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.

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.

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....

Domestic Violence

The calls I find the most challenging, personally and emotionally, are ones involving domestic violence. I find it extremely difficult to understand why a woman would stay in a position where she was repeatedly beaten. Theoretically, I know the reasons; cycle of abuse, substance use, mental health issues, etc., etc., but I simply cannot understand it.

One woman, with visible hand marks around her throat, started screaming at my partner when he pointed them out, about how rude he was to say such things. She quite literally kicked us out of her apartment, refusing medical care, and refused to tell the police where he had fled.

Another, almost child-like in her laughter and innocent eyes, refused to believe that her relationship consisted of anything but true love, extolling the many virtues of her man while her face swelled before my eyes. "I woke him up and made him angry, it was my fault." "He's hit me before, but he really does love me. I just annoy him sometimes". This poor woman would not or could not see that she was not to blame for his behaviour, and I found it extremely difficult to sit and listen to her on the way to the hospital with ever-increasing rage towards this man building inside me.

I simply cannot understand that mentality. I have tried and tried, but I just. can't. understand. If I was ever struck or abused, I would be out the door before his bloody corpse hit the floor behind me. I am ever-so-blessed to have a wonderful, gentle, compassionate husband and it is not even remotely a concern for me, even considering the idea is preposterous. I sincerely wish that every woman had a man like that, and the self-confidence and self-worth to never, ever, tolerate such behaviour. Until then, I apply ice, bandage their wounds and provide a shoulder to cry on. Again and again and again.

"Bleeding is Controlled"

The call came in as a Code 3 (no lights or siren), "Elderly woman has fallen and cut her foot. Bleeding is controlled." When we arrived at the apartment building, my partner remarked, "Let's take everything. Knowing my luck, it's an amputation or something." We slog all the bags and the stretcher into the building and cram into the tiny elevator. I really wish they made elevators in stretcher size, sometimes I don't want to get that close to my partner or to 4 burly firemen. On the other hand...well, sometimes that can be a perk of the job! Ahem. Sidetracked.

Her frantic neighbours meet us in the hallway, and her daughter says, "I think she broke her leg! There's blood everywhere!" Oh, really? Hmm, this could be interesting after all.

She is wedged behind the door, and of course, the entrance hallway of her apartment is absolutely tiny. Luckily my partner is a skinny guy, and as it is his call, he manages to shimmy through the crack in the door, literally climbing over the patient's head to get in. Once in, he lets me know quickly that it is very serious without alarming the neighbours, the daughter, or the patient ("Red, this will be a CTAS 2 return."). All I can do is pass him equipment through the crack in the door, there is simply no room for me with her pressed against the door. Peering in, I can just make out the snow-white top of the patient's head and a trail of blood leading down the hallway. He tells me later that her foot was cold and pulseless, 180 degrees in the wrong direction with tibia and fibula shreds poking through the torn skin.

Once he has her leg splinted, he slides her back from the doorway and I am able to get in to help. Now I realize the full extent of the injury. She is pale and grey, tachycardic and hypotensive, her foot is a deathly white and her leg has already bled through the stacks of gauze that were just secured. The trail of blood down the hallway looks like somebody was murdered - that's what blood thinners will do. We lift her carefully and carry her to the stretcher, then shoot off to the hospital before she gets any closer to dead. I have to repeat my return code twice to dispatch - they don't seem to believe that the non-emergency call they sent us on is returning on a life-threatening priority. I hear her ask my partner, "Do you think it's broken, dear?".  I feel bad for the sweet old woman, she has no idea how bad it is.

The triage nurse wants to assess the injury, so we carefully cut part of the splint away. As we peel back the gauze, we can see the artery inside her leg pulsing. It hasn't been cut, but the muscle, bone and tissue around it has been shredded, so we can see every heartbeat throb inside her shin.  She tells us she stood up and her ankle buckled beneath her. She tried to walk on it and it just shattered - the razor sharp shards of broken bone shredding through her muscle and skin. She collapsed to the ground, out of reach of the phone, alone and bleeding profusely. She spent the next hour dragging herself to the front door, where she banged weakly until her neighbours came to investigate the noise. We find out two weeks later that she was still in ICU, 4 surgeries later, and still may lose her foot.

More Than Just a Job

Looking back, my path to becoming a paramedic started very early, even earlier than I can remember. It's always been a career that I was drawn to, and there were many events that pushed me in that direction.

I grew up in the country. pre-internet, with no close neighbours and no TV. There wasn't any money for summer camps or sports, so I read and rode my bike all summer. Actually, that's still how my best days off are spent. Anyways, since I was such a voracious reader, I simply read everything I could get my hands on. I don't even remember when I started, but it became my summer tradition to read an old St. John Ambulance first aid manual we had cover-to-cover. I also spent many long, boring days longing for excitement and adventure, and I decided early that my career needed to fulfill that desire.

When I was in high school, my physics teacher had a seizure in the middle of class. She froze in the middle of a sentence, eyes glazed over, and somehow I knew exactly what was happening. While the other girls in the class started screaming, I raced to the front to try to catch her before she hit the ground. As I rounded the corner of her giant lab desk, she hit the ground. I will never forget the sound her head made when it hit the floor, and it took me years to get over the guilt for not catching her in time. I was terrified and unsure of myself, but I did exactly what the old first aid manual said, removing the recycling bin, chair and garbage pail so she wouldn't hit them, protecting her head and yelling at a classmate to stop holding her legs down. When the teachers started flooding the room, we were all sent to the library, where I started crying from the adrenaline and pent-up fear. I saw the paramedics go by, looking calm and assured, and I swore then and there that I NEVER wanted to feel the fear of not knowing what to do in a situation like that. I signed up for a first aid course as soon as I could, and started reading everything I could about first aid, emergency medicine and seizures.

That Christmas, my big brother bought me Paramedic by Peter Canning, which I read in its entirety in one sitting. I fell in love with the world he described, and decided I would also become a paramedic. I also managed to score a 1-week co-op with the local ambulance service, and although it was during the SARS outbreak and I was forbidden from riding out, I learned a lot and loved it even more. I had one paramedic tell me that since I could fall asleep in a chair and stand up straight in the back of the truck, I was already qualified. How true that is sometimes!

Breaking my foot in university ended up being the final push. I was treated by volunteer medical first responders, and I was impressed and touched by their knowledge and compassion. I was also blown away by the fact that I could also volunteer in that regard - what a perfect way to test drive my desired career. As soon as my foot healed (almost 2 years later, sadly) I joined the same organization and have been with them ever since, now training the very volunteers I once envied.

I think I was born to be a paramedic. There is no other career I want to do, no other path I wish I had taken. As challenging, exhausting, messy and stupid as this job can be, I love it more than anything else I've ever done. I am a paramedic through and through, I was born to be.

Back in Time

He drew the gaze of everybody in the crowd as he passed, a tall young man, strong and handsome. He was in perfect costume, tall leather boots, a polished sword at his waist and a long cape billowing out behind him. It felt like we had stepped back in time, with knights, soldiers, ladies of the court and princesses wandering around the park, along with obligatory tavern wench spilling out of her bodice.

Every half an hour, trumpets and drums drew the crowd to the castle where there was a choreographed battle between the knights of the court and the outlaws. Staged and choreographed and fought with blunted weapons, we weren't too concerned about the potential for injury until a squire came running over. We followed the frantic man behind the castle to check on the injured actor.

The tall young knight was now a scared teenager, trembling from head to toe, his shaking hands covered in blood. He neglected to block the outlaw's sword in time and despite the blunted edge, received a nasty gash to the top of his head. We bandaged his head neatly, taping gauze to his forehead to draw less attention then wrapping all the way around, then sent him to the hospital with his Dad. Apparently he caused quite a stir when he walked into the hospital  in his gorgeous costume, once again his confident self, to announce he had a sword wound to his head!

Tragedy

An ORNGE air ambulance crashed in Northern Ontario today, killing both pilots and both medics. I'm devastated, and although I did not know them personally, I feel like I have lost friends.

It is unbearable to think that I could've lost a dear friend last night - he works out of the very same base. I thank God it wasn't him at the same time I mourn the loss of those 4 men. May they rest in peace.

My Reality

Occasionally the normal, sane part of my brain catches up to me at work and I find myself wondering, "What the heck am I doing?!!"  So many of the things I see on a regular basis are once-in-a-lifetime things for my patients, and yet they are my everyday reality. An ankle so badly broken that it is hanging backwards by shreds of skin, a teenage girl so drunk that I have to hold up her head to catch her vomit, an intoxicated homeless man shouting obscenities at me as I step forward to catch him before he faceplants into the sidewalk. I hear the anguished cries of a family who have lost a loved one, the grief of an elderly man saying goodbye to his wife of 50 years as we rush her out the door in a vain hope to save her life. A woman punched and choked yet still "in love", a child fighting for breath in the middle of the night, an infant murdered by his own father.

I wonder what effect this is having on my psyche. It is the job that I have chosen, the calling that has been chosen for me. I would not trade it for any other, but I do not want to lose my humanity and sanity to the trauma of this world.

Days vs. Nights

I hate day shifts. With a passion. Days are loud and bright, with far too many people getting in the way on a scene, and far too many idiots on the road.  Far too hot in the summertime as well. The calls are different too, more nursing homes and fender-bender neck pain. Many of the full-timers on day shifts are older, more burnt out and crankier too.

Nights are much more fun. I like the younger group of medics and the more relaxed atmosphere. There is a greater feeling of camaraderie among the medics, nurses, fire and police too, it's us against the night.  I prefer the drunks, ODs and assault calls, and I love going home and curling into bed when the rest of the world is just waking up. Driving Code 4 is also much more fun and much easier at 3am when the roads are empty and the intersections are clear. Nights are definitely my time, too bad I'm on days all weekend.

"Soft Skills"

She had, in that moment, lost her humanity. She lay sprawled face down on the floor in front of us, an absolutely gigantic 500+ lbs. The nursing home had called 911 after she had attempted to get out of bed, her swollen, lesion-covered legs giving way underneath her massive bulk.

As we stood around her, 2 medics, 6 firefighters and several nurses, I realized that we were discussing how to move her like she was an inanimate object. I was embarrassed and ashamed by the fact that none of us had introduced ourselves or explained what we were doing, we were treating her just an object that we needed to move. I knelt down beside her head and with my hand on her shoulder, introduced myself and my partner, and explained to her what we were going to do to get her back into bed. Her muffled sobbing stopped and she apologized for trying to get out of bed when she knew she shouldn't have.

Now, it certainly wasn't an easy lift, as she was extremely heavy, covered in oozing sores and presented a truly unique odour, but I was able to sleep easily that morning by knowing that I may have made the situation slightly more bearable for her simply by acknowledging her humanity. Not a super-exciting paramedic skill they teach in school, but something we should never forget to do.