Some jobs you walk in and know exactly whats goinon and what’s gonna happen next and all the things you’re gonna haveta do etc etc. You can see the whole thing wind out in front of you like a damn roadmap, and you quickly fall into the rhythm and BAM it’s over before you know it.
This wasn’t one of those jobs.
A bigass dude, and I don’t mean big boned (all though he was that too) but Large and In Charge, looking a little worried and breathing kinda heavy. Our guy’s sitting on his bed in what’s called tripod position, leaning forward with his hands on his knees, puffing in and out like he just spent 20 minutes underwater. Still, I’ve seen much worse and he’s not blue, not lethargic, not gasping. At this point, could be a anxiety attack, a mellow dramatic head cold or a bad breakup.
He’s only 34 but has an enlarged heart- damn near the size of my head, the x ray later reveals- and i literally coulda crawled into his belly and taken a nap it was so effin huge, probably from the excess fluid buildup from his backed up heart.
When your ventricles are that gigantoid, they don’t work right. Sometimes they work so asscrappily that the blood doesn’t fully make it out and stays backed up, which causes the bodywide puffiness. That’s when the right ventricle backs up. When the left one goes the fluid ends up in your lungs, and that’s when you start drowning in yourself.
Neither of this dude’s ventricles were working well. You could hear the excess blood lapping up against his lungwalls, a rising inner tide.

Jumped into action. Checked his ekg (predictably fast but otherwise ok), found a vein and put an IV in. Put some nitroglycerin under his tongue to open up those tightly clenched blood vessels, lower that pressure some and get the blood flowing. Got ready to move.
Now there’s something bout moving patients that completely fucks em up. Even a relatively stable patient that we’re literally lifting up to put on the chair and carrying the whole way, no exertion whatsoever, can still end up like 5 degrees more effed up by the time you get em on the ambulance. It’s just the stress of moving, being moved, I suppose, plus the sudden rush of cold air when they get outside never helps. But it’s something you count on, so especially when it’s a dude like this, you treat a little aggressive before you move just to pre-empt the inevitable decline.
The problem was, this dude was getting worse and worse even before we started moving him. His mild discomfort had blossomed into a full blown freak out, which was causing him to stress his already taxed heart even more. The fluid was rising steadily higher and higher with each passing moment. My partner and i were doing the everything’s cool routine, without lying to him about what ws going on mind you, I’m just sayin we weren’t panicked, but there was no mistaking how fast we were moving. Dude was agitated.
So we get em on the chair but when I tell you I was eyeing it to see if it’d give out…Anyway, the other problem was that he lived DOWNstairs, which meant we were gonna havta heave him UP ‘em to get out. Plus he was in some weird basement complex, so we had 2 wind our way through a weird atrium, back into a building, over cracks and bumps and through a little tunnel b4 reaching the stairwell. And lemme tell you: the only thing worse than lugging hugeness is lugging hugeness that is freaking the fuck out and about to code. By the Grace of God we got to the stairs and then I swear it was like some serious epic shit, every single step. I was on the top part, yelling in Spanish at the patient “Tranquilo, papa, ¡calmate coño!” and a cop had the bottom bar, and he was just lookn copconfused and sweating. We heavehoe’d each step, letting out some real Neanderthal-ass grunts and there was a couple times i really didn’t think it was gonna happen but it did and we loaded him up in the bus and reassessed.
He was still bad, flopping and flailing bad, but not quite as bad as he coulda been. We’d pushed lasix earlier, which drains you out and makes you haveta pee something mean, and a few more nitros were working their way thru his system. My guess was that he’d make it (he did). Hopped in front, came up on the radio to let the hospital know were coming and what we had, drove the fuck off in a blur of blasting sirens and flashing lights.


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