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Damn it, Jim!

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Starting a story with a misquotation is likely a serious faux pas, but alas, I did it. Get over it.

We were called to Jim’s house by a 3rd party. Actually a fourth party. Jim had missed a lot of work so his boss called his next of kin–and estranged daughter–she called a neighbor and between the neighbor and his boss, made the decision to call the ambulance.

I was greeted on the rickety steps by a confused looking gentleman I learned to be Jim’s boss. As I walk past him he tells me Jim had fallen and was on the ground all night. Jim says he’s not hurt. He says he is fine. Every word he speaks is enunciated in booze. The fruity smell of cheap vodka and cheaper beer permeate through his pores. Even the feces he has all over himself smell of sweet, cheap alcohol.

But Jim is adamant that he isn’t hurt. He knows where he is, he knows what day it is, but he just can’t admit that he is hurt. He just can’t admit that he needs help.

See months earlier Jim lost his mother and sister in a week or two. Jim, already an alcoholic took these double crosses and stumbled back to the ropes. He bowed out and lost control. Now the alcohol has control.

See, Jim isn’t fine. You can see the cellulitis has eaten at his legs. He’s not eating. Not bathing. Not doing anything other than getting delivered in cheap booze. Intentional or not, he’s killing himself. He’s of sound, if not sane, mind. He by law, can make decisions for himself. People are allowed to let themselves die here.

But after I’ve spent a considerable amount of time trying to get Jim to go to the hospital today, with me in the ambulance, his family arrives. His estranged daughter, her husband, and the granddaughter he hasn’t seen in a year. I try to “prep” them for what they are going to see. This isn’t going to be the “dad” you’re use to. But she walks right by.

And the crying, and the begging, and fighting begin. PD tells me they have no grounds to hold him. No threat to self or others. See, Jim insists he’s in contact with his lawyer, who is going to take him to the doctor on monday. The problem is, he can’t tell me his lawyers name. If you ask Jim how much he’s been drinking he changes the subject. If you ask Jim to stand(knowing he can’t) he changes the subject again.

Jim wants to stay home and drink another day. I think he knows that if he manages to stay home and drink enough days his body will finally give in to his mind and end this all.

But just because someone thinks they want to die a miserable death doesn’t mean we SHOULD stand idly by. I had walked out, as the city around me is imploding with 911 calls and transfers, I’d given up. Nothing was working. I waked out, got my signatures and was getting into the truck when the daughter came up to me.

“Please help me”. I don’t want him to die here. I don’t want him to die alone”. I try to explain how little there is I can do. I’ll be honest, I don’t expend a great deal of energy trying to get people to go to the hospital. If people say they don’t want or need me, I send them on their way.

But not this time. I’d already spent 50 minutes on scene, a few more won’t hurt. I walked back inside, daughter trailing behind me. We walk past an unopened box of “Omaha Steaks” with a postmark before Christmas. What kind of man leaves a box of meat–tasty meat–on their front stoop?

Inside the front door Jim’s son-in-law and granddaughter are sitting there. Granddaughter is crying. I walked up to Jim and said flatly…. “if you can stand, I will leave you alone forever”. So he tries to stand up. And flails and fails miserably. Sad, but in a way, what everyone needed to see.

I kneeled down to his now low level. Firmly, but compassionately I said…

“Jim, look. Look around this room. These are all people that care about you. Your daughter. Your granddaughter. Your boss. Your neighbor. Even me and my partner. If we didn’t care, the easy way out presented itself 100 times or more. But we didn’t take it. I stuck around. WE all stuck around. Because I’m scared that we’re going to come back tomorrow morning and pick you up in a different way. In a black bag and instead of going to the emergency room we’l have to go to the morgue. I’m terrified that I’ll have to look at this little girl over here and tell her that her grandpa is dead because we couldn’t convince him to go to the hospital to take care of some moderate medical problems. I’m scared that I won’t be able to sleep if I don’t do right by you. You have a chance to go out with some pride. Go out on your own, not be drug out of area against your will or in a body bag. Do this for your pride, if nothing else. Your pride is going to kill you”

and all he said to me:

“Well I don’t wanna hurt your beauty sleep. You need all you can get. Lets go”

And so we went. Quietly and calmly. At first he was defeated, but then the relief swept over him and the fear faded away.

In my longest scene time ever(1 hour, 48 minutes) I actually did something. More than I do on every major trauma or code or stroke I go on.

When the powers that be wanted to talk to me about the scene time delays I told them to read the narrative. I wasn’t going to justify it any other way. I wasn’t going to say sorry. I got a sick person to go to the hospital.

THAT is my job.

Damn it, Jim.

Why it Hurts

1,582 comments

Like a page from a book, dispatch sends us code 3 for a finger amputation. Grumbling as I roll out of bed while dispatch updates us–a 27 year old female at one of the local state-run group homes who intentionally put her hand in a garbage disposal. The grumbling increases. The staff at these facilities leave something to be desired and the patients usually are fine. This has to be an overreaction, doesn’t it?

As we round the corner inside the door, the scene is as expected–practically empty.  One staff member sits with our wheelchair bound patient, everyone else seems to be missing, despite it being meal time. A quick once over leads me to believe there is no amputation, the annoyance sets in.

So I ask my patient “whats going on tonight? How come you did this?” I am completely unprepared for the answers that follow. My patient–a 27 year old paraplegic female who suffers from Bipolar disorder, severe depression, and a gamut of other psychological issues–literally just came from our Behavioral Hospital. The very behavioral hospital she has requested to be transported to several times over the last few weeks due to depression and serious thoughts of suicide.

The story goes like this… as a child she was sexually abused by her father, her brothers, and her uncles. Her father pushed her down a set of stairs leading to a mild Traumatic Brain Injury and complete paralysis from the belly button down.

The state put her back in this home where these ingrates continued to sexually assault, mentally abuse, and psychologically destroy her for the next 9 years.  Finally the father is arrested for assaulting a neighbor’s daughter–when the story comes out again and the state takes her into their custody–only to be bounced from group home to group home, from one mental facility to another and back to the group homes. She has literally begged to be given inpatient treatment and the physicians say she just needs long term counseling. She is unable to do anything for herself–she cannot function without someone pushing her along. Not because she is physically weak, but because she is mentally broken.

She hurts because she has to actually hurt herself to get anyone to listen. I tell her we’ll get her help but she knows what that means. I will take her to yet another hospital where yet another doctor will push her back into the care of undereducated and overworked group home staff. All she wants is to feel safe. She wants to know that she can’t get out and THEY can’t get in–but no one will give this to her.

By the time we arrive at the hospital I know her story. I know enough to know that she needs this help. She knows what she needs, but doesn’t have the resources to do it herself.  As I transfer care I take the doc aside and give him the story. I tell him how I think she is a genuine threat to herself and that her mental anguish is real–not like so many of the calls we go on–the ones that made me grumble as I rolled out of bed. This is the real deal.

– — –

Two months later the tones startle me awake. Code 4, Any unit in position, Cardiac Arrest to an address I am all too familiar with. Dispatch updates with a 28 year old female, unconscious, not breathing, her throat is cut.

My foot reaches the floor. My knuckles are white on the wheel. My partner looks at me and asks me if I’m O.K.  I just drive faster. I walk in, the same deserted scene. The same deafening silence. I look down and know we’re too late. I let out a sigh, turn around and make the call.

I hurt because we failed.


Clarity

1,581 comments

I told you all about my decision to finally go to the doctor and take care of myself…
Well I did it. My doctor agreed with me that my symptoms seem very much like Adult Attention Deficit Disorder. She prescribed be Strattera, rather than one of the controlled substances(per my request) so that I a) won’t have to worry about habit forming medications, b) won’t have to worry about work drug screenings.

While the medication has only been in my system for 4 days, I feel better already. It most certainly is partly placebo effect, but whatever it is, I am happy to have finally done something about it.

I am dedicated to being a better person–at home and at work, and this is my first step in that direction.

I feel like I can think clearly without my all too common cloud of thoughts bouncing around. I hope this works. I really do…

Godspeed, Friends

m3

OHP vs Ambulance

985 comments

Dave Statter has provided the youtube link to this video…

If you have been hiding under a rock up to this point, head over to STATter911 for a full update on this.

I only have one question. Why did the medic exit the ambulance right away when the dumb ass Oklahoma Highway Patrolman pulled up behind them?

Further, vengeance is a piss poor tool for LEO’s to use when deciding who to pull over. How many times does a cop have somone “fail to yield”? Does he freak out and pull every one over? How often do motorists Fail to yield to ambulances? I think we should be authorized to do the PIT manuver on vehicles that take longer than 3 seconds to yield.

An ego can be a dangerous thing.

Sources:
STATter911
Rogue Medic

Partners.

88 comments

I have some great partners. I’ve also got some really, really crappy partners. Some of them just know what to do. Others need me to hold their hands while they take a crap. Some just can not figure out what being a partner means.

 

So……

A partner is:

-A friend who shares a common interest or participates in achieving a common goal

-A member of an intimate relationship

-A member of a partnership

-A business partner

-Partner (business rank), a member of a law firm or accounting firm which is formed as a partnership; sometimes senior employees of the firm may have the title "partner" (e.g., "salaried partner") to indicate a profit sharing status; salaried partners are distinguished from equity partners, who own the business.

-A participant in a partner dance

 

Things partners should NOT do…

-Throw you under the bus every chance they get

-Use you in a piss poor attempt to further their own careers

-Kiss your ass after doing so

-Ask you for favors after doing so

-expect you to do them favors after doing so

-expect me to NOT give them a reciprocal bus-throwing-under

-Expect me to NOT succeed and leave you bloodied in a ditch off a dirt road in Idaho.

Seriously. When the oldest person at your station is the most immature, idiotic, and pigheaded dumb ass staff member, you know you’re in a ginormous cluster fuck…

87538416v11_350x350_Front

Oh, and some things you should not try to tell me that you are "allergic" to:

-Epi. Seriously? You’re adrenal glands are going to have to disagree

-Sugar. Specifically Glucose. You’re fucking kidding me, right?

-Ammonia? You do understand the difference between an allergy and a hypersensitivity? You get that NO ONE likes how breathing in ammonia makes you feel…

-Right?

-PS… since you are allergic to ammonia, sugar, and epi… what would you like me to do about your "allergic reaction" now that you are in anaphylactic shock? Fucking black magic?

-If you are allergic to sugar why are you drinking a humongo gas station Reese’s Capafrapasugarladencino?

 

The pediatric dose of Benadryl would actually give you MORE Benadryl than the adult dose… based on weight. F-tard(that is me restraining myself.)

 

How in the HELL did one small company with 8 full time employees end up with a concentration of 3(THREE) people with the same set of nearly impossible allergies? 

 

You are a walking, crazy talking, plumb fucking nuts train wreck.train_wreck-782867

The Walls are Closing in…

1,024 comments

We don’t do many Psych transfers here. My particular county requires a Mental Health board to meet to place someone on an involuntary hold. Not many people come to the local ED to commit themselves…. While on Internship I did so many 72 hour holds it wasn’t even funny(no seriously… it wasn’t). 

This is actually my FIRST transfer to the behavioral hospital(next to the Heart hospital in sorta-big-deal-ville) while working at my itty bitty service. 
My patient is voluntarily committing himself so I didn’t expect to have many problems. He had some ETOH and maryjane on board, but nothing out of control. He is depressed and “this is working.” –well… no shit Sherlock! Depressants aren’t helping with yoru depression?!?!?! I’ll be damned…
Back to my patient… We loaded him up, and he was just kinda zonked. I had asked if Ativan or Haldol would be necessary–but I was assured it wasn’t needed. Beings that I hadn’t gotten much of a report I wanted to do atleast some sort of assessment(I’m not good at being a meat wagon). I was in the middle of asking the usual “how long have you felt this way, do you think about hurting yourself” line of questioning when my(much larger than I had realized) patient’s voice began to get much more aggressive.
Whipers turned to screaming, sweaty hands turned to fists. So… I did the only thing I could do… Hopped from the bench to the airway seat and stopped assessing(interogating) my patient. I let him cool down and then just asked him if he wanted to talk about anything…
The remainder of the trip we talked about why Pizza Hut is better than Papa Johns. For the record–it isn’t.
Expect some sort of post about things to come within the next 3 days. I haven’t decided if I’m going to spill the beans. 

No. I do not care about your alleged "serious" medical problem of "got too drunk and did something stupid"itis.

1 comment


REAL calls that could have been way worse to follow….

Sitting. Waiting. Wishing.

74 comments

So… Took my CBT exam today. Walked out feeling like a huge moron. There were questions I just absolutely didn’t expect. Even worse… the whole “choose the MOST correct answer” bullshit just riles me up. You aren’t choosing the CORRECT answer. You are choosing the MOST correct answer. The answer is often not the one that I would chose to do in the field.

Computer Adaptive Testing(CAT) also makes judging your performance on the test very difficult. Unlike a written test in class, this test will either get easier or harder, depending on how big of a moron you are.

Whatever. I’m pissed, anxious, and preparing myself for the reality that I might have to retest. Hopefully I’ll have something to tell you tomorrow. I’m well on my way to being my own Psych patient.

You stupid Bastard!

14 comments

“You’re a stupid bastard! You Stupid Bastard! You’re just a government cronie!”

This was how the trip to the ED of my LAST call of internship started. We found Mr. Happy Pants sleeping ON the street with his head on the curb. A rather busy street at that. Oh, and by “sleeping” I mean passed out. Drunk as a Skunk. Bombed. Inebriated.

Yeah. So he wasn’t happy. Being the cautious young moron that I am, I yelled at him when we rolled up. Blew the air horn. Just trying to raise him. Not wanting to walk up to him and shake him awake… since waking drunks that way never ends well. Finally he got up–as PD rolled up, 2 squads, both with new recruits. New officers are fun. They have a certain “gung ho” attitude that can’t be matched.

They jumped into it. One grabbed his arm, “helping” him stand. The other went digging for the wallet. Well, this didn’t please our newly found friend and he went swinging. Remember how I said the new recruits were gung ho… Well, they swung back. As I said before, it didn’t end well.

They go through the ropes, cuff him, shove him in a car, deal with his non-sense… Then say “Detox is closed…. They’re all full. You guys wanna take him to ‘specials’?” Um… Do I have a choice at this point. So I go over to the car, and start talking to him. He’s being rather pleasant to me, since I’m one of the few people who hasn’t done anything to make him feel worse. Offer to help him and tell him he’s going to for a ride in the wambulance. He’s ecstatic. Till he sees the restraints.

Yup. 4 pt restraints… And my favorite friend was handy–the pillow case. Get him down(with the help of my over zealous friends) and on our way we go. We refuse the PD escort since our sleepy pal’s ability to fight is nill with his limbs secured.

As soon as the doors to the truck close it starts. “You’re a stupid bastard! You Stupid Bastard! You’re just a government cronie!”

On, and on, and on, and on. Just repeating versions of the same lovely phrase. But I have to do an assessment, don’t I? So I go into it, SAMPLE, blah blah blah. And then the fun starts. I ask if he has any pain anywhere at all. Rather quick for his level intoxication, he responds quickly with “yup. Yeah. I’ve got a gigantic pain in my ass! You. You are just a pain in my ass!”

So, beings that we’ve identified a new source of pain for him I feel it is important to identify the severity of said pain… “Sir, on a scale of 1 to 10, 10 being the worst pain imaginable, what would you rate this pain in your ass?”

“10. You stupid bastard.”

Yahtzee!

967 comments

EMS is one of the few career paths where other peoples’ misery makes our day interesting. As a matter of fact, it is pretty much essential to making our days complete. If we have boring calls, we are bored. Some of us are Trauma Junkies. Some love medical calls. Me, I like crazy people. Crazy people–I can relate to them. I’m just a few clicks from being off the rocker myself so crazy people are easy for me. Plus, you can mess with them…

Today we ended our shift(literally.. we were pulling into the garage and got toned out… again) with a “psych pt on the freeway”). Yes. ON the FREEWAY. Get your attention?

Apparently our lovely 22 year old passenger had fled(ran away aimlessly) from her group home(I love group homes. They supply 40%(made up statistic) of our patients. Most of them who need an ambulance about as much as I need a meth addiction.

This girl was mildly MR, but not bad. She had some depression, which is commonly associated with mild MR young adults. She said she had thought about killing herself–this was as close to a suicide gesture as she had ever made, and I’m not so sure it was intentional. None the less, she earned herself a 72 hour stay at one of the “finest” mental health facilities in the region. By finest I mean understaffed and overworked. They aren’t bright either–their ambulance garage is 500ft of winding hallway away from the ED.

Here’s where the fun starts. She states that she is 5 months preggers and due in LATE SEPTEMBER. Wait…. I looked at my preceptor, and casually asked him: “Is my math ok?” He looks up. “You’re a friggin’ math genius”. Yup… seems that our pt has planned to carry her twins–or was it quints–a few months extra. Yup. You’re nuts.

She was also the primary care provider to 3 young children from her friend who died in a car accident–or did she kill herself? Anyways. Somehow I’m not so sure that the group home has room for the 3 youngins. Whatev. I love a good story.

At least she has an excuse. Better than the uppity people we pick up who act like they weren’t drinking when then rammed that innocent pole.

Anyways–enough about crazies… more about Craziness.

Our first call of the day was for “one down, with burns”. We hear ‘one down’ as CARDIAC ARREST. Not so much. She wasn’t burned either, but that’s neither here nor there.

Apparently our mid-forties pt had just had lunch with her friends and a nice eatery in one of the burbs. She had got into her car, started to leave and apparently lost control of the car, hit a parked car… and her foot was still on the gas. This caused the front wheels to keep going till the point of starting on fire and thus where the “burns” I mentioned earlier came into play.

A bystander punched out the window(only to get himself a trip to the ED too) and pulled her out after turning off the car.

PD and FD arrived on scene about 7 minutes before us. One of our medics just happened to be at the restaurant too. He stated her BP was 240/120, she was posturing and had lost control of her bladder. Her friends said she complained of a headache.

Upon our arrival she was no longer posturing, but her BP was still 200/100. This is a scoop and go. She responds barely to painful stimuli. Not looking good.

En Route we start two 16′s, monitor, 12 lead, blood sugar, pulse ox, blah, blah, blah. I keep trying to talk to her, occasionally getting a little grunt. 10 minutes into our transfer she starts responding with coherent phrases. Appropriate too.

She can tell me she has had a head ache for a week. She has been taking Aspirin every day for it–shit. She doesn’t remember what happened at all. She can tell me everything before it happened though.

10 minutes ago I had a tube out and ready to go, and now she is holding a bucket and wants to puke. Who woulda thunk.

At that point I was dumbfounded. She presented like a classic bleed. Her history presented that way too. But bleeds don’t wake on their own. They don’t just get better.

Wrong. Her CT showed an 11mm ACA Aneurysm near her pituitary gland. WTF. They planned on going in and coiling it(spring to open the vessel).

Yup, one of those days.

Do Parents not PARENT anymore?

8 comments

So Today was a day that I can bet won’t ever repeat itself. At least that’s what I’m hoping.

It was really a pretty slow day. 8 hrs, 4 calls, nothing serious–well, that depends on your definition of serious. Calls 1&2 were run of the mill.
Calls 3&4… Well, they make me wanna hurl.

Dispatched code 3 to an Elementary School–on a psych. 11 year old girl who wanted to kill herself. She has made suicide gestures, had a plan(posted on myspace.com) and was very, very depressed. She’s FUCKING 11 YEARS OLD! What the hell is going on here? What happened to 11 year old girls playing dress up, house, reading cute books with pink covers and harassing little neighborhood boys?

To make it better, Dad(the sperm donor) could care less and wouldn’t be coming to the Hospital. Mom–well, she’s in prison–obviously more part of the problem than the solution.

Her aunt is the only one who seems to care enough to come… So she’s getting checked into a Pediatric Psych unit on a Mental Health Hold and she’s all by herself. Why do I see this ending badly. Maybe not today, or tomorrow, or next month. Eventually though the system will be done failing her and One of us will get to scrape her off the floor somewhere.

Absolutely disgusting.

Call 4. Code 2, same god damn school. Apparently they have a hold on the niche for kids with overwhelming psychiatric issues.

This one is 10. Yeah, that’s right. 10 god damn years old. He is “diagnosed” (by an overwhelmed, over-eager family practice Doctor, no doubt–not a psychologist or psychiatrist(Don’t get me wrong. I love doctors. They are smarter than me. But Family Practice doctors have as much business diagnosing and treating mental illness as I have treating cancer)) with ADHD and Oppositional Defiant Disorder(my fav… so he doesn’t like authority… find me a kid who DOES).

He decided teacher was pissing him off, so he kicked, screamed, bit, clawed, spit and threw a chair at him. Then the principal. Then PD.

I told him he had to go with one of us. Either with us in the ambulance with cool toys or the Police car with Handcuffs and a spit hood. He calmed down(like most people do when confronted with this situation) and walked out with us. Mom was no where to be found. She is an aide at another school in the district and was on a “personal” day. PD and school staff tried to locate her at home, friends, family. No luck.

One of the more memorable parts of that call–asking if he knew what meds he took. Benedryl. Every night. What could that be for?!?!?! Hmm…. Good Night.

What are our kids being thrown into psych facilities so often now? Case 1 was legit. She needed help. Case 2 needed parents who actually parented. We are failing our kids. We’re failing the future. I’m actually scared out of my mind about it.

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