Tag Archives: iphone

Lachrymatory 1/3

lach·ry·ma·to·ry

1 : of, pertaining to, or causing the shedding of tears

2 : a small, narrow-necked vase found in ancient Roman tombs, formerly thought to have been used to catch and keep the tears of bereaved friends

We’ve been sitting here in the rig, parked deep in the hood, for the last 25 minutes. Scottie is playing a word game on his iPhone and I’m checking e-mail and reading EMS blogs on my iPad. There’s an assault going on six blocks from us but there are no police officers on scene yet so we have to stage here until they tell us it’s safe to enter. It’s been raining all day and the wipers are on delay; going off every few seconds to wipe the rain from the windshield.

“Anything new in the notes?” Scottie doesn’t even look up from the game.

Glancing over at the mobile data terminal (MDT) in the center console I see that nothing has changed. “No, still no PD on scene.” It’s unbelievable to me that an assault can continue for a half hour and the police are stretched so thin that they don’t have the manpower to respond. I wish the city council members who voted to lay off the officers six months ago could spend the day with us and see what their decision is costing the public.

At the 30 minute mark the MDT finally shows that two officers have arrived on scene and five minutes later we are cleared to enter. We pull up at the same time as the fire engine who was staging on the other side of the incident. We ran a call with this crew earlier in the day and they were a good group. Walking up to the corner I smell the fresh scent of rain. It’s refreshing how it washes down the hood and makes it a little more pleasant but even the rain can’t change the fact that it’s a dangerous neighborhood.

The officer walks up to me and points to a young woman in tears standing by his car. “Just one vic – looks like a domestic, assaulted with closed fists.”

She’s crying and breathing fast but otherwise she looks okay at first glance; no blood and she’s able to walk and move all extremities. I look over at the LT on the engine and tell him I can handle it so they can clear and go on to the next call. As the engine is pulling away I walk my patient to the ambulance and she climbs in to sit on the gurney.

As I’m doing my regular checks of vitals and cataloging wounds the officer pops his head in the back door. “Hey, can you guys hang out here for a few? My crime scene tech is in a really bad mood and doesn’t want to go to the hospital for photos”

I slam the ice pack into my knee to activate it and hand it to my new patient to apply to her facial swelling, along with a few tissues to wipe away the tears. “Yeah, no problem, I’ve still got a little to do here and she’s pretty much stable.”

As I continue my assessment the officer is standing in the back door of the rig and questioning my patient, Anika. I listen in and start to get the story of what happened. She’s a foster kid who ran away from home with her adult boyfriend. She’s been living with him for the last few months. Today he was angry and and he took it out on her by hitting her in the head, stomach, back, and kicking her when she fell to the floor. She’s more emotionally distraught than physically hurt – all of the injuries are pretty minor. As she’s telling the story the other officer walks up with a gun. That is exactly why we were staging until the scene was secure…

“When he was beating you down did you ever see this gun?” With a cracking voice and uncontrolled tears she tells him no. The officer is looking for anything that would increase the charges on the assailant. Possession of a firearm during the commission of a crime would increase the time he spends behind bars.

Anika asks the officer, “How long is he going away for?” She’s scared yet also conflicted.

“We’ve got him on an outstanding warrant and firearm possession but you need to press charges for the assault to stick.” Anika is holding the ice pack to her quickly swelling face and eye while shaking her head. She doesn’t want to press charges. “Look, I’ve seen this before, it just gets worse; the next time he’s really going to hurt you. You didn’t do anything wrong and you don’t deserve this. It’s not okay to treat a woman this way. You need to help put this guy away so he doesn’t hurt you or anyone else. I’m telling you; it’s going to get ugly next time.”

I’m tracking her respirations on the monitor so I can see a wave form for each breath she takes. The wave form is getting smaller and the duration between breaths is getting shorter – she’s starting to hyperventilate. The officer is pushing her a little hard but it’s for her own good. We all know where this kind of thing will lead. We’ve all seen the final outcome and it really is as ugly as the officer said it would be.


Sexual Tension 3/3

Louis and I are taking a slow drive into the “killing fields.” That’s what we call this neighborhood since so many people die here from gunshot wounds and gang violence – cops, kids, bangers – they all die in this area. We just received the call – Code-2 – for penis pain. Now, you have to imagine that we see all kinds of stupid and tragic stuff all day long. Yet when penis pain comes over the MDT (mobile data terminal) in the rig we just have to laugh. I’m sorry but that’s the normal response. If my penis hurt I would go to my doctor or drive to the ED myself. Why the hell would I call 911?

But this is the poor neighborhood where people don’t have a primary care physician or any other avenue to the healthcare system other than by way of an ambulance to the ED. It doesn’t surprise me anymore, it just makes me sad. Code-2 also means that we are responding alone; no fire department to back us up. As we find the apartment building, not four blocks from a recent cop killing, we see bangers hanging out in the common area. We’re used to this – we always lock the doors to the rig, and have our heads on a swivel as we approach the building. Radios on our belts are on and we’re watching each other’s back as we walk up the stoop. Were I walking up here off-duty I would be missing my  wallet in less than a minute. Yet as they see we are EMS and not PD, the bangers are ready to help. They know we are only here because someone called and they look out for their own.

“Hey, you know where apartment F is?” The closest banger in his white tank top puts down his malt liquor and points up a stairway. “Thanks man.”

I’m walking up like I own the place – it’s better than letting my knees quake like they want to – and Louis has my back as we find the apartment. Knocking on the door, “Paramedics!” Louis pulls me back so I’m not standing in front of the door swing – or potential bullet trajectory…

A tall African American man in his sixties answers the door and motions for us to come inside. “Hey, what’s going on today?” I offer my typical greeting as I reach down and grab the remote to turn off the TV that is a little too loud.

“It’s my dick man, it’s hurt’n.” Before I can say anything else he unzips his pants and uses two hands to unfurl the most enormous penis I have ever seen. Sometimes I really have to take a step back and reflect on my career choice. I mean seriously, I just walked into a stranger’s house and he just exposed himself to me. Now I’m supposed to deal with whatever medical problem happens to pop up. Paramedics have an interesting mandate – whether we walk into a house with a blue baby, a dying grandparent, a choking sibling, or a wife who was beat up in a domestic violence, we MUST maintain the same expression on our face. People are relying on us to fix that which is beyond their own abilities to fix. And we do it day in and day out. Yet this is stretching my ability at the moment.

He unfurled maybe 14 inches of two inch diameter penis cradled in both of his large hands. “Okay, so what’s up, is this more swollen than it should be?” What the hell else am I going to say?

“Hell yes it’s more swollen and I can’t pee; nothing comes out!”

“So how did this happen, what were you doing?” Why the hell did I just ask that…

“See, I was have’n sex.” He lowers his voice. “And she kept saying, harder, harder, so I did and I guess I just rammed it in too hard!”

So I’ve pretty much got nothing left to figure out on this one; “So what hospital do you want to go to?”

He tells me that he goes to the County Hospital and starts walking back to the bedroom talking to someone saying he’s leaving. As soon as he turns away Louis and I look at each other – big mistake! We both double up in silent laughter and have to turn away from each other to regain composure before he returns.

I walk him out past the bangers, who ask if he’s okay, and into the rig. There’s not much I can do for this one so I give him an ice pack to stuff down his pants and just load him up with Morphine. Call it a male sympathetic response but if there’s anything wrong with a guys package then he deserves as much Morphine as my protocols allow me to push. It helps him, of course, but it also helps me get through the call without having to cringe every few seconds.

On the way to the hospital I do a quick lookup on my iPhone as I can’t remember the name of this condition. The result comes back quickly – paraphosis. It’s where the foreskin gets stuck on the proximal side of the head of the penis and constricts due to trauma. It constricts the penis and prevents urine from passing and creates a swelling of blood. It sounds painful and he’s only marginally better after the medication.

I get him through triage quickly by telling the nurse this is a matter of “life and limb” and it’s a damn big limb! I finish my paperwork and go back to his room for a signature. Sliding back the curtain I look in to see the MD injecting his penis with Lidocaine. UGH – another image I’m going to have to try to erase from my mind!

The MD tells me he’s going to numb the penis, clip on with a forcep, and pull the foreskin over the head. He’s using the Lidocaine as a local anesthetic and he’ll do a procedural sedation with Versed just before doing the deed. AHGGGHHH! Cripes, too much information.

Before leaving the ED, I decide to make a quick stop at the restroom – I learned early in my EMS career to never pass up an opportunity since I never know when I’ll get another. I have to let Louis know where I’m going, “I’m going to depress myself and hit the head,” I tell him. He replies, “Yeah, I think I’ll wait – I’m not ready for that kind of let-down just yet.” I wouldn’t even want to be as “well-hung” as my patient, but there’s still that male ego thing…

I go back to the rig to finish my lunch and hope for a nice and simple cardiac arrest call to erase the images of the last call from my head.

 

 

Distraction 2/2

Walking into the entertainment center I see the jumpy house with it’s bright yellow entrance which matches the yellow of my gurney. Sitting on a bench is a woman holding  a small girl who’s bleeding from the foot. The firefighters walked in maybe 30 seconds before we did. I’m in the more affluent neighborhood of my mostly urban county. The fire crews are more pleasant here as they don’t get run as hard as the inner-city crews. They are quick to break out the bandages and stop the bleeding.

Fortunately I’m able to get a look at the wound before it’s completely covered. It’s a one inch evulsion (skin torn away from underlying tissue) to the top of the small girl’s right foot; muscle and adipose tissue are visible where the skin should be. It looks as though someone just carved away the skin with a knife. The girl, whom I come to find out is named Kimberly, is crying. It’s more of a sad constant cry than a hysterical outburst. She must be quite a mature little lady not to be flipping out right now. Her mother, on the other hand is very distraught; brow furled, talking quietly in her daughter’s ear, she’s holding on by a thread. While inspecting the foot I notice that Kimberly’s pants have a thick quilted lining sewed into them; obviously a modification. I start to ask the mother questions; I want to take her mind off of her daughter as much as I need to understand what happened here.

“I really don’t know, I mean I only turned my head for a second.” Her brow is furled, voice cracking under stress, trying very hard to hold back the tears; very emotional. “One of the other children must have landed on her. She has Ehlers-Danlos Syndrome so she’s susceptible to skin tears.”

There are so many syndromes out there, I may run into the same one every few years or never see one in an entire career. I have to be honest with her. “I’m not familiar with that syndrome. How does it effect the skin?”

“It’s genetic, I have it also and passed it down to her. We’re missing the gene that creates collagen in the skin so the skin and connective tissue have no elasticity; even a simple bump can create a tear.”

Now that she’s focusing on me and not the compounded levels of guilt about her daughter I see that she’s a well spoken, educated woman. She has lived with this syndrome for all of her thirty something years and is fully versed in all of it’s intricacies.

I’m not going to be able to do much for Kimberly other than understand the nature of the syndrome a little better then treat the symptoms. Genetic repair hasn’t made it to the pre-hospital bag of tricks yet. “Are there any bleeding, coagulation, or clotting issues associated with the disorder?”

“No, it’s strictly collagen, it doesn’t effect the blood at all. That’s why I made the padded cloths and protect her as much as I can but they said she had to be bear foot in the jumpy house. I knew I shouldn’t have let her go in but it’s a special day.” She’s doing her best not to loose it in front of her daughter. The firefighters have finished wrapping the foot and Kimberly has stopped crying; just sporadic whimpers as she’s held in her mother’s arms.

Their both on the edge of cracking, I need to keep them focused on me to avoid a negative emotional feedback loop. “Okay, so Kimberly’s foot is protected now that it’s wrapped, how about you let me take you to the hospital? Their going to need to close the wound, either with sutures, or possibly a glue, to protect against infection.”

“No, I’ll drive her myself, God knows, I’ve done it before.”

“So, here’s the thing. She’s perfectly stable right now and I have no problem letting you drive her. But you’re very emotional right now. It would be much better if you had someone else drive so you can take care of her on the way. The last thing I want is to get called to a traffic accident and find the two of you there. Is your husband around or can you call him?”

“No, he’s out of the picture, I’m here alone.” Her non-emotional response tells the whole story. Paramedic opens mouth and inserts foot; news at eleven…

“Then it’s definitely a good idea to let me take you, it will keep the both of you safer and I can give Kimberly some medicine to help with the pain a little.” She agrees with a bit of a relieved look on her face. With all of the issues that she’s dealing with right now at least this is one less thing to worry about and she can focus on her daughter.

Once in the rig I tell my partner that we can start moving; all of the necessary treatment was done on scene by the firefighters. Kimberly is laying on the gurney in the back of the rig with mom sitting next to me on the bench seat. Kimberley is still letting out a soft stream of whimpers.

While I’m explaining to mom that I can give Kimberly some morphine for the pain I reach up to the front of the rig and grab my iPad. I don’t like to dope kids when their parents are present without a good explanation. I’m planning on using the iPad to keep Kimberly busy while I draw up the morphine and explain the effects to mom. I launch an app and hand it to Kimberly, after surreptitiously checking for blood on the hands.

“Kimberly, this is Talking Carl, say hello to him.” She looks at the screen to see an animated character waving at her. He looks like a short fat sibling of Gumby.

In a tentative voice, “Hi Carl.” Two seconds later in a slightly higher pitched voice Carl’s mouth moves and he mimics Kimberly, “Hi Carl.” bobbing back and fourth he waves at Kimberly. She starts giggling, “Mommy, he talked to me!” two seconds later Carl starts giggling and moving his mouth and in his exaggerated high pitch voice, “Mommy, he talked to me!

This goes on for ten minutes of giggles and laughter as we drive to the hospital. I show her how to tickle Carl on the screen and Carl starts laughing then she laughs and Carl mimics it and it starts all over again. It looks like we just created a positive emotional feedback loop. As Kimberly is now busy and mom is actually starting to smile for the first time since I met them I have a minute to look up the syndrome on my iPhone. It’s exactly what mom described.

With Kimberly fully engrossed in playing with Carl I see a relieved look on mom’s face and we have a few minutes to talk. Quietly so as not to distract her daughter mom confides in me. “I didn’t want to take off her shoes but they said she had to be bear foot in the jumpy house. I just wish I could wrap her in bubble wrap for the next ten years..” She’s conflicted with emotion; she wants to protect her daughter but at the same time she wants to let her explore, have fun, and be a normal child. She remembers her own childhood all too well and wants to do good by her daughter.

I’m pulling out my iPhone again, “Have you ever seen the shoes that martial artists wear to protect their feet when they spar? It covers the top of the foot with a half inch of foam dipped in a rubber coating. It’s bare foot on the bottom so it might be okay for the jumpy house.” I pull up a picture on my phone and mom sees how it may be applicable to her little girl. It’s not bubble wrap but it’s a good idea. We spend a few minutes browsing the site and looking at the different protective padding options that may be applicable.

As we arrive at the ED they are both a little more relaxed. Walking into the room, pushing the gurney, to get Kimberly settled in the bed I realize that I actually had two patients on this call; Kimberly with her foot and her mother with her anxiety. I didn’t lay healing hands on either of them nor did I open up the drug cabinet or perform any paramedic skills. Rather I treated with compassion, conversation, laughter, and a little distraction.

Distraction 1/2

dis·trac·tion

1 : a thing that prevents someone from concentrating on something else

2 : the act of distraction or the condition of being distracted

3 : something, especially an amusement, that distracts

4 : extreme mental or emotional disturbance; obsession

Kimberley always new she was different, ever since she was young. Now that she’s older she’s starting to understand it better. Mommy says that she can get hurt easier than the other kids so she has to be extra careful. But this is a special occasion; today Kimberly turns six years old.

Kimberly has her padded pants, her thick long sleeve shirt, the squishy headband around her head, and a big smile on her face as she enters the jumpy house. All of her friends from school are here; brightly lit faces and laughter as the primary colors of the inflatable castle illuminate everyone in a surreal light. The smell of kettle corn and pizza speak to the treats that await them when play time is over.

Outside the jumpy house Kimberly’s mother nervously talks to the other parents as the inflatable castle deforms from the constant jumping of the kids inside. She had reservations about bringing Kimberly to this place today but she wants to let her beloved and sheltered little girl have a special day. She paces outside the jumpy house, holding her breath at every fall.

She carries the weight of the world on her shoulders. Being a single mother of a fragile little girl she is on constant vigilance for Kimberly’s safety. She carries the guilt for her contribution to Kimberly’s condition and the roll that it may have played in her father taking himself out of her life.

One of the other parents brings her a soda as they all know she wants to stay close to the jumpy house. As she turns to accept it the smile of gratitude turns to alarm as she hears the sound of Kimberly cry out in pain. It’s a primal instinct that all mothers are programed to respond to; the sound of their child in distress. Spilling the drink on her shirt as she rushes to the clear observation panel of the jumpy house she knows what what to expect from her own experiences.

Laying in the corner of the jumpy house is Kimberly. Blood smears the bright yellow inflatable fabric, children scatter away from her daughter as they don’t understand what’s happening. How can such a happy experience go bad so fast? Kimberly’s mother knows exactly how it can happen; from personal experience and from the lengthy explanations from the geneticist.