Friday, January 22, 2016

PTSD is a Sneaky Bitch

I regularly assessed myself for signs of PTSD from calls at work, and although I have had some traumatic, disturbing calls, I have so far remained unscathed. What I was not expecting was to develop it from the birth of my beautiful little girl.

It was a long labour, 48 hours of contractions that, at their strongest, lasted for hours at 6-7 minutes long with 45 second breaks. Then came 8 hours of epidural labour, which was horrible as I had no control over my body and my blood pressure plummeted, causing me to vomit repeatedly while paralyzed and stuck on my back. I would go through a week of natural labour before I ever consented to another epidural.

After 56 hours with dilation now reversing, the decision was made to have a c-section. It was a very difficult decision as I am a strong proponent of natural labour and fully believe my body has the innate ability to birth a child. Feeling like a complete and utter failure, I signed the paperwork and was wheeled away. The surgery progressed normally at first, my little girl was born screaming her head off and after a brief introduction, was taken out of the room with her Daddy while I was repaired.

It started as a twinge in my side just before my husband left, "Ow!" I said as the pain hit, then was distracted by my adorable, albeit red and puffy, daughter, Shortly afterwards, the most intense, searing pain I have ever felt burned through my abdomen. I felt as though I had been stabbed through by a red hot sword, and screamed in pure reflexive agony. The surgical team stopped as a local anesthetic was administered and my epidural was topped up, neither of which had any impact. As I was still bleeding heavily, they continued with the surgery while I lay there; paralyzed, yet feeling every stitch and movement inside my abdomen. Tears streamed down my face as I sobbed and pleaded with them to give me pain meds, to make it stop. I accused them of torture and of being completely unethical as the anesthetist jammed a nitrous oxide over my face and ignored my pleas. He started casually discussing his X-country ski hobby with the nurses as my world broke into smaller and smaller pieces. The pain was unbearable, and no matter how I cried, nobody did anything. At one point he looked at me, obviously frustrated, and told me I needed to control my breathing, that I needed to control myself before he left the room to tell my husband that all was well and it wouldn't be much longer.

It was an eternity of pain; searing, burning pain that ripped in waves across my body as I stared up at the lights and begged God for relief. The surgery finally came to a close as they wiped surgical glue across the incision, causing a fresh spike in the pain that overwhelmed me enough to pass out. I awoke as I was being lifted off the table and taken to recovery. I whispered to my husband, "I felt EVERYTHING." and the look of horror on his face continues to haunt my nightmares. Finally a nurse realized how much pain I was in, I clearly remember her voice as she raised all kinds of hell in the hallway to get me significant medication. By then I was just as relieved that somebody was finally giving a shit as I was to get relief.

The nightmares and flashbacks have been terrible. I wake up crying and can't stop, I have moments of paralyzing fear where all I wish to do is curl up in a little ball so the world can't get me. I am incredibly, intensely angry at the anesthetist who ignored my cries and who - he admitted it himself to the hospital review board - screwed up, as apparently he was having "a bad day." I struggle with feeling like I failed at birth, what should be a natural human occurrence, and wonder, completely irrationally, if the botched surgery was punishment for not trying harder. I avoid anything medical or remotely violent in the news or on TV as those scenarios will inevitably turn up in my nightmares, usually with me desperately trying to get help and being ignored until I wake in a cold sweat.  The thought of going back to work leaves me terrified, I cannot face going back to that hospital or potentially running into that doctor. I will overcome this, but it has not been easy. I have a whole new perspective on how much of an effect PTSD can have on a person, and I applaud those who are able to work through it, as I have not yet managed that feat.

Thursday, January 14, 2016

Thinking of Summer

It had been a sweltering hot day that turned into an equally hot and sticky night, with not even a breeze to provide relief. One of those days where the uniform seems to made out of merino wool and undershirts get soaked through before you leave the base.

"Code 4, difficulty breathing to Local Cheap-Ass Trailer Park" comes in the middle of our coffee run, my partner is one of those crazy people who would still be drinking coffee if the entire city was on fire. The trailer park is full of helpful people who wave us in opposite direction at every intersection, it's not hard to figure out the the general layout is circular, but thanks guys! We pull off the main road into a rutted laneway, followed close behind by the fire department.

A robust woman stands in front of a tiny trailer, waving her arms and pointing frantically inside. I wonder where our patient is? I climb the tiny metal stairs into the trailer, my eyes adjusting to the darkness inside despite the late summer sun shining in the windows. I can hear a terrible sounding wheeze/rattle combo from my right, and I turn to see an equally robust man half-reclining on a tiny bed - on an elevated platform. How on earth did he even get up there? This is going to be a tough extrication, the man is large enough that he would have to turn sideways to get through the doorways, there is no chance any sort of stair chair would fit, and he can't lay even remotely flat for the tarp.

As I assess him, as my partner is too large to fit into the space, it is quickly clear that he needs oxygen, medication and the hospital before his asthmatic/COPD lungs give out completely. The problem is, there is absolutely no space to work and it is so hot and humid you can practically see the moisture in the air. Being in this tiny trailer is not helping his lungs any, we gotta get him out. That, however, is the real problem here.

With the smallest firefighter (who still dwarfs me) pressed in far too close for the temperatures, we get his legs swung around and help him slide off the platform onto the stool he uses to climb out of the weird tiny loft. As soon as his feet hit the floor, his legs buckle and we take all of his weight as we side-step our way to the little hanging ladder and fresh air. There is no way he can climb down himself, and no room to get any equipment or any help in, so fire dude and I exchange glances. "You good?" "Yup, you?" "Let's do this." Together we lift him into a fore and aft position and carry him down the ladder, my hamstrings and quads burning with every step and reminding me how much more I need to appreciate my giant leg muscles. Thankfully at the bottom there is plenty of help, and we are happy to pass off the weight while we stand in the shade and drip half our body weight in sweat.

The air conditioning in the truck has worked wonders on the way to the hospital, and we arrive with nary a wheeze in sight. As we help him into his hospital bed, he muses, "Next time it's this hot, maybe I'll stay home in the air conditioning." We agree that may be a good plan, and clear the hospital with visions of ice cream dancing in our heads. 'Tis not to be though, as hot summer nights are not the quietest of shifts and we get nailed for another SOB call halfway to DQ.

Monday, November 30, 2015

Jungle Cat

It has been a ridiculously busy evening, and we're already stacked 2-deep in the hallway of the hospital, waiting interminably for a bed, any bed. A crew has patched that they are coming in with a violent patient and is requesting the security meet them in the garage with restraints, they are accompanied by PD. As with any call that sounds interesting, bored medics start emerging from the woodwork to "help" the incoming crew. My patient is right near the door so as my partner joins the crowd in the garage, I have a great view to watch.

They arrive lights and sirens, and uniforms pour out of the back like a clown car, each one more sweaty and disheveled than the last. They've all definitely been in a fight, and we crane our necks to see what big, burly dude they're bringing in. When they pull out the stretcher we look at them in disbelief. A 19 year old, maybe 90-lb little blond girl lies sleeping on the bed, handcuffed, rip-hobbled and seatbelted in tight. Really? This seems like a bit of overkill. "Just wait" the one medic says wearily as he pulls the stretcher into the hallway. 

As if on cue, she starts to writhe and the medics, their student, several fire fighters and police officers assume their positions, it's obvious they've done this before and have a routine down. Security steps forward with restraints as the charge nurse comes around the corner to investigate the commotion. 

The tiny body on the bed starts to thrash, and each of her limbs, her head and her torso are held a little more firmly. Despite the manpower, I swear she begins to LEVITATE off the bed, her torso bending at an unnatural angle as she opens her eyes and begins to growl. She has become a wild animal, there is nothing human about her actions or the sound she is producing. An unearthly, wild snarl comes from her lips as she writhes and thrashes, nearly escaping the desperate clutches that hold her down. The hairs on the back of my neck stand up as the sound intensifies, everybody within earshot gets the urge to start throwing holy water or grab a wooden stake. And then just as suddenly, she relaxes. The rabid jungle cat is gone, and the sweet teenager has returned. As quickly as possible, the restraints are secured and she is moved into one a room, the door closing as the sound begins again.  We never found out what drugs she had taken, just as we all never forgot that bone chilling sound. 

Friday, November 20, 2015

True Save

Our 6 am shift is off to a good start, it's a beautiful, clear summer morning and we successfully managed to get coffee before heading to our downtown base. I have not worked with my partner before, but he seems like a pleasant enough older guy, obviously counting down the days until retirement. Dispatch calls our truck number; "Code 4 at the gym, unconscious male." The address is right around the block from us, so we swing around and arrive within seconds. "Update: CPR in progress." We see a lone police cruiser parked haphazardly on the sidewalk and load up the stretcher with all of our bags before heading in. An idiot of a security guard leads us straight to the escalator, and I look at him, then at our fully loaded stretcher, "Do you have an elevator?" "Oh, yah, I guess we do. But he's right up there, can't you just balance it on the steps?" Fire arrives to hear this and we collectively shake our heads. My partner and I grab our bags and head up the escalator while a couple  of fire fighters volunteer to bring the stretcher up the elusive elevator.

We are ushered into a small workout room where a spin class was taking place, and see a relatively fit-looking man in his 60s lying on the floor with a police officer doing impeccable CPR, an untouched AED is sitting at his feet. "Keep going, officer, you're doing a great job!" I set down the equipment I'm carrying, avoiding the pool of blood under his head, and we get to work - although it is quickly obvious that my partner should be thinking about retiring sooner rather than later, he is incredibly slow and flustered with everything he is doing - and he's an Advanced Care Paramedic. I cut his shirt off, slap the pads on, set up the ventilation gear and take over CPR while my partner fumbles with the monitor, finally succeeding. The man is in textbook v-fib, a rhythm where the heart muscle quivers like a handful of worms, a lot of action but not coordinated enough to pump any blood. The first shock is delivered and a firefighter continues compressions while I gather patient information.

The spin class instructor tells me that he is in class 3-4 times a week and has never shown any difficulty, that he has always seemed quite fit for his age. Today, he simply stopped peddling and fell sideways off the bike, striking his head hard on the one next to him. That explains the blood, at least. I turn back to the patient just in time to see his hands come up, "Stop CPR!". As I reach for his pulse, I glance at the monitor and see that he is now in a relatively normal looking rhythm. Awesome! Now our priority changes, we no longer want to stay on scene and work him, we want to get him to the hospital quickly, and hopefully still alive. I ask dispatch to give the nearest hospital, which luckily happens to be the cardiac hospital, a heads up, since we are only 3-4 minutes down the road and they tend to want a bit of notice when getting critical patients.

We get him packaged quickly, needing to restrain his arms as he starts to flail around widely. He is still alive and fighting a few minutes later when we unload him at the hospital, his vital signs amazing for somebody who was just dead. We find out later that he walked out of the hospital, neurologically intact, several weeks later. The spin instructor who began CPR started the Chain of Survival, the police officer who took over continued it, although using, not just grabbing, the AED would have been a great idea. He was extremely lucky that we were pretty much driving by the gym when he collapsed, and that the cardiac hospital was super close. All in all, a true save.

Saturday, September 19, 2015

False Hope

It was 5 am, still dark but with the sky just the beginning to lighten in the east. We're headed to a base for the first time all night, exhausted and spent after call after call, hoping to get a half hour to nap before we head home. Those weak hopes are dashed just before the base comes into view, "Code 4 to a VSA". I'm not sure if my groan is audible or not, but I swing the truck around and hit the lights. Somebody has woken up to find a family member dead, and it's our job to see if they are really dead or just nearly dead.

Fire is already on scene when we arrive, I have a good friend who works out of that station but its not his rotation. I like seeing him on calls because I know him, I trust him and he knows his stuff. We walk into the stereotypical Grandma and Grandpa's apartment, wall-to-wall thick beige carpet, pastel walls, ceramic plates and shiny silver spoons in a display cabinet. It could be my Grandparent's.

She is sitting in a well-used recliner, reading glasses on, paperback novel splayed out on the carpet beside her feet. She would look like she was napping if she was any colour other than bluish-gray. The Captain is with her husband and son in the kitchen, already explaining that she has passed away and there is nothing left to do. We approach her with our bags and my heart sinks as I begin my assessment. There is no question that the woman is dead, but she has not been dead long enough to allow for a field pronouncement. No rigor mortis, no mottling from where the blood has collected due to gravity. She is in fact, still warm. My partner and I exchange glances, we know she is dead and is most likely not coming back, but there is no other option, our protocol dictates that we must work her, we must attempt resuscitation simply because she is not quite dead enough. Damn. The family is already grieving.

We slide her out of her recliner and I begin CPR as my partner starts to assemble airway equipment and dictate tasks to the surprised fire department. I hear the captain in the kitchen rapidly change his tune as he hears what we are doing. He tries to explain the sudden flurry of movement without giving them false hope, but it is next to impossible.  We run through the steps of our resuscitation smoothly and quickly. There is no adrenaline rush, no sense of urgency, and it feels almost like a practice code from school. Check off the steps, but the outcome is already known, confirmed once we reach the point where we can call the physician and finally let the poor woman rest.

My partner goes to talk to the family as I clean up the living room. She is exposed from the waist up, so I tidy up her torn pajamas, smooth down her rumpled hair and cover her up with an afghan from the couch. She still looks like she is sleeping, lying on the carpet with a blanket she probably made herself, just now with a tube sticking out of her mouth and an IV in her arm. In my exhaustion, I am struck by the emotion of the situation. The family's despair, the hopeful 911 call, the firefighters storming in to save the day only to let them down, then our arrival and a burst of false hope, followed by the realization that she was indeed gone. As I hear the heartbroken sobs of her devoted husband of decades, I busy myself with gathering the assorted pieces of equipment scattered around, not trusting myself to make eye contact with anybody until I have composed myself.

Sunday, November 16, 2014

Dragon Medic

When I get ready for work, I am precise and methodical about my uniform, my route and my general routine. I find that this helps me put on my 'armour'. My armour is a psychological layer of protection that is tough and leathery, I envision it as a cross between dragon scales and medieval chain mail. It gives me the ability to remain polite and professional when a drunk, drugged out guy is screaming curses and insults, it allows me to remain expressionless when he then begins to detail exactly what he'd do to me if he caught me on the street. It enables me to put aside emotion when I work on a sick little child whose parents don't care enough about them to call for help before they stop breathing even while my whole being cries out to take that precious baby home. My armour is my way of remaining sane and compassionate amidst the sea of agony, abuse and apathy that I deal with every day.

When I am tired, sick or stressed, however, my armour weakens. This is when I am most bothered by calls, when I have to be very careful about my mental health. This weekend has been one such time. I am sick, functioning only on high doses of cold medications, exhausted and have had some extremely busy shifts. I had 2 patients crash hard and fast on me, including an adorable little kid, and pronounced another. Add in the needy flu patients, the stressed out nurses and the fact that my sinuses are ready to burst and you get one exhausted medic. Time to take a few days to myself and recharge!

Monday, August 4, 2014

Dumpster Diving

She has one more task left before she leaves work for a long weekend, and heads out to the dumpster to drop off a load of cardboard. As she tosses it in, she happens to glance down and sees a body half-buried in the cardboard at the bottom. Justifiably, she panics and runs back inside to call 911.

We arrive just behind the fire department and see several police officers leaning over the edge of the dumpster, laughing as they talk to somebody at the bottom. Pretty good clue that the guy's alive, most likely very drunk. When I peer over, that is exactly what I find. The round dumpster sticks out of the ground about 3 feet, but extends about 15 feet straight down. There is a half-naked (always the bottom half for some reason) man lying in the bottom on about 5 feet of cardboard and he slurs his name in response to my first question. Too drunk to stand and trapped by the perfectly vertical dumpster walls, he is relying on us to get him out. I just hope he's not injured so we can just help him up a ladder.

The FD lowers a ladder and a firefighter climbs down, asking him the questions I yell down. "Do you have any pain anywhere?", "All over.", "Any pain in your head, neck or back?", he winces and screams in pain as the firefighter palpates his neck and down his back. "Ow! That hurts!". Wonderful. Now I know I'm going down there, as this half-naked, drunk, incontinent man has to be immobilized, then lifted 10+ feet out of his cardboard prison.

Fortunately I rock-climb and have no issues with stuff like that, so after requesting a boost from the nearest firefighter (I think he was the Captain - oops), I swing onto the ladder and climb down carefully, as the base shifts on the mound of boxes beneath me. Once I land, my first priority is to clear out enough of the cardboard so we can work, and we begin to pass it up the the guys above us. Once I can actually see my patient, I begin a preliminary assessment of his vital signs as the fireman valiantly puts on his urine-soaked shorts. I establish that he has no life-threatening injuries, and we begin discussing how we're going to manage this extrication.

We decide (OK, I decide) that we will first strap him into the KED, a short spine board type immobilization device, then lower down the Stokes basket to get him out of the hole. Easier said than done, as the cardboard beneath him keeps shifting, the KED gets caught as we try to slip it underneath him, and there is barely enough room to work with the 3 of us down there. Let's just say we all got very cosy with one another. At least only one of us smelled!

Now that the KED is on, it becomes clear that it was actually the easy part of the extrication. We move him enough to allow the basket to be lowered down behind him, and it rests on a 45-degree angle. The next step is for the two of us - with barely enough room to stand shoulder to shoulder and an unstable base - is to lift 200 lbs of dead weight to shoulder height, hold him there with one arm, and strap him in with the other. Oh, all while maintaining c-spine immobilization. The firefighters from above lower down a strap that we slip under his arms and around his back in order for them to take some of his weight off us, and we manage to get him strapped into the basket. This is the reason I work out - and even being as strong as I am, it is the hardest I have ever worked on the job.

They pull up the basket and we give each other a sweaty high-five, ecstatic that we actually did it. Both of us are hot, filthy and soaked to the skin, but it feels great to have worked that hard and to have succeeded. The ladder gets lowered back down and I climb up to the top, getting off the dumpster by climbing down the nearest firefighter, and take back over patient care.