It hasn’t been a great week. We ran all the usual EMS annoyances, from truck swaps through ignorant hospital staff to late calls. I’m still adjusting to my new schedule, and my family is having a harder time than I. They’ve all managed to contract the flu.
Yesterday we were reminded that sometimes Evil truly walks the earth, this time in the form of one young man in a small town a mere 180 miles from here. A small town very like this one. . .
Add in early orthodonture and the intricate ballet that is Christmas with three different sets of grandparents, and you can see that I wasn’t spreading much holiday cheer this morning.
And what happened, then? Well, in Whoville they say – that the Grinch’s small heart grew three sizes that day.
Thank you, Random Jeep Lady. It was a simple gesture, and I surely can afford my own drive-thru order. Your random act reminded me that there are still Good and Nice in the world and came at a time when I really needed it.
Pay it forward, folks. You never know.
From the adjacent curtain bay:
“Good afternoon, sir. I’m Doctor Attending. What brings you in to see us this afternoon?”
“Well, back on March 15th. . .”
The door rolls up as I approach, and I hear the Powerstroke cough to life. I’m not on the clock for another ten minutes, but I’ll do the right thing and relieve the overnight crew. Regular Partner arrives as I take the reins, and we are off into the crisp fall morning.
“Medic 9, be advised we’re giving pre-arrival instructions. Ambulance 9 is coming in behind you.”
My luck has run out. I haven’t had a cardiac arrest in ages. I got to bed late last night and was up an hour early. I’m still getting over a cold and feel exhausted already. I haven’t had my tea, haven’t checked the equipment, and I’m not even officially here yet. It’s not about me, though. Someone has stopped breathing; bring it on.
And so the day goes. Pulses return, are lost, and return again. Chest pain, overdose, morbid obesity, Jaws of Life; our routine is shot but we’re rockin’ & rollin’ & Making a Difference. Seventeen hours later we sit in the parking lot of the downtown Dunkin Donuts, exhausted and four reports behind in our documentation. I finally have my tea in hand, girding myself for another hour’s worth of writing, as Bert the Muppet cruises past on a moped.
Welcome to October in the Witch City.
It’s been a while since I’ve had a theme day at work. Today started to look
like a Syncope Day, but that fizzled. Then we began to notice a pattern: all of our patients have had blood sugar readings in the same 6-point range. Every last one.
If only I played the lottery.
“Medic 9, respond for the unresponsive male. . .”
A BLS ambulance arrives before us and begins doing their thing. He has a pulse but isn't breathing. Oxygen and a BVM will take care of that for the moment. His environment suggests heroin overdose; his pinpoint pupils and track marks scream it. The Narcan performs its miracle and soon he's awake and talking to us.
Of course he denies using anything illicit. When asked if he realizes he wasn't breathing, he insists that “I'm just really tired.”
“Medic 9, respond for the shortness of breath. . .”
We arrive to find a befuddled fire crew staring at our patient, who sits on the edge of her bed waving a CPAP mask. “It's not working,” she says. “I can't go to sleep; I'll DIE!” As paramedic and resident sleep apneic, I am the appointed expert.
I really don't know much about anyone's machine other than my own, so I deploy my best cable company troubleshooting skills: unplug, wait 30 seconds, plug in. The machine beeps once, blinks twice, and begins doing its thing.
“Medic 9, respond for the unresponsive male with CPR in progress. . .”
We arrive in a perfect storm of fire engines, ambulances, and police all converging on one dilapidated apartment building. No one is doing CPR, but it isn't necessary. This looks familiar: environment, pupils, track marks. The treatment becomes routine: BVM, Narcan. Shortly he's awake and claiming, “I was just really tired.”
Two police cruisers idle in the cul-de-sac, lights off, projecting calm authority. Nothing to see here. Move along. An apologetic looking sergeant steps from his air conditioned refuge as we arrive. “She's off her medications again,” he tells us. “I've spoken to her doctor, and the paperwork is on its way.”
But of course it isn't here yet. We take a moment to discuss the situation and opt to wait. The officers say she won't go voluntarily, and there is no point in escalating the situation until we have all our tools in place.
She has different plans, however. Suddenly she materializes on the front lawn and walks to the side door of our truck, bemused police officer in tow. My first impression is of someone my age trying to look like an 80's pop star. Somehow I don't find that strange on this day, in this city. Her left hand clutches a half-empty iced coffee with which she gestures for effect. “Let's go.” She points at the ambulance with her straw.
Inside, I try to be nice. “So what's going on this afternoon, Ms. Lauper? Why am I here?” The response is vulgar and not informative. I try again, but now she feels my family and lineage are somehow relevant to her situation.
I sit on the bench and initiate the Stare of Life. I have nothing to treat and she won't talk to me, so I sit quietly and watch. She alternates her time between looking out the back window at traffic and shooting confused glances at me. I'm not going to play the game.
I have seven minutes of intermission before Act Two will begin at the Emergency Department.
A mild summer afternoon has turned to a muggy evening. The June storms have arrived, bringing a paradoxical increase in the temperature. We stand in the open garage bay facing south as lightning illuminates the clouds above, each flash forming shadow images on the horizon.
The minor league ball game across the street has called a rain delay. Neil Diamond blares “Raindrops Keep Falling on my Head” as the crowd thins out. The bravest souls move up in the stands seeking shelter under the overhanging roof.
One by one, heavy jetliners appear over my left shoulder seemingly just beyond arm’s reach. They drone onward below the storm clouds on final approach to Big City International Airport. Occasionally the storm will silhouette one against the sky, burning its image into my memory.
Gunshots ring out across the city, faint but too irregular to be fireworks. We turn up the police radio and wait, as the ball field begins to play “Here Comes the Sun.”
With #MarchofFilm completed, I need to pay attention to Project 366 again. I’ve still been doing as much film shooting as possible. This past week saw two experiments, one successful and one not so much.
First up was an attempt at red scale photography. Redscale is a technique where film is respooled backwards so the light passes through the film base before striking the emulsion. The resulting images show a red or orange color cast.
I shot my first roll in the Nikon N65. The auto DX coding made it difficult to get enough overexposure, resulting in dark, grainy images.
4/2 Dover Point
First negatives out of the new darkroom, and the first ones at home in over a decade. Ilford HP5+ black & white.
4/4 – Beth ‘training’ with Cricket.
Voigtlander Vito B with Ektar 100.
The end of the week brought a different experiment. I attempted my first roll of cross-processed film, Fuji Velvia 100 shot in the YashicaMat LM. Cross-processing (x-pro) also involves a color shift, based on processing slide film in negative chemistry. The results vary based on the film and chemistry used. In contrast to the redscale, these came out stunning.
4/5/12, Old Town Hill with Beth & Cricket:
4/6/12 “Locust Towers”:
4/7 – Sunrise over Stetson St. Vito B/Ektar 100.
4/7 – lest you think I forgot (iPhone)
4/8 – the ambulance bay (again) Voigtlander Vito B, Kodak Ektar 100, handheld slow exposure. It’s a lucky effect but I love it.
Also 4/8. Another lucky shot.
4/9 – Newburyport waterfront. Vito B/Ektar again.
4/10 is already here.
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.