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!
Sunday, November 16, 2014
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.
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.
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
CIS and PTSD
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.
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.
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.
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.
"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.
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