I'm changed

There are few things experienced in this job that leaves more of an impact on you than losing a pt. I've lost probably just as many as any other medic out there. You can lose a pt to anything, heart disease, cancer, COPD, sub-dural bleeds, respiratory arrest... well, you get the picture. When you lose a pt to trauma, however, it changes you. Every one you experience changes you. You learn that human beings can die in some of the most horrific ways imaginable. After today, I can tell you I have seen them all, or at least seen the tragic results of them. Before I get too involved here, let me outline the last two days.



I went into station 1 yesterday morning. I got to drive Engine 1 until noon, when our shift inspector came back to work. We didn't have any calls, but we tested 15 hydrants, so I got allot of driving time. It was a good, laid back start to a back to back for me, which is a 24 at the FD, off at 8am and on the ambulance at 8am. Little did I know what laid in wait for me. After noon, I was switched to Rescue 1. At 12:15 we had a call for a pt who is lethargic, no further information. We arrived to find a male pt very lethargic, very diaphoretic. So sweaty the ECG patches don't even stick. It has been my experience that when you can"t get patches or tape to stick to the pt, they either are having "the big one" or they were involved in the "big one" or "the big one" has burst. (A heart attack, a car accident or trauma, or an abdominal aortic aneurysm) So this guy was so weak he couldn't keep his arms on or in the cot. A bradycardic rate of 52, coupled with the diaphoresis, and weakness made me think this guy was in trouble. Pacing would have been an option, however we were 3 min from the ETC and by the time we got a line, twelve lead and called report, we were there. I left after pt care was turned over, walking out and laughing because I didn't have to restock the ambulance, make a cot, nothing! Being a medic and riding rescue is pretty damn good! We had a defensive driving class for the afternoon. The class was interrupted a couple of times due to a fire alarm and one medical call. Engine 3 and Rescue 2 took care of that. Back to the station and dinner! I had a pound of hamburger fresh from the store that morning, but only two cibatta rolls..... The answer to my query: make two 1/2 pound burgers! Great, with American and blue cheese, BBQ sauce... We eat pretty good at the fire dept. While waiting for my giant cheeseburger to digest, the captain received a phone call, asking if we could see the tall column of thick, black smoke in the south part of town. Sure enough, we could see it and it was inside city limits by the look of things. The smoke had some pretty good velocity to it, so I was expecting a hydrocarbon fuel fire or something like that. When the tones hit, we were already heading to the apparatus floor. The call came in like this: "The corner of 31st ave and Main street.... for a bonfire or a boat fire, we have had both reports" I assumed that the boat fire was the big weiner..er....winner. Upon arrival, we see allot of fire behind a wooden fence, and numerous bystanders yelling that a boat was on fire, and there are fuel tanks in the area. The fence was taken down in short order, to expose a 12 ft fiberglass boat fully involved, and the area was littered with black, 5 gallon containers marked "flammable" on them. Nice... real nice. An 1 3/4 line with A foam was put into service, and made a good knock down. I came in with a 10 lb dry chemical extinguisher and put the rest out. While heading into the yard, and going around the boat, I noticed a wheelbarrow in my way, which I swiftly navigated with my cat like reflexes... However, when I came back out the same way I noticed about 4 inches of a liquid in it. I thought it was water, after all we dumped 250 gallons back there. So I knocked the wheelbarrow over. I was hit with such a heavy blast of eye watering fumes I almost fell backwards. The wheelbarrow was filled with paint thinner. I am sure Mother Nature is pretty pissed at us for constantly interrupting her "natural selection" process. Anyway, the truck was packed, we cleaned our gear, watched "Sons of Anarchy" on FX, which is a great show, by the way. Off to bed, I didn't get woken up until my alarm went off at 6:30am. It was a pretty good night.



Off to the ambulance for 10 hours today. I was working with a basic, which I find gives me a sense of clarity and urgency. I know I am it. No other medic to back me up. I have no know it all. After a routine transfer or two, we were sent by 911 to a nursing home here for a pt who is unresponsive, but breathing. Upon arrival we found a female pt who is truly unresponsive. She is a "frequent flyer" but not for the reasons most people achieve this highly stupendous moniker. She has respiratory illnesses, and is diabetic. When she is having a "bad day" she doesn't call us or allow her husband to call us until she is so bad her "bad day" would kill a lesser person. But today, she can't tell us what is wrong. I gathered the facts, and decided she has had difficulty breathing with no oxygen (at home she has a 20ft leash) for the morning. Sats were in the 70's before staff placed her on a simple mask set at 10 lpm. While searching for a suitable IV site, I surmised that IV placement would not be very prudent at this time. I contemplated an IO, but hesitated because of the age of the pt, and not wanting to crack her tibia. (we still have the old style IO) CPAP was the answer. Continuous Positive Airway Pressure. It forces any fluid in the lung out and across the aveoli so they can fully expand and exchange gases like they are designed to do. The pt went from pale, clammy and lethargic, to warm, pink, dry and talking to me at the ETC. I love using new or underused protocols. It challenges me to wrap my mind around the concept, to fully understand it, to know it so well, that it magically comes to me within 30 seconds of pt contact.



Back to the station, for about 20 min. Then off to intercept with a BLS ambulance service north of us, the pt is having a "heart attack." I am very leery about the phrase "heart attack" since, to the general public, it means either someone who is having chest pain, or is coding. I've been caught off guard before. When you walk through the door expecting an old man clutching his chest, pale cool and clammy, and you are met with a neighbor preforming compressions, the "pucker" factor ratchets up a bit and you are thrown off guard. I know I have shortchanged some pt's who have thrown me off my guard. I am still trying to get to step 1 when I should be at step 4 or 5. It happens to all of us. Either way, the pt was in A fib.... for the past three days. Chest pain for three days and she calls an ambulance now? I thought this lady on the cot must be having real chest pain. A rapid A fib rate of 148, with hypotension is cause for concern. The one problem, the one I thought of, was that if she has been in A fib for three days, she might have a clot in the atria. If she converted to a normal sinus, she could throw the clot, maybe have a stoke. Disaster averted. I'm glad I paid attention in medic class.

So, you've seen it coming, the part of my day that changed me. Today, I had a call to a local park, to stand by for a suicidal pt. We went, arrived on scene, and waited, oh about 2 min before the radio came to life. A man shot himself, one .38 round, in the mouth, through the brain and out the apex of the skull. I've been here before, a call for the aftermath of the act. We show up, pronounce the pt, turn our names over to the cops, and take care of our secondary pts. The family. I really hate dealing with family. The pt becomes more than a dead body. You are now forced to listen about their love of hunting, or kids, or how they had their whole life in front of them. They become a person, and it becomes real. You are exposed to the grief, the pain, the disbelief of what just happened. This is usually where you are changed, where it hits you. I remember most of my calls where I lost a pt, or they when they were gone prior to my arrival. The ones that involve family and the really gruesome ones still stand out, these are the ones that changed me. I can't drive past a cross on the highway shoulder, a simple one story slate blue house, or now, a park where kids play and families gather for summer open air concerts, without being reminded of the horror I was a witness to.

But today was different from every other call I've been on. The difference? I was only 3 minutes or less from the extraordinary incident that claimed a mans life. He was leaning over the picnic table. There blood on the table, ground and around his face and arms. My immediate concerns were his pulse and airway. Pulse was good, 100 and strong at the carotid. The airway was being compromised though, by the amount of blood exiting the mouth. Only one thing to do, secure the airway. Two IV's and three attempts at a drug assisted intubation, the pt was intubated successfully, as we pulled into the ETC. You get a good feeling when your training comes together, when you adapt and overcome, you rapidly place another iv when your first gets pulled out, or when you draw up a medication and it spends about 4 second in the syringe before being pushed. But when it is all said and done, there are somethings you don't walk away from. Severe penetrating head trauma is one of them. Knowing you moved with skill, and actions that seamed to be far ahead of your thoughts, and still having the same outcome you feared and the pt desired, humbles you. Like I said, I was changed today. I saw a man, who shot himself in the head, die. I saw the immediate after affects; the blood, the bone fragments, the grey matter. I saw the look on his face, and was witness to the labored breathing, I heard the choking, the gurgling, the harsh expiration through the mass of blood and bone that now occluded the airway. I smelled the gun power. I was there.