Thursday, February 15, 2007

Tales From the Trenches

An old lady had fallen in the French Quarter. We raced to the scene (yeah, right) after being dispatched to the call. The fire department was already on scene, diligently bumbling around, one responder obtaining information, the others all performing unrelated and mostly irrelevant duties. The guy with the clipboard had tried to obtain medical information about our patient, but had no idea how to spell any of the medications that the patient had described. Hence we had to translate his phonetic approximations into English: “Mob-ax” apparently stood for Norvasc, “Ty-D-Bol” for Toprol, “Carrots-em” for Cardizem and so on. The usual.

The only one of the first responders who generally has any handle on the situation at all is the one with the clipboard. In his hands, it serves as a physical reminder of the job he is expected to perform. It prompts him to do something: get information. He can’t look down without seeing it. Yet it doesn’t always work out his way. Often I’ll ask the firemen for a copy of their report, only to be informed that their report is completely blank, wholly unmarred by the stroke of a pen, despite their having been on scene for ten, twenty or thirty minutes, plenty of time to write a rather descriptive essay of the scene, let alone acquire such basic information as the patient’s name, address and medical history. The duties of the rest of the firemen are less clearly defined, based as they are on cerebral calculations, observations and deductions as they try to deal with treating the actual patient, and so they frequently wander about in a haze, uncertain what they’re supposed to do. I sometimes wish that the patients would catch fire; at least then the firemen would know what to do.

Our patient was no less entertaining. I can’t remember her name but it was some very “old-lady” type name like Gladys or Mabel or Ethel. I liked talking to her because she said she fell on the “banquette,” rather than the sidewalk, an old, charming term that is rarely heard in conversation these days. She had fallen flat on her face, bruising her nose and causing her front teeth to pierce the area between her lip and nose. It sounds terrible, but it was barely noticeable and wasn’t bleeding at all. As most old ladies are wont to do, she was mostly concerned with who would get her groceries home and who would call her son and where was her purse and was her hair all right than focusing on the medical attention she needed. Just securing her to the spineboard was an exercise in patience. Every time we laid her flat to secure her, up popped her little blue-haired head to tell one of her friends standing by some vital bit of inconsequential information. “Oh, Margie, don’t forget to water my plants!” “Oh, Bernie, you need to go turn the lights off in my house!” You’d think she was moving to India rather than taking a quick trip to the hospital for a couple of hours.

After securing her and putting her into the ambulance, she was removed from her distracting audience and could devote her full attention to complaining in earnest. She kept asking for ice to put on her lip. Where people got the idea that ice is the cure all for every type of wound is beyond me. I’ve driven up to scenes where the victim was shot multiple times and bystanders would be trying to apply ice packs, a dozen of them, to all the little holes in his body. Our lady was evidently from the same school of thought. I gave her a sterile dressing, infinitely more useful and less messy than the ice. She kept asking how bad it looked and I told her that it wasn’t bad at all; it wasn’t even bleeding. After a couple of these exchanges, it became clear that such a simple evaluation would never do. “I wish you would quit telling me that! I can feel the blood running into my throat!”

My partner, Lisa, who was wise enough to humor her, said, “Don’t swallow that blood. Spit it into the dressing or else it may make you vomit.”

That put her in a predicament. How would she still be able to complain when her supposed bleeding dilemma had been solved from both ends? She was quick to respond, “Well, it’s not bleeding all that much.”

Just before we pulled off to go to the hospital, Lisa began to ask about her medical history since she certainly didn’t feel like translating the Pidgin English that the firemen had supplied us with. Our lady’s voice was a bit stifled with the dressing she kept stuffing into her own mouth, so at the first request to repeat the name of a medication, she began spelling each one of the hundred or so drugs she was on. By the time we got to the hospital a full twenty minutes later, the patient was still reciting and spelling out the contents of her medicine chest. She took obvious delight in her ailments. I suppose it gave her some distraction from the drudgery of complaining.

Later on after day had given way to the creatures of the night, there was a girl who had passed out, again in the French quarter. A woman was standing over her dressed in a waitress’ outfit. She explained that she was a Physician’s Assistant and when she arrived the girl wasn’t breathing until after she tried to rouse her with some painful stimulus. She said it looked like she was high on narcotics. I quickly agreed, but was rather distracted by the fact that this woman said she was a Physician’s Assistant, but was dressed as a waitress. She picked up on my perplexity and explained that she couldn’t make any money as a P.A., hence the waitressing gig. I gaped in surprise until I recalled my own start in emergency medicine; how it was a pay cut from my own previous job as a waiter. I thanked her for her help and turned my attention to the patient who had come around enough to slur an approximation of a conversation. I asked her if anything hurt and immediately felt like an idiot at my question.

“Not now,” she burbled, with just enough energy in her expression to convey the message ‘do you have any idea how good all this heroine is making me feel, you dummy?”

I wasn’t very hurt. After all, I was going to be giving her Narcan – the meanest medication of them all. Narcan prevents the nervous system from reacting to narcotics, and hence has the ability to knock the pedestal out from under the best opium high. Afterwards, the recipient doesn’t just come back down to earth, but they keep falling, down, down, down, until they feel as awful afterwards as they felt good before. This was her fate in my hands, and I had no sympathy for drug abusers such as her. You can’t dance if you’re not willing to pay the piper.

While I was getting everything ready, she felt compelled to tell us much of her life story: she was a dancer in the Quarter “a stripper, really” she confided. I wondered what her audience must think about that, since she had more tattoos on her body than she had unmarked skin. It must be like unwrapping a painting. The black fingernail polish and pierced face only made me wonder more at what that show must be like.

Every time I did something like check her blood pressure or start the IV or anything she would say “I’m all right; I don’t need any of this. Why do I need to go to the hospital?” And each time I explained that it was because she was found unconscious and not breathing this amusing little look of astonishment would cross her face and she’d say “Oh. Really?”

Yes, really. For the tenth time.

After the Narcan she came around and immediately started bitching. This was a violation of her rights and she doesn’t need to be here and why was she going to the hospital and she doesn’t want this IV in her arm and blah blah blah. I liked her better unconscious. At least she was just bitching and didn’t come off the stretcher looking to hit or bite me, like some Narcan patients do.

At the hospital the doctor told us to put her on one of the beds. She admitted to taking some pills so she was going to get her stomach pumped. This consists of a long thick plastic tube that reaches down your throat into your stomach through which is passed about five gallons of water to wash out the pills, followed by a nice healthy dose of black charcoal to absorb whatever toxins remain. It is affectionately known by hospital staff and EMT’s as the “Louisiana black snake.” All this was unbeknownst to our heroine, who came to the noble conclusion that she would simply imagine this trip to the emergency room as “a visit to the spa.” I feared to learn what women’s spa shoved hoses down your throat. I was grateful that I don’t go to spas.

Back out into the night we went, only this time we were going home. The radio crackled with traffic, we could here calls going out to our fellow paramedics who were on duty until the morning. We had done our time for the night in the trenches. Maybe we had made a difference, maybe not. One thing was sure: no matter how many people we had treated and brought to the hospital, there would still be no shortage of them for the next shift we worked.

Onward and upward…

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