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!

Life in Da City!

Doberman Overdose

 

So, I was working Medic Seven with Doug. We caught a run for an overdose, and proceeded to the call. Calling dispatch to announce our arrival on the scene, we stepped into the autumn evening.

So, there was (and, likely, still is) a considerable, amorphous, body of knowledge, that might be termed “street smarts”. For example, there is what we called “Decker’s Law”, which opined that, should you be on a block, and you were sure your call was at one house on that block, but, of course, there were no house numbers, you should knock upon the door of the house that appeared most likely to be a heap of rubble by the time you went back in service. Your patient awaited therein. Or, Ciaramataro’s corrolary: the house with the steel window and door bars was your scene. Or Ivan’s Axiom: the house with the “ghetto gates” had nothing within it worth stealing. And, those folks likely knew who was doing all the B & E’s in the neighborhood, because they were likely the ones performing them.

Other insights were more what might be called stagecraft. As in, do not have your back to residents of the scene. Or, know two (or more) exits from every scene. Or, do not stand directly in front of the door. Or, and relevant to this tale, plant your boot in front of an outward opening door, because you just might not really want whatever is inside, to abruptly come outside to play. With you. Or your partner.

So, TINS©, TIWFDASL©, with Doug on one side of the door, and myself on the other. Doug was on the handle side of the screen door, and I was on the hinge side. I knocked, and announced our presence in the immortal words of yore: “Fire Department!”

The occupant came to the door, and we heard his dogs enthusiastically greeting us before the door opened. Doug, thoughtfully placing his boot before the door, allowed said occupant to uselessly push against the door as the dogs leapt, barked, and slathered their greetings. This gentleman was exhorting us, “C’mon, c’mon, c’mon! He could be dying in here!”

We suggested, “Sir, if you will secure your dogs, we will be right in!”

He responded, “C’mon, c’mon, c’mon! Dude’s dying in here, and you all be fucking around!”

Again, Doug suggested, “Sir, you have to put your dogs up, or we aren’t coming inside! We aren’t going to get bitten by your dogs!”

Our Host again responded, “I ain’t putting my dogs up! Y’all get in here! He could be dying!”

I looked at Doug, and he looked at me. “You need to hear anything more?” Doug asked me.

“Nope, heard everything I need to hear.” Doug nodded, and said, “Let’s go!”

We got. Once in the truck, and around the corner, we went a couple of additional blocks, and called dispatch. “When you get another call to this location, send police. The resident has a couple of big dobermans, they are aggressive, and he refuses to secure them.”

I finished the run sheet, and prepped the next one. Dispatch did not disappoint.

“Medic Seven, you still near you last run?”

“Affirmative.”

“Respond to that scene, run number (number), address (address). Scout car has been dispatched. “

“Medic Seven on scene, around the corner, waiting for scout.”

The police car soon pulled up, we regaled them with the above story, and off we went. This time, the offices stood at the door, their boots were on the door, and we stood back to admire things.

The same gentleman opened the door, the same dogs danced and growled, and the same dialog. “C’mon, c’mon, c’mon! He could be dying!”

One officer said, “Sir, secure your dogs.”

Our Host had considered his response. “I ain’t locking up my dogs!”

The officer asked him, “Did you just tell me somebody inside there is dying?”

“Yep, and you all are fucking around on this porch!”

The holster snaps were released. “Sir, we’re coming inside in 3 seconds. Those dogs will be secured, one way or the other. You need to lock them up, right now!”

Our Host began to protest, as the other officer placed his hand on the grip of his sidearm, and began to count. “Three! Two! ….”

Somehow, it appeared, the dogs levitated, and disappeared with a “whoosh!”. Seconds later the gentleman announced, “They’re locked up, in the bathroom!”

The officers unholstered their pistols, and led us into the house. One officer, locating the closed door, presumably the bathroom, behind which the barking continued, ensured that it was latched, and waved us past. We moved on, and found an inert soul, unbreathing and pulseless. We started CPR, transported him to TSBTCIDC, and they pronounced him.

Yeah, some runs you remember, even after the better part of forty years.

Life in Da City!

Moving Targets

So, some background. I have spent some time in urban EMS, as perhaps you had determined from both the title of the blog, as well as my tales of rollicking good times. I have noticed a few things.

Thing The First: Typically, EMS service populations are not drawn preferentially from what might be termed “life’s winners”. Indeed, for some reason, the log books skew towards the underachievers, the disenfranchised, the unsuccessful, and those who, generally, actively choose the stonier path upon which to direct their lives. Thus, the Donna Reed Quotient is kinda low. Clean cut? Not so common. Well spoken? Again, um, no. Conversations revealing polish, education, and familiarity with The Classic Works of English Literature? Nope. Preventive, or any other sort of, maintenance in evidence? Uncommonly. Not of the dwelling, not of the vehicles in the yard on blocks, not of the furniture, not of the persons of the folks you meet.

There are, of course, exceptions to this observation. Among the impoverished portion of the community, there are folks who are clean, polite, energetic, hardworking, and who try to make that which they do have, last, and their households and persons reflect this effort. Their children can be seen, when you are on the scene, quietly, out of the way, watching you perform your EMS magic, when they are not completing their homework, or accomplishing chores about the home. But, these folks are outliers.

Thing The Second: There is a well nigh unitary correlation between what might be considered Dumb Life Choices (drug use, intoxication on a regular basis, failing to pursue an education, to name a few high profile such choices), and poor hygiene and poor housekeeping. Again, there are contrary examples, and I see within them a spark of potential for redirection of self into paths perhaps more life enhancing, but (1) they are exceptions, and (2) folks have to make these transitions themselves, because they value these changes, and will not do so because I am so freaking perfect, and think that they should. Because, for one, I’m not.

Thing The Third: There is a similarly high correlation between squalid domestic settings, and infestation with vermin. Deer hunters know (And, after all, I live in rural Michigan, and deer hunting is One Of The Eight Sacraments) that, if you want to attract deer (or any other game species), you provide those things that they seek, and they will come. Food source, shelter from wind, water, protected lanes of travel between these things? Set up your blind, the deer will come a’calling.

Similarly, if you want roaches, provide them with water (check your pipes), food (which we spell g-a-r-b-a-g-e), shelter (cracks in your cabinets, walls, or the openings for electric outlets).

As you can infer from the foregoing, dilapidated housing, with inattentive folks (because stoned/drunk/other), and a failure of the concept “take out the trash! Wash your dishes every several days! Remove/reduce the clutter everywhere that provides shelter for vermin!”, well, you get, at the least, bugs.

As attractive as that sounded to me, and as fun as it looked as well when in these houses, well, I was reluctant to form my own “Wild Kingdom” to enjoy in my very own home. I developed the habit of shifting my weight from one foot to the other, regularly, in hopes of at least providing a moving target for the insect life present in the biome. Kind of a common tic among my colleagues, at that time.

So, TINS ©, TIWFDASLIDC ©, and in the course of doing so, my partner, Doug, and I transported a soul to TSBTCIDC. Of course, this soul originated from, let us say, a domicile that would NOT win a Good Housekeeping Award, although Merck might be interested in seeking new antibiotics there. We arrived at TSBTCIDC, and I was giving report to Mallory. I was winding my tale up, about to deliver the epilogue, when she interrupted me.

Do you have to go to the bathroom?”

(Me, shifting weight from left foot to right foot, rhythmically and repetitively) “uh, no. Why?”

(Her, looking skeptical) “Because you’re doing the potty dance.”

I looked at my feet. Looked at her. Looked at my feet. Looked at her. “Nope, I just got into the habit of doing this, so as to make it harder for the roaches to hitch a ride home.”

Just so you know, that is not a particularly successful pick up line. For some reason, the women do NOT find that insight alluring.

Who knew?

Life in Da City! · Overdoses

War Story The First

27 July 2017.

Taking an Overdose to The Second Best Trauma Hospital in Da City (SBTHIDC): “Breathe!”

Let’s see if I understand this “blog” thing. In addition, I suppose we’ll see if I can translate my Tales Of The Dark Side narrative style to a screen. Let me know, OK?

So, this is No Shit ©, There I was, Fighting Disease and Saving Lives In Da Big City ©. As was not uncommon at that point in Da City’s history, EMS received a call for an overdose. Shocker, right? Further compounding the shock, my partner, Doug (Not His Real Name), and I caught that run. So, fleet of accelerator and steely eyed for Clovers in their natural habitat {(a) on the road, and (b) in front, or on a collision course with the Battlestar Galactica that was a Big City Ambulance}, we arrived on the scene.

In some regards, heroin overdoses were rather adult-adult transactions, with a minimum (generally) of drama and hidden agendas. It typically ran along the lines of “He’s too high, he’s fucking up our party, y’all snatch him on up, and carry him on down to the hospital!” (translated from Street into more easily transcribed neo-English). Conveniently enough, said action plan would minimize our time on scene, with a couple of beneficial effects. First, (OF COURSE!) was expeditious transport of this ill soul to higher medical care, and a life changing resuscitation courtesy of The Ghawd Narcan, and, secondly, enabling my partner and I to elope from the free fire zone that such a scene had potential to develop into, and do so in a time frame calculated to have us safely away before said fireworks unfolded.

Well, on this particular day, Doug was driving and I was medic-ing. We announced ourselves (“Fire Department!”), were admitted, and found Mr. Hypoxic inert, supine, but, par miracle’!, breathing. Well, sorta. He was breathing every 15 seconds or so. Doug handed me the BVM*, and skedaddled to the truck to retrieve the cot.

While I waited, I noted that Mr. Hypoxic seemed to move air OK, when he remembered that this was sorta important. I wondered if reminding him of this little chore would be productive, and so bellowed “BREATHE!” into his ear.

He breathed.

I wondered if this was a “one of”, or a replicable experiment in assisted respirations, and so, again, bellowed “BREATHE!” into his ear.

Again, he breathed.

I love it when a random thought produces an actionable plan.

When Doug returned with the pole stretcher, we rolled Mr. Hypoxic onto it and trundled out into the street, onto the cot, and into the ambulance, me hollering, “Breathe!” every 5-10 seconds or so. He continued to breathe.

Doug radioed dispatch, advising them of our priority two transport to The Second Best Trauma Hospital in Da City (SBTHIDC), and then dialed up said SBTHIDBC on the hospital alert radio (in those days called “the HEARN”, for Hospital Emergency Alert Radio Network, and on VHF. Ah, yes! The days before 800 mhz!). He supplied the abbreviated version of Mr. Hypoxic’s story, and then focused on driving a near-code through city streets. (I did mention The Clovers, right? They’re everywhere!)

Once we arrived, Doug and I debussed Mr. Hypoxic, and we strolled into the triage area of TSBTHIDBC, where Mallory the triage nurse, and my then-current girlfriend, awaited us. She looked puzzled when I wasn’t ventilating my patient, and that puzzlement only grew when I commanded, “BREATHE!”, for, like, the 1200th time. He breathed, again, of course.

So, what happens when you don’t yell at him like that?”

Uh, he kinda doesn’t breathe……BREATHE!…..See?”

She looked unpuzzled. “Uh-huh…(pivot, poke head into resident’s room) I need a doctor in here, right stat like!” (pivot to me and Doug) “Put him in the trauma room!”

Some people don’t really seem to appreciate whimsy, very much.

*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…