Thursday, June 18, 2009

- Not Good Enough

A few months back the hospital here in Backwater Parish closed down. It wasn't much of a hospital...a few levels above above a band-aid station. About a year ago a new company bought it out, and basically ran it into the ground - trimming the daytime surgery and closing down the L/D section that was operating. They declared bankruptcy before, I shit you not, jetting off to Aruba, leaving the residents of Backwater Parish to the mercy of the gods.

The ER was small but it in a true emergency was great for quick stabilization before we choppered out the patient to Major Metropolitan Area. And for minor emergencies it saved everyone time, money, and effort.

Since the nearest hospital in my service area (around 400 square miles, give or take - largely rural bayou area) is now at least 18 miles away, we've been doing a lot of driving. My region is a busy one and though two units work my service area, we've been caught with our pants down on coverage several times.

My supervisor and coworkers all shared the same thing with our corporate management. "We're spread too thin, out here." "We need to rework our coverage policy."

We're too wide open, and this isn't good enough, I said. It's only a matter of time before someone dies.

Our complaints, advice and suggestions all fall on deaf ears. The policy remains unchanged.

* * *

Derry is a young, severely mentally disabled patient of ours. I've picked him up several times since I came to Backwater, mostly for minor, chronic care issues - fevers, peg tubes issues, etc. He house is a mere 5 minutes from our station, and the trips are usually to the hospital in Backwater. Easy trips, back and forth. His grandmother doesn't always remember my name right away, but she knows my face. She always makes a big show of reading my name tag, and we cut up on the way to the hospital.

We had picked Derry and his Grandma up earlier in then day for a doctor's office visit. He had a slightly junky breath sounds and pretty good fever going, and was tachy at around 130. I teched the call and kept him on my monitor there and back to his home. His other vitals were OK though, and I let his doctor know about the tachycardia. We both agreed that it was probably from the fever.

The doc gave him a pretty good checking out, was a little worried about a possible respiratory infection. She wrote a handful of scripts and advised Grandma to keep giving him meds to keep the fever at bay.

We tucked Derry back into his bed.

"Alright, buddy, behave," I say to him. I tip my hat at Grandma on the way out.

13 hours later we are down in deep Backwater, at someone's duck camp for an accidental fall. As we get a refusal we get paged for a code back in The Locks, the biggest city in Backwater Parish, where our station is and hospital was. The address looks familiar on the pager, but it's not until I get the call notes that I know who's house it is. No unit is around or even close to The Locks. As a matter of fact, no other unit is anywhere close to Backwater Parish. We are it.

I won't say what happened on the way over, only tell you that it was a good thing that it was late at night and the roads were empty.

It takes 18 minutes to get there. As we pull up the chopper is landing in the parking lot across from Derry's House. The chopper was the next closest unit, with a flight time of 10 minutes from Major Metro Area.

The fire department isn't angry when we get there, just confused, maybe even hurt. "Where were you guys? We've been doing CPR, but the AED advised no shock."

The chopper medic and I code Derry for another fifteen minutes. We finally get a PEA, that goes into fib, we shock it, epi it, get an ugly, bradycardic pulse that we pace and medicate, to no avail. We get on the road but Derry slips back into asystole 5 minutes away from the hospital. They call him moments after we slide him over.

I am sweaty and spent, angry at myself, the hospital, the system. A loud BANG as I slam down my clipboard with a curse and leave the ER room to get some fresh air.

I see Grandma on the way out to my ambulance. I guess the look on my face says it all, and her expression collapses. I wrap her in a hug. She doesn't have to read my nametag this time. "Oh, March, why? Why?" she questions me.

I have no answers.

After a while, I walk her inside to the consult room and sit her down.I walk back into Derry's room and apologize to everyone. They are understanding and don't hassle me any.

Although this happened awhile back I still think about it a lot. I am at war in my own head.

My head tells me that this is a blessing for Derry, that he is now happy and whole, living the life in Wherever It Is That You Go When You Die. It tells me that I did everything I could for him and that you can't save everyone. It tells me that even with the perfect setup you're not going to get every patient back, and that I'm being too hard on myself.

My heart seethes with rage at our response time, and the coverage situation. It is furious with the Buy n' Fly health care company that raped the hospital and the residents. Over and over in my head I see Grandma's face crumple, feel her tears on my neck. The look of the firefighters, hurt. Where were you guys? they asked me. What took so long?

Derry lived in the middle of the biggest city in Backwater Parish. It took only 3 minutes for fire and police to arrive but 20 minutes for EMS personnel.

Later, I talk to one of the firefighters I am friends with. He's kind of a big deal in backwater Parish. "I know it wasn't yall's fault," he tells me. "I know it's dispatch. But they've got to do something."

Yesterday, we are twenty five miles away for what began as an asthma attack and ended up as a repository arrest.I don't know how the long the patient has been down. I medicate, intubate, and pass an electric current through her to bring her back to life. She gets choppered over to Major Metro Hospital. Last I heard she was still alive although not doing to hot.

I stock my bag and and replace the items I used, and only one thought burns in my head.

Corporate policy and Politics are all being placed ahead of the patients in Backwater Parish, and I'm mad as hell.

Because whatever the fuck the higher ups are doing, people are dying, and It's Just Not Good Enough.



nickopotamus said...

I'm appauled. I appreciate just how hard it is to cover rural areas - I'm always shocked when we run vehicles from thirty minutes away to arrests because they're nearest - but luckily this only happens when the shit really hits the fan, and everything possible is done to avoid this. Sounds like there's been no effort to sort out the situation with dispatch though, and that upsets me :(

Mrs. "Smith" said...

(((hugs))) This just plain sucks. People's lives are being played with, and for what? A few extra dollars added to the profit line? This story makes me ill and sad, I can only hope you stick it out and continue to try to help people.

directpressure said...

great post. thanks for framing a difficult story in the context of how it relates to everyday EMS and also for leaving the obvious questions unanswered for us to consider.

Medix311 said...

Thanks for sharing the story. My system works in a similar fashion and its frustrating and heart braking.

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