ON BALANCE & COMPASSION

We were held up in the ER for a while the other day, crossed the sacred 40 minute threshold that sends little alarms up and down the system computers, pissing off captains who send angry messages to lieutenants who in turn send angry and/or passive aggressive messages to us. But since we’re in the ER, we don’t get the messages, which come in on our onboard computer, so then heated lieutenants continue to get messages and fly over in their SUVs, full of wrath and indignation. This particular lieutenant came up on me all a-foaming and frothing as I was walking back to the unit to give an update.
WHY, he demanded, HAVE YOU BEEN IN THE ER FOR SO LONG!?
clearly he didn’t want an answer, because no one who asks a question in all caps really expects anything but a blank stare. I presume. Because if you really wanted to know something, surely you’d ask it in a mature-type way, using your inside voice and whatnot. Surely.
WHAT EXACTLY IS SO IMPORTANT THAT YOU HAVE TO BE IN THE ER FOR FORTY MINUTES?!
As it happened, we’d found the patient unconscious and ODing with no blood pressure in an apartment full of men that claimed to know her but didn’t have any information on her and told multiple glaring lies about how she ended up that way before disappearing completely and then locking us out as soon as we removed her to the ambulance, so we ended up spending a good chunk of time trying to explain the situation to some skeptical young doctors that didn’t seem interested in such complications, and my partner was only now wrapping up the paperwork.
But that wasn’t an answer that would get me very far, because what does any of that matter in comparison to the almighty power of numbers? The brass in EMS, in a sickly trickle down sort of way described above, is obsessed with numbers. Numbers make the EMS wheel turn. Period. You find occasional lieutenants here and there that still hang on to some interest in what’s going on with the patient or whether or not one of us is traumatized or burnt out, but when someone with a light blue shirt is getting worked up, it’s usually got something to do with blipping alerts on computer screens downtown and the corresponding tirade of messages from superiors.

ARE YOU GOING TO ANSWER MY QUESTION?! OR SHOULD I JUST GO AHEAD AND WRITE YOU UP RIGHT NOW!?
and honestly I was so surprised by how upset he was I really had nothing to say for a second. But then I just told him No, I didn’t like his attitude or how he was addressing me and so I wouldn’t be answering his questions. As he got all red and puffy another lieutenant swept in, one of the ones that seems to give a damn about a thing or two, and dismissed the first one sayin “I got this” and then the whole situation pretty much fizzled out: my partner finished his paperwork, I put us back in the system, life went on.

I said it on twitter and it stands true still, on a job with so many reasons to get worked up, I have no interest in giving time or energy to a person that can’t control his temper over numbers. None at all. We who deal with actual people have to work every day to land in that delicate balance between caring too much and not caring at all. We all slide back and forth along that spectrum throughout our lives and careers and the best medics I know aren’t the ones that cry for every patient (they burn out quick) or the ones that smirk and roll their eyes at every patient (they’re already burnt). They’re the ones that know how to measure out their compassion evenly, quietly, justly, sometimes with crass humor or a kind word, and without going overboard so they can do what they have to do and walk away at the end of each shift leaving the job and all its pettiness, hilarity and tragedy behind them when they go.

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.

The Ungrateful Suicide

Saturday Night. Gentrification has created these weird pockets of extreme wealth in that ambiguous part of town where Bed-Stuy and Prospect Heights overlap. Me and C wind our way through the corridors of some converted warehouse. It’s dim and dank and smells funny until we step suddenly into an ornately decorated apartment with frilly columns, oriental rugs and wall-to-wall theater memorabilia. A distraught, exhausted middle-aged woman ushers us into the bedroom where we find cops and volunteer EMTs swarming around a fat white male, obtunded like a goddamn beached whale and not breathing on the floor beside his king-sized bed.

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.

The pupils are pinpoint and his respirations are still almost none, so we have good reason to suspect a narcotics overdose. I pass C a needle with 2 mg of narcan- a medication so notorious in the heroin circles all you have to do is mention it and many addicts will come jumping out of their stupor just to beg you not to give it. Basically, it blocks all the opiate receptors in your body and completely and utterly deprives of you of any possible high you mighta had. Then, you go into instant withdrawal which can mean anything from extreme irritability to severe hibijibis to simultaneous shitting and vomiting to seizures. That’s why, to avoid prolonged cleanup/resuscitation sessions, narcan is best given a) in small polite doses and b) no more than two seconds before the patient gets moved out of the ambulance and into the er.
The Dreaded Narcan…

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.