Saturday, December 13, 2008

It harder when it's someone you know...

I don't know why that is. I have seen quite a few deaths - some peaceful and calm, some brutal and violent, The family is often there, their grief and anger raw and exposed. Yet it hasn't seemed to bother me. I felt emotionally distant, a detached observer.

Just today, though, I had a reminder of how hard it is when it's someone you know. Our neighbor, Alberta, up the dirt road, the sweetest, little old lady in the world, just recently had congestive heart failure spring up out of nowhere due to some medication problems from another condition. I have been to their house three times with the fire department and once while working the ambulance. Whenever I've heard their address over the radio, my heart dropped.

The most recent time, she was feeling weak and faint but was coherent and talking, but still she went to the hospital to be sure. I hadn't heard anything in a week or two - Thanksgiving got in the way - so we stopped by yesterday check in on them. We met her son there who said, "She's in the nursing home now. I don't think she'll be coming home." He didn't sound as if this was too serious. This was not too surprising as she is in her 80's and quite frail.

We called later that night to speak to the husband, Phil, and offer him a ride to the nursing home, about 30 minutes away. I had not thought he would, but he accepted our offer, but also saying in the phone conversation, "I don't know, Rick. She's terminal..." What? She was fine just a little while ago.

So we didn't know what to expect when we got to the nursing home, one that I go to on a regular basis with the ambulance service. Phil had made some rather ominous comments about her going to be with God soon, so we were rather apprehensive.

Unfortunately, it was as bad as we feared. Other family gathered there took us aside, and as Phil sat down, held her hand, and stoked her hair in a private moment, they told us that there was nothing to be done. They were just waiting for the end. She was basically comatose and was not receiving food or water at this point.

As usual, the time was taken up with the telling of stories, recent and past, of Alberta. Everyone kept it lighthearted and positive as possible. Joan and I were doing fine, trying to ignore the horrible reality in the room, something that we all will face in different ways at different times.

However, when it was time to go, and we went over to the bedside to take Alberta's hand to say goodbye, we both kind of lost it. It felt strange and guilty to show such grief over someone we do not know well, in front of her family, but what can you do? They've had the time to come to terms with this, and we were still unsettled by the whole thing.

As an adult, I have not yet had to deal with the death of a close family member. I am not looking forward to, but I hope I only hope I can be a gracious and strong as Phil.

Post script: The next day, I received a phone call from Alberta's son that she had passed away in the early morning. We will be going to her funeral service on Thursday.

Friday, December 12, 2008

Going home to die

Most people think of ambulances in terms of emergencies: lights, sirens, broken glass, blood, and pain. However, most of our work is just helping people who need a hand. They are too sick to walk to the car and ride to the hospital. Or they fell in the bathroom and need help getting up and back to bed. It's just part of the job; it's not glamorous or exciting.

Yet, sometimes they are most rewarding because you actually get to deal with the patient as a person, not as a problem that needs to be fixed. In a real emergency, there is often no time to ask about a name, hometown, or shared interests. It's all asses and elbows, frantically trying to hold the line until the hand off at the ER. While exhilarating, it quite honestly sucks.

We had sad but rewarding one yesterday. We took a transfer from the local hospital to a residence in the county. It was an older man with cancer, and he was going home for hospice care. Everybody knew, even the patient, that this was it. There was no more negotiation, no hopeful miracle. There was nothing more to be done, and now it's just an awful waiting game.

He was quite cheerful, a long time farmer, and told us stories about the area and households as we bumped down dirt roads to his house. As always, the family was waiting for us with smiles and good spirits. Yet, when they turned away or the patient wasn't looking, their faces fell. There were lots of hugs, and people kept stepping out of room to get control of their emotions.

As always, the hospice bed was set up in the front room so that there would be space for visitors and for hospice nurses to work. As always, the bed was positioned so the patient could look out the window.

We carefully brought the patient up the steps on our stretcher and rolled him next to the bed. Taking extra care, we adjusted the sheet he was lying on so we can lift and slide him over. We really didn't need their help, but I usually ask if the family could give us a hand, especially if men or the younger generation are standing there. They almost always lunge at the chance. They feel so helpless and want to be able to do something - anything... The patient winced as we gently lifted him up and moved him to the bed.

We tucked the patient in and answered any questions we could. Hands were shook, and I used my favorite parting line, which always gets a laugh, "I hope I never see you again."

We said our goodbyes and loaded the stretcher in the ambulance. We climbed into the cab and sat there for a long moment. Then, as always, a version of an eternal conversation happened. "That sucks," one of us said. Long pause. "Yep. Makes you think...," replied the other. Long pause. "I think I'll call my wife..." And off we drove to the next one.

Monday, December 8, 2008

Busy night in the city

I usually work the ambulances in my county; they are close to home, and the call volume is low due to its rural nature. However, I needed some hours, and the schedule gets really tight before the holidays. So when one on the EMTs in Jackson sent out a message on the text pagers asking for for a sub on Friday night, I said what the heck... It was from noon to midnight, and I had not worked a weekend night shift in the city before. Time for the country mouse EMT to see the big city bright lights...

Bobby, a paramedic new to me, and I started the shift and drove out into the cold. When it was all said and done, we ended up with nine calls, a pretty busy shift - two of them refusals with no transport and three of them interfacility transports with no lights/sirens/drama.

We often go to the scene with lights and sirens but usually transport the patient without them. Having to go to the hospital with the lights and siren on is a BAD thing. I've had to do it a couple of times (cardiac arrest, difficultly breathing, pregnant lady), either driving or with a firefighter driving while I help my partner in the back. I tell people that when you see an ambulance flashing and wailing by with a driver and a passenger, think good thoughts because they are on the way to help. If you see an ambulance with lights and siren and only a driver, send your prayers because it means that someone in the back is in a serous way.

As for the other four calls, I can honestly only remember three as of right now. They often all blend into one generic call. Unless there is something of note, it will fade away, even during the same shift as we try to remember earlier calls.

The first one was a sick elderly lady with emphasyma and a two-pack a day smoking habit. She was uncharacteristically weak and lethargic and had been vomiting. We loaded her in the ambulance, took her vitals, set up an IV, and away we went to the hospital.

Later that evening, with an outside temperature of 14 degrees, we got a call for a man down in a parking lot of a commercial area town. The police had been driving by and had seen him lying in a decorative garden bed. When we got there, the officer and two fire men had assessed him and figured out he was drunk as a skunk. I've seen some drunk people (yeah, college!), but this guy was wasted. He was able to walk with assistance and sit on the cot but that was it. If I hadn't found his wallet in his coat pocket, we wouldn't have known a thing about him.

The most interesting call of the night was to an elderly gentleman's apartment for difficulty breathing. We took the elevator with our cot and gear up to the fourth floor and knocked loudly on the door. We heard him shuffling and saying, "Just a minute!"

Once inside, we tried to figure out what was going on, asking all the questions we normally do. No medical history, no medications, NOTHING. He was walking around with his cane, saying, "Whew! I'm so weak. I feel so strange. I don't know what's going on here." So he agreed to go to the hospital to get checked out.

We loaded him up on the cot and wheeled him out to the ambulance where we got him hooked up to the monitor. I placed the blood pressure cuff, the pulse oxymeter, and started putting the heart leads on his chest. As I pulled down the collar of his shirt to put a lead on his right collar bone area, I felt a distinctive lump under his skin. So I casually asked, "What's this thing on your chest, under your skin?"

He answered, "Oh, that? That's my pace maker!" My partner and I looked at each other - "No medical history, huh?" More questions revealed he had an extensive heart history.

So on the way to the hospital, I was filling in the data fields of the patient care report on the laptop, asking and answering the patient. He was a talker; we got along just fine. Then suddenly he started talking about booze. Wait a minute...

"Sir, have you been drinking?" I asked him in a sort of shocked tone. "Why yes, I have," he replied, "Whiskey!" That might explain why he was feeling so strange.

I enjoyed giving my report to the ER staff at the hospital. They all rolled their eyes and had a good laugh. You just never know...

Saturday, May 31, 2008

A Quiet Moment in the Cab of an Ambulance

It's a Saturday, and I'm working an ambulance shift in a local city. I needed to catch up on some hours for the quarter, and I saw this open shift on the schedule and said, "What the hell..." Joan is in Ann Arbor, running a volunteer project, so I don't feel guilty about not being home on the weekend.

We were dispatched this morning to a PI (personal injury = car crash) at an intersection in town, a pretty typical, medium-speed crash. A middle-aged lady with her 85 year-old mother riding shotgun turned in front of an SUV. Broken glass and bits of car all over the road. Green anti-freeze running into the gutter. Fire trucks and police cars blocking the road. Only the mother, with rib/chest pain, was transported. Everybody else was OK.

The daughter was still in the driver's seat, her door pinned shut by the SUV, her mother still in the passenger seat. We helped her stand from the car and pivot to the cot. After covering her with the white sheet, we clicked the seat belt straps across the shins, waist, and chest/shoulders. With a "Ready? 1-2-3," we lifted the cot, letting the undercarriage drop down.

Once in the ambulance, I began hooking her up to the monitor: blood pressure cuff, fingertip oxygen sensor, and heart monitor leads. My partner successfully set up an IV as a precaution. Any complaint of chest pain is treated seriously.

The lady was upset about the crash, but more so about her daughter. "She's never had a crash before. I feel so bad for her..." We made comforting sounds as we worked.

Once ready, a fire fighter escorted the daughter to the ambuance passenger seat, and I climbed in to the cab and pushed the 'TRANSPORT' button on the computer screen. Up till now, she had been putting on a brave face for both herself and her mother, but as we drove silently down the road, her composure broke. She put her face in her hands and started to cry, her shoulders heaving. I know from being in this situation many times that there is nothing I can or should say, so I reached down between seats to find the Kleenex box. After a few moments, I simply said, "Here," and a handed her some tissues. "Thank you," she replied, then wiped her eyes and blew her nose. With a deep breath, she visibly pulled herself together and sat up straight in the seat. We didn't say anything else on the way to the hospital.

Saturday, May 24, 2008

Close to the real thing

"9-0 Engine 13. Report of a structure fire at Wisner and Carson. Smoke showing," came the report over the radio.

A few moments later, Mike responded, "Dispatch from 9-0 Engine 13. We're enroute to Wisner and Carson for a structure fire." Rick put the truck in gear and hit the gas, while the rest of us shrugged into our self-contained breathing apparatus (SCBA), masked up, pulled Nomex hoods into place, and secured our helments.

The engine pulled up, and we bailed out, each to our tasks. Rick put the engine in pump mode and moved to the pump compartment to start throwing levers to bring water to the nozzle. Dave and I grabbed the loops of hose in the cross lay compartment and pulled hundreds of feet out on to the ground. Mike quickly walked to the left and the right, checking out the structure, then giving a radio 'sit rep' (situation report) to dispatch. Dave and I pulled the hose toward the front door, flaking out the loops of hose so water would flow easily. When we got to the closed door, we took a knee, nozzle in hand and waited for Mike. He came up behind us, thermal camera in hand and told us to get ready.

Over the radio, Mike told Rick to charge the line, and we waited a few long seconds. Suddenly the hose closest to the engine started jerking and shaking as water pushed through the kinks and turns. We watched it progress down the hose, like a cartoon fuse, until it reached us, rocking us with its force.

Mike opened the door, and smoke started pouring out. On our hands and knees, we entered the building, looking for the fire. I was in the lead with the nozzle, Dave at my back, and Mike was third, guiding us with the camera. I couldn't see a thing and had to work by feel, bumping into furniture and keeping in contact with the wall to keep my bearings. Coming to a doorway, I turned right into an open space. I could feel the heat but could not see the fire through the thick smoke.

"Rich, stop!" yelled Mike. He said something further, but my breathing, amplified by the microphone/speaker in my SCBA mask, drowned it out. I yelled, "What?" and held my breath.

"The fire's behind us and to the left. I can see it with the camera," Mike repeated. We shuffled backwards and turned. Suddenly, the smoke shifted, and I could see the flames, red and reaching for the ceiling. The heat was intense.

"Hit it!" Mike yelled. I braced myself and opened up the lever on the nozzle, spraying water in a tight, circular pattern for a few seconds. Smoke and steam billowed everywhere. I stopped and yelled to Mike, "What do we got?" He replied, "It's almost out. Hit it again and then the walls and ceiling." Still unable to see, I sprayed more water, wider and higher than before.

"Hold up," Mike said, "I think you got it." I shut down the water, and Mike pushed past me to a charred sofa. He flipped it over, got out of the way, and told me to hit it again. Then he found a window and opened it, letting light in and smoke out. Now that I could begin to see, I sprayed more water on the sofa, walls and ceiling for good measure.

Mike radioed to the incident commander and reported that the fire was out and we were coming out. Backing out, we dragged the hose with us and exited the door into the sunlight. A safe distance away, we removed our helmets and masks, gasping at the cool, fresh air, sweat running down our faces.

"How was that?" the training office asked. "That was f*cking cool!" Dave answered. "That was the best training I've had in five years!" I added.

We were at a local fire department's training facility, a three-story building built from steel shipping containers welded together. With doors and windows and donated furniture, it was the closest thing to real deal we had ever seen. We spent most of a day running through scenarios, practicing just like it was real. We made a lot of mistakes, but we learned a lot more and, hopefully, gained confidence for the next true structure fire.

Wednesday, May 21, 2008

Sunday, May 18, 2008

Family Meeting Bonfire

It's hard work looking this good!