Tuesday, April 1, 2014

Parallel Universes

I saved a life last night.

We raced across the city with sirens blaring, cars pulling over rapidly as we roared past. Arriving at a lovely suburban house, my gorgeously sculpted partner effortlessly carried our bags in as I strode ahead. Long red curls cascaded smoothly down my back as I step into a gleaming white bathroom, smelling faintly of green apple cleaners. A well dressed man lay on the fluffy white bath mat, blue from the neck up and no longer breathing. I check quickly for a pulse and finding one, start giving him breaths with the BVM. My partner is intelligent and works fast, getting everything else done well I am occupied with airway management. Less than 10 minutes after we pulled up to the door, we sweep our patient through the wide, clean hallways on the stretcher and head off to the hospital. As his oxygen levels rise en route, he begins to wake up and is able to give me a thankful smile as we transfer him over to the resuscitation room bed and gracefully bow out of the room.

............................................................................................................................................................

I saved a life last night.

We manoeuvred our way through traffic either too dumb or too preoccupied to get out of the way and finding the cop cars and tactical unit, pull up in front of the dilapidated apartment building. My sweet, slow and frustratingly unintelligent partner helps me drag our heavily loaded stretcher through the snow and mud, entering the narrow, foul smelling hallways of the notorious building. In the stinky apartment, officers question several sullen, uncooperative people on the couch and point us down the hallway. An inch of dirty water coats the filthy floor of the tiny bathroom where a scrawny man lays on his back, blue from the chest up. A tall tactical cop who is 95% muscle stands in the only available space and slowly begins to tell me what they found out. I interrupt and ask him (politely, I thought) to move, as I can tell from the door that the man is not breathing. He shoots me a dirty look as he moves out of the room, I guess he's not used to being told what to do. Ah well. I straddle the nasty-ass toilet, trying not to think about it, and begin to breathe for the patient. I direct my partner as she starts to check vitals, direct the firefighters to start packaging and ask the cops for more info. We lift him up and navigate carefully through the crowded apartment, getting a few more elbow bruises on our way out and hoping my widely frizzy hair doesn't escape from its clips and go critical. Less than 10 minutes after we pulled up to the door, we head off to the hospital. As his oxygen levels rise en route, he begins to wake up and starts to fight, thrashing and growling as we hold him down to the stretcher.  Sweaty and hot, we finally transfer him over to the resuscitation room bed and slip out to clean our trashed truck and restock our empty bags.

Wednesday, March 12, 2014

Abuse


I am tired of being verbally abused by patients. I'm not talking about the run-of-the-mill obscenities and minor threats, that happens every day, every call. In the last week though, I have had 2 patients that are so incredibly abusive and belligerent that I have feared for my safety. And there isn't much I can do, either the police are unavailable or there isn't much more than a gut feeling about the person, no documentable reason to delay care. So I put on my professional face and carry on, praying for my safety and hoping I can move faster than the psyched out, drug riddled person sitting far too close to me.

The first one asked for drugs right on his 911 call, and they sent us lights and sirens across town with no police available. He started swearing at me the second I stepped out of my truck, demanding I give him prescription medications and a free coffee. He jumped in the back of our ambulance and then we were stuck. He became more and more abusive the longer we sat in the parking lot, to the point that waiting for police to arrive became more risky than trying to make it to the hospital without them. I was on the edge of my seat, talking him down the whole time, with the student behind me. My partner and I had already decided that the second he removed his seat belt, she was pulling over and the student and I were bailing. Fortunately we made it to the hospital without violence, but that was the longest 7 minute drive of my life.

Tonight, another one. The shelter calls us because he is crawling around on the floor, moaning in pain. When I ask him what is wrong, he rolls over, looks me in the eye and says, "None of your f-ing business". It didn't improve from there. Yelling obscenities, threatening to punch my partner and myself, trying to smoke in the ambulance....not what I want to be dealing with at 4am. I wasn't as concerned for my safety with him because he wasn't a huge physical threat, I can talk him in circles to keep him calm and move a hell of a lot faster than his drug-wasted body. It is still difficult though, to be in a career where I genuinely want to help people, ease their pain and care for their injuries, and I get this in response. Ever wonder why paramedics aren't always all sunshine and rainbows? This is why. The lowest, most vulgar, despicable free-loaders of society treat us like punching bags, and there isn't a damn thing we can do about it. Just stay calm, keep them calm, and pray we go home safely.

Thursday, March 6, 2014

Croup

We can hear it from the sidewalk as soon as we step out of the ambulance. A cough as distinct as it is terrifying, the "bark, bark, bark" of a child with croup. We haul the stretcher through the ice and snow that is thickly coating the driveway, squeezing past a minivan to get to the front door.

"Bark, bark, bark". An adorable little boy, about 5 years old, is being held by his worried mother on the couch. There are many firefighters and even a police officer in the room, but I ignore them all as I focus on my little patient. He is pale, with a bluish tinge around his mouth and nose; wide terrified eyes stare up at me, but never really focus. He is fighting for breathe through his narrowed airway, all of his accessory muscles have been recruited to help him draw air in. He is the worst I've seen yet, he is rapidly reaching exhaustion and will stop breathing sooner rather than later as his airway continues to swell shut.

My partner is assessing his vital signs as I talk to the parents and get a history, all the while pulling out the medication he needs to open up his throat. Remembering my last croup call where my partner knocked over my mask with 4/5ths of the medication already drawn up, I recruit the firefighter with the steadiest hands to hold it for me. The one without kids of his own, most likely. I now must crack open 5 glass vials and using a syringe, draw out each 1mL amount of epinephrine. I must be as fast as possible, as this child is losing the battle, his eyes beginning to roll back before he fights his way back to consciousness. He's a tough little guy.

We get the mask on his face and carry him right outside. No waiting around for the meds to work, I don't want to have to ventilate this kid if and when he stops breathing. Then, about 2 minutes after the mask goes on, the magic happens. His cough lessons, his breathing eases, and he begins to cry and squirm like a scared 5 y/o should. "Mommy, I don't want to go! I'll be good, don't make me go to the hospital!". His Mom has tears of relief in her eyes as she reassures her little boy, and thanks me repeatedly. I am so happy I have the ability to treat this illness, I never get tired of seeing the rapid turn-around in these kids. He is breathing much more calmly now, and his Mom and I keep watch as he starts to fall asleep, exhausted by his previous effort to breathe, bathed in the glow of our strobe lights.

Wednesday, February 19, 2014

Strokes

One thing that never ceases to frustrate me at work is when people see a loved one with OBVIOUS symptoms of a stroke, and yet wait to call for hours or often days. A stroke can either be a clot in the brain or an aneurysm, and the former is very treatable - if treated within the first 4 -5 hours. 

Symptoms include weakness or paralysis on one side of the body, arm drift, facial droop (think Jean Chretien's droopy mouth), slurred speech and confusion, for example. How can somebody see Grandma go from coherent and mobile to drooling and paralysed and NOT see that something is wrong? I had one who was curled in bed all day, covered in urine and not making any sense, and they waited 2 days before calling for help. Something like that doesn't just 'get better', and now your sweet little Grandma will be a permanent vegetable. 

I wish taking a first aid class was mandatory for everyone, as common sense obviously isn't. Until then, I will continue to see these poor people with previously-reversible symptoms that will now be suffering the consequences of their family's incompetence for the rest of their shortened lives.

Sunday, December 15, 2013

White Cloud


I have always been a white cloud, meaning I get far fewer serious calls than average. As a student, I didn't complete my cardiac call requirements until my very last call on my last possible shift, and I didn't have my first workable VSA patient until 6 months into work. In my last 6 shifts, I've done  fewer than 10 calls. Our average is usually 6-8 calls a shift, not 1-2.

I don't wish harm on anybody by any means, but I'm getting bored!! Is it too much to ask that I merely be able to use my skills? I seriously wonder when or if I will be able to become an ACP if I can't say that I've at least used all my PCP skills. I'm sure it will come in time, I'll just have to take joy in the fact that people stay safe when I'm at work.

Friday, December 13, 2013

Grandma

Unknown medical alarms can be a wide variety of things, most are accidental activations, some are lift assists, but very few are actually seriously ill.  Tonight I'm working with my former preceptor and favourite partner, Matt. We respond to such an alarm, eventually needing to wake up the poor building superintendent at 3am. She opens the door for us in a housecoat and slippers, then disappears quickly to return to her bed.

"Hello? Paramedics!" I yell as I knock on the door. Hearing a faint noise inside, I open the door carefully and peer into the darkened apartment.  Again, "Hello? Paramedics!" This time we hear her more clearly, a terrified and weak voice comes back, "Help me, help me!" It's Matt's turn to run the call, but I find her first as we wander through her apartment.

Rounding the bedroom door and flicking on the light, I see the poor woman, clad in only a t-shirt, who has fallen out of bed into a very tight space. Her knees are bent with her feet wedged against the dresser, and in her Parkinson's-weakened struggle to free herself, she has only managed to complicate the problem, as her head is now stuck underneath the wooden slat of her bed frame. "Help me! I'm so scared!" I kneel beside her as Matt steps over us and begin to assess her. ABCs normal, no head or neck trauma. Just an unfortunate fall, made worse by her futile struggles.

She is crying now, "I'm so scared, I was all alone and nobody was coming." I see my Grandmother in her, and my heart breaks for this lonely old woman who is so terrified. I cradle her head in my gloved hands as Matt lifts up the bed, and slid her out as much as I can. Together, we straighten her legs and finish moving her from beneath her wooden prison. I kneel on the floor behind her, letting her sink into me as she cries. "Thank you, thank you! I was so scared!". Matt moves into a more thorough assessment as I simply hold her and let her calm down slowly.

I'm not trying to be cheesy, but I truly feel honoured to be in this position. A scared elderly woman manages to hit her medical alarm button while lying trapped on the floor. Strangers, we are let into her apartment in the middle of the night and are welcomed, thanked and so appreciated. Not for our medical skills, not for our knowledge or many years spent studying, but as Matt reminded me often as a student, for our 'soft skills'. I forget sometimes that our job is comfort and support as much as it is medical. The reward in this difficult job is truly the people we help, how crucial that is to remember when we feel unappreciated and forgotten.

Wednesday, September 4, 2013

The Munchies

"Code 4, unconscious male" has us tearing across the city at 1 am on a busy Saturday night. We arrive to find the fire department already inside the small basement apartment, and judging by the fire fighter wandering around outside, he's not actually unconscious.

The smell hits me when we enter the room - and I usually have a hard time picking up on it. I notice incense and candles burning on every surface, and the coffee table is covered in chips, cookies and candy.  A young man is sitting on the couch, wide-eyed, with bags of frozen vegetables and fries covering his body. His girlfriend is sitting in the corner, looking petrified, with the largest pupils I've ever seen. She looks like a cartoon character.

We start the standard questioning, then quickly veer off into the weird.

"What happened?" "Well, I was going in and out of consciousness, but I totally knew what was happening. I could, like, see everything around me." Hm. Sounds pretty life threatening.

"What's with the frozen veggies?" "I was really hot and was using them to cool down." Frozen peas on your junk will certainly be effective.

"Any alcohol tonight?" "No." Doubtful, but that's obviously not the main issue here. We'll let that one slide.

"Any drug use?" He pauses. C'mon dude, don't even try to lie to us, you're high as a feakin' kite and your girlfriend doesn't have any iris left. She's all pupil. "Well....maybe a little pot." No shit. 

We sign him off and leave with the admonishment to lay off the weed for the rest of the night. I'm hoping it's just a coincidence, but my partner and I then hit up a convenience store for junk food. How fast can you get a second-hand high? Hmm....