Unresponsive, at shortly after 6am, is a thing. It’s the time of day lots of folks wake up and find the spouse isn’t breathing, or moving, or generally not like usual. Unresponsive, at shortly after 6am, is a special kind of horrible thing for a medic who is deep into sleep. Waking thickly in a panic as the tones sound overhead, stumbling feet into boots while pulling sweater overhead, fumbling for glasses, tucking in shirt while hurrying to the garage. Unplugging the shore line, zipping boots, hitting garage door opener, blinking at early morning while shoving the seatbelt home to a crisp click. Blinking and reaching for the mike, putting the truck in drive and activating siren and lights while listening to the repeated dispatch info. Glancing at the Navigator screen on the tablet for the address, merging into early morning caffeinated and showered drivers while still valiantly mentally joining the rest of the world.
Unresponsive male and odds are he’s been down a while so not likely we’ll get a ROSC and then the day starts with witnessing another human being’s heartbreak. It is what it is, but what it always is, is a losing proposition against the usual amount of time down at shortly after 6am.
We arrive about the same time our mental clarity reaches normal percentages, and the small house with the magic numbers above the door appears deceptively benign. No movement outside except the lights revolving silently on the fire rescue parked at the curb. My partner has care so I’m mentally reviewing the checklist for intubation as we grab the kit and monitor, and head for the front door. Is it just me or are our footsteps dragging a bit? Conversation en route was minimal. Unresponsive shortly after 6am is a conversation stopper.
Front door’s open and a lady’s sitting on the floor. There’s a fireman at her side, a new one on the rescue – third one since my shift started 22 ½ hours ago. A man in a recliner is visible at the rear of the house and there’s another firefighter somewhere in the middle. My partner stops, looks from lady on the floor to man in the recliner. The near (freshly showered) fire fighter says, “she’s the patient” and shortly after 6am gets a whole lot less depressing.
The story emerges through patient report and patient interjections. She woke up sick. He needs to go to dialysis and she has the GI bug like you can about imagine. He yelled at her from the rear recliner and she was working on keeping the groceries down, wasn’t feeling too chatty so didn’t answer. He called 911, she tossed the groceries and now here we all are.
She clearly states she does not want to go to the hospital, and after vitals check out, my partner clears fire. I razz the original firefighter about going thru three partners in 24 hours and he laughs. They leave; we turn to each other and get to work.
The husband needs to get to dialysis. The wife shakes her head weakly when asked if there is anyone who we can call to help get him there. It’s clear she won’t be driving anywhere. My partner gets on the phone and starts calling; the dialysis center, our dispatch center, wheelchair van. I go update the man in the recliner who is hard of hearing. I ask if he’s taken his insulin yet and he says yes – but when I ask if he ate, he shakes his head. I find a pear in the fridge, cut it up, spread some peanut butter we find on a roll, and serve him a plate of make-do breakfast.
My partner is meeting bureaucratic barricades. The social worker at the dialysis center isn’t at work yet. The dialysis nurse is unwilling to comp a wheelchair or taxi ride. Wheelchair van won’t take insurance. I feed the enormous, sleek orange cat talking earnestly up at me while winding around my ankles. He’s soon happily scooping out wet food with a paw, and licking it neatly off. He’s clearly practiced at the art of culinary enjoyment.
My partner finally calls the emergency room social worker who is basically part of our work family. He’s immediately assured the the emergency room can gladly supply a voucher for the taxi ride to dialysis & back. I’m sitting in the rear keeping the man in the recliner company and hearing his tales of Vietnam. He tells me Agent Orange did horrible things to the nerves in his legs, and I’m struck by the matter of fact way he tells me of his life post-war. He displays no self-pity, and he is truly glad for his peanut butter/pear breakfast. I put his shoes on as my partner updates the taxi company on the situation. I find his coat, and help his wife onto the couch with a throw blanket.
In the end, everyone was squared away and the cat was purring his way thru a bath on the kitchen floor. Last time I saw him, he had a paw lopped up over one ear and squinched up, happy eyes. Taxi was on it’s way and I grabbed the garbage by the door on my way out to the truck. Dropping the bag into the wheeled container at the curb, I stopped and looked up. The sun was out finally, and the snow was glittering in a triumphant win over the Christmas lights, still dimly visible up and down the block.
I climbed behind the wheel and looked at my partner. Bad boy sunglasses on and blue hat pulled on tight, his goatee split in a huge grin as he looked at me and said, “that’s some community paramedic stuff right there!” I laugh, and we pull away from the curb in search of coffee.
Life is a whole lot better at shortly after 7am.