The Handover, July Edition

http://traumaqueen.net/?p=1154

Check out this month's Handover Carnival, graciously hosted by Trauma Queen.

Another great job!

And while your at it, the last Handover, hosted by Basics Doc is worth a visit as well.

http://basicsdoc.blogspot.com/2009/06/handover-carnival_22.html

Beatings, Babies and Butter

"Did they put butter on your head?"

She looked at me like I was crazy. Thirteen years old, tough little girl, just got jumped by a crowd of people. There was a fight planned, supposedly one on one. Two girls settling whatever differences they had. Not my idea of the right thing to do but then I don't live in the inner city.

"Butter. Smear it on your head."

Her face was scratched and bruised, shiny. She lay on the backboard looking up, the c-collar uncomfortable but bearable. A few minutes ago she sat on a chair on a porch on Adelaide ave, surrounded by family members. There must have been fifteen women crowding her, speaking rapid-fire Spanish. I stood at the bottom of the steps and finally made eye contact. She wanted out of there.

I waded into the sea of breasts,(I do love Hispanic women in summertime!) crouched to eye level and asked her what happened. We walked to the rescue, followed by her mom and two of the breasts that belonged to her aunt. The family sat on the bench seat as we rode to the ER. Normally I despise Prairie Avenue because of the potholes and craters, today all the jiggling wasn't so bad.

"Why would I smear butter on my head?" she asked.

"Because, last night we picked up a baby who had fallen out of her baby carriage. Her mother smeared a pound of butter on her head before we got there, I think to reduce the swelling. Her hair was all clumped up and sticky, she looked like a little alien had landed."

I did my best alien impersonation. The two ladies on the bench cracked up as they watched their sullen thirteen year old laugh like a little girl again. It was nice to see her without the game face these kids have to wear to survive.

And I thought the butter was a waste of time. It may not have worked for the baby last night, but it did wonders for Auriella.

Shutout

The gods are smiling on me and all is well in the universe. For the first time this century, (well maybe not the first, but the first I can remember) Rescue 1 pitched a shutout after midnight last night. Four calls between 1800 hrs and 2359 then lights out. Zilch, Zero, Nothing!

Just when you think you have had enough a little tidbit comes your way and lets you think anything is possible. A little dramatic I'm sure, but what the heck, I really needed that!

That'll Teach Em'

http://proems.blogspot.com/

What else can be said?

What the Heck is Liquid G?

http://theemtspot.com/2009/07/25/what-is-ghb-anyway/#more-1306


Some of the strangest calls I've responded to involve "Liquid G" I never really had a handle on exactly what it was and how it worked until now. Thanks EMT SPOT!

Absolutely

As some of you have noticed I've grown weary of life on Rescue 1 and the EMS system as we know it. The thought of leaving this behind after eight years has become almost an obsession. An opening on Engine 10 on Broad Street has appeared and will disappear in a few days. I would be working in the same neighborhood on an ALS engine company as a firefighter. I did firefighting for ten years on various trucks in the city and enjoy it. The people who work at Broad Street are the best, I've been working alongside them for years.

So what the hell is keeping me here?

Stubborn Swede?

yup

The Glory?

hahahahah

The loot?

partly true

Some EMT's and Paramedics will be amazed to learn that in Providence the people assigned to the rescues are better compensated than the people on the fire trucks.

Alas, the real reason I'm staying is simple. I love it. It doesn't happen often, or nearly often enough, but when I am able to make a connection with one of my patients, and truly understand what is ailing them, be it physical or emotional, and help them get better, an indescribable feeling of well being takes over, something not available in a bottle or a pill, and makes me feel truly alive. The place I feel God's presence the most is in the back of Rescue 1, when despair, chaos and heartache lose the battle to caring, competence and healing.

It is at these times I feel truly blessed, and all the nonsense that comes with the territory becomes minuscule in the big picture.

Will the drunks continue to call?

Of course.

Will people consider us their free ride to the hospital?

I'm sure.

Will I still get six calls after midnight?

No doubt.

Will I find satisfaction in spite of everything that is wrong?

Absolutely.

Thanks for sticking around and reading this blog. One of the things I find most miraculous is that people I've never met take the time to visit here, offer words of encouragement and not only make Rescuing Providence bearable, but make it fun as well.

Birthday Party

Under a highway, next to some railroad tracks they made their camp. It was her birthday,she turned thirty-three today. He bought her a cake and a tube of frosting so she could write her name on top. Nobody had ever bought her a cake he told us as the IV went in. An Amtrak Xcella sped past, fifteen feet from where we worked, whipping up pebbles and dust. The wind it created seemed to draw you closer, but that is probably just an illusion. The fear of death is always close when standing next to a speeding train.

They decided to party, he bought some heroin. It was the least he could do for his girl. Generous by nature her let her have more, nice guy that he is. Put her right into respiratory failure. He tried on his own to revive her, slapped her, dragged her into the rain, soaking her, picked her up, crossed the tracks and tried carrying her up the twenty foot ledge we had just climbed down. He failed there, at the foot of the ledge, and used his cell to call 911. At forty-eight years old their simply wasn't enough strength left to do the job.

Once the narcan kicked in she was able to get up and help us as we helped her climb the steep hill toward the rescue. He carried the cake, the red scribble that was supposed to say her name nothing but a smudge, washed away by the mist. I wondered if she had died there, under a bridge, in the rain, twenty feet below the rest of us if her life would have been as easily obscured. Gone, just another junkie; homeless and abandoned.

She cried then, once she left the make-believe world under the bridge and entered reality. Her pupils remained pinpoint and her breathing rate slow but I just didn't have the heart to administer more narcan and take the little high that remained away.

Fools

She sat on the front steps of her home, overnight bag packed, cigarette in hand.
We stopped the truck. She kept on smoking. And sitting.

"Did you call 911?" I asked, nicely enough.

"Yup." Another drag from the cigarette.

"Why did you call?"

"I need to go to the hospital."

I stretched my neck and peered around the corner of her house. Lo and behold, THE HOSPITAL!

"Get in."

Slowly, ever so slowly she finished her cigarette as I stood there. Now, at one time anger would have invaded my sleep deprived mind and all sorts of unsavory things would have spewed from my bitter lips. No more. The minions of Providence have cured my of my emotionally charged rants. I'm simply a beaten man. I picked up her overnight bag, carried it into the back of the rescue, had a seat and waited. Eventually, she joined me, now wearing headphones, the music so loud I could hear the song clearly.

We didn't have long, so I got right to the point.

"Why do you need to go to the hospital?"

She graced me by glancing in my direction, lowered the headphones and said, "WHAT?"

"Why do you need to go to the hospital?" I repeated.

"I need to be seen."

She reached into her bag, pulled out a lean cuisine, opened the tin foil top, picked up a plastic fork and dug in.

Surely god tested me.

"Why do you need to bee seen?"

"I'll tell THEM when we get there." The phones went back on, I was dismissed.

We backed into the ambulance bay. Stephanie, my driver for the night opened the side door, fuming, ready to rumble. I smiled and shook my head, no. The three of us walked in together, me keeping the two women seperated. Later, Steph had me rolling when she told me they almost needed another rescue for some "Black on Black" crime.

I told the triage nurse exactly what happened, without embellishing, even a little. Our patient had exquisite hearing, apparently, as she shouted from the other side of the ER for me to "stop talking behind her back."

"I was not uncooperative!"

"Yes, you were."

"YOU were uncooperative."

"No, I wasn't."

"I don't need to tell no ambulance driver nothin."

"I wasn't driving."

"Just do your job."

"I couldn't, you were uncooperative."

She wanted to continue. I didn't care. The twenty or so patients in the ER looked on,bewildered. I continued giving my report.

"Her appetite isn't compromised, and her ability to smoke intact, other than that, I have no idea."

"Ain't no use arguing with no fool!" she said, and put her headphones back on.

I couldn't have agreed more.

RI Future

http://www.rifuture.org/diary/6945/because-fire-fighters-have-nothing-better-to-do

I just saw this on RI Future. Thanks for noticing!

Night Terrors

She had entered a place she may not have wanted to go. Sixteen years old, visiting a local college with a friend when a light went on in her mind. The things we keep there, stored in a safe place are a mystery. It may be better that way.

Part of the college's program included a guest hypnotist. One-hundred and fifty high school juniors and seniors were in attendance. One- hundred and forty-nine enjoyed the mass hypnosis, got a few chills, had a few laughs and went on to the next phase of the orientation. Ellie didn't come back. She stayed in a trance.

Rescue 1 was dispatched to the campus for an emotional female. Our patient, a pretty student dressed in a summer dress and sandals sat on a couch in the security office next to the hypnotist who coolly tried to talk her back from the place he put her. He seemed relieved when we arrived. I knelt in front of Ellie, thinking she was having us on and getting a huge kick out of all the attention and introduced myself. She stared blankly ahead, sobbing uncontrollably, hyperventilating. Her breathing rate had increased to sixty breaths a minute, she was close to passing out.

The hypnotist seemed genuinely concerned, but just as genuinely relieved that somebody else was now responsible. I thought it prudent to clear the room out, it was stifling and oppressive.

"Do you know where you are?" I asked, looking deep into her eyes. Nothing. She just cried and continued hyperventilating. I took one of her hands into mine. She flinched and tried to pull back. I held on.

"I'm not going to hurt you, I want you back." I said. She relaxed, stared into my eyes and kept crying. The intensity of her sorrow and terror increased, her body was wracked with shudders; she was truly terrified.

"Ellie," I said as quietly as I could, how old are you?"

She looked at me for a long time, her hand moist with sweat. She honestly couldn't remember. I remembered a technique I learned a while ago, Emotional Freedom Technique. It is similar to acupressure, tapping on different points of the body that are connected to certain meridians and central nervous system trigger points. I didn't think it would hurt so I started gently tapping the inside of her hand while talking to her.

"You're breathing too fast, Ellie. You have to slow down. Talk with me when you breathe. One, two, one, two." I said one upon inhaling, two when she exhaled and continued tapping her hand. It was fast but I was persistent. The group counsellor stood nearby, thinking I was mad and my partner for the night, Mark tapped his foot impatiently, but I thought I was on to something. Ellie's breathing started to slow down after a few minutes, but she was still far gone.

"One, two, One, two." Slower and slower until she was down to twelve. I tried to pull my hand away, this time it was she who wouldn't let go.

Unfortunately, that was as close as I could get. I tried for another five minutes to get her to come to, she couldn't answer any of our questions, but at least she was breathing normally. It was a small victory, but not the result I wanted. I had hoped she could rejoin her friends and have some fun while visiting the school. She should have been with the rest of the kids, clowning around, making connections and living the best years of her life instead of lying on a stretcher on her way to the hospital for a psychological evaluation.

The counsellor came with us and contacted Ellie's mom. I took the phone and asked a few questions. Was Ellie on any medications? No. Did she have psychological problems? No. Has anything like this ever happened before?

Ellie was completely gone, now. Her mother heard her daughter crying in the background and said it was like going back in time to twelve years ago when her daughter suffered with "night terrors" for a while.

"She sounds like she is five again," said her mom as goosebumps crawled up my arms. Ellie still looked directly at me, into me and continued to cry, body wrenching, heart stopping sorrow. I hung up the phone after asking her mom to take it easy, her daughter was in good hands and would be safe until she got there. She came from White Plains New York, about five hours away and was on her way while I had her on the phone.

We arrived at the children's hospital and told the story to the skeptical triage nurse. It wasn't long before she too was mystified by the patient, who was now pulling her tongue, trying to tear it from her mouth.

All this from a kid who never exhibited any abnormalities, left New York that morning as happy as can be and ended up in a hospital after hypnotist's trick went badly.

I checked on her the next day. She was gone, released to her family. They did a thorough neurological workup and found nothing amiss.

I don't think she will ever return to Providence, and I'm positive she will never get hypnotised again.

Good luck, Ellie. I hope the demons stay at bay, or better yet, you find the courage to confront them, and send them away for good.

Eternity

"Rescue 1, respond to 7265 Progress lane, at the Adult Video News for a man down."

I fumbled for my radio, sitting in the charger next to my bunk. The indicator light was still red, must not have been out for long. I stood, felt the pains run up my legs, felt the familiar stiffness in my back and neck and did a quick stretch. I took a deep breath. Dragon fire. Should I brush? How would the "man down" feel about his rescuer doing a little bird bath and breath refreshment before rushing to his aid?

I popped a piece of Trident in, because it freshens your breath while whitening your teeth, rubbed the bedhead out of my scalp and hit the pole. Three minutes later, we stopped the truck in front of the x-rated novelty store. A woman ran out, shocked.

"He's in there!" she said pointing into the dark doorway. The sun had barely risen, some days dawn is beautiful and refreshing, others, just downright creepy.

"He's not supposed to be in there!" she continued, hiding behind me as I walked into the empty building. I keyed the mike.

"Rescue 1 to fire alarm, have the police respond here, possible trespasser."

"Where is he?"

"In the back."

"What's he doing?"

"Just laying there."

I approached the back of the store where the private viewing booths were.

"Which one?"

She pointed to a closed door. I wanted to walk out and forget the whole thing. Instead, I opened the door.

A man lay on the floor, dead. His face was plastered to the stained carpeting. The last video he ever saw was over. I reached in, felt for a pulse that I knew wouldn't be there. Ice cold.

"Rescue 1 to fire alarm, time on scene and a police Sargent."

"0622 hrs. Rescue 1, Police have been notified."

When the cops got there I told them time of death 0622. In reality, he died around 2300 hrs, alone, watching porn in a dirty booth on a sceevy block surrounded by deviants. He looked to be around fifty. Fifty years of life, family, kids, maybe church, might have been a coach, a teacher, a firefighter, a priest...who knows.

All I know is his last act is probably not how he wanted to be remembered for all eternity.

Still Box

http://www.projo.com/opinion/contributors/content/CT_morse13_07-13-09_43EVTQK_v6.3f8a28b.html

http://newsblog.projo.com/2009/07/crews-extinguis-1.html

I wrote this during the July 4th holiday weekend. Rescue 1 did thirty-three calls in thirty-eight hours. In between runs I'd throw a sentence or two down.

As much as I enjoy Rescue 1, the allure of fighting fires is always with me.

*photo courtesy of wellinvolved

Filter

He sat on the stretcher; skinny kid, good thing, too or the bullet that grazed him would have been in his body. I let him talk on his cell phone en route to the ER, didn't bother me much, it sounded like he was talking to his mom who was pretty upset. He repeated over and over he was okay, was just standing there talking with his friend when some guys came upon them and opened fire. He was concerned about his friend, nobody knew where he was.

We got him to the hospital and were preparing to leave when another call came in to the same location for another gunshot victim.

Shit.

We sped out of the ER fully expecting the worst.

"Rescue 1, expedite," came over the radio.

We were on scene a minute later.

Lying face down in the dirt, head up against a chain-link fence, next to a swimming pool was his friend. I rolled him over, felt for pulses, looked into his dead eyes, noticed the holes in his torso and realized we were too late.

I focused on the sound of the pool filter, the water soothing as screams, sobs and shouting filled the air around us.

http://newsblog.projo.com/2009/07/providence-poli-48.html

Relentless

The calls keep coming. Every time I put the truck in service we get sent to another call. Now and the an hour or so passes without a run, mostly it's just one after the other. They are starting to blend into one. Nine years ago, when I decided to transfer from Engine 9 to Rescue 1 I made a promise; when I stopped seeing my patients as people it would be time to get off the rescue.

I haven't seen a lot of people lately. Just calls. And they keep coming.

Poverty

On a busy street, with the front door four feet from the street lives a family of five. They rent one of the apartments. It's small. Two bedrooms, a kitchen without a table and a small living room. A bathroom small enough to serve as a closet in a different place is filled with tools to help a handicapped child.

His father carries him out. He's five. His teeth are separated by quarter inch spaces but clean. They protrude from his white lips, almost like a set of joke teeth you would but at a novelty store. Only this is no joke. The boy's skin is grey. He hasn't eaten in two days and has been vomiting non stop. The father lays the boy on the stretcher. I can only watch him, stunned. I've never seen a living child look so dead. He is breathing. He looks at me when I come close, looks me in the eye and smiles. I put the blood pressure cuff around his tiny arm and it begins to inflate. The child doesn't flinch.

His mother enters the back of the rescue holding her daughter. She is one years old, beautiful dark curls surround her healthy, chubby face. She cries, non-stop. She too has been sick for days. What little Spanish I know is enough. These kids are sick. The boy has Cerebral Palsey. The girl is healthy. Another child stays at home with his father as I take the mom and two kids to the hospital.

She is a pretty woman, probably no more than twenty. Her hair is tied back with an elastic. Her clothes are clean, a long skirt and peasant blouse, brightly colored. The sandals she wears look good on her, but are at least five years out of fashion. She doesn't mind, at least she has shoes on her feet. Her toenails are carefully painted to match her clothes. A small luxury in in otherwise difficult life.

She smiles at her son as we ride together toward the hospital. He is in tough shape but smiles back. If anybody needed medical care, it is him.

She gives me two cards. I callously refer to them as "The Key to the Kingdom," sometimes. The cards represent free health care for the poor. A lot of people abuse the system, our medicare budget takes up a third of the State of Rhode Island's revenue.

I copy the information on the state report, occasionally looking at the kids.

I can't help but be proud of my standing as an American citizen, able and willing to help those so desperately in need. If the tables were turned, and I was born in Mexico and impoverished, I hope I would have the courage to brave it all and make the journey to where a better life existed for my family, laws be damned.

Loss

My friend Bill, a Captain on the Providence Fire Department lost his son early this morning. When we were neighbors I'd see them often, getting ready to take the kids camping, playing catch, making a skateboard ramp, just a great family man doing all the right things. From the sound of the linked story Kory was following in his dad's footsteps.

If you have children, take them aside, hug them whether they want it or not, look them in the eye and tell them you love them. Then let them go and hope they stay safe. And do it often.

I spent much of last night walking with my oldest, Danielle. We walked her dog to the beach near our home, came back and rescued a squirrel that was trapped in a downspout. Goofy, little memory that seems so much more important now.

My wife is refinishing a chest of drawers for "the baby." (she's twenty-eight) It's a long process, painting each drawer, sanding, putting a faux finish on it, sending a picture for approval then proceeding to the next step. It will be beautiful when finished.

We have each other. We are still creating memories. Every day is precious.

Nobody knew that more than Bill and his wife, they created enough memories to carry them through this tragedy.



http://newsblog.projo.com/2009/07/warwick-teen-th.html

Independance Day, 2009

Happy 4th of July!


http://www.youtube.com/watch?v=km3e9dngf5Y

I think you will be glad you watched this.

Back to Class

It is an awful place, the end of the road. At 0130 we entered through the front door, past the regulars, empty vodka bottles and spent cigarette butts leading the way. Some slept on benches, covered with little more than rags. Others stayed awake, staring into space. We wheeled the stretcher past them on the way to the sixth floor. We had been called to remove an intoxicated man passed out in the corridor.

The elevator seemed smaller than it actually was, stained stainless steel walls, sticky floor, filthy buttons. I tried to hold my breath till floor six but had to exhale around the fourth and breath in the fetid air before the doors opened into the stench of the sixth floor.

A man lie unconscious on the floor further down the door lined corridor. Inside the tiny one room apartments sounds emanated, AC/DC from a portable radio, a man on the phone telling somebody about the unfit living conditions, somebody snoring, somebody vomiting.

I approached the patient, leaned over and shook him. Cockroaches scurried when he moved, there must have been fifty of them under his body doing god knows what.

"Hey, buddy, wake up," I said, shaking him again. The security guard who escorted us up shook his head and walked away.

"Come on," I said, "we'll help you up."

He opened his eyes and looked at me, did a quick assessment, then tried to stand. he was unsuccessful. We helped him kneel, then rolled him onto the stretcher, covered him with a sheet and wheeled him down the corridor, into the elevator, to the lobby and into the night.

On the way to the hospital, as I gathered the necessary information something hit me in the back of the head like a 2x4 swung by a giant.

He was battling cancer, taking chemo and sick as a dog.

He was my age, had a family once.

He was my friend, a long time ago. We went to school together in the seventies. He didn't recognize me. I didn't say anything as I wrote his name on the report. Once, we had similar dreams, similar hopes and similar ambitions.

His fell apart. Mine came true.

I've done seventeen runs in seventeen hours. An hour ago I thought I had it tough.

Descisions

The Supreme Court ruled in favor of a group of white firefighters who claimed racial discrimination after the City of New Haven attempted the discard the results of a promotional exam because not enough minority candidates scored well enough for promotion.


http://www.nytimes.com/2009/06/30/us/30scotus.html

For those of you who are not aware of the testing procedure for promotion in the fire service in the United States, it is an incredibly competitive process that requires hundreds of hours of preparation to finish at or near the top of all candidates. Those who score highest on the test are promoted. Everybody eligible to take the test is given the same time to prepare, the same list of source material and the same incentive; promotion.

I have mixed feelings about affirmative action.

http://rescuing-providence.blogspot.com/2009/05/affirmitive-action.html

Once a person is hired, all preferential treatment must stop. It is an insult to the minority candidate to give him or her an advantage. It is difficult enough for minorities, even those who did not need affirmative action to be hired. They live with the stigma that they were not as good as others who were passed over because their skin was a different color, or their sex was different. That all fades once a person has proven themselves in the station, on calls and on the fire ground.

It will reappear, in an even more vicious form if preferential treatment is given for reasons of promoting minorities. I am thankful the supreme court ruled correctly, though dismayed that it wasn't unanimous.