Category Archives: Commentary

Service 2/4

As we drive from call to call and post to post in the Big City, Brittany is a constant source of questions and enthusiasm. Despite the poverty stricken streets that are ripe with urban violence, gangs, drugs, and everything else – I actually like my Big City and enjoy the opportunity to play tour guide to the underbelly of urban street life.

This is Brittany’s first visit to this state and only the third state she’s ever been in. Having grown up in Maine, she lived a rather sheltered life up until now. She’s loving every minute of the day even though we are getting the less than emergent – some might even say annoyance – calls all day long. We call it “third man syndrome” – it seems that every time we get a rider we get the nuisance calls and seldom get the dramatic high profile calls that the rider is hoping for.

Brittany was a good sport when we got called for the fifty year old lady who had a headache for the last three days. There’s really nothing to treat here yet it was a chance for Brittany to practice taking a history and get used to the frustrating reality of how difficult it is to take vitals in a moving ambulance.

From the mouth of babes come the rational observations, and Brittany made a very apt one after the call as we’re cleaning up the rig. “Why didn’t she just take an aspirin?” I don’t have any good answers for that one except to say that calling 911 is a learned pattern from her environment and when someone demands that we take them to the hospital we are obligated to do just that.

As if to hammer the point home our very next call is to an address that I am familiar with as I’ve been there many times. It’s a woman with every chronic problem you can imagine, taking all the regular medications, with the same complaint every time. Yet today we’re here for her twenty two year old daughter – I’ve never transported her before.

It turns out she has a back ache because she slipped yesterday. Of course she’s wearing five inch stilettos – my keen diagnostic abilities tell me they may have contributed to the slip. Dressed like a prostitute in tight pants, high heels, and a skimpy halter top she struts to the gurney and plops down so we can transport her to her favorite hospital.

It’s an interesting situation that boarders on scamming the system. Her mother is considered disabled by the state due to so many chronic illnesses. In conversations with her over the years I come to find out the daughter is listed as her “home health care provider” despite having no medical training. The state pays her $800 dollars a month to live at home with her mother. And the daughter has apparently learned from the mother that you call 911 whenever you have a problem because it’s cheaper to let Medi-Cal pick up the tab than to call a taxi – and a taxi is exactly what we are on this call.

Service 1/4

ser·vice

1 : of or relating to the armed forces of a nation

2 : work done for others as an occupation, business, or calling

3 : services, such as free medical care, provided by a government for its disadvantaged citizens, often used in the plural

4 : the act of a male animal copulating with a female animal

Consciously or unconsciously, every one of us does render some service or other. If we cultivate the habit of doing this service deliberately, our desire for service will steadily grow stronger, and will make, not only our own happiness, but that of the world at large. ~Mahatma Gandhi

“Prostitute at five-o’clock, look out the back window to your left.”

“Really!!?” Brittany scuttles to the back of the rig and peers out the rear windows like a ten year old looking under the tent flap at the circus.

“See the bored looking guy with the baggy pants, about twenty yards up the street? That’s the pimp.”

“Oh my god!! She just got in the car!” Brittany is actually squealing with excitement.

The back of the rig is dark and I can just barely make out Brittany’s silhouette in the rear-view mirror as her digital camouflage fades her into the background.

I met Brittany this morning as I was checking out my equipment from the deployment coordinator and he told me I have a ride-along today. Looking behind me I see a young woman in military digital camouflage; her hair is pulled tight into a bun at the back of her head and she’s standing in the corner holding a matching backpack, curiously looking around at the ambulance bay and the bustle of other crews stocking their rigs.

We often get EMT student ride-alongs in this county – it’s a mandatory component of graduation to ride with an ambulance crew on the streets. Some ride-alongs are from the military while others are from the local schools, and they span the full range of personalities and competency. For many of the local students, this is just a necessary yet annoying stepping stone on the way to the elusive job in a fire department. Some will make it that far but most will fall by the wayside. The military ride-alongs take it much more seriously, and as a result I much more enjoy having them. We get riders from the Army, Marines, Navy, and Coast Guard. These tend to be dedicated young men and women who are disciplined, motivated, and courteous. Because of the constant state of war over the last decade these young people know that the skills they learn in EMT school could vary well make a difference in future deployments. They tend to be very motivated, ask lots of questions, and are respectful to patients and personnel from the other agencies that we work with throughout the day. The military commanders know that the best chance of seeing domestic urban warfare happens to be on the streets of my Big City so we tend to get a lot of riders from the different branches of the military.

As I’m introducing myself to Brittany and handing her my computer to carry to the rig I hear another military ride-along nervously talking to the deployment coordinator. “Are you serious, you don’t issue flack jackets?” Brittany’s eyes get big and round at that question – a look that I see repeatedly throughout the day.

Brittany helps Kevin and I check out the rig as we explain where all of the equipment is stored and promise to get her as much hands on experience with patients as possible. As we clear the deployment center and notify dispatch that we are available for the Big City, Brittany looks down at the body armor poking out of my gear bag and her big round eyes meet mine in the rear view mirror.

“Don’t worry about it, we’ll keep you safe. We haven’t lost a rider yet.”

“So you’re not counting the last guy?” Kevin comes back at me with our well rehearsed schtick.

“Nah, he doesn’t count, he was an idiot! Brittany’s much smarter than him.”


Movement

move·ment

1  : the act of moving

2  : a group of people working together to advance their shared political, social or artistic ideas

This blog is largely a literary self conceit in that my personal views and observations are presented through the median of relating a story or series of interactions from the first person point of view. Over the last year of presenting these stories I’ve had the pleasure to meet like minded individuals across the world and have built an extended group of friends who share a bond and vision through the shared experiences of EMS professionals and first responders.

Through social media and the hard work of many professionals a vision of the future is slowly taking place. This vision of a new form of EMS has taken on the name of EMS 2.0 and though it means different things to different people we all share many of the same ideals for the advancement of the profession.

To this end I have started the transition to relocate my blog hosting to First Responders Network. In the very near future there will be a minor face lift to the blog aesthetics and URL. Those of you that connect directly to paramedicpulpfiction.com will still connect with that URL. Those that connect using paramedicpulpfiction.wordpress.com will get re-directed to the new site. And those that subscribe via e-mail or RSS may have to re-set the subscriptions once the transition is complete. For the most part this should be a fairly transparent process.

I want to take just a moment to thank everyone who has been reading my self indulgent musings over the last year and rest assured that the same level of content will continue and possibly improve over the years to come. There is no shortage of fascinating observations to be had in the Big City that is my daily workplace.

To the thousands of people that have read my little blog over the last year let me say thank you so much for your time. I hope I have given just a few people something to think about and that possibly some good can come from that. For those of you that are on the job; stay safe.

Thank you!

~KC

 

Dissolution

dis·so·lu·tion

1: annulment or termination of a formal or legal bond, tie, or contract

2: decomposition into fragments or parts; disintegration

3: formal dismissal of an assembly or legislature

4: extinction of life; death

It’s a Code-2 response – no lights and no siren – and I’m in a morose mood as I make my way to the middle of the county. I’m responding solo and driving myself for once. The passenger seat next to me is empty. Scottie is responding from the other side of the county and I’ll meet him there. As I start to get closer I see others on their way to the same place. Uniforms in cars and ambulances, driving slowly in the same direction. I pass a fire engine with its cab full of new hires who are in the academy. I ponder the lesson that the brass is teaching them by having them take the day off from the hard work of the academy and attending a funeral: death is real.

As I make the turn into the cemetery I see the ambulance parked across the street. The cemetery happens to be at a normal posting location. Ambulances are sent to this intersection as it has easy access to a few different cities, as well as the necessities of a mobile crew: a bathroom, some shade, and nearby food options. Many of the cars parked along the wide streets running past the headstones bear county EMS stickers in their back windows.

Walking up to the small chapel I pass ten ambulances, four fire engines, and even a ladder truck. Our brothers and sisters from the fire service have made a good showing – every city in our county is represented, and we all appreciate their presence.

Walking over the small grassy hill to the chapel I see the sea of uniforms – I’ve never seen so many of us in one place before, and it’s overwhelming. Paramedics, EMTs, dispatchers, firefighters, police officers, and of course the honor guard with class-A uniforms complete with swords. There’s even a mounted EMT from the equestrian unit – I never even knew we had an equestrian unit.

All are here to pay their last respects.

At any given time at least a third of us are working the streets and responding to calls in the county. But the 24×7 nature of our work and the size of our county makes it difficult to get so many of us together at one time and in one place. Today is the exception – they put out the call to neighboring counties for mutual aid. Other counties’ EMTs and medics came into our county, checked out our rigs, and opened up the map books to respond to our calls, allowing us to gather for this final goodbye.

There have to be over 300 uniforms standing around the chapel, yet Scottie is able to pick me out of the crowd and he makes his way through it to stand next to me. We have a comfortable silence between us. We’ve only been partners for about a month but spending twelve hours together on a daily basis can bring people together fast. I notice that many other partners have found each other and taken comfort from being together during this emotional time. There is one person who is unable to stand with their partner and that stands out that much more for his solitude.

I find myself in a line which is slowly making its way into the chapel; the honor guard stands at attention as we enter the doors. As I enter the chapel I realize that all the seats are taken and this is actually a line to view the casket – it’s an open casket funeral. I wasn’t quite prepared for this and that’s a strange thing to say. Unlike most people in the world, we get up in the morning and put on a uniform knowing that we have the possibility of seeing a dead body or even watching someone die. Somehow I forgot about that this morning and I wasn’t prepared to see a friend in a casket. I place the rose petals on his chest and file out the back of the chapel before I lose it.

Eulogies are given and a life that ended too soon is remembered. I look over at the crew that worked him in his last minutes and feel an unbelievable sadness. They were camping and hiking that day and too far away from any urban areas when they saw the skin signs. We all know the skin signs – pale, cool, diaphoretic – and the cardiac etiology that they speak to. They did CPR on a friend without their paramedic equipment and waited the 45 minutes for the ambulance to respond.

I can imagine the time feeling like hours as everyone does the sad math in their head. Only about 15% of cardiac arrest patients actually survive. Once in cardiac arrest the chance of survival diminishes by 10% for every minute of down time. I can imagine the absolute anguish of seeing the ambulance finally arrive only to find out it’s an EMT ambulance with no advanced life support equipment on board. The county where they were hiking isn’t as well funded as our county. The three medics and two EMTs that were with him could only use the most basic of skills in an attempt to save his life. The EMS gods were in a very bad mood that day.

The color guard snaps to attention and the bugler begins the sad song of Taps. The flag is ceremoniously removed from the casket and meticulously folded to be handed to the family. The casket is slowly taken from the small chapel to its final resting place. The procession slowly walks past a double flank of hundreds of uniforms standing at attention with salute in place. One of our own has been taken.

The color guard does a sharp left face and marches off. A final salute is given and the assembled uniforms are dismissed.

One week later Scottie is driving us to the post across the street from the cemetery. He angles the rig so we don’t have to look at the rows of headstones with flowers laid beside them.

“I don’t like this post any more.”

“Yeah, neither do I…”

 


Serial Killer

se·ri·al 

1 :  arranged in a series, or forming parts of a series

2 :  responsible for a series of usually criminal acts over a period of time; a serial arsonist

3 :  serial killings and/or attacks are a series of killings/attacks committed by the same person

kill·er

1 :  one that kills

The sun is shining and it’s a warm day as I walk into the barber shop. It’s my day off and  I’m trying out a new shop as I just moved to this area. It’s always hard to find a new place to get my hair cut. You’d think a flat-top would be a simple haircut, yet not too many people can do it well.

Sitting in the chairs, waiting for the next available person, I see an old man get up after getting his haircut. He stands and takes a step then starts to crumple to the floor. The woman who was cutting his hair and I both grab an arm and helped him to sit down in a chair. I instinctively went into paramedic mode – asking all the questions and running a differential before calling the man’s son to come and drive him home.

That’s how I first met Barbara. She’s younger than me with a bubbly personality. She gave me a free haircut after that because I helped the man out. Turns out, she did a good job so I’ve gone back to her about every three weeks for the last three years. We have the cordial familiarity that grows over time with a barber. We talk about work, the dogs, vacations, family, etc.

Three visits ago Barbara told me she found a lump in her breast. She’s comfortable talking with me about medical issues. We discussed the possibilities and possible treatments for a lump in the breast. When I left she said she had a doctor’s appointment the next day.

I often find that people are more comfortable talking with paramedics than with doctors or nurses. We are approachable – we speak plain English, yet we can translate the cryptic medical language. More importantly, we actually make house calls – no one else does that in the US anymore.

Two visits ago she tells me that the doctor confirmed that it is breast cancer. It’s an early catch but it’s also an aggressive presentation. He recommended a double mastectomy and a double round of chemotherapy. She tells me that she just had the first trip to chemotherapy a week ago and it knocked her on her but for five days. She’d scheduled the surgeries for the following week. We talk about what to expect for the next six months as she gets a dose of chemo every other week. The hair falling out, the nausea, the weakness. I’ve had patients tell me it feels like the worst flu they ever had – only worse.

On my last visit I see Barbara finishing up on a customer while I wait my turn. She has a little cap that covers her head. Both of her breasts are gone and her blouse is still a little baggy on the top after having been stretched out and tailored to fit her old shape. I see a little bit of a dressing and tape peek through the v-neck of the blouse. She’s still doing wound care after the surgery. I see the subtly rounded lump on the chest where she has a port-a-cath implanted under the skin. It’s a device that allows access to the veinous system for repeated treatments. Barbara is still her bubbly self yet I see the underlying sadness and uncertainty.

In the course of one month her life has completely changed. The two physical attributes that both men and women identify as the superficial expression of femininity have been taken away from her: her breasts and hair. The healthy woman who went to the doctor for a routine annual checkup has now become a frequent flyer of the medical community. It’s still too early to know if the cancer has been eradicated. Basically it’s a situation where she will be re-examined for years to come to see if the treatment worked.

In time her hair will grow back and the scars will heal. She tells me she’s considering getting implants but it’s a long and painful process where they insert a balloon and slowly inflate it over time. This allows the skin to stretch out to accommodate the implants. Whatever she decides I suspect I’ll see the progress at every visit – in order to check that my flat-top is flat, she always positions my head to where I have no choice but to stare her straight in the chest as she trims my hair with the clippers.

My blog has the word fiction in the title but this is a very true story that happened just one month ago. Breast cancer is something that affects us all and this month is breast cancer awareness month. Please get involved, donate, and spread the word. Maybe together we can make a difference.


Section 8

sec·tion

1 – one of several parts or pieces that fit with others to constitute a whole.

2 – a type of Federal assistance provided by the United States Department of Housing and Urban Development (HUD) dedicated to sponsoring subsidized housing for low-income families and individuals.

3 – category of discharge from the United States military for reason of being mentally unfit for service. The meaning of Section 8 became known in households worldwide as it was used often in the 1970s TV series M*A*S*H, in which the character Corporal Klinger was constantly seeking one.

As we’re responding to an address in the hood, lights and siren running in the background, my partner Brent and I are playing the prognostication game. It’s a way to alleviate the monotony of the day a little by trying to guess the actual nature of a call from the minimal information on the MDT (mobile data terminal), which is often inaccurate.

The prognostication game is a way of staying sharp. We take into account the time of day, socio-economic make-up of the neighborhood, whether it’s a house, apartment, or “corner of” call, and if the call was initiated by cell phone or land line. In our busy county each crew runs around 1000 calls a year so we start to see trends pretty fast.

The prognostication game is also a means for bragging rights between partners – we keep track over a period of time (a shift, or a week) and the loser buys the winner coffee. The only downfall to the game is you have to be willing to drop the pre-conceived assessment immediately when you get there and your actual assessment points in a different direction.
The dispatch notes on the MDT only tell us we’re responding to a 47 year-old female with shortness of breath. I nailed the last one with the 35 year old male having abdominal pain with a pre-arrival diagnosis of pancreatitis aggravated by alcohol consumption. This time, I’m going with the easy odds of an asthma exacerbation. Brent has about the same odds with the guess of a panic/anxiety attack.

We arrive on scene to see the BRT parked in the parking lot of a high density federally subsidized housing project. We call it Section-8 housing in reference to the portion of the U.S. Housing and Community Development Act of 1974 which provides a subsidy for low income families and individuals. The neighborhood is largely African American and the frequency of asthma in urban areas like this is quite high; that’s why I went with the easy odds this time.

As we walk into the ground-level apartment we see the patient sitting on the sofa with fire fighters doing an assessment. In unison my partner and I stop, mid-stride, and our jaws drop.

We stand there, dumbfounded, staring at the decor. One whole wall of the apartment is covered with NASCAR matchbox cars, still in their packages and perfectly aligned – tacked to the wall with edges touching. There must be 300 cars on the wall.

On the adjacent wall is an altar with a picture of Jesus flanked by pictures of Dale Earnhardt and Dale Earnhardt Jr. The holy trinity, really? All pictures are of equal size and displayed with equal prominence. Sitting on the altar are shoebox sized models of the number 8 car and the number 88 car aligned with their respective drivers. What, no car for Jesus?

In the kitchen are two cats, one sitting on the counter the other sitting on the ground. Both cats are fixated on a cage on the kitchen floor with four birds that nervously jump from perch to perch.

There’s an angry looking, heavy-set white woman, probably not related to the Hispanic looking patient, standing near a day bed that’s covered in cash. A four foot square tapestry hanging on the wall over the bed with a picture of a white tiger has the caption, “The Eye of the Tiger” under the image.

I’m starting to think my asthma guess is out because of the chaotic nature of the furnishings. There are some interesting contradictions in the décor which could speak to the mental stability of the occupant. I mean seriously, who puts a bird cage on the floor when you have cats? Which animal is being tormented more by the close proximity? And being a NASCAR fan is great, although I’ve never seen one in this neighborhood, but deifying the drivers??

Someone with a psych history is more likely to have an anxiety induced hyperventilation. Brent was probably right on this one…

The thing is, Paramedics are trained observers that profile. Maybe that’s not a politically correct thing to say these days but I believe it’s true. The city police won’t use the “P-word,” but the FBI likes it so much they made a division of people who specialize in it.  Paramedics often get only half the story on any given situation, we are often lied to by our patients, and many times the patients have no idea what’s going on. So we have to fill in the blanks. That’s why we play the prognostication game – to exercise our mental abilities to fill in the blanks.

If I’m going to a call in the hood and someone is passed out then I’m looking for signs of drug/alcohol use. If I’m going to a call in the affluent neighborhood and someone is passed out I’m looking in medicine cabinets to check for an overdose on prescription medication. It’s just a matter of prioritizing the rule-outs based on observations and high probability odds. Everything will get checked by the time I get to the hospital but I modify the order of rule-outs based on what I see and how the patient is presenting.

The fire medic has been waiting for me to take it all in; I suspect they had the same reaction that we did. Finally I have a look at my patient. She’s breathing very fast with shallow breaths. I see the cardiac monitor; she has a heart rate of 136 with a regular rhythm.
The fire medic tells me she thought she was having an asthma attack and used her inhaler, but she is still short of breath. I look at the O2 saturation on the monitor and it reads 100%. She’s getting plenty of oxygen to the blood so she should be fine. The fire medic watches as my gaze shifts, gives me a shrug and tells me her lung sounds are clear. I’ll recheck the lung sounds when I get her in the rig but right now I want to cut the fire crew loose as I’m not going to need any help on this call. They get run pretty hard in this neighborhood so I try to take over the call fast when it’s possible so they can try to get some down time before the next call goes out.

I introduce myself to Rita, my new patient, and tell her that I’ll be taking her to the hospital. As she’s getting her purse the LT asks her about the money. He’s going to lock up for her but wants to know what to do about the money laying on the day bed. Rita says to give it to the angry looking white woman telling us it belongs to her.

Once I get Rita into the rig I start over with the questioning and examination. I ask if there was any kind of emotional event that precipitated the asthma attack; she says no. I check her lung sounds and they are perfect – no bronchial constriction or wheezing. I have her on my End Tidal CO2 (ETCO2) detector so I can measure the CO2 in exhaled breaths and have a real time wave form on the monitor to see how she is breathing. It also gives me an accurate count of respirations per minute.

Rita is breathing at 44 times a minute with an ETCO2 of 16. Normal readings would be a respiratory rate of 16-20 and an ETCO2 of 35-45 so there is definitely something wrong here. When I ask she again denies any emotional stressors or history of anxiety or panic attacks or any drug use. Looking down at Rita’s hands I can see the carpopedal spasm beginning to cramp her fingers – basically, breathing too fast changes the metabolic balance in the body resulting in cramping fingers and feet.

I tell Brent we can start driving as I’ve done my rule-outs and decided what my treatments are going to be. I start an IV and inject Benadryl into the tubing to sedate her a bit. Benadryl is a drug that’s typically used for mild allergic reactions or seasonal allergies, but our medical director added it to our protocols for mild sedation, which is an off-label usage (i.e., drowsiness is a side-effect of Benadryl). It’s not going to put anyone completely out but it does help to calm people down. I think part of it is a placebo effect in that people see me draw up a medicine and inject it while I’m telling them it’s going to make them feel better.

I turn the lights down in the rig and sit at the edge of the bench quietly doing my paperwork on the laptop. In some cases my treatment for a panic attack patient is to ignore them. Maybe that sounds cold but I have my reasons and often it works. Many times a panic attack is to get attention or to get out of a situation. Well, Rita doesn’t seem to want any attention. She’s staring at the cabinet and not looking at or interacting with me. I’m thinking she wanted out of a situation. Having accomplished that I’m going to leave her to her thoughts while we take the fifteen minute drive to her favorite hospital.

As we’re pulling into the hospital I take a look at the monitor. Rita’s respiratory rate has dropped to 22 and the ETCO2 level has risen to 20. Both numbers are moving in the right direction and Rita has had her eyes closed for the whole trip. After getting her into a room and giving the report I sit down to finish my paperwork at one of the nurse’s desks.

A few minutes later, Rita’s nurse comes out and I catch her eye – I thought of something else. “You know, there’s one other thing.” I tell her, “There were $400 dollars all spread out on a day bed and an angry looking woman who may have been the building manager. I’m thinking it’s the middle of the month so if she was paying rent now it’s pretty late. And even Section-8 housing is more than $400. I bet that’s what caused the attack in the first place.”

The nurse’s eyebrows lift up and she goes back in to ask about the money. Three minutes later she comes out shaking her head up and down. “That was it.”

It looks like I’m buying coffee tomorrow morning as Brent is winning the prognostication game today…

Home Invasion 2/2

My partner kills the siren as we enter the residential neighborhood – it’s a courtesy to people trying to sleep. No reason to wake the entire neighborhood as long as we can drive safely. He still chirps the siren as we go through intersections, but that’s much better than having it on all the time.

The strobe lights, on the other hand, continue to blaze along our drive. It’s almost midnight so we need the visibility that they provide. The strobes also reveal the realities of this neighborhood – bars on the windows, graffiti on the fences, and dogs that bark at our passing. This neighborhood may have been nice forty years ago but these days it’s deep in the hood.

We finally spot the BRT (big red truck) down the street parked in front of a house. We are responding to a “Medical Alarm: Unknown.” That’s what our dispatcher calls it when an elderly person pushes their medical alarm and the monitoring agency calls 911 for them. I still remember the commercial in the eighties with the little old lady lying on the ground saying “I’ve fallen and I can’t get up.” It became a cliché saying back then but the high frequency on calls just like that have earned it an honored place in the abbreviated shorthand of EMS communication: LOLFDGB – little old lady fall down go boom.

Pulling in behind the BRT my partner and I exit the rig and find the lieutenant (LT). I’ve seen him now and again while working this urban county so we have a cordial familiarity. I also know a few of the guys on his crew, most of whom are young as this is deep in the hood. The old timers can bid to the “vacation stations” in the more affluent neighborhoods because of their seniority. Lacking seniority the younger guys are left with the crap shifts in the bad neighborhoods. They get worked pretty hard – sometimes 20+ calls in a 24-hour shift.

It’s midnight and no one is happy about getting woken up for a call that tends to be nothing. We’ll typically get cancelled off of this kind of call – at least half the time. It usually ends up being a simple lift assist or maybe they pushed the button while at someone else’s home or at a restaurant. The elderly often don’t understand the nature of the technology. It’s not a GPS (yet) and pushing the button only sends responders to the address on record.

LT tells me that they don’t have any more information than we do. It appears that no one is home; no lights on in the house, no answer to the door. They are going around the house to see if there’s a way inside. We can’t just leave when someone activates the medical alarm. They could be having the big one and can’t get to the door. They’ll break in if they have to.

Standing in front of the house with the engine noise of two rigs and strobes flashing I’m watching the firefighters check windows for entry. If they can find me a patient I’ll be happy to jump in but breaking and entering is their specialty, not mine. A neighbor walks up to me, attracted by the commotion.

“That’s Irma’s house, is something wrong with her?”

“I don’t know, that’s what we’re trying to find out.” First responders are always circumspect about giving information to bystanders because of patient confidentiality issues. But this seems to be a concerned neighbor. She tells me that she checks on Irma a couple times a day because she lives alone and is having an increasingly difficult time taking care of herself. I ask if she has a key or if she knows of a hidden key. She answers no to both questions.

I tell the LT what I know and he assigns one of his guys to force a window open. Of course the crap job of breaking and entering goes to the rookie on his crew. You never know what’s on the other side of a window – maybe a guard dog. The rookie is able to pry the window up and climbs inside. After maybe thirty seconds he screams out the window, “She’s got a knife!” What the hell?

LT and the other two firefighters instantly spring into action. LT gets on the radio requesting city PD to respond to our location code 3 while the other two run to the BRT and slide open the exterior cabinets containing tools. They rush the front door with the Halligan (think pry-bar multi-tool) and an axe. Prying the door away from the frame one of the firefighters puts a shoulder to it and breaks the dead bolt free of the hole. The door crashes in and we all rush into the living room.

Standing in the corner of the living room is the rookie; hands in the air, eyes big and round. In front of him is a little old gray-haired lady waving a huge kitchen knife at all of us, while supporting herself on a walker. She’s terrified – almost as much as the rookie. LT is trying to reason with her, “We’re the fire department, we’re here to help, no one’s going to hurt you, put down the knife!”

The neighbor pokes her head in the doorway. “She’s deaf, she can’t understand you.” She comes inside so Irma can see her. LT has everyone back away and the neighbor calms Irma down and takes away the knife. LT is checking on his rookie and I walk Irma and the neighbor into the kitchen to see if anything is wrong with her aside from being so scared.

I spend a half hour writing notes back a forth with Irma. I find out that she must have accidently pushed he medical alarm, that hangs around her neck, while sleeping and has no medical complaints. She doesn’t want to go to the hospital – she just wants everyone to leave so she can calm down and try to go back to sleep. As I interact with Irma the fire crew tries to piece her door frame back together. They’ve done this before so they have all of the tools – wood glue, nails, etc. It’s not perfect but it will keep her secure until she can replace it, which probably won’t happen.

Irma checks out fine and signs my release of liability form so I can leave her in peace. As I’m walking back to the rig LT and the other firefighters are giving the rookie shit for getting assaulted by a granny with a knife with a walker. He’s probably going to need to change his shorts when he gets back to the station and he’ll be the brunt of jokes at dinner in the station for months to come.

As my partner flicks off the strobes and we drive out of the deep hood I realize that PD never showed up and LT didn’t cancel them. They just didn’t respond. They’ve already reduced the police force by ten percent and we’re starting to see the results on the street.

That’s more than a little disconcerting… 

Home Invasion 1/2

home

1 : A place where one lives; a residence

2 : The physical structure within which one lives, such as a house or apartment

3 : An environment offering security and happiness

 

in·va·sion

1 : an act of invading; especially : incursion of an army for conquest or plunder

2 : an action or process which affects someone’s life in an unpleasant and unwanted way

3 : an intrusion or encroachment

As Irma lay sleeping in her bed the window was slowly pushed up from the outside. A young African American man wearing a beanie hat pulled low over his ears looks in the window. He pushes the window up further to fit his torso through.
Crawling in through the now open window he stands over Irma and reaches down to grab her shoulder. Irma is a heavy sleeper and doesn’t notice. The young man is wearing a dark jacket and pants. He puts a knee on the bed and rolls Irma on her back. He puts his hand on her throat as he brings his face close to hers.

Irma is startled awake and finds herself staring at a stranger in dark clothing kneeling on her bed with his hand on her neck. She lives in a dangerous neighborhood – she’s lived here for 46 years and has watched the slow decline; more gang violence, bars appearing on windows, pit bulls behind locked gates and friends moving away after having their houses burglarized. She’s had this nightmare before but it’s different this time; nightmares stop when you wake up – this one is just starting.

The man says something to her but she’s deaf – has been for years now and the hearing aids just don’t help any more.

She’s prepared for this moment, having run the scenario a hundred times in her head. Irma swats the stranger’s hands away, to his surprise. He didn’t think a woman in her 80s could move that fast. She reaches over to the side table for her knife.

She sits up on the bed pointing the knife at the intruder. He’s scared – not of the old lady in front of him but of the 12-inch kitchen knife being waved in his face. He yells out the window to his friends.

Even more frightened now, Irma grabs her walker with her left hand and stands up. The intruder is backing away from her – the knife has him concerned. In slow shuffling steps she backs the intruder out of the bedroom and towards the living room. She’s having a hard time seeing him – he’s wearing dark clothes, the house is dark, and in the excitement she didn’t think to put on her glasses, even though they were right next to the knife on the side table.

She wants to get to the phone to dial 911. She knows she won’t be able to hear what the 911 operator says but just dialing it will ensure that someone arrives. It’s becoming increasing difficult for a woman living alone with only the occasional neighbor to check on her these days.

Irma makes it into the living room while pushing the walker with her left hand and frantically waving the knife in her right hand. She’s been able to hold off the intruder for the last minute. Suddenly the room is awash with light. The front door has been forced open and men start streaming into the room; the intruder’s friends have broken the door down!

Irma is blinded by the light in the room yet realizes that she’s surrounded by more intruders wearing dark clothing. She is unable to hear anything and she is without her glasses. The men are between her and the telephone. She was scared when she saw the stranger kneeling on her bed, now she’s terrified. This nightmare has turned into a horrible reality.

Inception 1/4

in•cep•tion

1 : the establishment or starting point of an institution, activity, or idea

2 : the beginning of something, such as an undertaking; a commencement: origin

3 : Inception; a movie released in 2010, directed by Christopher Nolan, starring Leonardo DiCaprio

There is one skill that is shared by Paramedics across the country and around the world: the ability to sleep – anywhere, anytime, even after seeing some of the most disturbing things imaginable. It’s an acquired skill that is necessary for survival and longevity in this profession. As we work our twelve, twenty-four, and even forty-eight hour shifts the “power nap” becomes a tool for staying sharp to handle the next set of challenges brought upon us by the call of the dispatcher on the radio. We have the ability to tune out the ramblings of the dispatcher and sleep while sitting in the front seat of the rig, sunglasses hiding our closed eyes, until hearing that magic call sign that is unique to our unit. Then we snap awake to hear the instructions of the dispatcher as we’re sent to the next call.

This isn’t quality sleep by any means – it’s a light sleep in which the mind wanders, decompresses, and explores, freed of conscious direction. With the constant cycle of adrenaline and boredom throughout the day, the body takes this time to process toxins and stimulants through the kidneys and liver to attempt to return to a metabolic equilibrium. The byproduct of this kind of sleep is vivid, chaotic, and sometimes insightful dreams.

After the week I’ve had and the last call that took almost three hours to complete all I can think about is closing my eyes for just a few minutes to recharge. I’m on my fourth day in a row; twelve on followed by twelve off for four days puts me at the end of my endurance level anyway, and the last call pushed me over the edge.

I’m in the rural corner of my mostly urban county. It’s a suburban area with farms, quiet neighborhoods, and vineyards. A big rig full of grapes left this area headed towards one of the big wine processing plants. The freeways were slick from the rain as the big rig was cut off by a minivan, causing it to jack-knife on the freeway. The freeway was instantly covered with literally tons of grapes. Multiple secondary accidents happened within seconds of the first one. My partner and I were one of many units that arrived on scene to try to make sense of an accident stretching across more than a hundred yards of fruity smelling freeway, with multiple patients and injuries ranging from shoulder pain secondary to seat belt straps, up to life threatening internal injuries requiring a helicopter ride to a trauma center.

We found ourselves pushing gurneys through mounds of grapes, doing multiple rapid assessments, triaging the worst injuries for immediate transport, calling in additional units, coordinating a landing zone on the freeway and finally leaving the scene with three patients with minor injuries – we were the last ambulance out of there.

We arrive at the ED and I spend an hour doing three sets of patient care reports. I’m exhausted, wet from the rain, and all I can smell is grapes, which is actually refreshing compared to the normal EMS smells that assault me on a regular basis. As we arrive at the post back in the rural corner of the county I put on my sunglasses, turn down the EMS radio and stare at the rain drops on the windshield as my eyes slowly shut.

Conflict Resolution

con·flict

1 : a state of open, often prolonged fighting; a battle or war
2 : a psychic struggle; often unconscious, resulting from the opposition or simultaneous functioning of mutually exclusive impulses, desires, or tendencies

res·o·lu·tion

1 : the firm decision to do or not do something
2 : the quality of being determined or resolute
3 : the action of solving a problem or contentious matter
4 : music; the passing of a discord into a concord while changing harmony

I tell the fire crew that I’ve got this if they want to cut out. They are always in a hurry in this city and when it’s a stat call that’s a great thing, but when it’s a geriatric patient who’s looking for his reading glasses on a non-emergent call, they tend to get impatient and that’s not so good. I’d rather let my patient take his time and feel comfortable than hurry him out the door. He finally spots his reading glasses on the music stand surrounded by three trumpets he’d been practicing a short time earlier.

We were called here because his wife noticed that he got dizzy when he stood up from the couch and was slow to answer questions after sitting back down. I do my assessment and find him negative for stroke signs, STEMI (S-T elevation myocardial infarction, meaning heart attack), diabetic problems, and everything else I could think to ask about that may cause a near syncopal (fainting) episode.

It’s likely that the beta blockers he takes for hypertension kept his heart rate low enough that his blood pressure couldn’t keep up with the sudden demand of standing up and he got a little light headed. His wife cares about him and wants him to get checked out anyway. Both he and I can see that arguing with her is a losing proposition so he’s going to humor her and go to the ED with me. That’s okay with me, honestly I would rather take a man in his mid-eighties to the ED than spend an hour documenting why I didn’t take him.

I complete my entire assessment in his living room and he’s symptom-free so I’ve got very little to do as we drive to other side of the city to his preferred hospital. Being a non-emergent call (some might call it a BS call), I don’t have to rush him to the closest facility or take him to a specialty hospital — he can choose where to go. If it makes him feel better to go across town that’s fine with me.

As I’m sitting on the bench in the back of the ambulance, filling in his demographics on the laptop for my paperwork, I do a quick lookup on him to see if we’ve transported him before. We have, so his information comes up. His insurance information indicates VA (Veterans Administration) coverage.

His name is of Japanese decent and he’s in his mid-eighties. I always like to thank the older Vets for their service and sometimes hear some stories when I get a chance, so I ask if he fought in the war. Men in their eighties only recognize one war; everything since was just a conflict.

“Oh yeah, I fought in the war, got drafted in ’44 as soon as they let me out of the internment camp.” He has a slow meticulous cadence almost as if he is planning where to stop and take a breath and adjusts his words to facilitate regular breathing.

“Are you serious, you were locked up and then you went to fight for the country that did that to you?”

“Yeah, my mother told me to. She said, ‘You were born here, this is your country. If they want you to fight for it then it’s your duty.’ So I did.”

I remember hearing about the 442nd Combat Infantry Group that fought in Europe. It was comprised almost exclusively of Japanese-Americans. They became the most highly decorated regiment in the history of the US Armed Forces with 21 Medal of Honor recipients. Yeah, okay I’m a geek, I’ve been known to put off cleaning the kitchen because there’s something compelling on the history channel, much to me wife’s chagrin.

“Well, I was sixteen when they put me in the camp. When I turned eighteen they said I had to sign up for the draft and as soon as I did they drafted me. I was supposed to go to the 442nd and was in the States training for it because they were losing those guys all the time — almost half of them died. But part way in they changed their mind.

“See, I was bilingual with no accent so they wanted me to help out in the Pacific. They sent me to language school for seven months, it was supposed to be nine months but they were in a hurry. Once I was done I got attached to the War Crimes Investigators and did translation for the interrogation of prisoners as we took back Manila.”

I think of the integrity and maturity that was displayed by this eighteen year old boy. After being imprisoned in a camp for two years at such a formative time in his life, he’s able to come to terms with some of the most difficult issues faced by humanity; prejudice, loyalty, inequality, duty.

“So you’re eighteen and doing the translation as they interrogate people?”

“Yeah, they were worried about me being so young at first too. They asked me, ‘Are you sure you can do this?’ I said, ‘I don’t know, let’s give it a try!’ So I guess my language skills were pretty good because it was easy for me. They were really impressed and kept me busy for the rest of my tour as we moved across the Pacific and into Japan. Being bilingual probably saved my life – as a translator I wasn’t really in danger of being killed.

“When my tour was over I got a job as a contractor in McArthur’s Tokyo doing intelligence work translating military documents. It was a good job, I did that for another five years.”

I imagine what it must have been like for him as a young man of Japanese descent – working within the American military machine after the national outrage following the bombing of Pearl Harbor. Then to go to the country of his parents’ birth immediately after atomic bombs were dropped on civilian targets. The conflicted emotions must have been overwhelming.

“So what did you do when you finally came back to the States?”

“Oh, I worked as a CPA for twenty something years. I mean, I still do some work for them in tax season but mostly I’m too busy to work any more.”

“Too busy? So you’ve got a lot to do these days?”

“Oh yeah, I’m real busy. I play the trumpet in two bands, seems like I got a gig a couple times a week and I’m practicing all the time. I even go to a brass workshop for two weeks every year. I love to play the trumpet, it keeps me young.”

His face lights up, he sits up a little straighter, and gestures with his hands while talking about music. This obviously means a lot to him – it seems it’s a big part of his life.

“When did you start playing?”

“Oh, when I was a kid in high school, then when we were in the camp it was pretty much the only entertainment we had. A few of us in the camp could play an instrument. We’d get together and play concerts to keep people’s spirits up. Then when I went into the Army I played the bugle to wake people up in the morning.

“When I got out and started working I didn’t have a lot of time, but twenty years ago I retired, well mostly retired, so I had a lot more time to play again. Been doing it ever since!”

As we’re backing into the ED I realize I haven’t done any paperwork. I’ve been listening to this fascinating man throughout the trip. He’s a man of honor and duty who led an amazing life and is now enjoying his golden years as a musician. The whole time I’ve been talking to him he was smiling with an alert sparkle in his eyes as if recalling fond memories. He has made peace with the past and expresses his strength of character and love of humanity through his music. I am a better person for having met him.