By Crystal Wallin, NREMT-P, CCEMT-P, Gundersen Tri-State Ambulance
The reunion happened on a sunny spring day but I can’t say anyone would’ve seen it coming. Especially me.
It was the first shift in awhile; I’m not out on the street as much as before now that I am a part-time medic and a full-time ER nurse. But oh how I missed it, and I’m positively jovial—probably obnoxiously so but I can’t help it. Doing what you love means sometimes you just bubble over with joy in the oddest of places. And this reunion, I am sure, is literally the oddest of places. But I digress.
First call of the shift, it begins innocuously enough. I’m on a power truck with a medic I haven’t worked with in months, maybe over a year. We are catching up, we’ve done truck check and entered the narc count and the familiar routine is in play. The tones go off and our unit’s number is dispatched overhead in the garage bay where we are finishing up beginning of shift duties.
“303, report to <motel name> in town of <name>. You’re needed for a detox patient who has been vomiting and requires transport to the hospital. Law enforcement is on scene.”
I bound up on the running board and into the passenger seat, announcing “I can take this” and my partner grins, “have at it!” and we’re off. First responders are paged and en route. We take it nice and easy up the four lane through to the north side and into the adjacent community. Pull up alongside the motel, joining the squad car and first responder vehicle parked outside the room number given in the dispatch information.
An officer is rounding the back of the truck almost as soon as my boots hit the running board, and then the ground. He says without much eye contact, “gentleman inside has been detoxing, wants to go in for help with that. Watch out – there’s <another word for stool> everywhere in there”
And he’s gone.
My partner and I put the monitor and kit on the cot and wheel it to the door. Two fireman are inside, EMTs, taking demographic information and obtaining baseline vitals. Greetings are made and a short report received – in short, this patient has been drinking for days and has run out. He feels shaky, his heart is pounding, he is weak and he has been incontinent of stool. Repeatedly. Vitals are within normal limits, exact numbers are given by the veteran fireman who is holding the clipboard but the gist of it is that they aren’t worrisome.
My patient is seated on the edge of the formerly clean, modern motel room without much personal effects to be seen. He is wearing a button up shirt and nothing else. First things first, towel on the floor to walk safely through any landmines of stool. That taken care of, I reach my patient with the sad eyes, and I attach the four lead. Normal sinus on the monitor, no ectopy but the rate is a little rapid – in keeping with the dehydration his skin and dry mucous membranes are showing evidence of collaboration. He’s polite, almost submissive in his excessive manners and downcast eyes. Haircut is recent – ish. He’s a few days away from a razor’s touch to his face but all in all, not long. On the floor near the restroom are his jeans but they are not salvageable at this point without a heavy duty washer. An empty pint bottle of cheap vodka is beneath the empty luggage rack against the wall. Small amounts of unformed stool are gently deposited on the way to the restroom from the area of the bed, resting in smooshy looking piles. They look almost as apologetic as the patient on the bed, still very unctuous as he self-deprecates his way through paragraphs of regrets.
He was staying with a friend. No, he doesn’t live here. No ma’am, he doesn’t live elsewhere. He just stays wherever he can, ma’am. Been sober for about five months ma’am, partied a few days ago with some old friends until he ran out of money and he is feeling purely awful and he’d rather just die, ma’am, than go through this again, yes he would. No way to fix this but some vodka, any chance…?
No, I tell him. Help is here but help won’t include vodka. We put a bath blanket on the cot, folded in half the long way so that the blanket is perpendicular to the cot in a sort of plus sign. Another towel on the appropriate spot on the cot, then my patient is directed to sit on the towel. The bath blanket is folded snugly across his middle - a paramedic burrito - and a second bath blanket is used in the conventional way to cover him up. He is cleanly packaged; after being secured with straps and the monitor placed behind him on the head of the cot, we walk to the truck.
The air outside is fresh and the patient continues his dialog in the same vein as he did inside. We load him, I climb in the side door and have a seat. Secondary assessment reveals no additional findings, repeat vitals obtained (my second set, third set counting the first responders’ initial set). Transport begins.
During transport, I verify the demographics, get them entered. It is then that I see the name. The patient’s paragraphs of self-loathing, self-deprecation and obvious depression have been continuing to pour out and he refers to himself at this point in the third person. I am reading his name in the fireman’s handwriting, and I exclaim, calling him by name. He stops, looks up at me thru his eyebrows and bangs, chin down in that excessively submissive way. Says, “Yes?”
All the pieces fall into place here in this sunny day in the back of an ambulance in 2019 and I tell him I remember him very well. In 2010 as a new medic, we went to his mother’s home often for him. Acutely intoxicated, he would be semi clothed or not at all. He would have the issue of the piles or puddles of stool – all over the home, even sprayed up on the walls maybe as high as my waist. His father was deceased, his best friend, and he was drinking his pain away in the home of his elderly mother. He’d always sob, addressing himself in the third person and saying he “really did it again”. We always had to lay out blankets folded lengthwise to walk on, as there would be hardly a square foot free of stool.
In 2016 as a nursing student still also full time on the truck, I responded one rainy Saturday to a complex of midscale apartment buildings, to a basement apartment. The apartment manager had arrived in a response to neighbors saying they hadn’t seen a resident in days. The manager was pacing in the hall upon our arrival, running his fingers thru his hair wordlessly. A firefighter met me at the door and told me to watch where I stepped – there was stool everywhere, even up onto the walls. A man inside had been down for days, was detoxing. I asked if his first name was so-and-so, the firefighter answering, yes – how do you know? I asked if he spoke of himself in the third person, again yes. My patient inside was in very bad shape, worse than I’d ever seen him. That day I learned he had lost his mother, as well. His depression was intense. After a very complicated, careful extrication – walking again on blankets folded lengthwise - from an apartment that surely would need subflooring and some drywall replaced, he was in my truck and the doors shut behind my partner. During transport, I put the computer aside and met his eyes. That day they were looking up thru hanks of encrusted hair, full of what my best guess would identify as dried emesis. I felt as if I was able to make connection with him, just a little. We spoke of AA, of sponsors, of a community of sobriety that could rally around in the absence of his family. I told him I remembered him and his mother very well. I told him I believed in him and the path of sobriety, although privately I thought to myself, I wasn’t so sure he could beat this. On that day, his gaunt appearance and grown out hair and beard were stark and disturbing. He sobbed as I gave report to the nurse at the ER that day.
So now it’s 2019 and he has never looked this clean cut before, but it’s him, I can see it now that I know it. I prove I know him, really remember him, by listing his mom’s street name, tell him of the day I came to transport him out of that dark basement apartment – remind him I believe in him and that AA works if you work it. His eyes fill with tears and from the pocket of the button up comes a sobriety chip. He says, “Your dad was the recovered AA guy who went on to be a counselor?” I nod, he says with more tears, “I remember that day you took me. Nobody told me they believed in me since my mom died until that day.”
He breaks down. He tells me he was doing it, then he screwed up. I ask more questions and find out that he quit going to meetings, lost contact with his sponsor, connected with old drinking buddies. Again we go over “it works if you work it” and “one day at a time”.
When I leave him in the ER, he’s sobbing again. I give report to the nurse, warn her of the burrito’s contents and then make a point to shake the patient’s hand - although with my still gloved one. I tell him I don’t want to see him anymore, and I know he can do it. I strip the gloves off, leaving them in the wastebasket in the room. I’m walking out with my own head down, thinking that in my two days a month on a truck, what were the odds – when I hear him say my name. I turn, and that hand with the stool under the fingernails is holding that chip aloft.
“I can do it. You won’t see me again.”
I hope so. I really, really hope so.