Any paramedic will tell you of the many calls that frustrate us for they are not satisfying, meet the definition of an emergency, or necessitate dealing with unsavory people. However, depending on your call volume and luck, I will experience one of those calls that remind me why I love my job.
My partner and I were dispatched for a diabetic problem and came upon this very well kept house on a well kept block but only 2-3 blocks from a subsidized housing development. We first encountered a young boy, approximately aged 9, standing at the front door crying...his mother and he had crossed the street when they noticed that the elderly woman who lived across the street had left her front door wide open. Being the summer, doing so was not uncommon but it was past 9 PM and she should have been asleep with her house secured. Inside they had found their 80 year old neighbor in an altered mental status, pale - approaching white despite her african american ethnicity and diaphoretic - cold sweats. She was not speaking but mumbling incoherently and was slumped in the hallway of her house being supported by the neighbor who found her.
To any EMS provider, her presentation was a classic hypoglycemic - low blood sugar levels that result in a shock mimicking presentation. If uncorrected, this condition could be fatal but for many diabetics, this is a relatively common occurrence. Controlling sugar levels with insulin and other diabetes drugs against food intake, environmental stressors and metabolism can be like attempting to conduct a large symphony. One misplaced note can mess up the whole process. However, treating her is a simple process and among the easiest patients we treat.
To this child, she must have looked like the embodiment of death or dying. In fact, if she was in cardiac arrest, she probably would have looked better for she would have been still. Altered, pale, sweaty and mumbling, she was scary and ghost like.
With the boy crying and his mother managing to remain a relative calm for him, my partner and I quickly went to work. A quick check of her vital signs revealed a blood sugar of 20 (normal is 80) and no other pertinent findings. Though it is possible for diabetic shock to mask other conditions, correction of the low sugar level allows us to assess for other illnesses. The process is simple, insert an IV and push 25 g of Dextrose 50. However, I blew her veins twice (essentially missed). Though we carry an alternative drug to IV medication, I gave it a third try and succeeded! Pushing the dextrose over 2-3 minutes, the patient's skin dried, her color improved and she regained a normal mental status. Embarrassed at her condition she profusely thanked us, ate the sandwich we had directed the neighbor to make, and politely refused transport to the hospital. We assisted her to the bedroom to sit on the bed.
As I began the paperwork to allow for her to refuse transport since on reassessment there were no pertinent findings, my partner began cleaning up the mess we (or I) had made from treating her (and missing twice - still a sore point for me). Only then did he notice that the boy had watched us the whole time and now had a huge smile on his face. No longer crying, my partner initiated a conversation with him and covered the standard questions adults ask children. When he asked what the kid wanted to be when he grew up, the boy replied that he had always wanted to be a firefighter, but now he wanted to be an ambulance man.
The patient had been routine, the call unremarkable and the solution simple and easy. Despite my frustration at missing her veins twice, I had succeeded and to this child, most likely, appeared to resurrect her astounding him.
On this call, it was not the patient who reminded me why I love my job (even though she was a sweet lady and former school teacher) but the young boy. Convincing him by our actions that perhaps medicine would be a worthwhile career reminds me why I do it.
Saturday, January 26, 2008
Wednesday, October 10, 2007
If I was stuck in a nursing home...
Late night priority 3 call to an infamous nursing home in our city to take a patient with failure to thrive to the hospital.
That patient is not part of the story, but the circumstances of his stay and his roommate are.
Nursing homes can be profitable, can be swanky and nice, and can treat its patients well. Unfortunately, most nursing homes are not like that and to live in a nursing home like that costs vasts amount of money. This nursing home fits none of the above - much of its funding is derived from the bare minimum that medicare pays resulting in crowded rooms, aging facilities and transient staff.
The patient was found at the end of the hallway in a room with three other patients, all bed-ridden, unable to speak and probably close to forgotten by their families. The LPN responsible overnight for this patient who was surprisingly helpful, nice and provided a full report noted that the patient's failure to thrive was noticed because he was failing to take part in a moaning contest akin to a tennis match with the roommate diagonally opposite from his bed. The room crammed four bed ridden patients allowing them no privacy. Granted, considering their predicament, they had little awareness of their lack of privacy and such rooming arrangements were the norm for this facility and not the exception.
Yet this story is not entertaining for the lack of privacy or the depressing conditions in which some of the elderly live.
Slightly hunched and focused on the blood pressure meter as I sought to get some of the required vital signs needed to bill for the transport (I note this in my flippant tone since we were nothing more than a taxi cab with a bed for this ride to the hospital), my goal was to finish this transport as quickly as possible. When I lifted my head, my stethoscope still within my ears muting my surroundings, my mind already ignoring my nose's identification of that unique nursing home smell, my eyes caught an eyeful from a tv located across the room and operated by one of the patients. It took me a moment to process that I was now watching hardcore lesbian porn along with the occupant of the bed across the room from my patient's. Unsure of how to proceed, my partner noted that he had been aware of it from the minute we walked in but had avoided commenting. The facility nurse laughed as she noticed my attention distracted and said, "Oh he watches that every night. It took me a while to get used to it myself but now I just laugh."
The occupant of that bed was awake, was young for his surroundings, perhaps in his 40s, and apparently disabled from a motorcycle accident leaving him unable to speak, trapped in a motorized wheelchair but apparently fully cognizant of his surroundings. He was the victim of the disability which I would never want -- a working mind in a broken body. My partner asked him if he was having fun, and with a wide grin on his face he nodded enthusiastically as the playback of one woman using a large portion of her hand on the genitals of the other continued. The facility nurse laughed again and asked him if he had drank his beer for the night to which he shook his head. "Oh, your license was suspended after your accident." She quickly clarified to us that she wasn't referring to the motorcycle accident that had placed him in this facility but to his operating his motorized wheelchair within the hallways of the nursing home. As we exited the room, she pointed out a water fountain dislodged from the wall and resting on the floor. The porn watching bed ridden former motorcycle driver had after drinking his ration of beer for the night taken out the water fountain while motoring through the hallway on his wheelchair.
Our patient continued to rest on our cot, lethargic and sullen with no obvious findings that we could treat as we left the nursing home allowing my partner and I to attempt to summarizing what we had just experienced. My partner astutely noted that considering the quality of life resulting from that type of brain injury, what could be better than spending the rest of your invalid days drinking, watching porn and enjoying the last few of life's joys available in your current disabled state while residing in a nursing home?
Thoughts?
That patient is not part of the story, but the circumstances of his stay and his roommate are.
Nursing homes can be profitable, can be swanky and nice, and can treat its patients well. Unfortunately, most nursing homes are not like that and to live in a nursing home like that costs vasts amount of money. This nursing home fits none of the above - much of its funding is derived from the bare minimum that medicare pays resulting in crowded rooms, aging facilities and transient staff.
The patient was found at the end of the hallway in a room with three other patients, all bed-ridden, unable to speak and probably close to forgotten by their families. The LPN responsible overnight for this patient who was surprisingly helpful, nice and provided a full report noted that the patient's failure to thrive was noticed because he was failing to take part in a moaning contest akin to a tennis match with the roommate diagonally opposite from his bed. The room crammed four bed ridden patients allowing them no privacy. Granted, considering their predicament, they had little awareness of their lack of privacy and such rooming arrangements were the norm for this facility and not the exception.
Yet this story is not entertaining for the lack of privacy or the depressing conditions in which some of the elderly live.
Slightly hunched and focused on the blood pressure meter as I sought to get some of the required vital signs needed to bill for the transport (I note this in my flippant tone since we were nothing more than a taxi cab with a bed for this ride to the hospital), my goal was to finish this transport as quickly as possible. When I lifted my head, my stethoscope still within my ears muting my surroundings, my mind already ignoring my nose's identification of that unique nursing home smell, my eyes caught an eyeful from a tv located across the room and operated by one of the patients. It took me a moment to process that I was now watching hardcore lesbian porn along with the occupant of the bed across the room from my patient's. Unsure of how to proceed, my partner noted that he had been aware of it from the minute we walked in but had avoided commenting. The facility nurse laughed as she noticed my attention distracted and said, "Oh he watches that every night. It took me a while to get used to it myself but now I just laugh."
The occupant of that bed was awake, was young for his surroundings, perhaps in his 40s, and apparently disabled from a motorcycle accident leaving him unable to speak, trapped in a motorized wheelchair but apparently fully cognizant of his surroundings. He was the victim of the disability which I would never want -- a working mind in a broken body. My partner asked him if he was having fun, and with a wide grin on his face he nodded enthusiastically as the playback of one woman using a large portion of her hand on the genitals of the other continued. The facility nurse laughed again and asked him if he had drank his beer for the night to which he shook his head. "Oh, your license was suspended after your accident." She quickly clarified to us that she wasn't referring to the motorcycle accident that had placed him in this facility but to his operating his motorized wheelchair within the hallways of the nursing home. As we exited the room, she pointed out a water fountain dislodged from the wall and resting on the floor. The porn watching bed ridden former motorcycle driver had after drinking his ration of beer for the night taken out the water fountain while motoring through the hallway on his wheelchair.
Our patient continued to rest on our cot, lethargic and sullen with no obvious findings that we could treat as we left the nursing home allowing my partner and I to attempt to summarizing what we had just experienced. My partner astutely noted that considering the quality of life resulting from that type of brain injury, what could be better than spending the rest of your invalid days drinking, watching porn and enjoying the last few of life's joys available in your current disabled state while residing in a nursing home?
Thoughts?
Monday, September 17, 2007
First Post
This blog is intended to be anonymous (though I'm sure some hardcore digging could figure out who I am) and detail some of the events and calls I run as an urban paramedic. By keeping the details of where the calls and who the patients are, minimizing specifics and changing some details, and avoiding speaking about the agency for whom I work for - I hope to fully compliant with both patient privacy guidelines and any other rules dictating writing about patient encounters. Moreover, I have no financial gain from this blog and have not and will never place any ads or such that may generate any revenue from my stories.
Primarily this blog is my attempt to explain what I do to family and friends. Invariably, every time I mention that I am a paramedic, everyone always asks with bated joy in their eyes - "Do you get to drive the ambulance?" and when I respond with sigh "yes" they reply "that must be exciting."
The job of a paramedic goes way beyond driving, but the public perception is that we do nothing more than go to the scene of an emergency and scoop the patient onto a stretcher, run to the ambulance, and head off to the hospital once someone hits the back doors (as popularized by almost every television show and movie that has an ambulance in a cameo). Moreover, it is a common frustration amongst medics that firefighters get lauded as heroes for 'saving lives' when much of their traditional job involves saving property and perhaps, if lucky, a once in a lifetime rescue of a victim from a burning house. On the other hand, a paramedic can probably say that they legitimately save someone's life with their medical interventions at least once a month, if not more.
Finally, there is a huge difference between paramedics and EMTs though there is little acceptance of this by the public and is partly our fault. EMTs undergo approximately 160 hours of training which is about 4 weeks of full time training. Paramedics undergo at least a year of training in an accelerated program and closer to 2 years in a normal program for their position. By comparison, an R.N. requires 2 years (though there is a bachelor's degree of 4 years), fire and police academies last approx 6 months.
Like most paramedics, I started as an EMT and recognize the virtue of a well trained EMT but there are many limitations. The biggest thing an EMT brings to EMS is the experience they have garnered through running calls - it is the experience which sets them apart from other first aid trained individuals (like a boy scout or lifeguard). As a result, I will always take an experience EMT at the scene of an emergency than 50 boy scouts or even a podiatrist.
A paramedic, on the other hand, can perform almost every procedure a doctor will do for a patient in a cardiac arrest (intubation, IVs, medication administration). Medic training involves hundreds of hours of time in hospitals or spent as a student on an ambulance and demonstration of skill. Most EMT programs require 10 hours of observation time in an Emergency Department.
So with this blog - I hope to speak about pre-hospital medicine, including new treatments and protocols, while interspersing actual call experiences.
Primarily this blog is my attempt to explain what I do to family and friends. Invariably, every time I mention that I am a paramedic, everyone always asks with bated joy in their eyes - "Do you get to drive the ambulance?" and when I respond with sigh "yes" they reply "that must be exciting."
The job of a paramedic goes way beyond driving, but the public perception is that we do nothing more than go to the scene of an emergency and scoop the patient onto a stretcher, run to the ambulance, and head off to the hospital once someone hits the back doors (as popularized by almost every television show and movie that has an ambulance in a cameo). Moreover, it is a common frustration amongst medics that firefighters get lauded as heroes for 'saving lives' when much of their traditional job involves saving property and perhaps, if lucky, a once in a lifetime rescue of a victim from a burning house. On the other hand, a paramedic can probably say that they legitimately save someone's life with their medical interventions at least once a month, if not more.
Finally, there is a huge difference between paramedics and EMTs though there is little acceptance of this by the public and is partly our fault. EMTs undergo approximately 160 hours of training which is about 4 weeks of full time training. Paramedics undergo at least a year of training in an accelerated program and closer to 2 years in a normal program for their position. By comparison, an R.N. requires 2 years (though there is a bachelor's degree of 4 years), fire and police academies last approx 6 months.
Like most paramedics, I started as an EMT and recognize the virtue of a well trained EMT but there are many limitations. The biggest thing an EMT brings to EMS is the experience they have garnered through running calls - it is the experience which sets them apart from other first aid trained individuals (like a boy scout or lifeguard). As a result, I will always take an experience EMT at the scene of an emergency than 50 boy scouts or even a podiatrist.
A paramedic, on the other hand, can perform almost every procedure a doctor will do for a patient in a cardiac arrest (intubation, IVs, medication administration). Medic training involves hundreds of hours of time in hospitals or spent as a student on an ambulance and demonstration of skill. Most EMT programs require 10 hours of observation time in an Emergency Department.
So with this blog - I hope to speak about pre-hospital medicine, including new treatments and protocols, while interspersing actual call experiences.
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