Saturday, December 13, 2008
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
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
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
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
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
I was filling my waterpack at the truck when Dave’s voice came over the radio, “I’ve got a jumper on the north line. I need help quick!” Quickly shrugging on the pack, I started moving in his direction, listening to Matt and Lee on the radio, asking for instructions of where to go and what to do.
As I came up to Jen, the fifth on the crew, in the middle of the wooded, hilly unit, she said, “What should I do?” Jen is the newest on the crew and has not had much experience with things getting out of control. “Just a minute - let me ask Dave what he wants,” I replied. Pushing the transmit button on the radio in my chest harness, I said, “Dave, I’m in the middle of the unit with Jen. Where do you want us?”
“Rich, I think we can handle this with just the three of us. Why don’t you two hold the line down there ‘till we get this under control,” Dave answered back. “Copy that,” I replied. I told Jen to keep back burning, keeping the downed trees from catching fire and that I was going to drift back down to the southwest corner and make sure the fire didn’t cross any lines.
I got about ten steps away when Dave came back on the radio again, “Rich! It’s getting away from us. Get up here now!” I turned around and started hustling up through the middle, four gallons of water sloshing on my back. “Jen! Drop back down to the south, and hold the line there. If you aren’t comfortable with what it’s doing there, don’t mess around. Put it out,” I shouted as I went by her.
Coming over a low ridge that had blocked my view to the north, I saw the fire front racing up the steep slope from the pond to the ridge top. I couldn’t see Dave, Matt or Lee. “Dave, I’m at the pond, coming from the south. Which way do you want me to go?” I radioed. “Rich, take the west side, and try to stop the front there,” he answered.
I pulled my Nomex neck protector into place and ran down to where the fire tied in to the pond. The wind was pushing the flames above and to my left, running up the hill. I had to start at the bottom, or it would just run away below and past me. You can’t find a head fire from the front. You have to fight it from the flank and try to catch the head.
I slapped down the Plexiglas shield on my helmet and started pumping the brass wand, spraying water on the flames as I climbed the hill. I had to hope that fire would not re-ignite behind me; I needed to get to the top of the hill and the head of the fire. There was nothing over the hill that was going to stop it. The smoke and heat were pretty intense, and the sound of my panting breaths was amplified by my helmet as I reached the ridge.
The fire had gone beneath and past two logs that had formed a kind of wind break, slowing it down. However, the logs and an inconveniently place pile of firewood had caught fire, pouring heat and smoke into the area I needed to be to put out the head of the fire. I took a deep breath and jumped into the smoke, frantically spraying water at the flames, before I had to scramble back to fresh air. My lungs were burning, and I was not making any headway.
Matt appeared out of the smoke from the other side of the logs. “Matt, help me put this out. The smoke’s too thick. I can’t stay in there long enough to put it out,” I called out to him. We fought it together for awhile until I looked over my shoulder and glanced down the hill I had come up. Oh shit!
I started running back down the hill, gasping into my radio, “My line’s re-ignited! I’ve got to get to the bottom of the hill. Matt, try to hold it there, but watch your back!” The flames were racing up the hill again, building momentum. I reached the pond and started spraying my way back up the hill, still panting in my helmet. At the top, Matt and I finally managed to stop new flames springing away down the hill, but the logs and firewood still merrily burned away, threatening to throw sparks and embers downwind.
I finally ran out of water and had to trot back down the hill and past the pond to the hose spigot on a building on the property. A thoughtful civilian had brought out a large pitcher of water and a plastic cup. As my pack filled from the spigot, I gulped down two cups of water before heading back to the ridge top.
Finally, with a couple hundred feet of flat hose connected to that spigot, we got enough water on the logs and firewood to calm things down. As Dave poured water on to the logs and woodpile, I ranged around downwind, looking for spot fires and smoldering areas. Turning around to look at Dave… Oh shit, not again!
“Dave, Turn around!” I shouted into the radio. The line had flared up again, and the wind was pushing the flames into fresh leaf litter. Dave turned and started spraying from his side. I quickly ran through the fire to the other side and started spraying away. We knocked it down and stood there breathing heavily. Dave grabbed his radio and said, “OK, people. Let’s shut this puppy down. I don’t like the conditions. I want to put it completely out.” So after a couple hours of mop up, we finally put it all out. Needless to say, we were a little tired. Then it was on to the second burn of the day…
The post-game analysis revealed what caused the three-quarter acres of “bonus acreage,” as we call it. Just before we arrived, a landscaping crew had come through with at least eight guys wearing gas-powered backpack leaf blowers, like a swarm of angry killer bees. They had been clearing out flowerbeds and trail edges and in the process, had fluffed up all the leaves along the west edge of the burn unit. The jump occurred in the northeast corner, where our firebreak had big fluffy leaf piles on either side. Dave reported that he had driven the ATV (our new toy outfitted with tank and pump sprayer) right into the fire, driving along the fire front, trying to spray it out. When the smoke and heat became too much, he jumped off to fight it on foot, abandoning the ATV. Lee came up at about this point and apparently shouted, “The tires are on fire! The tires are on fire,” and promptly put them out…
Thursday, March 13, 2008
We had been having dinner with a friend when my pager started vibrating loudly on the wooden table, startling us and sending the cats flying.
"Station 9-0. Report of a cardiac arrest at (address) between (crossroads)." Joan and I looked at each other. We have a lot of family and friends that live along that stretch of road.
"Do you recognize that address?" Joan asked me, "Could it be Grandma?" "I don't know," I replied as I ran out the door, "I'm gonna go. Start making phone calls..."
I flew down the dirt road, truck shuddering and snaking over the icy washboard, my stomach in my throat. Over the pager, I heard the rescue go in route from my fire department. Pulling into Grandma's driveway, I realized I wasn't going to make it up the hill. I jumped out of the truck, grabbed my medic bag and started running up the driveway.
Coming around the side of the house, I saw Grandma, sitting in the kitchen at the table, looking fine. With relief, I turned around and ran back down the drive. Just then, the LCA ambulance drove by, lights flashing. I quickly followed as they drove down the road, past houses of people I know and love.
It was horrible. It seemed to last forever.
Finally, with guilty relief, we passed the last house of someone I knew. It ended up being a man I had met the year before when he moved into the area. Unfortunately, he didn't make it.
I've had calls on people that I know before, but it's always been a surprise. This was the first time I thought it was going to be someone I knew - not a pleasant experience at all...
Wednesday, January 23, 2008
Joan and I had gone to a small, local mall in Madison, Wisconsin, to see a documentary movie about Ann Frank, an emotionally wrenching experience. Instead of driving home, we decided to take a walk through to mall to stretch our legs and talk about the movie.
As we strolled down the long hallway, we could see a food court ahead. And there on a bench, was a lady slumped over, her bowl of soup spilled on the floor. A manager from a food place ran out, saying, "Miss? Miss?" We started walking more quickly toward the scene. He turned toward his counter and yelled, "Call 9-1-1!"
I asked, "Can we help? Is she breathing? Does she have a pulse?" The manager reached down and checked, "I think so!" We gently lowered her to the floor, and Joan cradled her head, saying, "It's OK. They called 9-1-1 and help is coming."
I stood there, feeling like I should be able to do something. So I said to Joan, "I'm going to see if I can find some help. Are you going to be OK?" She replied, "Go. I'll be alright."
I took off running toward the information desk, where an elderly lady sat behind the desk. "There's a woman having a medical emergency," I said breathlessly, "Can you use the PA system to ask if there is a doctor in the mall?"
She used a microphone and her quavering voice echoed throughout the mall, "Is there a doctor in the mall?" I quickly reminded her, "Tell them to come to the information desk," and she did.
Almost immediately, a man with a young girl in one arm and towing a young boy by the hand came running around a corner. "I'm a paramedic. What's wrong?" I explained the situation, and we took off at a quick trot back to the food court.
As we approached, a crew of EMS people burst in the door and started working on the woman. It was a flurry of activity we did not understand with equipment we did not recognize. We stood back and watched for a few moments, then realized we were part of a crowd watching the scene. It felt awkward and morbid, so we faded away and silently went to the car. We climbed in, put on our seat belts, looked at each other, and burst into tears. It's hard even now to recall all this.
However, we were able to help someone in the end. I called the mall the next day to find out if they knew what happened. They told us that the lady had not survived. Joan and I talked about how the lady had died alone and that maybe her family wanted to know what had happened, that someone had been with her. Also, to be honest, we were emotionally all stirred up and wanted to do something about it.
So I called the coroner and explained the situation and our desire to contact the family. At first, he was reluctant to give me the information but then decided it would be OK. I wrote a long letter to the family about what we had seen and done, emphasizing that we had comforted her, that Joan had held her hand, that she had not been alone. I sent the letter off into the unknown.
A few day later, the phone rang. It was the woman's family on the phone, calling from Milwaukee, and we all started crying. They said that they had been unable to find out anything about what had happened at the mall, that only she had died. They said that it meant so much to them to know that someone had been with her, especially since another family member had been killed a few years ago, alone in a car crash with no details. They never knew what happened to him, how he died. It helped them with a sense of closure
It was a horrible feeling, standing and not knowing what to do, wanting to help. I never want to feel that way again. It is one of the major reasons I joined the fire department and pursued more medical training. It is so important to know what you can do and what you can't do.
Thursday, January 17, 2008
In the tangle of headlights and taillights, I see a set of red lights violently bounce up and down about two blocks up.
What the hell?
"Did you see that?" I ask Rock. "See what?" he responds. "I just saw some taillights jump up and down, like those pimped out cars with hydraulics," I tell him. He just shrugs as we start driving toward what I had seen.
As we get closer, we still can't figure out what's going on. Traffic is not moving; headlights are pointing the wrong way; and people are moving around in the road.
Suddenly it all comes into focus. There's a sedan sideways in the road, steaming and smoking, with a crumpled front end. There's a city pick-up truck with a crushed front corner and buckled back end. And there's another car with mild front damage, and woman looking dazed behind the wheel. Bits of vehicles are strewn all over the road.
"Oh, shit," Rock says, "That was an accident you just saw!" He grabs the radio and says, "504, we've got a MVA at Main and Butler. Please dispatch fire to our location."
We bail out and split up. Rock heads toward the pick-up driver who is standing in the road on his cell phone. I head toward the sideways car, where I can now see the driver, who is conscious. His window is broken, so I tell him to not move his head and to keep looking straight ahead. I open his door, but it won't open all the way. I put my back and legs into it and manage to bend the door past the warped fender panel. Airbag deployment, seat belt worn, no loss of consciousness, some neck pain - so far, so good.
I can hear the fire department's sirens now, so I yell over to Rock, "You OK over there?" He shouts, "Yeah, got things under control. You?" I shout back, "We're good."
I climb into the back seat and take C-spine (hold the patient's head in neutral alignment to minimize any chance of more spinal damage/injury). I start asking the patient all the standard questions about medical history, allergies, etc.
Fire arrives and shuts down the road. A swarm of firefighters appears and takes over patient extrication and packaging. I hand off C-spine to one of them and then head to the ambulance to get the cot and backboard. The young man is collared, backboarded, strapped down, bundled up, and loaded into the ambulance.
Luckily, everybody was fine, and later in the day, when we brought another patient into the ER, I ran into the guy as he was being discharged with a soft, neck collar in place. We shared details about the experience - apparently he turned left in front of the truck. He thanked us, we shook hands, and he walked out the door.