Ain't Lyin'

On Wednesday I brought him to the hospital. It wasn't the first, second or fiftieth time.

"How have you been, Mo?"

"The same."

"I haven't seen you in a while."

"Been livin' with my sister."

"Beats living on the streets."

"Got that right."

I've known him for years. Can't say I like him, but he never gave me much trouble. He's a big guy, three hundred pounds at least and well over six feet. We used to pick him up from the same corner, drunk, usually, and either take him to the shelter or the hospital, depending on his level of intoxication. He's living in a three decker for now, on the third floor with some family members. It's not a nice place, far from it. People sleep on the dirty floor, relieve themselves in the dirty bathroom and eat in the dirty kitchen. The stairs are dark and in disrepair, sagging under my weight. Mo is a diabetic with heart problems. Most of his fifty-five years have been hard ones.

"Have you been drinking?" I asked.

"Ain't lyin', I been drinking."

"Diabetics shouldn't drink," I said, he smiled and rode to the hospital in silence.

"I hope he doesn't die up there," I said to my new partner, Adam after we dropped Mo off. "Be a bitch getting him down."

Last night at 0330 hrs I found out just how hard it would be. Despite our best efforts we never got a pulse, he was pronounced dead at Rhode Island Hospital at 0417hrs. He really died on his dirty bathroom floor at around 0325 hrs. At least he didn't die on the street.

The Handover

Check out "The Handover," a blog carnival started by Medicblog999. http://medicblog999.wordpress.com, or click the title.

Luncheon Special

Intoxicated man #1 sat quietly on the bench, appearing to doze. Heroin? nah, just tired. The safety belt kept him upright, without it he would be on the floor. He had been sleeping peacefully next to a dumpster before a concerned citizen with a cell phone intervened.

As usual, we were out of rescues. There must have been a luncheon special somewhere offering free 1/2 pints of vodka to homeless people. Four out of our six rescues had been dispatched to pick up "intoxicated males."

Another call came over the radio, this time Engine 13 with a Cranston Rescue. Another intoxicated male. He was on our way so we cancelled the out of town crew and grabbed him, a mid-week two for one special.

Intoxicated man # 2 was sprawled out on a sidewalk. Another regular. We put him on the stretcher, keeping some distance between him and # 1. They fought with each other anyway during our ride to Rhode Island Hospital; I sat in the captains seat filling out the paperwork, my two passengers occupied for the moment. At least they weren't fighting with me.

When Eisenhower was President

He lives by himself in a ten room house on Lexington Ave. Eisenhower was president when he moved in. A lot has changed since, the tree lined street used to be home to wealthy families, back when south Providence was THE place to live.

"Used to be quite a place," he said to me on the way to the hospital.
"It's coming back," I answered, sounding more hopeful than I actually was.
"Never be the same."

I guess it won't. He had been vomiting since this morning, couldn't eat, was worried dehydration was setting in.

"Sorry to bother you fellas," he said while seated on the bench after walking from his home to the rescue.

"You're pretty spry for an old guy," I mentioned, impressed with his vitality. This was call number thirty since 5:00 yesterday afternoon. In that time I had carried people in their forties from their third floor apartments because they had the flu, extricated people in their fifties from their cars after fender benders and pretty much served as a taxi for kids with fevers. Besides a few barn burners and three or four people who actually needed us Rescue 1 could have been Taxi 1 and nobody would have noticed.

"Well, I walk every day," he said. I imagined him walking the same streets he did when he was a young man, when Eisenhower was President.

It must break his heart, but you would never know it. I asked him about the old days during our short trip to the hospital, he willingly obliged. He was born in 1927, the same year as my father. Had he lived past sixty-one I bet he'd still be walking around the neighborhood telling me stories about the old days rather than the stranger in my truck.

Stranger or not, I'll take it. Thanks William. A goodnight, dad.

Three Days, Three Fires

Oliver at Engine 11's pump panel. Three lines in operation at this time. This was our third house fire in as many days. Fire under control in 45 minutes. Nobody was injured.

These amazing high quality images are provided to us from a rare Kalaidachrome 45 mm Zoom Cinemascope Camera... Special attention and meticulous care was taken during the filming and subsequent editing to achieve the illusion that the cameraman was actually there, using a cheap cell phone.

Somebody's gotta do it!

Afternoon Blaze

I arrived at the fire scene a minute after the first in companies. Plenty of trucks littered the fireground, not many firefighters. Ladder 5 was busy preparing to "get the roof," somebody was at the pump panel of Engine 10 and the Chief directed the operations from side 1. Everybody else was inside, mounting an aggressive interior attack.

It's strange being on the outside. I fought fires for ten years, seven now on the rescue. We treated three firefighters and a civilian for a variety of fire related injuries and could have treated many more if I didn't work with a bunch of mule headed people who don't know enough to stay down after taking a beating. The officer of Ladder 5 took a piece of roof planking to his head as I walked past him. The smoldering debris fell three floors before landing on his head.

He stumbled for a few moments, regained his balance, found his haligan among the debris and walked back into the fire.

Nobody listens to the rescue guy.

Minimum Manning

The Governor of Rhode Island, Donald Carcieri has proposed a supplemental budget to the General Assembly for passage. If passed local city and town officials would have the power to staff their respective police and fire departments on an "as needed" basis.

In my opinion, as stated in the Providence Journal Editorial (click the title) this is the same as allowing politicians to run a war from the safety of their office.

Language Barrier

Tommy lie on his back on an Oriental rug in a home in one of the poorest sections of Providence. His mechanical wheelchair sat idle a few feet away. His mother tried to explain what happened, when she stumbled one of the guys from Engine 14 translated for her.

"He was getting off the bus like he does every day. She didn't see what happened but he started crying. The driver stopped the lift but nothing was wrong, then lowered him to the ground and she took him home. She thinks something is wrong with his left leg,"

I kneeled next to him on the clean rug. What little these two had was kept immaculate.

"Does he understand?" I asked Tommy's mom. She didn't so the firefighter translated.

"He's mentally delayed, has good days and bad, usually he is very happy, never cries or complains."

I felt Tommy's legs, looking for deformities. I tried to straiten them out, then noticed the braces sitting next to his wheelchair and thought better. He was helpless, staring at me, then his mom then me again. Words between them were useless tools, their language understood by them and only them. I got a small taste when Tommy's eyes locked on mine.

He cried out when I touched his left knee, I didn't see any swelling but I just couldn't tell, and Tommy couldn't tell me. We wrapped him in a blanket and carried him outside. A bunch of kids stood at the door, eight, nine and ten years old, and formed an honor guard as we carried their friend; or if not their friend the kid in the wheelchair who lives on the corner into the rescue.

We rode to the hospital in language barrier silence. Me, English with a little Spanish, her, Spanish with a little English and Tommy with no language at all.

Except for those eyes. What goes on in his mind is a mystery to me, but I have a feeling his mom knows everything.

Money Troubles

"Bodies dropping, you think it's funny. I got somethin, you wait and see, been wantin' to shoot for a while now," he said, sitting on the bed in an upstairs bedroom. He was big. Bigger than me anyway, dressed in military fatigues.

"I got somethin for you all, what you think I can't, I been fightin since I was ten."

"We have to take you to the hospital, your family is concerned," I said in my best, reasonable, I'm your pal voice.

"I don't need no hospital! I need to get rid of you!"

As soon as I saw him reach into the dresser I started my retreat. Graceful it was not. In my mind I always go down with the ship, in reality I'm dressed like a woman and acting like a child watching the ship sink from the safety of the liferaft.

Negotiations had ceased at this point, our patient's wife and three kids waited on the first floor, hoping that by calling 911 their husband and father who suffered with bi-polar disease would go peacefully. He had been acting strange for a few days, tonight he "went off the deep end," was making no sense and scaring the family.

"It looks like a BB gun," said Steve, standing in the way.

"And you look like an idiot," I said, pushing past him to safety.

One police officer had been upstairs, saw that the situation was going to take more manpower and was outside radioing for help. Three officers stood at the foot of the stairs when our patient descended, walking backward, holding a handgun behind him.

For a few tense moments I watched, frozen. A man had just been shot in a confrontation with the police in North Kingston. I did not want that to happen here.

The man kept walking backwards, one of the cops quickly disarmed the man. he was fairly reasonable after that, we took him to Rhode Island Hospital for a psycological evaluation. While enroute he told us he was having some money troubles.

medicblog999

Many thanks to medicblog999 for saying what I have been unable to. Click on the title to visit him and his colleagues in the UK.


A Successful Resus?
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Michael Morse over at Rescuing Providence tells us about a job he recently had with an 11 year old child in cardiac arrest. Amazingly he and his colleagues managed to get him back and delivered him alive to their ER.
His post brought two thoughts into my head. One I will post about now and the other I will write about at a later date.

Reading through the comments to his post, it is all very positive and everyone (me included) is saying what a great job they did. Then, at the very end of the comments he informs us all that unfortunately the boy died the next day.
This almost changes the feeling from ‘what a great job’ to a ‘horrible job’. Which brings me to my point:

What makes a successful resus?

There are many different definitions of this, the most common is the ROSC (return of spontaneous circulation). This means that the patient has recovered from cardiac arrest and now the heart is beating by itself again and producing sufficient pressure to palpate a pulse. The patient may still be unconscious and not breathing but this is still classed as a ROSC.
Personally, my own definition of a successful resus is only when I hear that the patient made a full recovery and was discharged back home to their family to continue their lives. These are VERY rare but wonderful moments when you can really say that you have saved a life.
The vast majority of the time, the best I can hope for is a ROSC and a short stay for the patient in an intensive care unit before they die or have their ventilator turned off.

They will never regain consciousness.

Is this really a “successful resus”?

I would argue that it most definitely is. Agreed, we have only delayed the inevitable death of the patient, but what have we done for the family?

Instead of family witnessing their loved one drop to the floor suddenly, without warning and that being their lasting memory of their death, or getting a phone call from the hospital, or a visit from the police, they now get the chance to see their loved one for a final time.
They get the opportunity to say goodbye, they get the opportunity to say how much they love them. If they are religious, they get the chance to pray or have the last rites performed.
The success is now in the shape of what you have done for the family, and that is a gift that is beyond any statistic or performance indicator or successful resuscitation’s.

As far as Michael, his colleagues and their 11 yr old patient. Well done!!

His family will never forget what you all achieved for them!

Heartbeat

The kid was alive when Engine 3 arrived, but died within minutes.

"Engine 3 to Fire Alarm, eleven year-old male, code 99."

"Rescue 1, received,"

I put the mike down and put on the gloves. My new partner, Adam picked up the pace, instinctively knowing this was the real thing. We arrived on scene thirty seconds later, entered the home and saw CPR in progress.

"He was breathing when we got here, then he stopped and went pulseless."

We put him on a backboard, continued CPR, picked up our equipment and patient and carried him out of his home, through a snow squall and into the rescue. His mother sat in the front, peering back as we worked. The monitor showed asystole, no shock advised. Joe worked like a madman trying to find a vein while Donna and Adam did CPR.

"What medical condition does he have," I asked his mother, trying to keep my voice steady.

"A neurological disorder that causes seizures. He was at the doctors today for trouble breathing."

She sounded calm, I think she was in shock. Joe found a good vein, and sank the IV.

"Go," I said to Ray, a new guy who was in the drivers seat. He sped toward Hasbro while we continued to work. One round of Epi, pulseless. We tried an Atropine; nothing. I attempted to tube him, the potholes made it difficult, I failed then picked up the phone.

"Rescue 1 to Hasbro, I've got an asystolic eleven year old male, CPR in progress, IV established, ETA two minutes."

The doctor on the other end of the phone asked a few questions. I gave the answers best I could then hung up the phone. Another round of Epi was ineffective, we brought him into the ER and transferred care to the medical team that had gathered. I gave the story and stood back, watching them work.

Five minutes passed. More Epi, Atropine, them Sodium Bicarb. I gave up hope. The room was a flurry of activity, noisy, a little chaotic. I saw the boy's parents outside the door, the mom now crying, stunned, the father now in shock.

"We've got a pulse."

"The room went still. Sure enough a rhythm appeared on the monitor, sinus tach. A few minutes later I saw my patient open his eyes and look around the room.

It's kind of strange what happened next. I was fully prepared for him to die. Whatever it is we have inside us making it possible to do this job was in full operation. I didn't feel anything, not sadness, despair or frustration. I knew we did our job, and the outcome was out of our hands. I was at peace with that.

Whatever it is that allows us to do this job disappeared as soon as I heard he had a pulse. When I saw him open his eyes my own eyes filled with tears. It was strange, but I'll take it over emptiness any day.

It's good to know I still have a heart.

Strength and Experience

He sat in a chair in the corner of a once white bathroom, surrounded by attendants, skin as white as the walls were before being covered with his blood. The coppery taste in my mouth and sticky feeling on my skin connected me with this patient, whether I wanted it or not. His neck was sliced open, blood oozing from the one inch laceration that missed his jugular by a fraction of an inch. His right arm was split open, just missing a major artery. His left arm bore the brunt of the self-inflicted attack, blood pumped from the wound in perfect rhythm with his rapid heartbeat. He must be right-handed, I thought, applying pressure to stop the blood loss.

Somebody from the staff at the psych ward inflated a blood pressure cuff above the wound, probably saving the kids life. A flow of water continued to run from a sink in the corner, overflowing, mixing with the pool of spilled blood that covered the floor. Sheets were thrown down, absorbing some of the mess, turning the starched and bleached bed coverings into pink sponges. They squished as I walked over them, toward the patient. He was fading fast, hypotensive, major blood loss and losing consciousness.

We dragged the chair he sat on while carving himself toward the door, lifted him onto our stretcher and wheeled him past the secured doors toward Rescue 1, three floors below. From there it was business as usual, the chaos we left behind would sort itself out eventually, I was in my zone, with people I knew I could count on.
We replaced the 22 gauge IV somebody from the hospital had started in the kids bicep with a large bore IV, loaded him up with ringers and 02 and rolled toward the trauma room at Rhode Island Hospital. The fluids and 02 did him good, he became combative en route, but not nearly strong enough to do any real harm. The crew from Engine 10 helped restrain him during the five minute transport.

We transferred care to the Level 1-A trauma team that had assembled, BP 83/30, HR 140 or thereabouts. Before I left for the next call he was intubated, medicated, stable and in the operating room.

I can't help feeling great as I write this, nor do I want it to stop. Somebody is alive right now that would be dead had we not shown up with the right blend of strength and experience to do our job. To enter a blood splattered out of control scene and restore order to the madhouse while giving somebody a second chance is not something to be taken lightly. Having a capable team waiting to take over is equally important. I'm honored and privileged to be part of all this, and I thank everybody who participated in saving this patients life.