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.”

Fun And Games · Life in Da City!

Another Winter Tale

One night at Medic 7, Doug and I were whiling away the hours. For this house, in this city, it was a slow night. On the other hand, it WAS winter, and it WAS snowing it’s ass off. I was finishing my Nursing school studies for the next day’s class, and Doug was reading the book he had brought along for slack times.

We caught a run, and off we went. As we headed east on Warren, we noticed a young woman walking back and forth in front of our fire house. Strikingly enough, she was not dressed for the weather. The heels alone presented a slip-and-fall hazard, and that is not mentioning the short skirt she was wearing.

When we had completed that batch of runs, we returned to quarters. The lap walking woman was still there, and had walked a clear circuit in front of the engine doors.

Hours later, another run, same woman parading in front of the house.

Returned an hour or two later, and there she was, still walking circles on the sidewalk.

She was gone when we caught our next run in the wee hours of pre-dawn. I mentioned her departure to Doug. He, being more wise in the ways of the street than I, opined, “Likely, it took her that long to make her quota, so her pimp would let her back indoors!

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!