Punch and Judy

We get called for a routine psych transfer. A suicidal woman named Judy had swallowed a handful of pipecleaners earlier in the day and been sent to RIH for evaluation. She has a nurse with her and stinks of urine and unwashed skin, making me wonder about the hygiene situation in the Butler Institute.
Shes docile, cooperative even as we ask her to slide over to our stretcher, she complies easily enough and we follow the usual procedure for psych patients, wrapping the blankets as a burrito around her to immobilize her should she decide to become a pain in the ass.When we get her secured and Ryan and I lift the stretcher i realize she weighs somewhere around three hundred pounds.
Until about Thayer Street she is dead silent, not moving or making a word so I quietly fill out paperwork and watch her from the airway seat. I ask if she needs a blanket because she starts shivering and then shes up.
In one motion she pulled off the straps of the stretcher and sat up, clawing at the backdoor.
"No, no. Judy, don't do that." I jump next to her in the back of the bus and try to push her back down onto the stretcher. Her right hand balls into a fist and connects solidly with my left eye and cheek bone. I groan an expletive and drive a knee onto her pelvis and lock her hands behind her head with my own.
"I WANNA DIE!" She wails and thrashes as the nurse jumps through the divider and helps hold her hands down. I weigh close to two hundred pounds and spend a good deal of time in the gym and her legs are easily moving me while I try to pin her down.
"Are you good?" My partner Ryan asks from the driver seat.
"Get back here!" I snarl back and he says something about pulling over. "Fuck that, hit the lights and get back here." He fumlbes with the emergency board and then jumps out. The backdoor opens and he gingerly starts to try and control her feet while i struggle with her arms. Finally I get pissed off and tell him to call for the police.
Another ambulance arrives before the cops show up. With the help of Craig and a new EMT we manage to keep her still long enough for me to twirl a handcuff knot into a backboard strap.
"She hit him." Ryan tells them.
"Hit you?" Craig asks.
I laugh, "Yeah she clocked me when I asked her to play nice." The backboard strap tightens itself while she struggles against it, wildly kicking and bucking even udner the combined weight of Craig and I.
Providence PD shows up and all is just about under control so we tell them to clear. I tell the new guy to beach his truck under the overpass and drive our truck to Butler. He agrees and jumps out but Ryan is already in the driver's seat. The truck starts moving and the other bus follows us to the hospital.
Ryan is screwing, hitting bumps like crazy so I yell up front. "Calm down! You hit anymore bumps and I'm gonna get a headache." He complies, sheepishly saying he's sorry.
I shake my head and turn to Craig. "This is my last night, too. I start the fire department orientation on Monday."
"Oh yeah, good for you man. Where abouts?" I tell him about the small town just outside of Manchester New Hampshire and he tells me to enjoy it. The girl underneath us starts a mantra of "Iwannadies."
Once at Butler, two security guards come to the backdoors of our truck. The fourth EMT shows up and we try to pull out the stretcher while keeping our patient from going apeshit. Some how one of the discarded straps wraps around the nurse's leg and when we pull it out she yelps in pain, struggling not to fall on her ass. Craig yells to push the stretcher back in and we disentangle her. When we finally get inside, the nurse asks us not to leave without giving her back her coach bag. I tell her I can trade it for crack or a blowjob on Veasie street and she just laughes.
Polo shirted college kids doing volunteer time to meet this or that requirement descend on our little circus, offering to help hold the bucking woman down but all we need is to get her in the safe room, a rubber padded cell that she will probably smear her feces all over as soon as we leave.
The elevator ride upstairs is uneventful aside from her screams about death. A nurse approaches her with an Ativan pill and asks her to take it but she just snarls the C word at her. I laugh and say an injection might be better off. After some typical hemming and hawing they stick her in the thigh and a total of ten people lift her off the stretcher, dump her on her belly and cut her clothes off in the rubber room. They evacuate the room and I watch the heavy door close behind them.
"You guys got a men's room?" I ask a security guard.
"Yeah, are you the one she hit."
"Yep, its my last night too."
"You okay, you want some ice?"
"Nah, just a men's room please. My stomach's bothering me."
"She get you in the stomach too?" Craig asks.
"No, I gotta take a dump. Can someone point me in the right direction here?" Toilet humor is always a good way to lighten the mood.

Waterview

"Squad 22, from a phone in. Respond to Waterview Villa, patient with abnormal labs."
My partner, Ant, a guy I went through EMT school with keys the mike and tells our dispatcher we are responding.
"Abnormal labs, thats the most blanket fucking statement in the world. What were the abnormal labs? Is it a high white count with a fever? What the fuck, if its triponin thats even worse but they never fucking tell us.." Ant bitches as we skid and slide on the fresh black ice left behind by a fast moving front.
I knod, telling him I agree as I try to enjoy an Italian grinder I bought up on Federal Hill. Venda, a great little Italian shop threw about four tons of prosciutto, provolone, capicola, salami and some other Italian cold cuts on to a loaf of bread and covered the whole thing in oil and vinegar along with peppers, tomatoes and some huge palm trees of romaine lettuce.
There is some kind of sing along play the piano and dance thing going on when we get to the nursing home. Little blue haireds sit in their wheelchairs and sway while a few ancient Greek guys do a glacially slow oompa dance.
We push through the throng and go to a small but well kept apartment in the back of the living center. Her daughter and son are there making nervous jokes and small talk with her as we turn on the monitor and do a quick peripheral look (leads on the wrists and ankles.) She's tachy at about 135 or so. Vitals are unremarkable with a corresponding pulse, though weak and thready, her BP is at 130/80, not bad considering the heartrate and her respirations are at 18 with clear and equal lung sounds.
"Can you stand up?" Ant asks and shes tells him that when she does her BP drops and she feels faint. Orthostatic vital signs, usually indicative of something potentially bad. So we scoop her by knees and armpits, depositing her easily on the stretcher and leaving quietly.
Since she is doing fine we start to drive toward RIH with no lights or sirens. She's yammering away with Ant in the back and stayed pink warm and happy the whole time I drove us in.
Wedging the truck between two Providence rescue ambulances, I hop out and bring the stretcher out. As soon as the wheels kiss the ground she starts to look worse, she starts to gray up a bit, her eyes seem to go in and out of focus as she mutters something about her arm and back.
At that we start to run toward the ED doors. I find that they have been diasbled because of the cold weather, RNs wanting to keep warm. So I pry them apart and shout.
"Got a cardiac room open?"
A nurse looks startled as a Providence firefighter pulls his stretchered drunk out of the way and we come careening in. On the way to the room the overhead sounds with a medical/trauma team to room four on a stat priority. We give our report about negative and non diagnostic findings and about how the patient shit the bed in the ambulance bay. The doctors and nurses take over and start their own procedures, bloods and 12 EKGs, an aterial blood gas and so forth. I stick around long enough to spike a few IV bags for them and then get out of the way so as to let a CNA orientie get some experience.
While finishing up paperwork in the EMS room, we watch another NEA truck come in, this one with lights going. I finish off my ice water and go out to help them unload the stretcher. In the back a new EMT is trying to calm a man who is missing half his hand. The vetran Cardiac in the back with him looks up at me and says simply:
"Snowblower."
We unload the now fingerless man, the new guy carrying a bag of blood soaked ice and snow almost at arms length. Again the overhead chimes for a trauma team. I go and wash my hands while my partner finishes his paperwork.

At Last

My whole life I have wanted to be a firefighter/paramedic. On the 3rd I took a giant step closer to my goal. For the past year I have been in contact with a town in southern New Hampshire attempting to secure employment with the fire department. Last Thursday I sat for the oral boards, before three lieutenants and a captain. For forty five minutes I was grilled on how I would respond to certain emergencies and what I would do in different situations.
While it was a relaxed atmosphere, no class A uniforms, just sweatshirts and unzipped boots, I was somewhat nervous. Never one for a suit, I opted to wear the shirt my mom got me for Christmas and a pair of khaki pants. I had been in constant contact with the deputy chief for nearly a year, so he had removed himself from the process but the guys on the board were very nice and even laughing and joking with me.
It started fairly simple, the captain asked me to introduce myself and give a brief history of my experience and my life. So I started telling them about how I worked for four years as a firefighter/EMT in Holden. I told them about how for the past six years I have traveled all over New England taking specialized tech rescue classes, diving and salvage courses, I told them about how I dedicated a year of my life to becoming a paramedic. Over the course of my little ramblage they learned that I love to go camping and kayacking, that heaven for me is a full tank of air and murky black waters. They learned I have a bull mastiff named Gus and that I have plans to become a certified sky diver and that I want a Harley.
Next one of the lieutenants threw me a six foot length of rope and told me I had two minutes to tie a figure eight follow through. I almost jumped for joy as this is one of my favorite knots to tie. Not only is it very strong but it looks beautiful when all dressed up and tightened. Within thirty seconds I had the knot twirled into the rope and dressed with two safety hitches and found myself holding it at arms length for inspection like back in the academy.
"Good job." He said simply and lead me to a table covered in various hand tools. Hefting a Halligan tool he asks me what it is and how to use it. Back in Holden I always took the irons, a Halligan and a flathead axe. So I took it from him told the assembled board that it was a Halligan bar and that it could be used for prying, picking, wedging and jamming. I told them that it is usually married with a flat head axe but that law enforcement prefers a sledgehammer as do some specialized rescue units particularly in industrial settings. Somewhat impressed, the officer took his tool back and told me to explain the rest of the table.
Ceiling hook, used for pulling ceilings, brute force is all, jam it through and pull it down just don't dump it on your head. Bambam tool, a pry bar with a free floating weight on the leading end. Instead of using a flat head, you use the weight to seat the tool and fit the working end into wherever you want it. Spanner wrench, adjust couplings and in a pinch a small pry bar....just don't hit it.
After running through the various implements of a trade I have learned, the captain unzipped a small duffel bag and pulled out a baby doll.
"I'm a father, you just arrived on scene and I come running up to you. This baby is pulse less and apenic. Do your thing." I run through a quick round of CPR, BLSing the baby to the ambulance while trying to get a history from the father. I verbalize dropping a tube in the back of the truck. Instead of an IV I tell them that I will use an intra osseous needle in order to secure drug and fluid access through the baby's tibia. The baby is placed on the monitor and I tell them that I will follow PALS protocols and notify the nearest children's center that I am en route with a pedi code.
The rest of the interview moves fairly quickly. They show me a picture of a three story wood frame building with fire blowing out of the bottom floor. I give a mock radio report of the building and conditions. I request police for crowd control.
We discuss building inspections and how I would deal with buisness owners offering me free things despite not passing inspections.
I tell them how a friend of mine is getting me in on a class to be certified in Neonatal Resuscitation by the American College of Pediatrics.(To be chronicled)
Finally its over and the deputy chief meets me at the door, tells me I did a good job and that he looks forward to working with me. I learn that I will be assigned to that very station, cross manning the ambulance and the first due engine for that sector of the town. He tells me that the chief likes my idea of a paramedic level technical rescue team capable of rope, confined space and water/ice operations with the possibility of a dive element. As soon as New Hampshire recognizes my NREMT Paramedic card, he tells me I will be hired.
After I finish up at the fire department I sit for a second interview. This one with the Rockingham County Ambulance Service. A countywide EMS agency that provides EMS for Nashua, Manchester and Candia with paramedic intercept for the numerous Intermediate level towns that pepper the county.
With a firefighter schedule. Two nights, two days, four days off, I will be able to have a second job. Hopefully Rockingham will see fit to take me on but if not I was offered whatever schedule i want at 20 dollars an hour with New England.
Within the next month, paperwork willing, I should be working A-2 and Engine 4 out of Pinardville.