“I’m Hit!”
After my debacle at the office supply store fire things seemed to quiet down in town. It was business as usual. All medical calls, no fires. There would be the occasional false alarms here and there, especially once the first cold front of the year occurred. Everyone was turning on their heater for the first time since last winter. Dust accumulation on heating coils would scent homes with the smell of something burning causing mad dashes out of the house and a call to 911.
Jessica and I would be partnered up on the ambulance for a while. We got comfortable working with each other. Not like finishing each others sentences comfortable but cordial enough to make for a good shift. The more calls I ran, the more comfortable I was becoming at talking to patients. That is a critical skill in EMS, the ability to speak with people.
You would think that if a person was feeling bad enough to call 911 they would be open and honest about what was going on with them. This is not the case. I don’t know if people are embarrassed by their predicament or perhaps they are ashamed of having to ask for help? Regardless, people do not tell you everything you need to know as a paramedic. I lost count after the first year on the job of how many patients would deny having chest pain during assessments only to announce immediately to the ER doctor that they called 911 for chest pain. Because of this, interpersonal communication is the strongest tool a paramedic, hell, all first responders can acquire. Mine was getting better. Even though I was still pretty new at the game I felt comfortable interviewing patients.
Jessica’s was not good. Years of transporting an endless flow of non-critical patients and shuffling geriatrics from one nursing home to another took its toll on her. She had no patience for patients. At times there was a glimmer of a caring, loving, paramedic that would surface. But those instances were few and far between.
So, in order to get any patient care done it was up to me to question the patients about their present illnesses and injuries. If left to her we would literally be an expensive taxi ride to the ER. Which to be totally honest, 85% of the time that is exactly what the ambulance is.
We had a system in place. When we arrived on scene Jess would take a brief look at the patient and if they were not obviously dying I would step in and run the call. Easy cheesy. She would complete the vast majority of my run report while I was assessing the patient leaving only the narrative for me to do. I would deal with the patients so she wouldn’t have to. If the call was critical in nature she would take over and treat the patient quickly. All the while I would haul ass to the ER. She didn’t like staying on scene long. She believed definitive care was given at the hospital and that EMS should stabilize the patient in route there. She was good at what she did and had seniority over me. I didn’t question her way of doing things as she had way more experience then I did. Plus, despite her lack of bedside manner, I never saw her mistreat a patient up to that point so I had no reason to question her philosophy.
Early in the winter of my first year the two of us got sent to work at our departments downtown station. The officer in charge of that station, Walt, wanted to give his ambulance crew a break. The downtown station was much busier than the one I was at. He wanted to get me some time in the busier part of town. Jess was sent with me.
The station was a shit hole. It was old, dark, smelt like mold and looked like it was covered in it. The design was from the early 80’s when everything in that part of Texas was basically a rectangle built out of cinder blocks and covered with tan bricks. The roof was flat which led to drainage problems and leaks and the lighting inside was ultra fluorescent. There was a public restroom in the front of the station that was never cleaned. Yet, the public continued to use it.
The station was busier. It was in a more densely populated part of town. It also covered an obnoxious amount of territory. The city was getting bigger and it needed at least one more station. It would have been better with two more but one would help. At this station we would be up 2–3 times a night running calls. It sucked. That is just enough to ruin sleep. Despite what first responders will tell you, getting a few hours of sleep here and there is not sufficient. In fact, it is awful for your health. I highly recommend this book regarding this topic.
Our service area here contained the lower socioeconomic population of the city. This has a direct correlation to increased 911 calls based on my decades long observational study stored in my mind-brain. These neighborhoods normally use 911 services to address minor health issues that could be handled by a primary care physician and healthy lifestyle changes (not hating just reporting what I experienced).
With that said most of our calls were people suffering colds and seasonal allergy related ailments, assaults, drug overdoses, and mental health crisis. These calls are all the same but strangely unique in their own ways. You can run 10 overdoses in a row, same scenario, same drug overdosed on. However, there is always something that makes each call stand out on its own. They are all unique, like a snowflake, except they’re made of heroin.
Our area also covered the downtown area and the affluent professionals that lived there. The houses had historical status as they displayed the architecture of yesteryears. They were all beautiful despite the stage of reconstruction they were in. There was one in particular I always wanted to tour. It had the same construction as southern plantations had: large columns along the facade of the front elevation, a large porch with chairs, giant front doors, and upper level balcony’s that circled the house.
As luck would have it, I got my wish in the middle of a busy week. It was just past lunch time when we were assigned a call to that exact home. The call came out as a possible overdose, then changed to a psychiatric call, then back to overdose. That was not unusual as this is common for 911 dispatches. For those on the box it gets frustrating because we are trying to get ourselves ready for the call we are dispatched to. If it is an overdose we run a mental checklist to make sure we know what to do quickly upon arriving on the call. If the nature of the call changes, we scrap that checklist and review another one quickly. Then if it changes again, we get more and more frustrated because it is adding to the increasing level of stress we are feeling.
In defense of the call takers, they can only relay information the caller is telling them. If the caller keeps changing the details of the call, the call takers have to update the information to the first responders. Though I have never worked as a call taker or dispatcher I can only imagine it sucks to be stuck on the phone with someone in an emergency and not be able to reach out and physically help them. Plus the job is stressful in nature to begin with, considering the amount of turnover most 911 call centers have, especially here.
Since the nature of the call kept changing the engine at our station was dispatched to assist in case the call was more serious than expected. We pulled up in front of the house and I took a quick glance. I wondered what type of horror was taking place inside such a beautiful structure. The police had been added to the call but were 5 minutes out from arriving.
A good but debatable policy is to wait for police to clear the scene from any dangers. Typically when you find an overdose there is a weapon around or a violent act has taken place. You don’t want to walk into the beginning of a gun fight with nothing but a stethoscope. That is why police are normally dispatched with EMS on calls. I’ve honestly lost track of the number of calls in which guns, razors, knives, and other weapons were found while treating a patient on the ambulance. And these were calls that had no violent acts associated with the call.
So, it is a good practice to wait for the cops to make sure it is safe. However, if the patient is inside bleeding to death you must be OK with letting the patient bleed. So what do you do? Do you run in and save the patient that is bleeding to death as told over the phone to the call taker who did not see the patient bleeding and only relayed the information to you? Do you wait outside for the police to show up while the patient dies? Neither choice is great to be honest. What if there is a person inside stabbing everyone? What if no one is inside except a dying person? Scary, yes? What’s even scarier is doing it so many times you become complacent and just stroll in not caring what awaits you. That’s what my crew was like.
So as the lowest man on the crew my vote did not count. Regardless of what was going on in the house I had to follow them in. I recall not being nervous but just aware of the dangers that could be waiting us. I wanted to follow best practices as taught in school. That meant waiting for police to clear the scene. But, I was no longer in school. I was a street medic, a small town firefighter. That meant making do with what you had and getting the job done.
Entering the home was quite disappointing. It was being renovated internally so there was no visible architecture to enjoy. The walls were covered with differing shades of paint for the home owners to pick from. The floors were lined with plastic to protect the century old flooring. I still looked around as much as I could as I made my way up the banister staircase. We were following the sounds of howling and moaning that were periodically interrupted by the crash of glass and ceramics being flung in the upper room.
The home was 3 stories, something I never noticed from the exterior. The higher we climbed the more closed in I felt. The 3rd floor itself was a single room, perhaps an attic or office space. The stairs ended at a closed door. On the other side we could hear the voice of a very angry man. His voice was deep, his breathing was heavy. No other voices could be heard. His words were incomprehensible. Maybe he was overdosing, maybe a psychiatric breakdown, maybe a stroke. That is the beautifully wicked part of medicine a lot of us become addicted to: the exhilaration of the unknown. The mystery of what is going on with my patient and can I do anything to correct it.
I always saw it as a mystery. I was Sherlock Holmes, my partner Watson. Each medical call was a new case for us to solve. Sherlock Holmes and the mystery of the abominable abdominal pain. Some mysteries would be solved, some not. This is why I was never a fan of traumatic calls. They are messy and straight forward. I prefer a challenge.
So, here we were, 4 medics outside of a room housing a very angry and large sounding man that was not coherent. We made the choice to enter his home, there was no going back. We could have waited for the cops but, we were already feet away from him. So, we decided to make contact regardless of what was going on with him.
We entered the room and as his voice advertised, the patient was a large, angry, incoherent man. Large would not be the word I’d use at the time I experienced this. Looking back on it, I would probably have to describe this guy as 1980’s Hulk Hogan big. You remember, blond, tan, 24 inch pythons. That’s how big this guy was.
He was sitting behind a large wood desk. In front of him were broken vials. White residue was smeared on his desk calendar. His eyes were blown.
“Sir, my name is Lt. Walt, do you know where you’re at right now?”
SIlence.
“Sir, can you hear me? Sir, sir!” Walt said. He then decided to shake the patient on the shoulder.
“Ahhhhhhh!”
And like that the patient went from altered to violent. He sat up from his chair and began screaming. Like matadors side stepping a bull, we each managed to escape his charges. Walt and his partner got onto the patient’s back and were able to wrestle him down. Jess immediately loaded a syringe with a large dose of sedative and injected it into the patients deltoid. I had taken his legs while Jess gave him the sedative and we all held onto the patient tightly as we awaited the medication to sedate him.
What seemed like an eternity but was probably more like 3 minutes later the beast slept. The path of carnage left behind by his illicit drug rage told the story of violence. We eased up on the sedated patient and began to carry him down the stairs. I looked around his room just before we exited. It was a personal office. It was decorated in awards and accommodations. The floors were layered with broken glass and wood from smashed picture frames. Peaking out from underneath the carnage was deep brown, polished hardwood floors. The walls were covered with photos of him with local and state wide officials. Some still intact, others with smashed glass. Before his meltdown this office would have been a sight to see.
This guy was a somebody. Whom, I couldn’t say. It didn’t matter in the moment. What mattered was trying to carry him down the slim staircase without dropping him. The logistics of getting him down to the ground floor sucked. There was no safe way to carry him securely and maintain good lifting techniques. Only two of us could carry him as the staircase was built in an era were you didn’t have to account for people built like a wrestler high on drugs to be carried down.
Without incident we got him down to the first floor and on to the stretcher. As we rolled the stretcher to the ambulance I noticed the patient’s body seemed to stiffen. Not in a seizure kind of way but, more like gaining muscle tone. Does that make sense? It’s like comparing a person sleeping versus a person pretending to sleep. To tell the difference look at the face. The sleeping person has a relaxed face, no grimacing or squinted eyes shut. The person pretending will have the appearance of their face in some forced relax state. The muscles in the face are contracting to make the face appear asleep. That is muscle tone.
And that’s what I noticed. Though at the time I did not realize this is what was going on. To me, a novice still, it was just a weird thing that stood out. But for a seasoned medic, it is the appearance of a person coming to or one pretending to be sedated.
After loading him into the ambulance we all noticed the patient’s irregular breathing pattern. He’d take few regular breathes then he’d slow his rate down, then speed up. Jess recommended we bag him. This is when you see a person squeezing a bag filled with oxygen over a person’s mouth. It is a means of breathing for the patient as you are mimicking the patient breathing.
When you bag a patient it is good to place an OPA or NPA in the patient’s mouth or nose, respectively. The purpose of the OPA is to keep the patient’s tongue from falling backwards and closing off the entrance to the patient’s airway. It keeps the tongue down. The NPA goes in the patient’s nose allowing for an uninterrupted path for oxygen to flow. Some occasions call for an OPA, others for an NPA.
In this instance Jess elected for an NPA. She grabbed a box of NPAs and sized an appropriate one for the patient. Just before placing it in the patient’s nostril Walt spoke up, “Let Chapa do it, he needs to practice.”
As a black cloud I had already placed a lot of OPAs and NPAs. Walt should have been aware of this as he had run a lot of those calls with me. But, I was not going to pass an opportunity to play. In medicine, you never pass an opportunity to do an intervention when warranted. This is the only way to get solid practice in. You can practice skills using a mannequin all you want. The truth is it will never be the same as a live person.
So I grabbed the NPA from Jess, smeared lubricant on the end, and began to place it in the patient’s right nostril. Slow and steady the NPA entered the patient’s nostril. Once you feel resistance you twist the NPA while continuing to push it in. As I did this the patient began to scrunch his nose. Was he coming to? I finished placing the NPA and noticed the patient’s eyes had begun to water. Strange.
I stared at the patient momentarily after I finished placing the NPA. I heard him breath heavily from his nostrils. Like a prairie dog popping his head from a hole in the ground, the NPA slid half way out of his nostril. I reached over and with the tip of my finger pushed the NPA back in. I watched to see what would happen. Like clockwork he snorted out the NPA again. At this point all four of us were in the back of the ambulance watching. Everyone was perplexed. None of us had ever seen a patient snort out an NPA. I decided to play along with the patient and gently pushed the NPA back in. Snort, snort, snort, out came the NPA.
This exercise lasted a few more times until Jess spoke out in frustration. She was ready to go to the hospital. So I jumped in the front of the ambulance and drove us. The ride there was chill, no issues went on in the back with the patient. He lay there with the NPA in his nose while Walt bagged him and Jess placed an IV. We got to the hospital and rolled the stretcher to his assigned room. A group of nurses stood around to see what the fuss was.
We lifted the patient using the sheet underneath him and placed him on the hospital bed. It took six of us to do so. When we placed him down he began to scream and thrash around like he did on scene. I’d had enough of him and quickly made my way to the door. I was not in the mood to get punched by this guy.
I don’t know why but something made me turn around just before leaving the room. As I did my eyes locked onto the patient’s. A sea of rage filled his face. It was like he recognized me as the one that shoved the tube down his nostril. At this point everything around me slowed down. Like a scene in a movie, I could see everything in slow motion. His arms swung around violently, a nurse hanging on for dear life on each of them. He raised from the bed and screamed, like a banshee cursing me. He shook a nurse off from his right arm and reached to his nostril.
In a single motion he pulled the NPA from his nostril and slung it at me. It was like watching a ninja throw a shuriken at his enemy. The NPA moved slowly in the air. Drops of lubricant and mucus flung off it as wobbled towards me. I couldn’t move. All I could do was watch the NPA head towards me. It was like I was the target of a firing squad but was not given the courtesy of a blind fold.
Splat! I was struck me center mass. My uniform shirt was covered in lube and mucus. The NPA plopped onto the ground. It jiggled a few times then lay still. I didn’t know what to do. Everyone in the room was staring at me. Then I did the only thing I could think of.
“I’m hit!”
I flung myself backwards and slammed against the entry door. No one seemed amused by this so I quickly turned around and left the room.
Turns out the patient was super high on speed, a staple in our response area. The hospital sedated him again and kept him around long enough to sober up before discharging him. And like that, another patient was saved from themself.
It’s funny because you would think a person would suffer some legal ramifications from overdosing, raging, and fighting a bunch of medical personnel. But alas, nothing happens to these people. No consequences for their actions. Just an ambulance bill. Which may or may not get paid.
Interested in becoming a paramedic and/or firefighter? Read this first.
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