The Aftermath

I sat bolt upright in bed feeling the icy cold bead of sweat running down the back of my neck. I look to my left and see my husband curled up in the blanket sound asleep. I looked to my right to inspect my alarm clock except the numbers were just an angry glare of red staring back at me. I couldn’t help but wonder why I had woken up in the manner in which I did. I scanned my brain to try and remember what I had been dreaming about. Nothing. Just black.

Huh, that’s strange.

Just as I lay back down placing my hand on my husband’s chest (a strangely reassuring position that has just become habit) and resolve to drifting back to sleep, that shrill and frantic beeping pierces the darkness of the bedroom.

“Respond to 14732 Richards St. 22 year old male with gunshot wound.”

Somehow my breath got sucked back into my chest like a reverse pressure chamber.

“That is two streets down” I report to my husband, now across the room frantically yanking a t-shirt over his head.

He nods at me, his eyes attempting to reassure me; desperately trying to reassure me that it will be okay.

At this point, I feel as though I am molasses in January. I am trying to will my body to move from where my legs dangle off the side of the bed. The thoughts all flow through my head…

That’s Meggie dispatching. She doesn’t sound frantic. Usually she doesn’t though. Where is he shot? I need more info. Are the police on their way?

Before I realize it, I am at the glass door of my house. I stare at it, knowing that after I pass through, I will be changed forever. We pile into the car, praying for the garage door to hurry up.

“Deputies are en-route to the location.”

I paused at the end of the driveway, willing my foot off the little square peddle and to the longer one that will certainly push my car to the scene. My little red light remains off. No need to turn it on for such a short drive. A little voice in the back of my head tells me not to go there. Don’t go there! I turned to see my husbands face set with determination. Determination not to show the fear that is creeping up his spine. I yank the steering wheel to the left, away from the house with only one light on, void of any police out front. I pull out my cell and try to call to our responding unit. Finally my lieutenant answers. She will wait for us.

My hands fumble as I reach of the car door. I take a second to steady my voice.

“Unit en route with 2 EMT, 1 Firefighter. Update us when police have secured the scene.”

Just as I let go of the button on the radio, I hear a shrill voice coming over the radio, begging us, wishing that we were already there.

“Holy shit! That is Amy. She is fucking on scene!”

Never and I mean NEVER has that unit traveled that fast through the now eerily silent subdivision. Jessica pushed the pedal as if trying to put her foot through the floor, sending us speeding towards the house that I had just passed moments ago. That dark, ominous street sign appears before us. 3, no wait, 4 squad cars sat in front of the house; the lightbars blaring their warning of what was inside. We grab everything, except the suction unit.

All three of us scramble up the dark driveway to the rear of the house. I am forced to yell as I don’t know where they are, there are three doors in front of us. I follow the frantic yell of “In here.” I turn and in a voice I didn’t think I had, instructed my husband to stay outside. Somehow, he knows not to argue with me, but his eyes tell me the truth. He wants to see.

As soon as the door opened I recognized that smell. That lung paralyzing smell, grabbed my nostrils and pulled at them, feeling it in my soul.

I round the corner up the short series of steps it hits me like I ran into a wall. There was Amy, kneeling in the blood. Tears rolling down her cheeks and grasping on to the last shred of composure she has; her gloved hands clutching the sides of a young man’s head.

The blood was winning the battle.

His body was laying in a position that sent a shiver up my spine and the hair on the back of my neck stand out. An officer, kindly points out the hole in the ceiling, another standing over the weapon, guarding it’s position. Jessica, the most experienced of the three of us, knelt down in the crimson puddle. I lock my eye’s with Amy’s, silently letting her know she is doing great and to just hang in there. We move as if robots, protocol programmed into our brains. I hand over supplies crossing back and forth across the room. If I had not been wrapped in that officer’s bear hug, would have ended up lying next to him.

The ambulance arrives… never being so thankful to see those faces.

It feels like hours have passed. Finally, a spine board and straps, awkwardly maneuvering through the house and down the stairs past my husband, the Sentry. The ambulance crew and Jessica race down the driveway towards the running ambulance. Jessica with her feet wrapped around the base of the cot, as if she were surfing in the cool crisp ocean with the hot sun winking down at her, trying to seal the face-piece of his mouth and nose.

I instruct an officer to escort Amy away from the house, away from the blood, away from the smell.

Dutifully, I retrieve the red plastic bags from the unit and deliver a pep talk in my head as I return to the house. It took 4 trips to bring everything back out. Each time I returned, repeating the montra in my head.

The ‘thank yous’ and pats on the back are delivered. The “good jobs” flow from their mouths.

All the lights are on in all the houses now. Sleepy faces peer out the windows into the darkness, trying to assimilate the events. We dutifully trudge back to the station, taking turns peeling our clothes off in the shower and swapping out for whatever we had in our lockers. Our faces speckled with tiny little red freckles.

Incident reports, exposure reports and a phone call to dispatch and then we head home.



...


I laid back down in the darkness pulling the covers to my chin. I feel the warmth of my husband behind me, reminding me that I was safe, but still feeling the chill.

Tomorrow is another day. If I can just get a few hours of sleep, I can worry about it then.

I look over at the clock, adjusting my sleep-deprived eyes. It's time to get up.

Questions Unanswered

The venom shot past her lips and splattered on his face. The stinging pain spread through to his heart. He could see the hatred and frustration in her eyes. The only thought he had when he turned to see the empty spot where the car-seat usually sat was that he was thankful. Thankful that he didn’t have to hear this.



The dull ache that had been in his chest for months grew and spread like wildfire. He just couldn’t feel anything anymore. Everything around him blurred, the colors running together like a painting left in the rain. He tried to focus on the dirty room. The overturned table, the dishes piled in the sink, some even starting to grow life.



He turned back to look at her. A face that was once so beautiful and reassuring was now blotchy, red and stained with the tears of anger. He was struggling to think clearly. Nothing made sense. This wasn’t how it was supposed to be. Regret and pain poured into his heart. The tears fled from his eyes, trying to escape, his body trying to rid itself of the emotions that were taking over. Slowly the darkness crept in. He was losing his focus again. Waning in and out of clarity, he was losing the battle against the thick heavy cloak that was smothering him, choking the life and the will out of him, grabbing him by the throat, even squeezing out the lump that had formed.



He had no control now. The pain and hurt had conquered, posting their flag of victory in his head. He was not himself, this was not him. He was hollow. Empty.



He reached out. The click was the last thing he heard, silencing the heartache. Conquering the pain.

Deflate before you pop.

Everyone knows coming into this field, that we are going to face deaths at one time or another. Some escape it for months, if not years in their careers. I could tell you about every call I’ve had that involved a death. I’m not sure if that is healthy or not, but that is just the way it is. And of course, with each one, there is a single detail that I remember most. That one little detail that you focused on and acts as the placeholder in your brain for the events. Kind of like the Dewey Decimal system at the library. Piercing Blue Eyes – Traumatic code: May 2002.

Living in a small town, you will drive by the house, the field, the intersection or down that road. It is just inevitable. And from that, I honestly believe that any call that involves a death should require an automatic stress debriefing. It is far too easy to say “I’m good” and ignore it.

I don’t think that we utilize them enough. Sure we all process death and dying differently, but if it is mandated, then there is less chances of someone not getting one because someone else didn’t feel the needed it. Really, I honestly think they aren’t utilized nearly enough.

Where did I put my waders?

So as with any volunteer organization, there has been much discord amongst the ranks of my little fire department in the sticks. We have recently moved from depending 100% on surrounding departments to transport to us to hiring out a private to standby 24/7 at our station. To make matters worse, this change was mandated and put into effect in less than 3 months. Hectic? You bet you hiney it was. In fact, it still is. Granted everything is moving along as smooth as possible, but it makes you wonder.

Our 100% infant town board has thrown our department through the ringer. I cannot completely articulate how frustrating it is to have someone tell you how to do your job that has no clue what it is like. I am not even kidding when I say that we were asked why we can't re-use supplies such as NRBs and c-collars. While we're at it, we might as well re-use airway adjuncts as well right? Because obviously selling used widgits is the same as running a town. A fact we are made aware of daily. I am actually awaiting my turn for to see if I can get the old man to stroke out in front of me just by challenging his "authority." After all, I am just a woman and a young dumbass anyway, right?

So, town politics aside, you then have fire politics. A recruit that is arrogant enough to cover for half the department and has the brains of a dull rock, a chief that needs to reach his hands down his pants to reassure his stones are in fact, still intact and actually use them, and officers that continually put people in dangerous situations but are never reprimanded or punished (see the bit about the chief) all lend to some really pissed off members. So you chase away the ones that hang in the shadows and get shit done just to retain someone with "more experience." Honestly, is that experience really worth losing the people that keep the wheels turning?

Bad PR abounds.

Personalities are clashing leaving teamwork bleeding and gasping it's last breath. It is hard to bring up troublesome issues when everyone is related to someone or another. I know this first hand since I have several family members of my own on the department. Those who care and have the skills to actually lead are being pushed aside and verbally beaten so that those that have the power now, can retain that power.

It breaks my heart that an organization that was once looked upon as the closest and most talented in the area is laughed at and falling apart at the seams because power hungry dolts have gotten a hold and wont let go.

For me, the burnout is taking over. Do I continue to forge on and challenge others to do the same, or do I roll over and give up? I have never been one for quitting, but the towel is in my hand right now. Waiting to be tossed into the ring.

How to spot a newbie

1. They have more gadgets than Batman hanging off their belt.

2. They don't just crank the BP cuff up to 200 and let it go down from there.

3. They suggest using a KED board for extrication.

4. They have their pager on scan 24/7.

5 They have the 'Stare of Life' - Look on a rookies face during his first code.



On a side note, I have found that the word Tachypnea makes me giggle. I have yet to figure out why.

Breaker Breaker 1-9

Everyone loves shortening things. Hell, we are not referred to as Emergency Medical Technicians, but EMTs. So it is only appropriate that we have a freakishly long list of nicknames for equipment and mnemonic devices to remember what we need to and of course for our own entertainment. Here is a small list of some that have popped into my head in the last 5 minutes…

MNEMONIC DEVICES
~ETOH: A drunken wanker is in your midst
~MBHGT: Generally known as My Baby Has Good Teeth, but of course they can be replaced with tits or testicles. Depending upon your gender.
~BDGART: Big Dead Guy Assuming Room Temperature
~PUHA: Pick Up and Haul Ass. The calls also known as scoop and run.
~FUBAR: F*cked Up Beyond All Recognition – pretty self explanatory
~OSDF: Oh Shit Drive Fast - For when everything is FUBAR and after you PUHA.

TERMS
~Whale Tarp: The sturdy tarp-like sheet with handles that is used to move patients with great weight with *ease.
~The Pucker Factor: When you sphincter slams shut so fast that if there was a lump of coal in your ass, it would be turned into a diamond in seconds. This determines the level of PUHA.
~Circling the drain: The best way to describe a patient that looks like hell. Generally has one leg in the grave and one on a banana peel.
~Cabulance: This term applies when the patient really doesn’t need to go to the hospital emergently, but they just don’t have a ride.
~Coocoo for Cocoa Puffs / Nuttier than a Snickers Bar: The best way to describe your psych patients.
~ Vegetable Isle - Where a patient will reside after massive head trauma.

Listen to your momma.

Recently we had one of those “You’re kidding, right?” calls.

Since I live in the great Midwest and it is the dreary month of February, it is not uncommon to encounter snow, ice and generally just weather cold enough to freeze hot piss before it hits the ground. This particular day, it had just stopped doing that wonderful snow/rain mix we are so well known for and the temperature was rapidly declining. As I had anticipated, we received a call for someone who had slipped on the ice and now is complaining of ankle pain. When we get there, we slowly shuffle ourselves across the frozen parking lot and up the ice block stairs to the patient.

Once inside we find our patient with her ankle wrapped haphazardly in an ace bandage and a bag of ice over it moaning and crying. With our crew of 4 EMTs and one firefighter, we send one back out to bring the squad around back to the elevator instead of risking our own ankles to carry her down the stairs. (Sometimes we do actually come up with some good ideas!) The remainder of the crew start the routine. I was appointed to inspect the injured ankle. As I approached with utmost caution to lift the bag of ice, the patient screams in pain as if someone just drove a nail into her eyeball and we all instinctively freeze. I asked the patient what happened…

“You were going to touch my ankle.”
“Um yeah, but I didn’t touch it yet.”
“I just figured it was going to hurt.”

It quickly dawned on us that she is going to be one of THOSE patients. (I know you know what I am talking about.)

Somehow with the four of us left and plenty of whimpers from the patient later, we finagle her onto our cot. Once on the cot, we give her the required schpeal about giving ones-self a hug and keep your arms in, kind of like the droning you hear right before your harness tightens on the Batman ride at Six Flags. We count it out and on the utterance of “three”, the patient flails her arms, shrieks in a tone that I am certain only creatures with four legs could hear, and simultaneously bitch-slaps both people on the sides of the cot. Phenomenal. The lecture that followed just about brought tears to my eyes. You would have thought it was a well practiced Oscar speech. It literally just rolled off Rachel’s* tongue like singing ‘Happy Birthday.’

The fun did not stop there however. I drew the short straw and was voted to transport. Here are some highlights of the transport.

1. This patient is a lying liar. *See yesterday’s blog
2. You do not need to wear 7 support bracelets at one time, especially on one hand.
3. The smallest needle we carry is a 24g. The more you piss me off or hit someone on my crew, the less likely you will be to get “the little one”.
4. Yes, I have a license to do this even though I am volunteer, dipshit.
5. Just because I am not getting paid, does not make me a ‘nee-nee’ as you call it.
6. I really am glad that you were a tech on the cardiac unit, but does not mean you are a nurse. Self-diagnosing is a bit overkill.
7. Telling me you “know” when you break bones is hilarious. It is side-splitting funny when you have never broken a bone before.
8. Your veins suck, but you bet your ass I can hit them, even *gasp* while we are going down the road.
9. If the hospital tells me to take you to triage, your whiny ass is going to triage, even if you worked at this hospital in afore mentioned cardiac unit. Newsflash! You are not that special.
10. When I tell you to stay on the cot, I mean literally, do not remove yourself from the cot. Until I lock the wheels and lower it, you are taking one hell of a chance of “breaking” your other ankle.

I felt the need to apologize to the triage nurse for leaving her there as she did not understand why she was not ‘next’. (There are an abundance of references to the ways of triage in some of the blogs I frequent if you are unsure as to what I am referring to.) Unfortunately, this patient must not have learned that in the cardiac unit.

Finally, to answer the question as to why you shouldn’t hit your EMT…Because just like your momma told you, it just isn’t very nice.

Can I have some morphine too?

Through the years of being an EMT, you generally get a feel for what a patient will state for their pain rating. You know that wonderful 1-10 scale that we have to ask EVERYONE... Well, over time you start to associate certain behaviors with each number. Here is the breakdown I have come up with...

1: Nothing seems out of place. It is almost as if nothing is even wrong. Patient is generally gives this number when they are uncomfortable but feel they should at least give some sort of number. After all, you didn't give them the choice of '0'.

2: This number still has no outward signs of pain in the patient, but they don't want you to think that it is nothing, so they up it just a bit from 1. Think body aches from the flu.

3: This is a number a normal person would just pop a few Advil's for. Think of that nagging headache you get when your inlaws start in on you to produce grandchildren.

4: Here is where you start to see some mild distraction. This number is generally associated with mentrual cramping. (Hey, the masses don't lie!) Most female patients believe this justifies the bitchiest and nastiest responses, because of course they should receive some morphine for the agonizing pain they are suffering from. This is also the number that the tough grandpa Goodcookie's of the world give even if they are having The Grabber. Can't seem like a sissy you know.

5: This number is for those that really have no clue what number to give you. Not horrid like I want to punch someone in the head, but not your run of the mill papercut either. (Maybe a papercut with lemon juice, but still not quite.) You may or may not start to see some grimaces or pauses in sentences when giving their medical history.

6: I like to call this the knuckle stage. When patients reach a 6 they have generally one hand grasping the rail of the cot but still have full useage of the other hand. Of course this also includes the symptoms of #5.

7: Seven is where people start to mean business. This is the pain level that most people need to focus on something to try and distract them from the pain. Whether it be the giant unidentified stain on the ceiling of your ambulance or the mesmorizing rotation of the IV tubing as you roll down the road. When patients start to get that glassy look to them from the sheer concentration of not punching something, they have earned this status. Knuckles on both hands have become white from the judo-death-grip the patient has on both rails of the cot.

8: This number is rarely used by the fakers. I assume that is is getting to that point where eagles fear to fly. It is rough trying to find the most believable rating for their pseudo-symptoms without being obvious. 8 is the start of the "you've got to be kidding me" reactions from preciously mentioned patients. I assume those with obvious deformities to their body parts START at an 8.

9: If someone gives you a rating of 9. They had better be completely pale and vowing they are going to vomit from the pain. Vomiting may or may not commence at this point. Depends on last oral intake. Never have I received a blatant claiming of 9 from the wankers (IE fakers).

10: Vomitting has commenced. Sweating is definitely present. Most identifiable by the long string of words that would make a sailor blush. A simple four letter word is not that uncommon even in the case of sweet old ladies with chains for the eyeglasses and tissues up their sleeves.

There are some out there than can easily trick even the most skilled EMT. The trick to identifying the lying liars is to give a smidgen of pain meds and see how they feel. If they are magically better in a matter of seconds and their pain drops more than 5 points, give them the eyebrow (ala The Rock) 'cause me thinks they are fibbing.

Then again, what do I know. I'm just the "nee-nee" volunteer that is taking care of you.

Next time - Why you should not hit your EMT