Cold cold cold

Yesterday was the last day of classroom orientation and geo mapping. Tomorrow is the first FTO ride I have. A big change in everything from what I’m used to. New scope of practice (that is incredibly restrictive from what I’ve been privileged to work under), new protocols, new procedures. Luckily the monitors and most of what is on the truck is stuff I have used, so no problems there. But it’s gonna be a few hard days.
And to top it off, it’s snowing… in mid-May! Makes me miss NM just a little bit.

Although getting used to all of this is somewhat like medic school. You sit there and try to absorb enough knowledge to make a difference. And then you pray you’ll remember it correctly when the time comes to use it. My first major call in internship solidified this feeling.
Bus 2176, respond code three to the Corner Motels, Rm 155. Severe respiratory distress. Coded 6C1.”

My preceptor looks back through the porthole and just nods at me. “You ready for this? Hang on”

We take off following the directionals on our MDT. It’s a pretty rought ride in the box. I think our EMT partner forgot someone was in the back. “Good thing I’m belted in,” I think to myself. I’m a little nervous, this sounds like the real deal we’re going to.

We get on scene to our patient and he’s sitting there in classic tripod position, pursed lips, unable to talk to us at all. He looks scared, he looks very tired, and you can see his chest heaving with the effort of breathing. Every breath he takes brings up sputum, pink and frothy looking. He’s hooked to a home concentrator via nasal cannula running at 4 liters per minute, about as high as that thing will get.

On the table he’s sitting behind there’s a note. “Take me to VA” and “Hurry!” are both written out on the paper.

I freeze. I have not been on a bad 911 call by this point. My primary experience is IFT! And lots of drunks we’ve had until now. I’m not sure what to do. I know this is a Very Bad Thing, and Very Bad Things are something medics are supposed to be able to deal with.

I start off with the basics, have my EMT take vitals. Have the fire dept go get the meds and find out what he’s on. It starts to come together. I need to take a few breaths and calm down.

“This is not my emergency, it’s my job,” That thought keeps running through my head as I start to work. Fire medic has the IV? Good. Monitor is showing Sinus Tach. We need to get a 12 lead. No big bad signs noted there.

I start working just like in class, thinking it through and letting it flow. Lasix IV, 40mg, since he’s taking oral Lasix. BP is high, squirt of nitro. Get him on the gurney and start moving. This is a longer transport than most in this city, since he’s going to the VA.

Another 12 lead hooked up. No distinct ectopy. Maybe a partial bundle branch block. Take another set of vitals. BP still high, another squirt of NTG.

Think think think. I feel like I’m forgetting something. Ah! CPAP. Get the control box and mask out. Tell him what’s going to be happening. He nods his head when I ask if he’s ever used CPAP. Another nod when I ask if it has worked before. Good.

Hook up to our bus tank, turn it on and start increasing pressure until he nods that he has to work to breathe out a little. After a few moments it’s plain to see that he’s starting to feel a little better.

You can see it just looking at him how much he seems to relax once he starts being able to breathe easier. Looking outside, I see I’m about 10 out and call into the VA.

Ask for clearance to go to Med3 on the radio. City Radio Base gives me clearance.
“VA ED, VA ED, this is Bus 2176, code 3 traffic.” Trying to raise them. It’s not completely unheard of for the VA to not answer the radio. It’s happened more than my fair share when I have ER transfers I need to call on coming in from a SNF.

“VA ED, go ahead 76″. Yes! They are alive over there.

“This is TJ, medic intern on 76,heading to you code 3 with an elerly male, on scene very short of breath due to acute pulmonary edema secondary to CHF. 0.8mg NTG administered, 40mg of Lasix administered. 18g IV in right A/C. Currently doing much better on CPAP. Vitals are as followed…” rattle those off from my note sheet. “ETA 10 minutes. Any orders?”

“None, see you in 10″.

I clear the channel and tell Radio Base I’m clear. I’m feeling more confident after seeing how well my patient is handling the treatment. I sneak a look at my preceptor sitting tucked there in the corner of the box, a little smirk on his face. That smirk means a lot to me since I’ve never seen him so much as smile when I’m treating my patients.

We get our patients transferred over and give our report to the ED staff. Once he’s on that bed he shakes my hand and nods. I just smile at him and head on out once we get our CPAP controller back.

I think all of us dread that first bad call. We never know how we’re going to do, if we’re going to do the right thing. We can have all the training in the world, and freeze when we should be doing our thing and treating the human being in front of us.

That call is when all the treatment came together for me. But there’s something else that a lot of new medics have to work at. And that’s realizing that we don’t always save lives. We don’t always win.

I learned this at a pediatric code I helped with during my clinical hours. I wrote about it a while back. We did everything we could. We did everything we were supposed to. But the kid we were dealing with still died.

After those two experiences, it just clicked for me. I realized that every patient I have, critical or not, is important. Yes, it gives me a chance to practice our art of medicine, but that’s not the only reason it’s important.

Every one of those people who call on us are having an emergency, one of the worst days of their life. What makes them all so important is that we come in to help them. No matter if all we’re doing is holding their hand and talking them through what’s going on with them, or sticking a tube down their throat and breathing for them; it’s all to help alleviate their suffering and try to keep them alive.

We don’t always save lives. But even when we lose, we are still helping someone. That someone is the family the patient might be leaving behind. Someone who might get some comfort in knowing that everything was done that was possible.

Until that all clicked, I had always thought of medics as the ones who always get saves, who always do the ‘cool’ interventions. But now that it has all come together for me, I realize these things. It’s made me a better EMT, and a better person overall for it, because I know even when I lose, I’m still trying to help.

  • Mark Zanghetti

    I needed to hear this today, Thanks

  • Ellie

    Well done. 'It's not my emergency, it's my job' is an excellent mantra!