Chatting on the phone with my sweetheart last night, about fifteen minutes into the call, I absentmindedly picked up a folded piece of paper on the ambulance dashboard.
It was one of our old refusal of care forms, with a patient’s demographic information jotted on it. On the other side, printed in 3-inch block letters, were the words, “SAVE ME.”
Bemused, I showed it to my partner…
… who promptly nodded in understanding, and barked in a stentorian, credible simile of our dispatch data terminal, “INCIDENT ASSIGNED!” followed by, “Hey Kelly, we have a call! CCT 526 to headquarters, we’re on it…”
Not quite what I had in mind, but it’s good to know she’s got my back.
Patient: “So I was sleeping on the couch, and I just woke up, and my pants were on fire!”
AD: “Uh huh. And how did the rest of the garage catch on fire?”
Patient: “I, um, might have turned over some paint thinner and stuff while I was trying to put my pants out.”
Skinny: “Do you smoke, sir?”
Patient (suspiciously): “Yeah, couple packs a day. Why, you insinuating I was smoking in bed? Because I wasn’t!”
AD: “Of course, because that would be stupid.”
Skinny: “And you’re obviously not stupid…”
Patient: “Damn straight! I know better!”
AD: “And yet, by your own admission, the couch was nowhere near a possible ignition source. And you say that the last thing you were doing before you fell asleep was drinking and smoking a cigarette.”
Patient (slurred): “I’m not drunk! And I didn’t fall asleep with no lit cigarette!”
Skinny: “Right. Because that would be… stupid.”
AD: “Had you been lying, sir?”
Patient: “Sure, right there on the couch!”
AD: “No, I mean fibbing. Telling falsehoods. Prevaricating.”
AD: “Well, normally when one’s pants are on fire…”
Patient: “You sumbitches are trying to say I burnt my own Goddamn garage down!”
Skinny: “No one’s accusing you of anything, sir.”
AD: “We’re just trying to get all the facts. We try to do that whenever we report a case of spontaneous human combustion. You know, in case Ripley’s calls later.”
Text conversation from a few minutes ago:
Epijunky:“A simple nasal cannula at 15 lpm applied by your partner in addition…”
AD: “Heh, you’re reading my apneic oxygenation article on EMS1?”
Epijunky: “Actually, the one in EMS World Magazine about how an EMT can save the medic’s ass.”
AD: “Either one is a wise choice. Consider me your fount of paramedical-type wisdom.”
Epijunky: “Our nasal cannulas tend to pop off the regulator if we run them at 15 LPM.”
AD: “Then you should ask a firefighter to attach it for you. I guarantee that sumbitch won’t come loose, even when you want it to.”
… a new story on EMS1.
I should have seen it coming, really.
At home, I'm still Dad. I'm the guy she comes to when she needs help, the guy she likes to hang out with, the guy whose approval she craves. As long as it's just us, watching Princess Bride or going shooting or playing out on the lake, it's all good.
But when she's around her friends, I'm the hovering, uncool parent who is embarrassing (spoken in a mortified pre-adolescent whisper) her in front of her friends, and would I please go away?
I got dragooned into being an overnight chaperone at 4H Camp this week, because Katy needs occasional assistance and I couldn't see burdening one of the camp counselors with the task of getting her dressed and undressed, cleaning her after bathroom breaks, and so on. So, I submitted to the criminal background check, credit check, anal probe, and tediously boring online education program for becoming an adult camp chaperone.
And once we got here, it turned out that one of the camp counselors is friends with Katy's older stepsister, and volunteered to do all the tasks I was hesitant to ask a teenaged camp counselor to do.
So here I sit, banished to Places Elsewhere while Katy gets her camper on. I wound up volunteering to help out with the outdoor skills and shooting tracks, and my only duties concerning KatyBeth are stretching her before she goes to bed every night. Meanwhile, I'm staying in a cabin with 30 pre-adolescent males who were NOT NEARLY tired enough at lights-out on the first night of camp.
I'm going to do my best to wear these little buggers out today, or go to town and lay in a stock of zip ties and duct tape to make bedtime more manageable for the rest of camp. And after my first night here at camp, I have been able to make a few observations:
- 30 pre-adolescent males giggle and bicker every bit as much as 30 pre-adolescent females, only with more farting.
- Because I hold a PhD in farting, I am still cool to this particular demographic.
- Shouting "REVEILLE, REVEILLE! DROP YOUR COCKS AND GRAB YOUR SOCKS!" is not an acceptable method for waking up thirty 5th graders in the morning. A loud, ten-note hail call on my duck call, however, works very well.
- Because I can blow a duck call and am from Monroe, every kid wants to know if I know Phil Robertson. And since I can honestly answer in the affirmative, I get extra cool points.
- You DO NOT want to follow thirty boys into a bath house. I had to march them all back in there with pointed instructions to use that little silver handle on the side of the toilet, and to remember that the tile surface under their feet is not the friggin' trash can.
- When you shout, "I need some volunteers, two for each side of the cabin!" every hand will go up. Their enthusiasm will be markedly dampened, however, by handing the likeliest candidates a mop and a broom. We'll see how many volunteers I get tomorrow morning.
- The advertised "heated showers" in the bath house is a despicable, cruel lie. The bastards.
- The meals here may meet the nutrional needs of a bunch of 80-pound kids, but for a grown-assed man? Not so much. The deli counter at the convenience store down the road is going to see a lot of me this week.
- I though camp songs and cheers were supposed to be fun, enthusiastic, uplifting, team-building sort of things. This morning, I listened to a song about a cute, googly-eyed frog getting squashed in the road and his entrails and eyeballs getting licked up by a dog, and a charming song about a shark attack. "Hey campers, let's sing the Gory Amphibian Death Song! Now, who's ready for a snack?"
Now, if you'll excuse me, I'm going to help teach archery to a bunch of sugared-up 10-year-olds. I see impalement in my future.
AD (reading directly from dispatch notes on our data terminal): “Patient is a 34-year-old female who swallowed a handful of Flintstones vitamins, and now feels as if some of them are stuck in her throat.”
Partner: “How ironic it would be to choke to death on vitamins…”
AD (continuing): “Patient states she is no longer choking but her throat is still scratchy.”
Partner: “… and why is a woman her age eating Flintstones vitamins? Why not One-A-Day, or Centrum?”
AD (sagely): “I’ll bet it was a Dino. You know, the long tail. Gets hung up.”
Partner: “And why call an ambulance for it, fer Chrissakes?”
AD: “Ours not to reason why, son. Ours to simply head that way, and don’t spare the horses. A life hangs in the balance.”
Gas station clerk: “He’s drunk, and trespassing. When I asked him to leave, he made like he was going to sit on one of the concrete pump barriers, pretended to fall off of it, and now he won’t stop screaming.”
AD: “What’s your name, sir?”
Patient:“AAAUGH! AAAARGH! WOOOO! GAWD HAVE MERCY!”
AD: “Luther, is that you?”
Patient (nodding) “WAAUGH! LAWDY JESUS HAVE MERCY, I’M DYIN’! AAARGH, THE PAIN!”
AD: “Howdy, Luther, long time no see. Didn’t recognize you with the beard. Where you hurtin’?”
Patient: “WAAUGH, MY HIP! AARGH, THE HEARTBREAK OF PSORIASIS! LAWDY JESUS LAWDY JESUS LAWDY JESUS!”
AD (taking him gently by the arm): “Let’s get you on the stretcher and on the way to the hospital, Luther.”
Patient (angrily pulling away): “DON’T FUCKIN’ TOUCH ME! AAAUUGH!”
AD (tiredly): “Okay, Luther, your choice. Get on the stretcher if you want to go to the hospital. You’ve got ten seconds, and then we put you on the stretcher.”
Patient: “OOOHH, THE HUGE MANATEE!”
Cop (losing patience): “Buddy, you either get your ass on that stretcher right now, or I’ll put you on it myself, and I promise I won’t be as gentle as these guys.”
Patient (complying, with no evidence of limp or inability to bear weight): “WAAUGH, THE AGONY!”
AD (to partner, before closing the rear doors): “Luther T. Malingerer, 1125 Fydalla Ho Expressway, DOB 4-1-1955, history of alcoholism, hypertension, and status dramaticus.”
Cop (wryly): “Frequent flier?”
AD: “Actually, I haven’t seen him in three years. Used to live with a 18-year-old prostitute, get drunk and mad at her, and punch the wall. Must have broken his hand about twenty times. I only recognized him by the way he carries on.”
Cop: “When you can recognize your patients by the way they scream…”
AD (sighing): “… it’s time for a change of scenery. Or a change of patients.”
Day Medic: “Dude, it’s 6:20! Best get started on your beauty regimen, because I’m ready to get up outta here!”
AD: “Fear not, Ma’am. I shall be in uniform and ready to save lives at the duly appointed time, for my beauty regimen does not take long.”
DM (looking dubious): “…”
AD: “When you start with a baseline of beautiful, all that is left is polishing the masterpiece. And no, that’s not a euphemism for masturbation… but it should be.”
DM: “I think I may be sick.”
Wouldn't it be nice if response times were like cellular rollover minutes?
"Yeah, boss, I know it took us three hours to get to Frankie Frequent Flier's chronic gout pain, but you see, there was a Mel Brooks movie marathon on AMC, and we had a dispatch-to-balloon time of 34 minutes on that acute myocardial infarction last week. So we're good, right?"
It would take a better dispatch and triage system than
might as well just flip a coin MPDS, but if we could come up with some realistic response time standards for the truly time-sensitive emergencies, we could provide quality EMS with half the staff at twice the salary, and subcontract out all the Alpha and Omega calls to the local cable company's call center:
"What's that, Sir? You've been bitten by a brown recluse spider? Hold one moment, Sir, your call is important to us… [insert eleven minutes of Barry Manilow and Neil Sedaka music]… Sir, are you still on the line? Looks like we can get a BLS ambulance to you next Tuesday, between the hours of noon and 5:00 pm."
When my legion of flying monkeys completes my quest for world domination, that's the way we're gonna do it.
Earlier this evening in the way to work:
AD: “Hey, Soop. I’m gonna be about 20 minutes late for my shift. Got tied up taking my kid to the optometrist.”
Supervisor: “That’s what, three tardies for you this year? You’re fired.”
AD: “You wish. I haven’t been tardy in over three years.”
Supervisor: “Okay, thanks for the heads up. I’ll tell the day crew. Of course, you know we’ll have a written warning for you to sign next shift.”
AD: “Yeah, I know the drill.”
*flash forward one hour*
AD: “Hey Soop, I’m at the station at 6:52. No disciplinary action needed.”
Supervisor: “Strong work, son! It would have been a shame to fire you.”
AD: “I ran four little old ladies off the road getting here, so not only did I arrive on time, I substantially contributed to keeping our run volume high, thereby helping to assure The Borg’s continued profitability.”
Supervisor: “Like I said, strong work.”
AD: “Attaboys don’t pay the rent, sucka. Where my raise, beeyotch?”
At the Nebraska EMS Association spring conference this weekend, while chatting with a few new friends over beers, one medic lamented that his spouse had imposed a “buy one, sell one” restriction for new guns in their household. If he bought a new gun, first he had to sell one of his safe queens that he never shot.
Said spouse rolled her eyes good-naturedly and said, “Well, he has way more guns than he needs. Half of them he never shoots anyway!”
Silly spouse. What that have to do with the price of .22LR in Cabela’s?
First of all, I reject in principle the right of anyone who does not share my bed and bank account to tell me that I do not “need” a lawful product purchased with my own money.
Second, “need” is based upon the faulty premise that one can actually have “enough” guns, when math clearly says otherwise:
“If we let X equal the number of guns one owns and Y equal the ideal number of guns, then for any given value of X, Y shall always equal (X+1).”
I call this AD’s Theorem of Justification, commonly known to you non-mathematical types as, “Honey, but I really do need this one!”
I expect to be hearing from the Nobel Prize people shortly.
Coming into one of the local Emergency Departments a few minutes ago:
Triage Nurse:: [raises eyebrows questioningly]
Ambulance Driver: [clutches chest dramatically, indicating a patient with chest pain]
TN: [cocks one eyebrow skeptically, indicating disbelief that our 22-year-old patient is actually suffering from an acute coronary syndrome]
AD: [makes drinking motion with one hand, followed by back of hand to forehead theatrically, indicating a drunk female patient with Status Dramaticus]
TN: [peers musingly at status board, presumably looking for available beds]
AD: [clears throat, then looks significantly at a nearly empty ED, as if to say, "Dude, really?"]
TN: [sighs in resignation, then points in general direction of cardiac telemetry beds]
AD: [raises eyebrows questioningly]
TN: [growls and points more emphatically]
AD: [turns and scans the row of available beds, then looks at Triage Nurse questioningly, as if to say, "Which one?"]
TN: [shrugs diffidently, as if to say, "Pick one."]
AD: [smiling innocently, but not moving, because I can't resist twisting Triage Nurse's tail every now and then]
TN: [gesturing forcefully toward the first bed in the row]
AD: [striking my best Saturday Night Fever pose]
TN: [gesticulating frantically like a flight deck controller fighting a lightsaber duel with an invisible Darth Vader]
AD: [doing the YMCA]
TN: “OH FOR PETE’S SAKE, PUT HER IN TELEMETRY FOUR!”
AD: “You know what’s wrong with you people? No sense of whimsy, that’s what.”
And people wonder why I wear a N95 mask to staff meetings…
Verbatim conversation at the homeless shelter this morning:
AD: "Hello, Sir. What seems to be the problem this morning?"
Sullen, Uncooperative Patient: "I gotta get outta this place, man."
AD: "Okay. Any particular reason?"
SUP: "I catch seizures."
AD: "Okay, and you caught one this morning?"
SUP: " … "
SUP: "I done told you I catch seizures, muhfucka. Now can we get da fuck up outta dis place?"
AD: "Did anyone see this seizure?"
Pontificating Roommate: "I seen it!"
AD: "Can you describe what happened?"
PR (sucking in a loooong breath): "See, whut had happen wuz, he s'posta be takin' DeLorean and he ain't had it in 72 hours because of a dispute he had wit' the Medicaid folks and his body be metabolizatin' all his medication and thass why he catch seizures and he need some more and he compulsed about fifteen minutes and then he locked up in the fixed stare and I stayed wit' him and put a spoon in his mouf so he don't swallow his tongue…"
AD: "And when did all this happen?"
PR: "About four hours ago."
AD: "Well… alrighty, then."
I'm glad they called the ambulance so promptly. If we hadn't gotten da fuck up outta dat place soon, who knows what might have happened.
Rescue 911 mastered the art of EMS stories with fairy tale endings. Seems like the entire post-Emergency generation of EMT's was inspired by Willim Shatner's narration of heroic EMS actions where everyone gets saved, the victims live happily ever after, and the EMT's all get invited to the birthday picnic a year later.
At 0330, in a romantically lit bedroom somewhere in Louisiana:
Woman: "We were having sex, and all of a sudden, he screamed."
Man: "And then blood spurted everywhere."
Woman: "It ain't coming from me."
Man: "And my privates hurt real bad."
AD (sighing because I am once again about to violate a Rule of EMS*): "Okay, lemme see."
Man (flipping away the sheets and looking up at me fearfully): "I hurt real bad, dude."
AD: "Ah, I see. When this happened, were you, um… how do I phrase this… having vigorous intercourse?"
Man and Woman: [blank stares]
AD: "You know, kinda enthusiastic?"
Man and Woman: [more blank stares]
AD (sighing): "Were you tapping it good, bro? Hittin' it hard?"
Man (proudly): "Yeah, I was. I was really plowing the short rows, man."
AD (suppressing a grin, and mentally adding a new phrase to my euphemisms for rough sex): "Yeah, that'll do it. You broke your penis, sir."
Man: "I didn't know you could break your penis. Will it heal on its own? I really don't want to go to the hospital."
AD: "You need to go to the hospital, sir."
Man (pressing hopefully): "Yeah, but it'll heal on its own, right? They're not gonna cut on my dick, are they?"
AD: "I don't know."
Woman: "Go to the hospital, baby. Somethin' wrong wit' you."
Man: "You said you've seen it before, though. What do you mean you don't know?"
AD: "I've seen broken penises before, but never one that bled externally. You need to see a urologist."
Man (stubbornly): "I ain't going to no hospital. I ain't lettin' nobody cut on my dick."
AD: "Sir, your penis is not supposed to look like an eggplant. Moreover, there are only two things that are supposed to come out of your urethra, and blood ain't one of 'em. If my junk was spouting blood like a friggin' pulsating shower head, I'd wanna get it looked at before it fell off."
Man: "Okay, I'll go to the hospital."
AD: "Wise choice, sir."
Paramedics have a pretty high threshold for what constitutes an emergency. Generally, if you ain't dying, we don't think it needs an ambulance.
But for anything that makes your penis spout an arterial blood spray, I'd make an exception.
*Rule Four of EMS: Handle no one's junk but your own.
Those of you who read Sean Eddy at Medic Madness are probably familiar with his Celebrity Medic series, in which he imagines what a celebrity or fictional character would be like as a paramedic. So, given the dramatic win last weekend and the upcoming divisional playoff game against the Patriots, Sean and Greg Friese have challenged us to imagine what it would be like if Broncos quarterback Tim Tebow were a paramedic. If you’d like to play along, consider this a meme. Drop us a link to your blog post in the comments.
If Tim Tebow Was A Paramedic:
He’d have more code saves than any other medic in your system.
Of course, his detractors would point out that the reason is that Tim Tebow has more people die in his rig than any other medic in the system, because Tim Tebow struggles reading 12-lead EKG’s and recognizing subtle patient presentations…
… but his fans would counter with the fact that, once the patient is dead, Tim Tebow always seems to convert the patient to a perfusing rhythm on the first shock.
“Yeah, but that doesn’t happen until they’re dead!” his critics would retort.
“What does it matter as long as they go home neurologically intact?” his fans would crow. “A save is a save, baby!”
“Dude, the guy‘s a weak medic,” would come the counter argument. “He can’t read EKG’s, struggles with drug dosages, can’t remember the landmarks to do a needle decompression, breaks half a dozen teeth when he tries to intubate someone – “
“ –but gets the tube in when it really counts!” his fans would proclaim. “That’s what’s important, right?”
“Puhleeze. The guy has killed more people than smallpox.”
“He’s saved more people than Billy Graham!”
“Johnny Gage and Roy DeSoto!”
“Dude, you’re talking about the guy like he’s an elite medic. Elite medics know cardiology like Tom Bouthillet. Elite medics manage an airway like Ambulance Driver. Elite medics are cool under pressure like TOTWTYTR. Tebow couldn’t stand on a stepladder and kiss those guys’ asses.”
“Oh, yeah? Well, how many code saves did those guys have this month? None, baby! Woo hoo!”
“That’s because those guys don’t let their patients code. They manage the call, so they don’t have to do any heroics at the end!”
“ Tim Tebow rules!”
“Tim Tebow drools.”
“You just hate him because he’s guided by the hand o’ Gawd!”
“I hate him because he gets the credit for every save, when it wouldn’t have been possible without the uninterrupted chest compressions done by his partner, or the prompt call to 911 by the patient’s family, or for the contributions of half a dozen other people. Nobody gets a save all by themselves. Resuscitation is a team sport.”
“TIM TEBOW WAS THE BEST EMT-B THAT EVER LIVED!”
“Yeah, but now he’s a medic. Everybody in this system was an awesome EMT-B, or they wouldn’t even be here. This is the pros, baby, and your boy’s game doesn’t work here.”
“YOU TAKE THAT BACK!”
“Not gonna happen. Maybe your boy might make a decent – I mean just decent – medic with a lot of practice and a few years. But he ain’t there now, and he doesn’t even deserve to be mentioned in the same breath as Rogue Medic, or AD, or TOTWTYR, or Happy Medic. “
“HERETIC! GOD SEES YOU, UNBELIEVER!”
And while the argument raged around him, Tim Tebow would keep on running calls and doing his best for his patients, because he’s Tim Tebow, and he’s a good kid. He’d recognize that he’s got a gift for the heroic save, but he’d also be honest and admit that he’s still nowhere near the medic he should be.
And nobody would outwork him in getting there.
He’d be humble and self-effacing to his fans, always deflecting praise to his teammates (and God), and he’d be gracious to his critics. And he’d make some serious gaffes, but he’d keep on racking up saves.
And after each one, he’d Tebow.
Fred Sanford Syndrome: clinical disorder characterized by the life-threatening complaints in the absence of any objective clinical findings. Sufferers of Fred Sanford Syndrome (FSS) usually present with chest pain, often accompanied by a constellation of associated symptoms including respiratory distress, dizziness, anxiety, syncope, flatulence, incontinence, amnesia, seizures, speaking in tongues, headaches, blurred vision, loss of vision, aphasia, dysphasia, paranoia, combativeness, belligerence, and catatonia.
FSS is thought to be triggered by emotional distress, often resulting from verbal conflict with family members. The hallmark signs of FSS are dying declarations, although these dying declarations are easily distinguished from from the far more ominous "profound sense of impending doom" often reported by acute coronary syndrome sufferers, primarily by the volume and frequency of the declarations, and the presence of a receptive audience.
FSS is exclusively found in males, although many healthcare care providers note its similarities to Scarlett O'Hara Syndrome (SOS) found in females, and postulate that it may indeed be the same disease.
Given the frequency at which I see this disorder, I think it's time we added it to the ICD-10.
Or, given the total lack of objective clinical findings, perhaps the DSM V.
I've been teaching EMT's for years, and let me tell you, there's nothing so satisfying as that look of discovery on a student's face when the light bulb finally comes on. Instructors live for such moments.
The Borg has partnered me with green partners ever since I started here, and I try to impart a little of the experience and wisdom I've earned over the years. I mentor them, fill in the gaps in their knowledge, perhaps season them a bit, and ready them for paramedic school. Thus far, all of my previous partners are now medics, or currently in school. They've all been successful. I'm kinda proud of that, actually.
And since I'm literally old enough to be father to most of them, I sometimes get a little paternalistic, and teach some of life's lessons that have nothing to do with EMS; the things they'll need to succeed in life.
Like early this morning, for example, when I took the opportunity afforded by a slow Christmas Eve to teach Betty Rubble the most accurate -and most importantly, repeatable – way to bounce a quarter off a table into a Dixie cup. Hard to believe she made in through high school and a couple years of college without mastering that vital skill, but apparently she took different electives than I did in school.
You'd think the poor kid had never seen a man roll a quarter off his nose before.