Numero Uno

I am a bona fide paramedic; I’ve worked hard to learn about the myriad of disastrous complications the human body can endure and ultimately, what interventions can be made on my part to keep a person alive in the face of abominable circumstances. Essentially, I was ready. Bring on the Grim Reaper-I am ready to stare him down and pull lives from his grimy, heart-stopping, possibly mummified hand! This is honestly how you feel when you’ve been a paramedic for a week: part superhero and part purist. Your heart is full of altruism, your brain is full of knowledge you’ll likely lose from lack of use, and the rest of you is petrified that you’ll kill someone. Ah, the life of a para-pup.

Then it happened: I got my first priority (read: really bad, possibly about to kick it to the next adventure, depending on your particular brand of spirituality) patient. The dispatch came over the radio, and I wasn’t necessarily anticipating anything serious in nature considering the vast majority of the people who call 911 are in no severe distress what-so-ever. The possibility still remained that this person could be in severe distress and I could swoop in and save the day with my knowledge, medications, and equipment. I can nearly see it in frames of a comic book, vibrant colors showing my hair blowing (and possibly a cape, too, for good measure) as I defibrillate the patient’s heart, stopping a lethal rhythm from claiming the life of yet another innocent soul. I intubate the patient with grace and style, protecting his or her airway from the always dreaded aspiration injury. I give life-saving medications through an intravenous line that I have managed to administer without so much as spilling a drop of blood. I can see the sparkle off my teeth as I wheel the patient into the hospital with nothing left for the doctors and nurses to do because I have saved the day. The patient, their family, and doctors and nurses thank me profusely, as they are positive that without my interventions, the patient would have inevitably experienced a harsh and painful death. On top of all that, I have never looked better in my uniform as with the added advantage of a touch of cleavage. My fantasy world quickly comes to a halt as I pull the ambulance into the parking lot of your standard ghetto-fabulous apartment complex.

True to form, the apartment itself matches the faÁade: smoke wafts through the air, the furniture is minimalist and cheap, untidiness is abundant, evidence of fast-food is scattered throughout the areas I see, and more people appear to live there than the fire code will likely allow. I see my patient sitting upright on a battered couch, her hands on her knees, clearly struggling to suck precious air into her lungs. Shit. Shit! SHIT! I realize two things for certain: if I donít do something immediately, this woman will die, and I have absolutely no idea what Iím doing. Reality sucks. I can only imagine how I must have looked to my patient: a 26 year old blonde with the color drained from my face, eyes wide and unblinking, frozen. Perhaps she thought that I was fulfilling the agencyís special needs requirements for equal opportunity employment.

Luckily, Iím working today with an experienced paramedic who I would trust with my own life. Sheís the real superheroine here, and I find this comforting enough to snap myself out of my stupor. Somehow, my training kicks in, and I become a woman of action, albeit a clumsy woman of action, fumbling with my equipment with shaking hands, mostly unsure of every patient care decision. I call out for the patient to be put on oxygen. Holy crap! The firemen are doing what I say and instead of looking at me like Iím speaking tongues. Well, thatís kind of cool. I listen to breath sounds, note wheezing all over and diminishment in the lower lobes of the lungs. I attach a probe to her finger that reads oxygen saturation levels: 74% and dropping with a high heart rate. The patient is unable to speak and tell me her medical history, but she is relatively young and is able to answer some yes or no questions; I just have to choose them wisely. The patient is able to nod that she has asthma and that this problem came on quickly. She shakes her head when asked if sheís allergic to any medications.

I call to my partner to set up a nebulizer with albuterol, stronger than her home version of the drug. I tell her to toss me the epinephrine, I want it readily available in my pocket. A fireman reads off medication names from a grocery bag full of medications, ďalbuterol, metformin, hydrochlor-I canít say that one, but itís a big word, lasix, and prozac.Ē Fantastic. Those medications indicate that she could be either having an asthma attack of the worst kind or drowning in her own blood, and if I treat her wrong, Iíll kill her.

I listen to her lungs again and there is no change, her oxygen saturation level is holding steady. We pick her up to put her on my stretcher, and as I put my hand around her left arm, I feel the swoosh of blood that indicates she has a dialysis shunt, and I briefly panic. She could potentially have toxins and fluid backing up in her bloodstream and into her lungs, and the medication Iím giving could be helping her drown if this is the case. Super. ďHave you missed any dialysis appointments?Ē She shakes her head no, and a family member says that she went to dialysis yesterday. Hereís hoping I donít screw this one up.

It feels like weíve been here entirely too long, but I know it couldnít have been more than two or three minutes. We need to get moving immediately, and I ask a fireman to drive the ambulance to the hospital, with what I like to think was politeness and urgency, but probably appeared more along the lines of frazzled bossiness.

Her blood pressure is dangerously high, making me again concerned that Iím treating my patient totally inappropriately. I reconsider and decide that this has asthma written all over it, and I make an active decision to stick to my guns and see what happens. My partner is furiously working to put together the CPAP, a machine that forces air into oneís lungs, while Iím searching for IV access. She yells out to me that the machine isnít working as I yell that the patient has no IV access. Abandoning paramedicine in lieu of permanently living in my comic book fantasy is looking more appealing by the second. In one arm, her veins have been totally deteriorated by diabetes and high blood pressure, and in the other her veins have been altered by the surgical placement of a dialysis shunt.

I peek up at my patient to see the beginning of The Look. The Look is not a new concept for me. Iíve seen The Look as an EMT-Basic and not directly responsible for doing things like keeping people from dying. Until now, The Look meant I should say to the paramedic, ďHey, you should probably do something about that,Ē because The Look is typically followed by death. Now Iím the paramedic. Crap. I suggest to my partner that I think itís time to give epinephrine, but she disagrees. My partner thinks this very strong medication could put too much strain on her heart. Thatís a distinct possibility, and by doing this we could give her a heart attack. We agree to hold off on the epinephrine for now, but keep it close by.

My partner is able to rig the CPAP machine with brute force; it leaks, but it works. Good enough. The oxygen does the trick and The Look is gone for good. The patientís oxygen levels steadily rise until they reach 100%, where they remain. We have managed to alert the hospital prior to our arrival, and as we roll the stretcher into the waiting room, the doctors and nurses immediately get to work. The room is crowded and wires and tubes seem to fling through the air as our equipment is traded out for that of the hospitalís. I manage to relay my report to the room, despite the frenzied activity, without appearing to be a complete idiot, which is no small feat. An experienced nurse is attempting to obtain IV access and I hear her say ďShe has absolutely no IV sites.Ē Well, that makes me feel a little better.

As I leave the room, my hair is matted to my head with sweat, I didnít save the day with grace and style, and I have no tasteful cleavage. I did, however, get the patient to the hospital alive with the invaluable help of an experienced partner and an accommodating fire department. As I replay the events in my head, I remember and remark to my partner that Iím most impressed that we never got distracted by the fact that there was a midget on scene to begin with; she agrees that this is an achievement worth celebrating.

After what seemed like an eternity, I finished the bulk of my written report and documentation. I reentered the patientís room for a little bit of early follow-up. The patient is sitting up, on continuous nebulizer treatments and finally able to talk. ďHoney, did I scare you?Ē she asks me.

ďYes, maíam.Ē

ďDonít worry. You did a good job.Ē Well, it isnít people falling at my feet to appreciate my valiant efforts, but Iíll take it.

4 Comments

  • Matthew says:

    That was great! Reminds me of my first priority one. It is all so true that you think you are going to go in and save the day when in reality you are scared to death yourself. Great job Tiff. You will always be a superhero in my book!

  • medic9five says:

    You did GREAT!!!! I will give you some old EMSasaurus advice oh para-pup. Be nice patients don't sue people they like….oh sorry that is for another time. Your story reminds my of my first ALS call. The wet ink on my card was dripping on my boots, ( and adding a nice shine I must say). I had a new EMT, who is now a supervisor at the agency I used to work for. And we were dispatched to the ever dreadful respiratory distress. 56 year old woman CHF, in the land before CPAP!!!!! HOLY CRAP. 12 lead by MCL ( modified chest leads, the old school life pack 5) Ntg lasix I think she got 120 mg iv. She did fine and felt better. Myself on the other hand. not so well. the doc looked at me and started laughing. " you look worse than the patient you brought in" If he only knew. keep smiling and keep your chin up. be safe.

  • Tiff this is pretty good stuff. We've all been there. Your right we've all seen, and dread the "Look".

  • Taffy says:

    Thank you guys so much! It makes my day to know people enjoy my interpretations of the job. ;)

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Tiffany Nash

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Comments
RealMedics
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AWESOME. We would have been right there with you... until we saw Gravity in 3D, that is... :-)
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Why yes! I do have a favorite astrophysicist or two! :) Awesome blog post.
2013-03-21 11:18:00
Gabrielamccoy
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WTF!?! ! I SENT that to him. Credit stealer. It was your Venenzuelan cousin!!!
2013-01-11 13:48:00
Ambodave
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Why have I not visited here for so long? You make me laugh! Cheers, Dave in Australia
2012-12-30 13:58:00
tangle
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That's so awesome! Have you seen the Canadian PSA for bystander CPR? Holy Zombie Apocalypse, it's fun. https://www.youtube.com/watch?v=UN4STZwjORw
2012-12-10 03:17:00
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