Shit Magnet

Every now and then you go through phases in your career. When I worked for the fire department I was a car accident and dead body magnet. I would work and we'd either get a dead body or a car accident. Or a car accident with a dead body.
Now I am a cardiac shit magnet. Maybe its because of my mother but I can't go through a single shift without at least one cardiac call. Or a call that becomes cardiac.
Last night at about quarter of 8 we get a call for a woman having severe abdominal pain in the right lower quadrant. Blood in the urine, vommitting and sweating. Kidney stones, I mean the walk in we took her out of even saw them on her X Rays. So we run her down to RIH for a work up. She's in a lot of pain but in the back of my bus her pressure is fine, 130/70, pulse of 65, good sats and a decent sugar.
Once at the triage station at RIH we find her BP skyrocketing. Shooting through the roof, pulse dropping. Shes clutching her shoulder so I ask her in Spanish what's going on and she complains that her shoulder is "killing" her and she can hardly breath. "Hey hon," I call all the nurses 'hon' except for Amy, a spicy little vixen over the psych ward who delights in giving me violent EDPs for removal to Butler. "Hey, hon. She just started complaining of CP and SOB, wanna do a 12 lead or you want me to, I don't mind, if you're busy." I wasn't being an ass, RIH was getting slammed but she was cool and said she would do the EKG and I give her a hand because I'm pretty curious.
Once we get a decent read on our little kidney queen we see elevations climbing off the page and punching people in the face, right there in the ER. East Providence had a drunk complaining about how hot it was as our woman couldn't breath. A cop told him to "Shut the fuck up, you tool." As I grab a transport tech and help two nurses start a second, large bore IV. As they run her up to the cath lab I have to explain to her 15 year old son what is going on and where his mom is going.
I bring him over to the EMS room and explain that she's having a heart attack and that they are going to help her. As we were sticking her she told me to tell her son everything so my ass is covered via HIPPA and all that don't talk about the patient stuff.
On the ride to RIH I let him play with the sirens and showed him how everything worked. I let him look through our trauma bag once we get his mother into the ED. Now I have to tell him his mother is having the big one. In broken Spanglish I explain his mom his upstairs, going into to get her heart fixed. He asked what happened so I give him a simplified version of what happened and he asks me to explain what "The wiggles on the page mean." He had came in just as me and the nurse were going "Hot damn" over her EKG. So I explain that each of the different markings represents a different part of the heart and that right now the front and the side of her heart are not doing too well. In my language thats an anterior lateral MI. To him it means that his mother is taken away from him while she gets all sorts of procedures that he doesn't really understand. I grab him a soda and a pastry from the EMS room and wish him luck. I hand him over to the family conselor and try to figgure out where I should go for dinner. Then I realize i already ate and that I should be a good little doobie and go back to satelite and try to lay down for a bit.
But once I get back I get sucked into an episode of Law and Order and a book I just took out from the library on pirates. At least until we get a call for a woman with severe back pain. It turns out to be osteoporsis, but with her in the back we have to by pass a car accident with noone on scene. I radio to dispatch to get a 911 truck to the area before little miss back pain starts screaming. Apparently a nerve got even more pinched and she was in excruciating pain.
Once we get to Miriam, yes Miriam from some little address in Cranston (a long ass ride no matter what) the nurse gives her enough morphine to kill a horse and I try and steal several boxes of large gloves.
Another nurse catches me so I just start humming the Mission Impossible theme very loudly as I spin around her like a master thief. She laughes, calls me an idiot and walks away but I got some nice, textured ribbed for my gripping pleasure Nitrile larges in stylish purple.

Rainy Sundays

Usually my Sunday overnights are fairly quiet. A difficulty breathing here, a trauma or nursing home fall there. Occasionally I get a decent call but usaully, well its Sunday ......
Last night had to go and be the exception to the usually easy shift. Last night started with a diffculty breathing that turned out to be dramatic new onset Congestive Heart Failure. (Fluid backing up into the lungs and therefore causing difficulty breathing) Mr. CHF had ankles the size of basketballs, a sure sign of poor fluid movement. His lungs sounded like a water park and his skin was ashen.
Time to go.
Rain slicked roads made the normally easy shot from Warwick to RIH in Providence a massive pain in the ass. As did an 18 wheeler that decided flashing red lights meant jack on the breaks in the middle of 95. In front of said flashing lights.
We pushed Lasix, a diuretic that should pull the fluid out of the lungs and help our boy breathe. It did but he pissed all over my stretcher and the back of my bus. After transfering him to a critical care room I set about cleaning the peepee from the back of my truck with a spray bottle of bleach and a towel that was last washed several days before Nixon resigned the presidency.
After ensuring that my truck was urine free and smelled somewhat better, we drove back to satelite and tried to get a few hours sleep.
My partner, Dave, starts hacking and coughing due to the humidity and agrees to sleep in the day room on a couch instead of the bunkroom. Five minutes after he leaves, he comes back telling me we have a guy in Kent who needs to go to the cath lab at Miriam. A twenty to thirty minute drive sans rain and tonight its like Noah's Ark.
Our guy is upstairs in Kent's Critical Care floor hooked up to so many pumps we have to pin them to the stretcher and cary the extras. Kent has yet to unlock the magic of the pocket pump, a glorious device the size of a CD man. This guy has a thick accent so his words make very little sense to my sleep deprived brain, along with the fact that he can barely breath because of chest pain.....his skin is steel gray. Not good at all. As we rush him down to the bus with a nurse, he decides to pull out an IV and covers himself in Heparin thinned pinkish blood. Tearing through the emergency room we pass a 2o something covered in blood and vommit projectiling his expectorant across the room. Despite having a guy who has that "code smell" of too much triponin, I manage to slap a firefighter I went through EMT school with on the back and call him a fag.
We get our guy in the bus and beat feet to Miriam. Our guy goes into VFib, a useless death rhthym that means the heart is basically quivering. My partner grabs the paddles to shock him and has them jellied before sighing "O thank god....." For some reason our patient snapped back into a blood circulating beat.
Finally after litterally running this guy to the cath lab we clean up the mess made in the back of the bus. Again I am playing Martha Stewart with a bottle of bleach and a newer, cleaner and whiter towel. The rain still comes down in humid, choking sheets as we try to figgure out where to get more electrodes.
Once we get back at satelite I decide to lay down and no sooner do I have my boots off then I have to go back to Kent for a man with a massive skull fracture.
Upon arrival we find Warwick's drunk shaking and bucking violently as a nurse screams "We need to tube him!" repeatedly, in his drunk, drugged out state he is lashing out at whatever moves so I jump on him and hold him down while they push Ativan and shove a tube down his throat. We board him, collar him because if he broke his skull, he could have broken something in his spine too. His dope wears off and he starts spazing again. I get upset and just mutter "Oh, fuck this!" and use an abandoned backboard strap to loop his hands down with a California love knot, all while trying to soothe him by telling him to relax and give over to the tube, let us do the work for him.
Half way to the trauma center he goes into full on repitory arrest, pulse skyrocketing as a brand knew respitory tech doggedly bags him. On arrival, the RT is in awe of RIH and as we wheel our guy in I noticed her hands have stopped squeezing the bag.
"I've never been here before.....its huge."
"Squeeze" I tell her, politely to no avail. "Squeeze" I repeat, politely again but to no avail. "Honey, squeeze the fucking bag."
"O right, " she continues the breaths, her little lapse not long enough to cause any issue. And again we get a critical care code room. Finally it stops raining and cools off to some degree. Although how long our semi decent weather will last is really anyone's guess.

The funny thing about hospitals is that not all of them do the same things. Some of them are what is known as Level I Trauma Centers, that means that at any given time you can take the victim of a car accident or other "event of badness", as my medic instructor would say, for immediate surgical treatment. Still others have 24 hour cath labs. Others specialize in certain infectious diseases.
When I worked in Holden I didn't have to transport. AMR would provide a paramedic ambulance to come and whisk away the sick and injured. Sometimes I would have to drive or in really bad calls get in the back and either do CPR or help the medics do their medic things. All of the hospitals in Worcester were Level One, they all had cath labs. It was great because there was very little thought involved and you could focus on patient care. Wherever you end up based on diversion, traffic patterns or being pissed off at a nurse because she wouldn't give you fresh linens , you would get what you need and your patient could receive optimum care.
In Rhode Island (as most things related to the emergency service system are) its a bit different. Kent Hosptial, the one I usually transport to out of proximity and just plain easiness is not a Level One nor is it a cath lab. Usually thats fine because grandma drippy butt with pneumonia and a fever of 103 does not need surgery or catherization. She needs drugs, lots of them very quickly and Kent is good at that. Kent excells at little old lady fall down and go boom calls. Kent works very well on cardiac arrest calls so long as no cath lab is needed. Kent even has a barriatric pressure chamber for injured divers. In short, usually Kent gets the job done and there is no need to get on 95 and shoot up to RIH.
Rhode Island Hospital is the only Level One Trauma Center in RI. It is one of two 24 hour cath labs, the other being in the ass end of nowhere or as Rhode Islanders call it "Pawtucket". So last night when Warwick Rescue brought a lady into Kent for chest pain, they were doing right by her. There was no problem bringing a chest pain patient to Kent, shit, I do it all the time. But when that lady started having severe ST elevations and her once high blood pressure went down to 70/30 she was in a bit of trouble. Intially the blood pressure will sky rocket then as the person starst to circle the drain it will fall through the floor, all the while as the pulse drops. At one point Li'l Miss Chest Pain had a pulse of 27. Not good.
So Kent decides to ship her to RIH, a trully necessary and brilliant deceision on the part of the staff. I say this in all seriousness because it is hard to say "We can't handle this, you need to go somwhere else" and make the patient suffer through another transport. I had to do it twice at the Norwood, calling for a bird to take very critical patients into the BW and Mass General. Its difficult to admit defeat and call for help. So what the staff at Kent did last night was commendable.
I get dispatched for the transfer, a critical care run because of the amount of pumps, monitors and drugs running, around 10 last night. We pick up the lady complete with a little Indian man who is a transport nurse. He tells us that he is studying to be a paramedic and wants to get more experience.
All in all he did a good job. He was nervous as hell, couldn't get a decent blood pressure but when you are used to working in a hospital, where its quiet and controlled, I can imagine the back of a movin ambulance with sirens going would be pretty difficult. Jokingly I told him to wait until he tries to get a BP in the back of a mangled car when the boys have the Hurst kit going. He turned bone white and asked if we could take a pressure for him. 70/20. no real change of note, but he got nervous as her heart rate fell from the atropine induced 65 back to 50 again. He begged us to go faster as he pushed another half miligram of the heart rate increasing Atropine. She perked up and asked us to call her daughter and have her take in the meatballs she left on the counter.
I asked her the recipe and she went on and on about garlic and peppers, onions, tomato paste before even getting to how to prepare the meatballs. "The secret is in the gravy." Only a Rhode Islander will call the thick, delicious tomato sauce "gravy".
When we get to RIH or as I call it on the radio "Trauma" we rush right through the emergency room, passing drunks and stabbing victims. The triage nurse says "Hey what the..... O you called for the cath lab, go on up." As if we were going to stop but she has her hands full with a 17 year old who thought it was a good idea to get drunk and try to fly off of his father's tool shed and a regular named Bernie who I have jokingly threatened, to his face, to "shit the beat out of him." Not to mention countless other ED dwellers and a trio of Providence rescues (again a fancy name for an ambulance, not the heavy rescue stuff I did when on the job) whose crews are trying to figgure out where they can get new equipment because the supply closet is quite litterally bare.
So we bring our lady upstairs, watching as she occasionally blacks out and we have to yell at her to wake up. I start demanding to know more about her meatballs and sausage recipes as we run through the halls. The male nurse frantically looks for the BVM thinking our lady will code and I simply and calmly tell him. "Knock that shit off, you wanna tempt God here?" He manages a nervous laugh and I ask if Miss CP knows any good ways to make garlic bread.
We finally end up depositing the woman in the cath lab, rushing her into a kind of holding area where we can slide her to a special bed festooned with even more pumps and gizmos. Its much bigger than the Norwood's Cath Lab and for a second I miss working with my old friends like Kerri and Terri and the ancient, brillian ED guru Janet. I miss Nick G, the former special forces soilider turned nurse, I miss Karren, the X Ray tech who was almost bitten by one of the ubiquitous Dedham drunks. I even miss Dave, the psych nurse who once got mad at me for using an uninhabited psych room to store a body when the morgue was full.
But then I snap out of it, give my report and pack all of my stuff up and prepare to bring the unnamed nurse back to Kent to finnish his shift and study up on EKG recognition as in the back of a bouncing truck everything looks the same. On the way out I steal an O2 key because I have never had one and the hospital had an extra just sitting there....tempting me. Now its looped to my shears with a hospital ID bracelet and I wear it tucked into my belt at the lower back as opposed to in the back of my Leatherman sheath. I like it better that way.