It is my personal opinion that in 200 years our descendants will laugh out loud at the concept of dialysis. Not unlike the scene in Star Trek IV when Dr McCoy says, “Dialysis? What is this, the Dark Ages?”
It is an interesting life extending service, but lately, more and more, I’m encountering folks on double borrowed time. And others who are happy to get them in and get them out.

THE EMERGENCY

A man has an altered level of consciousness at the dialysis clinic.

THE ACTION

Leaving personal feelings at the house, we arrive to find a man sitting in the dialysis chair, one of the more alert of the 3 dozen folks in this giant blood filtering factory. Half are asleep, most of the rest are about to doze off and the remainder are watching us with suspicious eyes.

Our client is seated in the chair, shunt freshly clamped, and a nasal cannula hanging from one ear.
“His sugar is too high,” says the heavily gowned dialysis technician.
“How high is too high?” I asked thinking it was a fair question. 200 high or “Hi” on the glucometer high.
“His reading is high, our machine said high.” She responds handing us the folder clearly prepared long before we were activated.

The next question I have never thought to ask until this morning and the reason I want to pass it along.
“What was his sugar before he got filtered?”
She froze, pointed at the folder and stormed off.
Inside the folder are barely legible copies of his record and results of this mornings filtering. In the space for the blood sugar reading pre-treatment someone has scribbled initials, not a number.

Our client is a bit confused and tired, we get a reading of 501 and everything else looks OK so until the ambulance arrives, I’m off to speak to the staff.

“Did you filter an insulin dependent diabetic without checking their blood sugar?” she’s trying to avoid me and run off.
“No, I told you it was high.”
“So you filtered a hyper-glycemic insulin dependent diabetic on purpose?”

“Can you move him please, we have people waiting,” another technician chimes in.

I look around and realize that we are bothering the flow of cash into the center. These folks have to get them in and get them out as fast as possible.

When the ambulance arrived, I was impressed the medic immediately asked for the pre-treatment blood sugar reading. when I advised her of the situation she cleared us and took a deep breath.

One day we will look back at this practice and ask, “Did they really think that helped?”

Round 1 seemed normal enough, at least as normal as things get in the big scary City some nights.

Round 2 begins as I’m assisting Bubba down the stairs and he decides an elbow to my face would make his night better.
Luckily, I watch a lot of movies. Not fighting movies or martial arts movies, Happy is a lover, not a fighter, but I enjoy a good strategy and tactics film when I can.

I had 3 options as Bubba took his first of many swings.
Option 1 – Let him hit me. Um, no.
Option 2 – Try to duck or dodge out of the way. I’m not one for choosing the direction of an assault and I figured I had a 1 in 3 chance of moving the correct way.
Option 3 – Close the range to target.

What came to my mind in a flash was the Hunt for Red October. When he turns into the path of the torpedo before it can arm itself. My reasoning after the fact seems perfect, in the moment I just needed him to chill.

The bottom of the stairs had along it’s side a large wrought iron ornamental security gate, the kind we have to force open most days.

As Bubba moved with the elbow, I forced my shoulder into his, jamming him into the gate. My right leg got up under him to throw him off balance while my left hand dropped the computer and squeezed Bubba against that gate. I knew if he got me off balance and I went to the ground I was going to get hurt.

My partner was already on the radio screaming for police assistance. She had to scream to be heard over the screaming of, in ascending order of volume, Me, Bubba, the girlfriend…and mom, who’s voice had found new heights.

Bubba was my height and had at least 20 pounds on me. I was tired and sober, he was drunk and rested. My only hope was to keep him against that gate until the cavalry arrived. All I wanted to hear was the screaming of the police sirens.

I was able to get his right hand into mine and forced behind his back, now near my waist. His left arm, the one that swung the first time was pinned between him and the gate, not moving for now.

The scene from Pulp Fiction when Julius is telling Honey Bunny to be cool was playing over and over in my head and I’m sure lines from the scene were coming out of my mouth. All I remember is wanting to keep his 230 pound frame off balance and against the gate which was almost more than my one leg could do.

After what seemed like hours of holding him he began to calm and still no sirens filling the night air, only screaming. He promised he was “OK,” and I reminded him that I had no problem keeping him there all night if I had to, a thought my leg would most certainly disagree with.

I decided, possibly foolishly, to let him back down to the ground, partly for a rest and partly because he had indeed calmed. I kept his right hand behind him and made a reach for the left wrist, controlling both rather well considering the circumstances, I thought, and we slowly made the drunken, angry stumble towards the ambulance, feeling him squirming and trying to get free the whole time.

There in the middle of the street, mother still screaming and us now screaming at her to go back inside, Bubba sees an opportunity to try knocking me down again. He’s got one leg up on the rear step of the ambulance and one hand on the rail to climb in when, I’m told later by my partner, Bubba takes a swing. All I recall was seeing him shift his weight and losing my cheerful disposition.

He quickly found himself flat on the cot as I tackled him into the ambulance, landing one leg on his hip and one arm on his chest. I’m not entirely sure it was one maneuver but I would have loved to see the video.

As we’re struggling now in the ambulance, as if by stealth, a sea of blue rushes the back and there are no less than 3 boys in blue saying and doing things that I can not. They have him four pointed and are able to clearly shout over the rest of the commotion outside where I can make out at lest 2 more officers dealing with mom and the girlfriend.

I look at my partner and share a look of, “Holy s*it, did that just happen?”

I took off my duty jacket and took a deep breath throwing it to the bench seat in frustration, suddenly feeling the strain in my shoulders and legs from holding him for what turned out to be 4 minutes against that gate.

The officer looked to me and told me he was impressed I didn’t fight back. What I had taken as staggering towards the ambulance, they had seen from afar as him struggling and swinging elbows, all while I’m walking behind him.

The final part of our tale, Round 3, will be covered tomorrow morning, Friday as a perfect You Make the Call.

The next 3 posts will cover 3 distinct parts of a rather interesting job.

Round 1 – The Dispatch

1:15 AM and the MDT tells me you’ve cut your hand. It also tells me you’re in your twenties. It doesn’t tell me if you’re seriously calling 911 for this. I assume you know more than I do about who needs an ambulance and away we go.

THE EMERGENCY

A man has accidentally cut his hand.

THE ACTION

This was a perfect storm of mystery, intrigue, alcohol and lies. The building is older and has a large partial S staircase leading from the street level to the first floor door. So when we start our trek up the dark staircase, the front door is out of our sight above us and to the right. I stood there at the bottom of the stairs, tired already from the first 16 hours of the shift, waving my arms at the motion sensor light that, apparently, has yet to be installed. Warning flag #1.

The door is open and I hear high pitched voices speaking, nay shouting, in a language I do not understand. As is habit I scanned the floor for blood. I see none. In the next room is Bubba. (See Glossary of Terms)

Bubba has his pants half way down and has a towel tied to his thigh with twine.

“Hi there.” I say, hesitant to put anything down quite yet.
He mumbles in response. Even just this slight mumble sends a waft of alcohol breath my way that would have caused me to fail the brethalyzer right then and there.

He’s telling a story about opening a can of oysters and missing, hitting his leg. Then, after a few questions he tells a different story about how he got cut. All the while I’m telling him I know he is lying. And all the while the mother and the girlfriend are shouting and won’t leave the room until my associate for the day finally convinces them to give us peace and quiet.

His leg is cut, not his hand…warning flag #2.

Using my Happy Medic skills we’ve convinced Bubba to come to the hospital to have the 5cm wide 2-3 cm deep wound from the chef’s knife examined.
Oh, did I skip that part? After arguing with the landlord Bubba thought it would be a good idea to get wasted drunk, grab a couple of knives from the kitchen and wave them around like a child demaning more dinner. Darn it if those things are sharp when you get a little too animated.

His mother and his girlfriend, who hovered over my discussion with Bubba in the room are still shrieking in their native tongue and Bubba is trying to shout back at them as I’m guiding him towards the front door and down the stairs.
Quick aside, the wound is wrapped, not bleeding and he flat out got angry when we tried the chair. Warning flag #3.

Halfway down the dark stairs I have my hand under his arm to help him balance, as I offer to everyone I treat. I have Bubba in my right hand, one step ahead of him and the electronic PCR in my left. I looked away to check the bottom steps. When I looked back up…warning flag #4, a swinging elbow coming my way.

Coming soon – Round 2 – the Struggle

I have spoken before about the strange days one can have on the ambulance. Sometimes everyone has the stomach bug, other days everyone is having trouble standing up. Other days you’re on your 3rd intubation wondering “Really? Again?”

I call this the Whine de Jour, the one common thing going through the day. Either they’re whining or we are. Well, today is kind of similar, except everyone has been sick. Legitimately, actually, needing a Doctor, sick. Not Sick, dying, Sick but sick none the less.

We’re getting the calls as code 2 falls, sick evals and even a code 3 diarrhea. I think we’ve all been there for that.

But most days the folks are not nearly as sick as they think they are, or as sick as they try to convince us they are.
“You said your fever is 104.5 and yet you’re not hot…explain that to me.”

Today is the day from the Twilight Zone.

Our complaint of vertigo actually had vertigo. Most folks we get who self diagnose think a headache is vertigo. We arrive and they’re on the phone, watching TV in a brightly lit room and walking around. This guy was seated in the kitchen, holding the tupper ware of vomit loosely in his hands as we entered, eyes closed wincing each time I spoke and unable to lay down the dizzyness was so bad.

Our clogged catheter call turned out to be the beginning of quite the bleed. I’ll spare the details, but It’s a good thing the live in 24 hour care nurse waited 96 HOURS to call for help when the cather was clogged, then suddenly started bleeding. 4 days of bleeding through your…well…we hurried him in.

And wouldn’t you know it, the altered consciousness was actually altered for a medically unknown reason. Every assessment tool came back normal except for the part where he wouldn’t wake up all the way.

No quick one liners, no discussions about the importance of the ambulance, no critical interventions, just some good old fashioned, “You look sick, let’s get you cared for.” But we’re only 6 hours in, maybe things will go back to normal.

Today’s Whine de Jour, “I’m actually sick.”

Go figure.

Mr Murphy and I have an understanding of sorts. If I bring full C-spine equipment to the 7th floor, I won’t need it after all. If I get my full PPE on for the trash can fire, it will be just that. And if I bring the valium all the way into the jail, I won’t need it when I arrive.

THE EMERGENCY

Jailers report a man actively seizing

THE ACTION

Gosh darn it if there isn’t a maze of doors, gates and guarded elevators in this jail. I guess it’s to keep folks in, but since it often takes 4-5 minutes just to get confirmation we’re supposed to be there, I decide to bring along the good stuff so I can stop this life threatening seizure. Besides, like I said, if I bring it, I won’t need it.

We’re led by the jailers to the medical ward where no less than 3 RNs and an MD are standing over a man sitting up on a stretcher, talking with him.

“Hi, did you report an active seizure?” I try not to sound accusatory, but I was told later I sounded upset.
We were informed that this man has had 3 seizures today and policy requires that he be transported for evaluation and observation.
He has no history of seizures. No one witnessed his seizures. He told his guard he had a seizure and came to the medical ward. Then he was released.
Then two more times and here he is. Never postictal, according to my explanation of what that meant to the guard who responded, “Not in the slightest.”

The MD and the RNs are asking if I’m going to be sedating him for transport, since he is a violent offender.
“That’s what these guys are for,” I said pointing at 2 jailers salivating to rig this fellow up to our ambulance gurney.

Enroute the patient told me about how he was innocent and no one will listen to him, so he has to find ways to get them to listen.
“Like faking seizures?” I ask casually.
“Yeah, whatever it takes.”

Sigh. At triage I passed everything along and the nurse was familiar with our friend who began to tell the entire ER how he didn’t do anything wrong.
“What did he do?” I asked the jailer later.
“According to him, nothing.” He replied, then smiled, “but according to the state, a whole lot of bad stuff.”

It was then I finally remembered the valium was still just sitting in my jacket pocket, likely visible from more than 1 angle, and I can cross of another of my List of stuff I always wanted to do:
#32 Sneak narcotics into prison.

Expecting a long post about geriatrics? As our friend MC says, “Wrong f’ing blog.” On this call I was glad to hear that NorthCentral Positronics, a division of LeMerk, was still around. If that makes no sense, I beg ya’ cry pardon.
Or read how something from my favorite books found me at work.

THE EMERGENCY

Transit authorities have a woman who has fallen.

THE ACTION

Often our first question is “How far?” In this case, very far indeed, but she has yet to land. Our patient is sitting on a chair in the lobby of the transit area with two LEOs (Law Enforcement Officers). Sorry, that always makes me think of Dr Evil talking to Mini Me about Leonardo DiCaprio. You boys in blue need a new…I’ve got it! BIBs (Boys in Blue) ((girls in blue represented, just not present on this call)).

Let’s start over.

Our patient is seated in a chair with two Officers (dang, BIBs) near the entrance. She’s tracking us as we approach and we see no trauma, so into question mode we go.
The following, as usual, is the back and forth that followed.

HM – “Hi there. What’s your name?”
A1 – “I am an ancient one.”
HM – “Do you have names?”
A1 – “I have a machine inside me,” she speaks softly in a noisy transit lobby.
Quick aside, I thought the same thing you did, that is, why does a seemingly healthy 30 something woman need a pacemaker?
HM – “Does the machine help you survive?”
A1 – “Not lately, no.”
HM – “Well, I’m not trained to repair the machine, but can I examine your organic systems?” I said with a straight face and with all honesty. This is no place to challenge what may be a serious mental health issue. Let’s just roll with the punches.
We do our thing and find nothing of interest, so onward with the questions awaiting the ambulance arrival.
HM – “Tell me more about the machine.”
A1 – “It was placed within me by the ancient ones and will last until the end of the world. I believe that time to be near. The universe is collapsing.”
HM – “Too true indeed. Do you take medicine for anything or does the machine need fuel or oil or anything?” I was trying to find out if the ‘machine’ maybe was a metaphore for something else. Turns out I was looking WAY too far into the possible meaning of machine.

The ambulance arrived and there was a nervous looking Paramedic intern with them who didn’t believe my initial report. When he leaned in to confirm what I had told him, the patient told the same tale.

So when the world moves on, remember, you heard it here first.