Random Thoughts From Sleepless Nights

noreply@blogger.com (JackOfHares) — Sun, 30 May 2010 21:35:00 +0000

"Hey...hey Man...yeah you" The man smelled as if he had used beer for bodywash and sauntered up to me as I was gathering my patients belongings.
"You got an ambulance out there?"
"I sure as hell hope so" was my reply.
"Cmon. Let me drive it"
"Nah......My partner would get upset. Its the highlight of his night to drive and I couldn't take that away from him"
"You guys suck"

And to think. This wasn't even the dude I was picking up. Turns out the guy I was picking up was built like a linebacker, clutching an apple juice in one hand and a bible in the other. Apparently He had been hearing demons tonight that had been telling him to kill himself. My only question to the man was this "What are they telling you to do to me?"

Most of us have the common sense to ignore those inner voices rather than try and start meaningful dialogues with them. Either that or we assign the inner voices to our housepets. Cats apparently lead the way in this due to the increasing frequency of crazy cat ladies.

"Nope. They aren't talking about you. They don't even know you" Boy was I relieved..

We all have inner voices. The ones that have separate conversations in our head while we are having another. The shoulder devil and angel that we all have but can never see unless we are in the middle of a bugs bunny cartoon. How many of us listen to them? We all have had moments where we have said "Was that my out loud voice?" Thats the demons getting out. Maybe its the ones of us who hold them inside and never give them voice eventually go mad.

So guess what I am saying is that we shouldn't fight these inner voices, rather we should embrace them and listen to them. but give them the same consideration we do that that crazy friend we all have, or that uncle that you just knew somehow that you didn't want to be in a room alone with. I've seen what happens when you don't accept your entire personality. Both sides, good and bad, right and wrong. To deny our feelings and innermost thoughts will only lead to madness and a trip to the zoo

Sick?

noreply@blogger.com (JackOfHares) — Sun, 30 May 2010 21:35:00 +0000

So I thought we would have a little discussion of the term "Sick"

For starters, sick can mean any number of things.

According to Merriam Webster

SICK
Adjective
affected by physical or mental illness : nursing very sick children | we weresick with bronchitis [as plural n. ] ( the sick): visiting the sick and the elderly.
• of or relating to those who are ill : the company organized a sick fund for its workers.
• figurative (of an organization, system, or society) suffering from serious problems, esp. of a financial nature : their economy remains sick.
• archaic pining or longing for someone or something : he was sick fora sight of her.
2 [ predic. ] feeling nauseous and wanting to vomit : he was starting to feel sick | Mark felt sick with fear.
• [ attrib. ] (of an emotion) so intense as to cause one to feel unwell or nauseous : he had a sick fear of returning.
• informal disappointed, mortified, or miserable : he looked pretty sick at that, but he eventually agreed.
3 [ predic. ] ( sick of) intensely annoyed with or bored by (someone or something) as a result of having had too much of them : I'm absolutely sick of your moods.
4 informal (esp. of humor) having something unpleasant such as death, illness, or misfortune as its subject and dealing with it in an offensive way : this was someone's idea of a sick joke.
• (of a person) having abnormal or unnatural tendencies; perverted :he is a deeply sick man from whom society needs to be protected.

So for the purposes of this discussion I am going to use a typical call in order to try and illustrate this point.

We are called by the local police for a sick person. Yeah. Thats all we get over the radio for dispatch. So for as far as we know this could be just about anything.
Our guy turns out to be a young male in the company of the local authorities walking around and spitting on the sidewalk......Joy......So after the police motion to us proceed in we finally get the skinny on what I would personally consider a bad night. Lets see what you think.

"So what happened?"

"Well I was passed out on a bench when I woke up somebody stuck me with a needle. Then I got up and started throwing up all over the place and felt all weak and dizzy. Then I started to feel better. I just want to go and lay down somewhere."

"Well I don't really handle the hotel reservations around here but if you want to go to the hospital to get checked out then I'll be more than happy to take you there and get you checked. Could have been kool aid or drain cleaner in that needle. Only way to find out is to take you in"

(A pretty convincing argument I thought. I mean the man did wake up and begin projectile vomiting.)

"No dude. I'm fine. I feel better now. I just want to go lay down"

"Well heres the thing. You could go to sleep and not be able to wake up again. I mean I dunno about you but I don't get stuck by random psychos wielding needles while passed out on the bus stop bench. Might have been something bad in that needle."

(Again I think I was making my persuasive face and the persuading words come out)

"Nope. I just want to lay down"

So lets examine this with Mr Webster.

So the guy was sick.

Figuratively, because the man was carrying his worldy possessions in a backpack and sleeping on the bus stop bench.

In the Archaic sense he was pining away for a horizontal surface where he would not be disturbed by the constant annoyance of diesel fumes, stray dogs and cats, or those annoying bastards who have nothing to do but run around town sticking needles into people (Which ironically sounds like what we do but we use clean needles and neither kool aid or drain cleaner.)

He was also feeling nauseous and said he had vomited

He did look pretty sick and miserable

And of course off the cop looked pretty sick that he had to deal with this.

All in all you can use any one of the definitions for sick for this guy. Did he go to the hospital? No. Should he have gone? Probably :)

Jumper

noreply@blogger.com (JackOfHares) — Thu, 05 Jun 2008 00:23:00 +0000

You never know what you are going to be doing that day. I think about it sometimes while checking my gear for the day. Be ready for anything.

The call goes out for a fall off a parking structure. We pull up to find the police already on scene as well as the fire department. I go to grab the backboard and collar bag as a state trooper comes over to me

"Do you have a blanket? I think they are going to pronounce her here"

I hand him a sheet, and walk over to the patient, not wanting to give up the only blanket I had in the ambulance.

She is an elderly woman, lying on her back with obvious angulated fractures of her lower legs as well as the left side of her face being uncannily flat save the large hematoma on her forehead. Her pupils are fixed and dilated and the ground is littered with teeth and blood as I kneel down and place her on the monitor.

The monitor shows V-Fib, the womans heart is still quivering.

"You have got to be shitting me" my preceptor says as I grab out the Defib pads as the fireman is doing CPR.

I get the pads on him and am turning to begin charging the monitor when my preceptor and I see that the rhythm has changed to a single flat line telling me there is no electrical activity.

We resume CPR while doing a quick assessment and cataloging the injuries in my head as my partner calls medical control. Its no surprise when the doctor on the other end of the line tells us to go ahead and presume. Due to injuries sustained she is not a viable patient.

Time on scene is less than 9 minutes.

Those are the calls in which time just seems to stop. You start doing things faster than you ever thought you could and everything feels like second nature. After the call you look at your scene time and find it hard to believe you were there such a short time.

I can't help but try to imagine why these things happen. How difficult it would be to just make that decision and step into the void. I can't imagine things would ever be that bad and I hope in my life they never get to that point.

Long time no post

noreply@blogger.com (JackOfHares) — Sat, 31 May 2008 12:30:00 +0000

630 in the morning and the call goes out for a working code.

Shaking off the power nap I had just taken I jump into the jump seat as my preceptor signs us onto the radio. The call is for a 6 week old who is pulseless and aepnic. CPR in progress.

After what seems like a slow drive at 95mph we arrive at the house and find volunteer firefighters in their pajamas out front. "We are bringing him out now" they tell us so I get what I can set up in the back.

He is a little thing. So tiny, limp and blue it almost doesn't seem real. He barely reaches the gray area of the Broslow tape. We cut away his onesey and put the pads on him while ventilating him and doing CPR. A flat line burns its way across the screen telling us what we had already suspected. We don't even have a name as we close the doors and speed off to the hospital. Luckily there are three of us in the back. I am kneeling on the stretcher doing CPR and ventilating the best I can while my partners grab the IO drill and the intubation kit.

The first IO goes in and it does not look stable and we confirm the miss as we see the site infiltrate. I remove the mask and my preceptor is attempting to intubate but he sees nothing so we resume ventilations. The ambulance rocks back and forth down the road to the hospital as we place another IO needle in her right leg and draw up Epinephrine. One more try for the intubation while the Epinephrine goes in and we pull up to the hospital. Still nothing on the monitor except artifact and CPR. We move her over to the hospital stretcher and give report to the doctor as he tries to intubate. The hospital staff takes over care and I step back exhausted. My stomach is burning and my throat is tight.

The doctors calls time of death at 659. I walk out to my ambulance as the doctor goes in to tell the family who is still in their pajamas and I hear the sound of her mother screaming and crying as I clean up and restock. I am thankful my shift is over.

The fun never ends...

noreply@blogger.com (JackOfHares) — Thu, 01 May 2008 05:36:00 +0000

So I got called in right as I was getting ready to actually get to
sleep at a decent hour. Its a good thing though because I function
best on about 4 hours of sleep anyways. Yet another fire in our small
city raged through another house in the lower income part of town
displacing 4 adults and 8 children. No one was injured in this one
thankfully.

There was even a hamster that was rescued from the blaze after the
firefighters had knocked it down. I can only imagine the horror that
hamster has experienced and if anyone knows of a small furry therapist
that is accepting new patients, please let me know.

A rare occasion such as this....

noreply@blogger.com (JackOfHares) — Thu, 01 May 2008 01:09:00 +0000

It is not very often that I get to write about let alone participate in what we in the EMS field call a "Code Save"

But today was a spectacular day......

So as I am enjoying my mid morning snack of Fig Newtons and Mountain Dew, for unlike others in EMS I am a healthy eater *cough* *cough* a call goes out to my buddies car sending him to a "Working One Hundred" or what we commonly refer to as a witnessed arrest. My preceptor and I looked at each other, shrugged our shoulders, and called upstairs to let dispatch know we would be "wandering around the area" if they just happened to need a second unit for help. With that we left the bay and meandered towards the location.

Which ironically is actually in a Doctors office that is ATTACHED to the hospital. But they do not like us doing the "George Clooney" (which is the act of riding the rail of the stretcher as it is being pushed into the ER while doing compressions or *ventilating the patient)

*Only corpses and groceries are "Bagged"

So of course we get toned and just happened to be the closest unit for the assist.

So into the doctors office we go with a backboard and a collar bag because the other equipment would not be needed as the other crew should have everything but going in empty handed seemed rude. As we enter the building and walk to the elevator a poor young lady carrying Fed Ex packages is surprised as I stick the backboard into the elevator stopping the door. So she is startled but still has the presence of mid to ask which floor we were going to.

I can only imagine what was going through her mind as three men walked into her elevator and began nonchalantly putting on rubber gloves with no patient in sight. We kept our composure and refrained from making the obvious jokes that would most assuredly come later after the call.

Entering the doctors office one of the nurses at the desk told us "There is already an ambulance here" We thanked her for the info and another staff member explained to her that the more the merrier in these types of situations. So into the room past a very distraught doctor we go. You can hear the AED (Automated Defibrillation Device) chiming "Analyzing Rhythm in 2 Minutes" and we enter the room to find A Paramedic supervisor and her preceptee (A fellow classmate from my paramedic class last year) trying to move the patient on the backboard, attach the monitor, ventilate the patient, start an IV, and get meds ready. So my preceptor began helping them get the patient on the backboard while I opened our bag to get out straps (Which for some reason I brought our bag and it turns out they forgot theirs) and then went to get a brief history and story from the staff. Turns out the guy was there for routine labs and just went unresponsive when he was about to get blood drawn. The staff put the AED on him (Annoying little things but they are the best thing since Pez and I absolutely love them) and it had delivered a shock to the patient TWICE before our first unit arrived with a monitor. So at this time the man is breathing by himself at a rate of about 8 and he has a pulse and a blood pressure. Good Ole Lidocaine. So we "Clooney" him out to the ambulance (Of course the only way out was through a waiting room FULL of patients) and to the ambulance. I am setting up the intubation kit while we are securing him in the back when my partner asks me "Who's Driving?"

Now I have to explain that while I am on the clock I drive, tech etc. But while doing precepting we are not allowed to drive the ambulance. So we run crews of three. One Paramedic, One Preceptee, and one EMT-B to drive. Their driver was in a meeting in another part of the hospital (which explained why they got called to it first because they were already parked there)

"You are dude!" I say to my partner who just laughs and jumps in the front. So I am helping set up a Lidocaine drip, my friend is sitting on my lap trying to get the patient intubated, another medic is trying to get new vitals, and I am ventilating with one hand and trying to get a patch set up with the other.

Thank god we were LITERALLY in the parking lot of the hospital about 500 feet from the ER door.

So we are piling out of the back looking like what Barnum and Bailey envision EMS to be and wheel the patient in and get him transferred over while I magically produce a full history, meds, and his latest Lab results and hand them over to the receiving doctor who looks at me with surprise and a grin.

The patient has a bounding pulse, a strong Blood Pressure, and a stable rhythm. Thats all we could ever ask for.

But wait.......

15 minutes later I go in to the room to grab copies of the paperwork for the report and the man is not only conscious, but he is answering questions. I tell the rest of the guys and they don't believe me. 10 minutes after that he is sitting upright in a hospital bed, talking and he even signs for treatment and HIPPA information. He thanked us. After signing he was told to take it easy and hope he feels better soon.

"Well I could only be worse if I was dead"

"Sir you already were once today"

we walk back to our ambulance and laugh about what the woman in the elevator must have thought and make a few rubber glove jokes

Happy to be of service

A different type of call

noreply@blogger.com (JackOfHares) — Wed, 30 Apr 2008 23:09:00 +0000

*Beeep*

My pager goes off and vibrates as they call our car onto the air for a routine call. I sigh as I see we are doing a transfer from the maternity ward of one of our small community hospital to UConn medical center. "I probably cant count this one" I say to my partners as we pull out of the bay and onto the road. My disappointment is further fueled as we hear a call for an overdose coming over the radio as we are leaving the city.

We arrive on the maternity floor and the nurse gives us report, she mentions how quiet we all are and makes a joke at the other nurse at the desk.

"Here's a lively bunch"

I smile as I look over the paperwork, making mental notes for my report and trying to figure out how I can count this as one of my precepting calls.

"She came in for a checkup and has one of the highest urine proteins I have ever seen. She is also pre-eclampsic so we have given her labetolol and have Lactated Ringers running"

I look at my preceptor quizzically and he knows what I am thinking.... Why would you be running fluids into someone that is already hypertensive?

"She is a very pleasant woman, she is from Tanzania, this is her second pregnancy, she had a previous miscarriage, but if you ask her this is her first pregnancy. She does not know anything about the father"

These transfers are pretty routine for us. They tend to be uneventful (which is a good thing) but kind of awkward because you are in an ambulance doing vital signs every 15 minutes and there is not much care to be done.

Sometimes I hate myself for coming to conclusion based off of first impressions. She is a young immigrant woman living in a town where there is a large immigrant population living and working for the local mills and stores. So in my mind I put her into that category. Not maliciously mind you but just to start building that file in my head.

She is very pleasant and we talk about baby names and I tell her about my son. After hooking up the monitor and getting my baseline assessment I have run out of medical questions to ask so I do what I normally do and try and start a conversation. Thats when I begin to feel like an ass.

She has been in the United States for 6 years now and is just over a month away from her PhD in Anthropology. She already has a BS in sociology and a masters in cultural anthropology. We talked about the places we had lived and the differences in climate both weather wise as well as socio-economic. She was honestly one of the most intelligent and interesting to talk to people I have met in a long time.

I checked her vital signs every 10 minutes or so and we continued talking about her home in Tanzania, where it is very cold. You never really think about Africa as a cold place. But they have their mountainous regions where is is very much so. She lived near the base of Mount Kilaminjaro. She told me about driving down the road and seeing elephants, lions, zebras, giraffes, gorillas, and other animals I only see in a zoo or on the discovery channel. She talked about them like I would talk about seeing a hedgehog, squirrel, or deer on my way to work.

Too often we are blinded by our own preconceived notions of people. I am as guilty of it as the next man even though I try and put myself above that there are the inevitable times where I let it take over. A convenience of dealing with the many different people I do on a daily basis. I make no excuses for it and it is a part of my personality and thought process I would like to one day be rid of. I doubt that will ever happen but on days like today, it shows me that taking the time to talk to a patient can sometimes be more educational than you would ever think it could be.

I am glad I got sent on this call. It reminded me that no matter how many patients you take care of and however many situation you find yourself in to never take anything for granted and to take the time to appreciate the slow and easy "routine" calls.

***UPDATE****

My long time friend and colleague PMRN Cleared up a few things for me that I should have known.

1. The reason they were running Lactated Ringers is because "in pre-eclampsia you administer hypertonic IV fluids to speed up the process of getting rid of excess body water" Citation
2. Elevated proteins in the urine is a late sign of Pre-Eclampsia
3. since there's a loss of protein in the urine they're probably losing electrolytes renally more than usual (since proteins are big bastards), so the LR replaces em, while still being hypertonic enough to draw out all that third-spaced liquid

Seriously this man is a wealth of information that he can just pull out of a hat at anytime I need it. His blog is very informative and I would recommend it to anyone interested in Nursing or medicine in general.

Six random things

noreply@blogger.com (JackOfHares) — Tue, 29 Apr 2008 19:32:00 +0000

Thanks to Stretcher Jockey for dragging the new kid out to play. Still getting used to this blogsphere thing. I am always surprised to find that people actually read my stuff.

so here goes...

Rules of the game:
- Link to the person who tagged you.
- Post these rules on your blog.
- Write six random things about yourself.
- Tag six random people by linking to their blogs.
- Let each of the six know they've been tagged by leaving them a comment (on their blogs).
- Let your tagger know when your entry is up.

Six Random Facts about Jack Of Hares:

1. I spent 8 years in the Army as a Military Police Investigator. 5 1/2 years of that in Japan
2. I have an unusual memory for details. I remember and retain the most random bits of useless information.
3. I carry a rock with a lizard engraved in it whenever I go to work. Its my good luck charm and my father gave it to me.
4. I have an unusual loyalty to my boots. I wore one pair from 1993 to 2005. I was tricked into getting rid of them and the current pair has been around since 2005. Always Doc Martens.
5. I forget the names of people I like within 5 minutes of learning them but the people I don't like the names stick.
6. I always have to have a fan going when I sleep. Even in the winter time.

So I would like to see what PMRN and Equine005 have to say

My Morning

noreply@blogger.com (JackOfHares) — Fri, 25 Apr 2008 12:28:00 +0000

So tired from a strange night we managed to catch one last call of the morning. And if you were wondering, yes those are feathers. My uniform looks like I just ran through a chicken coop in some twisted three stooges sort of way. So here's what happened...

18 year old driving along the road drifted into the oncoming lane, effectively bought two cars. She was awake but did not remember the accident at all but that's common in serious wrecks. Alot of confusion, metal, glass, and the unforgettable smell of airbags deployed. Her abdomen was tender and becoming larger by the minute, probably her liver but all I can go on is probably but that's all I need. We immobilize her head and hold her still while I am ding a quick head to toe assessment. Neck pain, abdominal pain, pelvic pain upon palpation, and a strong urge to pee were her primary complaints. She was wearing a Fubu jacket, it actually made me sweat looking at it as it had been so nice out the past few days. I take no pleasure in ruining someones favorite jacket, pants, shirt etc. But on the same token I don't hesitate to cut them off a patient. Unfortunately as I began cutting the jacket to clear it from around her neck I realized it was a down jacket. What can you do though? I had already committed and besides, there was no way in hell we were getting the jacket off of her without cutting it. So we get her into the ambulance and I position equipment and begin to finish what I started and clear the jacket from her arm. I must say they are well made and there is alot of down in those jackets. So now the feathers are flying as I am getting her on the monitor and getting her vitals and I have to brush them off my face once or twice. I get her name and she denies any history of medical problems. So another more detailed head to toe while I am waiting for the blood pressure to cycle. She screams at me and keeps telling me how her belly hurts and I try my best to calm her down as we are only a minute or two away from the hospital. So then I drop a 14 gauge in her arm and now she has something else to yell at me about as I flush it and secure the line. My Observer Paramedic Partner hangs a bag of saline and then sets up the med patch for me. I give them the info, letting them decide whether to call a trauma alert on it. We are backing into the ambulance dock as I am trying to get another 14 gauge in her other arm but it won't advance so I pull the line and patch it up with gauze and tape. We open the back doors and it looks like a herd of chickens floating out. We wheel her into the ER and they have called a trauma alert due to hypo tension and the possible belly bleed. I give my story to the doctor and charge nurse as the ER staff works like a well oiled machine, stripping her the rest of the way, inserting a Foley catheter into her bladder, and doing ultrasound and x-rays, as well as drawing labs and a 12 lead EKG. I go out to the ambulance, have a cigarette and laugh as I look into the back and see the mess I made. It took an extra hour to get all the feathers out.

This is my life and I am loving every minute of it

This ones for you Jamie

noreply@blogger.com (JackOfHares) — Wed, 23 Apr 2008 11:45:00 +0000

Nothing breaks up the monotony of work sometimes than when you get an extraordinarily strange call. So with that said I will relate a call that happened to a co worker of mine last night.

Kind of a busy night, moon is waning, weather is nice and mild. Rode with the windows down for a while.

We get sent out to take a psych or two to the Behavioral Health Institutes (I love that title but I do prefer looney repositories)

Our first sign that something was in the air was brought into focus when we get called to the local Holiday Inn for an intoxicated person. Now let me say that I have been drunk once or twice. You can kind of rate the degrees of severity by the actions that signalled the end of the evening like hugging the throne, waking up half naked in the hallway right before you reach your door, waking up in the shower, or the classic waking up with one foot on the floor because the night before you thought it was a very clever and logical idea that if you put one foot on the floor it would stop the rest of the room from spinning. And yes, it does work.

So we find this guy, sitting in the middle of the parking lot, covered in feces. I won't go into too much detail but I had not been so happy it was my turn to drive this much for a while. So we transport him in, and while my partner did turnover to a nurse who was probably imagining creative ways to torture us at the next group party, I was compelled to ask the guy how he got all the crap on him. I mean I was not even sure if it was his. That being said my opening remark was the bizarro polite thing to say which was

"So um is that YOUR crap on your all over you?" Lets define the situation here man

"Yeah"

"How did you get crap all over you?" Now that the source had been established

"Well I tried to take a crap outside and did not have any toilet paper" A problem many of us have faced even if we do not all admit it

"So you used your shorts?" I had to bring this into perspective here

"Kind of" Kind of does not validate this situation in the least

"And your shoes?" for they were covered as well tops and the bottoms

"WHAT? my shoes? I got crap on my shoes...Dammit!" Does this make sense to anyone?

So he was more worried about the crap on his shes than the 3 foot smear down his back and leg

But wait...thats not the actually bizarre call for the night.

After relating this to my coworkers as walking out to my ambulance, another ambulance pulled in beside us and the medic got out, saw me and handed two handfuls of pill bottles ranging from barbituates to muscle relaxers and ask me to follow him into the ER with is patient, whom I notice is sitting straight up but wiggling and trying to step off the stretcher while still strapped on. She is covered in vomit and making noises the likes of I have only heard on discovery channel. We get her into the room and my friend starts giving turnover to the nurse.

Are you ready for this one?

Her boyfriend had called 911 because she had taken unknown quantities of a myriad of pills and had been acting strange. EMS gets there, fire had gotten there a few moments before only to find this woman in a squatting position on the floor near her couch retching and wiggling around making afore mentioned animal planet noises. The couch was next to her and the arm of the couch was tattered and appeared the dog had been chewing on it. The thing is, the dog had not been chewing on it. Actually I am not sure they even had a dog. The story goes she had been eating the arm of the couch and had managed to consume a respectable amount of the arm of the couch. Now normally when dogs do this they spit the pieces o the floor, but not this woman, she was a champ, she had not been spitting the pieces out but had been actually eating the couch.

"So did she have any cuts on her mouth from the wood and the staples?"

"I aint putting my fingers near her mouth...Bitch ate a couch!"

God I love my job sometimes.

Apparently after we left the ER she began mooing incessantly

Thoughts

noreply@blogger.com (JackOfHares) — Sat, 12 Apr 2008 10:27:00 +0000

So tonight I am starting my ride time for the last portion of
Paramedic School. I get to put all the things I have learned during
the past year and a half to the test and see how it works out. Kind
of nervous but thats to be expected.

First call is to a 89 year old womans house due to a change in mental
status. Now a "Change in Mental Status" can mean a multitude of
things and be caused by an equal multitude of things.

So we get to the residence and we are greeted by a very sweet elderly
lady. I'll never get used to the fact that my patients remind me of
family members, friends, and other people I have met over the years.
Sweet Elderly women always make me think of my Grandmothers.

The house looked neat and tidy apart from the smell of feces coming
from the living room. While my preceptor was getting basic
information from her I stayed within earshot to listen but also wanted
to observe the living room. There was a parakeet in a cage next to
the sofa chirping loudly probably due to the strangers in its home.
There were several stains on the carpet, a large one near the front
door, and a few in various stages of being cleaned up.

"Do you have a dog Mam?" I asked

She looked at me puzzled and said "No, why do you ask?"

Not wanting to point out that I had noticed the state of her carpet
due to the embarrassment it might cause her I replied.

"Just asking because I noticed the bird you have and was wondering if
you had any other pets" I smiled and made eye contact with my
preceptor who had understood why I asked the question. So I made the
mental notes and went back to the patient.

She had not eaten in three days and had called her friend because she
had just had a period of delirium in which she thought she was being
attacked and killed in the living room. She denied any previous
incidents but told us she had been having increased difficulty
remembering things and generally taking care of herself.

This had to be a very difficult and frightening feeling and I
sympathized with her. So we obtained our vital signs which appeared
to be within normal limits, collected her medication, and carefully
walked her out to the waiting stretcher. So we got her into the
ambulance, did an EKG, BGL, IV, and got her to the ER.

The elderly in general are not as willing to volunteer information if
they think it might prolong their hospital stay. the old "If it ain't
broke or hurting, it must be working right" Many times when we ask
them if they have any health problems they will tell us no but then
give us a laundry list of medications.

"Why do you take a high blood pressure medication? Do you have high
blood pressure?"

"Nope. I used to though but I take a pill for it now"

Its all a matter of perspective.

So our next call is for a 28 year old man, having a seizure. We
arrive with the fire department and go inside to find his girlfriend
quite distraught describing what sounds like a classic seizure. The
patient is diabetic and has not checked his sugar since this morning
so I do it while I am talking to him. As we are waiting for the
results he keeps telling us he is fine and all he needs is to take his
insulin and rest. His results come back as 429. Normal sugar range
is usually 80 to 120 so needless to say this was concerning.

Now what many people don't understand is that we don't necessarily
like to take people to the hospital. Meaning if we don't think you
are really in need of an ambulance or a trip to the ER we will not try
and convince you to go to the hospital if you tell us you do not want
to go. We advise you of the possible consequences, obtain some legal
signatures and we are on our way. Thats not to say we would ever
refuse to take anyone to the hospital. I could hate you as a person
and I would still do everything I can to get you to the hospital
stable, comfortable, and safe while doing anything in my power to help
you. Be it breathe or pump your heart for you as well. What I am
saying is this. If we are trying to convince you and recommending you
go to the hospital to get checked out then you should take our advice.

He was conscious, alert, oriented and able to make a sound decision so
we obtained the paperwork and info we needed and told him to call if
he needs us again.

We were back there an hour and a half later, he was more than happy to
go with us this time.

I'm telling you folks. We do have an idea what we are talking about

noreply@blogger.com (JackOfHares) — Sat, 12 Apr 2008 02:56:00 +0000

Another Night Shift

noreply@blogger.com (JackOfHares) — Fri, 11 Apr 2008 11:18:00 +0000

Another night shift. Last one on my rotation. Its always easiest to
stay awake and alert on the third one. I mean your body has gotten
used to the time shift so you aren't dragging as much but you also
know that after the last one you just have to get back into day mode.
Won't have to worry about that for a few days at least.

Tonight started off slow enough. Get called to a 15 year old girl
hanging outside one of the local Ice Cream Shoppe in need of a
psychiatric evaluation.

Before starting this job I had no idea how well adjusted I actually
was as a child. Nowadays I find many of our psychs are young kids,
having trouble relating to their parents and likewise their parents to
them.

This girl was no different. She was very manic and happy to get into
the ambulance. It was a short ride to the ER but more than enough
time for her to tell me an abbreviated life story filled with strife
and fights with her mother. Tonight it had escalated to "I wish you
were dead" statements. The girl had tried to cut her wrist with a
pair of scissors. I looked at it and thought to myself that I could
probably do a better job with a McDonalds straw. She did not want to
die. She was just looking for someone to actually pay attention to
her and listen to her story. More often than not thats what we end up
dealing with. Of course some people are a little more aggressive and
successful with their attempts but some of these people have years of
practice trying this. So I lent an ear and noted everything, giving
the nurse a good report as I turned this girl over to her care.

Later I met the girls mother, she refused to take her home and when it
was explained to her she would be charged with neglect she said a few
choice words and walked out of the ER, refusing to take her daughter
home.

Our next call was for a complaint of chest pains. A sweet little lady
of 93, lives alone, and who was just about to go to sleep after
letting her cat in and felt pain on the left side of her chest, she
thought it was just gas pains but it is best to get checked out. Many
elderly are afraid to actually go to the hospital. In their later
years they value their independence more than anything. So following
the chest pain protocol, Oxygen, Baby Aspirin, Nitroglycerin, and a 12
lead EKG and a short 5 minute drive to the ER, we turn her over to the
night staff.

Then it is off to grab coffee, straighten up the ambulance and be
ready for the next call. This is life.

noreply@blogger.com (JackOfHares) — Fri, 11 Apr 2008 10:25:00 +0000

Finishing ER Clinicals

noreply@blogger.com (JackOfHares) — Sat, 22 Mar 2008 12:17:00 +0000

So it has been a busy past few days. The ER was insane. Had my first
Gunshot wound victim to take care of. Victim of a drive by shooting.
He was out walking to the barber shop to get a haircut at 1030 at
night with 600 bucks in his pocket. Apparently the place stays open
late and gives great haircuts. According to the police people drive
up there, go inside, and within a few minutes they are coming back
outside with smiles on their faces and haircuts that look suspiciously
identical to the ones they already had.

Needless to say he was quite the patient. Also had a girl try and
kill herself with Aspirin, Advil, smoking crack, and snorting
cocaine. She was 22 but she looked about 40. She said goodbye to her
kidneys that day and will be on dialysis for the rest of her life.

Then we had the guy involved in a high speed chase who lost control
of his car and ran into a woman in a jeep cherokee. The state police
deny chasing him but they were right behind him with lights and sirens
on until the accident. The woman was fine, just a sore ankle. The
guy driving gave me an opportunity to assist with placing a chest tube
in order to re-inflate his lung.

The night ended at 230 am with a really nice guy who decided to play
chicken with a tree, get thrown from his vehicle, and they found him
sitting up against the car since he was having a hard time walking on
his ankle, which had been completely shattered. If he had not been
thrown from the car I would have never met him because he would have
been dead at the scene due to the entire passenger compartment being
crushed. He refused any pain meds and said the ankle only hurt when
we pressed on it. I can honestly say he is a bigger man than me and
thats the thought going through my head as I removed the gauze which
had a piece of his ankle bone on it. I could see the artery that
supplied his foot with blood actually pulsating.

On March 21st the young girl I treated for the overdose passed away leaving two young boys behind. I found out she had been the girlfriend of a friend of mine for 4 years when they were in high school. Life is never fair and you never know just how close you are to anyone or anything.

Job Hazards

noreply@blogger.com (JackOfHares) — Thu, 28 Feb 2008 16:20:00 +0000

So I get a page to pick up a patient I have transported many times before. I had not seen her in a couple months since I dropped her off at her nursing home. She is an enjoyable patient. One who is always engaging me in conversation and telling me about her life, the history of the area, and her family and philosophies in general. Thats one of the great things about some of the patients. You learn real history. Not just the stuff in books. After all history is written by the winners of the wars and those with the most influence so as a rule it is not always an unbiased and true history. So I walk into her room to say hello while getting the stretcher ready. She is in pain and I call for a nurse to make sure this is not a new problem coming to light that she needs to stay in the hospital for. Everything is fine in my mind until I ask her how she has been. I quickly realize that she does not remember me anymore. Its a weird feeling losing someone in that way. I dread having to deal with it in my family as my grandparents and parents get older. This woman was only 12 years older than my own father. Cherish those stories your parents and grandparents tell you. The stories of how things were and those moments they truly felt alive and excited. You never know when you might have to remember them for them. So I sat on the transfer and heard some of the same stories again, I helped out with the missing pieces and that made her happy. I told her about myself again, all the things we had talked about before, and a few new things that she had never asked. This was in a way more important than the basic care I was providing. I look forward to talking to her again. And if I have to I will remember for her again.

Another night at work

noreply@blogger.com (JackOfHares) — Thu, 21 Feb 2008 02:09:00 +0000

Perspective is a funny thing. Today I had a patient who was an admitted IV drug user going through withdrawal symptoms. She was in alot of pain and discomfort. After a couple people attempted to start an IV another nurse and myself were asked to take a look and give it a try. IV drug users are notoriously hard to stick. Due to scar tissue and the destructive nature of the drugs combined with infections caused by dirty needles eventually you develop very poor circulation in the places you shoot up. So we went into the room to take a look at her. Her arms and hands were covered in years of scar tissue, sores, and a few fresh track marks on her hands where she told us she had shot up this morning. So as the nurse prepared to start the IV the patient looked up at me and said “Could you hold my hand? I hate needles, they scare the shit out of me and hurt like hell”. Without a snappy remark about the irony of the situation (that I am notorious and well known for) I went over to the opposite side of the bed, took a seat on a stool and held her hand while rubbing her shoulder and talking in a quiet voice to distract her. She looked at me tearfully and said “Thank you for not judging me” and winced in pain as the nurse plunged the needle into a well abused and scarred vein.

noreply@blogger.com (JackOfHares) — Thu, 21 Feb 2008 02:00:00 +0000

Well I had a great day boys and girls. "Why was it so great?" you may ask. Well it was a particular patient that made my day. So today I went out on a call to pick up a patient for a psych eval. Well When we get there he is waiting out front with two of the staff. Now this guy is dressed in boots, Jeans, a camoflage photographers vest and a boonie cap. He carries his worldly possessions on his back for he is a street prophet (fanfare) and one thing I have learned. Street Prophets are a voice in the silence, a candle in the darkness, a brilliantly stark perception snap. So this guy starts out by telling my partner and I "Well I have been seeing alot of alligators lately and it is beginning to scare me"

Fair enough.....

So then he proceeds to tell us he has also been seeing people fall out of trees. But it does not stop there. The people would then rush away in blue pick up trucks.

Ummm Ok. How about lets go to the hospital where you can get some meds

Yessir thats what I need. SO he gets in the Ambulance. Now normally I do not relish the thought of being in a 4 fot by 8 foot space with a guy who has in all likelyhood not had a shower since dinosaurs roamed the Earth and puppies were the oldest mammals, but I had to hang out for a minute or two while he explained to my partner about how the people falling out of the trees incessantly call out for help but then change their mind and told him "we are alright now" right as he gets near them. Hallucinations can be quite fickle like that. He then explained that he had injured the back of his head when he was younger and when they fixed it they put in a volume knob.

Oh yes....
You know you want to ask...I certainly did

What is that for? "Well you can stick your finger in the back of my head and mess with it so I can hear everything or turn it down so I can't hear a thing"

I could not make this shit up people

Well then.....I guess I did ask.....Anywyas We drive this guy to the hospital. During the trip he tells us about his life. He was a jet pilot in the afgani air force (russians made him do it) he had also learned how to fly a helicopter (apparently this guy he knew taught him how in an afternoon) And he had been "satanically abused" in some foreign country accidentally.

I resisted the teptation....oh yes...it was difficult

He had also joined the Army Reserves but was tracked down for being AWOL. Well he did not mean to be AWOL he had apparently gotten so stoned that he forgot to show up. So, as he tells it "A lietenant came to my door and my uncle answered it and said 'hey some army guy is here' and thats when he took me to the back yard where he had landed a helicopter to take me, and four other guys he found, back to the Army."

Right as he says this I pull into the WWBH parking lot only to hear the angels sing as a LifeStar helicopter was doing a slow approach to the LZ a mere 40 feet from the road.

I slowed down and rolled the windows down to get the sound to travel to the back of the ambulance. And this is when he tells us he was a ranger with "Navy Seal hand to hand combat" training. He then tells us the one revelation that made my day.

"STEVE IRWIN IS TRYING TO GET ME TO HUNT CROCODILES AS WORK"

Yes boys and girls.....Steve irwin had apparently only 2 days prior told this man to carry on with his work.

For those of you that have absolutley no conciousness and have not heard one way or another, Steve Irwin, the delightfully clever, witty, kind, good hearted, stereotypically Australian, Crocodile Hunter died earlier this week. Like 4 days earlier.

Well...I guess thats what people call a "calling"

So we get him inside and turned over to the staff who upon inventorying his belongings find a camouflage net (apparently to conceal himself while hunting aforementioned reptiles)

Wow....I love my job. It is days like this I know I am witnessing a side of life I could not see anywhere else. Not in any other Job. So the next time you see a Street Prophet looking for work or looking for some spare change think about it....they could be a crocodile hunter just taking some time off from their real job....or maybe a superhero...or a prince in rags. They are all kings in my book.

An old story most of you have heard

noreply@blogger.com (JackOfHares) — Thu, 21 Feb 2008 01:53:00 +0000

So it is 11pm and we get called out to bring this sweet old man to his house after a harrowing day in the ER. This trip should take about 30 minutes and then it is back to my cozy spot on the couch checking my eyelids for their light safe characteristics. So everything wwent fine with this guy, good spirits, nice, stable, but well seasoned at 85. I checked the address and I knew where it was (which is good since I was driving) and away we go. So as I pull into this complex the address was B2. I soon noticed after parking and walking through the complex that there was no B2 in the place. So I thought "Hey maybe it is 2B!" Looking at the buildings I soon noticed they went 1 to 3 to 4 and all the way to 12. No 2? This was kind of strange. So after calling my dispatcher who unfortunately thought the address was for a different town entirely, my partner called the mans wife who after explaining that WE had her husband and were bringing him home tod us she lived in "4". So we took the patient to building 4 and began knocking on the door. There was no answer. My partner went around the other side of the building and startled an elderly lady who had no clue what we were doing there or who this poor man on our stretcher was. We called again as the man was gettng quite scared and upset. Apparently he thought we were just going to give him to the first person who opened a door for us. This time we asked the mans wife if she could see our ambulance from where she was. To this she replied "yes". We then asked her what unit she was in and again she told us "4". So we asked her to flip her light on and off for us so we could ascertain the location of the dubious "4" Loking around the complex I see the light flicker on and off at Unit 12a. This did not look like "4" but it was a multiple of the number so we took this poor man to the unit. Nervously I approached and found it to be the right one. We got the man into bed and all was well. Upon leaving I looked at the front door only to find that some sadistic bastard with an equally twisted sense of humor had placed the numeral"4" on her front door. Fair enough I though.

As we are driving away from this adventure I was getting some fresh air, my window down, passing the state hospital when god decided to yank my chain one more time and suck my paperwork out of my window and deposit it at the side of the road next to the creepiest building at the Norwich State Hospital.

But this night only got better. At about 145am we get called out to a "Deranged Person" near the bus station downtown. We arrive and there are three police cars surrounding a very large and very angry man. "Greeeaaaat" I thought. Lucily my partner had dealt with this guy and they had a rapport. So she got into the back with him, his sleeping bag, and his backpack. He had been drinking the better part of a 30 pack and was feeling very angry and stated he had recently lost his father and had just buried him. So we get to the hospital and as he is getting out we helped him zip up his backpack. Well when he said he had buried his father it was only parttially true. Apparently his fathers wishes were that he be cremated. And this guy has "buried" his father under a t-shirt in his backpack. Keeping him close at hand for when he neded him apparently. So into the ER we go as this guy us telling us that he is going to fight everyone he can once we are in there. We sit him down, clutching the backpack, and explain to the charge nurse the situation.

Well he is a bit upset and angry about losing his father and he has also been drinking. He has beer in his backpack.

He has beer in there?

Yes and he says his father is in there too.

Oh his father is in his backpack eh? (sly smile here thinking this guy was imagining it)

No really...his father died recently and he is IN the backpack.

Your serious?

Yep.

I can't make this crap up people.