I respond, “If I had, then the odds are I would be sitting here being grilled by you for kidnapping. Give me a break.”
“Judge,” Cochran says. “Judge, this is an outrage!”
And then Judge Ito finally tells him to sit down and shut up.
I read my textbooks on carbon monoxide poisoning. I am hoping they will say nothing about patients being combative as a sign of carbon monoxide poisoning. My textbook says: “Signs and symptoms of carbon monoxide poisoning include headache, instability, errors in judgment, vomiting, chest pain, confusion, agitation, loss of coordination, loss of consciousness, and even seizures. On physical examination, the skin may be cyanotic or it may be bright cherry red (a very late finding).” The words “agitation” and “errors in judgment” catch my eye. But then I think he didn’t have loss of coordination, chest pain, difficulty breathing, or seizures. And as Michelle tells me, agitation and errors in judgment are as likely a diagnosis for an asshole as they are for carbon monoxide poisoning.
I read the section on liability and consent. Under the heading “Problem patients,” I find reassurance: “If the patient refuses and still remains alert and oriented, then he or she cannot be forced to accept treatment.”
I hand in my incident report the next morning. When I see Daniel in the afternoon, I ask if he got a chance to read it.
“About which incident?” he asks.
“The one where the guy was going to sue everybody. The carbon monoxide call.”
“Oh, that one. There are so many.”
He hasn’t read it yet, but he doesn’t sound too concerned today. He says he read something on carbon monoxide himself last night and couldn’t find violence as a side effect, unless you counted it as a side effect of hypoxia.
He puts his feet up and starts talking about carbon monoxide. Daniel is one of those few medics who has come as close as possible to having seen and done everything at least once. He tells me about a call he went on where he and his partner were unknowingly exposed to carbon monoxide. They learned that it was a problem only after they had left the scene with their patient. He says he was enjoying inflating and deflating the blood pressure cuff. His partner was driving the ambulance eighty miles an hour. When they hadn’t arrived at the hospital a half an hour later, their dispatcher called to see how they were doing. The driver yelled at the dispatcher, then threw the radio out the window, and kept on driving. The company had to get the cops to find them, and they were eventually run off the road, and taken into the hospital as patients themselves.
One thing I know is I’ll be more on guard next time.
Long Day
It is the last day of our shift and we are getting hammered—call after call. It’s been in the nineties all week with the humidity index at the soup level. We can’t get a Gatorade and drink it before we get another call. By the time we clear the hospital, the thirst quencher is as hot as tea. We drink it anyway, go to the convenience store, buy another bottle, then hear the dispatcher say, “Four-five-one.”
“Leave us alone,” Glenn shouts at the radio as I reach to pick up the microphone.
He says he’s getting pissed off, but I don’t mind it. I like being busy—I just want time to drink my drink when it’s still cold.
It’s eleven and we’ve already done five calls, one refusal, and two wild-goose chases where we are sent crosstown, lights and sirens, for a “man down,” only to arrive and not find anyone.
We’re sent for the “unknown.” Again, we race through traffic, lights and sirens wailing. I try to time my sips of the Gatorade with the bumps in the road.
Ahead we see five police cars in a circular driveway. A police motorcycle is lying on its side, a few feet behind a parked car. It looks like the car probably backed out and clipped the bike, which has little damage to it.
The cop who was driving the bike is strutting about, saying he’s fine.
“Get me a Band-Aid,” he says to me. “I cut my finger.”
He has a small cut on the tip of his finger. “Did you knock your head or anything?” I ask.
“No, just get me a Band-Aid.”
I go back to the ambulance and get one four by four, which I hand to him when I return.
“We don’t carry Band-Aids,” I say.
“What, you don’t have an alcohol prep so I can clean it?” he says to me. He turns and looks at the other cops like I don’t know what I’m doing.
I go back to the ambulance and get two alcohol preps. Glenn, who has applied to be a cop, stays with the cops and tries to bullshit with them about how hot it is today.
I come back with the alcohol preps and give them to the cop. “Here’s one for your finger, and one to keep for next time you cut it.”
He looks hard at me while he opens the prep, like he is trying to figure out whether or not I am dissing him.
“I need your name and address and you have to sign this form, stating you are refusing treatment and transportation to the hospital.”
“You ought to go get checked out,” one of the other cops says to him.
“It’s fine with me either way,” I say. “But you come with us, you get collared and strapped to the board.”
“I don’t need to go.”
“Your buddy here can drive you.”
“Yeah, maybe I should get checked out.”
“What’s your name?”
Another cop tells me his name.
I write the name down. “Address?”
He thinks a second then says, “Fifty Jennings Road,” which is police headquarters.
“Sign here,” I say.
He signs, then I start back to the ambulance.
“See you, guys,” Glenn says, but none of them says anything.
“Was that BS or what?” I say when we’re back in the ambulance. “Sending us crosstown, lights and sirens, for a cut finger.”
“That was BS,” Glenn says.
“Five cop cars for a cut finger.”
“Four-five-one,” the radio calls, and we’re off for a chest pain.
As soon as we clear the hospital, we stop at the Charter Market, where Glenn buys some hamburger rolls and bologna. “I got us lunch,” he says, but before we can even get all the way into the ambulance, they call our number again, and we’re sent to West Hartford for a possible dead body.
“Well, it’ll either be a code or a no transport,” I say.
“I just want to eat,” he says.
Our West Hartford medic, Bob Gionfriddo, is already on scene. When we enter the apartment, which is suffocating with heat, and enter a tiny cluttered bedroom, I am expecting to see Bob either doing CPR or looking over a stiff, but the woman on the bed is moving, though she is out of it. “Your guess is as good as mine,” he says. “I just got here.”
We put her on oxygen and the monitor. She seems to have left-sided weakness. She gazes to the left. On the monitor she’s in atrial fibrillation, a disorganized beating of the upper chambers of her heart that can cause blood clots. We’re suspecting a stroke at this point, but Bob checks her blood sugar anyway, and it comes out normal. Glenn gets the stretcher while I search through the cluttered room for a name or prescription drugs to give us a clue. All three of us are sweating. There is a fan on, but the room must be over a hundred degrees. The lady is lying on the far side of a large four-poster bed. The stretcher cannot fit entirely in the room, due to the heavy dressers that keep us out.
“I might as well just pick her up and carry her out,” I say.
She is not light, but I figure it will be quicker than moving the heavy dressers. I just want to get out of the hot room. I bend my knees and put one arm around her shoulders and one under her legs. I lift her and start toward the door.
“She’s letting go her bladder,” Bob says.
“Great,” I say, feeling the growing dampness on my leg. I get her over to the stretcher and look down at my black pants. There is a visible wet patch.
“Great,” I say again.
We wheel her out and get her into the back of the ambulance. Glenn drives, lights and sirens, while I put in an IV and draw bloods. We have her on full oxygen. She starts to come around but cannot speak or move her left side. She squeezes my hand and looks up into my eyes with desperation. “My name is Peter,” I say. “I think you have had a stroke. You’re in an ambulance. We’re going to the hospital. Do you understand that?”
She squeezes my hand. Her eyes are filled with terror.
I squeeze her hand back. “I’m here with you,” I say. “I’m here.”
After we get her taken care of and I write my run report, I call the office for our run number and our times. “Can I make a quick stop back at the office to do some laundry?” I ask.
“Huh?” she says.
“I got peed on,” I say.
We get an hour to eat our lunch while my pants whirl around in the laundry machines. I wear a green hospital sheet wrapped around my waist. “See what a good partner I am,” I say to Glenn. “Willing to do anything so my buddy can get a break and eat his lunch in this air-conditioned office.”
“I ain’t complaining,” he says.
While we are there, Daniel Tauber comes in and laughs at my hairy legs sticking out from under the sheet. “Let this be a lesson: you should always carry a spare uniform,” he says.
“Yup,” I say.
Glenn asks about our stork pins from the baby we delivered who died a couple months before. Daniel had promised them to us, but we hadn’t gotten them yet.
Daniel has us follow him into his office.
“Boy or girl?” he asks.
“Baby girl,” we say together.
“She even has a name,” Glenn says. “They named her.”
The stork pin is a small gold pin of a stork carrying a baby in a white diaper in its mouth. The stork is pink.
We both put them on. “I wavered a lot on this one,” I say, “but I don’t feel bad about wearing it.”
“We did the best we could,” Glenn says. “We were there with her.”
“Yeah,” I say. I look at him and know how much it affected both of us. “Papa Glenn,” I say.
He smiles.
We’re back on the road within the hour, responding to the Community Health Services on Albany Avenue for a possible fractured skull.
When we get there, we wheel the stretcher inside along with equipment to c-spine the patient. The fractured skull turns out to be a seven-year-old boy who fell and cut his head, which has been elaborately bandaged by the clinic’s PA. It is not fractured, she says, but she wants Saint Francis to do a head film of it before it is sutured to make sure there are no foreign bodies inside. We have the boy hop up on the stretcher, and we belt him in. His mother sits in the back of the ambulance with me.
“Where we going now?” he asks.
“We’re going to take you to the hospital,” I say, “and have the pretty nurses look at you.”
“What are they going to do to me?”
“Well, you might have to have a few stitches,” I say.
He starts to cry.
“Be good, Tyrell,” his mother says.
He undoes his seat belt and tries to scamper off the stretcher.
“Whoa, little man!”
“I don’t want no stitches. Let me out of here. Let me out of here.”
I belt him back in.
“Tyrell!” his mother says.
“But, Momma, I don’t want no stitches.”
No sooner are we out of the hospital than we’re sent priority one for a man unconscious on Brown Street, third floor.
We find him facedown against the wall in the corridor. I kneel next to him to check his breathing, and the first thing I feel is the wet carpet on my knees. I am kneeling in pee.
“He knocked on my door, and he was shaking when I opened it,” a woman says. “He takes Dilantin.”
He is breathing fine, but he is totally out of it—in the postictal phase that follows most seizures. I turn him over on his back and do a full assessment while Glenn gets the stair chair.
“No air-conditioning in here,” I say to the lady as the sweat runs off me.
“It’s on,” she says, “but it don’t work too good.”
“Tell me about it.”
The patient is a stocky young man, and we have to secure him tightly to the chair because he is still out of it. I take the foot end, and as we go down the flights of stairs in the suffocating stairwell, I feel like my back is going to explode.
“I’ve got to put this thing down,” I say, pausing on one of the landings.
Both of us are sopped.
“Let’s get moving. It’s too hot here,” Glenn says.
I pick it back up, but the pain won’t go away. We make it outside, and I have difficulty straightening up. I feel like I need a stiff kick in the back to set me straight.
As I do an IV and draw bloods en route, my sweat drips onto the face of the patient, who finally opens his eyes.
“You know what happened?” I ask.
“No.”
“You had a seizure.”
He shakes his head as if to say not again.
At the hospital as I am walking back out to the ambulance, the nurse who will be caring for him calls to me and thanks me for putting in the IV and drawing bloods, and that makes me feel good. She is nice and pretty, and I like her. I am glad she thinks well of me.
“Well, I got pee on me again,” I say. “But I don’t think they’ll let me launder again, seeing as it’s five o’clock already.”
Before Glenn can comment, they call our number and we’re sent to the “man down” on Main Street, which turns out to be a guy who fell running after his bus. He has a bloody nose but doesn’t want to go to the hospital. We give him some cotton five by nines and an ice pack.
As soon as we clear the scene, they send us to West Hartford for a general weakness at the walk-in clinic. They are about to start an IV, the dispatcher tells us. When we arrive the doctor meets us outside the examining room. She explains the man is a diabetic who has been feeling poorly since this morning and has a blood sugar of 90. “Do you carry fluids?” she asks.
“Yes,” I say.
“Oh, wonderful,” she says. “Would you like us to do the IV?”
In the room there are two nurses with latex gloves on, standing by a table that has a tray with IV supplies on it.
“No, thanks anyway, we can do it.”
The nurses seem relieved to hear this.
One says to the other, “I do want to learn how to do it.”
The man is alert, though slightly confused. His skin is very hot. We get him on the stretcher and take him out to the ambulance. I tell the wife we are going to wait in the parking lot for a few minutes, while we get him an IV and some dextrose.
“But he’s a diabetic,” she says. “He has to be very careful with his sugar.”
“Yes,” I say. “This should help him, but it won’t hurt him.”
“Shouldn’t you wait till we get to the hospital?”
“His hospital experience is starting now. We’re an extension of the emergency department. This will speed his visit. We’re also going to draw blood.”
“Oh, you’re going to draw blood. Well, he should be checked for Lyme disease. We played golf all day yesterday, and one of our neighbors had Lyme disease, and just collapsed, and it turned out he had Lyme disease.”
“I’ll mention that to the doctors,” I say.
I let Glenn do the IV. I have already done five today and am feeling guilty for hogging them.
He puts in a sixteen and draws four tubes of blood while I spike the bag of saline.
“D fifty?” he says.
I nod.
He knows how to do it. I trust him. While he can be a pain in the ass at times, he has good skills. Though he does most of the driving and cleaning up, he is thinking about applying to paramedic school, and I think I should let him do as much as he can, and help prepare him to be a medic. He pops o
ff the yellow tops, screws the D50 into the injector, attaches it to the medication port, turns off the line, then we slowly inject the sugar. The man perks up a little, but I am suspecting his problem is more exhaustion than diabetes.
When I am giving my report to the triage nurse at the hospital, the man’s wife starts to give his whole medical history and insists that he be checked for Lyme disease.
“Do you want her to go over to admitting and get him signed in?” I ask the nurse.
“Yes,” she says. She points her to the waiting room, and we head down the hall.
“You again,” the nurse says to us when we wheel the patient into Room 9.
“One of those days,” I say.
On the phone to dispatch to get our times, I am tempted to clear the call as “Lyme disease,” but I just call it “Exhaustion/hypoglycemia.”
It is 6:45 now and they send us to area nine, on-line with HPD. We get more Gatorade at the Charter Food, and after sitting for about ninety seconds, we are sent to a possible fractured leg in the north end.
There is a crowd gathered around a young girl and her mother who both lie in fetal position on the sidewalk. Nearby is a pink bicycle fallen on its side. I kneel by them. “What’s wrong?” I ask.
“My leg hurts,” the little girl says with a sniffle. She is seven years old. Her mother, who could be in her middle twenties, is crying.
I look at the leg. It does not look misshapen. “Can you move it?” I ask.
She shakes her head no. I touch it and feel she has a good distal pulse. I reach under the leg and then see blood on my gloves. With Glenn’s help, I turn her over and see she has a cut—a three-inch avulsion that is oozing blood and is dirty.
“Mom, you’re going to have to calm down,” Glenn says.
“You wouldn’t be calm if this was your daughter,” she says.
“Mom has to be calm so daughter can calm down,” Glenn says. “Do you understand what I’m saying?”
I get some five by nines and tape but have to return to the ambulance to get some sterile water so Glenn can wash the wound. Since most cuts and small fractures are basic calls, I let Glenn handle them. Besides, blood and broken bones give me the willies. Not that there is any fracture here.
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