prep the cot for the next lucky contestant. One of the nurses ambled over, and engaged us in conversation.

“How come you guys only bring us drunks? We can handle anything TBTCIDC can handle!”

Doug spoke up. “Uh, Ma’am? That’s kind of the majority of what we bring to TBTCIDC, ya know? Most of our runs are sick folks and drunk folks.”

She wasn’t gonna let this go. “Aw, c’mon! How come we never get any good trauma! I know you guys take all the trauma to TBTCIDC! Howzabout occasionally bringing us some of the stuff you always are taking to TBTCIDC?”

We mumbled something that maybe could have been taken as assent, and she meandered off to fight disease and save lives, or something.

As Kharma sometimes deigns, our next run was not too far from Suburban Community Hospital. Indeed, the Grin of Kharma must have been epically large, as the next call was for a very drunk, very loud, very combative inebriate.

Once we had him restrained and in the truck, we conferred. Consensus was, we were about to return to Suburban Community Hospital. After all, they had ASSURED us that they could handle ANYTHING that TBTCIDC could handle.

Well, to paraphrase Bill Engvall, “Heeerrreee’s yer patient!”

When the nurses began to chastise us about our patient selection, as well as our destination selection, our refrain was, “Well, you told us that you were perfectly capable of handling anything TBTCIDC could handle! This fine young man, right here, is completely typical of their patient population!”

And, then we scurried away……

Life in Da City! · Pains in my Fifth Point of Contact

HIV Transfer

So,TINS©, TIWFDASL©….well, OK. I was a nursing supervisor, and therefore, in the view of my peeps, I was, at best, not an impediment to their doing their jobs.

So, in any event, this was way, way back in The Dark Ages, Before Cell Phones (Gasp! No! There were PEOPLE, way back then?!?). This was around the time that some bright clinician noticed that there was a peculiar form of impairment of the immune system, that seemed particularly prevalent among homosexuals (currently described as MSM, for “men who have sex with men” in the clinical literature), and IVDAs (“Intra Venous Drug Abusers”). Nobody was really clear on how this was transmitted, although some sort of exposure to bodily fluids originating in one of the sufferers of this malady seemed a common feature of acquiring it.

My little hospital had a drug rehab unit, the purpose of which was to smooth the discomfort of discontinuing narcotics use, so as to help the recovering addict start to re arrange the other pieces of his/her life, into a non drug dependent direction.

So, it developed that our medical director of this unit had determined that one of his patients on the rehab unit did, indeed, have this acquired immune deficiency syndrome. (You may have already recognized the acronym “AIDS”). In these dark days, the capability of treating this disease was limited to specialty units in tertiary referral centers, and therefore we made arrangements to transfer our patient to The House of God, Local Edition.

I called the contract transfer ambulance service, and provided the needful information. All was set, I turned to my next problem. Or so I thought.

On the order of an hour later, I received a page from the drug unit. They desired my presence, pronto. I trotted on up.

Once buzzed into the unit, I beheld a pair of basic EMTs, one irritated patient, and one pissed off charge nurse. I drew the charge nurse aside, and asked WTF was happening.

“These idiots are acting like extras from “The Andromeda Strain”, and refusing to take our patient unless they and he are in full isolation garb, and they didn’t bring anything. They are insisting that we outfit them with masks, gowns, gloves, masks, and surgical hats. You’ve been to the same in-services as I have. That’s bullshit. Unless they are going to share needles in the back of the ambulance, there is nearly no risk whatsoever. Could you please talk some sense into these guys?”

I invited the ambulance crew to join me in the nurse’s lounge, and asked them what the issue was. One spoke up. “That guy has AIDS. I don’t wanna catch no AIDS. That’s why we need all that protection!”

Now, remember. This was a BASIC transfer. This guy was alert, lucid, cooperative, not bleeding not coughing up amphibious life forms, continent. All in all, not spreading any bodily fluids anywhere at all. It had, I’ll admit, been several years since I had been on the road, but my paramedic license was still current, and I was unaware of any evolutions in pre hospital care on a basic inter hospital transfer that might place these guys at any measurable risk. I told them as much.

“Yeah, well, I dunno how it was way back in your day, but nowadays, well, we gotta protect ourselves!”

Uh, yeah. “Back in my day”. So, my response was measured, and professional. “Gentlemen, please get comfortable. I’m going to chat with your supervisor, and we’ll get this all squared away, pronto!”

I lied. I talked to MY supervisor, the director of nursing, and told her my little tale. She was, to be charitable, irritated, and mused aloud about her to-do list for the morrow. Prominently featuring contracting with the Non Imbecile Ambulance Service, which, so it appeared, would NOT be the employer of the happy go lucky souls with whom I had shared our nice little chat. She suggested that I share that project with the on duty supervisor of the Incumbent Ambulance Service, with the suggestion that they may want to reflect upon how far into this project they really wanted her to get. “Yes, Ma’am!”

I called their dispatch, invited them to have their on duty supervisor call me, right stat like, and awaited the return call.

This worthy was not any sort of improvement over the dolts that he had caused to be sent to us. I smiled, reminded him that we’d be in touch, and went back to the unit.

By this time, both EMTs were garbed as if for joint replacement surgery, absent only the PAPR respirators. They had wrapped the cot with plastic, and then, standing several feet from the cot, invited my patient to “Sit!”.

Nice.

I apologized to the patient, and wished him the best of luck at the House of God, Local Edition. He shrugged, thanked me for my efforts, and gracefully in demeanor, settled in for his ride.

A couple of days later, one of the medics from A Competing Service stopped me in the hallway. “I heard you put a good word in for us, and we now have your transfer contract. Thanks!”

I corrected him. “I didn’t say one thing about you guys. Likely, my boss remembered your stellar performance with our out-of-state transfer a couple of months ago, and when the need for a new contract came up, remembered you and how smoothly you guys ran that.”

I didn’t tell him to thank The Incumbent Ambulance Service, and their crew of Laurel and Hardy.

Fun And Games · Life in Da City!

If You Are Taking Medical Advice From The Voices In Your Head, You Are Doing It Wrong!

So, TINS©, TIWFDASL©, when we caught a run for a “sick person”. My tales of adventure notwithstanding, the overwhelming majority of EMS runs in Da City were what the personnel called “sickies”. This tale is about one such soul.

We arrived, and things progressed in the usual fashion. Six questions, one command.

  1. “Who’s sick?” (show of hands).
  2. “What kind of sick are you?” (the response generally ran along the lines of “I’m really sick”, or “I’m just sick, that’s all!”) (so much for “History of Present Illness”)
  3. “How long have you been sick, Sir/Madam?” (typical response was some variation of “A good little while.”)
  4. “Do you want to go to the hospital?” (A surprising number of people did NOT want to go to the hospital. Some wanted to be told that they were alright, others wanted to go to some place in West Bumfuck, way, way, way outside of Da City’s service area, or wanted a ride to the doctor’s appointment that they, surprisingly, had made. We did not take folks to their doctor appointments or to BFE Community Hospital. Fire department rules.)
  5. “Can you walk?” (the correct answer is always, “YES!”. Occasionally “No”, but the number of trivially ill/injured folks traveling to ER via EMS was both surprising and disappointing.)
  6. “Where are your shoes?” (Again, a surprising number of folks who presumably had lived in Da City all their lives, and had noted snowfall and freezing ass temperatures arrive each and every winter, did not think to have their shoes staged, oh, I don’t know, NEAR THE DAMNED DOOR, once they had determined that they required ambulance transport to the hospital emergency department for their sniffles or whatnot.)
  7. (Command) Follow Me!”

So, one such soul, seated in the back of the ambulance with me late one night/early one morning, was being interviewed by me. I asked him his allergies. “No, none, not really.”

I asked him his medications. “Well, no, none, I guess.”

That did not sound right. I asked, again, differently. “Does you doctor think that you are taking any medication regularly?”

“I suppose so.”

“What might that medication be, that you suppose that your doctor thinks you ought to be taking?”

“Oh, some nerve pill.”

“Oh? ‘Some nerve pill?’ Why aren’t you taking your nerve pill?”

“Well, the voices in my head told me I didn’t need them any longer!”

“The voices told you that, did they?”

“Oh, yes! They were very clear about that!”

“I bet that they were!”

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.

Life in Da City!

Things you learn in your early jobs….

Before I was a medic, full of derring do and beating back the scourge of death and disease, I was an orderly at Da City General Hospital. There, I shuffled bedpans, obtained vital signs and generally attempted to do all the routine stuff that did not require the skills nor education of a nurse. I learned a lot, particularly among those things that I learned, was that I did NOT desire to become a floor nurse on a med surg floor.

One day, I was gathering the vitals on our guests, working my way through the wards. One particular gentleman had recovered, sort of, from a stratospherically elevated fever. In most regards, he was on track to recuperation, although the fever had done malign things to his brain. He appeared to have a rudimentary understanding of his surroundings, and did not engage in conversation. We were feeding him each of his meals, although he had (re)mastered chewing and swallowing.

So, bright and early, before my coffee had had the opportunity to effect therapeutic caffeine levels (in my bloodstream, that is), I was bent over at his bedside, both siderails up and secured. For some reason, I was having difficulty establishing his BP, and went through several retries.

On one of them, I had failed to note that he had scooted himself over to the rail, rolled onto his right side, and introduced his penis through the slats of the siderail. That, of course, placed me downrange of the volley of urine he was about to produce.

It is never good to be downrange when that range is hot. I received quite the baptism, and reacted smoothly, suavely, and effectively: I cursed, and attempted to leap, from a standing start, over the bed. Didn’t work, but the other patients in the ward certainly found it amusing.

Later on, on a night shift, I was working on the orthopedic floor, and the nurse requested that I provide a suppository of one sort of medication or another, to one of our male patients. Sure, no prob. She bade me pause, before I left the nurse’s station to administer this to the patient, and asked me, “So, Mr. McFee, how are you going to do this?”

I recited, “I’ll inform the patient that this is the suppository of (whatever it was) that your doctor ordered, and the nurse handed to me, so if you would be so kind as lay on your left side, I will lubricate it, and, with my gloved finger, insert it into your rectum.”

She paused. “You missed a step.”

Huh? “Uh, what step would that be, ma’am?”

“You did not include removing the suppository from it’s foil wrapping.”

Huh? “Uh, OK, ma’am, I’ll be sure to remove the foil from the suppository, before I administer it.”