Silent Siren, page 19
Pablo
Val Harris and I are bleary-eyed, at the tail end of a shift in Sedro-Woolley, heading to the boonies for a woman who has just given birth at home. Well what do they need us for then? I think. Mama’s already done all the work. The dispatcher can hear the squalling of a newborn in the background. That’s a good sign.
Val and I arrive a few minutes later. She rummages around the rig for the obstetrical kit while I grab the yellow pediatric box and walk inside the tiny apartment.
There are at least five Mexicans standing around in the front room. My guess is that most of them live here, owing to the haphazard arrangement of blankets on the floor. Two tiny children peer at me from behind a bedroom door. The new mother’s other children? Anybody’s guess.
Val and I enter a back bedroom and find a volunteer firefighter kneeling over a very young woman—nineteen, she says—lying on the floor, covered with blankets that have apparently been stained with amniotic fluid. There is no bed in the room and at least five other Mexicans are standing in the corner. Is one of them the father? Nobody seems to know. Nobody speaks English.
A tiny baby lies swaddled in a blanket, still tethered to his umbilical cord. He is healthy and pink, looking around the room at his new world with bright brown eyes.
The volunteer, a young woman in her early twenties, is still a little breathless with excitement. “I clamped the cord but I haven’t cut it yet,” she says.
The baby looks healthy, moving his little arm and legs around, so it seems okay to cut the cord. “Go ahead,” I say.
The volunteer says, “Shouldn’t we have the father do that?”
“Who is the father?” I look around the room.
A man with a wispy mustache and brown eyes the size of saucers steps forward. He doesn’t look much older than the nineteen-year-old woman lying on the floor. I hand him the scalpel from the OB kit and he slices between the two clamps, blood squirting onto his forearm. He is unfazed, though, and looks enormously pleased.
Val goes to get the stretcher and I try to find a hat for the new baby. The OB kits are supposed to come with them, but this one seems to be missing it. I improvise with a washcloth. The baby now looks like a very tiny member of a religious order for midgets.
The young volunteer picks up the little critter and coos to him, rocking him in her arms.
“You’re a natural,” I remark.
She glares at me and then flashes a half-smile. “Shut up,” she says.
We load mom and baby into Med 1 and head for Skagit Valley Hospital. Dad rides up front with Val as I attempt to get some vital signs on the baby. We’ve got the heat cranked to about ninety degrees in there. It’s unbearable for me, but new babies are prone to rapid heat loss, so I have to keep him warm.
For once, I have a happy report to give over the phone to Skagit Valley Hospital. The nurse directs me over the phone to go directly to the Labor and Delivery Department. They are about as comfortable in the ER with newborns as I am in the field with them.
I ask the mother if she’s come up with a name for her baby. “Pablo,” she says, her voice barely audible over the whir of the heater.
Pablo, I repeat to myself. I think of Pablo’s young, unmarried parents, their lack of education, their tiny, cluttered apartment with all the aunts and uncles and brothers and sisters living together. Pablo will likely spend his first couple of formative years in that apartment and I hope for better for him. I hope he gets the chance to be somebody—this healthy, perfect child with the bright brown eyes and so much potential.
But I can only do so much. I have helped in some small way to welcome a new life into this world, an opportunity I rarely get.
What happens now is up to God and the guidance of his parents. As we clear the hospital, I say a little prayer for Pablo and his family and then put our rig back in service—“Med 1 clear Skagit, available.”
Comfortably Numb
Brad and I are clearing Skagit Valley Hospital when we are tapped out to a call in our area—man unconscious at a residence on McLean Road. It’s about a seven-minute response and the McLean Road Fire Department will beat us by several minutes. We get no further information from dispatch, so it could be anything from a man taking a nap to a cardiac arrest.
I maneuver the wide ambulance down a narrow dirt road that terminates in a large metal workshop. My “windshield survey” tells me two things right off the bat. Number One, the man is definitely unconscious. He’s visible on the floor, just inside the workshop. Number Two, he doesn’t appear to be breathing. McLean Road’s fire chief and two other volunteers cluster around the stricken man and one is using a mask to ventilate him. Brad and I grab all our kits and head inside.
The man appears to be in his fifties and is a rather unattractive shade of blue. Aside from an occasional ragged gasp, he is not breathing at all and has a Glasgow Coma Score of 3, exactly the same score as could be achieved by a tomato, a lampshade, a ball of dryer lint, or some fire chiefs. Since it is impossible to receive a GCS score of zero, the man is about as “gorked” as you can get.
Another man in his fifties sputters excitedly. “He came into the shop to chat and dropped right in front of me. He didn’t say nothin’!”
I ask if the man had any known medical problems—heart issues, diabetes, etc. The excited man says he doesn’t know much about him—“Just a buddy of mine.”
Brad slaps EKG patches on the man while I prepare his arm for an IV. I direct a McLean Road firefighter to obtain a blood pressure.
I pop the IV in without difficulty. The guy has great veins, looks like a working man, so I’m not faced with my usual problem of ninety-year-old emphysemics and their paper-thin skin. Thank goodness for small favors.
A perfect sinus rhythm at 70 beats per minute undulates across the Lifepak 12’s EKG screen. From a cursory examination, there didn’t seem to be anything wrong with the man’s heart. The blood pressure tells a different story however. The firefighter obtains a pressure of 170/110—dangerously high. It could indicate the man had bleeding inside his brain.
Just to rule out anything correctable, I obtain a small blood sample, squirt it onto our glucometer, and get a blood sugar reading of 150. Not the problem either.
Brad readies his equipment to intubate and hands me a syringe with succinylcholine for me to inject into the port when he’s ready.
It’s Brad’s call, but I do feel some obligation to be a helpful and active partner, participating in the decision-making process. What could have caused this man to drop suddenly, unconscious onto the floor? Just as Brad clicks his blade onto the laryngoscope, I have a thought.
“Brad, check his pupils, would ya?” I say.
As Dr. Copass once said, “The eyes are the windows into the brain.” Big pupils usually mean hypoxia or amphetamines. Unequal pupils mean brain herniation. Small pupils usually indicate narcotics.
Brad checks. The man’s pupils are small, less than a millimeter bilaterally. “Hmm,” he says. “You want to try some Narcan?”
“Couldn’t hurt.”
If the man had opiates in his bloodstream, Narcan would quickly, if temporarily reverse their effect, bringing him back to consciousness and restoring his breathing.
Brad hands me a syringe and I inject 1 milligram of Narcan into the IV port—just enough to get a response out of him if he’s overdosed, but not enough to make him sit up, vomit, swear, and tear out his IV.
Within a minute, the firefighter who is bagging the man says, “He’s fighting me. I think he’s breathing on his own!”
I request the firefighter to withdraw the BVM and replace it with a non-rebreather mask. In another minute, the man tries to speak. I pull the mask away from his face so I can hear.
“I took too much pain medicine,” he says.
Brad stows his blade and scope and the firefighters bring our stretcher to the man, who is now moving and attempting to sit. His buddies are overjoyed and Brad and I get to look like heroes.
It’s not too often we get to look like rock stars, but the administration of Narcan is one of those instances. So is giving IV sugar to an unconscious diabetic. If one is theatrically minded, one could lay hands on an unconscious heroin overdose victim and, just at the moment Narcan is being injected, say something like, “Foul demons of addiction, come out of this man at once!” The formerly dead overdose victim would awaken, sit up, swear, and, by the power of Glaxo-Smith-Kline, be healed. Women would adore us. Babies would be named after us. But I digress.
I get behind the wheel and drive to Skagit Valley Hospital. I can hear Brad in the back telling the patient to be more careful next time. “You almost died,” he says. “If your friends hadn’t have been there to call 911, you’d be dead right now.”
Brad and I unload the stretcher at the ER entrance. As we wheel him through the double doors, the man has an ethereal look on his face, as though he is seeing the world anew.
“I almost died,” he says. “I almost died.”
Medics Say the Darnedest Things
The old man slumps in his wheelchair, staring at his catheter, and swimming in baggy clothes that haven’t fit him in months. “I need to go to the hospital,” he says.
My partner wheels the stretcher close. “Can you walk?” he asks.
The old man looks dumbfounded. “I don’t have no legs!” Amid the drama of a medical crisis, communication errors often crop up between emergency responders and patients, sometimes with humorous results. At times it may seem as though EMTs and those they serve are speaking two completely different languages. Consider the following examples:
Paramedic: “What medical problems do you have?”
Patient: “Meegraines.”
Paramedic: “Migraines?”
Patient: “No, meegraines.”
Paramedic: “What’s the difference?”
Patient: “I’m English.”
When I worked in downtown Tacoma, I frequently had occasion to treat so-called “medically naïve” patients. I had just loaded an elderly man who had fallen in his driveway onto my stretcher and was obtaining his medical history:
Me: “Do you have any medical problems—heart problems, breathing problems, high blood pressure, diabetes?”
Patient: “Nope.”
Me: (Sorting through a bag of medications the patient had brought with him). “And why do you take these?”
Patient: “I s’pose that would be on account of my high blood pressure and diabetes.”
To be fair, it’s not always the patients who communicate in a somewhat enigmatic fashion. A paramedic, his brain otherwise occupied with various observations and facts, will occasionally break out a truly original malapropism. My brother, whose impeccable grasp of English often led him to correct an ex-girlfriend’s grammar, had once stood politely, trying to keep a straight face, while a grizzled senior paramedic puffed on a cigarette and attempted to explain the wasting effect of chronic heroin use on an addict: “They get all emancipated,” he had said. Ben had figured that, in this case, discretion was the better part of valor, thanked him for his explanation, and went about his business.
Whilst examining an elderly woman who seemed quite comfortable in her overstuffed chair, surrounded by her own toxic atmosphere of cigarette smoke, a senior paramedic friend of mine asked her if she led a “sedimentary lifestyle.” I imagined her as a bottom-dwelling fish, rooting around for food on the sandy ocean floor, her cigarette still inexplicably lit, fins pale and droopy from disuse.
***
I’m working Med 1 one blustery afternoon. We are called to a suburban address in Sedro-Woolley for respiratory distress. Apparently, a twenty-year-old man and his friend were stripping the paint off an old school bus with a high-powered air hose. At the conclusion of their work day, they had taken turns using the air hose to blow paint chips off one another’s clothing. The twenty-year-old, who I’m guessing was a bit of a hypochondriac, got a bruise on his chest from the pressure of the hose and was convinced that he had a collapsed lung, thus the 911 call.
Jay and I pull up to the scene. A young Sedro-Woolley volunteer in a T-shirt and bunker pants approaches with his clipboard and begins to give me his short report on the patient’s condition: “So, these two gentlemen were using an air hose,” he begins, “blowing each other off…”
I don’t remember what he said next because I had to stop myself from laughing and put on my Concerned Paramedic Face.
I had to bite my lip throughout Jay’s entire patient examination to keep from laughing as I thought of “these two gentlemen blowing each other off.”
The patient was fine; he had no serious injuries, and I restrained my laughter until we were safely back in the rig and on the way back to the station.
A few months later, I have the misfortune of working Mount Vernon Med 2 on a particularly busy Saturday night. Nobody we see is seriously ill, but, had natural selection been working as it should, many of our customers would have been taken out of the gene pool long ago.
We get called at about midnight for a patient with abdominal pain. Arriving on scene, my partner, whom, for the sake of sparing embarrassment, we’ll call “Steve,” and I find a mountain of a man seated on a stool in the kitchen of his mother’s house. He is six foot nine and weighs about four hundred pounds. As it turns out, the dispatcher had been confused. He had no abdominal pain. Instead, his pain originated from just below his left knee. A diabetic, the man wore a below-the-knee prosthesis and his stump is giving him grief.
It’s Steve’s call and he asks the usual questions in an attempt to ascertain the cause of the man’s severe pain. “How long has it been hurting? Have you bumped it against anything? How long have you had the prosthesis?”
A Mount Vernon firefighter takes vital signs on the giant man. Steve asks a few more questions about medications and then asks the man to remove his prosthesis so he can get a better look at the source of his distress. He pokes and prods and scratches his head but ultimately is unable to come up with an explanation for the man’s sudden and severe pain. At this point, I’ve gone into an adjacent room to prepare the stretcher.
“Well,” Steve says, “I’m stumped.”
Nobody in the room, least of all Steve, realizes that he has made an unintentional pun at the expense of the patient. I suppress my laughter long enough to transport the man to Skagit Valley Hospital.
Steve and I get back into the rig for the short ride back to the station, I let him in on his own joke.
“Do you realize what you said to that guy?”
“No.” Steve looks concerned.
“You told a guy with a prosthetic leg that you were stumped!” Steve laughs and hits his head against the steering wheel.
“I’m an idiot!”
“Not at all,” I say. “You gotta laugh at these things.”
The shift continues to be busy and by 0300 hours, we have still not made it to bed. We are called to an address in Mount Vernon for seizure activity in a thirty-year-old female.
As is often the case, the address is not visible on the front of the low-income apartments we think may be the patient’s residence. To make matters worse, the letters and numbers on the individual apartments are so small we can’t read them in the dark. After at least five minutes of Med 2 and Mount Vernon Med 129 mucking about, trying to locate the apartment in question, a shirtless Hispanic man appears at a doorway and leads us inside.
Our crew ascends a set of filthy, steep, carpeted stairs to an even filthier bedroom where a massive, gelatinous woman tosses fitfully on a bed with greasy sheets. She wears a T-shirt so tiny it appears to be shrink-wrapped to her ample torso. A pair of giant panties with some sort of garish design completes the hideous ensemble. I make the assumption that the patient, a white woman, is the little Hispanic man’s wife, and I am instantly unimpressed with his taste in women.
She certainly isn’t seizing, as there is no rhythm to her thrashing. She is probably post-ictal from a seizure though, and I ask the little man some questions about her medical history.
“Does she have a seizure disorder? Where are her meds? When was her last seizure?”
The man does his best to answer my questions in broken English. We do our best to get the woman to communicate with us, but it doesn’t seem to be working. We attempt to put oxygen on her but she pulls it off, turns over, and thrusts her head into the pillow.
We are in the bedroom for probably fifteen minutes but it seems like much longer. I threaten the woman with needles in her veins and tubes in every conceivable orifice if she doesn’t talk to me, but still she fails to interact in any meaningful way with her environment. I attempt to pry open her eyes and assess her pupils. She coughs in my face and her spittle hits my eyelid. Then, as if to say, “Screw you, get out of my house!” she turns over and belches loudly.
“Could have done without that!” I blurt. I don’t care if the little man knows I’m irritated.
As I turn from the patient to interview the fat woman’s husband standing at the foot of the bed, he begins farting every few seconds. At least I think it’s him. It could be the baby he’s holding.
Terrific. They’ve reproduced.
I am being treated to a symphony of bodily functions as sort of an accompaniment to my irritated internal dialogue.
Compassionemia has set in.
I have the irresistible urge to usher the husband out of the room and then smother this worthless waste of protoplasm, putting her out of everyone else’s misery, but since I have that patch on my shoulder that reads “Paramedic” I have to at least pretend to care and decide what to do with her. After all, I’m not getting a very good medical history from the husband. Has she overdosed? Does she have meningitis?
I’m going to have to transport. I glance at the other two medics and EMT in the room to see if anybody else has a stroke of brilliance that could help me with my care plan. Nobody does. We wrap the woman in a slick tarp that appears up to the task of transporting a sick walrus. All four of us grab a handle and, puffing and grunting, drag her down the filthy stairs to the stretcher.
