Tagged: CMTSU

Pear shaped

Just another Sunday afternoon. Average. We’d seen a few patients, none too sick; I can’t remember what was for dinner. The fire tones dropped for a box alarm at a high rise.

It was no big deal. The engines go there multiple times a week, usually for burnt food. The timing was right for a well-done dinner. Conversation resumed in the ambulance bay.

“Fire Alarm to responding companies, I have a report of smoke in the hallway.” It was still not a very big deal; likely still burnt food.

Companies signed on scene, command was established, elevators were secured, and then things began to go sideways. “Engine 68 to Command, we’re bringing down a victim.”

That got our attention. Four of us dove for our ambulances, clearing the doors before the EMS tones could drop. We never leave together, but tonight we executed a perfect synchronized turn leaving quarters as I fell in behind Ambulance 9. A remote part of my brain saw the opening credits of Emergency! with the engine falling into formation behind the squad. That small part has never grown up, but there was no time to indulge it.

Radio traffic was busy with the ongoing rescue and a developing fire attack. The short ride seemed to take forever. As we arrived, Command was calling for us to meet the engine at the elevator bank.

Most of the residents had yet to realize that there was actually a fire in the tower. Evacuation was ongoing at what seemed a leisurely pace. We swam upstream with our gear. One elevator stood open, blinking its fire alarm light. The other showed activity on the floors above. Residents exited the stairwell and stared at us as they strolled past.

We began to review and mentally prepare. Airway is the primary concern, followed by smoke inhalation and burns. We have oxygen & the intubation kit, there are burn dressings in the first-in bags. The supervisor is en route with the cyanokit if we need it. What’s the Parkland burn formula again? It doesn’t matter; we can see the hospital from here.

The elevator dinged. The doors rolled open with a crashing rattle, and everything went pear shaped. This was not burns or smoke inhalation. It was a whole new nightmare, one I will remember for the rest of my life. My thought process came to a crashing halt just like the elevator.

Only for a second, though. We reboot quickly. We have the tools. Airway, breathing, circulation. Everything else comes later. We can do this. Let’s get moving.

Don’t get intubated

When you stop taking your Lasix because it makes you pee, you can’t breathe.

When you can’t breathe, your wife calls 911.

When your wife calls 911, the paramedics come.

When the paramedics come, they put you on CPAP.

When the paramedics put you on CPAP, you may get intubated in the Emergency Department.

Don’t get intubated in the emergency department. . .

 

(With apologies to DirecTV.)

 

 

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Heaven or hell?

“Medic 9 respond, 10 High St for the unresponsive patient.”

My partner groans. It’s a Known Address; a rooming house. In fire inspector parlance it’s a Single Room Occupancy or SRO. Each ‘apartment’ consists of one room large enough for a bed, a television, and maybe a microwave. Everyone shares a kitchen at one end of the hall and a bathroom at the other.

Its denizens are a teeming mass of humanity one small step this side of homelessness, but that’s not why we know the address. Among all the stories and lives, the mundane and the desperate, two stand out.

Jefferson is an alcoholic. He hasn’t hit bottom yet; he still pays rent and has a roof over his head. We see him regularly both here and on the streets of our city. He’s a big, mean drunk, a danger to both himself and the people who respond to help him. We dread this address because of him.

Abe, on the other hand, is a small polite diabetic. He’s always friendly, even when his sugar is in the tank. He tries hard, but sometimes it gets away from him. He apologizes after we wake him up, and he always wants to walk himself down the stairs. You just have to like him.

Big, small; friendly, mean; diabetic, alcoholic. Heaven or hell, which will it be today?

Duet

 Friends since high school, their lives have orbited and intertwined for decades.  War, marriages, children, careers; all have come and gone yet friendship remains.

Upstairs we dance the ballet.  Compressions, airway, breathing, electricity.  Three paramedics, four firefighters, and an EMT all choreographed around one person on the floor.

Downstairs a lone EMT does the real work as the curtain closes on a duet.

Dropping names

He sits on our stretcher inside the Medic 9 looking slightly dazed. The firefighters and police officers have retreated to their respective vehicles, their part in our little drama now complete.

As I peel back the layers of sweatshirts to check his blood pressure, he fixes me with an alcoholic gaze.  His eyes struggle to focus, and I’m reminded of my trusty Nikon trying to decipher a complicated scene.  In, out, in.  Bzzzt.  Finally the image resolves itself into something coherent.

“I know Mike Smith,” he tells me.

Good for you, sir.  “And who might he be?”

“You know, the Smiths.  They own this ambulance company.”

Oh, the SMITHS.  Why didn’t you say so sooner?  Of course, I know the Smiths too.  One of them signs my check every week.  I may never be invited to their home for dinner, but I’ve met them all and had conversations with them.

I’ve never heard of one named Mike.  If there is a Mike in the family tree, he must be way out among the leaves.

“So do you drink with Mike Smith often?”

“Yup, every day.”

Uh-huh.  Let’s go see the nice nurses at Local Suburban Hospital, shall we?  I think they know Mike Smith too.

Tightrope

Our city is one of a number of places which can lay claim to being the “Birthplace of the American Navy.”  Local fishermen and sailors figured prominently in George Washington’s narrow escape from New York and in his famous crossing of the Delaware.
 
Tonight there are no foreign troops in our harbor, yet the marina is protected by a large wrought iron gate.  If the Redcoats do come by sea, they won’t get in.  A firefighter holds the gate for me as I muscle the stretcher across the brick walkway.  NRP has gone ahead with the bags.
 
The stretcher and I rumble down the gangway.  The metal grating seems ephemeral; a literal ocean of blackness yawns beneath my feet.  At the bottom, the narrow wooden dock suddenly becomes a tightrope.  An ocean of cold black space looms above; an ocean of reflected stars lurks below.  We pick our way among the ropes and cleats, guided by tiny lights along the edges.  The winter’s night air seeps under my jacket, and the thought of that frigid water creeps into my soul.
 
Somehow our high wire act makes it to the end without incident, where a large white blob rocks in the darkness.  It’s completely shrouded in plastic and ready for the worst weather a New England port can muster.  A zipper is cracked, and light and sound come from inside.  I step in to find my partner, the patient, and an entire apartment’s worth of furnishings crammed into a space only slightly larger than my ambulance.
 
It’s light and warm in here, but I know we will have to walk the tightrope again soon.

Poppies

It was some time before the Cowardly Lion awakened, for he had lain among the poppies a long while, breathing in their deadly fragrance; but when he did open his eyes. . .he was very glad to find himself still alive.

–L. Frank Baum, The Wonderful Wizard of Oz

After our second dead patient of the day, NRP looks at me and says, “I haven’t had a good overdose in a while.” As if scripted, the tones drop.

Medic 9, the overdose. . .

I hate it when she does that.

It’s on the third floor, of course. The stairs fork near the top without benefit of a landing. I’ve never seen a Y-shaped stairway before. We trudge up the left fork with our jump bag, oxygen, cardiac monitor, drug box and stair chair.

Leo lies in bed in his single room apartment. He’s still awake but loopy and getting worse. He tells us he has a terminal illness, and that he can’t live with it anymore. He’s taken a large overdose of his painkillers, but he doesn’t really want to end things tonight.

We walk a fine line with our naloxone, trying to give just enough to keep him breathing without bringing his pain crashing back.

We load him into the stair chair and start to make our way downward. He nods off, but a quick shout wakes him again. “Leo, how are you doing?”

He opens his eyes and smiles. “High as a (bleeping) kite,” he mutters with a grin and nods off again.

Imperial Recreation

“Medic 9, respond for the overdose. Caller reports the patient is in the garage.”

We arrive first at a commercial occupancy late at night. From the looks of it, there shouldn’t be anyone here. The windowless steel building is dark and desolate, sitting on the edge of a scrapyard. We circle the building once, looking for signs of life and finding none. On our second pass a man emerges from a side door and waves to us. “He’s in here,” he shouts and then disappears back inside. We follow him through the door into another world.

A giant RV sits in a slightly-too-small garage. Dark and hulking, backlit by security lights and twinkling with tiny ornamental LEDs, it’s easily worth more than my house. If Darth Vader decided to go camping, this is what he would use. Our escort stands in the open doorway, beckoning us up the steps. “He’s in here!”

Inside we are greeted not by a Sith Lord but a Jedi. Old Ben Kenobi paces about in the center of the bus, in a space somehow larger than it should be. More ornamental LEDs twinkle in the ceiling, shining their star-glow down on the four of us. “I’m fine, I’m fine, I’m fine,” Ben fires off at us. “She threw me out. I’m living here. She’s going to get it all.”

He completes another circuit, then pauses to look at us. “I died on a race track once. You guys revived me. I’m fine, I’m fine, I’m fine,” and he resumes pacing.

Fun times in the city

Overheard on the radio tonight:

“Ambulance 683, respond to the police station, in the lockup, for the party who can’t open her eyes.”

“Ambulance 684, to the carwash for the motor vehicle crash with injuries. Inside.”

It’s hot, sticky, almost a full moon and it’s baaaaaaack. The night is still young.

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