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.