Standby for Tones

Standby for Tones

Featured Writings by

Crystal Wallin, NREMT-P, CCEMT-P, FTO

La Crosse, Wisconsin

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  • Friday, January 12, 2018 7:13 AM | PAAW Administrator (Administrator)

    By Crystal Wallin, NREMT-P, CCEMT-P, Tri State Ambulance

    He’s the center of attention and he’s trying to be brave. It’s hard to be brave though when you’re lying on your back on a shiny brown cot in the nurse’s station and the room keeps filling with more grownups. All of the grownups are gathered around him when I add my uniform to the room, and they’re all peering down at him. He’s valiantly trying to lock it down, but the hiccuping kind of sigh/crying kids do when they’ve been at it awhile is going on. The sad noise out and the kind of inhale that’s short and sad; sometimes the lower lip gets involved. His face is red and splotchy, and if I didn’t have the dispatch information, if I saw him sitting in a chair somewhere without the accouterments of grown up people, I might’ve chalked up the discoloration to long-term crying.

    But we are all gathered here today in the presence of Mom and the school nurse, and I do have the dispatch information. So I come in with the knowledge that he has a tree nut allergy and he’s eaten walnuts in a muffin. The very capable and kind hosting nurse tells us he was given an EpiPen prior to any EMS arrival. She produces it and gesticulates with it, punctuating the close air for emphasis as she tells the story – or at least what she knows of it.

    Someone brought a snack, and when you’re 7 years old, you like snacks. Honestly, when you’re a tall human you love snacks too but I drag my mind back to the gesticulating nurse and resolve not to think about how many double digit hours since my own last meal. My abdomen grumbles but I prevail.

    So the snack was wrapped up and store-bought and (here he interjects) there weren’t any visible nuts. But as nuts sometimes do, they were hidden by their small size within the muffin and when he realized this fact, he was maybe four bites in. I’ve seen 7-year-olds eat snacks, so I know no assumptions can be made about the size of the bites. I hunker down by the small hiccuping sniffling miserable person on the cot and gravely introduce myself, shake his hand. I tell him he’s the star of the show, that nothing is going to happen that he won’t know about first, that I will explain anything he wants, and that he gets to choose what order we do things in. He’s intrigued but a tough sell. I press on. I am impressed that he didn’t cry from the shot, per the nurse. She nods and punctuates the air again with the depleted device. He nods. I ask him if he’d like to sit up so all these tall people aren’t looming over him, and we open the door and pretty soon he’s upright and looking like he feels a little more on even footing with the situation.

    Vitals. Assessment during all of the above, because it’s reflexive and interacting with him affords me his mentation, his lack of drooling, his speech is clear, he stops being red and blotchy and turns out yep, it was long-term crying. Or at least somewhat.

    Next step; Mom. Mom is at the feet of the man of the hour, and has been watching all of this with grave interest and no small worry. I establish with her number of times he’s been exposed to nuts (once before), and what happened (swelling, face and throat). Negative intubations, excellent response to medication. In fact, so good that there is no EpiPen with him at school. It might be at home but she isn’t sure. We all turn to look at the device which has been passed on to the first responders. It is expired. Is it the school’s? Unsure. The nurse is gone. To where, I’m not sure but I don’t see her again until we are exiting through the office.

    Soon inside the ambulance, transport is beginning. I’ve let the patient choose whether he wants the blood pressure cuff on first or the light on his finger for pulse oximeter. It doesn’t matter which is first, what matters is that he is calm and is beginning to have a small rapport with me. He’s perked up, he giggles when I complement his bright and busy coat and matching boots. He’s acting like a regular 7 year old.

    Mom and I chat on the way in. She’s a little frustrated that despite the numerous papers she filled out, there was this series of events. Little man’s brow furrows at this and he hangs his head. A lightbulb that thankfully no one can see goes off, and I put some of the nursing training to work – this is a teachable moment. So we discuss the honest way a tiny ground up amount of nuts could be in a banana muffin packaged from the store without anyone knowing. We aren’t even sure if the muffin was consumed in class or shared in a hallway in a free moment between structured times. She nods, shoulders relax.

    She asks why I wanted to know how many times he’s eaten nuts and reacted, genuinely curious. I explain the initial response, the subsequent responses and the need for hospital evaluation even after an EpiPen is administered. We talk about reoccurrence of symptoms, the window of time in which they may return and need immediate treatment again. She is struck by all of this and we go on to have a productive dialog.

    During the dialog I ask the patient questions both to keep him interested and so he understands the importance of telling someone each time he feels a symptom, even if he has been treated already that day or night. He is bright, asks appropriate questions, and throughout the conversation I am able to monitor his continued swallowing, breathing, as well as the pulse ox level, heart rate and blood pressure.

    I give radio report maybe five minutes out. He says his throat is itchy and his belly hurts. Mom is asking about an EpiPen, she’s not sure where theirs is. I advise the ER physician can help with that, and she nods. Her shoulders slump though, and her face clouds. I tip my head and she tells me in a hushed voice that her husband’s company recently downsized and his position was eliminated. She doesn’t have $600, or insurance. I suggest an area free clinic, wondering aloud if they may have some resources with which I am unfamiliar. I am matter of fact, careful to keep any sympathy from sounding like pity to this proud, sad mama. My hands are busy, too, letting the patient pick which 18G needle he wants, which small syringe. I’m getting out our epinephrine vial, and he’s watching me with interest and some concern. Mom mentions the name of the doctor at the free clinic, whom I know well, and I tell her so. She’s struck by how small a world it is, and I’m able to explain to the patient that we might need to give him some more medicine. I remind him again though that he will know if I am and that he is the boss, applesauce. He grins. We’re stopping, now, and I realize we are in the garage bay.

    Mom hops out, my partner comes around and we take the patient out. He is jacked up, riding the automatic cot lift and I see no signs that worry me. We go inside, walking with Mom I ask her permission to approach the staff inside about options for covering the cost of that oh so necessary EpiPen. She agrees, and then we’re in, I’m giving bedside report and the small human is checking out the inside of this new environment. I see a red spot by his ear, and point it out to the nurse.

    Leaving the room, I find the most senior ER nurse I see, and quietly fill him in. He directs me to the social worker, who nods during my tale, then reassures me that I shouldn’t worry – the EpiPen can most likely be added to their ER bill for today. Which they aren’t going to be able to afford either, I think to myself. I ask if there are any programs, and she repeats that they will work it into the bill. I meet the eyes of another ER nurse who was once a street medic in my same uniform, and she smiles sadly. I nod, mutely, and head back to the truck in the garage so we can clear and enter the system, ready for the next call.

  • Thursday, November 16, 2017 8:08 AM | PAAW Administrator (Administrator)
    The whole way there I had pulmonary edema on the brain. Dispatch information wasn’t very alarming; “70s male, shortness of breath, coughing up blood.” But as soon as my boots hit the garage floor, that’s all I kept thinking. I’ve had three calls before with pulmonary edema – and two of those times it was the same patient. I’ve never been to this address, and despite nothing screaming clearly in the dispatch information, my gut says its pulmonary edema. 3am thoughts or gut instinct?

    So the trip out to the country road consists of me, all the way awake in a way you understand if you’ve ever seen pulmonary edema – bonus points for the pucker factor that is flash pulmonary edema – I’m chattering. My partner is an EMT tonight and he’s still waking up. He bears with me though. I explain what we will need to do in a short period of time if it is pulmonary edema. He gets it, he’s a great partner and I know I can concentrate on what I need to do. Knowing he will do what needs to be done and he isn’t the sort of partner who requires a lot of hand holding and validation.

    We arrive on scene, he puts it in park and I hop out the passenger side, round the side corner and spy a man approaching. He’s well dressed, fully dressed, and walking spryly. Coat neatly zipped up to the chin. Dapper hat atop his head. He looks like a retired cowboy, tan skin and western button up shirt. I ask if he’s the patient and he nods. I’m able to get the side door open and my patient is loading himself right up the steps before I can say much.  Climbing up after him, I catch my first auditory of my patient.

    Pucker. Factor. Right there. Right now. Yep, we’re about to do medicine. I nod at my partner, and we go to work in the choreographed steps we worked out while the truck winked and blinked its red and blue strobes down this back road and across the corn still waiting to be harvested.

    Sublingual nitro – check. CPAP – check. IV – check. Nitro drip – check. Furosemide – check.

    My patient is working to breathe, and working hard. The telltale wet sounds of crackles and rales are screaming the alarm for me, for anyone, to notice this man is attempting to exchange gasses at the alveolar level through liquid. Sternomastoids, scalenes, and intercostals – they’re all desperately doing their level best to move air in and out. The air is going in and out. The problem is that the air can’t pass into the blood through all the liquid filling the lung fields. He’s breathing fast, tachypnic, and blood pressure is high. His body is trying to compensate and from the looks of things, it has been for a while. There is no pink frothy sputum, and while acute, I’m not sure this presentation paints a picture of sudden, flash pulmonary edema.

    Transport begins. We’re maybe eleven minutes out and we need to be at the ER yesterday. He needs a tube, but out here on this pitch dark country road I’m the only paramedic in the county. State law states intubation is a dual medic skill and so we get to work. We’re making the pavement disappear between us and the ER with all of its equipment and people. I’ve always been one of those medics who is not fond of transporting emergent, and I do so seldom. Given the amount of medications and procedures we can perform in the patient compartment of our trucks, the due regard we need to demonstrate in driving, the aggressive protocols under which we operate, we are able to enjoy the ability to do many of the things on scene that the ER would do. There is not often a need to endanger ourselves, our patients, or the general public with the heightened level of adrenaline that comes with lights and sirens. Not to mention the effect on my patient, quite often the heart rate and blood pressure increase if we need to use the sirens and lights. Evidence-based practice is what we have learned, and we have learned to take the time to manage our patients before and during transport, driving non-emergent towards definitive care rather than just throwing them in the truck and “apply diesel therapy” as we used to say.

    But when my partner asks me if I want him to transport emergent, I consider it, then say yes if there happens to be any traffic, use the lights and sirens to move them, then just lights. It is the wee hours of the morning in this farming community and there is no need to awaken every coon hound between here and the ER.

    My patient seems determined to ask me questions and speak beneath the CPAP mask. It’s not as loud as the model we used to have, but it’s loud enough that I can’t hear him. PEEP is between 5 and 8 mmHg, the nitro is blurping along and the Lasix should be starting to kick in. His SpO2 shows oxygenation in the gutter though, and falling. He’s tiring out. I lean forward and speak quietly in his ear. I always do this and it seems to help them in their soundless mask, to feel less alone. I start with the basics; is he having pain, does he understand what is happening, has this been going on for more than a little while? He denies pain, indicates understanding and answers in the affirmative that this has been going on longer than a bit. Yes’s and no’s get me worked around to, he’s been up most of the night, he thought it would get better, he used inhalers, and he’s had this before. Then the big question I have to ask, has he been intubated before? He nods. I ask him, in the hospital? And he shakes his head, points to my gold patch. “By EMS?” I ask. He nods again, eyelids closing. He’s so tired, still hypertensive, still tachypnic. I keep speaking, verbally coaching him to remain awake. We cover that he is a former smoker, lots of years. He lives alone. It must’ve been a long night before 0300.

    I wonder if he wonders at my inactivity after the flurry when he first got in the truck. I explain to him what the nitro under the tongue – and now in the IV – is doing to help his breathing by reducing the workload on his heart. I tell him about the injection of Lasix, and its role in pulmonary edema management to begin to move the excess fluid out of the lungs. I promise him that the CPAP mask is helping push the fluid out, too, with positive pressure. He nods weak thumbs up. SpO2 is 74%. I give radio report. 71%. This is killing me. He needs a tube.

    ER. Bright lights. People. So much help, now. Handoff report at bedside. Remain and watch the C-MAC and Bougie make short work of the tube placement. Confirmation, tube is good. X-ray comes, lab. RT. I get a facility acceptance signature, accept the face sheet registration hands me. Walk out to my truck.

    There’s his hat and coat. Can clothing look forlorn? These did. Take them back inside.

    Hours go by. Flight team comes for him; he’s not hypertensive anymore now that the respiratory drive isn’t so desperately triggered. The ventilator is sedately moving air in and out of lungs that are much more baseline. RT tells me “his lungs were full”. I nod. Guess this nursing student does still have a medic’s gut instinct.

    Shortly after, I watch the EC145 spool up. The horizon is ever so faintly light, and somewhere over my head now, the hat and coat are dutifully following their owner.

    I wonder how many people would’ve put down their last cigarette and never picked up another – if they could’ve seen him, valiantly moving air in and out – and essentially drowning in front of me. I wonder what he would tell them, if he could.

  • Monday, September 25, 2017 6:04 AM | PAAW Administrator (Administrator)

    His VFW jacket is deceptive on his small frame, and the corresponding ball cap on his head is similarly boxy. He’s currently occupying a ditch alongside a small pickup truck where a few moments ago he was a passenger. Now he’s meeting my partner and I, so obviously his day has gone downhill. Literally.

    They go up this hill every day, he’s telling the passerby who is seated next to him in the tall summer grass, keeping him company before all the sirens went from distant to loud, then finally silent here at the scene. The garish lights are strobing up the countryside but they are held to a dim minimum on this sunny summer day. Him and his buddy go down this hill every day to see another buddy, and then back up the hill to the ridgetop they call home. He never thought this would happen today. They were headed up the hill when the gentleman in the VFW jacket thought the engine sounded funny, “Like it was slipping gears, ya know”. Soon the driver told my patient, “I got some bad news for ya. I think we’re gonna crash.” My patient thought it best then to click on the seatbelt he’d removed to access his smokes in an inner pocket of the VFW jacket, and no sooner did the seatbelt click home than the engine did die. Within short order the steering and brakes left as well and they ended up somehow going back down the hill backwards. As my patient tells it, “after about five minutes, we rolled over. Just once I think but it’s hard to say, ya know.”

    More turnout gear is accumulating next to me in the ditch throughout the retelling of this saga. I’ve taken report from the passerby who turned out to be a nurse driving by on her day off, I’ve attached the three leads and assisted an arm out of the jacket to place a blood pressure cuff and I’ve got the pulse oximeter on a nicotine stained finger. But I’m not having much luck slowing the flow of words, or guiding it. All of us are wearing grins and all of the data my equipment is supplying is pleasing, however. So I ask the firemen to bring the cot if they would be so kind. My partner reappears and states that the driver is refusing all medical evaluation and treatment, and she returns to him for a refusal signature AMA. Through sheer force of will, though I cringe at the necessity of interrupting this intriguing gentleman, I manage to evaluate him for injuries, perform palpation and range of motion checks and all the usual things we do for an MVC.

    The firemen and I get my patient seated on the cot and secured with all the straps. We encounter a concerned looking lady on our way to the back doors of my truck, and he calls out to her by name. He starts the story one more time for her, adding that he left his cell phone at home and would she mind calling his daughter? She reassures him she will and after a short time I’ve managed to verbally edge my words into his dialog with a gentle reminder that we really must get him inside and start working our way towards transporting. I assure her we will take very good care of him.

    Once inside the ambulance, secondary assessment reveals no additional findings. I start an IV as he tells me about Vietnam, and I thank him for his service as I connect the tubing. Inspecting his shoulder where he indicates “just a little soreness, ya know, just a little, just starting” I see no visible injuries. My partner returns and we begin transport.

    Up the hill for the second time in a short while, he expresses his relief that this trip was successful. He tells me of his years after Vietnam, after the head injury saw him live out a few decades in a “VA home, cuz the USAF owns me, ya know” he left Chicago for the beauty of the ridge in the Coulee Region that he now calls home. He’s in love with the breezes, fresh and smelling of sweet hay, and the lack of mosquitos. He tells me with dead earnest eyes that he’s seen some pretty bad mosquitos in his day but this third summer on the ridge has him believing there’s no mosquito that could fly in the ridge wind.

    He tells me of his children, his grandchildren who are the loves of his life and as we wind our way from the rolling fields of the ridge into the concrete and traffic of the city, I realize that as much as I can talk – and it surely is a lot – I have nothing on this sweet veteran who is now clutching his VFW coat under his elbow as he tells me about how good his life became after he gave up alcohol. He tells me stories as we wait and then proceed through stop lights, as I get repeat vitals, as I switch the IV bag from the hook in the roof to the pole on the cot. As I give radio report to the receiving facility the stories continue to swirl around my head in the air as his quiet voice patters on. We park in the garage and I explain the privacy act notice, offer him his own copy (“now why would I want that? Those politicians, ya know I think they are behind all of this paperwork everywhere. Well, them and lawyers, ya know”), explain that his signature will allow billing of his insurance company (“well the VA will get it I guess, the USAF owns me ya know”). He signs while telling my partner about that hill they go up every day, who would’ve thought that today of all days…

    We walk in; give the name and DOB to registration who is waiting for us at the door. Stories continue to spool still unimpeded as we walk to the room, give report to the staff there, transfer him from my cot to the ER bed, and finally I interrupt again as I offer my hand. He breaks off, mid story, shakes it. “Thanks girlie, keep a listen on your engine, won’t ya”. I assure him I will. The nurse signs my prehospital care sheet, takes her copy and I head out the door with my copy in hand. Up ahead my partner is wheeling the cot. My boots squeak, always on this floor. It’s the only sound I hear. For a moment, it’s a beautiful thing.

    I think of the young man who would’ve made that coat seem small. I think of hurtling backwards down a hill, then rolling over, a slight man in a big coat unable to see what was coming. I think of the small pickup. I’m sobered by what might have been, and I’m glad I got to meet this veteran, that he was here to tell his many stories. Such a vibrant soul might’ve been lost and I am certainly grinning as I walk to the truck, spirits lifted by this loquacious veteran who I realize may very well have made my day.

    Don’t ya know?

  • Saturday, August 26, 2017 5:39 PM | PAAW Administrator (Administrator)
    The first thing I register is the officer’s words as he gives report to my partner. “…hasn’t taken meds in six months…hasn’t been out of the apartment in six months…hasn’t eaten in three weeks…” The officer continues to fill in the blanks, that she lives with a roommate but that he is bipolar and hadn’t thought these things were concerning. The report complete, my partner and I enter the residence.

    The second thing I register is the haze. I’m no stranger to odors but as we walk into the apartment, my lungs physically rebel at roughly the one minute mark. The apartment is literally foggy with acrid, dense cigarette smoke. I follow my partner’s grey shirt in front of me, sizing up our surroundings as we advance. I register a synthetic “feather” duster on the stove, between the electric burner and a frying pan, but the light indicating a hot stovetop isn’t lit. The duster isn’t smoldering, and so I continue towards the back bedroom, entering just after my partner. I’m already coughing, thanks to the lung issues I’ve been slowly coming to terms with. Last December my primary care provider tells me my seventeen years of smoking have had some impact on me even now, six years after smoking cessation. Each room we’ve passed now, in this apartment, has had at least one overflowing ashtray and my lungs are registering the effects.

    I can see the patient over my partner’s shoulder. There is a plethora of belongings and in the bed a fully dressed female, frail and nearing emaciated. She is older than myself but of indeterminate age beyond that. More ashtrays are heaped and packs of cigarettes, of the empty crumpled kind and one full pack, ring the bed. The fingernails and toenails of my patient are long, curved, and black with an unknown substance. On the floor next to my boot, two flat dried dark substances that may be mud but which my mind tells me are not mud. The patient’s hair is dark with white chunks. I look harder thru the fog, my face squinting up with effort. The white chunks are accumulations of dead skin, scalp tissue.

    At this point, my lungs aren’t kidding around, I register honest pain. They hurt, and the coughing seems to be drawing the fog deeper into my lungs between barks. I move into action now, encouraging the patient to swing her feet to the floor, to sit on the edge of the bed, to stand up. We do these things slowly but with purpose, letting her get her bearings, letting us evaluate her for steady gait, etc. She ambulates to the middle of the kitchen with copious encouragement but that is as far as she can or will ambulate. I ask if my partner would like the stair chair, and when he nods, I flee to the corridor in relief. The officer remains at the doorway, holding the door open. Some of the fog has leaked into the hallway but it is still infinitely clearer out there than in the apartment. I place my hands on my knees and bark the deep kind of cough, the kind that hurts and makes others uncomfortable. I do this for a bit, sucking in the sweet air. The officer asks if I’m ok, then kindly tells me, “I’ve seen worse”. I don’t tell him so have I, or that I’ve come to know personally, much as some of my patients have learned the hard way – smoking is the gift that never stops giving. I just nod, and after the barking subsides, I walk outside, gulping beautiful outside summer air, and return with the stair chair.

    The apartment is just as I left it, with one exception. The roommate is hovering in a helpful manner near my partner and the patient, who is now seated on a kitchen chair. As he hovers, the roommate is also smoking a fresh cigarette. I set the stair chair down and pull the red levers which drop the seat, and the tracks. Except the seat refuses to descend. Resolutely, the sweat now running down my neck from the heated, close apartment air, I try again, and again. Same refusal of mechanism. My partner tries and on his fourth attempt, the seat meekly drops open. I maneuver the chair behind the patient, encourage her slow standing and reseating, then fasten the belts and make my second escape to the hallway with her in the stair chair in tow. I bark some more. The officer tells me kindly “you’ll get used to it eventually” and again, I nod with a smile.

    Driving down the street a few moments later, I rest my head against the seatback and savor the air conditioned breeze filling the cab from the vents.

    In the back I hear the patient worrying to my partner about the duration of the hold she is on. She states last time she was in the hospital ten days. That she was homesick.

    I think of her home. If services become involved, as our report and the chapter hold by law enforcement will surely necessitate upon hospital discharge, how long would a change last in the face of the apartment’s occupants’ life choices? How do we as a system assist positive change and support public health, combining compliance with medication regimens and sanitary living conditions? Such a front row seat we have to the inner workings of a myriad of homes. With that great privilege comes great responsibility but sadly too often the workings of the system seem as foggy as that apartment. The horizon seems full of potential growth as we strive to learn to combine street paramedic roles in collaboration with hospital personnel, identifying and implementing public health and social services.

  • Wednesday, July 19, 2017 7:36 AM | PAAW Administrator (Administrator)
    It’s hot, and she’s not dressed for it. Sweatshirt and sweatpants, tee shirt and socks with laced up tennies. She’s currently sitting in the rear of a squad car, guzzling on a bottle of Sprite that is sweating only slightly less than she is.

    Passersby found her, she was down on the ground and it was pretty clear she’d fallen. Someone helped her up, but then she fell again. So they called it in, the nice officer who responded scoped out the clothing situation and her speech, and activated EMS non-emergent. Now we’re here, and I lead my student across the street from our parking spot towards the black and white. My partner updates MedComm that we are on location, and brings up the rear. On this initial evaluation we’ve got the cardiac monitor. The bag is feet away should we need anything.

    The lady was assisted out of her sweatshirt by the officer prior to our arrival. Pink and white camouflage, it’s more at home in a rural environment than here in the city but I guess you never know where people hail from originally. Little bits of home from all over converge in any metropolis, and you get what you get. The only constant is that the kaleidoscope keeps moving, the bits and pieces keep on tumbling.

    Her speech is softly rounded, not in the drawl of the southlands but in a gently slurred sort of way. Her facial features are a little slack, and in the first few minutes while my student assesses her, I wonder if she has some cognitive delays. Soon we have the first vitals, she’s hypotensive and my partner brings the cot right to her side. She’s still seated mostly on that rear seat with the door open, one leg in, and one leg out. Her cane is leopard print, and I grin at her style. Pink camo and leopard print – lady’s got flair.

    Securely fastened to the cot, we wheel her to our truck and the automated system whirs her into the air conditioned truck. The doors kathunk shut behind us and we survey the situation. Then she says, in that soft speech, “I believe it’s a low volume issue, I’m dehydrated and forgot my cooling shirt at home.” I cock my head and evaluate her again. She tells me she has MS.

    She tells me she used to be a nurse. Before the disease progressed.

    The remainder of our contact is wonderful. She encourages my student thru the IV start, she matter of factly discusses her evening schedule of HCTZ and why it is taken then, the need to schedule it so far apart from her diuretics. She’s a smart lady. The day didn’t seem that hot when she set out to walk for a snack. She became over heated. My student informs me after we’re in station, later, that increased body temperature in an MS patient decreases the ability of the non-myelanated sheaths to conduct impulses. So with no one to help her out of the sweatshirt, and the increasing heat making her co ordination worse, she was on a downhill sled with no trees in sight.

    We take good care of her, and after my student gives report at the receiving facility, we shake her hand and inform the young nurse taking care from us that this patient is a nurse. The patient softly corrects me, “WAS a nurse.” I think of how she welcomed my student, walked her through a failed IV and told her that learning takes time. I think of her gentle patience on scene, her grace in the face of adversity of a cruel disease.

    I bend down, and softly say, “you taught me as much today as my nursing instructors. You are once a nurse, always a nurse. Thank you for today’s teachable moment.”

    She didn’t say much, but her eyes shined a little brighter as a smile spread across her face. I walked down the hall and thought to myself, teachable moments, indeed.

  • Wednesday, May 24, 2017 8:07 AM | PAAW Administrator (Administrator)
    I’m 27, and I have no idea how profoundly this class will affect me. The ways in which it morphs who I am into a better version of myself. The people I will be honored to care for, the things I will witness. The ways those things I witness will impact me for months and years to come. I have no inkling that my appreciation for life itself will grow, deepen and become a nearly measurable entity.

    I simply know that I am taking a class, an EMT-Basic class. It meets two evenings a week, from 6-10pm in a town roughly half an hour away from the bank at which I then worked. A nice customer from the bank also is taking the class, and we carpool. His wife is funny and kind and I look forward to those visits at their house before we hit the road, off to class. One day we get to town a little earlier than usual, and we swing by a used car lot just to kill some time. Before you can say SAMPLE, I’m the owner of a lipstick red Camaro just a few days later. In my young mind I think it’s funny to pay extra for a license plate that reads CTCH ME.

    We graduate, I continue banking. But something has changed. As the pager I’m given goes off, my heart rate accelerates in a sympathetic nervous system response, and now that I mention it, I’m not certain it’s ever quite gone back to normal. The more I see, the more I am frustrated by the limited ways in which I can help. I want to learn more, I want to help more. It’s not enough, the need is too great and so soon I leave the bank. I’m working now for an interfacility ambulance company. A few years pass and I’m working in a small town ER – and dispatching for an air medical service and the largest ground transport service in our area. I’m meeting paramedics, and the more of their air I breathe, I know – I simply must learn what they know.

    I’m back in school, I’m now non-traditionally old. I find it amusing then but I will find it even more amusing later. I learn more procedures, more skills, more drugs, and I drink in the knowledge like water. I can do more, I’m in heaven.

    The years go by and the calls accumulate. Back in the volunteer EMT days, I once asked an experienced first responder who was a nurse, “When do your hands stop shaking?” She smiled and said, “In time.” I volunteer no more, I work 24, 36, sometimes a rare 48 hour shift. I sometimes struggle with exhaustion of the empathetic kind, and that’s when I know that the overtime needs to rest. But those mornings when you hold the hand of a spouse after pronouncing time of death, or those midnight kitchens when the patient’s lungs are struggling to move air across the alveolar membrane in spite of the obstructive fluid impeding the process – that’s when I’m more alive than I can describe to anyone who’s never dropped everything when the tones go off.

    Then I’m 40 and I’m in nursing school. Now, boys and girls, I am decidedly non-traditional. Now I’m an older student, because after all that’s what non-traditional is kindly saying, all along. The calls and the years and the patients never stop coming. That old country song by one of the highwaymen has a line in it that reads, “the road goes on forever and the party never ends.” I’m used to this lifestyle and yet it’s wearing on me. I’m giving a talk one day to a group of paramedics and afterward, one comes up to me.

    “You really love this job” he says, “don’t you?” Without hesitation I answer, “of course.” He asks me then, how can I be leaving it? I think about it then, and for the first time I verbalize what I guess I’d been rolling around in my mind the whole time in my nursing classes. Rolling it around like you roll a hard candy in between your teeth and your cheek. Sometimes you hold it there until it makes the skin of your cheek get all funny feeling from the concentration of the sugar.

    “I’m not leaving” is what I say. “It’s who I am.” And I mean every word of it. As long as my body can respond from a dead sleep to wheels turning in under that two minute mark, as long as I can lift and pivot and hustle a cardiac monitor and backpack up three flights of stairs to an overdose at the end of a hallway, I know I can’t give away the radio. The pager is gone, now. Replaced by a nice Kenwood and a Boston strap. But the tones still activate the sympathetic response, and the drive to help, to revel in the autonomy of the street at 2am, the back roads lighting up with the red and white lights, the way the dispatch information activates the training and the street knowledge and my mind begins to run down algorithms and dosages on the way to the scene…no other profession can meet the speed at which this paramedic’s heart rate has come to love. There’s no other drug quite like the rush of a hand squeeze from an elderly patient whose breathing you’ve eased, or the never-fail feel good call of a diabetic wakeup when the family sighs with relief.

    I walked out in the garage the other day. The weather has finally warmed, and I opened both garage doors to let the sun shine in and the fresh air swirl around the stale dust. The sunlight gleamed off that lipstick red Camaro parked crosswise in the rear of the garage, back behind the everyday cars. Her license plate is current, paid and valid. It still reads CTCH ME. I think of EMS like that. Lipstick red. Always another road, RPMs just begging to be elevated like a heartrate.

    We are here for our patients, our communities, those we know and those we’ve never met. We’re on our way when help is needed. Always – in service. Because it’s who we are, it’s more than a profession. It’s a choice, a lifestyle, a calling, a gratification, an honor and a joy.

    Happy EMS Week 2017.

  • Wednesday, May 17, 2017 8:03 AM | PAAW Administrator (Administrator)
    The children outside are curious, playing but in a sense of studied nonchalance. Not that any of them look old enough to know the nuance of the word, but innate in them as in all of us lays the gist of the word’s implication

    The fire apparatus is already curbside ahead of us, lights silently announcing to anyone watching that activity is happening within this building, this day. My partner takes the cardiac monitor from me and I keep the jump bag over my right shoulder. Dropping their pretense of play, the children fall still, openly checking out our accoutrements. One brave boy calls out, “hey, whatcha got there? What’s that big bag for?” My partner returns, “helping people”. Simplified, yet valid.

    Inside, a middle aged man with an air of importance around him meets us, gives us a short layman’s report.  It is remarkably succinct, and with nearly all necessary components I could’ve asked for if making a list. We continue on in the direction indicated, where ahead a small group of people can be seen gathered in the cafeteria. It’s after hours, at this school, and yet the gathering is modest. I see fire ahead, and a slight woman with grey hair barely visible in the middle of the navy shirts, suspenders attached to turnout pants, and male muscles.

    I greet the lieutenant by name and make my way around the far end of the cafeteria tables arranged in neat rows. The patient has the gathering of firemen around her as well as a couple elderly ladies and amidst all of these, a few more assorted small humans, watching with grave interest. The lieutenant was a new fireman when I was a new medic and he gives report after greeting me by name.

    “Patient was getting up, caught her sneaker” <I remember thinking, “Jimmy said sneaker, who says sneaker? Have to tease him later on at some point”>  “on the bench and fell, hitting her head. She did lose consciousness. Her blood pressure is low; she was very pale when we got here. Her heart rate is very slow, blood sugar is 92.”

    The patient is discussing her last meal, her certainty that she is just fine, and I make my way over to her side. Seating myself on the bench of the cafeteria table so that we are near one another, I introduce myself. I speak quieter than is necessary, in this big echoing space full of people and conversations. She quiets, to hear me. Excellent. I need her to divert her attention now to the things I must know, some of them repeats of what fire have told me. This helps me to ascertain that she is remembering and maintaining not only the events about which I will ask, but that she continues to give the same version of events. I’m ruling out not only an obvious injury with this method, but also considering the all too often seen brushing under rugs of significant events by patients who fear a loss of independence. My concern in the here and now is her welfare and immediate medical issues. Independence and living arrangements, while not likely to be impacted by this event, are always concerns on the far horizon, handled by other professionals. We am mindful always, however, as this fear in the mind of a patient can result in a skewed version of events as relayed to us on scene.

    She is clear on her events, clear in her gaze, and calm in her recitation of events just as the lieutenant described to me. While I ask and listen, I place cardiac monitor on her and am greeted by a sedate normal sinus rhythm out for a Sunday drive at the slow pace of 52. She’s still hypotensive, but not as markedly as fire’s initial vitals. We go over past medical history (not much to speak of, hypertension for which she is compliant with her medication regimen), and the regular familiar rolling questionnaire of intake, output, new medication changes recently, dizzy or weak before the fall, syncope of falls within the last few months, symptoms now, any pain, day, year, president and so on. She denies anything of note during all of this, her answers accurate and remaining oriented.

    A few minutes later we have her on the cot, I’m handing for her purse near her when she asks me for her Bible. I spy it on the table, zipped neatly in the black leather case that is exactly like the ones in which my dad and mama always kept their Bibles. I pick it up, and the reassuring familiar heft of it is like an old friend. I grin at the familiar comfort of a memory as old as my childhood here in this moment, and ask her if they were having Bible study here. She shakes her head and with a smile, tells me as we walk to the truck about the program they have with the children here, points awarded for verses memorized. The children watch solemnly as we walk out, the man who I’m now almost certain is a pastor finalizes disposition of the patient’s car, and soon we are at the back of my truck. Opening the doors is a senior fireman who I haven’t seen in a while, and I feel the glad smile on my face. He says, “how ya doing, Crystal? Up here on the north side, tonight!” and we chat briefly while my partner loads the patient with the new power load cot. Then the back doors shut, I climb in the side door and it’s us ladies, in the back. I reattach the cables and begin another blood pressure.

    She sighs, then, smiles and says to me, “all of this….” Her voice trails off. I nod and respectfully offer that we do need to think of the implications of things like a loss of consciousness after hitting a head, especially as we think of ages when our bodies don’t handle injuries as they once did. Cervical spine was cleared on scene, she has no obvious outward injuries and we pull away from the curb after she politely declines an IV. En route to the hospital, she checks in on a lady who she has taken in, tells me earnestly of her story. She elaborates on the program with the children, and when I enter the demographic data into my patient care report, I double check the date of birth in surprise. She assures me that I am correct, and with a twinkle in her eye tells me she works out.  In fact, she prefers weight training the most. I cock an eyebrow and tell her perhaps the heart rate in the mid- 50s isn’t quite as out of the norm in her case.

    Report given, signature obtained, we walk into the bright lights of the emergency room, wheeling the cot. Two care techs I’ve never seen help us transfer the patient, and a nurse I’ve never met takes report. I walk down the hall a few minutes later, thinking of ladies who lift weights at twice my 40 years, and the equally preservative nature of small humans, taken once weekly, q Wednesday night. Repeat as needed for a life of service and happiness.

    And wear sneakers, no matter the age.

  • Monday, March 27, 2017 9:57 AM | PAAW Administrator (Administrator)
    They only moved here a month ago, she says. It’s quite dark outside and you can’t tell it’s foggy unless you catch a glimpse of the misty haze in the glow of the passing small town streetlights. From another part of the state, they loved the topography of the bluffs that line the mighty Mississippi in our driftless region. The coulees stretch fingers up among the gentle swells of the bluffs, and in the warmer months the surface of the water is glassy and rippling, in turns. They knew exactly where they wanted to move when they retired, and just under a month ago they made my region of Wisconsin their permanent home. When she speaks of the views she enjoys from their new home, her face lights up and she beams. The joy is incongruous in its juxtaposition next to the ecchymosis evident on her eyelid and surrounding tissues which occlude her vision on one side.

    The Badgers played awhile back and lost the game to the Gators in the last 4 seconds. She and her hubby haven’t really met anyone here yet, so they enjoyed a couple beers at home. Unused to the unfamiliar home, she stumbled in the dusk afterward and lost her footing. A retired healthcare provider, she chalked up her subsequent pain and stiffness as just a result of tumbling down some stairs. Time went by, the sun rose, she began to admit that it was more than pain and stiffness. Listening to her history of the events, I’m struck by her strength. The paperwork accompanying her lists a fracture as well as an anteriorly displaced shoulder dislocation – in the same upper extremity as the ecchymosis. A reduction attempted was unsuccessful due to some myoclonus and trismus evidenced after administration of etomidate. I’m currently transporting her to a larger facility for further care.

    As so often happens in the back of my ambulance, the paperwork is forgotten and the patient care report is neglected as a human connection is formed. I read each patient and if they wish to close their eyes and rest during an interfacility transport, I respect that. On those transports, my report is 90% complete before we arrive at our receiving facility. Some patients are nervous about the reason behind the need for transferring to the larger facilities, some are really sick and I’m busy with managing their medical presentations throughout the transport. But some, like this wonderful lady on this drizzly foggy night, are just warm and naturally want to connect with their care provider.

    She tells me a little bit about her life, that’s how I learn of the retirement. She is no stranger to the environment of medicine, and she uses “our” language. We frankly discuss the trismus, we both evaluate her hypotension and work to find a semi-comfortable position for the upper extremity that’s now so painful. She rates her pain an honest high score, but says she can handle it. She doesn’t like her hypotension and neither do I. We discuss the hypotension as perhaps transient and lingering due to the medications she was given prior to the expected shoulder reduction: Fentanyl, 4 doses of 50mcgs each, Etomidate, Ketamine. She states Ketamine helped her pain not at all. Ketamine would be my medication of choice right now, I tell her, due to its analgesia without systemic effects to blood pressure etc. She nods and says she agrees but in the ER it did nothing. We discuss pressors, discuss the possible surgery ahead, the rebound hypertension when all the ER meds wear off. She states frankly that she has no symptoms, and I can measure none objectively either – other than her blood pressure. I give her a 500cc fluid bolus and the systolic comes up where I’d like it. She grins and says it’s probably the bumps in the road more than the bolus. We tried to position her with head down and feet elevated during the bolus but that is too painful with the still dislocated shoulder. She is grateful it’s displaced anteriorly rather than posteriorly – we both shake our heads at the rough ride of the ambulance with a shoulder displaced to the posterior. It is certainly easier to protect a shoulder displaced anterior, in this environment.

    The ride through the wet velvet black night rolls on. She begins to tell me of her love of sewing, how this is going to put a damper in the wedding gown she’s making for her daughter. I tell her my mother-in-law loves to sew, too. I tell her of the large quilting machine that sews designs onto quilts and my patient knows the name of it right off the top of her head.

    My patient tells me she went back to school when she was in her late 30s. I tell her I’m currently in nursing school and just turned 40. She is encouraging about changing life directions no matter your age. We discuss education for a while, noting the similarities in our choices. She tells me then about her childhood some. Her mother taught her German, despite her grandfather’s wishes that his grandchildren never know German. I cock my head and she explains. Her grandparents emigrated here in the late 1920s. They never spoke German in public because of the negative opinions held by many at the time regarding Germans. She tells me her uncle married a Jewish girl, who ultimately did not survive the concentration camps. He, wracked with grief, stepped in front of a train. The family was afraid to appear too German here in America, even to the point of abandoning their native language. The isolation and loss of culture, coupled with a new country and personal grief must’ve been profound. This personal account of the horrors most of us have only been exposed to through a history book or class is striking. I listen with respect as she tells family tales, the ambulance parting the fog on the road like a knife in the darkness.

    We approach our destination. The monitor takes another blood pressure and we watch for the results. Better. I take the mic off the hook and give report. Arriving, we make our way to the team waiting to take over her care from here. I shake the wrong hand, her good hand, and thank her for her encouragement and sharing her life with me, the lessons she’s had along the way. She smiles that smile with the one eye out of sight under the truly impressive ecchymosis – and tells me it was good to find a friend in this new part of the state she’s made her home.

    My partner is new but quick, and he’s gone by now with our cot, off to strip it and remake the linens. I walk down the familiar hall with my boots the only sound echoing. The lights shine off the floor and I’m reminded for the hundredth time how no matter the day, the weather, the circumstances – the human connection is surprisingly often unimpeded by situation. People in the most dire straits, or with pain levels that have to be significant, are calmed by being heard, knowing they matter. A thank you from a patient sustains and uplifts us through an entire shift.

    Perhaps the walls we tend to put up to do the job aren’t helpful at all. Perhaps the walls we put up only serve to isolate us from the human connection we were born to have. No man is an island, isn’t that what John Donne said? (although, as a child I heard the adults say that once and wondered for days after why there was no mayonnaise in Ireland.)

    The trust our patients put in us, the hours we give up to be there for them – those are no small things. I’ve said it before and it still holds true for me – the front row seat to the human experience never grows old.

    “Sometimes our light goes out, but is blown again into instant flame by an encounter with another human being.” – Albert Schweitzer

  • Saturday, February 25, 2017 1:39 PM | PAAW Administrator (Administrator)
    He’s seen a few presidents, and he’s known a few good decades. Right now, he’s hanging out with me, because his head laceration is impressive. Fire did a great job of bandaging the wound up, but no one’s addressed the puddle of blood just yet. His speech is slurred, refined but slurred. I’m making his acquaintance as I put on my three lead, take my first blood pressure, scope out the oxygen saturation level. Everything checks out within normal parameters, so I press on. No odor of alcohol, blood sugar also within what I’d like to see. He cocks his head, then, looks at me.

    “I sound funny.”

    “Funny ha, ha?” I ask lightly, carefully watching him. 

    “My words – like I’ve been drinking. I haven’t been.”

    There it is, then. Altered from his baseline – and he knows it. Assessment continues, he denies loss of consciousness, denies any neck pain, CMS is intact, on down the line. Cervical collar in place, we assist him to a standing position and with the cot positioned behind, guide him to be seated. Securing him with straps, wheeling him to the truck, loading him within. Once inside, transport begins as secondary assessment shows no new findings. Eyes equal, round and reactive to light – I go on down the familiar road of assessment. I keep up a light banter about the weather, the circumstances surrounding the purpose of my arrival at his home today. I circle back around some details so he ends up re-answering questions he’s already answered. His answers remain on point, consistent.

    Radio report complete, we walk inside wheeling the cot and I give report at bedside; turn over care. We remake the cot, get the face sheet, scan it in the system, mop the floor where the cot wheels left their salty tracks, return to service. Rolling out the opening garage doors into the bright sunlight, I blink and reach for my sunglasses. My partner is telling a story of a shift a few days ago, and as the cab fills with our laughter, I tell myself I’ll follow up on this slurred speech head laceration gentleman.

    When I return later, no one from that shift is still on. No one can tell me the outcome. The patient isn’t in the room anymore.

    I walk down the hall and the sense of sand shifting beneath my feet is so incongruous in Wisconsin winter.


    We’re heating up our leftovers from home and the station is filling with good smells. Well, you know what happens then, so often as it does now. Overhead, “bleedle bleedle bleedle, 302 you have a call at blah blah blah, female ate some fish, now feeling gaggy.”

    I look at him, he looks at me and I imagine my face looks much like his.


    Food back in containers hastily, containers in fridge. Grab a water bottle in case I don’t see the station again for a few hours, throw the radio strap over my left shoulder and hook it on my right rear belt loop. I climb in, hit the garage door and hold my key fob up to the ignition until it beeps so the on board system knows who’s driving. Door goes up and we wheel right, then right again.

    “MedComm, 302 updated, en route.”

    “302, blah blah blah address, female ate some fish earlier, now feeling gaggy. This will be a non-emergent response, room X”  

    The address, once a motel now month by month rental residence, one room and bathroom equaling one tenant’s allotted space. We arrive just behind fire. The patient is ambulatory outside as my partner puts the truck in park. Fire is making contact, clipboard in hand – but she’s headed straight for the side door of the truck. My partner has care on this call, I’m just the driver. He directs her to the captain’s seat and assists her with the seatbelt. I determine receiving facility from fire, chit chat with them a few minutes and then we’re on our way down the street. In back, the conversation:

    “So what’s going on tonight, what made you call 911?”

    “My neighbor, he made some fish, I had some. Now I’m feeling so….gaggy.”

    “Did you throw up, then? Diarrhea?” 

    “No. Just feel a little gaggy, like maybe I could puke if I smelled it again.”

    My partner falls silent then. I put on my blinker, turn, continue down the familiar dog track route to one of the two receiving facilities in the city. In back, he attempts again.

    “So, do you have a medical history of any problems associated with GI issues? Problems I should know about so I can tell the doctor? What made this necessitate an ambulance tonight, ma’am?”

    “No medical problems, I just can’t afford a taxi and I wanted something to stop feeling gaggy.”

    Silence ensues. We arrive, I park, the three of us walk in together. I break off before the entrance doors to the Emergency Room itself, find the ladie’s restroom. Washing my hands, staring in the mirror. Trying not to think about the status red I heard while we were getting out of the truck as she met us outside her residence. The call holding because there were no trucks to send. That caller needing help, then the call pending, waiting for a truck to clear.

    I hope they’re ok. I hope a truck was able to get to them in time.


    We’re sitting at the posting parking lot, and we’ve got the giggles. Somehow it came up that neither of us are much good without a map, or a GPS, even after all this time. He’s been a medic somewhere around the two-decade mark. Me, seven years – but I dispatched this service in this town for six years before that. But once he lost his partner inside a house while he circled the block in their truck as the partner gave him directions, and once my partner and I loaded and transported our patient in another crew’s truck without noticing for a solid ten minutes. We have snacks, though, so we decide if we get hopelessly lost, at least we won’t starve.  We spoof off this until we have tears from laughing so hard.

    It’s the middle of the night, we’re 18 hours into our 24-hour shift. We’re the only truck left in the city, and whatever happens next for a range of maybe 40 miles – it’s mine. I’m up for care. My legs want out of the cab, but I’m not willing to brave the cold to oblige them with a walk outside. An occasional car passes on its way to the interstate on-ramp half a mile to our north, the only movement except for a forgotten Cheetos bag mournfully bopping thru the snirt as the puny wind half-heartedly backhands it. I ate clean all week, but in my guilty hands I hold without apology one chocolate milk, and one cheese filled Danish.

    Today lies in the dust behind us. I’ve already forgotten the name of the man with slurred speech. I can still smell the urine wiped off the captain’s chair from the gaggy lady, though. A hundred more just like them, and nothing like them, I’ve met, treated, cut the cord of one, called time of death on a number I don’t care to retain.

    Autonomy. Empathy. Tact. Tongues bitten in half and an ear to listen, a partner to laugh with at two o’clock in the morning and gas station food, lest we get too lofty an opinion of ourselves.

    These are drops in the ocean of paramedicine. This job that weaves itself into you until you can’t remember who you were, before. We witness and echoes linger sometimes for an hour, sometimes for years.

    I am the sum of my experiences – and theirs. I am 911.

  • Monday, January 09, 2017 7:51 AM | PAAW Administrator (Administrator)
    The address was straightforward enough – until we got in the neighborhood. The streets curved around and the numerics visible all were for the cross street. We had been told the patient would meet us in the parking lot, then updated information from MedComm was that he was advised to wait in his apartment. Inquiring for an apartment number, we were told the dispatcher would call back to find out. Updated information? The subject was indeed waiting in the parking lot; we were to go to the rear of the building. Finding the alley, we rolled slowly along, our right flood lights illuminating the successive row of apartment buildings. The problem with this method was that the rear of apartment buildings – including these – often does not have numerics displayed. We’d rolled along behind half a dozen when the radio came to life again. “301, caller is on the line again, advises you to come out of alley, take a left and you will see him outside.” We acknowledge, follow directions and emerge from the alley to find a front light across the street furiously winking on, off, on and off again. I flick our floods on and off in acknowledgement but the furious winking does not subside. Driving up alongside the curb directly in front of the door where the light lives does not make it stop, either. Directly beneath the light, cast by turns into stark relief and pitch blackness in paroxysms of the continuing on, off – is our caller. I roll my window down and he barks with extreme agitation, “I said to tell ya, go around back! AROUND BACK!” “Yes, sir, we…..” “GO AROUND BACK!” “yes, sir.”

    We go around back, the light collapses in relief I’m sure, as the door closes and darkness falls, for good. Blinking amid the stars dancing in front of my eyes as my partner navigates Around Back, I see a cramped stretch where the woods have been beaten back into grudging submission.  In this stretch are numerous vehicles and a dumpster taking up more than its rightful share of space. As we advance cautiously, I see a man hanging back in the shadows against the building. He withdraws further from our headlight beams. He is not the patient, and of this I am certain as a furiously walking man approaches directly towards our front bumper. He is pushing a walker almost as an affront to the air ahead of him. He appears to not need its assistance; rather, it seems an unwilling participant in a charge of righteous indignation. Almost as an avoidance of a certain collision, my partner puts the truck in park. I open my door, place the first boot on my running board.

    “YOU SHOULDN’T HAVE PARKED HERE! ICE!” My partner opens her mouth to ask “where-“ he cuts her off “IT’S FINE, LET’S GET GOING!” I tip my head, put a carefully submissive smile on and put myself in the path of the walker. “Sir, my name is-“ he stops me, “JUST GET ME TO THE HOSPITAL”. I open the side door and he collapses the walker, tosses it inside, and is seated on the captain’s chair before I can say a word. Our nature of the call at time of dispatch was “can’t change dressings, sores on legs” so I am not as alarmed as I would’ve been if someone with an unknown problem was so desperate to begin transport. For a moment I think of the man drawing back into the shadows, of the dumpster partially obstructing egress, of the dark strip of woods immediately behind this strip of apartments who’ve seen better days. But I don’t think the patient appears afraid, and I climb inside behind him.

    My partner hands me the monitor and I try again. “Sir, my name is Crystal-“ and again I am cut off. He reiterates “LET’S GO” so glancing at my partner and her raised eyebrows, I nod. Maybe I’ll have better luck establishing rapport and getting some information once the truck is in motion. She navigates her way out and I begin to apologize for the slight delay with the address. Mollified now that we are moving, the patient waves aside my apology. Apparently this is not his first transport by our service, as he tells me this happens every time.  “Screwed up address. What’s that? I don’t need any of that crap. Just need a ride.” I’m holding the blood pressure cuff and I explain that I do need to ask him a few questions and take some vitals. He isn’t loving it, but he sticks an arm in my direction. His eyes are rolling hard enough to scrape the back of his skull but they return to me quickly as I say, putting the cuff on “I’m really sorry you’re having such a bad night, sir. I’m Crystal, not sure if you caught my name, but I’d sure like to hear how I can try to help. What’s been going on?”

    His face softens a smidge and his shoulders sag forward. The hand on the arm I’m taking the blood pressure on is bandaged, seeping yellow – spots dried in concentric circles and new ones visibly damp. The fingers remind me of when I was in elementary school and we would put our fingers in Elmer’s glue, then peel it off when it dried. He tells me in a softer voice that he’s been battling cellulitis on his legs, and he is supposed to change his dressings every three days. Today is day four, and his hands are getting worse. He shows me the other hand, painfully red and swollen to what appears to be maybe twice it’s normal size, judging by the wrist and arm above it. He tells me in this soft voice – still with his brusque, staccato cadence – that both hands have been like that but yesterday the one got “real bad”. He looks at it and then I see it on his face, under the gruff exterior – fear.

    “I just can’t even change my leg dressings now, sorry I was such a – well, you know. My right leg is just raw meat, I stink, and it stinks, now my hand-“his voice catches. I shake my head in sympathy but careful not to offend him with any pity. I reach out and hold his hand in my gloved ones. He needs some empathy more than anything I can find in this state of the art truck, so I give him that. I inspect the hand, tell him it looks painful. Ask him how he’s been dealing with the pain. He earnestly describes the non-stop burning, his dwindling independence and his fear that the other hand is soon to follow. His blood pressure taken, I sit back in my seat, computer ignored, and give him a human who will listen.

    He tells me he was a HazMat trained first responder at a local business, tells me with pride that he loved learning how to help others. There’s a pause, then, and he looks down at his old boots. In an even quieter voice, he tells me how he couldn’t help his brother though. Hanging out with his brother one night, the brother told him he was not feeling good. Couldn’t catch his breath just right. My patient advised his brother they should go to “the doc”, get it checked out. His brother said if he wasn’t feeling better by morning, he would go. My patient got up every two hours throughout the night. His brother seemed ok, not great but ok. When my patient went in at 7am to see if he was ready to go, his brother was cold – gone.

    My patient takes a minute, then. Purses his lips. Nods to himself. Looks up at me. “Of all the people I shoulda helped….ya know?” Somewhere I register in surprise that this patient understands something few people do. I get it – it’s that wish, no matter how many strangers you help, that you could’ve helped a family member. If only you could go back in time. I buried a father at 14 and a brother at 21 but I don’t say any of that. I simply nod, and he nods, watching me. “Yeah, you do know, dontcha?” He says that his brother’s autopsy showed a pulmonary embolism.

    After an appropriate amount of respectful time, I turn the conversation to more stable ground. We both love to watch Game of Thrones, it turns out and the remainder of our time is spent laughing about TV shows and actors. Who’d have guessed it? My patient is conversant in Hollywood gossip!

    Report given to receiving facility via radio, upon arrival my patient straightens his spine, follows me out the side door. Briskly he pops open the walker and sets off at a furious pace past the nurse meeting us in the garage. The patient told me en route that he brought his own bandages and indicated his trusty walker. He just needed a wound nurse, he said – and he is clearly out to find one. The charge nurse directs him to the triage room, I obtain a signature and bid him farewell. His mask firmly in place again, he nods curtly and says as I leave, “thank ya, lady.”

    Waiting for my face sheet at the registration lady’s desk, I’m half listening to her cheerful voice telling me about her Christmas – and half wondering what it must be like to have one halfway healthy limb, out of four.

    And that flash of understanding I just shared with a human being almost completely opposite of me in every way. Aren’t we all so very the same, underneath it all? And why does that keep on surprising me after these years on a truck?

    Happy Holidays, Happy New Year. May you often in this coming year have someone cross your path that makes you stop, and look at life a little differently.

    “I truly believe that everything that we do and everyone that we meet is put in our path for a purpose. There are no accidents; we're all teachers - if we're willing to pay attention to the lessons we learn.”  -Marla Gibbs, Actress, 1931-?

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About the Author

Years ago my neighbor John from down the road told me there was a volunteer first responder class being held evenings. Since my bank job ended at 4pm he figured I could probably swing the time, and volunteers were needed badly. From those years of responding in a private car with a pager, to volunteering 30 miles away as an EMT-B, the EMS bug took hold. Roles over the years have included working for a private inter-facility transport service, rural emergency room EMT for five years, emergency medical dispatcher for helicopter and ground EMS for six years, then on to the paramedic classroom and critical care licensure. The more I learn, the more I see I have yet to be taught. The more people I meet, the more stories I'm told. The front row seat to the human experience never grows old.

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