GO TO PRISON OR DON’T SAVE YOUR BUDDY

Ok, that’s not a real choice anyone should ever have to make.
I just liked the title and I chose it because people seem to think that’s the deal. I’m here to dispel that myth.
Let me explain:
I was speaking on a panel this weekend for the Audre Lorde Project’s summit on keeping Brooklyn safe for LGBTQ folks and it was pointed out that a lot of people have trouble figuring out who’s the cops and who’s not. This is very true- we all wear the same navy blue uniforms with many pocketed pants and have blaring radios and that self-important strut. It can be a lethal mistake though, because, as happened the other day, people are less than willing to speak to cops about things they really do need to be telling paramedics.

At daybreak we found ourselves in a shwank lower-east side condo looking down at a middle-aged hipster who was literally blue. When you’re upset and trying to pretend you can’t breathe to get back at your girlfriend or whatever, you turn red. When you actually can’t breathe and are about to die or already did, you’re blue. Elmo vs. Grover. This dude was blue, not breathing, out. While we start getting set up to put some air in him I yell over to his buddies: “What’d he take last night?”

Now look- it was kind of a formality, i admit. There’s really only so many things that’ll do that to you and most of them are heroine or some family of it. His pinpoint-ass pupils confirm that it’s some opiate involved, but whatever, it’s always good to ask.
“Uh,” the friend yammers. “I mean, some beer and some weed, that’s like it really.”
The thing about a heroine OD that’s awesome is we have this drug narcan that I’ve already blogged quite a bit about and it whups you out of that high so quick you don’t know what hit you and go into withdrawal in the blink of an eye. It’s not fun, but still better than respiratory arrest and death.
So, I’d like to think most medics would give that Narcan shot regardless of what dude’s dumbass friends said, but the friends don’t know that. For all they know, we’ll swallow whatever dumb story they invent and be on our merry way while homeboy codes in the back of the ambulance. Of course they were all high as hell too and surely we were interrupting their pleasurable afterparty. As it happened, another medic on the scene DID go for their story (he was pretty new) but we talked him out of it and of course we gave the shot and the dude came back all irritable and groggy and ‘Oh my god I just died’ and all the friends gawked and we hauled the dude out and that was that.

The point is, EMS is not PD. Patient confidentiality laws prohibit us from telling cops anything pertinent about the patient, including what drugs they did to make them that way. If anything, you can usually take one of us aside, away from all the po-pos and have a word in private. Do that, because the alternative, letting your friend drop dead because you don’t want to face too many questions, is much much worse.

¡ECLAMPSIA!

I was working BLS this weekend, which basically means I’m lugging 30 lbs less equipment and they send us the stupid nonsense calls on purpose instead of by mistake. Except this one: comes over as your average boringass ‘SICK’ call, which can be anything from ‘My nose hurts’ to ‘I’m upset.’ This one was 23 year old female with headache. No further information. Fine. When we get there a dude’s flagging us down from outside the building looking real urgent. “She’s having a stroke or a seizure or something! Come quickly! Please!”

I’ve already mentioned that people love to hurry us along for even the lonliest little toothache or whatever, but as time goes by you can kinda distinguish between the guy that is just wants to someone around and the person who really and truly fears for their loved one’s life. This guy was definitely the second. Then he mentioned, as we hustled through an outer open area and up some stairs, that his wife had just delivered a baby five days ago.

Now here’s where any medic or EMT worth their salt should have the word ‘eclampsia’ dancing through their mind. Not as a definite, cuz we gotta wait till we see the patient and all that, but between the call information and the husband’s story, you have a pretty textbook eclamptic patient. What it is is an obstetrics disorder where the blood pressure shoots through the roof causing blurred vision, massive headaches, edema in the extremities and sometimes blood backing up in the lungs. All that is pre-eclampsia, when the patient actually goes into a full tonic-clonic seizure it becomes eclampsia proper, which is gets its name from the Greek word meaning “shining forth.”  It’s rare we see even a pre-eclampsia in the field and rarer still to see a fully seizing pregnant woman, but sure enough when we walk in we find the patient just finishing her last convulsion and settling into a postictal stupor complete with snoring respirations, drooling, rolling eyes and occasional tremors. (I’ve heard varying reports but apparently it can happen up to 4 weeks after delivery.)

So, like I said, I’m BLS and don’t have any medicines with me and really there’s nothing worse than being at the scene of some magnanimous disaster and utterly helpless to do anything about it (See previous posting for more on that…) The family is going through all the motions of utter freakout, from screaming that she’s going to die (her mom) to trying to shut the gloomy screaming lady up (her husband) to bawling and pointing (her nieces and nephews). The pregnancy wasn’t high-risk, plus it’s over, and she has no medical problems so you can see they were all taken totally off guard when she suddenly seized after complaining of headaches and blurred vision all day. I call for a medic bus to back us up and my partner and I start getting her ready to go. Baby’s sleeping quietly in her crib the whole time.

The medics are waiting for us downstairs. I give the story as I’m fighting the stairchair with the lady in it over some bumpy pavement, praying she doesn’t seize again and topple. We’re on the bus and let me tell you, when I’m working BLS and medics show up I generally make it my business to be quiet and stay out the way, mostly because the worst thing in an emergency is three alpha medics yelling three different things. Plus, the guy working was a friend of mine and knows what he’s doing. HOWEVER, just when it seems like we’ve fallen into the whole swing of the job and everything’s moving along smoothly, he goes for an utterly different medication, Dextrose in fact, which would infer a treatment modality for a whole other situation than what we’re dealing with.
“Wait!”
I really don’t like doing that, especially when there’s a student, another medic and an EMT all right there. The guy looked at me cock-eyed. I ran down the list of symptoms and watched it dawn on him. “Why didn’t you say all that when we got here?”
“I did!” I had!
“Oh! I didn’t hear you. And I figured my partner’da given me the story.” She hadn’t.
A moment went by where we all kinda looked at each other. Then I don’t know if anyone said anything or what but we all just fell back into the business of treating the patient, now truly on the same page. Magnesium Sulfate relaxes the smooth muscles and can ease/prevent the eclamptic seizures. We also treat asthma with it and a rare form of v-fib called Torsades de Pointes. You have to mix 2 gms of it up in a 50 ml bag of saline and set the drip rate to deliver it over 10 minutes, which is a little project unto itself, so while the other medic is doing that I get on the phone with our telemetry doctor to get clearance to give the medicine.
Talking to telemetry can be an outrageous experience. There’s a medic that you have to get through to actually speak to the doctor and he’s always angry about the fact that he’s wasting away in an office while you’re out there having fun in the street and he always manages to find something to pick a fight over. I brush through him as quickly as I can, doing everything possible not to take the bait of his irritability. Then some absurd pop song comes on, because I’m on *&*&#^#*! hold of all things and finally the doctor gets on. I spit the situation out quick to him and make it very clear with my tone that I know what I’m doing, because certain doctors enjoy verbally shredding medics when they smell uncertainty. “Alright give the mag,” he mumbles, hangsup and returns to his cave.
When I get back in the bus I see the medic has asked the student to draw up the 2 gms of Mag, which he’s done, but now he’s got the syringe full of medicine and is reaching for the patient’s IV, about to mainline it. I can’t say for sure that his would kill her, but anytime you dilute a medicine in saline and drip it over 10 minutes it’s for a reason. Both me and the other medic yell “NO!” and lunge at the student who realizes his mistake and cringes. We gank the syringe from him. “Sit down,” the medic says.
“But…”
SIT.
he does.
We put the mag in the bag and I hop in the driver’s seat while they set the drip rate. Get on the mic to give our notification as I peel off into traffic. She saves her last seizure for when we roll up into the ER bay, which makes getting her out of the bus and into hospital but we eventually manage and the doctors swirl in on her as we yell out the story once again. After some messiness, they break the seizures and she’s sleeping quietly when I leave, her worried husband holding her hand and shaking his head.

STUCK: A Long Night In The Ambulance During Snowpocalypse 2010

Since the snow is once again billowing down on NYC I thought I’d take a second to recall my lovely experience during the original Snowpocalypse 2011.

It started coming down heavy midafternoon and Brooklyn was already completely blanketed head-to-toe in white (omit gentrification joke) by the time I got to work at 6.  There were no plows out, barely any buses or cars and only a few scattered people here and there. Our first job took us from Brooklyn Hospital to Fulton and Kingston, which on a normal day isn’t bad but during the arctic death blast turned out to be quite a trek- didn’t want to drive too fast because it took me about 3 blocks to come to a full stop, but I didn’t want to stop either because that meant maybe never starting again. PLUS every three to five minutes the back of the bus would jacknife around and try to pass the front. When we get there, a solid twenty minutes later, the radio’s crackling with units responding two a double shooting not far away, one of the victims is dead and the other’s critical. Our patient though is upset because every time the wind blows in her face she becomes short of breath.
Are you short of breath now?
No! Ze wind she is not blowing!
Do you want to go to the hospital?
But of course! I could not breathe!
The hospital, mind you, was around the corner, but she wanted to go to another swankier one across town. That didn’t happen. When we dropped her off at the crummy around the corner hospital the shot guy’s homeboys were just getting there and running rampant around the ER looking for their friend, who was resting in peace under a sheet in the resus room. When they found him they erupted into a barrage of curseouts and revenge promises and we left outta there, turned onto the completely snowed in Atlantic Ave and immediately almost got stuck. But we didn’t, barely, and made it back to Brooklyn Hospital.
Meanwhile- the radio is nonstop with units getting stuck. I mean- EVERYONE was in a snowbank somewhere, completely snowed in and once they came up on the air to report getting free it was usually on a few minutes before they were stuck again. This meant, besides the huge backlog of jobs building, that paramedic units were getting assigned lower priority jobs and EMT units higher priority jobs, just because the dispatcher was forced to hand out jobs to whoever might be available at the moment.  Total disaster, in other words. Meanwhile, not a plow in sight.
We got stuck on Fulton and St Felix for like ten minutes, dug out, got stuck again a block further, dug out, got another job, took us about twenty-five minutes to get five blocks away for a kid that bumped her head in the PJs and thennnnnn lord have mercy they sent us to Red Hook.
Now, for those of you that don’t know Brooklyn, if downtown Brooklyn is on some Day After Tomorrow Code Three disaster status you KNOW a backalley boondocky spot like Red Hook is gonna be all the worse. We got detoured by a jacknifed tractor trailor and ended up winding along Van Brunt Street, which runs by the dockyards. Then we hit a non-moving line of cars, tried to turn off down a sidestreet and got really really really stuck. A couple neighbors came out to help us dig snow along with a happy little Pakistani guy who was stuck behind us and an ornery Mexican that came down the wrong way and got stuck in front of us.  Finally we dug out, backed back onto Van Brunt and got stuck again. This is when the wind picked up and started bullwhipping icy snow into our faces, thank you very much.
My partner, who was in the back doing her hair while I jolted the bus back and forth trying to lurch us out, puked. Then she cursed out almost every element in the natural world and went back to doing her hair.
It was getting on towards midnight. The radio was still crackling with units getting stuck. I added our names to the list and gave up. We’d moved a half a block in two hours and were only deeper entrenched than before. I had some cold coffee and two chicken wings and three quarters of a tank of gas.  The snow was up to the doors. I tweeted. I gchatted. I laughed. My partner woke up around 3 and started cursing again and went back to sleep.

The radio never stopped chattering with units and they’re stuckness except now none of them were getting unstuck, they were just holing up like we were. For a while people were updating, cuz EMS is really update-retentive about crap, you always gotta account for yourself if you’re somewhere too long or they start coming for your wig. But during snowpocalypse it just got relentless and the dispatcher  started coming up on the air with this whole “OK, Units, I know you’re stuck. If you’re still stuck, don’t update, I know it. Just be quiet. If you get unstuck just hit your button. I don’t need the updates. Thank you.” And then it’d get real quiet, cuz frankly that’s all that was happening. Then of course every couple hours some horrific exchange would go down- a unit would get to an Abdominal Pain and find someone lying dead in the street instead and then all the units trying to back them up would get stuck on the way and then they’d get stuck and be screaming on the air like some horror show… it was not fun.

I think the first time I saw a plow it was after midnight, and- surprise surprise, it was stuck.
I slept from dawn till 8 when some firefighters trudged up to our happy little embankment and informed us that we were stuck.
Oh crap really?
Looks like it.
Well gee.
You got a supervisor you can call or somethin’?

We trudged the five blocks to their rig and they gave us a ride back to our base where we dried off, coffeed up and then i jumped into an SUV with this old Jamaican cat that was going to help out our other unit.
Basically nothing was plowed that morning except Atlantic Avenue, some of Fourth Avenue and a few of the major throughway streets in Bed-Stuy. A few. We were lucky enough to fall in behind a jeep full of Mexicans with shovels who happily jumped out every time a car got stuck in front of us and dig them out and then whizzed past them laughing. That’s the only reason I made it home at all.

Made it to bed sometime that afternoon and woke up to hear the Mayor blaming EMS for our shoddy response time.

OFF DUTY

 It was daybreak and the daytour was giving me a ride home. We were just pulling off from the ER bay when a dude came running up to the ambulance. Now…when people come running up to ambulances about 90% of the time it’s to either ask directions or tell us about how their friend’s like sooo totally drunk could you just like take her blood pressure or whatever. So, excuse us if we don’t get really excited when folks come tapping on the window. Anyway, it was still dark out and we couldnt quite tell which of the 2 this guy was until he said “Yo, some old dude just got fucked up over there!” Still…this could mean sooo many things, but we rush on over and sure enough, there’s a car sticking out of a building and an old dude crumpled on the curb next to it. And yeah, he was pretty bad, because as we were approaching I first thought he was just a pile of random debris, so still was that old dude. Usually when you mistake people for inanimate objects it’s because they’re dead, but this guy actually took a breath just as we started going to work on him. So he wasn’t dead, but he was an absolute complete damn mess. The bystander’s description actually turned out to be pretty accurate. I’d thought he had been in the car and either been ejected or stumbled out when it crashed. Usually when people are ejected though they’re like, across the street or in a tree somewhere, not right right there. What actually happened was the guy’d been on the far adjacent corner, minding his, when a carload of drunken patygirls barreled on through, clipped him and sent him in a massive acrobatic airborn spin across the street and onto the curb. To hear the witness tell it, the guy’d done like three pirouettes and a butterfly kick on the way (“Yo, his legs went up like this and they kinda did one a these and then he rolled up and over” like it was all in slowmo…).
Anyway, then the car had swerved and smashed into the wall, the gaggle of hoochie mammas all hopped out at once, clucking away apparently, took one look at the patient and screamed, simultaneously “YOU KILLED HIM!” and clackity-clacked off towards Flatbush in a perfume flavored huff. The driver, a really irritated looking dude, was standing there talking to 911 on his cellphone when we rolled up, trying to make it sound as little his fault as possible (“No, the guy musta been drunk! Walked right into my car!”)

We call for backup, put the patient in the back and take a look at what we got. The left tibia is pretty much shattered, his left arm is pretzeled and there’s an open wound where the bone broke, and he’s got more than a few ribs that are in many many pieces. Also, he’s got a buncha little cuts and bruises and whoknowswhats going on with his head. We have him boarded and collared and nothing seems to be actively bleeding anywhere, although there’s blood EVERYWHERE.
He’s coming around, which is wretched for him in the short term but ultimately is a pretty good sign. What’s not good is that as we’re getting ready to go the genius that hit him decides he has neck and back pain and needs to go to the hospital too. I’ve been in this situation before, and it sucks. Since there was no other ambulance on scene, it means we can’t leave without technically abandoning a patient and opening ourselves up to colossal lawsuits, getting fired, all kindsa stupidness.
We come up on the air, tryna express the urgency of the situation without cursing, and then get back to caring for the patient while we wait for another unit to show up.
At this point i remember I’m off duty. Not only off duty, I’m wearing some a spiffy all white suit (for a change) that miraculously has remained bloodstain free up to this point. I’ve always said if some mess goes down while I’m not on the bus you probably won’t be seeing me leaping across the street to stick my fingers in the muck. It’s not that I don’t care about my fellow humans- I wouldn’t be doing the job if that were the case- it’s just that without any equipment there’s really not much I can do for you. CPR…that’s about it. Anyway, here I was in my civies, off the clock, and yet I had a bus full of medic goodies to play with. What struck me though, as I was reaching over the crumpled up old guy to put an IV in, was how different it felt, being out of uniform and dealing with all this mess…It seems like a small thing, or it did, but the mental space that wearing those techpants and button shirt and having that heavy belt on put you in is thoroughly somewhere else from the I’m-just-walking-down-the-street-in-my-nice-white-suit mental space. Like, a whole other planet. The physical act of gearing up, clocking in, checking out the ambulance, carrying around that chattery little radio…it all serves to ground us into that realm of service- a singlemindedness that I’ve spoken of before that can be so cleansing when it climaxes in the thick of a brutal job.
Without all that, i felt naked.
The other unit finally skidds up and we speed off. The dude’s talking and conscious by the time we roll into Belleview. The sun rises. I help the daycrew clean out the back of the bus. scrubbing away blood, picking up shredded clothing and bandage wrappers. I wonder, as we made our way back to Brooklyn along the East River, what life will be like when I’m done with this job for good and no longer spending half my week intimately wrapped in the ridiculous and tragic beating heart of the city around me. I think I’ll miss it.

STAT EP

Seizures suck.
Now that we’ve got that important announcement out of the way, lemme clarify some things bout EMS and seziures: If you call 911 right after someone seizes, the call type is just “Seizure” and they send EMTs. If you call while someone is having a seizure, they presume it’s been going on for long enough to qualify as status epilepticus, which is a prolonged series of seizures without a lucid interval inbetween, and the job becomes a “Stat Ep,” and they send paramedics. Also, if you call 911 and say “Yo, I’m abouta catch a seizure son!” they make the job a “Stat Ep” and send medics, unfortunately. This happens more often than anyone would care to know about. (More on the difference btwn EMTs and Paramedics here.)

Anyway, there’s a couple reasons one might catch a seizure. Most common is epilepsy, which really just means you’re prone to seize, but there’s also hypoxic seizures which you get from lack of oxygen and usually precede death by a couple seconds, withdrawal seizures, including delerium tremens, and seizures resulting from traumatic brain injury. But by far the most common seizure call I’ve ever done is this one guy, we’ll call him Fred, that we always find blasted out his mind and writhing in a puddle of his own pee on the last stop of the cross town bus in Harlem. This dude, every—-night gets obliterated, on what Fred?
“ABTHOLUTELY!!”
The Vodka?
“YETH!”
Are you sure?
“ABTHOLUTELY!!”
Ok.
And winds up cursing out everyone around and screaming that he’s having a seizure (so it’s a Stat Ep). Or sometimes chest pain (“The Cardiac”). Then we lug his pee-covered ass to the hospital and by some unknown bum magic Fred always emerges the next day at dawn, not only sober and with a British accent but wearing pressed pants and alligator shoes, all dapper and ready for another day of getting blitzed and writhing round in his pee.

True seizure patients are usually really out of it for a while after they come around, sometimes get violent and wanna pound you for taking them to the hospital, sometimes they do not under any circumstances want to be bothered by anyone and often act like a teenager not getting up for school in the morning. Also they’re confused, cuz last they remembered they were sitting at the table or whatever and suddenly they’re across the room with a fat lip looking up at me and I’m holding a big needle. Or, in what might a worst case scenario we had a while back, they wake up butt naked in the basement of an HIV shelter covered in their own feces. I’m still not sure how the dude got down there. I mean, he was a resident of the place, but still- damn. The security guard was ornery and couldn’t give us much of a story. I tossed the dude a sheet and he kinda cleaned off best he could, mumbled something about ‘yeah this happens sometimes’ (o.O) and walked out to the ambulance. Well…hobbled kinda.
When we got to the hospital he insisted on walking in, even though we realllllly dont recommend it cuz if you seized once you might damn well seize again. But dude wanted to walk and wouldn’t be dissuaded.
Halfway between the bus and the door he turns the wrong direction and takes two steps. I open my mouth to say “No it’s over…” and then realize what’s happening. I break into a mad dash towards him as his body goes rigid and he starts to keel over backwards, get there just in time to stop his head from exploding on the concrete and lower him down gently as his whole body rocks into a grand mal seizure. My partner that night,  a confirmed jackass, pokes his head around the corner.
“What’s wrong?”
I’m holding this 300 lb seizing man’s face away from the gravel in an ER bay. What the *#&(@*%)#@*#*Q@ do you think is wrong?! “Get me the stretcher!”
“What happened?”
“STRETCHER!! NOW!!”
Partner disappears and shows up not with the stretcher but with…an oxygen tank.
Lemme tell you something: yes, by the guidelines and protocols, a seizure patient gets oxygen. Yes. This is true. But what this one in particular needed was to not be seizing on pavement. And what this paramedic needed was not be holding him up. I think I cursed out my partner. I’m not totally sure, cuz it all happened very fast, but eventually he made the stretcher happen, after some grumbling. It’s probably a good thing my hands were busy. By the time we got dude on the stretcher he’d wrapped up the shaking and fallen into that deep sleep. At least he woke up in better circumstances the second time.

WEIRD LITTLE RUNNING GUY RUNS OFF

I know this job is gonna be ignorant the second it comes over because the text is telling me to go to a psyche facility to pick up a patient acting mentally unstable. I’m already deeply unimpressed and we haven’t even got on scene. However, I’m also happy: psych patients usually walk all by themselves and provide for good conversation to boot. This one, as if to prove my point. disappears up a flight and is gone the second we arrive. The guy running the place comes over looking exhausted.
“This guy’s acting fucking crazy!”
“Sir…this is a psychiatric facility, correct?”
(I shouldn’t even need to have this conversation)
“Yes, but he’s really acting bonkers man! He might set the place on fire or something.”
It’s amazing how two people can create total chaos all by themselves.
“We don’t chase people,” I say, putting down my bags and sitting my Cuban ass in a chair.

Usually PD is all over a job like this. They love gettn all hunkered down in their gear and tasering people or putting them in the slug outfit or whatever. But perhaps they gleamed from the job text how utterly ridiculous this was gonna be and didn’t bother. I get on the radio and ask for a squad car. Jumping on people is their job, not mine.
“I think he took too much of his meds,” the stressed out guy in charge tells me.
“You don’t mean too few?”
“No! Too many!” (maybe he’s not the only one?) “He was sitting right there and then he just started rolling around the floor! It was…crazy!”
Again…ah forget it.
Then the guy comes running past. He’s little, filthy, mustached. Wearing an Aerosmith shirt from circa 1976. And he’s fast! I barely realize he’s there before he’s out the door and off into the night.
“There goes your guy,” I tell the supervisor. He turns around and runs out the door too. I put some gum in my mouth.
Supervisor comes back in a minute later. Tells me PD showed up and took off after the guy down the block. My partner and i saunter outside, see PD reversing in a fury toward Fulton Street as homeboy cuts a hard left and disappears. We saunter into ambulance and at a saunterly pace roll around the block.

PD is having an extended negotiation with the dude when we show up, which is amusing mostly because they don’t speak Spanish and he barely speaks English. He’s carrying on about someone ganking his dinero, they’re all: ‘Sir, you’re gonna havta calm down. Sir.”
I tell him in Spanish he gotta go to the hospital, get on the ambulance right now.
He curses out all of us, all our mothers, all our sisters, all that we hold sacred but sheepishly complies.
In the ambulance, I notice he’s utterly wasted and won’t stop chewing. Not in the gum kinda way. In the way old people do all the time. Might be the Parkinson’s like effects of certain anti-pyschotic meds, or perhaps it’s just him being high. It doesn’t matter toooo much, and we roll of the hospital. When we get in the ER first thing he does is spit a walnut on the ground. Everyone groans.
I hate it when my patients are rude to the ER staff and I tell him. He looks at me like, meh? and he’s still chewing. Ugh. “Ju my frien’,” he informs me. “Ju too,” he tells my partner. Terrrrrific. While they’re taking his vital signs he produces an EKG electrode from somewhere in that mouth of his, regards it for a second and then puts it back in his mouth. I think me, my partner, the nurse and the registration lady all facepalmed at exactly the same moment.

NOTSOMUCH: The Truth About Black On White Crime

I took this little hipster dude to the hospital seven years ago; he’d left his apartment door unlocked and then got pistol whipped when he came home to find someone going through his stuff. Now why would I so clearly remember a minor injury from ages ago? Because in my eight years working EMS in Bed-Stuy, East New York, Harlem and the Bronx, that was the singular, solitary white patient I’ve had who was a victim of violence at the hands of a person of color.  I remember sitting in the Woodhull ER with him. He was holding an ice pack to his little forehead gash and going “God! I can’t believe I got pistol whipped! It’s like…it’s like a movie!” At that point I had already given up checking the newspapers in the morning to see if any of my crazy jobs from the night before would show up. They never do; the patients are all black and brown and their tragedies, no matter how gruesome, are automatically deemed run-of-the-mill and unworthy for news attention.

In general, the white patients we get are either little old ladies, drunk Polacks who tried to play frogger across McGuinnes Boulevard, college kid anxiety attacks and overdoses. We also get the occasional “All these Black people are trying to rape and kill me so I can’t leave my apartment!!” and sometimes “I stopped taking my meds and I’m about to do something really really bad.”

All this is to say that the amount of time and energy that white culture puts into being afraid of the crimes that will be committed against them in the ghetto could be better spent thinking about something that actually happens.

For instance, white on black crime, which we see faaaar more frequently. A lawyer was interviewing me the other day for a case they wanted me to testify in. A patient I’d had who’d also been pistol whipped, also seven years ago, this time by cops, was suing the NYPD and this lawyer was trying to take apart the guy’s story.  He showed me a picture of a middle aged black man with a swollen lip and busted eye and asked me if I remembered him. I had to laugh. “Do you have any idea how many times a week I go to the precinct to take care of black men who’ve been beaten by cops? Plenty. Times fifty-two times eight. No I don’t remember that dude.” Or the kid I met last night, who’d been cardoored by a police cruiser and then arrested before he could get up, all for riding his bike on the sidewalk. Or Iman Morales, who was naked on a fire escape in Bed-Stuy having a psychotic fit when PD tasered him, causing him to fall to his death. Or Sean Bell. Or Oscar Grant.
And then there’s the entire 81st Precinct, who’s institutionalized racism was recently unveiled by a defecting whistleblower and thoroughly detailed here.

Most white on black crime happens without the majority of whites having to perpetrate a single violent act. Another unspoken benefit of white privilege is the ability to win without  even having to fight. Gentrification, and the uprooting of communities that it entails, will happen regardless of how the incoming hipsters feel about their neighbors; the pieces are already in place, the gears turning. 911 doesn’t get called- it’s a slow motion race riot, which history has proven can be the most devastating kind.

ON EFFING UP

One time, when I was a brand new medic my partner and I gave the wrong medicine to a patient. It saved her life anyway but both meds in question were narcotics, the most regulated drugs ever, so we ended up getting dragged downtown to explain ourselves.
The lady was succumbing to a bout of Acute Pulmonary Edema- a situation I’ve talked about a few times on this blog that involves the failing heart backing up fluid into the lungs, essentially drowning a person inside themselves. You can have it just a little bit- your lungs sound like  a straw sucking out the last bits of soda around wet ice cubes- but it can also flash flood and pinkish fluid will gush up your airway and asphyxiate you. Plus, if you’re old, even having a mild amount of fluid can cause so much respiratory distress that the body will quickly exhaust itself with the effort of each breath and give up. This lady was a few minutes away from crashing. The fluid was at the top of her chest and would come pouring out her mouth any moment. Her eyes weren’t focused, her body was doing that spiraling down the toilet bowl swirl that I tell my students to watch out for. 
My partner and I had spent the day having a friendly debate about Morphine, cuz that’s what bored medics do. We use Morphine in that situation to help open the veins up and lower the blood pressure, which is usually through the roof in APEs. It also has the added benefit of sedation, which allows you to intubate, which is what this lady needed because she was about to stop breathing completely and a tube down her throat’d be the only thing that’d keep her alive.  When my partner called up the Online Medical Control people to get permission to use narcotics, he asked for Valium and they gave it to him. Valium is a sedative used specifically for the purpose of knocking someone out so you can tube ’em. But Morphine musta still been on his mind, cuz that’s what he handed me and that’s what I gave the patient, although neither of us realized the mistake until after everything calmed down.
The thing about knocking someone out to tube them is that then you HAVTA tube them, cuz you kill their respiratory drive too and that’s already low. And the thing about tubing a living person is you can see the weird little inner mouth that the vocal cords form and watch them open with every troubled breath the patient takes. And you wanna open up that airway, see the cords and then sit there poised with the tube ready to stick down there at just the right moment. It’s like some creepy Indiana Jones/William Burroughs insanity, but we love that mess as I’m sure you’ve realized by now.
Anyway, I opened her mouth, took out her dentures, got all up in her airway with the tube ready, holding her tongue out of the way with a metal blade, and watched the cords open, close…open…close…open and I pushed the tube through and secured it in place. It was in, confirmed, solid, %100 and we triumphantly zoomed off to the hospital all happy happy that we’d saved another life.

Until we realized we’d given the wrong sedative.
Anyway, like i said, we ended up downtown at EMS headquarters to explain what we’d done. My partner was the senior medic and he did most of the talking. He said- Look, we did mess up and give the wrong med, it was a very hectic scene, the lady was crashing and we were under pressure and we messed up. That’s it.
There’s always one EMS lieutenant they bring to be a total dick and then a doctor who’s mad coool (that was the only time I’ve been but everyone tells the same story)- the Lieutenant basically was like “Well, you’re job is to deal with stressful situations and not mess up. So that’s no excuse at all.”

And, much as I hate hate hate to agree with a lieutenant, the dude had a point. First of all, we deal with all kindsa situations and an old lady dying in front of us was really not the peak of insanity. She was on the bus, so it was a controlled atmosphere. Plenty of times it’ll be the same thing but there’ll be children crying for us to make mommy breath again, fire men crapping themsevles, angry husbands cursing us out, threatening our lives, crazy frothing dogs, cocaroaches, mice scurrying around, gettin in our equipment, endlessly cluttered apartments with no room to move in, let alone spread out and work up a cardiac arrest. PLUS, dirty needles, electrical volts, freakazoid partners, white supremacy and patriarchy…anyway, you get the point. We deal with stressful situations. It’s what we signed up for. It’s what we joke and carry on about at the bar after work. It’s part of what we love and hate about the job. And we all will and have made mistakes, it’s also a part of the job, we’re not super humans, but to ask for an out because the situation was hectic is to ask to be told: That’s your job. Do it.

I say all that because EVERY time, every DAMN time, a cop effs up and shoots an unarmed man of color, you get the mayor, the police chief and a hundred different union reps and apologists screaming and crying about the line of duty and you don’t understand what it’s like to possibly have a gun pointed at you. (or a wallet). And it’s true, I don’t. Nor do I want to. That’s why I chose the job I chose. But for someone who chose to be a cop, they’ve taken on the responsibility of living in the cross hairs and having the power of death at the whim of their trigger finger.  That you were in a stressful situation doesn’t get you a pass; it’s not the go ahead to go buck wild. Especially because it’s probably those same stressful situations that you go bragging about at the bar, that you roll your eyes and shrug off about at parties when someone asks you about the craziest mess you’ve had to deal with…. For both PD and EMS it’s those challenging moments of the job that makes us love it, which means we don’t get to run back and hide underneath them when things don’t go our way.

End rant. 

THE MOST SKEEVED OUT I’VE EVER BEEN

I was gonna write about death again- but I do that  (…reading back over old posts..) A LOT o_O
 so instead I’ll talk about um…oh crap this ones about death too but whatever…THE MOST SKEEVED OUT I’VE EVER BEEN.

it wasn’t on the evisceration, or the lady who’s leg was hanging off or any of the crazy shootings stabbings rectal bleeds or other bloody disasters I’ve been on. This might even come as kind of a let down, cuz people at parties are always asking me: What’s like the CRAZIEST ISHT You’ve EVER seeeen? And this definitely was not it. But it skeeved me to the bone none the less.
We were riding with this Hasidic kid that night, a student, and some of his boys were on the Hatzolah truck that works nearby- Haztolah is the all Hasidic ambulance group- and somehow they’d gotten a call for a jumper down- it was one of their guys and I guess he’d gone from the roof of one of the all Jewish projects on the Williamsburg/BedStuy border (yes there are Jewish projects). We were nearby and the kid wanted to meet them at the hospital and lend a hand, whatever, see what they’d done, learn something i suppose, so I rode over to let him take a peek.
Hatzolah is famous for rolling deep. They call it the clown car cuz the bus rolls up and nojoke like eight little bearded EMTs will pop out, all muttering at each other in Yiddish and usually dressed in tshirts and sneakers. But for some reason, that night, there was no one there, they all musta hopped out and scattered, or maybe they all decided to go in and notify the hospital together, the way girls flock to the bathroom. Either way, it was just this one little sad yarmulka’d fellow left to bring in the patient. Even my student was nowhere to be found.

I really don’t like to get involved in other people’s jobs. It’s wrong for so many reasons but you can’t roll into the hospital with a traumatic cardiac arrest and no one’s doing CPR, no one’s giving ventilations… It’s not because the guy might make it- that was definitely not going to happen- it’s just a really bad look. it’s like showing up to play baseball wearing a tutu. You dont do it. So like a idiot I gloved up and positioned myself on the stretcher to start pumping the guy’s chest.
Considering that he’d come down from a PJ, i was surprised that the dude wasn’t splattered. He was  white- literally white not just racial construct white- pale as a piece of paper, probably his internal organs had exploded and the blood was scattered inside somewhere, and his feet were pointing in all the wrong directions, surely from having been landed on. They said he’d just gotten out of woodhull’s psych ward and that Jews who suicided weren’t allowed to be buried in Jewish cemeteries but since no one had seen him jump, he might’ve been pushed or it might’ve been a freak accident and he’d get the benefit of the doubt.

Anyway, on my third or so compression, one of the man’s chest hairs caught me right where the glove stops and my wrist begins- that tendon right there? YO. It was like the long finger of Father Death tickling my soul and NOT in a good way. I can’t tell you what it was that eeeked me so much about that all i know is within 2.7 seconds I was off that stretcher and halfway across the street yelling “OH HELL NO!!” and making all kindsa faces. By that time, some other Hasids had materialized and took over but I couldt’ve cared less to be honest with you, I was DONE.

WE ALMOST LOSE A KID

One of the biggest decisions a medic has to make is Grab-n-Go or Stay-n-Play.
Most of the time it’s relatively simple- trauma’s are always grabngo as I’ve talked about before, because trauma patients really need a surgeon to help them, so whatever we do to ’em we do it enroute to the hospital, ideally. Most medical situations are the opposite: we ‘re equipped to do for an asthma or heart attack what any ER would do in the first line of treatment anyway, so it’s worth taking the time onscene to get the IV, the EKG, do the full workup.
Kids can seem like they fall into the inbetween category. When a kid is critically ill it feels like a trauma job because people are freaking out, tensions are high, there’s a certain element of chaos that makes you wanna go go go and be gone no matter what. Adding to that tension is the high compensation/sudden plummet thing that kids do. Unlike adults, who will spend hours sometimes circling the drain, kids tend to compensate and compensate and compensate- sure they’re struggling but they look okay, right? and then suddenly they’ll just turn blue and crash completely and  die in a matter of seconds. A good medic knows that, and it makes us anxious to pass the potato, but we also know that what happens in those fleeting moments between life and death determines whether a patient makes it or not.

So this kid was big for 13. A hundred and seventy-five pounds actually and foulmouthed to boot, and he was standing outside his house at 3AM flagging frantically at us. He stumbles over to the ambulance as we roll up, his pants falling down. “I’m gonna fuckin’ die!” he screams and jumps in the bus, crapping himself as he goes. Now, people saying they’re gonna die- you know that’s neither here nor there. You get the people that say it over a fight with their ex and then you get the people that look fine, say they’re gonna die and then do exactly that, which yes is creepy as hell. But you can’t fake crapping your pants- it’s always a bad sign whether asthma attack, heart attack or trauma, it means the body is giving up less essential functions to concentrate on the only ones that matter.  The mom came running up a second later. The boy laid out on the stretcher, gasping and started turning blue. I mean, the kid literally used his last drip drops of life force to  make it to us and then everything started giving out.

Moments like that, the world goes into slow-mo. Actually, we were moving pretty fast, but it felt like hours as I moved across the bus and pulled open our medicine kit to find a syringe and the epinephrine. My partner was dealing with the oxygen, setting up an albuterol treatment, and I’m wondering if the kid’ll even be breathing by the time we get it to him, but I can still hear his tight little gasps and his mom sobbing for us to help him. 
The stupid epi comes in stupid little vials that you have to crack open and extract the liquid from painfully carefully with a needle. It sucks. drip drip drip. 0.1 mgs and I need 0.3. Drip drip drip. Gasp…gasp…gasp. “Please, he’s turning blue! Help him!” I hear the shushhhh of the oxygen (Finally…only seconds later though…) and Mike straps the mask onto the kid’s face as the treatment seeps out in a little cloud. It’s a start, but epi is the real turnaround medication. Finally I hit 0.3 mgs, grumbling, and I stab the kid in the arm and push the meds in and exhale.

But he’s looking worse. “I think we’re gonna haveta tube,” Mike says. I nod, throwing the defibrilator pads on the boys chest so we can get a read out on the monitor and shock if we have to.  A tube is a last ditch effort for someone in respiratory failure. It’s for when the body simply can’t breath for its self anymore and so it allows us to do the breathing for the person. His heart rate turns out not to be so bad- it’s 110, which is about normal for someone having an asthma attack. (Kinda bad woulda been much much faster that, 140 or 160 but really really bad woulda been slow, anything below 70 would signal him sliding straight down the drain at any second.) His oxygen saturation is crap though. That’s the percent of o2 that’s gettin to his blood. It’s normally %97-%100. Someone struggling to breath might be down to %80something and we’d be pretty concerned. This kid’s is %54.

Mike opens his mouth to intubate but the boy is clenched up. It means he still has some fight in him, but still…I take a quick look to see if there’s an IV to be gotten, but he’s large and nothing popping up. The moment to move has come. The first lines of medicine are onboard, the oxygen is flowing. Stay and play is over. I put on the machine gun scatter siren and blast off to St Johns, giving the notification breahtlessly as I go (“13 year old…male…(pant pant)…imminent respiratory arrest…(pant pant)…vital signs are as follow…(pant pant)) and make it there in 2 minutes flat. Mike has popped an IV and some more meds in on the way, bless his soul. I can tell the epi has done its thing before i even get out of the driver’s seat- the kid is coughing and crying. People who are about to code don’t cry. He’s moving air. I hop out and by the time we roll him inside Little Big Man is actually talking, almost in complete sentences.  “Jesus Christ!” he pants. “I almost fuckin’ died!!”