"I want to be an ambulance..:."

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.