Wednesday, January 22, 2014

 Friday, July 17, 1981, I was nearing the end of my Paramedic training at the University of Kansas, school of Allied health. It was a beautiful evening, and our field training consisted of riding with men and women who were there to hold our hands, dry our tears and teach us what advanced life support was really all about.
I was assigned to KARE 43which was stationed in NW Kansas and was home to pranksters, yet professionals. “Reilly. get the booster line for the BBQ in case we have to leave quickly”. I did as I was instructed, not wanting to disappoint, and was promptly knocked on my rear end by a blast of water. All in good fun.
It was dinner time on a hot Kansas summer evening and as is typical in any firehouse across America, hotdogs ,burgers and local culinary specialties were being cooked. I really loved this time in my life. I was soaking up every bit of medical knowledge that I could, yet at the same time developing a bond with folks who had forgotten more than I could ever hope to know.
It was hot, muggy and painfully slow. (these facts are borne from memories and may not be as accurate as one might hope). It seems that around 7:15pm, we got a call for a mutual aid response into Kans City MO. for a building collapse. As we (me being the 4th on the crew) responded, we got the news that it was the new Hyatt Regency Hotel.
It was chaos in the ambulance with speculation on what was going on. The dispatcher broadcasted that an aircraft hit the building. Other misinformation related that the revolving restaurant at the top of the hotel had failed. This to me seemed preposterous, but I kept my “student” mouth shut. We arrived to a scene of utter chaos. I once wrote of the particular smell of blood and it occurs to me now that this is when I first really, truly noticed it. The stank, smell of iron was everywhere.
Across town was my friend and American hero Jody Gragg. The evening remains fuzzy and confusing, but suffice it to say that my pulse slowed and my comfort level grew when I saw my fellow student and smartest man I know, Jody in and amongst the chaos.
When I entered the atrium at the heels of my preceptors, I almost threw up at horrific scene which lies ahead. Walking into the opening of the atrium, I saw a blond woman’s head. Just her head with blood soaked highlights in her hair. As the walkways failed, glass slid down the railings which held them in place. Her head, with a horrified look was all that remained as the glass, acting like a giant meat cleaver, removed her head from her shoulders. Even now, as my mind grows quiet, I see her head, her face, almost hearing her last screams.
While I was an unwilling and unwitting participant in the events of September 11, 2011 in NYC, I will NEVER write about them. Head first explosions into West Street cannot compare
This event was a failure of one or more architects to do their due diligence. It was a failure of the folks we trust to make our buildings safe.
Bodies without heads, dismembered torsos and architectural failures, are things we sometimes have to deal with. There is a great book “Why Buildings fall Down” that is a must read.

Here is the YouTube video.
https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=9&cad=rja&ved=0CFIQtwIwCA&url=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DczmQS81k9eM&ei=7SPgUt2VBPPJsQTRgYGIAw&usg=AFQjCNHnyK12py6fGA_qxqveR9s867ITQg&sig2=6bIxGL1CMnhuMnPRHoD6eQ&bvm=bv.59568121,d.cWc


As an aside, my son Timothy was days old when this happened. I would be a liar if I didn’t say I was distracted and preoccupied upon this dispatch. One cannot let that distraction happen, and for that I ask God’s forgiveness.  

Monday, January 20, 2014

Death of a beauty at the hands of a monster

Responding to a call for domestic violence is never an easy task. there is this autonomic function that occurs when one hears the words "Child injured by father". You move more swiftly, pulse races more quickly and you find yourself wringing your sweaty hands in what can only be described as a response to anticipated vengeance.

February 1983 was a particularly cold winter month in New Haven. I remember this vividly because my wife was pregnant with our youngest son, Christopher and she suffered terribly with the cold. We lived in a run-down neighborhood full of violence and chaos. Truthfully, we never felt safe there. Our eldest son Tim was almost 2 and a day did not pass that i didn't fear for his safety. It was not uncommon to hear screams, gunshots and the harried cries of neighborhood children. Why not move, you might ask. We couldn't afford anything better. Paramedic salaries at the time were abysmal and Kathleen worked as well, as an evening dispatcher in the 911 system. Even though we are not together any longer, I am still supremely proud of her for her calmness under fire and doing so while pregnant.

She wasn't working the night we got the call (around 2 am I think) for the injured child. As we got closer to the scene my mind raced, as did my partners, of what would await us. We thought of our own children and the children we had come to love. 

New Haven, while home to Yale University, was a poor city. The impoverished were well hidden away from trustees who had deep pockets and sang the Yale fight song at the Yale Bowl, Saturday afternoons during football season. The dichotomy struck me cold. 20 year old players wearing helmets, pads and the like were well protected from the violence they hope to make an NFL living at some day. Children, with underdeveloped orthopedic structures, malnourished bodies and bloated bellies from poor diet didn't stand a chance from abusive, alcohol or drug fueled rage.

There was snow on the ground on Ashman Street where low income housing once stood. As we arrived, there were tears, screams, signs of self flagellation; prayers offered to God, as a small girl lay half impaled on a security fence and the bottom half of her torso lay a few feet away, transected and lifeless.  Steel from the fence protruded through her long locks of beautiful black hair.

This beautiful child was not injured. This stunning beauty who now lies in peace, was lifeless, and to add the exclamation point to the sadness, she was in two distinct parts. Naked from the waist down, her life blood still yet not frozen, but steaming on the sidewalk, surrounded by crime scene tape and a mother who just stared at her lifeless daughter in shock and disbelief.

Dad, and I use that term with disdain, was manacled in the back seat of a New Haven Police Car. He was sitting there smiling and for one brief solitary second I wanted a piece of his flesh. I am ashamed to admit it, and I hope God will forgive me.

Epilog: She didn't put away her toys.

Wednesday, January 15, 2014

A retired Paramedics musings: A retired Paramedics musings: Lunar Events

A retired Paramedics musings:  Lunar Events: January, 2014 I have often wondered, as I am sure many of you have, why certain accidents or calamities happen more frequently during ...

A retired Paramedics musings: Lunar Events


January, 2014

I have often wondered, as I am sure many of you have, why certain accidents or calamities happen more frequently during a certain time of the month than others. Sure, violence seems to increase when the checks come out as do car accidents, but what is it that predisposes folks to act out, other than those factors of certainty like money and alcohol.
Why, when alcohol isn’t involved, does domestic violence seem to be more prevalent when there is a full moon. According to Full Moon Antics (http://www.bubblews.com/news/1427486-full-moon-antics)Some psychologists say they can tell when a full moon is approaching by their visits with their patients. People are not as in control of their emotions and impulses. That could be because the phase of the moon affects our sleep.

Studies have shown that people have a harder time getting to sleep. They sleep for less time and report a poorer quality of sleep during a full moon, even when they are not aware of what phase the moon is in.”
Frankly, I’m not sure if they sleep better or worse, but wackiness prevails.
Take for example the suicide rate. My educated guess is that most people who take the ultimate step of killing themselves aren’t tired. Maybe tired of living, but not physically exhausted. They are typically depressed, often manic, have taken the time to spend hours or days even to author a note to their loved ones and finally commit the ultimate act of (what some might call) selfishness. We once saw a sad case of a 30 something man who put a shotgun in his mouth and there were 99 messages on his answering machine. He either didn’t answer or was already dead the 99 times his mom called him.
Lunar activity not only affects fish, tides, reptiles and other mammals,, but the profound effect it has on fragile humans is profound and unless recognized, can easily be dismissed as just another person who is acting out.
Those of us who see people at their best and at their worst owe it to our patients to be overly sensitive to the sensitivity that many experience to lunar events.
Do your patient a huge favor. If the sky is clear, look up and gaze at the stars and the moon. The explanation may be paramountly clear as to why they are acting out.

Our job isn’t just recognizing a 3rd degree heart block or an overdose of xanax. It is to be sensitive to psychological variances in behavior based on things we may not fully understand.

A retired Paramedics musings: Ambulance Drivers


January, 2014

I have often wondered, as I am sure many of you have, why certain accidents or calamities happen more frequently during a certain time of the month than others. Sure, violence seems to increase when the checks come out as do car accidents, but what is it that predisposes folks to act out, other than those factors of certainty like money and alcohol.
Why, when alcohol isn’t involved, does domestic violence seem to be more prevalent when there is a full moon. According to Full Moon Antics (http://www.bubblews.com/news/1427486-full-moon-antics)Some psychologists say they can tell when a full moon is approaching by their visits with their patients. People are not as in control of their emotions and impulses. That could be because the phase of the moon affects our sleep.

Studies have shown that people have a harder time getting to sleep. They sleep for less time and report a poorer quality of sleep during a full moon, even when they are not aware of what phase the moon is in.”
Frankly, I’m not sure if they sleep better or worse, but wackiness prevails.
Take for example the suicide rate. My educated guess is that most people who take the ultimate step of killing themselves aren’t tired. Maybe tired of living, but not physically exhausted. They are typically depressed, often manic, have taken the time to spend hours or days even to author a note to their loved ones and finally commit the ultimate act of (what some might call) selfishness. We once saw a sad case of a 30 something man who put a shotgun in his mouth and there were 99 messages on his answering machine. He either didn’t answer or was already dead the 99 times his mom called him.
Lunar activity not only affects fish, tides, reptiles and other mammals,, but the profound effect it has on fragile humans is profound and unless recognized, can easily be dismissed as just another person who is acting out.
Those of us who see people at their best and at their worst owe it to our patients to be overly sensitive to the sensitivity that many experience to lunar events.
Do your patient a huge favor. If the sky is clear, look up and gaze at the stars and the moon. The explanation may be paramountly clear as to why they are acting out.
Our job isn’t just recognizing a 3rd degree heart block or an overdose of xanax. It is to be sensitive to psychological variances in behavior based on things we may not fully understand....

Tuesday, January 14, 2014

Ambulance Drivers

Ambulance Drivers


Every person on earth , no matter what their profession (or lack thereof) has a name called them that is not only derogatory, but sinister.
I attribute this slang to a lack of educational facts. Lets face it, if we were ambulance drivers, who would take care of the sick and injured riding in the back! The term ambulance driver conjures up anger, a blatant shortfall of our years of training and is akin to the “N” word when it is used.
Emergency medical technicians of all sorts, including Paramedics are held to the highest prehospital standards dictated by a governance of state and federal agencies.  We have to rectify our licenses every 3 years, attend massive amounts of continuing medical education (CME) and the mere fact that you show up does not in any way guarantee you will pass. If you don’t pass, you lose your livelihood and become unemployed. There are no jobs for “ambulance drivers”
We carry medications, do minor surgical procedures, are subjected to physical violence, and have to carry 3 times our own weight. If one responds to a home loaded with cockroaches, quickly you learn not to put your gear on the floor. Roaches climb in and are carried to other homes, or in the worst case scenario, back to the place you call home.
When God calls you home, there is nothing, and I mean nothing we can do. We try to resuscitate you, but God has the final word. Rightfully so.
 Paramedic carries between 30 and 52 different medications. It’s impossible to deliver those medications if you are an ambulance “driver”.

Please help the profession that I have lovingly given over 30 years to and drop the phrase ambulance driver. You have no idea the marked increase in self worth we will all feel.

Tuesday, December 17, 2013

Blood has a very distinctive odor.


Blood has a very distinctive odor.

 Typically, “normal” blood has a metallic smell largely because of the iron. Iron is contained in hemoglobin which is a protein which carries oxygen to your entire body.
One of the things that is first learned when approaching a patient is that you MUST use all of your senses. Nose included, perhaps even (in my opinion) the most important. After seeing the various manifestation and appearance of blood, there are certain diagnoses that can be fairly accurately made just by having a whiff.  The blood I’m speaking of, of course, is blood that has already left the body. It’s either in the bed sheets, on the floor, in the toilet or spattered around the inside of someone’s car. Each of the aforementioned locations tends to bring with it, a different smell and a different diagnosis.
For example, if you respond to a car accident at 3am and the driver is dead but there are large amounts of blood on the seats or floor boards, the smell of the iron is nonexistent.  You can smell the alcohol in the blood on the seat.
Blood in the toilet or in other places on or around the patient that is dark and tarry is called melena. Melena is caused by a site in the (usually) lower intestines that is bleeding.  There is no mistaking the smell of Melena for anything other than what it is.
Ah, the nose.  We were dispatched to a “woman bleeding” in a very poor, very cold, 4th floor walk up apartment. Women’s bodies are much more complicated than a man’s body. Their bodies have more sites to bleed from, and often, when they bleed, they BLEED! Any bleeding must be taken seriously. Any bleeding from a woman must be met with greater urgency.  I digress. On the 3rd floor of this cockroach and bedbug infested home (no disrespect) our noses simultaneously did a quick sniff, smelled nastiness, and almost at the same time said “great”. Not in a good way.  Carrying our 50 or so pounds of gear another 13 stairs, already winded, breathing hard, made the aromatic and pungent air seem particularly unpleasant.
After knocking on the door and doing a quick assessment of our surroundings, we were introduced to our patient. I am a firm believer in the power of human touch and introduce myself each time, trying to get a handshake and touching the upper arm with my other hand. Touching is very important. It gives you an idea of the patients ability to follow commands, you get to feel their skin temperature to see if they are either hot, cold or normal and it creates a bond instantly that shows you care. Too many times I have seen EMS folks walk into a room, arms folded and simply begin firing questions at the patient. Who needs THAT! This patient no more wants you there to see her suffer in her embarrassment that you want to be there, trying to figure out how to effectively mouth breathe so your nose can take a break.

 Our lady today was a 50 year old woman with gastrointestinal (GI) bleeding as a result of years of drinking a fifth of vodka a day for more years than she can remember. Kids as young as 4 or 5 were trying to stay warm,   asking us for food, and begging us to help Nana so she wouldn’t die.
We were still holding our gear, with the help of the fire department, because one learns early that if you put your drug bag or airway bag or defibrillator on the floor, it goes without saying that a cockroach will wander into your gear, and you have now become a vector for disease.  According to the CDC  (http://www.cdc.gov/asthma/triggers.html) cockroach dropping are a trigger for asthma in kids and we don’t need to be introducing more distress into the community.
Nana was clearly sick. In fact she was probably hours away from stranding her grandchildren with only a memory and perhaps a few pictures.
Privacy is very important to patients. My partner took the kids into another room so I could get some concrete answers on the history and do a cursory physical exam. He kids don’t need to see or hear any of this. Nana is their link to the outside world and to diminish that by involving them, to me, is a sin.
She was frail, her eyes icteric (the yellow color of a yield sign), skin was cool and she was clearly dehydrated. The only medicine she took was for high blood pressure, which she should have flushed down the toilet, because she didn’t need them any more and you don’t want the children getting their mitts on them either.
This is not a complicated case, at least not any longer. Her blood pressure was terribly low, she had had melena on and off for a “couple years”, marked weight loss over the course of the past month, yet still kept drinking. Addiction can’t be fun. I’m not sure if the predisposition for some to become addicted to something, or anything, will be fully understood. At least in my lifetime.
Nana was in trouble, but we could stabilize her for the trip to the hospital where (I’m guessing) hospice and social services would get involved. Nana needed a few things. Oxygen, IV fluids to try to get her blood pressure to within reasonable numbers, Thiamine, and prayers. We tested her sugar and it was fine.  Her cardiogram was a mess and showed she had had heart attack in the past, but was way too fast. Not crazy fast, just a sign of her pain, stress and perhaps most importantly her illness and dehydration.
The oxygen was easy, and her oxygen saturation got better instantly. The EKG was easy, although on frail skin the adhesive can be tough but certainly not a contraindication. Accessing a vein would prove no easy feat. Earlier in Nana’s life she loved her heroin and lots of it. The access to her vasculature was impossible. My fear was that once we sat Nana up to move her, because her pressure was so low, she would pass out, which is exactly what happened. Eyeballs rolling back in the head, flaccid body except for the isolated focal seizure which happens and unconsciousness.  We laid her flat, feet elevated for a couple minutes while she came too. Last thing you want to do on a cold, poorly lit 4th floor carry down is to do it with someone who is unconscious.
Typically we try to keep our “on scene” times to 20 minutes, but this took slightly longer. Nana needed fluid and the only place I could place an IV catheter was in her external jugular vein in her neck. I discussed it with her, told her the options and she said “Baby, if you can get a needle in my neck, you are a better junkie than I ever was”  Apparently she used her neck veins prior to using her arms, hands, feet and fingers. It was going to be uncomfortable for her for two reasons. This was going to be a big IV catheter and we had to really put her head down, as in almost upside down to get her neck veins to fill up with blood.  She tolerated it well, and I stuck the 14 gauge catheter in her neck without difficulty. We laid her flat again and started giving her some Saline. She was much tougher in body and soul than I.
You never want to take a 1000cc bag of saline in a patient with multi organ failure and give her all the fluid at once. Rather, we break it up into a smaller bolus to see how the tolerate it. After about 250cc, we sat her up. She stayed awake, but said the room was spinning. Progress. Reassessment of her lungs was fine. No gurgling. 250cc later she really perked up. I knew this was transient, but positive nonetheless. We sat Nana up and she stayed awake and was even laughing. Now don’t forget, my partner still has the kids in another room and she is still carrying her gear. I called for the kids so they could see Nana and give them some happiness and happy they were.
We got Nana to the hospital better than she was, and that’s the rewarding part.

To this day, I wonder what happened to those children. I know what happened to the late Nana.