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. 

Saturday, July 12, 2014

Lament of the Ice Cream

We're having a great shift, bouncing bases but yet to actually do a call, so we stopped for ice cream (for me) and coffee (for him). Rookie mistake. Just as we get back into the ambulance with our respective vices, we got a call, code 4 for chest pain in the sketchiest area of town. Alright, I guess my ice cream will have to wait, since I'm driving on this call.

We head up dark, dingy stairs to the second floor of an apartment building, into an equally dark and dingy apartment. The patient is lying on the couch, gray and sweaty, alternately rubbing his chest and his left shoulder. Hmm, that would be a clue.

Upon realizing that his pulse was no higher than 40 beats per minute and his blood pressure just as abysmal, I turn to the nearest firefighter while my partner leads the assessment. "Would you be able to grab our stair chair, please?" He looks at me, looks at the patient, then back to me, "Dontcha think he can walk?" "Um, no. Stair chair, please." He leaves and I brush off his comment, not realizing until later that I could've and should've torn him a new one. Once we get the monitor attached and run our 12-lead, we see that he is having a massive inferior MI, a type of heart attack that typically presents with low blood pressure and low pulse, both of which he has - to the extreme. The fire department is still milling around aimlessly, not realizing that this patient could literally keel over dead any freaking second. Once I pre-alert the cardiac hospital that we are bringing in a STEMI, they perk up considerably and become extremely helpful.

On scene for less than 15 minutes, which includes carrying him down the stairs, we book it to the hospital, taking a firefighter with us just in case he codes en route. As I drive lights and sirens through traffic, I periodically glance at my ice cream, losing integrity by the second and turning into warm soup. So sad to watch.

We take him right upstairs to the cath lab and the procedure to re-open his coronary artery is started. The doctor thanks us for doing a great job and confides that based on his presentation, he has a very long road to recovery ahead of him, if he makes it at all. At least he has a chance, my poor ice cream is long gone.

Saturday, May 24, 2014


I've been thinking a lot about critical incident stress (CIS) and post-traumatic stress disorder (PTSD) lately. They taught us the list of symptoms in school as well as the requisite 'ask for help if you need help' routine, but it is so much more real than that. I had a partner a few weeks ago who exhibited at least half a dozen symptoms within the first 2 hours of our shift, and many more medics show signs as well. It is impossible to do what we do and not be impacted by it, to not have it change us in some way.

The response I've seen to it so far is twofold. On the surface, there is support and cheerleading, both management and medics say the right thing when asked, post supportive links on facebook and champion CIS/PTSD causes. However, when actually faced with somebody who is having difficult, the actual response is much less by-the-book. Medics who are struggling are faced with ridicule on the street level, as if nobody actually realizes what is happening. Comments like "they need to just grow the f*** up" or "somebody needs to find a new career" are not helpful. They minimize the difficulty that medic is going through, turning their struggle into a maturity issue or personality flaw.

I'm not sure that there will ever be a solution. Retirement rates for paramedics are dismal, sitting around 4%. I am a big fan of the work the Tema Conter foundation is doing, and the more I watch Flashpoint reruns, the more I realize that they brought a personal touch to CIS. There is a lot more work to be done, and it comes down to the need to change attitudes of all the street-level staff. When a supervisor makes disparaging comments about another medic at role call, anonymously or not, it sets a terrible tone for everybody. When a crew is begrudgingly given an hour max by dispatch to decompress after a terrible call, like a murdered child or an MCI with multiple fatalities, it drags down both the personal and collective moral. I know we have to be tough to deal with everything, but there has to be some room for compassion. Not just for our patients, but for each other. More communication, less gossip. More support, less judgement.

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 hit critical mass. 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.