This Week In Other People’s Disasters

There’s an ebb and a flow.
months and months will pass and you’ll only bring in chronic neck pain, chest colds, the occasional migraine and the same five drunks again and again. A minor MVA will seem exciting. These are the months i want to quit and never see an ambulance again in my life. Then, just when you’re starting to drop your guard and accept that you’re really just a glorified taxi for the inept and accident proned and chronically vaguely unwell, some real ass shit goes down.
And while you’re still marveling that anything worthwhile happened at all, it happens again. And then you’re pivoting and splicing your way through a whole barrage of megacodes, epic disasters, medical mysteries and whatever other series of other people’s misfortunes the world has to offer. Fun!

These past two weeks were in that vain. First a perfectly healthy looking fifty-year old just up and died for no apparent reason in the West 4th Street train station in the middle of the mid-afternoon rush home. So death became a spectator sport because let’s be honest, who wouldn’t stop and stare at such a sight: A team of firemen, EMTs and medics pumping up and down on the guy’s chest, yelling commands, disagreements, possibilities, drug administration numbers, semi-coded curseouts, intubating, sticking in IVs, glancing at monitors…All that. The gapers irritate me, but the truth is i’d watch too.

He came back. And well he should’ve, young fellow like that, plus he dropped in public, which means everything happened fast and speed is everything in those situations. Still, you never presume someone will come through. Well, I don’t. But yes, there was that bounding pulse at his neck and then we heaved him up four flights to ground level and loaded him onto the bus and lo behold, the pulse was gone. Crap. Did some shit, got things ready to move and enroute he came back, good strong pound pound and a solid blood pressure to boot and last time I checked he was still at it.

Then some dude who’d been coughing for like six weeks called from around the corner from the hospital because he was “coughing a lot.”

Ok.

Then was the 40 year old that nearly passed out in a swank uptown bistro. She’d had a sudden bout of unfathomably intense abdominal pain ( did she say “unfathomably?” maybe not. But her face did. ) and when she went to the ladies room everything got bleary. She slid down the wall and we found her sobbing, holding her tummy and with no blood pressure at all. No blood pressure, unless there’s a good healthy reason for it like you’re an athlete or extraordinarily chill or a yoga master, is a very very bad thing. It usually means you’re about to die. Your heart should be zooming at that point, to compensate, pumping as much blood as it can and if it’s not you’re really really about to die. So, her heart wasn’t going that fast, another bad thing.
Why do people have no blood pressure? Either their blood vessels have suddenly opened up wide to fight off a perceived threat, like with an infection or a allergic reaction, or the heart isn’t pumping right, usually this would be a massive heart attack or someone with a cardiac problem already in the works, or you’re losing blood or massively dehydrated. Since she’s not febrile or breaking out in hives it’s not the vessels, and she’s not having chest pain or a cardiac patient so it’s almost definitely not cardiogenic shock, so we’re left with the fluid. She’s not visibly bleeding out, she hasn’t been shot, so the bleed is internal. Usually, these are in the GI tract and they eventually find their way out in the form of blackish tarlike poop. No fun. Sometimes it comes out all fresh and bri…you get the point.
Anyway, ok, that’s a good possibility here, but there’s another piece of the puzzle to consider. The patient’s last menstrual period was two months ago — she could be pregnant. Anytime you have a hypotensive, almost passing-out woman with sudden onset lower abdominal pain and any possibility at all of being pregnant you pretty much have to assume she’s having an ectopic pregnancy. This is when the egg fertilizes in the fallopian tube and then ruptures, causing massive internal bleeding. Which is exactly what happened with our lady.
There’s not much we can do for that prehospital. We put a huge IV in to replace as much fluid as we can as fast as we can. We throw an oxygen mask on her, we lean her back and move fast, plowing rudely through the shocked diners and whispering waiters. We haul ass to the bus and then haul ass to the hospital and let ’em know what we comin’ with so they have fluids and surgeons standing by.

Then some lady called for her grandad, he was having “chest pain”, even though he hasn’t spoken or moved any of his extremities since 1998, still, he was having chest pain. And difficulty breathing. And he had to go to the hospital. Right.

Then a slew of drunks. All familiar.

Then an old guy laid out in his own piss, squirming, moaning, writhing. Home Health Aid epically unhelpful, but still, he’s a diabetic so we just go head and check his sugar figuring that’ll be that. And it’s low! So low the monitor just says “LO” which is great for him, because sugar is a thing we can fix up, so we do. Except then he’s still not with it. And his blood pressure’s insanely high, 240/130 or somesuch disasterness. This is all very bad. It means he’s having a stroke and there’s absolutely nothing we can do except move fast, and even in the ER they’ll be pretty helpless because with stroke treatment, timing is everything and since we can’t get a straight story from the HHA, who’s probably high and definitely…not bright, we don’t know the onset time. So, grandpa is basically on his own as far as healing. We package him up, drop a most difficult and delicate IV in one of the meandering little slipstream veins hiding along his forearm and go go go, knowing all the while the deal is basically done.

TOO LITTLE TOO LATE

It’s amazing how many calls we get for old men that wanna complain about the “tiny little guys” running around their apartments. There must be an infestation of freaky leprechauns in the city. I know it’s gonna turn up in 1 of my short stories soon…
But anyway, that’s not today’s topic. Today’s we’re here to discuss the little dude that makes sandwhiches at one of the delis of 125th St in Harlem. He called because he was having pain all up and down his left side (came over as a CARDIAC job, because they included the chest in “all over”…smh). So he’s 32 years old, no medical problems, no medications and he’s basically rocking back and forth and going “OOOh it feels so WEIRD! It feels SO Weird!”
what’s weird?
My whole left side of my body!
Does it hurt?
No! I can’t feel it! Or it’s like pins and needles! Aiiiii!
How long it’s been going on?
Since the day before yesterday…
Anything else wrong?
Yeah, when I poop: blood comes out…
Oh boy…how long THAT been going on??
Since about…well, matterafact since the day before yesterday!
What the hell happened the day before yesterday?
I fell down the stairs.
How many stairs you fell down?
Shit…all of ‘em.
…And you’ve been shitting blood ever since?
Yep.
And you can’t feel half your body?
Uh huh. You think Imma be alright?
NO I DON’T THINK YER GONNA BE ALRIGHT! …jeeeeeze…(aside: do you really need me to tell you that?)
So you think I should go to the hospital?
No, I think you should’ve gone to the hospital 2 days ago when you ruptured your internal organs and severed your damn spinal cord but now u HAVE to go to the hospital…
Sigh….okay let’s go…
That is all.

BLEED IN BLEED OUT

When the word INBLEED pops up on our screens as a call type it inevitably means the next hour of life is gonna be either messy and stupid or boring and stupid. This is because INBLEED is the kind of call you become when you tell 911 you’re bleeding out yer butt, so the range is from “I have hemorrhoids” to lying dead in a lake of blood. That was actually a job I had a couple years ago- start as a INBLEED, turned into an UNCONSCIOUS while we were on the way and then a CARDIACARREST when we rolled up. Sure enough, the landlord met us at the door with the delightful words: “He has HIV and Hepatitis and he just vomited up all the blood in his body and died.” Sure enough, the damn room was painted, floor to ceiling with bright red blood (bright red means it’s recent, dark coffeeground blood means it’s old. For what it’s worth) and there was a dead guy lying in the middle of it all.

Anyway, you basically treat a true internally bleeding patient as if they were a trauma: they need a big IV with lots of fluid going through it and they need to get to a surgeon ASAP, no time to play. But that’s really the very rare exception that shit turns out so dramatic. Most, like 90% of em turn out as
“yeah I found a streak of blood in my stool, wanna see?”
nope.
or “I just vomited and there’s some red in it.”
What were you eating?
“Cherry ice cream with beets and ketchup.”
Hmmmm.
BUT anyway, by whatever odd logic of the EMS gods was at work last Monday, we ended with 3 inbleeds in a row, spanning the whole range of madness. The first was a chick from a shelter who’d just had a little dab a blood here and there whenever she did a number 2 for the past three weeks. Ok, doo dee doo, let’s go. Second was basically the same thing but the guy tried to fake a seizure on the way out cuz he didn’t think we were paying him enough attention. Then the last guy- he made like he was alright, even convinced himself he was I think. He’d had a near syncopal episode (almost fainted) coming back from the bathroom and while he didn’t have any active bleeding, he’d been diagnosed with a bleeding tumor and a stomach ulcer. But the dude wasn’t showing any signs of crashing or even being shocky at all, no dizziness, wasn’t pale, wasn’t weak, his blood pressure was fine, heart wasn’t racing. Did you know when your bloodpressure drops your body realizes it and makes you thirsty so you can compensate the fluid loss? That’s why so many trauma patients’ last words are “can I have some water?” and then they die.
Anyway, this dude had none of that, and he wanted to walk, so we said alright, but kept a sharp eye on him as he stood. Halfway to the door, right in the narrowest part of the hallway, he went gray, flung his arms out to either side, rolled his eyes back and collapsed. Man…
The boyfriend starts yelling about how he always does this (!?) and why he have to be so macho, then their cat starts hollering and carrying on too, and meanwhile my partner’s passing me the IV line and needles while I’m making sure dude isn’t in arrest. It’s tight in here, mind you, like one person at a time tight, and the patient’s large and in charge, but fortunately, not dead. He still needs an iv though, so I wrap the rubber cord round his big ol’ arm and start feeling round for a plump vein, but there’s NOTHING, not a damn thing. He’s waking up now, talking bout –oh I feel better now I can walk? and his man’s like –oh HELL no, boo! And I’m like, dude- where’s your veins? But like I said, he’s fat and probably bleeding out somewhere deep inside, which depresses already hiding vessels. Grrr. Then to top it off, it turns out when I do take a stab at something, his skin is alligator thick. Like, you have 2 put shoulder into it to get the needle through, which sucks for everyone. So he’s screaming and yelling, the bf’s like “man up” in a startling about face from his earlier position, and my partner’s peering over my shoulder tryingto see if my IV any good or not. I push hard, break skin but get no flashback, no love whatsoever from those escondido mothafuckas. We try twice more but with no luck.
He still wants to walk, which is generous to our backs but unfortunately, not even remotely possible. Just sittin up he gets dizzy again, so we call for a backup truck, pull out the scoop and ease him onto it. Takes some serious heave ho’ing but eventually we get him hoisted up, down the skinny ass hallway and into the ambulance and then carted safely and happily off to the hospital.