“Rescue 1, respond to 398 Oxford Street for a man ill.”

I keyed the mike.

“Rescue 1, on the way.”

Just when things were getting good. Claire was up to her knees in blood and gore, while Jamie fought for his life on the battlefield. In another page or two the confrontation between father and son will take place, and even though I know who won the war, I have no idea if William will kill his father, or if Jamie kills his son, though I suspect some compromise will occur, wartime honor and chivalry or something like that and father and son will survive, and go on to fight another day.

1776 isn’t going anywhere, I folded the back cover into page 687 and put the book aside. A couple of hundred years ago troops came from Providence, joined the Continental Army and fought for our independence. Allen’s Avenue was probably little more than a trail, and Oxford Street a path used mostly by wildlife, but that is the road I travel tonight, in search of a “man ill.”

How far we’ve come.

A hundred yards from the front door of 398 Oxford Street the radio sparked to life.

“Rescue 1, we have a report of a suicidal male at that address, stage for police.”

“Roger.”

A woman stood at the doorway waving frantically. Against my better judgement, we forged ahead, stopping at the front door.

“Rescue 1 on scene.”

She led us up some stairs and into her apartment, through a comfortable living room toward the rear of the house. I hoped the suicidal male wasn’t planning on shooting himself, or blowing himself up.

Propped on an elbow, vomiting, was our patient. I’d never seen skin so colorless, it was if it didn’t exist. His eyes pleaded for mercy, or escape, or death, or a combination of the three, then he let his head rest, into the pool of vomit. The frantic woman handed me seven or eight empty pill bottles.

“He took them all,” she manager to blurt out, maybe in Spanish, maybe English, I sometimes can’t tell the difference.

“Rescue 1 to Fire Alarm, send a company for assistance, no police on scene.”

“Roger Rescue 1.”

I dragged the man out of the contaminated area, he soaked up most of the vomit with his skin and clothes.  I didn’t want to work in the middle of it. Rubin, my partner for the night had the stair chair ready, we tried and failed to get the man strapped in. He was a big guy, two-hundred pounds at least, out cold now, diaphoretic and somehow even more pale than when we found him. His mother continued screaming. I heard the sound of Engine 10′s sirens in the distance, a soothing diversion to the woman’s high pitched wail.

Some of the empty pill bottles used to contain Ribavirin, the others Haladol. The patient’s breathing slowed, eyes rolled back, body soaked and limp. Rubil looked at me, thinking I had some answers.  I knew the Haladol was heavy duty psych medication but had no idea what the other was for. I did know that the combination was doing what the patient had intended; killing him.

“Shouldn’t we start an IV?” he asked.

The 10′s were on the next block. The hospital ten blocks away.

“Not yet.”

The calvary came over the hill just in time. The guys from Engine ten climbed the stairs, saw our predicament and immediately went to work. A couple of guys helped us lift him onto the chair, the other guys cleared a path and we got him outside, onto the stretcher and into the truck. Oxygen and an IV vital signs, some narcan for good measure and we were ready to go.

The rear doors of the rescue closed. As if on cue, the patient started the most violent seizure activity I’ve seen in ages. It lasted for about a minute, then stopped as quickly as it began.

The calvary was here, but the army was still blocks away.

“Let’s go.”

Things are a little different in the trauma room. First, the lighting is better. Second, there are a lot of people around. Third, and for me, best of all is there is somebody else responsible for the patient. This time it was Dr. Victoria, one of the resident MD’s. It’s amazing how a year in one of the country’s busiest emergency departments prepares a person for just about any medical emergency. I gave her my report, she got to work. Just a year ago she observed, now, the buck stopped with her, and I was quite relieved to pass it.

Within minutes, the man was medicated, intubated and stabilized. They were getting ready to administer activated charcoal as I left.

It is frustrating knowing all I can do is bag somebody until he eventually dies. I could have, and probably would have administered the charcoal in the rescue if time permitted, but doubt if that alone would have been enough. The frustration is only temporary, however, knowing that the best Level 1 Trauma Center anywhere is right around the corner.

I found out later that Ribiviren is a drug used to treat Hepatitis C. The patient’s prognosis is not good.

http://theemtspot.com/2010/05/28/the-may-2010-handover-blog-carnival/

One of the best, and probably the most informative blog I’ve come across is The EMT Spot. Steve is hosting this month’s edition of The Handover, the only one I’ve missed. I wrote this as a comment but figured I’d post it here.

http://theemtspot.com/

Thanks for stopping by.

When it all Came Together

The dog was dead. The woman stood in the middle of the road, screaming. The car that struck the dog was gone.

My partner at the time called it HHS and looked bored. (HHS is short for Hysterical Hispanic Syndrome in these parts.)

I walked over to the woman, tried to get her out of the road and into the rescue. She wouldn’t leave her dog. A bystander told me the woman was deaf, her dog specially trained to assist with doorbells and other sounds.

This was a bond that went deeper than one would have first thought. The dead dog had been her companion for eight years, offering everything to a woman who lived in silence.

I stood in the roadway, trying to think of a way out of this predicament while my partner, who was actually the senior person on our crew and supposedly in charge talked on the phone picking players for his fantasy football team.

I got a sheet from the truck, bent over the dead dog, carefully wrapped him in the sheet, leaving his dead face exposed and presented the body to the woman. She stopped screaming, cradled the body and walked out of the street and into her apartment, and closed the door.

Then and there I knew that all the medical training in the world is useless in a person who has no heart. I decided to stay on the rescue after ten years fighting fires.

I haven’t looked back, and have no regrets.

“I can’t walk.”

“Well, that presents us with a problem.”

“What do you mean?”

“We can’t bring the hospital to you, and you can’t walk.”

“But I need my meds.”

“Then you need to walk.”

“I can’t”

“You’re thirty years old with no medical problems, walked fine yesterday, even managed to get up those stairs.”

“Well I can’t walk today.”

Another country heard from.

“Just get her to the hospital!”

“Any suggestions?”

“Carry her.”

Half way down the spiral stairs the other country heard from went into some ridiculous tirade about how incompetent we are, how “you’re supposed to be professionals,” and how we had better smarten up and get her down the stairs.

“I must have fallen asleep during the spiral stair extrication class.”

“Just do your job!”

The patient stayed catatonic. She said her legs just suddenly went numb and couldn’t help at all and the pain was unbearable.

The other country’s cell phone rang, apparently something more important came up, at least it kept him occupied until we managed to get the catatonic person to the bottom of the stairs where we put her in a stair chair and carried her to the stretcher and loaded her into the truck.

An hour later I saw her walking out of the hospital. A cynical man would assume she had a pocket full of Vicodin.

I spent nearly an hour in her home, talking with her friend, learning why she refused to get out of bed, refused to stop drinking and refused to join the rest of us in life. Her boss had been there earlier, poured two bottles of vodka down the drain and left with her wallet so she couldn’t get more. She had no family to speak of, a brother in Maine, parents dead, husband of twenty years dead since August.

A big black German Shepard cried at the rear door during what I call negotiations, eventually I let him in. I think that may have been the breaking point, she showed a little sign of life once the being closest to her showed concern. She got out of bed, threw on some clothes and gave in.

“I’ll go.”

Her friend closed up the house, promised to take care of the dog and simply looked relieved as this drama seemed to be heading in the right direction.

What had started in the usual way actually looked like it might have some sort of happy ending. I’ve done this a few times, and it never is easy. Somebody is refusing to take care of themselves, drinking, not eating, not bathing, just waiting to die. I cannot make them go if they don’t want to. Because somebody else thinks it is in their best interest to get on with things is no reason to drag somebody from their home and force them to rejoin society. It’s still a free country, we are free to thrive, or not.

That being said, I am free to use all of my powers of persuasion to make a difference. It is one of my strengths as an EMT. Some of us are great clinicians, others born to teach. I’m more of a therapist. Every now and then I get the tough stick or impossible tube, but talking has always been my strong point. Even when talking to the dog makes the patient pay attention, get dressed and get in the rescue. Whatever works.

We rode to the hospital, me and this desperate forty-four year old widow. She was still reluctant to give up the life she had been living since her husband’s death. But she had the courage to get going, this being the first step. I did my best to explain the procedure at the ER, how it can be cold and impersonal, but when she gets to her room and wakes in the morning the healing can begin, for real. I think she believed me.

I had her on the stretcher, she really couldn’t walk that well. We wheeled her into the busy ER. The triage nurse barely glanced in our direction.

“Can she get off the stretcher?”

“Not really.”

“What do you mean, not really?” a look of disgust from the RN.

“She’s hurting.”

“We don’t have any beds, put her in a chair and throw her in the waiting room.”

Throw her. I swear to god that is what she said.

When you lose perspective and compassion, it’s time to find a new job. Maybe administration, maybe retirement, I don’t know, but get the hell out of the ER.

Perhaps if she had spent an hour in this patients home, saw the wedding pictures over the mantle, the notes from her dead husband still on the refrigerator, the dog, well taken care of and still mourning the loss of his master, the NASCAR posters and cars in the living room, the men’s sneakers still in their spot, only unfilled for five months now, probably longer considering he fought a two year battle against cancer she wouldn’t have said, “throw her in the waiting room.”

After explaining the situation, and seeing my words fall on deaf ears, I realized that she actually would have left her there, alone, to rot.

I swear, I will never be that kind of person, no matter what comes my way.

I stayed with her until I found another nurse, and a compassionate registrar, and made sure she was okay.

Her friend walked in and I left the hospital, all I can do is hope for the best. People make our health care system work. When some of those people are broken, the entire system suffers. A broken link in the chain of patient care throws all the good everybody involved has done into the trash, and everything we do is rendered useless.

One bad apple is all it takes.

http://www.projo.com/news/content/Moulage_Man_05-23-10_CHIJ5FV_v74.173f4093.html

Who is that Mad Scientist? It’s none other than JoeEMT, frequent commenter here, previous Rescue Captain at Rescue 5 and current firefighter at Engine 10.

Great work Joe!

I wonder…

Does he remember his friend being dragged from his side, hysterical, and a firefighter taking his place?

Does he remember the collar going around his neck?

His arms being held down?

His legs tied to the board?

A 16 Guage IV inserted into his arm?

A mask covering his face?

Me, pushing his head down and securing it to the board?

Me again, looking into his eyes, telling him to relax, save his energy, stop fighting?

Does he remember the ride in the rescue at one in the morning, being taken away from the party, leaving his friends behind, drunk, crying, yelling and in shock? Or the trauma room, where he finally stopped struggling and lie still, barely breathing?

Does he know that right now he is in the ICU with a swollen brain; the result of a fall through a second story railing onto cement, and his family is by his side, hoping and praying that the boy they sent to Providence for college makes it home? Or walks again? Or hasn’t suffered permanent brain damage?

Does he know that his father is bringing the kids he can find that were at the party into the hospital room, one at at time and letting them see the result of reckless behavior, even though the experience is killing him, hoping they will avoid the same fate?

Does he know that there is a very good chance that he will never regain consciousness, but might linger for years in that strange place between life and death?

Does he know anything now, or is it all gone, finished when he struck his head, and it’s just a matter of time till they pull the plug?

I wonder.

http://www.projo.com/news/content/STATION_FINAL_SETTLEMENT_05-19-10_MOII0T6_v10.38f9466.html

“Don’t you make fun of me!” she shouted at the super market customers who walked past her. People came and went, some gawking, some ignoring, some just glancing our way. A spilled gallon of milk rested between her legs, a bag of groceries sat next to her, filled with what she had planned to be the ingredients for a “nice night.” A 1/2 gallon of ice cream, some steaks, a can of veggies and some boil in bag rice packages were supposed to be put together for her and her man. Fate intervened. “A friend” offered to “split a pint.”

“Joann, why did you do it?”

“To kill my pain.”

Last week I found her at Kennedy Plaza, unconscious at Bus Stop K. We get a lot of drunks there, usually homeless men, worn out from life on the streets. A blond, young woman stood out, even lying down. She stirred when I shook her but was unable to get up, or even get on the stretcher. We lifted her, she struggled. Somehow during the struggle her shirt and bra lifted, exposing her torso. 80% of her body had been burned, badly. Her breasts were there, but instead of smooth skin and nipples something that resembled wet particle board had taken its place. Any nourishment or pleasure that may have come from her body burned away.

She lay in the stretcher, covered now by a few sheets but still semi-conscious. I sat in the Captains Chair and watched her sleep. The fire spared her face, but her hair had to be carefully combed to hide the bald spots where the grafts prohibited new growth. She was pretty, troubled and scarred, emotionally and physically.

The people continued to stream in and out of the store. Normal people doing normal things. Things Joanne should be doing, rather than drinking a pint with another desperate soul at five in the afternoon.

“I have to take you to the hospital.”

“Can’t I go home?”

“You’re drunk and high. I don’t think so.”

We helped her to the truck. She managed to stay upright in on the bench seat. She told me her address.

“Is anybody home?”

“My man.”

“Will he be mad if I take you home like this?”

“A little.”

They would have let her ice cream melt if I took her to the hospital.

And thrown away her dinner.

And her man would wonder where she was.

And I think she has suffered enough.

I took her home.

All the money in the world won’t give back what was taken from the survivors of The Station Fire.

May they find peace, finally, and those who did not survive, may they rest in peace.

Thursday, February 20th, 2003

Louis S. Alves
Kevin Anderson
Stacie Angers
Christopher Arruda
Eugene Avilez
Tina Ayer
Karla Bagtaz
Mary H. Baker
Thomas Barnett
Laureen Beauchaine
Steven Thomas Blom
William Christopher Bonardi
Kristine Carbone
Richard A. Cabral, Jr.
William Cartwright
Edward B. Corbet III
Michael Cordier
Alfred Crisostomi
Robert Croteau
Lisa D’Andrea
Matthew P. Darby
Dina Ann DeMaio
Albert Anthony DiBonaventura
Rachel DePietro (Florio)
Christina DiRienzo
Kevin J. Dunn
Lori K. Durante
Edward Ervanian
Thomas Fleming
Rachael K. Florio-DePietro
Mark A. Fontaine
Chief Petty Officer Daniel Frederickson
Michael Fresolo
James Gahan
Melvin Gerfin
Laura Gillet
Charline Elaine Gingras-Fick
Michael James Gonsalves
James Gooden
Derek Gray
Pamela Gruttadauria
Scott “Skott” Greene
Scott Griffith
Bonnie L. Hamelin
Jude Henault
Andrew Hoban
Abbie L. Hoisington
Michael Hoogasian
Sandy Hoogasian
Carlton “Bud” Howorth III
Eric James Hyer
Derek Brian Johnson
Lisa Kelly
Tracy F. King
Michael Joseph Kulz
Keith Lapierre
Dale Latulippe
Stephen M. Libera
John M. Longiaru
Ty Longley
Andrea Mancini
Keith A. Mancini
Steven Mancini
Judith Manzo
Thomas Marion, Jr.
Jeffery Martin
Tammy Mattera-Housa
Kristen McQuarrie
Thomas Medeiros
Samuel Miceli
Donna M. Mitchell
Leigh Ann Moreau
Ryan M. Morin
Jason Morton
Katherine O’Donnell
Nicholas O’Neill
Matthew James Pickett
Carlos L. Pimentel Sr.
Christopher Prouty
Jeffrey Rader
Teresa Rakoski
Robert L. Reisner III
Walter Rich
Donald Roderiques
Tracey Romanoff
Joseph Rossi
Bridget Sanetti
Rebecca “Becky” Shaw
Dennis Smith
Mitchell Shubert
Victor Stark
Benjamin Suffoletto
Linda Suffoletto
Shawn Sweet
Jason Sylvester
Sarah Jane Telgarsky
Kelly Viera
Kevin Washburn
Everett “Tommy” Woodmansee
Robert Daniel Young

Sincere condolences to the families, from a Providence Firefighter.

http://wbx.me/l/?p=1&u=http%3A%2F%2Fwww.ems1.com%2F

Try to visit EMS1 and vote for your favorite story as it relates to this year’s EMS week theme, “Anytime, Anywhere, we’ll be there.” Below is my entry, a revised version of an earlier post. It didn’t make it to the finals, and when you read the entries that did, you will see why!

Great job and congratulations to the finalists.

Close Call
“Rescue 1, Respond to 1835 Broad Street for an intoxicated male at the payphone.” Duty calls. Duty waits. I refastened my belt loosely and hit the pole. “Rescue 1, responding.” We rolled out of the station and into the city. Some folks would have taken care of business first; others may have gone out of service until the job was done. Not me. Nope, a call for help needs to be answered. I cleared my mind and focused on the emergency. Not my emergency. That would have to wait. It wasn’t long before the cause of my discomfort was on my stretcher and I sat behind him, squirming. Now and then my pressure relief valve opened, biding me time and some unintended revenge as the intoxicated homeless man wrinkled his bulbous nose and slurred, “What stinks?” As we rolled our patient through the ER doors I realized I had reached the crossroads. A pivotal decision waited. The staff rest room was occupied, the public one simply out of the question. “We have to get back to the station,” I said to my partner, Mark. “I’ve got to go.”
A good partner knows instinctively when things are critical. “Let’s roll.” It’s a three mile trip from the Emergency Room to the Fire Station. ETA six minutes. I could probably make it. Everything was going great, light traffic, perfect weather conditions, no road construction in sight. I could see the Promised Land in the distance, a little more than a minute away. I relaxed, briefly. “A train!” said Mark, hitting the brakes as my intestines churned. “You have got to be kidding.” “It’s the Harbor Chemical Train, slowest moving locomotive on the Eastern Seaboard!”  “Oh. My. God.” I was now diaphoretic and rapidly cramping. Respirations increased as my heart raced. The railway gates closed, blocking our approach. Lights flashed, the shuffling monster crept toward the intersection.  Just when I thought all was lost, a slight reprieve. Mark rolled the window down. “Turn around, we’ll backtrack to the one way, circle around the bookstore, go up the one way down and double back over the railroad tracks.” “Done.” He flicked on the warning lights and turned around.  We approached the one-way, ready to make our move when a Battalion Chief appeared in the distance, heading our way. “BOGEY AT 12 O’CLOCK!” said Mark, turning off the emergency lights. I curled my toes, smiled and waved politely to the chief as we passed his vehicle. We were now headed in the exact opposite direction of the Promised Land. Suddenly, inspiration. “Stop at the Burger Place!” “You must be desperate.” “I am.” I flashed back to my last visit to this particular facility; an overdose in one of the stalls. Hygiene was not a priority. Thirty seconds later the pain in my abdomen subsided. “I think I can make it, keep going.” “Are you sure?” “I can do this. I can.” We left the burger joint in the dust. The station was around the next bend, salvation moments away. I saw it in the distance, a beacon, a ray of light, the most beautiful thing I had ever seen. We roared onto the ramp, I rolled under the slowly opening overhead door and duck walked to the rest room, just in the nick of time. The radio came to life.   “Rescue 1, are you available?”   I smiled and keyed the mike.   “Roger that, what have you got?”

The hour was late, somewhere between total darkness and the crack of dawn. The usual suspects had been rounded up already, the drunks, crackheads, lunatics, brawlers and assault victims treated and released, or hunkered down for the night.

My patient followed me through the doors of the ER, followed by Brian, who had my back. We seated him out of earshot and far enough away from another patient who continuously shouted weird things to nobody in particular. I couldn’t wait to tell my story, certain that my patient was by far the craziest of the night.

“Get this,” I said to the triage nurse, who shall remain nameless. “This guy thinks he was bit by a mouse, but isn’t sure if it was his cat scratching him because the cat and mouse have been fighting all week and he finally had enough and broke up the fight. He’s not sure if he is rabid or suffering from Cat Scratch Fever, but he has started to hallucinate and is positive the cats and mice are conspiring against him and it’s only a matter of time before they take over.

“Beat that,” I smugly said to myself and waited for the triage nurse who shall remain nameless to be shocked, amused or something.

Instead, she raised one eyebrow and glanced in the direction of the “other” patient who was now shouting something about the F.B.I.

“Well,” she said. “He’s been banging his dog for weeks.”

I hope the dog’s okay.

At the end of the road, fifty yards from the river on the front steps of a well maintained home sat a sixty-year old woman. Her brother stood close by, apologetic and concerned.

“We tried to get her to go but she won’t budge.”

The woman stayed seated, defiant. She knew what little control was hers was about to be taken away, and she had no intention of giving it up willingly. A little dog scurried close by, I knelt and scratched behind his ears as the intoxicated woman looked on.

“She’s been drinking for ten days. Says she wants to drink herself to death. My sister is inside getting some things.”

I looked her in the eye while petting her dog.

“We’re taking you to the hospital.”

“Bullshit,” she slurred.

One of the firefighters who was on scene before us chimed in.

“We can do this the easy way or the hard way, it’s up to you.”

I never was a fan of the strongarm tactic.

“In five minutes we are going to be at the ER. I know you don’t want to go but I am required by law to intervene if family members present a strong  case that you may harm yourself. And, you are intoxicated, so I can’t leave you here.”

She tried to rationalize, tried to claim her freedom was being compromised, tried to get up and run, tried to be a rock and refuse to cooperate.

Years ago I would have called police, let the firefighters help me wrestle her and tie her to the stretcher and drag her away from her home. Today, I let go of the dog, took hold of her arm, had my partner take the other and lifted her to her feet. We walked to the stretcher, put her on it and fastened the seat belts. The struggle lasted about twenty seconds, then the crying began. She cried all the way to the hospital, taking a break now and then to glare at me, but her resolve was broken, along with her spirt. She did make one desperate lunge for the rear door, but before the seatbelt was undone I had her back down.

Five minutes later we brought her in.

I do these things mostly on automatic pilot now, there have been so many incidents. As I walked out the door of the ER the woman’s sister who had accompanied us in the back of the rescue stopped me. She took my hand and looked me in the eye.

“I want to thank you for being so kind.”

She held the gaze for a moment, her eyes filled up and she turned and walked away.

I quickly wiped my own eyes and got back in the truck.

Alcoholism is a crafty, evil disease.

Something is seriously wrong with me. I’m haunted by the images and memories of murders, accidents, suicides and dead people, but god forbid a call for “two dead bodies at 84 Oxford Street,” of “a motorcycle accident on Prarie Avenue,” or a “suicidal female,” or “gunshot wounds,” or “multiple stabbings” comes in and I miss it.

I’ve lost count of the number of times I’ve cleared a scene or the triage desk to respond to something horrible. Then I whine about it, or write about it here. You would think I’d just let it go. But I can’t.

Something is definately not right.

I’ll let you know when I figure it out.

“You don’t like me do you?” he asked.

It was late. We had been running all night, he had been drinking all night. He smelled. We smelled. He smelled worse. A lot worse. Days of piss dried onto filthy clothing reeks. It fills the back of the rescue instantly, making me retch.

I could have said, “No, I don’t.”

Having somebody dislike you is far better than not being seen at all.

I could have said, “Of course I like you, you are a fellow human being, and I’m here to help you get back on your feet, brother.”

Everybody needs a little kindness now and then.

I could have said, as I’ve told him before, “I don’t necessarily dislike you.”

That’s better than nothing.

Instead I chose the worst possible thing to say.

“I don’t care enough about you to like or dislike you. You simply don’t matter to me one way or the other.”

I knew what I said was the last thing he needed. I said it anyway.

He looked crushed.

Sorry about that, Kevin, sometimes I can be a first class asshole.

He seemed like a nice enough kid, polite and all, figured I’d give him a break and take him for a ride-along. He needed ten hours rescue time to get his EMT-B license, provided, of course he pass the written tests and finishes his hospital time and doesn’t bomb the labs.

He hadn’t walked in the door when the first call came in. Mind you this was  Tuesday night, best chance of a quiet night we have here in the Capitol City, usually 4 or 5 runs before midnight and two or three after.

I forget the exact order the runs came our way, but by midnight a suicidal female overdosed and was seconds awar from respatory arrest, two firefighters were injured at a fire in our district, a pedestrian was struck, an allergic reaction at the local college and an intoxicated Kevin. Prior to his arrival we responded to an MVA and an emotionally unstable six year old.

Things went downhill after midnight and continued until seven o’clock last night when I finally was relieved, and what a relief it was!

Twenty-seven calls in twenty four hours. I’m getting way to old for that pace!

I hold the student fully responsible. Some folks are just Black Clouds.