The MacMedic

I was right, the day shift was out with a crashing patient and I only feel a little guilty saying “better her than me”. They didn’t get back to quarters until almost 2000 and I pitched in to repack and clean the gear that had been used. I would eventually have to head over to the ED to retrieve some medication that we didn’t stock at that station.

Fortunately the only call of the night, a fall, came in while I was out of town at the ED. The ambulance covered the call and confirmed that no ALS was needed leaving me free to take a leisurely drive back to quarters. Once back I sat down on the couch and opened my book and promptly fell asleep. I slept fitfully, being awakened frequently by coughing fits and bone jarring sneezes every once in a while but I managed to stay reasonably asleep until 0600 when the day ambulance crew came in for shift change.

I’m still feeling pretty lousy but at least I am reasonably well rested. Today’s tasks are many and my time will be short.

I only slept for a few hours this morning. I have been fighting a miserable cold and cough which has made it difficult to stay asleep and when I woke up it felt no better.

The afternoon was booked for going to the nearest Ikea store and buying some furniture for the new house, mostly stuff for the kids bedrooms. Admittedly I am not a shopper, I don’t like crowds, I shop my list and get out, and browsing shelf to shelf is not my idea of fun. Imagine how excited I was to arrive and find that it was a weekend when they were having a large 15% off everything sale and that the crowds were enormous. It ended up taking us quite a while to get through the store and finally load the car with our purchases. I was quite happy to have the trip done with even if it meant going to work.

I’m hoping that the night will be slow, the day shift is still out on their last call and since both of the ambulance crew members are gone as well I can only assume that she is with a critical patient. I hate to say it but with how I feel better her than me. For a change I want a slow night with the hope of a little sleep.

Could have been a better night but could have been a lot worse too. I have mixed feelings about the one memorable call I did during the night.

I had been dispatched into Medic 2’s area to cover a call for an unresponsive while he was already out. During my response I heard lots of radio traffic looking for a crew for the ambulance and from the first responder on scene. I learned that it was not an unresponsive patient but rather one with right sided paralysis. A few minutes later a crew for the ambulance had been secured and a couple of minutes after that the first responder asked for the helicopter to be dispatched. I was still several minutes out so this was the only information I had.

I arrived on scene just after the ambulance and found that when I entered the building the patient was just being secured to the stretcher. Also on scene as part of the ambulance crew was the paramedic who had worked the Medic 2 day shift who gave me a detailed report.

The patient was a woman in her mid forties with a history of high blood pressure who had a sudden onset of right sided weakness that rapidly progressed to right sided paralysis accompanied by a significant headache. The initial blood pressure that I got was 280/160 which, I don;t think I need to say, made me very concerned. Once loaded in the ambulance the helicopter was still more than 15 minutes out, the patient was feeling her headache worsening, and her blood pressure was not coming down.

I had to choose. I could wait for the helicopter and have the patient transported to the most appropriate facility, one of the larger tertiary care facilities that could do something for the stroke that the patient was pretty clearly having. The other choice would be to head for the nearest ED, the satellite ED that Medic 2 is based at for emergent control of her blood pressure prior to transport.

The day paramedic and I both concurred that if we didn’t get the patients blood pressure down we had the potential for things to go very badly wrong. I decided to head for the closest ED with the intention of having the support of the staff there to try and reduce the patients blood pressure while waiting for transport. It seemed to make the most sense.

We were into the ED about four minutes later and I thought that everything was going to go well. Unfortunately the doctor on duty had it in her mind that she didn’t want the patient here and kept badgering me about why I didn’t wait for the helicopter. I tried explaining about the blood pressure, my lack of resources, ETA of the helicopter and proximity to the ED by she wanted none of that and only wanted the patient transfered out ASAP. I certainly understood that this was not the optimal place for this patient to be but the optimal place was 35 to 40 minutes from the scene.

The helicopter was enroute to the ED but was going to be delayed since my message that they be diverted to the ED rather than just cancelled was relayed improperly and they had turned around to return to their base.

Even though the helicopter was coming to the ED for the transport she continued to berate me about the poor choice I made. Still, medications were being administered to reduce the patients blood pressure and the patient seemed to be no longer worsening. I accepted the fact that she didn’t agree with my choice and with the patients blood pressure coming under control I offered to transport with the patient to the tertiary care center with either the BLS ambulance that I had come in with or with the ALS ambulance that was there to transport a stable patient to the hospital for admission.

Neither of these were acceptable, the patient HAD to go by helicopter even though ground transport was going to be no longer and maybe even a touch faster since the flight crew usually takes longer to load and get underway than we do. It was clear that there was no way that her mind was going to be changed, it was going to be transport by air at all costs.

It finally made it through my thick head that I was not going to make any headway and that I should probably just back down, restock, write my paperwork, and head back to my service area.

I think that I made an appropriate decision with the information I had available, the doctor disagrees. Was I right? Was I wrong? I don’t know. I think I made a good decision but can see some pluses for taking the path I didn’t take.

Total calls for the night: 8 
2 ALS transports 
2 BLS downgrades 
2 Cover assignments 
2 Cancelled

Milage for the night: 98

Music for the night: XM70 Real Jazz and “The Dana Owens Album” by Queen Latifa

I slept long and deeply today, as much as I wanted to spend some time with my family, the one time I actually woke up I rolled right back over and went to sleep again. I felt so much better when I finally got out of bed.

Tonight is another shift as Medic 1 with the added bonus of an additional hour on shift when we set the clocks back at 0200. I’m hoping for a busy night in the city though since my favorite BLS crew will be working the overnight. With luck we will see some interesting calls.

By 0600 I was struggling to stay awake, two days with little sleep and an uninteresting shift were taking their toll. I had no sooner had that thought when the tones went off assigning me to an unresponsive person along with an engine company and an ALS ambulance. Normally at this hour of the morning an unresponsive frequently means someone who has died during the night and my suspicion was that this would be the case this morning.

The building we were going to used to be a seedy hotel that was full of drug and alcohol users. It was one of those where you were always careful not to get to close to the walls just so something wouldn’t jump onto you. Several years ago they closed the hotel, changed the address and turned it into a low income apartment building. We still go there and for a lot of the same stuff.

This morning I arrived on scene with the engine company right behind me. We headed upstairs in the elevator with memories of hauling patients down the stairwells from the fifth floor or more in the past because the elevator never worked. Certainly a working elevator was one of the upsides of the renovation.

We arrived at the apartment, really a single room with it’s own bathroom and were shown in by one of the occupants. We could see a cyanotic body lying next to the bed with an ocassional gasping breath. Not what we were expecting but certainly someone who was well on their way.

The engine company started bagging the patient while I threw the defib pads on only to find that the patient was in a normal rhythm with a rate of 120 or so. Even her trunk was cyanotic telling me that she had not been breathing much for quite a while. No obvious track marks, no alcohol on what breath she did have, but her pupils were pinpoint, extremely constricted and nonreactive, I was being led down the path of a narcotic overdose.

Her “boyfriend” told us that she was on methadone and had had her dose increased yesterday, didn’t drink and didn’t do any drugs anymore. That may be, but it was certainly looking like narcotics to me. By this time the ambulance had arrived and the engine company had pulled the patient out further into the room so that we had room to work. Too bad I found that I was blocked between the bed, the wall, and the firefighters who were ventilating her. The ambulance could work on an IV while I extricated myself and my equipment from the corner I had allowed myself to be backed into.

They tried twice but couldn’t get one, I couldn’t really wait longer and I fell back to my next option. I gave her an injection of 0.8mg Narcan (a narcotic antidote) in the muscle on her arm. That would take much longer to work but it was better than nothing. I took my own look for an IV site and made an attempt on a shadow that looked like it maybe could be a vein. Lucky shot, it was in and good. Secure the line down and administer another 0.4 mg of Narcan by the IV. It didn’t take more than 20 seconds for the patient to take a very deep breath, open her eyes, become incontinent, and then vomited. Well, at least she was breathing again.

By the time we got to the ED she was reasonably awake, answering questions mostly appropriately. Still, the story was that she had not had any alcohol or drugs other than her methadone in the past 24 hours. My gut was telling me otherwise and the story was the same right up to the time that the doctor walked in the room and then it changed to partying last night, alcohol, cocaine, heroin, and some other “stuff”. Figures, they’ll change stories every time. No matter, she was breathing again for now and that was the outcome I had been hoping for. Just goes to show that listening to your gut is not a bad thing.

total calls for the night: 9
2 ALS transports
1 BLS downgrade
2 Cancelled
4 Cover assignments

Milage for the night: 94

Music for the night: “Water Music” by Handel

I didn’t sleep anywhere near enough. It was a strange feeling getting up this afternoon and knowing that I no longer owned my home, or any home for that matter. Still, it had to be done and in reality nothing changes on the surface. We continue to live here for another two months. Shortly after I dragged myself out of bed to get the kids off the bus the moving company came to drop off what seemed like hundreds of boxes for us to do more packing. Our move date has been confirmed, December 21st with the company starting to load the truck on the 19th.

I’m hoping for an interesting night tonight. Medic 1 should at least be busy on a Friday night. The only work that I have on my plate for tonight is getting ready to hand off my administrative tasks to whoever is going to be taking over.

It was a pretty beautiful night last night with clear skies and crisp cool weather. For the first time I had real frost on my car when I got out. As nights go it was pretty boring with no transports, a pair of cancelled calls, and a couple of cover assignments.

Now that I am home I am looking forward to my youngest going to school so I can head off to bed and try to get a few hours of sleep before I have to get up and do it all again. With luck I won’t wake up when the buyers do the final walkthrough of the house.

Total calls for the night: 4
2 Cancelled enroute
2 Cover assignments

Milage for the night: 82

Music for the night: XM70 Real Jazz

With the sick day I took last week it has been ten days since I have been to work, it seems much longer. Only 17 shifts left and I am still feeling somewhat unsettled by the thought of leaving what has long been the job that I had wanted to retire from. Who am I trying to kid? Lately most of my life has been unsettling.

I took my daughter to the children’s medical center today for her last appointment with the doctor that has been helping us manage her Asperger’s Syndrome. All in all we agreed that things were going pretty well and that no major changes were needed in her treatment plan at this time but we would need to watch her carefully over the next few months as the stress of the move may suddenly surface in unexpected ways. We still don’t have a doctor in the area of our new home for my daughter and her current doctor will make some contacts and give us some recommendations. After so many years with this doctor I’m really unsure that I want to leave her and try to find someone else who may or may not have the excellent rapport with my daughter that she has. I don’t know what the answer is.

Our attorney for the sale of our house came by before I left for work with a stack of paperwork that needed to be signed for the closing tomorrow. After the first few legal documents that I tried to read I gave up and just signed what she told me to sign. I trust her and I know that there will be no surprises.

The buyers are coming tomorrow afternoon to do their final walkthrough of the house before they close. It is worth mentioning only because they were pretty insistent that they do the walkthrough at 1300. Since my youngest and I will be home in the morning before she goes to school I suggested that they come then so I could sleep in the afternoon but they refused that suggestion. Instead they will be coming at 1300 knowing that I will be sleeping and with the understanding that they will have to be quiet and leave me alone. If they can agree to that I guess I can tolerate the intrusion. I’m sure it will be as weird for them as it is for me knowing that they are walking around the house while I am asleep in one of the bedrooms.

It looks like it will be a pretty nice night as far as the weather is concerned and after a ten day absence I am looking forward to just being back.