Tag Archives: Sikh

Peaceful Warrior 3/3

Walking into the small bedroom with the fire medic we can actually feel the heat radiating off of the little old man laying on the bed. He’s frail and skinny, dressed in traditional Punjab garb and a matching turban on his head with a long white beard. Sitting on a side table by the bed I see the Kirpan. It’s a curved knife, one of the five external articles of faith, that symbolizes the safety of all and the carrier’s personal duty and responsibility as a Sikh to protect the innocent in the message of peace.

The family called us because he’s “not acting right.” It’s a common call in this mostly urban county and pretty much just means I have to rule out everything with a full work up. My new patient tracks me with his eyes as I kneel beside the bed to put my hand on his chest; attempting to get a quick read of core body temperature. Even through his light clothing he’s really hot and I notice he’s not sweating – bad sign.

“Does he speak English?” I’m addressing the grandson who followed us into the bedroom. In families that are recent immigrants I find that the children make the best translators as they learn English through the schools.

“I speak little English,” replies the boy in a thick accent and not directly addressing my question. I don’t think I’m going to get much translation on this call.

I try going back a forth a few times to get an assessment of my patient’s mentation, his normal baseline, medical history, allergies, medications etc. I’m batting about 50% on getting straight answers and quickly decide to stop waisting time and get moving to the hospital.

I take the time to explain to the family that I’m going to have to remove my patient’s turban. He’s burning up and I need to start the cooling process. They’re not happy about taking off his turban but eventually we have an understanding that it’s the best thing for him. As I’m taking off the turban and shirt I notice he’s wearing adult diapers and there’s a plastic sheet on the bed. Checking his pulse I see that he’s in the 130s. It’s pretty obvious where this is going.

As I slip the turban from his head I notice the long, uncut hair neatly wound around the top of his head and secured with the Kanga, a wooden comb. The uncut hair and comb are two more of the five external articles of faith which symbolize cleanliness and tidiness. Sikhs believe that the hair, like everything else, is a gift from god and therefore remains uncut.

He’s light enough that I can just cradle him and move him to the gurney myself. While carrying him to the gurney his arm dangles in front of me with the Kara – iron bracelet – resting against his outstretched hand. Heading towards the ambulance I have a working differential diagnosis and I’m mentally running through treatment options.

The elderly who wear diapers and have incontinence issues often get urinary tract infections. This often leads to fever and sepsis if it’s not treated quickly. Laying on the plastic sheet with all of his clothes on he was radiating heat and increasing the fever. Eventually he stops sweating as he gets dehydrated. The elevated heart rate is the body’s compensation mode – attempting to circulate an ever-decreasing fluid level and fight off the infection.

I tell Scottie we can start transporting right away. I’m on the fence about lighting up the rig and driving fast but decide against it as I can’t confirm his level of consciousness because of the language barrier. If anything changes I’ll light it up but for now we’re driving Code-2. I check his vitals, run a 12-lead, and use the temporal thermometer. Wow!

I poke my head through the pass through to give Scottie the ring down information. “78 year old male, possible ALOC (altered level of consciousness), language barrier, fever by two days, temp of 106.2, sinus tach at 138. Go ahead and call it a sepsis alert also. Code-2 for now.”

Our county recently initiated the use of sepsis alerts. Sepsis has finally blipped on the collective radar of the hospitals in the county and they’re asking us to give them an early heads up when it’s a strong possibility. Basically people were sitting in the waiting room or stuck in triage and were getting overlooked in the critical first stages of sepsis where aggressive treatment of fluids and antibiotics can reverse the downhill spiral of MODS (multiple organ dysfunction syndrome).

I start a very large IV and turn the fluid on letting it go wide open. With this size needle I should be able to get a liter on board during the ten minute drive to the ED. I break out some ice packs and place them on his neck, in the armpits, and tuck them into his diapers at the femoral artery. Reaching over to the control panel I flick the air conditioning on high. The best thing I can do for my patient is an aggressive fluid challenge and try to get the fever down.

As I’m pulling the gurney out at the hospital I look up to make eye contact with a patient I can’t communicate with other than giving him a reassuring look. He has a peaceful look on his face as he looks down at the IV in his arm. His gaze continues down his arm to the iron bracelet and he seems just a little more relaxed for the reminder of his faith. I envy him.

After running a lot of calls in a part of the county that has a high Sikh population I became curious about their culture. I started reading and researching to learn more about them. I feel it’s important for a Paramedic to understand the people who live in the community so as to better serve their needs. It was fascinating to learn of their rich history and devout faith with a focus on: honesty, equality, fidelity, militarism, meditating on God, and never bowing to tyranny. I find them honorable, caring, hard working people. But most of all I see that they are just like everyone else – they have the same illnesses, the same vices, and the same ideals; they are human just like everyone else. 

 

Peaceful Warrior 1/3

peace·ful

1 : undisturbed by strife, turmoil, or disagreement; tranquil

2 : of or characteristic of a condition of peace

 

war·ri·or

1 : one who is engaged aggressively or energetically in an activity, cause or conflict

2 : a man engaged or experienced in war, or in the military life; a soldier; a champion

In thy childhood you were ignorant and blind. And in your youth, you were lured away by sin. In the third stage, you gather riches and when you get old, regretfully you leave them all off.

Ramkali – Sikh Guru

“Sikh temple, seriously?” I didn’t even know we had a Sikh temple in the county and I’ve been working the streets for years. This is one of the things that I love about working here; the cultural diversity is never ending and continuously developing. This call is pretty far from our current post so I have time to check the notes on the call. The notes in the mobile data terminal (MDT) tell us that we’re responding to a man who burned his hand in a kitchen deep fryer.

I’ve been called to a few deep fryer mishaps and it’s never pretty. In this case I’m hopping it’s the left hand because Sikhs wear a steel or iron bracelet on their right wrist. Given that we have a long response time I expect the fire department would clip it off with the bolt cutters before we arrive. The secondary burn from the steel and constriction while the hand swells could be problematic.

Strobes are illuminating the darkness and Scottie is navigating us deftly as we speed through the suburban sprawl. I decide to see how big this temple actually is and pull up the google street view on my iPad.

“Uh, Scottie, this is a huge temple and the notes say there’s a festival going on right now. We might have some crowd control issues. If we can I’ll want to move him to the rig quick so I can work him up without an emotional crowd scene.”

I’ve run a number of calls in the Sikh homes in this part of the county and I feel they are largely misunderstood by most Americans. In the post 9/11 outrage many Sikhs were mistakenly thought of as being Muslim – one man was even killed in an ignorant act of violence. In fact, quite the opposite is true. Sikhism is an offshoot of Hinduism that came about in the 16th century. In only 500 years it has grown to the worlds fifth largest religion – and this from a religion that does not actively recruit. With its roots in the Punjab region of India, which borders on Pakistan in the northwest part of the country, the Sikhs found themselves on the front lines of conflict and protecting India from Muslim expansion. Many people in this country fail to see past the beard and turban to fully appreciate their rich history and culture.

As we round the corner to the temple I can see that my crowd concerns were well founded. Pulling into the circular driveway I see at least five hundred people in the courtyard of the temple. Parked cars have been lining the residential streets for the last several blocks and their large parking lot is full. A bearded man wearing a turban and traditional garb – covered by a reflective vest – is waving us past using a flashlight with an illuminated orange cone. Its a paradox of old world and new that somehow reminds me of a Jedi master. We pull up behind the big red truck to the side of the temple.

Half a dozen young men in turbans and traditional dress encircle us as we exit the rig with the gurney. They usher us towards the side entrance to the kitchen while providing a crowd break. They are yelling excitedly at the crowd in Punjabi; presumably telling them to get out of the way. They’re doing a great job of clearing a path as the crowd parts allowing us to pass.

There are men, women, and children of all ages. The strobes from our rigs illuminate the intricate metal lace interwoven in the women’s head scarves and the traditional curved knives worn at the men’s waists. Many people have plates of food in their hands and the delicious smell only serves to remind me that we never got a lunch break today – a feeling which is juxtaposed with the fact that the man who may have prepared some of this food is now in excruciating pain.

Finally we turn the corner to the kitchen to find my new patient. He’s a man in his forties wearing a white traditional shirt and matching turban. His right hand and forearm are wrapped in a trauma dressing. His face is silently contorted in pain yet he doesn’t make a sound. Damn! It is the right hand.

As the fire medic unwraps the dressing so I can have a look I catch a minty smell. The arm appears to have circumferential partial thickness burns to approximately four percent of overall body surface. Yet it’s difficult to visualize the surface because of a white ointment that appears to be slathered over the arm.

I know the firefighters wouldn’t have put anything on it so it doesn’t really make sense to me. “What’s all the white stuff?”

The fire medic looks up at me with a totally straight face and deadpan delivery, “Toothpaste.” Seriously? Toothpaste?? what the hell?!?

Okay, I’ve seen people put some strange stuff on burns but this is a first. In the last few years I’ve seen: mayonnaise, butter, and yellow mustard. It seems people are always treating burns like a hot dog, although I’m still waiting for sweet relish. But toothpaste is a new one.

I listen to the description of how it happened as I cut his shirt off and move him to the gurney. I’ll leave the turban on for heat retention as he’ll get cold and start shivering here in a few minutes; covering the head helps to hold in heat. I see the bracelet that was cut off of his wrist sitting on the counter, pick it up, and put it in my patient’s good hand. He’s still stoic yet seems to appreciate having it back. He inspects the perfect circle that is now broken and frowns as he puts it in his pocket.

The bracelet is called a kara and is worn by both male and female initiated Sikhs. It is one of the five external articles of faith that identify a Sikh as dedicated to their religious order. The Sikhs wear the kara as a reminder to have a calm spirit and life – it’s an expression of eternity. In India, warrior Sikhs are still seen wearing several karas of large sizes, designed to be used as a weapon in hand to hand combat. It’s an integral item in the martial training that was developed by the warrior Sikhs. I wonder if he assigns significance to the fact that bolt cutters have severed the perfect circle and thereby thrown mind, body, and spirit into a state that is less than harmonious.

Once he’s on the gurney I stick to my original plan and start moving quickly to the rig to treat him further. As I head out of the kitchen my six escorts jump into action and make a path through the crowd. I wish I could take these guys to every call with me as they are doing a great job of expediting my egress from the temple.

After loading into the rig I tell Scottie we can start driving. All of my treatment can be done en route to the hospital because hot oil burns have a way of getting worse with time. I’ve watched blisters form in front of my eyes while transporting similar hot oil burns. Treatment at this point is fairly straightforward: irrigate with sterile water to minimize the heat of the oil and get rid of the toothpaste, get rid of the trauma dressing and apply a sterile burn sheet, load him up with as much morphine as I can, and treat for any signs of hypothermia.

The body’s reaction to a moderate burn is to shift fluids to the tissues to replace fluid loss from the burn. It’s called third spacing as the fluids are taken out of the circulatory system and shunted to the peripheral tissues.This can reduce the blood pressure and cool the core, thereby inducing hypothermia and dropping the blood pressure.

It’s a long ride to the burn center – I have to go out of county as he meets burn patient criteria. Having a circumferential burn to the fingers and wrist could result in swelling, yet the skin is no longer elastic so it could restrict circulation or burst like a grape. A burn center is better equipped to deal with this than a basic ED.

My treatment is basic at this point and he has been stoic throughout. I can still administer a few more rounds of morphine yet as I go to administer he holds up his good hand and refuses additional pain meds.

Laying on my gurney In the back of the ambulance, arm elevated to reduce swelling and so he can feel the cool air if the air conditioning, this brave man refuses pain medication. His face softens from its original squinty-eyed grimace and he relaxes his back to lie more comfortably. With turban in place and a peaceful look to his face I see a tear trickle from the corner of his eye and travel down his face to get absorbed in his beard.

Acceptance is the bridge. Accept the pain, accept the wounds, accept yourself as you are. Don’t try to pretend to be somebody else, don’t try to show that you are not this. Don’t be egoistic, and don’t go on pre-tending and laughing while your heart is crying. Don’t smile if your eyes are full of tears. Don’t be inauthentic, because by being inauthentic you are simply protecting your wounds from being healed. Your whole being will become rotten.

Osho; ABC Of Enlightenment