Monday, September 24, 2007

- Old Hands

Lifeless eyes stare through the ceiling as my partner does compressions. The bicarb we pushed in a little while might be helping out because even though we don't have pulses yet, our patient has reached an organized rhythm. My partner, the new one, is getting tired quickly. This is the first time she's ever performed CPR on a real person.

"Get your shoulders over the chest a little more. You want to be at a 90 degree angle" I coach her.

The other paramedic squeezes air into the man's lungs.

The patient in question is a 51 year old former employee of the company I currently work for. He had moved into our service area recently after starting his own safety business. We've called in the chopper and are on our way to the LZ across the bayou.

My partner is starting to tire out, so I tell her to take over bagging and I take compressions. The other medic, who I went to paramedic school with, pushes in another epi. I feel the burn start in my shoulders as we pull up to the LZ. The Flight Medic opens the back doors, looks inside. The man on the stretcher was his partner for 2 years, back when he was still on the truck.

"Fuck. What we got?"

I give a rundown of the patient - 51 year old male, told his wife he was having trouble breathing, dropped. CPR almost from the moment he hit the ground. All we've had on the monitor is PEA.
IO drilled, number 7.0 tube, almost done with his first bag of fluid, 6 epis in, maxed out on atropine, bicarb in, d50 in, narcan in. Hypertension, didn't take his meds, no allergies.

The Flight Medic loads up the patient. The other paramedic flies in with him.

The man doesn't make it. They lose the rhythm shortly after takeoff and don't ever get anything back. They later say it was due to a massive infarct.

I wipe the sweat from my forehead, walk back to the cab of my unit, pick up the phone. Could I've done anything different? I run through my algorithm in my head. I treated the hell out of him.

The funeral service is well attended.

I walk out of the funeral home, run into the Flight Medic. He and I aren't on the best of terms - I don't think he's a very nice person, and he has a lot of disdain for the paramedic factory that I was churned out of, which I don't blame him for. Some of my class mates were less then stellar, and some of those were less than competent.

He takes a drag from his smoke.

"I was really mad at you, MedicMarch. When they called him, all I could think of was that you did something wrong, or fucked up somewhere, and it was your fault he wasn't coming back. I was looking for someone to blame."

I stand there silently, wondering if I'm about to get hit.

"Then I thought about it a little more. Thought about the report you gave me." He points inside. "Thought a lot about him. He never listened to his doctors."

He takes another drag. "I just wanted to say I'm sorry about that. You did what you could for him, and I'm embarrassed for having been mad at you. It was very unprofessional of me. I'm sorry." He sticks his hand out and shakes mine.

I walk to my jeep and get in, rest my head on the steering wheel for a moment. At home that evening, I am sitting on my porch, and I pour a little of my beer into the garden. One for me, one for my homie.

-MM

Sunday, September 16, 2007

- Switchblade McGrew

So my buddy Chad is currently in Iraq.

I'm not going to go into the politics involved. I've already said this.

Well, Chad is sending me a present. I had mentioned to him how upset I was that my old SpyderCo G-10 was stolen - it fell out of my pocket one night while laying on a couch, and when I went back the next day it was no where to be found. It was a great knife that I really enjoyed and I got a lot of use out of - it worked fantastic and handled whatever I tossed at it.

So I was chatting with him about it and he told me that in 4-6 weeks I shall be receiving this :


Pretty, No? A real nice knife, expensive, but it's gotten good reviews.

I'm excited! Are you excited?

-MM

Wednesday, September 12, 2007

- Requiem

I was a junior in high school. I was sitting in Ms Gauthier's Gifted American History class and the period had just started when the teacher next door came in. "A plane hit the World Trade Center!" she said. We turned on the television to see. One of the towers was burning - it looked like it was wearing a belt of fire. The test we were taking that day lay forgotten.

Then, as we watched the television, the second plane hit.

I know we all have our particular memories of that day, but sitting in the back of the classroom, next to my friend Matt, the silence among us is what I remember most. It was a dead silence, that lasted about 15 seconds, but watching the debris fall from the other side of the building, it was in slow motion.

Our teacher turned off the TV, and faced us, pale. "We....We have a test today. Time starts now."

We took our test and turned the television back on, and watched the fire trucks, the police cars, the ambulances, responding to the scene.

We watched the towers fall.

It's been said that 9/11 was my generation's Pearl Harbor or Kennedy Assassination, and I'm inclined to agree.

* * *

When I stopped in at my mother's this morning to play with the dog and get some free breakfest, I remarked to her that this was the first year that's gone by that the wounds 9/11 left on me haven't felt like they've been rubbed with salt. I don't say this to suggest that the passage of time has eliminated the pain and rage I felt that day, sitting in my orange chair at my black desk, useless, hopeless. Time has merely dulled my choler and hurt, made it almost bearable.

Almost.

I've seen some horrible things at work, been a part of some hopeless situations. I manage through these because I can. However, I still have trouble watching the attacks played again and again on television. Something twisted in me that day the hasn't been set right, that has healed broken. However, the memory of those killed in the attacks will live on through all of us. We are all survivors of those attacks, and we are all tributes to the dead. I would challenge myself to remember that. I live on in the place of those victims, and I'm going to live life to its fullest.

I'm not going to go political on this, but I think this country has a lot of problems that we aren't addressing. But I also think that we are the greatest county in the world, bar none. And I'm proud to be an American.

-MM

Friday, September 7, 2007

- From now on, you're my cleaning lady.

How do you motivate someone to do the worst, shitty, bitch jobs that EMS has to offer? All the stuff that to the casual observer would not be what they think is involved - all the boring stuff.

-Washing the unit
-Cleaning the unit after calls and at the end of shifts
-Cleaning the station

I've tried to show leadership by taking the helm and showing my rookie the ropes of doing all the nonglamorous-but-necessary shit we need to do so that we can concentrate the rest of our time on "actual" work.

Personally, I don't know if I'm weird, but I've rarely had to have been asked to wash and clean the unit or station. I'm not obsessive compulsive but when you think about all the shit that happens in the back of your unit...

Plus, I like being in a clean unit. I take pride in it. I Pledge my tires. I disinfect the keyboards of out MDTs. I take the mattress off our cot and spray it with a hose. I go the extra mile, and I like to inspire my new Basic to do the same. Not only does it look good, it's healthier for you.

Case in point: 3 medics at one of our stations were diagnosed with Staph infections. Nothing but guys worked at the station and it was notorious for being a sty. I hate to think what might've been crawling around the back of their unit. I had worked over time out at the station, and when I woke up before shift change and started to mop, and asked the paramedic to give me a hand, he looked at me like I was retarded. "I'm the paramedic," he said. "You're the Basic. You do the Bitch work. That's what the B is for!" I thought he was joking, but when he refused to pitch in, I got pissed off.

I don't want to be that paramedic. I do realize, though, that the Basic gets the short end of the stick when it comes to stuff like this. For me it was part of the territory. So to instruct my new Basic partner I've been trying to lead by example. I try to make her do her job duties by explaining why they're important - like doing your inventory at the beginning of the shift. I rely on the oxygen and boards and other equipment. Until she can look at the cabinets in the unit and instinctively know what's missing, I want her in the back, with the sheet, going over each item. She just plain hasn't had enough experience to pencil whip though the inventory. I'm not blaming her yet - her preceptors, I think, might've showed her the easy way instead of the right way, and now it's biting her in the ass. A lot of times, she doesn't even know she's screwing up, and then when I point it out, she gets slightly frustrated. But what bothers me is that she seems to be lacking Basic skills. I ask her to do things like hook up the 4-lead or spike a bag, then I have to drop what I'm doing because she doesn't know how. At least she learns quickly. I just don't want her to get upset and too frustrated and sometimes I think I'm throwing a lot at her.

I've told her that if I take something from her on scene and do it myself, I'm not mad at her, I just can do it quicker because I've been doing it for longer. I always make a point after to show her the way I need and like it do be done, and that seems to be working pretty well.

This hasn't been the case with her station duties. I had to prompt her to wake up and sweep the station several times yesterday before I went outside to restock my bag and begin washing the unit.

She ended up falling back asleep. By the time I walked back inside to mop out the station it was near crew change and the station wasn't swept. I had to hop on another unit across the parish so I didn't have time to do it myself. When I woke her up and told her that she needed to get up, she gave me a real hostile look and it pissed me off, so I turned around and walked back out and finished the unit. Whenever we did changeout with the oncoming crew I told her she needed to sweep and mop the station now because I couldn't stick around to do it.

Well, apparently a few minutes after I left so did she. Our supervisor came by to give us some Narcs and saw the station hadn't been mopped. I got a pissed off voice mail from him asking me to come back to the station to do my station duties. I was already on the other unit by this point, but the oncoming crew mentioned that'd I singlehandedly washed out the unit and cleaned it up while she was supposed to be sweeping and that I was on my way to work. He called me back to apologize. Later I found out he gave her a light ass chewing over the phone

All of this could've been avoided if she'd done what I asked her. I think the problem heremight be that that I'm two years younger then her and she might precieve that I'm ordering her around....I don't know. I just wish she'd get with the program. I do my best to help her out but I'm too busy as a new medic trying to keep my own shit together to do much for others right now.

Thoughts?

-MM

Wednesday, September 5, 2007

- Voices

The man in black laughs at me as I compress the baby's chest. His mother found him face down in his crib, unresponsive. I try to ignore the small cold body that I hold in my arms as we get back in the unit.

The man in black laughs at me as I play my flashlight around the body lying in the field. He has been thrown out of the back window of a car, and lies, motionless and broken, in tall grass near the interstate. A beetle crawls across his nose, which I brush off.

The man in black laughs at me as I watch a nursing home CNA do lazy, ineffective compressions on the chest of a resident, her hands splayed across the middle of his chest. She does not lean over the body or press down much. The man's eyes stare vacantly at the ceiling.

The man in black sits in an easy chair across from the patient I am now assessing. His heart is beating 30 times a minute and he is so pale that he looks like a black and white photo of himself.

"You're too late. He's going to die." The man in black is leaning over my shoulder as I fasten the velcro of the cuff around the man's arm.

I can't obtain a blood pressure.

"He's going to die," he says. Smiles. "He's going to die. You can't save him."

I quickly run a twelve lead. No STEMI. We load into the unit. Oxygen is applied. We get enroute to the hospital.

"You're going to miss the IV. He's gonna die. You can't save him."

I stick the IV in his arm. Pace or Drugs? Pace or Drugs?

The man in black sniffs at me with a grin on his face. "You're killing him. Every second you wait you're killing him. He's going to die."

I compromise by slapping the pads on the man and pulling up my atropine.

"A little medicine to help you, sir!" I cinch the line and push in the medicine. The man's heart rate rises to 35, 40,37...stays in between 35-40.

The man in black looks at me sourly. "It doesn't matter. He could be having the big one. He's going to die."

I try again for another pressure and get a systolic of 70. No bottom number.

"You should've gone with pacing!" The man in black is gleeful again. "You've killed him."

Shut up, I think to myself.

I push in another half milligram of atropine.

Slowly, the man's rate picks up. I look at him and see he's gotten some color back in his cheeks. Not today, buddy, I think to myself.

I leave the line wide open and patch the hospital. His rate is now in the 60's and I have a pressure of 100/50. We bring him into the cardiac room, and I walk out, sweaty, tired. But I won. I won it this time.


* * *

I slide the atropine boxes into the trash can and look at the man in black triumphantly.

He stares at me petulantly. "I win in the end!" He says. "I win! I always win in the end."

I give him the finger.

"Maybe so," I say, my voice strong and loud. "Maybe so, dipshit. But not today."


-MM