We lost a good man yesterday

NM EMS suffered a terrific blow yesterday. We lost one of our best educators, Cy Stockhoff. I met Cy close to seven years ago when he helped proctor one of my first practical exams for EMT-B. Then I got to have him when I attempted my EMT-I cert for the first time. The man knew what he was talking about, and always pushed for us students to question the norm and push to make our profession better.

Cy taught a good portion of my first try through paramedic school, and was my biggest supporter when I withdrew from the program and took my EMT-I exam instead. He told me that life will never let you follow your plans exactly, and that sometimes things happen and you have to make do as best you can.

The last time I saw him, it was a fun little reunion when I came by his office to ask about starting their degree program with my current paramedic cert. He remembers nearly all his students, it seems, and I was no exception. He asked me how it was going, and congratulated me on my paramedic cert and asked how I was liking my rural 911 service (I  was in uniform at the time, so it was an easy jump).

Even then, he asked if I had thought about doing any further training and education, including getting my instructor certs. After those years away from being his student he still wanted me to do better than the status quo.

Cy, you’ve helped mentor me, helped me learn how this EMS thing works. You’ve made me question the ‘why’ about why we do things. I’m grateful to have been one of your students, and I will keep striving to be better, and to make our chosen profession better. Thank you for everything you’ve done for us. You’ve helped teach a state full of providers who will fight to the last, with what little we have to work with.

18860_509068561461_8166473_a

Memories, and new beginnings?

I’ve never like Albuquerque, not since before I moved here for school. When I left last March for Colorado, I thought that was it. I swore I’d never willingly move back to Albuquerque. But somehow in the course of talking to you the NEXT March… we agreed to find a place together in Albuquerque, and I would have been so very content to stay here for the next 18 years with you if you’d have had me. That’s when it hit me. You were what was missing the first few years here. Even staying at your parents (which I’m still so very grateful they put up with me :p), being with you felt like home. You were my home, the place I felt the safest. The place I felt most comfortable. The person I loved being with so much.

Now Albuquerque is a bunch of memories, of things we did. Of places we visited. Unfinished plans that we made together. Albuquerque feels empty to me now. Worse than before you, it’s now a black hole that seems content to suck out any happiness or wanting to do anything. This is not my home any longer.

I guess that’s why when this hospital district offered me the opportunity to come out and test, I took it without a second thought. I knew you would have been ok with it. That’s why I bristle a little when people accuse me of trying to run away from my problems here and run there. And to be honest, that thought gave me a panic attack on the drive back today.

For a little bit, I didn’t know why I was doing it. Was I really running away? Or was I doing it because it’s something I wanted? Because it’s something I thought would be the best idea for me? I really didn’t know. That made me feel horrible. Then I thought about it. Both of us loved travelling, granted you hated TX, but we both had plans to move as much as we could. And this would really be a good opportunity for me. Maybe I’m doing it for a little bit of all of those reasons? But you know what, if it’s better for me in the long run, who cares right this second why I’m doing it?

But that means I need to try and put some things behind me. Sweetheart, losing you is something I’m still having a hard time dealing with. I listened to a song on the way home and these were part of hte lyrics

“I don’t wanna not remember
I will always see your face
In the shadows of this haunted place
I will laugh
I will cry
Shake my fist at the sky
But I will not say goodbye”

That’s rather how I feel towards you. The last month I’ve gone through so many emotions… Gods know that there have been times I’ve been so very pissed off at you. Pissed that you left me alone here, pissed that you wouldn’t talk to any of us, pissed that you were gone. Pissed in general. But it reminded me too that I wouldn’t have been anywhere near that mad if I wasn’t in love with you.

What I can do, though, is remember the memories. Remembering you so many years ago, walking into the interview for that trip with me. I saw you back then, braces, frizzy hair, and all, and it was like something inside me clicked. Like my heart went “Oh! Hi! I’ve been waiting for you!”

And that trip was amazing. I know you had some rough spots during it, and so did I. And I’m sorry I ever took it out on you then. But we enjoyed each others company so very much. And I loved squirelling a smile out of you when you were in a bad mood. It helped my mood so much too. And then  when we got home… This blushing little girl, so cute and innocent looking, walking up to me and kissing me on the cheek, then walking away. You left me standing there breathless and staring. I still smile when I think of that memory.

Then we had some bad times. I was dating the one-who-will-never-be-named (yes she is that much of an evil bitch that she would give Voldemort a run for his money) and she took great exception to the fact that I might have been falling for someone that wasn’t her, or that I was even talking to someone that wasn’t her. So she took it upon herself to make sure we’d never talk again… and for several years we didn’t. I remember spending hours trying to find you online, looking for any sign of you. And come to find out you were doing the same thing to find me.

I remember the first day I saw you again. It was after you and my mother realized who each other was. I came down from ABQ for just a chance. We called each other when I got on campus and left my mom’s office. And in a typical Zita moment, and Nate moment for that matter, I look ahead of me and see someone talking on the phone… making arm motions that looked very familiar. I asked you what you were doing and you told me walking. I was smirking to myself the entire time, and I asked you to turn around. God, seeing your face for the first time in years was amazing. You had just gotten even more gorgeous and grown up from that little girl I remember. The smile on your face when we both realized we’d been on the phone with each other from about 20ft away is still one of my favorite memories.

Remembering how you smiled at me this past Valentine’s day when I surprised you with flowers at your parents. You were always so hard to surprise because you hated them and tried to get all the info you could before it happened. That’s why I’m amazed that me and your mother managed to pull off me sneaking by without you knowing. The happiness you had on your face when you saw me walk through the door was amazing, and then the surprise and smile when I handed you flowers. I was hoping that flowers to you on V-day would become a normal tradition with us, the first time I’d ever enjoyed that day at all.

Or how a month or two later when I walked into your parents house again on a mini-vacation from TX. I had been working up the courage to ask if I could kiss you on that trip, so can you imagine how surprised I was when the first thing you do as I walk in is kiss me on the lips, kiss me very soundly? Heh, I think it was almost a repeat of the airport and me just standing there. You smiled so sweetly and just giggled at me. That was the turning point of us becoming an ‘us’ even if we didn’t want to admit it to anyone.

Those are just a few of my favorite memories of you and me. And kind of why I think I might be running away from ABQ… there are memories of you, of us, of all three of us, everywhere in this state. And I really am having a hard time dealign with it. I still wake up and expect to be looking into your gorgeous hazel eyes, or hear you giggle at me whenever I do something stupid. I miss your gentle touch when I’m upset, and boy, lately, I could have used that wonderful touch so often. I miss just being able to cuddle you to me when you were upset. All in-all… I miss you honey. Miss you so much that the pain makes me want to curl up into a ball and stay there.

I think what really gets me… is that we didn’t really have a chance. We were good together for the short time we had, and it kills me that I’ll never know how we would have turned out. I think it would have worked, but now I’ll never know… and that, to me, is one of the things that makes this so hard.

So, yea, maybe I am running away. But I’m also trying to move on. You would want me to move on. You’d want me to become a better man. You knew of my love for EMS, and you told me shortly before I lost you that you could never tell me you wanted me to give it up. So here I go. I’m trying to get on with one of my dream services (the only one I can get on with as an EMT-I as opposed to a medic). I’m trying to become that man you would be proud of. I’m just hoping you keep watching over me. Keep visiting me in my dreams, for that’s the only way I can see you now, and gods know that I miss you. I still think of you every second of every day, and I can’t see how that will change any time soon. But for now I just need to keep pressing on. Keep trying  to push forward. It’s what you would have wanted for me. and it’s what I would have wanted you to do if the situations would be reversed.

I know I still can’t tell you goodbye. Like I said earlier, I don’t know if I’ll ever be able to tell you goodbye. But I will not, cannot, ever forget you. You’ll stay in my heart forever. And I think you took the best part of me with you when you left, so at least you have some company. Until I see you again lover, watch over me and help keep my dumb ass safe when I do something stupid.

“The blackest night must end in dawn, the light dispel the dreamer’s fear.”

——————————————————————————

So… I just got back to NM last night. I left NM on sunday to go to SE Texas to test for a large hospital based agency. From everything I have heard, they are in the top three services in the state of TX and they’ve always been one I wanted to work at. But man it was a long drive. 15 hours or so from here.

The hiring process consists of a written test, three practical tests (airway incluiding pedi and adult ETI, vital signs, and LSB), an interview, and a PAT. I passed the written with an 88%, passed all three practicals with only one retest (vital signs?! I think I just got nervous and started counting my own pulse), and had a great time on the PAT. It was actually a very fun PAT, and one of the few for private, non-fire EMS that I’ve seen that has you do a full course, not just a stair test. The interview I think I did ok on too. Now I just have to wait till Friday to hear if I got the job or not. If I did, orientation will start on July 18th.

And it’s not just orientation. They run a 3 week academy followed by 4-6 weeks riding third before you’re released as a probationary crew member under a mentoring medic.  I love the idea of the way they do new hires. So… fingers crossed that I’ll get the call once I get off duty on Friday. I go in for a 36 down here in ValCo tonight. I’m hoping I’ll have a resonably busy shift.

It’s like a roller coaster.

The last two and a half weeks have been both the best weeks and the worst weeks of my life professionally and personally.

It all started on what was supposed to be a 36 hour shift over New Years Eve and New Years day. Great time to work EMS right? Good calls, fun times.

Well it didn’t quite work like that. First few calls of the shift were all routine. A drunk or two, a minor MVC or two, a drunk doing CPR on a fully alive drunk person (“Sir, if the patient is saying ‘OW!’ every time you compress his chest, he DOESNT need CPR!”), and then it started to get interesting.

We worked a nasty tractor trailer rollover about 15 miles from town. We get on scene and see a pretty much demolished tanker truck laying on it’s side. The roof of the cab had been peeled back by the wreck and the patient was laying about 10 yards from the truck. He was laying on the ground moaning but not really responsive to us at all.

We quickly get him collared, boarded, stipped, and strapped and then haul into the bus. Just a quick look at him showed what looked like a grossly deformed femur, shattered left arm, distended neck veins, and no breath sounds on the right. Left pupil was sitting pretty at about 4mm and slow to respond while the right was about 2mm and non-responsive.

Our second bus pulled up on scene as me and my medic were getting him situated in the back. We pull the medic from the second truck to come with us while her basic drove. A PD officer drove our second truck back into town. It was decided by my medic that we would call the local fixed wing transfer service to get them ready and just meet them at the airport to get the guy to the Lvl 1 200 miles away from us, since the rotor would take at least a half hour to get to us, and the airport was in town.

We took off towards town and started our thing. Pads and electrodes on, 1 14g in the good AC, an EZ IO in the good leg. Started giving him a fluid bolus cause his pressure was in the dumps. My medic darted his chest and got a little air out, but not much, which led us to believe maybe a hemo. I cleared his airway with suction and tossed in an NPA, then tried positioning and tossed in an OPA.

I noticed his breathing was getting more and more ragged and irregular, so I double checked with the medics and grabbed a scope and ET tubes. Snap on a Mac 3 and grab a 7.5 w/ stylet. Go in and take a look and I can’t see crap. I suction him out some more and still can’t see anything. Ask for cricoid pressure and finally see that white winking of the cords. I sink the tube, pull the stylet.

Grab the slipstream, hook it up and start bagging. Listen to lung sounds? Yep they’re there. ETCo2 looks good too. I look over the patient, who is looking more like a train wreck every minute. His femur that’s deformed looks like it’s quickly collecting tons of fluid, which between that and the chest would very easily explain his low BP. We get about to the airport when I notice that I can’t feel a pulse in his neck anymore. I look quickly to the monitor and notice flatline (like the monitor making all sorts of noise doesn’t clue us in). My medic starts CPR just as the back doors to our bus open up and the flight team hops in.

Since we’re not sending him by flight we beat feat to the ED and get him in there as soon as we can. They work him for another twenty minutes but never get any organized rhythym, let alone pulses, back.

We take our time cleaning up from that call and get paged out to an 911 hangup call that PD went to and then called us out on. The PD officer sounded frantic which made us wonder what was really going on. We get on scene and find something that goes down as the worst call in my career so far.

“PD, Medic 4, we’re pulling up now, does the officer have an update for us?” I casually ask into the mic, wanting to make sure the scene is still safe for us to enter and see what we might need.

“Medic 4, PD 214, get in here quick, young child unresponsive, trauma related!” This PD officer used to be one of our EMTs back when we were a volunteer agency, or so I’m told, so we know we can usually trust his judgement. Hearing him that upset rattles us a little bit though.

We bail from the unit, grabbing our pedi-board, collar, first in bag and toss it all on the cot. As we get inside we get the story from the officer.

“The husband and wife were apparently having an argument, and the kiddo dropped and broke something. So because the father was upset and the kid broke something he beat the kid until the kid was quiet. Wife called 911 then hung up after she thought better of it,” The officer tells us. We take a look at the kid and my vision goes red.

He is completely unresponsive to us as we get in there. He has bruises already forming on his face and neck, along with old bruises that we reveal when we start cutting into his clothes. He has several lacerations to his face, along with several to his forearms that look like they are defensive injuries. His face appears to have several fractures, but we can’t tell just how bad.

My medic and I work quickly and silently as we get the little boy packaged up onto our board and call our local fixed-wing service to get the boy transferred up to the childrens Lvl 1 250 miles+ away from us. I drive the bus so the medic can be in the back with the kiddo but we wind up staying in the ED to help prep the kid for the flight out. During transport my medic had intubated the kiddo because he had stopped spontaneous respirations, and reported that the kids’ pupil was blown.

The kid was transferred to the flight crew without any more problems and flown to Big City Hospital Lvl 1. I’m still waiting to hear more, I would love to hear that the kiddo would be ok, but I don’t know if he is. He is still on my mind and I can’t get him out of there. It’s just… I don’t know…

Seeing that just shook me to the core. I don’t like kids, but I want them eventually. My ex-fiance and me were supposed to have one, but working in the field made her miscarry, at least that’s what the docs said. There’s another little girl that I would help take care of in a heartbeat if the mother decided she wants to come out here with me. I love them both more than anything and I haven’t even met the little one yet.

What makes this even more like a roller coaster is the fact that the call that I term as the best call of my career. I had my first delivery in the field as a lead EMS provider. It was the most amazing experience I’ve ever had. I helped deliver a healthy little girl into this world without any problems for her or mom. I.. I can’t even begin to put into words how this felt. It felt like it made up for all the bad calls I’ve had since I moved here, all the bad stuff I’ve seen since I became an EMT 3 years ago (BTW, I realized that earlier this month marked my third year anniversary as a certified EMT). It has given me the energy and drive I need to push me forward, to continue on and keep going. To keep on riding hte bus day after day.

Then again, life is like a roller coaster to begin with, and EMS just exemplifies this.

I am one very tired TransportMonkey. It’s been… well, it’s been a week.

 

Some very good calls, and one that left me with a horrible feeling afterwards. And several transfers that really had no business being sent up to the City Medical Center. All in all, not a bad week, really. Even with that one call hitting home in a bad way.

 

One thing I’m finding out about working in this rural area… For the most part, the 911 calls are usually legitimate calls. I’ve seen more people actually drive themselves to the ED for minor things than have called us to take them to the ED. I have run one call that would usually be considered BS. Compared to when I pulled medic internship in NM I could run a twelve hour shift with 8 or 9 calls and they’d all be BS.

 

Our transfers on the other hand… If Rural County Hospital even think it might be a patient they can’t handle, they will transfer them out. Some high acuity, legitimate transfers get flown out on either fixed or rotors. But they will usually turf some calls to us that leave us scratching out heads. For example, these are some of the type of calls I’ve seen, personally, come out of that hospital:

Finger that needs sutures

Chest pain, non-cardiac in origin

Pt needing a lapcholy

Any cardiac chest pain.

Abcessed tooth.

 

In fact one of the medics I ran with joked that the criteria for transferring chest pain patients to Big City Medical Center is… Chest pain. They have yet to keep a single CP patient in the last 9 months.

 

One of our transfers runs an average of 3 hours of time from start to finish. That is if we run into no delays picking up or dropping off the patient, run into bad weather, or stop to eat while we’re there. When you wind up doing three of them back to back with patients that a Lvl4 trauma center should be able to handle, it gets old quick. Especially when the patient gets back to Small Town before my bus does cause the ED in Big City discharges them right away.

 

Add onto this that my department now thinks I’m a gigantic black cloud. In the last two weeks I’ve seen… 5 dead bodies, plus the two I’m gonna tell you about later. Only one of them was a viable code. That’s more DOAs than the agency has seen in the last two months put together. Between that and the fact that we ran a 5 pt rollover along with 7 other calls last night on the 1800 to 0600 shift (that I wasn’t even on duty, just on call for… although I was on duty for 10 of those 12 hours), it just seems like the call volume has gone up steadily as I’m there.

 

Now… onto the call that made me just question even if I want to do this job forever. Don’t get me wrong, I love my job and couldn’t imagine doing anything else, but when I see things like this I question things.

“Son of a…!” I curse quietly to myself as I shocked myself on the battery terminal on my car. One of the advantages of this job is I can try to get my car fixed once station chores are done and no calls are dispatched for us. And since I have gotten stuck at the station during my oncall shift cause it wouldn’t start, I wanna get it fixed so I can got to my apartment and sleep.

 

“DEEEEEEEEEEEEEEEEEE-BOOOOOOOOOOOOP!” I hear the radio on my belt signal the EMS tones. “All EMS Personnel, please respond to neighboring county, rural route highway, marker 20, for reports of several patients with GSW.”

I quickly sprint from the driveway back into the station to slip on my uniform shirt and grab my stethoscope from where it was hanging by our little closet. My partner passes me as I head out to the rescue we’re taking out there. He hops in the driver seat while I pull out our map book.

 

“Rescue 1, leaving quarters, en route code three to call location,” I say quickly into the radio, letting dispatch know that the station was empty. We flip on our beacons and siren to clear the road so we can get out.

 

“How far out are we?” I ask my partner, since I’m not familiar with the area we’re headed to.

 

“Not too far, about 8 miles out.” He replies as he scans the intersections to his side.

 

I return the favor and scan mine. There are only a few intersections before we’re out onto the rural route and don’t have to worry about cross traffic. “You’re clear on this side. Glad to hear it’s not too far out.”

 

“Rescue 1, Dispatch. New update from deputy on scene. Looks like two codes. LEOs are investigating looking for shooter.” Our radio squawks at us, I pick up the mic and answer in return. “Copy dispatch. Advise of any further updates.”

 

We spend the rest of the time running out to the scene in almost silence, punctuated only by conversation when we need to clear intersections or my partner is telling me what he wants me to haul into the scene. As we get closer we can clearly see the area of the shooting, since there are many emergency lights strobing the air. We turn into the street and just see a deputy shake his head at us.

 

I keep my head on a swivel as we pull onto the scene, trying to take everything in at once. I see what looks like two bodies in a heap beside a vehicle. There appears to be family all around the bodies, and PD is doing next to nothing to control the scene. I think to myself that this is not a good looking scene.

 

I hop out as soon as we stop and reach into the cabinet on the outside of the box behind the cab to get the first in bag. I’ve already gloved up just prior to us getting on scene, so that’s one less thing I need to worry about. I walk over to the patients and just from looking from 10 feet away I can tell this is not going to be a workable situation.

 

I look over the patients as I get close. The male patient is lying on top of our other patient, blood spilling out of his mouth with gray matter in a pattern behind his head. Yep, that’s an injury that definitely is not compatible with life.

 

I turn my attentions to our other patient. She is lying in a pool of blood. I get in quick to check a pulse and feel nothing. When I look for where the injury is, it looks like a grouping of 4 rounds right in the area of the heart. I turn the patient slightly looking for exit wounds and see three. My medic makes the call not to work the patient, and I have to agree, since it looks like the rounds most likely took out the heart and pretty much her entire blood volume is in a puddle under her.

 

We get up without opening our bags, being careful not to contaminate what is now a crime scene more than we have already. When the family sees this they let out that sound. That god-awful sound that I have only heard a time or two in the past. A sound that I could go the rest of my life without hearing again it it would still be the worst sound I’ve ever heard. It’s the sound of realizing that someone they love isn’t going to be getting up off the ground. I’ve heard it most commonly called by other EMS providers as ‘The Wail’. It’s probably the most disturbing sound that you can hear while doing this job.

As we get up the family that is surrounding the scene starts to surge in towards us. They are upset that we aren’t doing anything. They feel like we’re not doing our job. Then I see something that just breaks my heart. The victims two small children (both elementary age) kneel down in front of their parent and just cry. It’s not a sight I don’t think I’ll ever get out of my mind.

 

There are some days that this job really sucks

 

 

So… yea. It’s been one hell of a week. The last two weeks I’ve racked up over 100 hours of time on duty, plus 80 or so of on call hours. And tomorrow I have to head up to the city to turn in my application for medic school that starts in January. I need to find something to do to distract myself from work. That’s the only downside to working in a small town.

 

Ya’ll stay safe out there.

 

 

 

 

http://transportjockey.com/2010/11/16/165/

Rural EMS can really suck sometimes

“Dispatch will be changing frequency to dispatch ambulance.”

As I hear those words I grab my boots and quickly slip into them and start running, carefully, down the stairs. I know from experience, quite painfully actually, that if I don’t pay attention while going down these stairs, I’ll wind up head first heading towards the floor. I quickly grab my steth and hat off the table where they lay after we got back from our last call.

“EMS, EMS, Ambulance requested in tiny south-county town. Called in as a difficulty breathing. Deputy is responding to scene,” The radio on my belt squawks. I stop and think about where exactly they’re sending us. I can’t recall that little town being on any of our response maps.

“EMS to PD Dispatch, copy call, clear page,” I say into my radio as I pull it from my belt. I head into the bay and hop into our rig. The senior medic I’m riding with is right behind me. We start the rig up and he flips the lights and siren on as well pull out of the parking bay.

“Hey, OldMan, where the hell are they sending us?” I yell over at my partner, while flipping through the map book trying to see where we’re headed to.

“It’s just north of SmallerTown. Usually their vollies will cover that area, guess they can’t raise anyone again, so we’re covering the county,” He tells me as he scans the road ahead and to his left as we blow through town. He gets on the radio to ask dispatch if the volunteers are responding at all.

“Negative on that, EMS. Volunteers are out of service today due to insufficient crew available. SO is sending a deputy out to assess the scene for you. He should be there in ten minutes.”

“Copy that. We have an ETA of 45 minutes to the scene,” my partner tells them, shaking his head in frustration.

The South Town Volunteers might only be BLS capable, but they could still make a difference in this call if it’s anywhere near serious. But since they are unstaffed, a common occurrence lately from what I’ve been told, the patient has to wait for our EMS service to show up. Since we are a paid department, and the only other EMS agency in the county, we are always staffed. Luckily.

We hit the highway once we’re out of town and OldMan gets on the gas for all he’s worth, trying to get there in time. It’s a long trip there, even running flat out with lights and sirens. Luckily it’s pretty much all flat and straight till we get into Tiny South-County Town.

“Dispatch to EMS, SO reports that the patient is not breathing and has no pulse. He is starting CPR.”

“Shit!” My partner curses in the radio’s general direction before picking up the mic. “Copy that dispatch, get EMS2 rolling once they get into station.”

“EMS2 to EMS1, copy direct,” The voice of the OldMans son comes back, since he is the on call lead today. “We’re rolling now.”

Thirty minutes still till we get to scene. No telling of how long the patient has been down. This could wind up not being fun at all. I just hang on and watch the terrain fly by to either side of us, keeping alert for cross streets so I can tell my partner if something looks like it’s gonna come out in front of us. I know what to do if we have to work a code, so I try to relax and just be ready.

As we pull up on scene I notice it’s a single family dwelling, with a slew of vehicles parked in front of it. This gives me a little hope that maybe we got called the minute something started to go wrong. There’s also a deputies truck parked in the driveway with it’s lights still twirling. I quickly glove up and grab the first-in bag from the side compartment behind me. I see my partner grab the cot first thing.

“There’s that working a moving code mentality again.” I think to myself.

We rush inside the residence and take a look. The deputy is in the middle of the floor of the living room with an AED attached to the victim, while performing CPR. I see a face mask there too, so it looks like he’s been doing everything right. Judging his compressions I see that they are good, solid, and deep. Perfect.

The OldMan has him stop and he does his quick assessment. By the way the body moves when we roll it, this person has been down a hell of a lot longer than 45 minutes. As we look at their back we notice lividity present as well. We both look at each other and shake our heads. As he talks to the family to get the story, he motions me to talk to the deputy to get his viewpoint since he got there.

The family is of course not happy with us when we do not continue CPR. They are mad at everyone, especially us, for how long it took their call to go through. It sounds like they tried calling the Small Town Volunteers station to try and get response from them for about a half hour before calling 911. They told the dispatcher that she wasn’t breathing. So why did we get paged out for difficulty breathing? Ya’ll know dispatchers as well as I do. Guess.

Apparently the family thought that calling the vollie station was just as good as calling 911. And they couldn’t figure how the station could be unstaffed in the middle of a weekday. They apparently weren’t happy finding out that the vollies have real jobs and don’t have the staff to maintain a crew 24/7. They were blaming us for taking so long to get there from town, even though it’s impossible to get there faster than we did.

The deputy said he got there and started CPR as soon as he checked for a pulse and got none. He never thought to look for rigor or lividity, but then again that’s not his job. I get some more information from the deputy for our report and watch as he goes to call the JP and make arrangements.

I meet up with my partner again after I finish loading the cot into our rig and put the bag back in the side compartment. As he sees I’m done putting things away he asks, “Still so happy to work in a system like this?”

———————————————————————————————————

This is the first time working here in Rural Town, TX that I wanted to pull my hair out. I wonder if this will be the call that gets the county and my town to decide that our service needs to spread to cover the entire county and needs a station down south in Small Town. In a situation like this it might have made all the difference.

How do I do it?

I’ve been a black cloud the last week. Both at my volunteer spot and the moderately sized hospital I work at.
Last Saturday, wow was it only a few days ago?, I had one of the hardest calls I’ve ever had to help with. We intercept a BLS crew so that our magical ILS skills (sarcasm) can save the day. Apparently it was a charlie-foxtrot from on scene till we get to them.
6 month old baby. A little girl. Apparently her drunk parents were arguing with her in the vicinity. Words were said, ancestries questioned, tempers flared. What also flared was a .45 caliber pistol. The husband wasn’t pointing it at his wife, he said it ‘just went off’.
Now, as anyone who knows anything about firearms can tell you, a loaded pistol does not just magically go off! And if it’s a 1911 like the one that discharged, there are several steps to take before it will fire. 2 separate safety systems, and in some cases three.
Anyways, the stray round hit this baby that was laying in her crib. Hit her near her right scapula. I think anyways. By the time we saw her, it looked like such a large gaping hole in the baby’s shoulder that we weren’t exactly sure where the round went in.
The BLS crew did what they could. Pulse? below 60 but palpable. Start compressions. Breathing? Not enough, start bagging. Wait. Do we have a bag that size? Look! Call for intercept! County EMS not available? Any volly’s that can meet us?
And this my friends is where I come in. It took my ILS truck (me on an ILS graduate license and my partner who has been an ILS provider for 2 years) almost 20 minutes to intercept with the BLS rig who was running flat out to meet us. Another 35 minutes to the Lvl 1 trauma center.
Hop onto their rig. SHIT! This doesn’t look good. Have my partner hop back with us. BLS truck has 3 providers? Good. One dive my truck, one drive theirs, one bag.
Baby is a pasty color, blood is all over their stretcher. The wound has been dressed as well as can be, but it’s starting to bleed through. Another trauma dressing is slapped on and taped in place. Lung sounds? With my adult steth, hard to hear. Sounds like air is moving in both sides.
Lines? None of course. Look for a vein. Nothing happening. Where’s the Jem-shidi? There it is. First time I’ve done one of these. There’s the pop. Aspirate! Some marrow return. Good. Secure it. Lets see…. Braslow tape out. Got a weight. Quick figuring. First bolus is running.
We’re too far out. Call dispatch. Is there a flight team available? None? Ok then we run code into city to the Only Trauma Center in the State, luckily only 30 more minutes away.
Put the kid on a 4 lead. Sinus. Brady. Very Brady for a kid this age. Still doing compressions? Ok keep em up. Oh hey I should spell you for a bit. Keep it up.
Another bolus going in. Good. Let’s give OTCITS as much notice as possible. Let em know we’re coming and what we got.
Report given. Reassess what we got. Good brachial pulses, but still too low. Airway is open and we’re bagging. OPA in place. We have an IO in place and running a bolus. No way of telling BP, out smallest cuff is too big for her. Can we secure the airway better? Nope, nothing that small except ETT, and we can’t use em.
Any spontaneous breathing? None?! Well keep bagging. Monitor. Still Sinus Brady. Call for orders for a third bolus and permission to start 2nd IO. Third bolus yes. Second IO, no.
Hey, there’s the city limits. OTCITS should be coming up soon. Pulses? None?! Great. Monitor? Asystolic… Not good. Full on coding the kiddo now. Have I mentioned I hate Peds yet? Well I do.
Hey we’re pulling in. Trauma team waiting for us. They haul ass iwth our gurney to the trauma bay.
Tell em what we got.
“6 month old, single GSW right shoulder area. Single exit wound. Went pulseless and apneic on us right before we pulled in. Single IO established. Epi given per protocol once asystolic. 3 boluses in. OPA in place.”
They work the little girl, the one who could have had a long and productive life ahead of her. The one who should never have found herself in this position. The one who’s parents are going to have to live with this for the rest of their lives.
After 20 minutes they call her. I feel my shoulders slump as I walk out. Gotta get our truck cleaned… Or in this case help Tiny Town BLS get theirs cleaned up. Time to go. Back to quarters. For more of this. Great. I hate ped calls.

That was my weekend shift. Last night at work was fun too.
Sitting with two patients because they were both in for SI. So someone had to watch them. One was very aged and not doing well. He coded about midnight. So while I was busy starting to call the code and doing compressions, his roommate decided that it woudl be a good thing to pull out his IV. And his Foley… Balloon inflated still. Talk about bloody. I’ve seen less blood from a GSW. So it was not a good night.
My first patient last night wound up being called about 30 minutes from when he coded. He did too much damage to his body over teh years with all kinds of drugs. Funny thing though. I don’t feel nearly as bad, if really at all, over this one as I did the kid. Two lives gone, but one seems to hit me worse than the other. I guess that’s life.

I’ve just had a bad week and needed to vent a little. The ped call still has me a little worked up over it. That was not a pleasant scene… But then again I know it was probably harder for the BLS crew that worked it first. Lord knows what I would have done to those ‘parents’ had I been in the room with them.

Interesting

Well, I wound up going to a funeral w/ my ex-finance (promised her I’d go before we split up) and got a very big shock when we got there…

The man who she has known since childhood, laying there in the coffin, was a man I have transported many many times over the last 6 mos going to and from cancer treatments. To say the least I was blown away. I didn’t think I’d ever go to a funeral for a routine transfer pt, especially one who two months ago, I was given report saying he was doing much better.

To think that a month ago (when I transported him last) we were talking and exchanging stories like we have been for months. Turns out he graduated exactly 70 years before I did, from the exact same high school. I got to hear very cool war stories from his experiences in WWII, got to talk to him about politics, about family, about every topic I could think of. In short he became a friendly face I would see.

All these thoughts just ran through my head at the funeral, and I couldn’t help but shed some tears. My ex thought I was crazy until I told her what was happening. Then she told me that she too had transported him, but thought that the night shifts would never have done that.

I had a chance to talk to the family, and low and behold, the daughter-in-law and son both recognized me on the spot. Might have helped that I was still in uniform from just having come off shift. They told me that he liked our times transporting him because someone finally treated him as more than just an anonymous face. Turns out that he would request my crew specifically. And he said that he was honored that no matter how busy we were, we were always polite and respectful when we showed up for him. And I set a record by transporting him on a day shift 6 times in one day, and each of those was a fun and interesting transport.

I saw him progress from a man that could walk and laugh deeply, to a fragile looking, older gentleman who needed help from the bed to my gurney. He still had that same sparkle in his eye no matter what was going on, and that was there until the very end when I transported him for the last time. I don’t think I will ever forget that face or those eyes. They always seemed to bore into me no matter the topic of discussion.

I knew I would watch people slowly fade away, but for some reason I never thought it would be him. My brother asked me once if I would ever get a normal job (heh!) and I think I know now the reason. If I didn’t work this job, I wouldn’t be feeling this hurt over the situation, but at the same time I never would have been able to comfort and talk to this man in all the time I spent with him in the back of my rig. I never would have learned how he felt when his son married, or when he help his first grand child.

So, no matter what, this kind of reinforces why I love my job so much, no matter how trying it might be.

Yes, I know I rambled, but it’s my blog, so I’m allowed.