Monday, March 4, 2013

- Meat in the Street

The scene is, in a word, chaotic. Fire trucks, police cars, a rescue unit, and now my dinky Jap pickup truck are strewn along the side of the highway as officers reroute traffic in a procession of bright fluorescent eyes to side roads. A ring of responders, some of who I have known for years from working in Backwater, circle a body lying in the roadway. A firefighter sees my vest, and pats me on the shoulder.

"He's 10-7, bro."

I smile and keep walking toward the group and shoulder my way in as I slip on gloves.  I've been going on the fire department page-outs for medicals for about 6 months now and they always seem to be happy to see me. No paramedics work for the paid/volly service that serves Backwater City so they have no ALS providers on scene - the ambulances summoned to the scene aren't there yet.

(Acutally, a point of contention of mine with mangament, XXXX EMS has a contract with Backwater Parish in which they are REQUIRED to have two ALS units in the parish limits at all times; the dispatchers don't commonly adhere to this policy. Which means that, when some poor bastard gets smoked by a Cavalier on the state highway, there's going to be a longer response time as the units scramble from one or two parishes over. There's going to be some interesting points made at the next business meeting between XXXX EMS and Backwater parish council. But, I digress.)

The thing in the road does not immediately resemble a human body and looks more like an abused side of beef wearing a sweatshirt. There's a lot of blood, but no breathing. An elderly firefighter is crouching near the body, and looks up at me. He shakes his head as he feels for a pulse

"Oh, hey MM! I don't feel anything. We're about to call the coroner. His shoes are over there." He points to a spot about 60 yards up the highway.

"No problem," I say. "You mind if I double check?" The ring is beginning to dissipate as firefighters go back to their various vehicles.

"Sure! Suit yourself."

I crouch down to the body. The legs are jigsawed in different directions with large dark stains over the lower parts. The right arm is parallel to the head and the left is near my boot - both seem fractured. And his hand is bleeding....rather profusely?

I press my hand to the man's neck. Faint but regular, I feel a ticking sensation.

I immediately stand up. "I've still got a pulse"

Just probably not for very much longer, I think to myself.

The sudden pronouncment of life causes several pairs of eyebrows to raise, and several pairs of lips to mutter "Oh, shit!"

I grab the closet firefighter and tell them to grab a BVM and airway plus a spineboard and collar, and contact our dispatcher to tell them to send a chopper. A State Trooper walks over to me.

"What the hell is going on?"

"He's still got a pulse, trooper."

"Aw, shit!."

I turn back to the elderly firefighter who looks at me with a sheepish smile.

"Heh, guess I was wrong, huh?"

I pat him on the shoulder. "Don't sweat it. Was anybody else injured?"

He points to a sedan a little farther up the roadway. "They had some kids in the car. The windshield came in when they hit him."

The thing at my feet, with this much tramua, is really more an "it" than a "him" at this point, but I don't correct him. I thank him and jog over the sedan. A family of 5 looks at me and the body with wide eyes, uncomprehending.

As I draw near, one of the kids starts crying.  "I thought he was dead," says the mother. "They say he was dead."

"Ma'am, we're going to do what we can for him. Can you tell me if you're hurting anywhere?"

Putting on a fresh pair of gloves I snag I quickly triage the family. No one seems to be hurt, other than minor scratches. I tell them to sit tight. A quick look at the sedan reveals massive damage. It appears they struck the man with the direct center of the vehicle, causing him to dent the hood, shatter in the windshield, and roll over the top.  As I walk back over to the man, who is now nearly immobilized and receiving BVM ventilation, the ambulance crew rolls up. I busy myself with assissting the responders. A shadow looms over me. The medics are standing there, neither one with a bit of gear on them, stretcher still inside the unit.

"What are ya'll doing?" asks the medic, obviously confused. "They said he was dead."

"He's not dead yet," I say. "He's got a pulse."

The medic looks at me and then back at the body. "Bullshit."

"Check for yourself."

The medic leans over laborously, and touches his neck.

"Aw, shit!"

I stand up and strip off my sweaty gloves, and grab the EMT by his arm. "Get your stretcher ASAP. Let's get this dude out of here."

A fire lights under the asses of the crew and they do their best to step it up. We get the man loaded in the back of the unit. His pressure is low but the pulse is still regular, although he is not breathing.

We cut off the man's clothes and the EMT gags for a second. The man's lower legs look like he stepped on a mine. Bone and muscle and skin are twisted and frayed and mixed into something nearly unrecognizable as human. Incredibly, a completely intact and empty gin bottle is in the man's pocket. I have no idea how it didn't shatter.

The ambulance departs the scene shortly, with an flight medic from the air service onboard that had landed on scene as we loaded up. Right before I step out of the back, they lose the pulse.

I watch the ambulance shrink and the red lights go dim as they roar to the hospital.

The State Trooper walks up to me.

"Why didn't they fly him?" he asks.

"Lost a pulse. Easier to do CPR and ventilations with 3 people in an ambulance than 2 in a chopper.

"CPR? I thought you said he had a pulse."

I unzip my vest and start walking up to my dinky Jap pickup. "He did."

-MM

Saturday, December 15, 2012

- Whoops

We had just transferred care of a patient and I'm making eyes and telling jokes to this overly made up nurse who is sitting next to three other relatively attractive nurses at a local ER. One of my friends, one of the ones sitting next to the Barbie, works there. She's entering information about a patient and gets a confused look on her face. I ask her what's up, and she tells me.

"I don't know how to describe my patient's pee."

I suavely look at the squadron of nurses and say, "I'm pretty creative. I think I can I can help you."

The Barbie looks at her friends and looks back up at me in shock. "You really want to do that?" Her eyebrows go up.

I give an arrogant toss of my shoulders. "It's just pee. How hard can this be?", and walk into the room behind my friend. I can see Barbie's reflection in the glass of the patient's room. She looks just like a confused puppy, albeit  one used for cosmetic testing.

My friend closes the door and goes to the side of the bed, where I assume I'm about to inspect a Foley bag filled with urine that looks like a resort of sea monkeys. Instead, she reaches down and grabs the corner of the patient's blanket, which she promptly pulls all the way up to the patient's chest. Ok, this is weird.

The Barbie nurse sneaks in with us, still staring at me, which is getting a little freaky.

I turn around to find my friend holding the patient's junk in her hands, pointing to the weirdest Foley insertion I've ever seen - it's like a supra pubic catheter placement, except going through the patient's scrotum.

I suddenly realize that my friend didn't say "I don't know how to describe my patient's pee."

She said "I don't know how to describe my patient's penis."

And in their eyes, I went from flirting with 4 hot ladies to immediately and enthusiastically attempting to stare at a patient's wiener.

Yeah.....

-MM

Friday, September 21, 2012

A little bit of blogroll housecleaning, and two posts for today below. I guess the writing bug has got me again. If you would like your blog linked, leave a comment with below with the address and  I'll check it out, as long as it's hosptial/EMS/FF/PD related, I'll probably link it.

As always, your bikini/cheesecake/nude photos can be sent to me directly :)

-MM

- Guns in EMS

This has been getting a lot of discussion lately about EMTs carrying on the job. Personally, I think if you have gone through the process of getting a concealed carry permit, you  should be allowed to carry everywhere, including at work. I do not have a CCP but am considering applying. To be honest, I don't know if I would carry at work, but I think the freedom to do so should be there for others.

I had a call once for a infant cardiac arrest. It was tragic, the family was extremely upset, and as I was doing compressions. I wasn't even MedicMarch yet: I was just joe-blow March, doing a ridetime. As I looked up from where I was compressing, I saw an AK47 style rifle in the closet. This, combined with the uncle's threats that we needed to save the child, "or else", led me to point this out in a whisper to my preceptor. He calmly asked for Sheriff's department to come out (they were already on the way) and the officers arrived and politely escorted the distraught gentleman outside. Nothing bad happened.

But if the man would have gone for the rifle, I personally would have preferred to have gone down shooting than with a scared look on my face.

-MM

- Back in Back(water)

I missed this area. I missed the cane fields, the bayous, the people at walmart.

The farms and farm animals.

The poor part of town.

The rich part of town.

The food.

And the calls.

"How long has your toe been hurting, ma'am?"

People don't believe me when I tell them about the broken toes and itchy butts.

But we also get good calls.  A young flips his truck into the bayou and we have to jump into a flat bottomed boat to get him extricated.

A lonely older lady who tries to overdose.

Heat exhaustion, shootings, strokes, heart attacks, GI bleeds.  A diverse profile of calls and patients, keeping my skills sharp.

I believe in this job. I know now that  I can't do it forever. I don't think I'll make even another 2 or 3 years. But I'm back here now, moved completely away from home into Backwater, and joined the fire department in addition to working for XXXX Ambulance.

And it's good to be back.


Sunday, July 15, 2012

Original recipie, or....

"Frankly, I don't understand. Your performance is slipping. Look at all these refusals on transports. You're 2 percent below the minimum."

I'm in the boss's office, called to the carpet. He's got a new clock on the wall. I look up at; it's got the company logo across it. I've been in here so much over the past 6 months I think the chair is conforming to my ass.

I'm in trouble because I told a patient "holler."

 This, of course, has only been on item in a long line of infractions:

-Slightly uncleanshaven, one shift.
-Ran a YELLOW light. Then was accused of lying about it.
-4 records completed late.
-Argued with the local trauma line; gave medication without asking (the ER physician complimented me for the same call, and was most assuredly NOT concerned about my lack of asking permission.)

I tune back into my boss. "....repeated infractions of policy. Why are you such a disciplinary problem?"

"I don't think I'm a problem," I say.

He stares at me. About 30 seconds go by.


I've lost my taste for everything here. The apathy I feel is all encompassing and every day at work is a struggle. I've never felt like this about anything. I'm not even sweating. If I get fired at this point, I could care less. I can no longer stand the weaselly politics and back stabbing and I've lost my taste for the upper management's tactics.



I guess this is burnout.

"I'm putting you on probation. 90 days. If you have one more infraction, you will be terminated." He closes my folder. "I think you need to go back to Backwater."  There's no threat in that sentance, but his voice is gravid with suggestion and...anger. Is he really this mad?

I think of Backwater, another service area in our company. I'm burnt....but....it could work.

I spend the next three months off the radar...my boss never misses an opportunity to praise me in front of his boss - I get compliment letters every other month or so, and at staff meetings he pulls me to his side with a big shitting grin and compliments me, hitching himself to the praise wagon, taking credit where he is due none. But when other employees are praised on our company's website, my name is absent from the rosters; the compliments are filed into my personnel file and he does not speak to me about them personally.

On day 91, he shakes my hand and tells me what an improvement I've made and that he's glad I'm finally listening to his leadership. I give him a big shiteating grin and shake his hand. The next day I'm weighing my options about other employment or going back to school. Instead, I put in my request to go back to Backwater. Maybe there's still a little life in me after all.
 

-MM

Friday, March 2, 2012

- Thunder in Paradise

She's been standoffish, and it's starting to affect our team dynamic. There's an underlying tension between the two of us - we hang out off duty, drink beers at a local sports bar, whatever off duty is no problem. But two or three hours into a shift and I can tell she's frustrated with me, or with something. Benni has been having serious issues with her boyfriend, I know. I need to be understanding, but I need her present and get it together, because I can't do it all by myself.

I just can't figure out a way to tell her. I never tired just telling her that, and I wonder now if things would be different if I had.

It comes to a head one afternoon. I get frustrated with patient and it bleeds into my voice. She gives me a disgusted look and melodramatic sigh and walks off the scene. Later she refuses to help me move a stretcher. After the call, when we get back to the station, I tell her not to get out of the cab. I want to be compassionate and ask her whats wrong, but as I start to open my mouth she rolls her eyes and my temper skyrockets.

"Okay, look, I don't know what your fucking problem is, but let's get it worked out."

She immediately snarls back at me "I CAN'T BELIEVE YOU TALKED TO A PATIENT LIKE THAT!"

The patient is question was a psych patient refusing to answer any of my questions. She was completely uncooperative, and finally I said "Holler!" and walked out.

"You can't be serious Benni. You've got to be fucking KIDDING ME."

We argue in the cab, yelling back and forth. I won't get into more detail then that. Our supervisor happens to walk outside and sees us yelling. I see Bennie glance out of the corner of her eye, and she stops arguing, open the door, and yells "I JUST CAN'T WORK WITH YOU ANYMORE, MARCH!" She starts crying and runs towards the back.

My supervisor walks up to me. I put in a dip and tell him "get me a fucking partner who wants to work."

I walk to the front of the station.

He rejoins me about 20 minutes later and I give him my side of the story. He suspends me a shift for the "holler" comment. I want to fight about it, but I'm too tired. I'm too fucking tired. And deep down I think he's right.

To Be Continued.

-MM

Sunday, February 12, 2012

Overheard in ACLS refresher:

Instructor: "Ok, MedicMarch, how would you prepare your patient for cardioversion?"

MM: "I get right in front of them and scream 'Prepare to see the face of GOD, MOTHERFUCKER!'


I still passed.

-MM

Saturday, November 19, 2011

- Scaramedics

I was not a good paramedic when I first started out. Shit, I wasn't even a very competent Basic. I mean, I did OK, no truly grievous fuck-ups, but I was not Basic of the Year material. I tried, but in retrospect, I could have tried harder. I think my youth may have played into it a little, and for those of you that have been reading this blog for a while, you know that my off-duty activities played into it as well. Water under the bridge now, but not that far downstream. To be honest I didn't think when I was 19 that I would still be paramedicing when I was 26. I'm getting older I suppose - it seems like time is flying now, as opposed to when I first started.

I feel like now I've reached comfortable level of proficiency. The new guys ask me questions and I explain things, and it's not till later I realize they ask me because they trust me and/or because I've been here so long. There's only one medic senior to me on my shift.

There's been a lot of changes in protocols, equipment, and management. I've worked 3 disasters in 7 years (2 hurricanes and an oil spill). My old partner Izzy is going to be a doctor in a year. Best Partner Ever is probably next in line for a supervisory position. Ink has his own ambulance as a paramedic, and Fabio is in paramedic school. Red is in nursing school and almost done. I've taught them things I've meant to, and some things that I haven't. I could've been more patient. I could be more patient now. But really, I've had a pretty good bunch of guys and girls to work with.

...but I tell you, over the past 5 months I've had four new basics. It's driving me nuts. One was a whiner, one showed up drunk and then got a DUI, one rammed our unit into 3 a foot pole....sometimes I wonder where they're digging these people up.

-MM

Friday, August 5, 2011

- Obstructed


The room is hot. I guess the patient didn't like having the AC on so much. She's been here for days and recently returned from having a pacemaker put it. When we walked in, one nurse has her brow furrowed, attempting to ventilate the patient, with difficulty. She has no airway in. We were paged out for a respiratory arrest. The other nurse stares at us.

And that's all they're doing. I look at the monitor they have the patient hooked up to- an ugly complex obviously being fueled by the new pacer marches across the scene. I check a pulse.

"I don't feel a pulse. Start CPR," I tell Benni, my partner.

"Wait," says the nurse, grabbing Benni's arm. "She's got a rhythm. You don't do CPR with a rhythm. We just need to bag her and send her to hospital."

"You don't do CPR with perfusing rhythm," I correct her. "I don't feel a pulse. Go ahead, Benni."

The nurse gives me a dirty look that lights a rage in me so hot my eyeballs steam. "How long has she been like this?"

I guess the anger carries in my voice, because the nurse flushes and scowls at me. "Ten minutes."

"So she hasn't had a pulse for ten minutes?"

The nurse's face breaks and a look of fear flashes across it "She had a rhythm. We didn't check. "

I sigh and grab an oral airway from the bag, gently grab the BVM from the nurse, and try to insert the oral airway. She's got a lot of emesis, which I suction out. I then hand the BVM back to the nurse. I'm mad at myself. I probably could've made that a teaching moment and instead I let my anger get the better of me.

The BVM nurse is having problems, so after I push an epi through the conveniently preplaced IJ I have a recently arrived firefighter take over compressions and direct Benni to bag. I thank the nurse through clenched teeth.I can tell Benni is having a pretty difficult time trying to ventilate, even with the airway in. The patient's rhythm is unchanged, still a PEA. I grab my intubation equipment and, with the firefighter still doing compressions, intubate. The angle is horrible, but I can see the bottom of the cords and manage to slip my tube in. I watch it pass, but when I attach the BVM to the ET I can't bag, not even a little a bit. What the fuck? It's like there's no outlet for the air.

I pull the tube and reinsert the oral airway. Benni tries the BVM again, and now she can ventilate with no issues. What the hell is going on? I look back at the monitor. The patient's pulse ox is now picking up, holding steady at 79. I shake my head. At least air is going in. I push an epi and plot my next move. I as I'm disconnecting the prefill I look at the tube I pulled. At the bottom is a massive wad of blue gum, lodged in the tube. Oh.

I successfully intubate shortly after and about thirty seconds later, the patient's pulse ox goes to 100 percent, with a ETCO2 of 102. I go to check a pulse and realize I don't have to - I can see her carotids throbbing in time to the now organized sinus tach marching on.

We package and transport to the hospital, where I mention the gum and turn over care. The patient's pupils are large and nonreactive, and seem to stare up at me accusingly. But she doesn't blink, and when I move away, she stares lasers into the flourescents.

-MM

Thursday, May 19, 2011

Soaked

There is so much blood on the bed I can't believe it - the sheets are saturated with all hues of red. You can even see blood on her hands, darker than that on the sheets, where I'm assuming she was trying to hold pressure on the quarter-sized hole on her thigh before she went so hypovolmic she went unconscious. She breathing agonally, about 4 times a minute. I'm glad I told Fabio to grab an extra handful of 4x4's and Kling, and he is rapidly taping up the leg wound.

"I called as soon as she axed me," says the son, in the door way. "She gon be aright?"

"We're going to try. She's lost a lot of blood." I open her airway and slide in an OPA as I hand a BVM to a firefighter standing next to me. Her mucous membranes look like black and white photos of an airway.

I knew we were in deep shit when one of the firefighters, who arrived 45 seconds before us, came running back out. "STEP IT UP, GUYS! SHE AIN'T DOING TO HOT."

"Understatement of the Year," I mumble to myself, reaching for a pulse. Nothing at the wrist. A carotid is present, but so faint I can barely feel it. Fuck it, it's there, that's good enough for me. Fabio's pressure comes back as 70/30 and I immediately reach in the ALS kit for our EZ-IO and drill. I love this thing. Fluid is soon being pressure-infused as I take another look at the EKG. Her sinus rhythm suddenly gets squirrelly and I actually feel her pulse getting fainter as I recheck her carotid. She's going PEA. I've got the most likely cause being treated as well I can right now but the situation has some unique challenges. There's so much blood on the bed, but we can't do compressions on this mattress anyway.

We pull her off towards me, on the side of the bed, and a literal wave of blood accompaines her of the sheets, fanning out all over the floor and onto my pant knees. Fuck. Stupid. I should have backed up a little more. Nothing to do now but roll with it. Fabio starts CPR as I fire an epi down the IO. We've already got around 200mL of fluid in. Our backup arrives and I tell them to set up my intubation equipment. It's foolish to do all this, I think, her entire FUCKING VOLUME is spread out on the sheets, bed, and my pant knees. After slipping on a procedure shield I open the airway with the scope and am greeted by a wave of pale yellow mucus and emesis against what looks to be a waxwork replica of an landmarks and vocal cords. I suction and go in again, looking at the bottoms of the cords. The backup medic applies pressure and they drop.

I sink and secure, and hook up our ETCO2. The value is only 20, but at the very least confirms I'm in.


The whole neighborhood is outside, and I hear some curses about our response time. Fuck it. I did the best I could. We're not even really supposed to go to this area of town with a police escort.

We secure to a spinebord and push another epi. In the truck she briefly regains a pulse but looses it again. We can't find anywhere to stick an IV...it's all scar tissue and tiny pipes. We fire more epi in and even a bicarb.

It looked like all the blood she had was on the mattress, I tell the doc. The family told us prior to departure that she had a large aneurysm in her leg that was supposed to be operated on later in the week. They hang blood and put in a central line. They too get temporary returns of pulse and pressure, but it's to no avail. Nurses leave the code area an hour later, dripping with sweat.

I look at at our Alert and On Scene times. 8 minutes apart. She went from conscious and talking to completely vampire'd in 8 minutes.

I got blood on my shirt at some point during the run, and I toss it in the washing machine along with my pants. The detergent lifts all the blood as cold water pours in, washing it out to the sewer, and then to the sea.

-MM

Monday, April 18, 2011

- Wow

Fabio and I are blazing to the scene, a gas station off of the main drag in our company's hometown. I've been working here for about a year, following my departure from Louisiana DOC. We're en route to an "Unknown", so that means when we get on scene, it's going to be something ranging from a stubbed toe to multiple shotgun homicide.

Ah, the life of a paramedic. At least I know my new haircut kicks ass.

There isn't a mutilated body upon our arrival on scene, just one man sitting in the driver's seat of his SUV. A drunk bystander comes up to us as we get out of the unit. "He wuz pumpin' gaz, and he drop da pump and walk back to hiz truck," he says. "When he dint get up for 20 minnits and wooden talk to us, I call 911."

"Thanks."

He stumbles off as I walk to the driver's side of the SUV. The man is older and slightly out of shape, but doesn't seem to be in any phyisical distress, until I see his eyes. They have a look of pure panic in them, and when I introduce myself and take his wrist I can feel his pulse pounding.

"Sir, my name's March, with XXXX Ambulance. Can you tell me what's wrong?"

The man swallows, and tries to respond, but all that comes out of his mouth is a salad of mismatched vowel sounds and hard consonants. He stops, swallows, and tries again, but experiences the same result.

"Don't try and speak sir. Can you squeeze my fingers? Tightly, like you're trying to crush them."

The left hands squeezes my fingers tightly, but the right barely manages to keep grip on my hand.

"Open your mouth wide and try to show me your teeth." The right side of his face seems frozen while the left is normal.

"Sir, I suspect you might be having a stroke. We're going to assist you out the vehicle." Fabio grabs the man's legs and I get underneath his upper body, and we carry him out to our stretcher and lay him down. We load him up quickly and I get his vitals as my partner secures his vehicle. He is slightly bradycardic, but his twelve lead and CBG are normal. We rush him to the hospital. Dr Mick does an assessment and sends the man to CT immediately.

The staff are a little shorthanded, so I go upstairs with the nurse, a lively lesbian whom I've become chatty with. As they are cranking through the CT, she notices my new haircut.

"Does your girlfriend dig you hair?" She asks.

"Nah. We broke up ages ago, El."

"...So you're not seeing anybody?"

Uh-oh, I think, I dont want to be some 35 year-old lesbian's one last reassurance she hates dicks.

"Nope."

She has a gleam in her eye. "Seriously, no one? No girlfriend-"

"Nope."

"-or Boyfr-"

"NO. GODDAMMIT. IS IT THE HAIRCUT?"

"No! No,' she says. She turns a deep shade of red.

"What?" I say.

"...are you interested in being a sperm donor?"



to be continued.

-MM

Friday, January 28, 2011

- Damn

(This whiny, selfserving post deleted by the author. You guys don't need this bullshit)
-MM

Thursday, December 30, 2010

- For those of you under a rock...

....Confessions of an EMS Newbie, featuring my bloggy daddy Ambulance Driver, is a GREAT podcast that covers a rookie's journey through Basic and Paramedic Class. Check it out!

-MM

Tuesday, December 14, 2010

-Self Defense

We have been called out to a domestic dispute between a father and his 16 year old daughter, where the daughter apparently made some sort of threatening gesture after an argument with her dad. The deputy meets us outside.

"He took away her cellphone after an argument. She got pissed and went home, and when he walked by in the hallway she shook a bottle of Aleve at him, and he freaked out and thought she had taken them. The bottle is still full."

"What an idiot. Jesus."

We go inside and get the story, the daughter still simmering with anger and crying. She raises her voice at the dad and yells at him a couple of times. The dad refuses to send her to the hospital, saying he would take care of the matter himself. The daughter's vitals check out and Dad signs the refusal, even after I explain that it may be in her best interests to get checked out at the ER. He still says no, and I get my supervisor involved, but the supe tell me to let it slide.

Everyone is out of the house now except for me, the daughter, and the dad. Apparently their screen door sticks if it closes wrong and is now locked in to place. The dad gives it a solid kick, but it stays stuck in its frame.

The daughter steps out of the hallway at this point, looking at her father. Her frustration is evident on her face, and tears are still drying on her cheeks. She walks into the kitchen, opens a drawer, and pulls out a large steak knife.

Then she starts walking towards me and her father with a determined look on her face.

Her father is still facing the door, preoccupied with getting it unstuck. A quick look around shows no other exits. The girl is still walking towards us. I think I could break through the frame of the screen door but I have to get through the father, who is maddeningly still hemming and hawing at the stuck door. The daughter still advances, feet whisper soft on the carpet, knife in hand, staring at her father's back.

7 feet. Definitely no way out now. My butt sucks up about half my underwear. She's big for 16, rivaling Serena Williams in musculature. She can probably get some serious torque on that stabbing arm.

4 feet. She's almost in range. I plant my feet shoulder with apart.

3 feet. Go.

I grab her knife-wielding arm as she walks by me, twisting at the wrist and squeezing, stepping into her with my hip and pinning her upper arm between my arm and chest. The knife pops out and, still holding the girl's arm, I trip her down onto the carpet, where she lands on her back with a confused look on her face. I kick away the knife behind me, towards the wall and near the dad

'WHAT ARE YOU DOING?" I yell directly into her face. A sheriff's deputy had been on the other side of the door and saw the whole thing, his pistol out and pointing over the dad's hunched form, trained on the daughter.

"It's for the door!" She yells.

The dad, incredibly, finally notices all the commotion, and turns around and stares at me and the daughter, who is sitting up and rubbing her wrist.

"Oh," he says. "Thanks, babydoll." He then picks up the steak knife and uses it as a wedge along the interior side of the screen door, which pops open deftly after he slides the blade down the length.

"That thing always sticks. Sorry, sir, thanks for the help this evening."

The deputy on the other side of the door is bent over laughing.

"No problem at all, sir," I say to him. "Have a good night."

-MM

Wednesday, December 1, 2010

- Numb

The carnage is amazing for only having one vehicle involved. The car has flipped multiple times - that much is obvious, from the impact marks in the grass trail of car parts from the roadway. To top it off, the car, which was now skidding on it's driver's side, slid roof-first into a large, sturdy oak. The passenger compartment is like the inside rim of half a donut, with the trunk of the tree filling the donut hole.

The driver is sitting on the ground next to a cop car. He has a lac on his head but is awake and talking, so I downgrade him to "Can Wait a second" as I walk over the car. It's pretty rough.

"One inside," says the fire captain who is prepping his extrication gear. "He's hurt pretty bad."

"Breathing?" I ask.

"Yep. Twisted around in there pretty good though. We're going to take out the back window to see if we can slide him out."

"Sounds good."

I crouch down to the back window where a firefighter is reaching inside maintaining immobilization. This patient isn't going anywhere for the time being. A quick look in the back shows most of his body lying along the interior driver's side of the vehicle, along the roof. His right leg looks wrong, but I'm not sure why yet.

"Can you hear me, sir?" I ask the the young man. "Are you hurting anywhere?"

"No, not really. My nose kind of itches."

"Ok. Do you remember what happened?"

"Uh.....no?"

"OK man."

I walk back over to the driver and do a quick assessment. He has a small lac on his head. My partner, who has been prepping immobilization equipment, takes over. I walk back over to the smashed car as the extra unit pulls up.

The car is actually leaning against the tree it hit, allowing me access in through the rear driver side window. When I wedge my hefty frame inside, I am a mere foot away from the entrapped patient. There is plenty of blood on the roof from what looks like a lip laceration, but nothing else seems to be actively bleeding. I ask the patient his name. Now that I am inside, I can see that his right leg is covered by jacket, obscuring my view. I pull it aside and find out why it didn't look right.

The femur obviously has at least two fractures - it's bent in the shape of a "C". There is a large lac below that. And there is an ominous bulge in the front of the patient's loose gym shorts.

Fuck.

I grab the patient's hand.

"Hey, bud, can you squeeze my hand?"

There is no squeeze.

"Bud, squeeze my hand"

No squeeze.

"Tell me when you feel my pinch." I pinch his fingernail. Hard. Hard enough to make someone
pull away and yelp.

There is no reaction. He just stares up at ceiling. I take my pen from my hip pocket and drive it into his palm.

There is no reaction.

His eyes dart over to me. "When are you gonna pinch, man? Don't leave me in suspense."

Well, that's why his leg isn't hurting. He's paralyzed.

I do a couple of tests. He's numb from the navel down, and shoulders out.

It takes 35 minutes to extricate him. When we get him out he's starting to get shocky. The bulge I saw earlier is priaprism, an indicator of spinal injury in this case - I don't think the kid has had time to pop a Viagra with all the commotion. The chopper is fogged in, and our limpdick dispatcher is waffling about sending me some more back up. Our third and fourth trucks in the service area have both gotten emergencies on their way to the wreck scene, he says, and he can't spare anyone. It's going to be at least a 30 minute drive to a real hospital.

Tired of his jabber on the main radio, I pick up the 800, and lean forward into the cab, so the patient can't hear me. "Listen B, I don't care who you send me or where they come from. We can do an intercept. But I'm going to need someone soon, or I'm not going to need anyone at all."

I get my back up about 6 minutes later.

We manage to get some large IVs started, and hurry the kid to the hospital. He's starting to go in and out on me, and I have my intubation equipment set up, but a gentle verbal command perks him up and gets him breathing again.

We transfer care.

At home, in the shower, I wash broken glass out of my elbows, and try to wash the exhaustion off of everything else

-MM

Thursday, September 23, 2010

- Medals

I am not in the line of fire, although most shifts I encounter life-ending contagious diseases. I am not a hero, but most shifts I help save a life. I'm not a rich man, but I help enrich lives. I'm not a counselor, but I've comforted more grieving family members then some psychiatrists.

I'm not much. I'm two years of crunch medical training inside a delicate fleshbag that's as susceptible to the trauma of everyday life as anyone else.

I don't have a gun or handcuffs.

I don't have flame retardant clothing or a breathing apparatus.

All I have is a stethoscope, a bag of salt water enhanced with chemistry, and my own assessment skills to keep me ahead of the game and to help save your ass.

I don't wear my medals. I don't take them. I'm doing my job.

I am a medic.

And I am proud.

-MM

Friday, August 6, 2010

- Ventilated

I step under the yellow police tape. The young man is lying there, bleeding, on a pile of towels the people who's threshold he had fallen across had grabbed from under a sink. The towel givers are all in the same room as him, but pressed up against the walls, present for the action and at the same time wanting to be as far away as possible. He is lying on his left side looking face to face with Snoopy. Woodstock, farther down the towel, is turning an ugly orange as blood seeps from the gunshot wound to the young man's chest.

He had tried to break into a home several blocks over from where we are standing (or laying, in his case). The old man in the house had already been robbed twice this month. As our hoodlum slid open a window the old man, sleeping on the floor, silently rose up. He fired at the shape as soon as a clear silhouette presented itself.

The .38 hits about two inches of the midclavicular line at the 3rd intracostal space. The young man sprints across two yards, jumping fences, before I imagine the fact that he had been shot made itself present to him. He crossed over another a fence and limped, then crawled to a door - I can see the drag marks and impressions in soft earth where he went to his knees. The residents opened the door, fetched their old and ragged washcloths.

He looks up at me feebly as I step over him, assessing the damage. The slug went all the way through, a slightly larger exit wound out of his scapula. His hands are cuffed behind his back. I give him the once over as I place a collar. He has no other injuries. As we load him up in the back, a large, bloody bubble pops from hole in his chest. In the good light I can now see the bullet has almost perfectly bulls eyed a large cross tattoo the young man has on his chest.

His pressure is 100/60, but his heart rate is relatively steady at 100 and he is breathing with only a slight extra amount of effort.. As my partner affixes an oxygen mask and opens the tank, I slap dressings on. We are only 6 minutes away from the hospital. His left lung sounds about a third full. This kid needs a chest tube. I quickly call the state response network and the hospital and sink a large bore IV. It's all I have time to do - we are only 16 minutes from going on scene to transfer to a trauma bed. The doctors remove my dressing, now soaked, and another large ruby bubble pops out of the hole on the chest.

They stick in the chest tube with barely any warning. A torrent of blood splaches onto the floor and the doctor steps away, cursing. In his haste to insert the tube he neglected to wear shoe covers. The young man yelps. Eventually they sedate him and in short order intubate and ship him up to surgery.

I walk out of the room and throw my bloody gloves in biohazard on my way out.

In the unit the young man, a boy really, weakly asked me:

"Am I gonna be OK?"

"Yes," I tell him. "Don't worry. You're going to be fine."

I read his obituary three days later.

-MM

Friday, April 16, 2010

- State Job

Well, I've been a paramedic with Louisiana DOC for about 2 months now, and I am not impressed. Although I find the expanded medical practice extremely satisfying and rewarding. Jumping through all the bureaucratic hoops is starting to drive me nuts. Add in the 1.5 hour commute? Eccchhh....

Pros:
Extended practice
POST certification
free certs/recerts
I can tell someone "NO"

Cons:
Shitty pay
micromanagement
Spend a lot of time cooped up in the ER



New Hotness:

www.emssaudiarabia.com


I put in my application. Let's see what happens.

PS - everyone still alive? Drop me a comment, folks.

-MM

Saturday, March 13, 2010

- Horizon

I'm having a conversation with the Office Czar.

"No, I didn't check."

"No. I just said I didn't check."

"Because I was off duty."

"Well, I work 60 miles away from where I live."

"No."

"No."

"Seriously?"

"Fine."

I hang up. Ink raises his eyebrows. As I finish my run report the pagers go off again.

"Another fucking BLS transfer. You've got to be KIDDING me. I swear to God, Ink, I'm going to kill someone."

My unit, a 24 hour truck, is running BLS transfers while one unit sits in our base town. Now, from our base town, we cover a large rural area. One ambulance is not enough to cover it - if they get a call, the next closest unit is at the least 15 minutes away, and more likely 20-25 minutes away. And if they're responding to the eastern part of our area, which is bordered by the America's largest swamp, it's a 45 minute response time. That's a long time to wait when you're seriously sick.

To add to this, XXXX EMS has also been becoming more corpratized. When I started 5 years ago, the company was very employee oriented, really taking care of us. Since then the benefits have started to fade, and the company has in my opinion put profits ahead of patient care. Moral has dipped severely and not a lot of the EMTs and paramedics are very motivated. The call load has increased because they've cut units to save money. It's not unusual to run 10 or 12 calls in a 12 hour shift. The pay for a paramedic in my area is laughable - one parish over, they pay 7 dollars more an hour for the same job.

My personal job satisfaction has plummeted.

So when a friend mentioned that a state prison was hiring paramedics for its fledgling EMS program, I took them up on their offer.

Stay tuned...