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

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!”

Fun And Games · Sometimes You Get to Think That You Have Accomplished Something!

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!

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

“Fittin To Throw Down!”

When I worked the road for Da City’s EMS, several of my colleagues were simpatico with the majority of our service population. So, the habits and mores of the folks on the street were not much of a novelty for several of my colleagues.

Indeed, one gentleman who was my partner for a schedule or two told a tale of a cousin of his who, exchanging words with another soul, found their conversation adjourned outside the bar in which they had crossed paths. Words grew more and more heated, in my partner’s telling of the tale, and the party of the second part drew, displayed, and announced his intent to employ, a handgun.

My partner described subsequent events. “Well, my cuz stood up tall, and challenged the other guy, saying, ‘Well, hell! SHOOT me!’. Which he did. My cousin did not survive the exchange.”

Tough crowd.

So, TINS©, TIWFDASL© with my regular partner, Doug, and we (of course) had our squelch open so we could hear radio chatter from other medic units. If one of them got into trouble, well, THAT might be a handy thing to know, so we could begin to sidle our happy asses over closer to their scene, to lend a hand should medical hands be required.

Over the radio came the memorable tones of Abbie Smith. He was able to recreate the richly evocative tones, rhythm, and nuance of the patois of the street. Partly this was due to the fact that he was of the street, and partly because he was an old hand on the job, and therefore wise in the mannerisms of the citizenry from that perspective as well.

So, anyhow, he drawled out his greeting: “Dispatch, this is Medic Nine!”

The dispatcher on duty that night was another old hand, who had been dispatching since Marconi had first dispatched “S” from Cornwall, England. He, in contrast to Abbie, was an old white boy, who was renowned for knowing off the top of his head where every ambulance was, and what they were doing, at any given time. When you are in a tense, hostile scene, is is reassuring to have a sort of radio bodyguard looking over you!

So, he acknowledged Medic Nine’s call: “Medic Nine, go!”

Dispatch, could we get the po-leece out here?”

Very good, Medic Nine. Why do you need them?”

Dispatch, these folks are all hot and bothered, and they fittin to throw down!”

Remember, our dispatcher was a white boy. He had not immersed himself in the vibrant, and ebonics speaking, culture of the street. In contrast, our friend Abbie, had. Dispatch sought some clarification.

Medic Nine, what are they going to throw down? And, from where?”

We could hear the sigh from Abbie, before he even keyed up the microphone. “Dispatch, this is Medic Nine! They fittin to throw down! You know, get it on! Fight!”

That cleared things up for our friend the dispatcher. “Are you involved in this fight, Medic Nine?”

Naw, we down the street. But, they gonna get to fighting pretty soon!”

Dispatch got it. “Medic Nine, clear that scene! Clear that scene! Police are on the way, repeat, police are on the way!”

Dispatch, this is Medic Nine! We clearin the scene!”

Again proving the importance of speaking, so that they can understand you!

Fun And Games · Pre Planning Your Scene

Blizzard in Da South.

I did not always work for Da City. Nay, I eventually moved Up North, married, and found myself living in Cincinnati. To my disappointment, once our little family was settled in Cincinnati, I learned that they had, somehow, resolved the Nursing Shortage, raging everywhere else in our fair land.

Shit.

I contacted a travel nursing agency, and sought employment. They accommodated me, finding a placement in another, Southern city. Something like 120 miles distant from our home.

Realizing that “beggars cannot be choosers”, I gave thanks for this job, and settled in for some commuting. Conveniently, the hospital needed a unit nurse, and I had, indeed, worked as a unit nurse. In addition, adding to the convenience, TDW-Mark I worked Monday to Friday 0900 to 1700, and the hospital needed somebody to work weekends. Score!

Therefore, I motored my way to work, and worked my 12 hour night shift. They had a need on 3-11 (or, more precisely, 1500 to 0300) the following day, and I volunteered to work it, if I could avoid working until 0700.

They were agreeable, and, indeed, I could work 1100 to 2300, and go home Sunday night, around 8 hours early. Worked for me!

One weekend, I headed for home immediately ahead of a storm that swept in from the west, chasing me back to Cincinnati. I got home as the flurries materialized. I am from Northern Un-Named Midwestern State, so snow, meh? Nothing I haven’t seen before.

We awakened the following morning, and found ourselves in a low budget winter wonderland. Maybe an inch of accumulation, dusting in the trees. This being not-the-snowy-north, well, let’s just say that the snow management infrastructure was, well, lacking. They closed everything, and the evening news talking heads breathlessly filled us all in on the Horrible! Disaster! That the snow had occasioned. (yawn!)

Being an Amateur Radio Operator (“a HAM”), I listened in to the wide area repeater, taking note of the communications supporting shelters for those who could not stay home (for reasons that I did not understand), as well as other disaster relief communications.

The week passed, and my next fun filled weekend fighting disease and saving lives (betcha were wondering if I was gonna work that one in there, weren’t you?) arrived. I loaded up the truck, packed my meals, kissed the wife and kiddies goodbye, and set off into the wintry wastes.

I took just a little longer than I was accustomed to, since there were stranded tractor trailers scattered here and there on the interstate. Evidently, the snow to my west, and therefore closer to my workplace, had been more serious and more serious than atmy home. Things were not particularly better as I approached Southern City. Monitoring the local repeaters, I heard, four full days later, communications supporting shelters, (still!), as well as other, related, communications.

That malign prognostic indicator was only supported as I exited the expressway, and bunny hopped my full sized truck across nearly frame deep ruts in the frozen snow layered over the roadway.

I had lived in Da City for years on end, and had been impressed with the inattention paid to snow removal. Gotta tell you, Southern City passed them on the fly! On the other hand, the little “no snow removal infrastructure” thing might have played a role.

Fun And Games · Fun With Suits!

The Boiling City Ballet, and Gaps In My Classical Arts Education.

This one time, I was nursing on nights in a Rural ED. TDW-Mark I and our little family were living “Up North” in a small town, outside of a little town outside of a middling sized town that served as the commercial center for that corner of the state. Our small town, let’s call it “Boiling City”, had a bar, a short distance from our no-stop-light town center, and their claim to fame was serving as the region’s titty bar. We locals called it “The Boiling City Ballet”, as a snide reference to the exotic dancers that were it’s main draw.

At this point, I had something like a 15 years of nursing experience, as an ED nurse, ICU nurse, nursing supervisor, all on top of my years on EMS in Da City. I was kind of proud of my “been there- done that” self image.

Remember that thought. As well as the ancient aphorism that “pride goeth before a fall”.

So, TINS©, TIWFDASL©, and registration let me know that there was a patient with a knee injury. I meandered up front, collected the chart, summoned the patient, and invited her to join me in the back. I asked her what had prompted her visit to ER.

“Well, I was doing a pole trick, and landed wrong, and fucked up my knee.”

I goggled at her. “Uh, what?”

She giggled. “I was dancing, I did a pole trick, I landed wrong, and my knee gave out on me!”

BTDT fail on my part. “Uh, what is a ‘pole trick’?”

She filled that gap in my life experience. “I dance at the Roadhouse, out side of Boiling City.”

Ahhh! The formal name for the “Boiling City Ballet”!

“And?” I prompted.

“So, a pole trick is where I do something on the pole, like spin around, and this time I just landed with my foot placed wrong, and my knee started to hurt!”

“Uh, OK. Here, here’s a gown, and I’d get the doc so we can get you examined and x-rayed and everything.”

She was having fun with my norminess. “So, you **DO** know what I do for a living, right?”

“Uh, kind of…”

“So, why do I need a gown? I’ll just whip my pants off, right here and now, just like this…”

I backed out of the room, and shut the door. “No, that’s alright! Just put on the gown, and I’ll get the doc…”

Fun And Games Off Duty

Things You See on Road Trips!

In late 1989, I had applied for a job as a nursing supervisor in a little hospital Up North. As is customary in such conversations, they wanted me to meet for an in person interview. The drive from Da City, to the new place was on the order of three hours, and I did not see how arising at around oh-dark-thirty, bathing etcetera, dressing in my interview clothes, and then driving for three hours, all so I could be on time for an 0900 interview, was calculated for success.

So, I drove up the preceding evening, and secured a motel room for the night. On my happy way there, I drove, fat, dumb, and happy, casually listening to my CB radio. (for, these were the fabled Eighties, when CB radio was A Thing!)

As I motored along the interstate, somewhere kinda north of Bay City, I heard, briefly, the declamation invoking The Patron Saint of Regularity: “Holy Shit!”

That successfully snapped me out of my reverie. I slowed, moved into the right lane, and picked up the microphone and invited my corespondent to elaborate. “Station calling, what is happening?”

Several similar entreaties elicited no more information, I resolved to Pay More Attention.

Doing so, paid off shortly, as I beheld headlights of southbound traffic. This was unsurprising, as that interstate is kind of a major north-south artery.

What became surprising, was the insight that this particular southbound car, WAS IN THE FREAKING NORTHBOUND LANE!

That was startling, right there! Fortunately, after a manner of speaking, this vehicle was staying to his right, traveling southbound in the high speed lane of the northbound highway. He flashed past me, and I continued my deliberate, frazzled, way north.

Fun And Games Off Duty · Fun With Suits! · School Fun And Games

Hazards of Immobility







So, TINS©, TIWFDASL©, working full time and going to Nursing school full time when not in the firehouse. Oh, and sleeping. When I could.

As you may have surmised from the foregoing, I was acutely-on-chronically sleep deprived pretty much entirely through school. I have previously revealed what the director of the program thought of my first pass resolution of that problem, wherein I skipped lectures and slept in, however briefly. (Review: NOT MUCH!)

Therefore, I showed my happy academic ass up for every lecture, and attempted to take notes and generally avid snoring and/or drooling. In order to assist with my camouflage, I typically sat around 2/3 of the way back in the lecture hall, and about 40 degrees off axis from the lecturer’s line of sight. One particular failure of my strategy still stands out in my mind.

The subject was “Hazards of Immobility”. Unfortunately, one of the hazards of immobility, that the instructor did not enumerate and then explain in PAINFULLY elaborate detail, is somnolence. For those sleep deprived, as I was very much so in those days, sitting still was nearly a death sentence. I was wedged into my seat, and getting more comfortable, and more comfortable, and finally felt my pen slip from my fingers. I woke up at that, and retrieved my pen, again settling myself into my wedged-upright position.

I shook myself kinda sorta more awake, and resumed taking notes. Sleep crept up on me, again, until I heard our instructor asking, “Perhaps Mr. McFee can tell us about calcium and immobility. Mr. McFee? Won’t you join us?”

Without opening my eyes, without moving, I responded, “Well, patients who are immobile long enough, began to mobilize calcium from their bones, and excrete it via their kidneys. This places them at risk of both renal lithiasis, as well as pathological fractures.”

I heard the pause. She sounded surprised. “Mr. McFee, I was convinced that you were completely asleep!”

Still eyes closed, still unmoving, I cleared things up for her. “Ma’am, I understand how you might think so. In contrast, I find myself in an advanced state of relaxed alertness. Ma’am.”

I managed to stay awake enough to take notes for the balance of that hour.


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!”

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 · 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!