He didn’t make it through the night tho.
He didn’t make it through the night tho.
ME: What’s the trouble today young lady?
PT: I’m bleeding…from my vagina.
ME: Um…this has happened before ever?
PT: Yes! A month ago actually!
PD started getting excited on their radios cuz a car accident came over and it was right at their favorite bar. Then a shooting came over at the same location. Then it turned out to be one in the same and you could hear all hell breaking loose. “It’s an MVA! It’s a shot! It’s both! Blaaah!” I was around the corner in Garvey Park so I just kinda started easing over that direction nice an’ chill like. When you’re medics, you don’t wanna get on a trauma before everyone else. Better to let the EMTs get there first, deal with all the annoying putting the dude on the backboard/getting him out of the car etc. and then you get to do the fun stuff- starting the IV, intubation, whathaveyou. So I sat on 121 and Park and listened to sirens come screaming towards me from all around the city. Emergency Services flew past- those are like the NYPD’s swat guys. Then some EMTs zipped by and we fell into place behind ‘em, bee-lining towards the sea of flashing lights.
They were pulling the dude out of his escalade. He was 60, 300 lbs and dead. There was a gunshot wound in the back of his head and no other visible injuries. His escalade was mashed into the brick wall of the cop bar. A kind of controlled chaos was hanging in the air as everyone swarmed about our business. Eerily, the guy’s cellphone won’t stop ringing.
A word about being dead: as Billy Crystal said in The Princess Bride, there’s dead and then there’s MOSTLY dead. According to our rules- you’re only truly dead if you fit certain criteria: rigor mortis- which is you know when you’re all stiff, dependent lividity- which means you’re so dead all the fluids are pooling at the lowest point in your body (yes, it’s gross), decomposition- which is self explanatory, you’re rotting and then the wonderful catchall: Obvious Death. That includes everything from beheading to burnt-to-a-crisp. Usually if brain matter is involved, it’s Obvious Death (unless the person’s still squirming). If you fit into any of those categories or have a DNR, we put a sheet over you and call it a night. Otherwise, it’s the whole rigamaroll.
This dude wasn’t quite obviously dead enough to be Obviously Dead, plus they’d already gone to work on him when we got there and it’s a whole other rigamaroll to stop a workup in progress. So we did our thing: got him on the EMT’s ambulance, I set up a fatbag o’ fluid and prepared my iv, my partner took out the laryngescope- a metal scythe shaped tool with a flashlight on the end that we use to look all the way into people’s throats so we can stick a tube down there. Meanwhile, I tossed my keys to the other EMT so he could drive our bus and yelled to the driver to start rolling.
The best way to find a good vein to poke isn’t by looking, it’s by feeling. Sometimes you’re better off not looking- you just roll your finger gently along the area where you know the juicy ones hide until you feel that bouncy vessel poking up. Then you trace it, see which direction it leads, and sink your needle just below it. When the needle finds its mark, blood pours into a little filling chamber. You push the plastic catheter forward while pulling the needle out and then attach the iv line to the hub left behind. All this happens while the EMT is frantically barreling down the street and around corners because he’s new and never been on a shooting before, let alone a crazyass car crash head shot traumatic arrest. Just as we’re ripping off scene though, the ambulance stops short.
What’s the problem? I yell from the back.
There’s a Captain onscene, the EMT reports.
So what? I ask. They’ve been getting real uptight about certain things and apparently this one wants to check on us. But really- now is not the time.
He’s blocking the bus, the EMT says.
Drive around him, I holler. Both my hands are busy trying to keep the IV bag from swinging into my partner’s face while he sticks the tube in.
We drive around the captain.
The line is in and so is the tube when we swing into the ER bay a few blocks away. Since we made patient contact, eight minutes have gone by. The energy is coursing through my body- it’s more than adrenaline- it’s the glow of total focus and purposefulness of action and it feels amazing.
At the hospital, they pronounce the dude pretty quickly, but when they x-ray his head there’s no bullet there. Now we have a riddle: there’s only one hole, so where’s the damn bullet? I ask my partner what he saw when he went to intubate. –Just a lot of blood, he says, couldn’t see much. The doctor in charge gets his suction and a light and after some cluttering around in the dead man’s mouth announces he has found the other hole. The entrance wound. Turns out our guy was a suicide. A general murmur flutters around the detectives. Apparently he was talking on the phone with his girlfriend, had been depressed for a few days, crashed the escalade and did the deed, gf still on the line. That’s why she kept calling back.
The doctor puts a sheet over him and I head outside to clean off the equipment.
Last Saturday:This dude was 60 and totally out- speaking garbly gook like he might have a head bleed but the also kinda had that o.d. look to him. Or maybe his sugar dropped. The thing is, for a medic, the most useful skill we have is our ability to get the story. The best ones are like medical Sherlock Holmeses- can figure out the whole damn scenario from getting the history. New guys always gush about the skills: can u get an iv, how many tubes have you done, etc etc but bottom line is that if you don’t know what to do with that iv when you got it, it aint worth shit. But then there’s dudes like this, who can’t tell you what’s going on cuz they’re just going: Blarga blarga blarga and the cracked out middle age ladies who were with him were either clueless or withholding info.
All they would tell us is: he’s hopped up on p-funk.
They didn’t know. His pressure wasn’t high enough to really look like a stroke and he didn’t respond when we put an amp of sugar in him, which he would’ve if he was hypoglycemic. He doesn’t look much like a standard narcotic OD either- pupils aren’t pinpoint and he’s not in respiratory depression, but he could have any number of things on board, so we push a judicious little squirt of narcan in him to see how it settles.
Full body seizure. Not even a fake one.
This’ll happens sometimes with addicts, because the narcan puts them into such immediate withdrawal their body rebels. But this wasn’t enough to do that and it seemed unlikely that he was that far in anyway. He came out of it on his own as we sped off to the hospital, where we found out from google that p-funk is a saucy mix of powdered heroin and crack-cocaine…. Which makes me think the seizure happened when the narcan zapped the heroin out of the equation and left him suddenly full of pure crack.
Sometimes all you can do is shake yer head and sigh…
Yesyes, clusterfuck, but first, this:
It’s pouring rain in that weird semi-suburban part of East New York where the mafia used to put all their dead. We’re backing up a BLS unit on another nonsense DIFFBREATHER. You can tell it’s gonna be no big thing from the call description on the monitor: FEMALE, 48, UPSET, NO MED HIST, DIFFBRTHR… and the EMTs are already inside so I tell my partner to wait in the bus, I’ll just take a quick looksee. When I open the door to the little ramshackle house I find a lake in the living room. The water is easily knee deep. A little electric pump is at the entrance, frantically scooping water up, but it’s facing the wrong way so all the waters’ splashing back into the house. An old blind guy is sitting on a mattress that’s floating in the middle of the room. He’s propped up on his elbows, looking around curiously.
Uh- sir? I say.
Sir? Someone called EMS for trouble breathing?
I gingerly wade thru the domestic tide pool to a back room, where the EMTs are chatting with a crying lady.
She didn’t take her psych meds for three days, the EMT reports
She’s not upset about…, I nod my head towards the disaster area behind me.
The EMT shrugs and the lady sobs.
Any chest pain, ma?
She shakes her head.
Any medical problems besides the psych stuff?
I make my “you good?” face at the EMTs and they nod (because EDPs get EMTs). I slosh back out into the living room, past the little floating old guy who says “eh” and out into the rainy Brooklyn night.
Ok now the story, and this people, is 1 of the ones that comes to mind when people go ‘Oh what’s the most fucked up shit you been in on the job?’:
Big T was grumpy that night, which usually meant that any little thing could ignite a rambling curseladen monologue that would eventually lead back to his wife. Always amusing, once you got past the fear that he might stab you up. But still- one of my all time favorite partners.
You can tell a shot is gonna be legit when it comes in a whole bunch of times in a whole bunch of different ways. This job came in on three different corners, once or twice as a shooting, once a stab. It’s not because there’s so many patients (usually), but more a hint of the clusterfuck that awaits us: shit is so chaotic and everyone is going batshit so everyone calls 911 with a different batshit story. As we start heading in the job becomes a CARDIAC ARREST, which doesn’t even mean he’s dead, just means more insanity. Now an arrest by its very nature requires two units, an ALS and a BLS, so the EMTs can do CPR while we start the ivs and intubate and shock and all that. But tonight, all the east new york EMTs were busy taking stuffy noses and stubbed toes to the hospital, so they had to send a unit from Crown Heights to back us up.
The night was thick with chaos. Even before we get to the job someone’s trying to flag us down cuz he’s getting his ass kicked over some petty robbery shit. Cops are flying around in all directions like dogs chasing their tails. It’s hot as shit out. We have to park at the top of the block because the whole thing is covered covered covered in people who spilled out of a houseparty whn the shooting went down. Everyone already wants to kick our assses the second we get there, and the only back up we have is a bunch of surly Long Island firefighters, who aren’t world renowned for easing the community’s aggression. They do help us cleave a path through the crowd though, and we finally get to our man.
BUT- there’s a chick clinging to him. They’re both covered in blood, who knows whose, and she’s screaming for us to help him but won’t get the f out of the way.
We erupt into a chorus of: lady, you gotta get off the dude so we can help him, lady, miss, seriously, now, lady, get off the dude NOW RIGHT NOW YOU’RE NOT HELPING.
And she’s screaming: HELP HIM MY GOD PLEASE OH HELP HIM PLEASE…
And believe me people, I wanted to physically detach her myself but i already had a large angry crowd looking for a reason to whup my ass and touching the screaming lady was not about to 2 be that reason. Meanwhile, we still have no BLS to back us up and the Fire dudes are looking pretty iffy about the whole thing.
Lady: HELP HIM! SAVE HIM! PLEASE!
Us: Get…OFF…THE SHOT DUDE…NOW!
And the guys barely moving at all.
It takes FD, PD and us to convincer her to get the f off him AND THEN: (and i don’t even like using capital letter but if i was telling u this in person I would be raising voice plenty, because although this happened a few years back when i was a new medic, the trauma of the night lingers. In a healthy way) Aaaaanyway: AND THEN: it turns out the lady didn’t even know our guy. Did…not…even…know…the dude….Damn. Just rolled up on the scene and jumped right into the action. Covered herself in his blood, delayed his medical care- which in any other circumstance would land yer ass in central booking, and he a total stranger. Well…sometimes you just have to move on.
EMTs showed up and I swear I’ve never been so happy to see them. Situations like this- you need as many hands as you can get. When we get him on the bus they get a blood pressure and cut off his clothes while i set up an iv and my partner does a full body super fast assessment. He’s got one thru the hand, one in the left chest and one in the gut. The chest one turns out to be a problem because it’s pierced his lung, collapsing it- that’s why he’s not talking. This is the most pressing issue he’s got, will kill him quickest. Second most pressing is the gut shot, because you can easily bleed out and/or later on, toxify your system from that. Those are eerie because you may not even see a drop of blood, but it’s all gathering in the abdomen somewhere and then they’ll suddenly have no blood pressure and crash, just like that.
For his bleeding out gut, we have a big bag of saline, attached through a drip set which is attached to HUGE ASS IV that I stick into his arm. The collapsed lung is more complicated: I pass my partner an equally hugeass needle, which he inserts into the third intercostals space, meaning between the second and third rib. With the needle removed, the open catheter allows the extra air that’s built up in the chest cavity to escape so that the lung can reinflate. It did and the guy started talking and looking a little more alive as we rolled into the er bay.
Unfortunately, that’s when things started getting really ugly.
We musta caught em off guard, cuz it was a hosp i’ve seen work miracles in some f’ed up situations. We definitely told the dispatcher to let them know what we were coming in with, but maybe they never got the message. Either way, they weren’t ready for us, which led to chaos: nurses and doctors running around, paging trauma teams, screaming back and forth. You know things aren’t going well when you have to repeat the presentation like five times to different people. In the midst of this, homeboy’s lung recollapsed right in front of me, so I re-decompressed him, using my partner’s needle hole as a marker. Then someone pulled out that fat iv i’d worked so hard to get, and a scramble commenced to get another. Then suddenly everyone disappeared for a haunted few seconds, but not for an x-ray, maybe just to huddle and try a new approach, cuz then they were all back with renewed chaos. I should’ve known just to do my job and back away, but like i said, i was new, and we’d worked so damn hard on this guy, i wanted to see what happened. He could see things weren’t going well, was yelling and screaming for them to help him and then finally, out of breathless and hopeless, just looked at me, dead in the eye actually, and said goodbye. Then he dropped his head back on the stretcher. They tubed him but didn’t have a oxygen ready to push into the tube, and by the time they got it his pressure was bottoming out and they whisked him away to surgery, where he died.
Having said that, there are 2 exceptions. The first is non traumatic cardiac arrest- cardiac arrest because CPR only requires hands- (the American Heart Association recently took mouth to mouth out of the equation cuz no one wanted to do it and compressions work well on their own. holla. ) and non traumatic because traumatic cardiac arrests usually involve lots of blood, and I love humanity and all but not enough to catch something nasty from some stranger. Aaaand traumatic cardiac arrests rrrrarely make it anyway.
The second exception would be the choke and by choke I don’t mean the guy holding his hands to his throat going Oh my god I’m…I’m choking! I’m choking dammnit! Because someone who tells you they’re choking is like someone telling you they’re in cardiac arrest- it means they’re not. Real chokes don’t talk, they’re too busy turning blue and coding and I’m too busy getting my forceps out and putting em down their throat. They don’t turn red. They don’t cry and moan. And usually, they were eating right before it happened, not talking on the phone with their ex like most CHOKE calls we get. But yes, for the real legit, bluefaced not talking not demand making not EDP or recently dumped choke, the good old heave ho on the tummy will do the trick most of the time and make all the difference.
So there you have it.
Now on to the subject of tonight’s pleasant/gruesome chat.
I was pleasurably napping on my couch yesterday when all the sudden I was downstairs in a strange duplex and people were filing out of some meeting on the second floor. An old scruffy fellow with a beard came up to me and sort of collapsed onto me, getting his drool all over my shirt. I lifted him up and he puked on the floor and looked like he was about to check out as I was waking up.
Damnit- I thought, back to work already…
Later that night:
You can tell this job’s gonna be retarded from the way it comes over on the screen. It’s an UNCONCIOUS and the text says “FEMALE CALLER STATES MAY HAVE LO BLOOD SUGAR” so you already know the lady is not unconscious at all, but lucid enough to be already trying to rationalize Why she called 911 and told the operator she wasn’t conscious. And it’s at a bar. Any UNCONSCIOUS at a bar sucks on principle cuz it automatically means the patient’s having more fun than we are.
When Mr C and I pull up outside 1 of these new trendy spots on Myrtle, a short white guy approaches the bus. He has thick glasses and a little hair left and carries himself like he owns the place but doesn’t want to throw it in your face but wants to make sure you know but doesn’t want any trouble either. The creases on his forehead say that he’s gonna try to maintain calm and keep control even though he’s very fucking concerned about how this looks for the business. He immediately irritates the shit outta me so I open the window just a quarter of the way. He wraps his anxious little fingers around the edge of the window and gets up on tippytoes to peer in at us.
Um- excuse me…
Yes, can we help you?
Yes, um, there is a lady inside, she was shaking, and she said that um, her sugar might be low, and um so now though she’s like, unconscious and so we you know called and she’s inside so maybe you could you know…um. Yeah.
I roll up the window.
The bar is all wide eyes and whispers. The unconscious lady has decided to stay in the back area and she’s moaning and carrying on, waving her hands in the air in the midst of a small crowd of onlookers. She’s middle aged and fattish with an indigo girls haircut leftover from 1992. Predictably, she’s trashed.
Oh god! She’s yelling in a thick british accent. God, this is- this is so Not Me! I just- I don’t know what’s wrong with me, it’s like…I’m like…It’s like I’m perhaps I’m or my sugar is low!
Are you a diabetic? Mr C asks.
No, but I mean, oh it’s crazy, I’m so, I’m so embarrassed. I mean…
Ma’am, could you hold still a second?
I mean, I’m so- this is so not me. I can’t even, oh godddddd
Ma’am, stop writhing please and sit in this nice orange chair.
(Patience waning, waning away)
It’s like…oh! I’m so embarrassed. Perhaps it’s you know, something menopausal, you know, like I don’t know, I feel so weird, perhaps it’s something with menopause…
Perhaps, I suggested, it’s that you’re drunk.
At this point her friend chimes in helpfully- Oh, she wasn’t drinking tonight!
Mostly without meaning to, both me and my partners’ eyebrows raise with wonder.
I say that I think maybe she was, just a little.
Just three vodka tonics, says the patient, but that can’t be it…
Everyone stares as we wheel her out, which usually bothers me, but this one’s still moaning and carrying on so much it’s hard not to think that she’s feeding on the attention. When we load her into the bus she enters the apologizing drunk lady phase, starting with a thick round of Oh god, I’m so sorry boys, I’m really really really really- uh sorry. Oh, I think I’m gonna be sick again, oh my god- like, i”m really really sorry, guys. I’m really embarrassed and I really think this is the menopause, you know, and maybe my sugar.
Must be some combination, dear, -the friend offers reassuringly. Some combination of chemicals, you know, in your body. Reacting to each other, you know? Not to worry- this isn’t you, darling, this isn’t you, just some combination of chemicals.
Yes, I think: alcohol and blood.
Drunk people l o v e to repeat shit, just in case in the retelling some new detail will emerge that makes it all make sense in that satisfying drunk way. And when you add a mostly drunk person to a completely drunk person, they usually end up repeating themselves and egging each other on to repeat things even more, ad nauseum (literally). So I was happy to be driving last night, and not sitting in the back listening to the pissfaced brit fest skip back to the beginning of the monologue again and again.
At Brooklyn Hospital, she decided that she needed a cool room please, and a clean bucket to be sick in, and that perhaps it was actually, you know, food poisoning.
Perhaps, my partner said, it was alcohol poisoning but she’d already cycled back to the low blood sugar theory and her friend was nodding enthusiastically.
Even later that night:
Our EMTs are dealing with a drunken head trauma when another guy approaches them to say he’s having trouble breathing. So they call us to come handle it while they continue longboarding and collaring their guy. Our guy is outside on the stoop, puking and yelling that he can’t breath. It’s dark, so we don’t really get a good look at him till we’re inside the ambulance and starting the workup. He’s 59, a diabetic and has just been having shortness of breath all day but no chest pain, no bleeding, nothing else unusual at all. When he takes a breath you can hear the rustling of excess fluid frothing in his lungs. It sounds like someone sucking the last bits of soda out of a cup of ice and it means his heart’s failing.
There’s a few things I tell my students to look for when they’re trying to assess whether a respiratory distress patient is about to check out. They’re not medically proven and you won’t find them text books, but as someone who sees people on that gray breathless line between alive and dead fairly regularly, i can tell you they are almost without fail warning signs of someone looking to not make it.
The first is Non-Tolerance of Oxygen.
I can’t breath I can’t breath!
Ok, Here’s some oxygen, this’ll help.
No! I said I can’t breath damnit! Ah!
When someone’s so deep in their hypoxic stupor that they can’t even bear to have the O2 mask strapped to their face, I start looking at my tube kit.
The second sign of imminent respiratory and then cardiac arrest is the Toilet Spin- they start making crazy circles with their upper body like someone just flushed them down the big linoleum bowl of death. Their eyes stop looking at anything at all because the patient’s too busy trying to breath to bother seeing. It may be why we call it crapping out.
Finally, Everything That Once Was Fast Gets Slow, real slow. That fast thing is how the body compensates: They can’t breath, so the heart beats faster to pump more blood to the lungs and other vital organs. The respirations speed up to try and get more air in, but adds to the hypoxia and franticness. Sometimes a patient can keep going like this for a long time, their chest muscles flexing in and out in a desperate attempt to keep breathing, but eventually, exhaustion will kick in from all that hard work, and that’s when Everything That Once Was Fast Gets Slow. They’ll go from “OhmygodhelpmeIcan’tbreath
This fellow had all that going on within minutes of getting on our ambulance. AND he had no veins for me to put an iv into. AND his lungs were quickly filling up with backedup fluid from his failing heart, so he was literally drowning inside himself, which is only a deep concept when you’re not watching it happen to someone right in front of you. Now, usually folks in this condition, it’s called Acute Pulmonary Edema, have extremely high blood pressure, which sucks a lot for them and could quickly kill them, but suck tho it may, it’s still much better than the ones with fluid filling up their lungs and NO blood pressure at all. Those guys are in whatscalled Cardiogenic Shock, and they’re fucked. That was this guy. He was cold to the touch. No one could find his blood pressure. His veins were collapsed. It was the kinda guy that you keep looking up at to make sure he hasn’t coded yet, even if he’s talking to you.
And he was talking away at first, while we were digging around in his hands for that lucky little flash of blood to tell us we had IV access and could get some life-saving meds in him. Then he got agitated, and started taking off his O2 mask, and me and Mr C exchanged a glance. Then we still couldn’t get a blood pressure or an IV and he started getting quiet, which is when I said “Imna start rolling.” As I hopped out of the back I saw him make a little sightless spin with his upper body.
When you’re a paramedic and the man you’ve been assigned to keep alive is about to die and you don’t have an IV, all you have left is you’re lights and sirens (this is why I don’t mess with patients when I aint working). I fucking flew to the hospital, my siren turned up to an ear shattering, frantic splatter that makes yuppy scum jump the fuck out the way and then look on irritably. Made it there in a minute and a half and by the time I opened up the back our man was in cardiac arrest, intubated and lifeless. Can’t say I was surprised. The only thing that didn’t fully add up about the situation was no chest pain- for someone to be in as much cardiac distress as he must’ve been, judging from his EKG and symptoms, he shoulda felt it, but diabetics are known to have whats called silent heart attacks, meaning you can catch and not know it.
In the hospital they put a central line in and got him back for about ten seconds before he coded again. They shocked him more than a few times, brought him back again, lost him again and last I checked he’d coded and revived a total of five times but was still alive and ticking all by himself.
What’s the story with this guy? The doctor wanted to know.
No history, I said, except the diabetes. No chest pain, he was just sitting on his stoop vomiting and looking like he was about to check out.
Then I remember my dream.
A five story walk-up on the Grand Concourse. Why do folks who need to be carried always live on the fifth floor or higher with no elevator? The patient’s wife opens the door and she looks like she’s not sure whether to be irritated or worried. (Strange to have our own expressions mirrored back to us for once.) She leads us inside where we find a pale, sweaty, agitated, half-drunk 40 year old with bags under his eyes, clutching his chest and yelling that he’s fine and he doesn’t need to go to the hospital so dejame en paz, carajo!…
We finally coax him to calm down and sit down and usher his teenage daughter and five year old son into another room. Turns out, the doctor told him that he ever drank again he’d have another heart attack.
And I jus had a drink.
And I’m fine. I’m- AAAAH MY CHEST!!! (Sweat sweat, clutch clutch…) But is not that bad, I swear!
It’s funny because…wait a minute, in writing that I realize that a lot of you might not find anything funny about a man having a heart attack in front of his whole family. And you’d be right not to. But in reading ahead i would encourage you to let go of preconceived notions and all that right/wrong junk and just appreciate what a pleasurable thrill the twisted disasters of life and death bring. That’s all. People die in horrible and ridiculous ways day after day and when you’re there to see it, well, sometimes all you can do is laugh- once all the busy work is done of course, and you’re having a cup of strong black coffee at the Lechoneria around the corner with your partner. It’s not that if you don’t laugh you’ll cry, it’s that if you don’t laugh you’ll become a fucking shell of a person who can’t function.
AAAAaaaaaaaaaaaaanyway, it’s funny because we spend SO Much time, Most of our Time, dealing with people that have no business at all calling 911, or even 311 for that matter, but really just want a little human touch. Okay, I’m full of sidetracks tonight, but I’m restless so bare with me- like the lady last week who said: “I was opening a window and I think I pulled a muscle and then my whole left side of my body went numb.”
And then what happened? (because you could tell there was more coming..)
So then I took my asthma pump and…
Wait, why’d you….nevermind
And it worked!
Yeah, I can feel my left side again. But my pulled muscle is still kinda bothering me.
You wann go hospital?
(Later in the elevator)
By the way, ma’am, how long ago was it that you tried to open the window, an hour or two?
No, it was like three, no four day ago.
I really enjoyed that call, actually, because it really truly had me laughing. Like LMAO kinda laughing, not just a sardonic chuckle.
AAAaaanannnnnyyywayyyy again- back to the story at hand:
Where was I? Ah yeah- it’s funny Because: we spend all this time with folks that truly don’t need us, or our 40 pounds of equipment, and then here we have what turns out on the EKG, the 12 Lead and in every possible way to be a bonafide Myochardial Infarction AKA The Big One AKA a fricken heart attack- and homeboy has no intention of letting us treat him. We practically have to beg him to let us put an iv in, and all the while:
I’m fine, I’m fine, I’m fucking AAHAHAHAHA MY FUCKIN CHEST OH CONO CARAJO MY CHEST JESUS MARY AND JOSEPH!!!
When we finally convince him to come with us to the hospital and not commit suicide by stupidity in front of his family, he want s to walk down the 5 flights. Now, believe me- just about any other patient I would’ve actually hid the stair chair from so they didn’t get any dumb ideas about being carried, but the Llaaaast thng you wanna let someone having a heart attack do is walk down 5 flights of stairs. BUT- one the other hand, the last thing our patient wanted to do was get paraded out in front of his whole building looking weak and being carried in a gimpy EMS chair by another man. So we were at a standstill.
My partner and I wasted many graphic explanations of how the heart crinkles up and dies without oxygen and what it feels like when you’re lungs fill up with fluid and you drown inside yourself (more on that in some other posting, I’m sure…) trying to reason with our dude but it was no use. He didn’t even seem to be listening, mostly just sat there sweating and clutching his chest and whining that he was okay leave me alone, papa, estoy fucking …bien… (ow! Shit!…ow!)
Finally, I lost my patience, my temper and my cool all at once and launched into a satisfying, curse-laden tangent, (any of you who’ve seen my do a workshop…like that, but without the stupid smile…)…(why should patients be the only one’s who get to curse?)…
DUDE, I said, yer gonna die. In fact yer gonna fucking die, more than likely, on this staircase, in front of your family and it’s gonna suck AND me and my partner gonna haveta stick a tube down yer throat and pump on yer chest. . It won’t be poetic, it’ll just be ridiculous. I don’t like carrying people down 5 flights of stairs, but for you it’s how it has to be. Sit in my chair. Put this sheet over your head. And stop screaming in pain and saying you’re okay, cuz you’re not. Then, we go to the hospital. Okay?
I knew he would concede when he looked at me the way I look at some EDP’s (like the one hiding the rock in his sock). It’s a look that says: Are you gonna kill me or am I gonna kill you? Or are we just gonna fucking pretend to be friends and go to the hospital without a problem?
BUT…oh, the but.
Before he could go, he had to have a pep talk with his successor. And this…really, this was one of those moments that I could kinda feel civilization crashing around me.
Before I go, he said, Bring me my boy.
Someone brought the boy (age 5 remember).
Boy- he said. He said, Papi’s going away for a little while. You da man of the house now, hear? You in charge.
His grown ass wife and mostly grown ass daughter looking on, traces of embarrassment plain to see.
You running things round here, he continued. You the boss. Okay?
The boy nodded but his face said WHAT THE FUCK IS WRONG WITH YOU DAD?
And with that, we draped the sheet of shame over his head and carried his ass down the five flights to the ambulance.
Okay people- I realize as I’m scratching out all these stories that a lot of folks don’t have much idea what the this whole EMS thing is all about. So here’s a primer for those that’re interested.
Q: What the hell is EMS anyway?
A: EMS is the Emergency Medical Services. That’s the whole system. There’s the transport side, which is mostly when nursing homes, dialysis centers, etc have contracts with private companies and call an ambulance to get their clients towed back and forth inbetween, and then there’s 911- which is when you call 911 and someone at 9 Metrotech in downtown Brooklyn directs your call to EMS and a GPS system tells them which 911 ambulance is closer. 911 has private ambulance companies, hospital ambulances and FDNY ambulances in it, all doing the same job and each claiming the other is full of useless skells and lowlifes.
Q: What are you- EMT? Paramedic? What’s the difference?
A: There’s Basic Life Support and Advanced Life Support. EMT means Emergency Medical Technicians; they do BLS, which includes bandaging, immobilizing, bleeding management, delivery of oxygen and a few medications and transportation to the hospital. Paramedics (that’s me) do ALS, which involves more invasive procedures like giving IVs, intubation, needle cricothryoidotomy (putting a HUGE ass needle right below someone’s adam’s apple when they have an airway obstruction) and chest decompression (putting that same hugeass needle inbetween someone’s ribs to let the air out of their chest cavity when their lung collapses.) We also give medications, about 50 of them from Adenosine to Vasopressin, and are equipped to do for an asthma or heart attack what any Emergency Room would do in the first hour of treatment. If you call 911 and say you stubbed your toe they’ll send you EMTs. If you say you stubbed your toe and your chest hurts, you’ll probably get medics. If you tell them you stubbed your toe and now you’re dead, they’ll send both. It’s happened. Sometimes EMTs will get called for the sick and get there and find a heart attack, so they can call for us. You get shot, it’s EMTs unless you get so shot up your unconscious or dead. That’s why sometimes we medics keep an ear to PD radio and take a quick ride over when there’s a shooting. If you “feel weird” you get EMTs unless you’re especially old or diabetic, then you get us. It’s all a little ridiculous but also there’sa weird logic to it. I’ll just say, when the man called the other night to tell 911 that he was unconscious, they made the job an “UNCONSCIOUS” and sent us. If you just had a seizure it’s EMTs but if you’re having one, even if you’re the one saying you’re having one, it’s a “STAT EP” (status epilepticus) and it’s medics. Even the guy that calls every other weekend because he feels like he’s about to have a seizure, but never actually does, even he gets medics, even though he’s actually an EDP and EDPs get EMTs.
Q: What’s an EDP?
A: Emotionally Disturbed Person. Aaah we could go on for hours about the many wondrous events that happen when folks don’t take their psych meds or lose their shit for one reason or another. Any of us could go EDP at any given moment, far as I can tell, cuz they range the range across all borders. Many jobs will start as DIFF BREATHER and end up as EDP when we get there and patient says something like “I haven’t been able to exhale for like three days,” or “I haven’t taken my psyche meds and I want to fucking kill somebody.” Sometimes EDPs hide behind locked doors, which makes them BARRICADED EDPs, or hide weapons places (“that’s just my rock…i keep him in a sock…” which makes them VIOLENT EDPs. They can also stand up on high places, when they become the JUMPERUP, and then fall, when they become JUMPERDOWN.
NYPD is always getting into a hot mess over EDPs and then having to get retrained on how to deal with them. Usually its cuz they get confrontational with em, and the last person you need to argue with is someone who’s completely disengaged from reality (“Sir, you need to go to the hospital.” “I am in the hospital…” “uh…”). It’s like arguing with the last drunk guy at the party. (most recently see: Iman Morales, who was screaming naked on a Bed Stuy fire escape before PD tasered him, causing him to fall to his death.)
Q: Do you really drive the ambulance?
A: We do and yes it’s really cool but blowing lights and parting traffic jams like the red sea is really not nearly as cool as some of the shit that happens in the back of the ambulance. But people are usually more excited about the woop-woop.
Q: What’s like the craziest shit you’ve ever seen?
A: Why do people always ask that like they’re the first person to think of asking it? I dunno, depends on when you ask I guess. I’ll probably blog about it sometime…
Q: Do people really call for stubbed toes?
A: Stubbed toes, runny noses, burning genitalia, crying babies. “I feel: tired, sick, lonely, strange, different, okay, weird…” “I have an appointment at the hospital.” “I just needed to get out of my house for a while.” “I was bored.” “I hate my husband.” “Can you look at this huge cyst I have on my nuts?” “My tooth hurts since like, three weeks ago.” “I don’t want to talk about it.” “I’m bleeding from vagina, same as i was about a month ago.” “i can’t get out of my chair but i don’t want to got to the hospital, just help me…get…unstuck…”
Those are really the vast majority of our calls. About 80% let’s say is freakish dumbshit and then 15% is like mildly important medical situations and the last 5 is really good urgent crazy shit. Depends on the week though.
Finally, I’ll end with this one:
We were called for the CARDIAC- 78 year old with chest pain. We arrive to find a dapper little elderly gentleman sitting calmly in his East New York apartment.
Whats the trouble today sir?
My heart is broken.
It’s broken I say.
It hurts a lot.
How…long has it been going on?
Oh quite a few years now.
You want to…go to the emergency room?
And away we went.
Well: I was really planning on the next piece i wrote being about all the mundane bullshit we do, which is like 90% of the job, especially cuz now i got fricken jud and saraivy telling me how i’m just trying to show off on facebook with all the gory shit we do…BUT, f them- cuz this week was Babalu’s day, and in his catholic form, Babalu was Lazarus, who Jesus famously raised from the dead, and in honor of this I somehow ended up with 2 Babalu-relevant jobs, and I’m sitting here bored out my skull so I will now share them with you.
There’s this crackhead motel on 125 and Park. Everytime we go there it’s some scene out of The Wire or Pulp Fiction. Job comes in as first DIFFBREATHER, then UNCONCSCIOUS and then, inevitably, ARREST. Means the guy’s supposedly dead. We get there, walk up the rickety stairs and our dude is laid out doing a very loose impression of a dead person, surrounded by a swath of mortified and confused cops and fire fighters.
On a sidenote: this is a classic firefighter maneuver called The Circle Of Death: it’s when they get there first and form into a small circle of curious white faces looking down at the patient. It’s FDNY sign language for ‘what the fu-u-ck?’ Many a time we roll up on scene to find this peculiar huddle and it’s usually not a good sign.
Anyway, if you’re any kind of medical personnel you get good quick at knowing the difference between a true cardiac arrest and a guy that wants attention (the best are the fake seizures, when they go “I’m having a seizure!” and squirm awkwardly till they realize you’re not buying it). But firefighters and cops are not trained in this art, so they really were convinced. O and I took one look at the man and O set up the stair chair and i said “Get…up!”
First he squirmed and moaned and the firefighters all gasped. “Get up and get in my chair,” and reluctantly, he struggled to his feet and planted himself in our chair as the room fell completely silent.
We had ourselves a good chuckle driving back to our spot when it was all over. Not so much at the fireguys’ expense (a little though…) if not at the whole situation in general: here we are again in the midst of this whole huge bureaucratic clusterfuck, dozens of different agencies and crossed lines and legalities and so much work done covering ass and so little done treating patients, between dispatchers and insurance companies and godknows what kind of existential spiritual lifendeath tug-of-war, and right smack at the center of it all is five guys with helmets standing in a circle around one old bobo trying his best to look dead so he can get a night of sleep away from the other crackheads.
That was Wednesday, December 17, sacred to San Lazaro, who shocked everyone by
Which brings us to the second cardiac arrest of the night.
No wait, first, another sidenote:
Approximately 100% of the recently dead on tv and movies who are treated with a touch of poorly performed CPR come springing right back to life and go back to killing bad guys. Most notably, James Bond, who just one movie ago defibrillated himself back from the beyond and then went on playing poker straight away.
Yeah- that’s not how it works. First of all, it’s literally about 1-2% of people we get in arrest ever get a pulse back at all. In my five year career I’ve gotten 2 maybe 3 pulses back total. Second of all, and maybe most importantly, of those few the vast vast majority of them are total vegetable matter from then on out. You just can’t deprive a brain of oxygen for that long and pop back around like nothing happened, it doesn’t work that way. In NY the situation’s complicated even more by tall buildings, projects, traffic and numerous other obstacles delaying patient contact.
So, so so so, that means when it’s your time it’s your time, and most guys that’ve been working the field long enough know better than to walk into every arrest that comes over and raise the dead.
I was particularly feeling that way on Saturday, not just cuz of the first messy arrest, but because i was working with, oh let’s call him Gerk- a certain medic that I just wouldn’t trust giving treatment to anyone i knew or cared about or had ever met. At all. I mean- well his name says it all. And then I was even less thrilled, you can imagine (maybe…) when the second arrest of the night came over not long after we finished cleaning up the first one. Oh lord, i said to myself, this poor whomever, wrong night to flatline…
Whomever turns out to be a 72 year old Indian gentleman lying flat on his back in his underpants with a bright red flare of blood at his lips and nostrils and a burly EMT thumping up and down on his chest,. He has no signs of trauma and appears to be in good health except for a large unsightly triple bypass scar stretching across his chest (and the fact that he’s dead).
Our monitor says he’s flatline, so there’s no movement at all in the electricity of his heart, nothing to shock in other words, so I start looking for a place to put my iv while Gerk prepares his tube kit to get an airway. This guy has only slightly better veins than the last lady, and having no heartbeat doesn’t help, but i manage to sneak one in right along the top of his left hand. Gerk’s having trouble with the tube, to his credit the blood in the airway means he’s just staring into a dark tunnel of fluid, with surely no vocal chords in sight to pass the tube through. Eventually, we do get it though, and just when I’m thinking the EMT is gonna have his own cardiac incident from how hard he’s pumping and sweating, someone announces that they felt a pulse.
No shit, i think, but there it is- a vigorous thump-thumping along his carotid artery. There’s some excitement now as the crew shifts course, one EMT running off to get the stretcher, the other taking the blood pressure, Gerk on the phone with our on-line medical control to get more meds, me and the lieutenant prepping the patient for transport. As we pull up I check again and miracle of miracles, there it is, that rhythmic murmur of pressure against my finger… In the ER bay they do their usual half-joking complaining about how we have all the fun and get right to work on him, setting up a dopamine drip, getting a ventilator set up, etc. I can’t help but feel good, and I’m literally typing the first words of a jubilant text message to Gabi when I see all the nurses run over and a doctor start compressions again.
The family’s all there screaming and praying as we load up our post-arrest patient and stick him in the ambulance, and though I’m trying to be pessimistic I’m feeling good about this one right up until he arrests again as we’re flying along to the hospital. He’d come back strong with a solid blood pressure and the pulse way up in the high 140’s but halfway to Wyckoff his heart dropped back down to the 60’s, then 30’s, and while we’re frantically working on him he loses pulses again completely and we’re back to thumping his chest while trying to keep balance amidst the tossing and turning of Brooklyn streets.
Crap! I shut the phone right quick and walk over cringing. For a third time though, our man decides to live that night, and this time he stays for good. When we leave the hospital he’s pumping away all by himself, but he’s still, and maybe always will be, a vegetable.
As we pull up I check again and miracle of miracles, there it is, that rhythmic murmur of pressure against my finger… In the ER bay they do their usual half-joking complaining about how we have all the fun and get right to work on him, setting up a dopamine drip, getting a ventilator set up, etc. I can’t help but feel good, and I’m literally typing the first words of a jubilant text message to Gabi when I see all the nurses run over and a doctor start compressions again.
My partner C was here last time this guy tried this, and he’s asking the wife what our patient took tonight but she won’t say. The EMTs get the bag-valve mask on to giving him respirations and I’m driving tonight, so i set up the IV while C gets down to where the patient is and starts looking for a vein. The guy’s teenage son is coming in and out, I’m trying to get a coherent story while squeezing saline into lines and ripping open plastic bags, but all we can get is that the guy was drinking all night, has been depressed, has tried this before, etc etc. There’s a not that says “Dear so-n-so i love you and i’m sorry’ and then it’s all garbly chicken scratch. PD was here a few months back cuz our man locked himself in a room with a gun (a BARRICADED EDP- more on that some other time…). He’s h e a v y like you wouldn’t believe and out like a pile a rocks. I pass C the tourniquet, then the catheter (a smallish one, cuz the fellow’s fat so he’s a tougher stick and there’s no reason for anything big), and when he reports that he’s in i hand over the iv lock and a flush of saline water along with the stickies to hold it on.
But a suicide is a horse of a slightly different color than a typical addict OD, especially when the guy is HUGE, has taken unknown mountains of unknown narcs and is already pretty far gone. So we drop in the two mgs, enough to make your average user do the shitnpuke right quick, and it doesn’t even touch him. Practically bounces off the guy. He’s still pinpoint, obtunded, not-breathing. A hot mess. And we’re all still wedged into this awkward space between the bed and the wall. I pass C an amp of dextrose, sugar water, in case on top of everything else he happens to be diabetic and hypoglycemic as well, and then another 2 mg of narcan. Then we start packaging to go, cuz he’s still not responding and we’re reaching our limit of options. It takes about five of us to get him, strap him to a board and get him moving. We’ve all carried some fatties, but this guy is solid, dead weight and managed to collapse into a particularly un-reachable corner of the master bedroom. So we heave and ho and finally begin carting him through the windy passage ways back towards the street.
Just before we make it back out I see his arm start to raise up, and slowly he blinks back into consciousness. He looks around groggily. His hands are taped together to keep them from flopping out of the stretcher. He has an iv in him. He’s surrounded by cops and medics. He looks each of us in the eye and says:
”Fuck you guys, why didn’t you leave me the fuck alone…” and then falls grumpily back into his stupor. Then he wakes up again as we loading him up. “Damn you. Damn you all. Motherfuckers…”
What do you say to a dude like this? I mean, none of us are really in it for the thank yous, but shiet- if yer gonna be hufuckingmongous and a big a-hole to boot, yer ass can walk to the ambulance or just keep it to yerself. But in the end, you say nothing. You chuckle. Brush it off and take homeboy to the hospital, where he proceeds to curse out each and every one of the nurses, security guards and techs and then falls back asleep.
And then you go get dinner.