Tag Archives: Morphine

Reflection 2/2

I’m a little disoriented as I sit in the front seat of an ambulance that is foreign to me and the unfamiliar dispatcher sends me to posts in my mostly urban county which are obscured by code numbers that I don’t understand. The computer on the console draws lines on a map telling us where to go as we fumble with the switches trying to find the siren.

“Medic-40, delta level response for a seventeen-delta-three, fall-not alert, switch to fire control three.”

“Uhh, Medic-40 copy.” What the hell is a seventeen-delta-three and how do I switch to fire control three?

Having finally found the siren and switched to the proper response frequency we are following the line on the computer in hopes of finding the call location. Rolling through traffic I see the familiar landmarks and denizens of the hood hanging on their normal corners. It’s somehow comforting to feel a connection with the hood on a day that seems so different in every other aspect.

Pulling up to the corner I see my neighbor, Darren, the lieutenant on the fire crew that beat us to the scene by only thirty seconds. Sitting on the stairs in front of him is Chauntel, a frequent flyer that I recognize from just last week, and her husband standing next to her holding a huge purse.

“Hey Darren, what’s going on?” The rest of the firefighters on Darren’s crew have bailed on taking care of the patient and are poking around my ambulance to admire the equipment and new ambulance smell.

“You know Chauntel right? Looks like she took too many of her Vicodin and wasn’t able to keep her feet under her while walking down the stairs. She’s not altered or anything, just feeling a little dizzy and complaining of knee pain.”

“Cool, I got it.” I kneel down to look at Chauntel as Darren joins his crew in opening cabinets on my rig. “Hi Chauntel, am I taking you to the hospital today or are you okay to go home?”

“I best go to the hospital, you know, jus to get checked out. I don’t think my Vicodins are work’n too well cuz I still got the pain in my knee.”

I help Chauntel onto the gurney and raise it up with the push of a button. Power gurneys; finally a career-extending piece of equipment.

As my partner drives us to the hospital I continue with my assessment of Chauntel.

“How bad is the pain in your knee?”

“It’s a ten outta ten! An’ it feels sharp!” Awesome, she knows our pain scale without having to be prompted.

“Do you want some Morphine for the pain Chauntel?”

“Na, I can’t have Morphine, I allergic to it! You got any Dilaudid?” Classic!

“Chauntel, you know I don’t carry Dilaudid. And when did you become allergic to Morphine? You weren’t allergic to it last week.”

“Well, I is now!” I’m not one to judge her pain level, or her, but the drug seeking mentality is fairly transparent to us at this point. I guess some things never change.

“How do you like the new uniforms Chauntel? Did you notice the shirt’s a different color?” Just making small talk as there’s not really that much to treat on this call.

“Oh, is those new? Now you mention it you got some pretty eyes. Is you married?” Seriously, that’s what you notice. Bloody hell with the eyes again!

“Yeah Chauntel, I’m married, and so are you. As a matter of fact your husband is sitting in the front seat.”

In a conspiratorial, quiet voice. “Well, he ain’t really my husband, I jus’ call him that. You mind if I take a nap on the way? I feeling kinda tired.”

“Go ahead Chauntel, we’ll be there in about ten minutes.” I switch to the captain’s chair to try to figure out how to use the new computer.

Now you put water into a cup, it becomes the cup. You put water into a bottle, it becomes the bottle. You put water into a teapot, and it becomes the teapot. Now water can flow or it can crash! Be water, my friend.

Bruce Lee, TAO of Jeet Kune Do

 

 

Lachrymatory 2/3

The grumpy crime scene tech finally arrives and climbs into the ambulance with a camera to document the injuries. He’s a middle-aged bald guy with a goatee and a belly, wearing a jumpsuit and a badge. In big yellow letters on his back it says; crime scene investigator. I see him often and we have a running joke. “Man, CSI Hood, I sure thought you’d be prettier.” He just growls at me. I guess he is in a bad mood.

Once the photos have been taken we start driving to the county hospital. The officer tells me he’s going to meet us there so he can finish taking a statement form Anika.

Now that we’re away from the crime scene and alone in the back of the ambulance the reality of the situation starts to sink into Anika. She’s a minor who’s dealing with some very adult problems. She’s emotionally unprepared for everything that’s happening around her and has no active parents or advocate. The system has let her down and she’s quickly falling through the cracks.

Scottie did most of my paperwork on the computer while we waited for the not so pretty CSI tech, so I spend the ride talking to Anika and trying to calm her down. But it’s not working.

I had initially planned to just do basic treatment and only give her an ice pack for the pain and swelling. Yet with her emotional state I decide to more aggressively treat the pain with some Morphine. It will help with the pain a little but even more important it will calm her down so she can make some rational decisions in the next few hours.

As the Morphine slowly drips into her vein I watch the waveform of her respirations change to reflect a more relaxed state. Now that she’s calm we can have a more productive conversation. I continue where the officer left off in pushing her to press charges. I give examples of things I’ve seen on the streets in the hopes that it leaves an impression. I have a special affinity for kids in the foster system. I know from personal experience what they are going through and how the deck is stacked against them.

The statistics are grim. According to a local foster advocacy organization, youth in foster care are 44% less likely to graduate from high school. Less than half of former foster youth are employed 2.5-4 years after leaving foster care, and only 38% have maintained employment for at least one year. Sixty percent (60%) of women who emancipate from foster care become parents within 2.5-4 years after exiting care. Girls in foster care are six times more likely to give birth before the age of 21 than the general population. Parents with a history of having been in foster care themselves are almost twice as likely as parents with no such history to see their own children placed in foster care or become homeless.

I don’t give Anika these statistics – she’s had a bad enough day as it is. Yet it’s all in the back of my mind as I talk to her on the way to the hospital. She really doesn’t deserve this.

She’s much more relaxed now that the Morphine has taken full effect. I can tell by the way it’s effecting her that she has a clean system. She had no track-marks or signs of drug use. I think she’s just a good kid in a bad situation. She starts to feel comfortable with me and talks about her life. She mentions that she was in the same hospital two weeks ago.

“Why were you there two weeks ago?” I already know the answer…

“I got beat up and thought my nose was broken.” She has a slight slur to her speech from the Morphine. I noticed the minor swelling to her nose but thought it was from today’s beating.

“Did you go in by ambulance?”

“No, my boyfriend took me on the bus.”

“Is he the one who hit you two weeks ago?” She just nods her head.

Sexual Tension 1/3

sex·u·al

1 – of, characteristic of, or involving sex, the sexes, the organs of sex and their functions, or the instincts, drives, behavior, etc. associated with sex

 

ten·sion

1 – the act or process of stretching something tight

2 – a force tending to stretch or elongate something

3 – mental, emotional, or nervous strain: working under great tension to make a deadline

4the interplay of conflicting elements in a piece of literature, especially a story

Louis and I are taking a leisurely drive to the call as it came in as a Code-2, which means no lights, no siren, and we obey the traffic laws. Being sent to the call Code-2 doesn’t always mean it’s non-emergent; it just means that the call taker in the 911 center was unable to find any critical problems during a brief conversation. I’ve had many Code-2 calls that resulted in a Code-3 trip to the ED. This happens either because the caller is unable to fully convey their problem to the call taker, or the call taker is unable to interpret what is really going on. I don’t fault anyone for this. I mean seriously, I sometimes have a hard time understanding what’s going on even when a patient is explaining it to me in-person. If anything, I’m surprised that calls aren’t mis-lebeled more often than they are.

This call came in as a possible dislocated shoulder. Now granted, this isn’t the most critical of calls, but I would think it deserves a full response of Fire and EMS running Code-3. But I have to follow the directions of the dispatcher; I can’t go upgrading or downgrading a call based on my intuition. I’ll just have to apologize to the patient for taking fifteen minutes to reach him if it turns out to be a real emergency.

We roll up to the converted hotel in the middle of downtown Big City. The address is for an SRO (single room occupancy) and the room is on the fourth floor. When tourism dropped off the older hotels became vacant as people wanted the newer, more modern ones. Developers came in and converted the older hotels to SROs and classified them as low-income housing, for which tenants pay by the day, week, or month. Having been in the majority of them in the city I know what to expect – dirty, unkept hallways and tiny little rooms with a hot plate and mini fridge. There’s a shared bathroom on every floor.

Fortunately, as we drive up to the lobby, it appears my patient made it down to the street and is walking towards the ambulance as Louis puts it in park. My new patient seems to be a man in his late forties being supported by a woman in her mid thirties. I hop out of the ambulance and walk up to him.

“Hey, what’s going on today?”

“I think I threw my shoulder out. It hurts like hell!”

I take the coat off that’s draped across his shoulders so I can get a better look. Sure enough, anterior rotation with deformity. “Yeah, looks like it’s out, this ever happen before?”

“Yeah, just last week; same thing. It happens a couple times a year.” The woman is just standing there holding his coat and caressing his head as he’s in pain. Louis is pulling the gurney out to bring it to us so my patient doesn’t have to walk any further.

“What were you doing when it went out?”

“We were fix’n to have sex!” She slaps him on the good arm. “Hey, stop it! The man asked.” He’s just a little bit proud of the situation; she’s a little embarrassed, at least I think that’s what’s going on. “I was about to climb on top, supporting my weight with my arms, when I felt it slip.” She actually starts to push him to the gurney as Louis is almost here.

We get him loaded into the rig and Louis looks at me with anticipation. “Yeah, go ahead, it’s all you.” Louis dives into the cabinets and grabs the triangle bandages to make a sling and swath to support the shoulder. We’ve had a couple of shoulder dislocations in the last week; it’s a common injury in late summer as the first few football practices start up at the local schools. Louis has been working on his sling/swath technique so he’s excited to get this one perfect.

I take a set of vitals and start getting set up to administer some Morphine for pain and some Versed for sedation. If I can relax him now the muscles will stop pulling against the shoulder and make the reduction a little easier when we get to the hospital. In his current state the muscles and tendons are actually contracting to apply tension to the shoulder, and that keeps it out of the socket. It’s got to be excruciating! 

Just making conversation while I’m getting things set up, “Is your wife going to be coming to the hospital with us?” I noticed that she kissed him while we loaded him in the rig but had since disappeared.

“No she’s not coming, and she’s not my wife. But she might as well be – I’ve been seeing her for about eight years.”

Louis finishes up the sling and swath with an ice pack on the shoulder about the same time as I sink the IV in the vein on the other arm. Louis did a great job; it’s always a good feeling to get the same call just a week apart so you can do things better the second time.

As we’re leaving the curb for the five minute ride to the hospital I inject the pain killer and sedative. My patient is feeling much better now and he asks for his coat so he can get his cell phone. I have the lights turned down and I’m just working on my paperwork as I hear him on the cell phone.

“Hi honey…yeah I’m going to be a little late tonight, my shoulder went out again and I’m on the way to the hospital…yeah, I love you too.”