Movement

move·ment

1  :  the act of moving

2  :  a group of people working together to advance their shared political, social or artistic ideas

—

This blog is largely a literary self conceit in that my personal views and observations are presented through the median of relating a story or series of interactions from the first person point of view. Over the last year of presenting these stories I’ve had the pleasure to meet like minded individuals across the world and have built an extended group of friends who share a bond and vision through the shared experiences of EMS professionals and first responders.

Through social media and the hard work of many professionals a vision of the future is slowly taking place. This vision of a new form of EMS has taken on the name of EMS 2.0 and though it means different things to different people we all share many of the same ideals for the advancement of the profession. 

To this end I have started the transition to relocate my blog hosting to First Responders Network. In the very near future there will be a minor face lift to the blog aesthetics and URL. Those of you that connect directly to paramedicpulpfiction.com will still connect with that URL. Those that connect using paramedicpulpfiction.wordpress.com will get re-directed to the new site. And those that subscribe via e-mail or RSS may have to re-set the subscriptions once the transition is complete. For the most part this should be a fairly transparent process.

I want to take just a moment to thank everyone who has been reading my self indulgent musings over the last year and rest assured that the same level of content will continue and possibly improve over the years to come. There is no shortage of fascinating observations to be had in the Big City that is my daily workplace. 

To the thousands of people that have read my little blog over the last year let me say thank you so much for your time. I hope I have given just a few people something to think about and that possibly some good can come from that. For those of you that are on the job; stay safe.

Thank you!

~KC 

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Gangsta Rap 3/3

The police officer sees us on the security camera and pushes the button that activates the large sliding metal gate. We drive in to see the parking lot full of police cars and head towards the sally port – a secure transfer spot for taking prisoners in and out of the city jail.

Five officers are waiting for us as Kevin and I step out of the rig to see why they called us to the back of the jail today.

The officer with the stripes on his sleeve approaches me and gives me the story. “Hey guys, so we picked this guy up on being drunk in public. While we’re getting him booked he starts talking about being suicidal and wanting to kill himself. So instead of booking him we put him on a green sheet to get checked out at EPS.”

“Did he actually do anything to hurt himself or is it just talk?” I’m just trying to see if I’ll have any injuries to deal with or is it just verbalizing suicidal ideation.

“No, he didn’t do anything – he actually wants to go to EPS. Go figure.”

“Has he been violent with you guys?” Trying to gauge the need for restraints or not.

“No, he’s been good, but he’s a big guy so we kept him cuffed.”

“Sounds easy enough. Do you want us to come in and get him or do you want to bring him out?”

“You can hang tight here, we’ll bring him out.”

We’re in the mid-county, more affluent cities, so there are more available police officers than in our Big City. In these cities it’s common to have four or five police cars respond to a single incident where as in the Big City they are stretched so thin it’s hard to get just two cops even when we need them.

The officers return from the sally port escorting a man in handcuffs. With one officer on each arm, and three more keeping watch, the man is doing a slow shuffle towards me as I wait next to the rig. He’s got his eyes closed down to slits which gives him a menacing look yet also allows him to surreptitiously observe his environment without others seeing the direction of gaze – prison yard stealth. With his shifting gaze he never looked past my blue uniform, which matches the police officers, to see who I am.

“Yo, Lil’G, what the hell you doin’ down here?!” The officers stop mid-stride as they didn’t expect to hear “street speak” coming out of the clean cut paramedic standing in front of them.

Lil’G’s eyes pop up to full round and he drops the prison yard stealth mode as recognition sets in. He gets a big smile on his face, “Yo, T2, it’s my boy. Ya’ll did me right, you called my boy to come get me.”

“Lil’G, you all right man. You gonna be cool if I get you outta those cuffs?”

“Yeah man, I cool, you my boy.” I can smell the alcohol coming off of his breath and hear the slight slur to his speech.

I turn to the officers holding on to his arms. “I’m good guys, you can un-cuff him. We’re old friends.” They catch the irony in my voice.

Lil’G happily climbs up into the ambulance as I chat with the sergeant for a few minutes.  “I usually see him up in the Big City around the seventies. I’ve never run into him down here.”

“Yeah we haven’t seen him before. I’m happy to send him up to EPS and out of our city.” It’s the classic small town sheriff giving the trouble maker a bus ticket out of the city.

“I hear ya’. We’ll take care of him. See you next time.”

I climb in to sit on the bench next to Lil’G and pull out the fat person blood pressure cuff to fit around his enormous guns.

“Lil’G, you losing some weight? You’re looking skinnier than the last time I saw you.”

“Yeah man, I going through some shit, you know. Not eatin’ much. I lost my daughter two week ago, she dead.” He’s introspective and just a little bit sad. I’d say that’s justified.

“Oh man, I’m sorry to hear that.” I’m curious about the circumstances but I honestly don’t want to talk about it too much with him. Remembering his bipolar diagnosis I know he could cycle on me and you just never know where that’s going to go.

In an attempt to steer the conversation somewhere else. “You got any new raps for me?”

“Yeah man, I got a rap for ya T2, it’s my story.”

—

I’m a play’a… that’s my number one life style.

I’ve been a play’a… since I was a li’l child.

I grew up… havin’ hard times every day.

I had to choose a road… but didn’t know which way.

 

Started kickin’ it with the fellas… on seven ohh.

Makin’ money… cuz that was the way to go.

Smokin’ dank, full tank… get an even high.

Even had three ho’s… on my side.

 

Two was cool but one… thought she was a gangsta.

But I didn’t know… I was fuckin’ with danger.

She kept on tellin’ me how down she was… you know.

She said she didn’t give a fuck… about five-ohh.

 

Till the day on the ave… we was kickin’ it.

Wasn’t nothin’ else to do… but get lit.

Straight hands to a gangsta… whole nine yards.

Till the sucka tried to pull… my damn playa’s card.

 

I threw a left… and connected to the fool’s jaw.

The punk fell an’ tried to walk… but he had to crawl.

I split the scene… and went to the fuckin’ sto’.

On the way back… I ran into the Po Po.

 

Shit was cool… so I didn’t want to bail.

Fuck the po-lice… I ain’t going to jail.

I cocked my nine… then I fired at the dirty mack.

I started trippin’ and my mind… started to un-fold.

I’m in the middle of a shoot out… damn I’m told.

 

As curiosity was fuckin’… with my damn head.

Bullets kept flyin’, people dyin’… and bodies bled.

I dropped my nine, then I reached… for my four-four.

Empty one clip, then I headed… for my car door.

 

I couldn’t believe my eyes…

It’s my mind’s surprise…

I’m the only black nigga gonna stay alive.

 

Jesus Christ… this mutha fuckin’ gang.

Po Po try an’ jack me… and playin’ wit my fuckin’ brain.

But I ain’t going down… I’m not a sucka.

You want me… you gotta kill me mutha fucka.

 

Bill Gates… and the rest a the klan.

Ya’ll can suck my dick… cuz I’m a crazy ass black man.

But in the mean while… I’m just as versatile.

That’s my life… gangsta life… that’s my life…style.

 

My name is Lil’G… and I’m out.

—

Lil’G is a very real man and the above rhymes are his words. I apologize for the graphic nature and language yet I think it’s important to keep it authentic as an accurate  representation of how his mind works. It would be easy to dismiss this as typical gangsta rap but I think it goes deeper than that. This is a man who has been in and out of institutions – criminal and psychiatric – since he was young. He may have actually picked up some coping mechanisms to deal with the turmoil that haunts his waking moments and it manifests with introspective communication in the only way he knows how. Just as his bipolar mind cycles from emotion to emotion his physical body will cycle from street to institution until both are exhausted. There is no escape for his mind or body from the streets that created his life…style.

Gangsta Rap 2/3

Kevin and I are dumb-founded. It was actually a good rap, despite the disturbing subject matter, and Lil’G seems to have some talent. I’d much rather listen to him rhyme than watch him tear the place apart.

“Lil’G man, you got some talent, you write that when you’re in prison?” I’m honestly curious.

“Nah man, I gots too much to do when I’m in the joint.” He’s dismissive with a wave of his hand.

“Too much to do? What, you working out all the time? Gotta build up those guns?” Referring to his biceps. Yet a tickling on the back of my neck reminds me that we didn’t exactly search him before he got in the ambulance with chest pain a few minutes ago. I hope Kevin did the “EMS pat down” as he put the monitor leads on him.

“Nah, I don’t work out in the joint. I’m too busy keepin’ an eye on all those niggas. Don’t never know when some fool’s gonna come up and try to stick me. Gotta be ready for a smack down, you know?”

After what seemed like an eternity PD shows up. Fortunately they pulled up to the front of the rig and I’m able to brief them before Lil’G notices they are here. The officers walk around the back of the rig so Lil’G can see them and it’s obvious by his expression that he’s not surprised. He knew this was happening all along. He’s been in this situation before and knows the drill just about as well as we do.

After a quick conversation and some paperwork the green sheet is finished and we can start to transport to the Emergency Psychological Services (EPS). Lil’G will get a psych evaluation and maybe stay a day or two for observation. It all depends on how he answers the questions.

It’s Kevin’s tech so I’m up front driving to EPS while Kevin finishes off the paper work. It turns out that no restraints or sedatives were necessary as Lil’G seems to want to go to the EPS. I can only imagine the life he’s led up to this point and how it may actually be comforting for him to rest in a relatively safe institution for a few days.

Growing up in the hood he presumably had few positive role models. He must have been in harm’s way often and exposed to some traumatic events. Just as a soldier comes back from a war with PTSD, I can imagine that life in the hood can create the same effect. Then at a formative age he’s placed in prison with its strict routine and lack of freedom accompanied by the ever-present danger of prison violence. Past traumatic experiences have created at least as many mental/emotional scars as physical ones.

Yet even with these obstacles this man has made it to his forth decade of life, which is rare for people in his situation. He seems to focus his energy on his rhymes, which he presents in all modalities of communication, with a harmony of visual/kinesthetic/auditory artistry. A man with limited education and vocabulary is able to access his inner emotions and express his feelings, dark and violent as they may be, to others and himself.

Pulling into EPS I hear the disturbing rhymes from the back of the rig.

—

I chop your head off… let it roll in a buck-et.

I punch your eyes out… so I can skull fuck-it.

 

But I aint trippin’ nigga… I won’t beg.

I drink the blood… from a bull dog’s left leg.

 

I told you once nigga… I ain’t even trippin’.

You get found nigga… by three old men fishin’.

 

We can do some shit… I might bust your brain.

But on the tip of my shoes… I’m leavin’ doo-stains.

 

Gangsta Rap 1/3

gang·sta

1  :  black slang; a gang member

2  :  a type of rap music featuring aggressive misogynistic lyrics, often with reference to gang violence and urban street life

rap

1  :  to hit sharply and swiftly; strike

2  :  a criminal charge; a prison sentence

3  :  music; to talk using rhythm and rhyme, usually over a strong musical beat

4  :  to have a long informal conversation with friends

—

Violence is a part of America. I don’t want to single out rap music. Let’s be honest. America’s the most violent country in the history of the world, that’s just the way it is. We’re all affected by it. That’s one of the frailties of the human condition; people fear that which is not familiar.

Spike Lee

—

“Ya’ see, I didn’t really call you here because I was havin’ chest pain. It nothin’ like that at all. Ya see, I thinkin’ about killin’ myself.” As the fire engine accelerates away from us Kevin and I have a very different call on our hands than the one we thought it was going to be just a few seconds ago.

Getting called to the middle of the hood for chest pain is a common enough thing and we answer these calls on a daily basis. Today we happened to be just a few blocks away when the call information arrived on the Mobile Data Terminal (MDT). I turned the ambulance around and we were on scene in less than two minutes.

Sitting on a chair in front of an urban church outreach center was a man in his early forties. The pastor and church volunteers are comforting him as we walk up to see what’s going on. Holding his chest he tells us of the pain he’s feeling and how he wants to get checked out at the hospital. It’s an easy call and the assessment and treatment are so rote that we fall into auto pilot as we go through the motions.

Seeing the fire engine approaching from down the street I write the man’s name and birthday on my glove and hold my hand up high so the fire lieutenant can copy it down for his records without having to exit the engine. In seconds they are off to the next call and we are alone with the patient. Of course, that was before I knew the true nature of the call.

After our patient drops the bombshell on us, Kevin and I take a collective deep breath and one look between us confirms the sudden detour this call has taken. In our business suicidal ideation is taken very seriously. A person who is truly suicidal, who has ceased to care about their own life, may not care about other people’s lives. Therefore, we can be in danger when dealing with these people.

Our new patient, Lil’G, is quite a formidable man. He has scars on his face, one of which is consistent with a knife wound. He’s 240 pounds of compact, short, boxer’s build with huge upper body development. He’s seriously built like a smaller Mike Tyson. He jokes with Kevin because he had to pull out the fat person blood pressure cuff just to fit around his huge biceps. He does a muscle man flex and smiles showing me a gold tooth. I’m feeling very uneasy about this. I give Kevin a look that he understands. “I’ll be back in a second.”

“Hey, where you goin’?” He’s quick with predatory instincts, watching every movement – nothing escapes him.

“I just have to get the computer from the front.” It’s a half truth which I hope he doesn’t see through.

Walking up to the front of the rig I turn on the portable radio on my belt. Opening the front door I grab the computer and turn off the rig radio which can be heard from the patient area in the back. I stand in front of the engine compartment so I can keep an eye on Kevin through the windshield as I call in to dispatch on my portable.

“Medic-40 go ahead.” The radio crackles back to me.

“Medic-40, please send PD to our location, code-2, our chest pain call just turned into a 5150 with suicidal ideation. We’re code-4, for now.” The code-4 tells my dispatcher that we are not currently in danger. The ‘for now’ tells her that I don’t know how long that’s going to last.

I’m standing outside of the back doors as Kevin is doing further assessments on Lil’G. Kevin knows the drill: we have to stall as long as possible so PD can get here to write up the green sheet (5150). Without it we have fewer of the options we may well need in this case, like restraints and chemical sedation.

I’m watching Lil’G as Kevin continues with the 12-lead EKG. Lifting up his shirt I see the multiple GSW (gun shot wound) scars.

“Lil’G, how many times you been shot?” Anything to distract him and buy us some time.

“Yo, I been shot four times, stabbed two, and sliced up a couple. It’s hard man, growin’ up in the 70s.” He’s not referring to the decade – to him the 70s are the street numbers in his corner of the hood.

“You ever do time?” I’m thinking prison ripped could explain the boxer physique.

“Yeah, I did six year, fo’ bangin’. You know; sellin’ a little, had sum ho’s, and a little bit a shootn’.” He’s not talking about shooting up with heroin. “Yeah, I got a strike on me.” In this state it’s three strikes for felony convictions and you’re in prison for good.

Kevin’s still trying to stretch out the assessment as I’m typing on the computer. “You got any medical problems?”

“Yeah, I got PTSD, bipolar, paranoid schizophrenia, and depression, but I ain’t takin’ no meds for it.” FUCK ME!!! I’ve got a bipolar psych patient who’s off his meds, built like Tyson, and thinking about killing himself. I really need a raise.

Lil’G could shred both Kevin and I if he put his mind to it. Not to mention tear the ambulance apart. We’re walking a fine line here and we have to keep him on the good side of his bipolar disorder. I’ve watched manic bipolar patients cycle from happy to violent a dozen times in the course of a single transport. If this guy cycles on us we’re fucked.

Despite the lethal potential of Lil’G he’s actually pretty engaging. He has a fast wit and keen observation skills. He decides I look like the silver terminator from Judgment Day, in reference to my hair style and clean cut white boy appearance. Seeing as the terminator impersonated a cop through most of the movie I’m not sure I like the reference.

“Yo man, that’s your new name, I’m gonna call you T2.” He has a full bodied laugh with muscles rippling to the diaphragmatic contractions. Great, I have a street name.

And just like that Lil’G cycles on us. Yet not to a violent nature – quite the contrary. Right there in the back of the ambulance he starts rapping. With perfect tempo and surprisingly colorful depictions he tells us what’s on his mind in the only way he knows how.

—

I’m on the microphone… gotta do it quick.

But never give a care… I ain’t scared to hit a bitch.

Gotta hit her from the back… nigga back side.

I don’t give a fuck nigga… it’s time for a wild ride.

 

Call me Lil’G… when you see me.

I see niggas on the street… trying to be me.

I got these knuckles man… I make ‘em laugh man.

Never give a care… put ‘em in a bath man.

 

Gotta do it good… cuz you know what’s right.

I never give a care nigga… cuz I’m hell’a tight.

I come from 69ville… nigga eight-five.

Never give a care… boy I don’t duck and hide.

 

I’m born on the east side… I’m going east bound.

You a block head… whose name is Charlie Brown.

Heart Attack 2/2

There’s a saying in paramedicine: trauma is trauma. Basically that just means that it is what it is. Unlike a complex medical emergency with co-morbid factors on a patient with chronic conditions who takes ten medications, treatment for trauma is actually pretty simple. If it bleeds, plug it. If it’s floppy, splint it. Then go find a trauma surgeon quickly. Yet the real nuance to effective trauma care is staying ahead of injuries by anticipating problems before they happen and caring for the injuries that you can’t see.

All of Maria’s vitals are recovering nicely and she’s answering my questions well enough, although she’s understandably in a lot of distress and on the verge of freaking out on me. I made sure to apply the occlusive Asherman dressing to the chest wound. In a perfect world that will reduce the risk of a collapsed lung. In the imperfect world that I live in I’m not certain I could do a needle decompression to re-inflate a lung on Maria because she’s just too fat. But for now she’s breathing effectively in all lung fields.

I call my vitals up to Kevin as all of my assessments and treatments are pretty much done. I just need to start a couple IVs before we get to the ED. I take the oxygen mask off of Maria, as her saturation is at 100%, and put on a nasal cannula that tracks her expelled CO2 and gives me a visual waveform of each breath. I’ll be able to see a change in respiratory effort if she develops any complications.

She’s still a little scared and crying now and then. I cover her up with a blanket and tuck it around her shoulders. On one hand I want to stay ahead of the impending shock symptoms by keeping her warm yet on the other hand the simple act of tucking a blanket around someone tends to calm them. Despite the constant bouncing of the rig and melodic whine of the siren Maria seems a little more relaxed.

“Maria, you’re doing really well. I’m just going to start a couple IVs in your arm. You can help me out by talking to this nice officer over here. She has a few questions for you.”

The officer has been waiting patiently for me to finish my initial assessment and treatment. Hearing my prompt she stands up so Maria can see her and begins the question process.

“Maria, who stabbed you?”

With tears rolling down her cheeks she answers. “My boyfriend…”

I’m in my own little world as I preform the rote task of starting IVs and reassessing vitals. It’s strangely calming to have a single task in front of me as I’m a fly on the wall listening to the back and forth between the officer and Maria, as she tearfully describes the melodrama of an argument that escalated to attempted murder.

As Kevin and I push the gurney into the brightly lit trauma room we’re met by a room full of hospital staff. Fresh baby docs are pacing nervously wondering who gets to do the chest tube today, seasoned nurses are leaning against the wall, thinking about the twenty other things they should be doing while they are interrupted by this trauma, and the stoic teaching docs are standing in the background to observe everything and be ready to jump in the second before someone makes a mistake.

“Good morning, this is Maria…”

—

The officer was able to get suspect information before we even reached the ED. His name, vehicle description, address, and associates were relayed to police dispatch during the trip. By the time we rolled into the ED police were already on the man hunt. I heard the police dispatch tell them that he has prior warrants for violent crime and to consider him armed and dangerous. I stood in the corner of the trauma room with the officer who rode with me and explained what the doctors were finding as they did their assessment.

A quick sonogram showed that Maria had plural effusion – excessive fluid pouring into the lungs. And then a second pass showed that the knife tore open the pericardium – the sac that surrounds the heart. The fact that Maria was a large girl actually saved her life. Had she been any smaller the knife would have punctured the heart. She was up in the operating room before I even finished my paperwork. By the end of my shift she was recovering in the ICU and the (now ex) boyfriend was in custody. Had the officer not come with me the suspect information would have been delayed until after the anesthesia wore off and that would have given him a 6 hour head start.

Heart Attack 1/2

heart

1 : a hollow muscular organ that pumps the blood through the circulatory system by rhythmic contraction and dilation

2 : regarded as the center of a person’s thoughts and emotions, especially love or passion

at·tack

1 : to set upon with violent force

2 : the act or an instance of attacking; an assault

—

Passion is the enemy of precision. Forget the misnomer ‘crime of passion’. All crime is passionate. It’s passion that moves the criminal to act, to disrupt the static inertia of morality.

Daryl Zero; The Zero Effect 1998

—

Kevin angles the rig behind the BRT in the parking lot of the apartment complex and puts it in park with the strobes still flashing. I can see the firefighters grouped around some shrubs and by their actions I can see it’s a serious call. All scenes that we go to have a vibe and once you get used to reading body language you can usually tell how serious a call is before even getting to the patient. Bags are open, oxygen is about to be administered, clothes are being cut away, officers are asking questions of bystanders, the police dog is barking from the back seat of the K9 unit… this is a serious call.

Kevin looks over at me, “Just go, I’ll grab everything.” It’s my tech and Kevin knows I want to get to the patient and start my assessment and treatment quickly.

As I walk up to the shrubs I see an officer holding her hand on the patient’s chest. Judging by the amount of blood covering my new patient’s clothing it appears that the officer is holding direct pressure on a wound.

The fire medic is applying the oxygen mask as he looks up at me. “We just got here a second ago. Looks like a penetrating wound to the chest; maybe a stab wound. Unknown downtime; she was found a few minutes ago by a bystander.”

The bloody shirt is finally removed and I ask the officer to lift her hand briefly so I can visualize the wound. She lifts up her bloody glove and I clear off some of the blood with a dressing. I see a three centimeter horizontal stab wound just to the left of the sternum. Pushing my fingers into the chest for landmarks I find that the wound is directly over the 5th intercostal space and it’s likely the knife slipped between the ribs. Judging by the length of the wound the knife likely traveled pretty deep. Crap! That’s a bad place to miss the ribs!

I look over to the rig just as Kevin rolls the gurney next to the shrubs. “I need an Asherman and C-spine.” Kevin nods and rushes to get the supplies, returning in just a few seconds. Kevin and I tend to truncate our communication to the bare minimum on stat calls. More often than not we’re thinking the same thing and we really don’t need to verbalize most things during treatment. It makes things flow so much better when partners are on the same page and have worked together for a while.

As we cut off the rest of my patient’s bloody clothing and look for any additional wounds, I try to get a baseline on her mentation. She’s not tracking with eyes or answering questions yet she has spontaneous, erratic movement of all extremities. Actually a little too much movement – she’s slowing down our attempts to strap her to a board. I look forward to the day that we adopt a protocol that allows us to forego spinal immobilization when a patient presents with no neurological deficits. But for now we have to do it based on an abundance of precaution.

With my patient strapped down and the occlusive Asherman dressing applied, we’re ready to start transporting. It takes four of us to lift the gurney as my new patient is a bit on the obese side. I’m at the head as I push her towards the ambulance. She yells out as we lift the gurney and her big round eyes look up at me with a terrified gaze as she locks onto my eyes.

I smile down at her. “Hi, I’m KC, what’s your name?”

“Maria.”

“Maria, we’re going to the hospital because you got stabbed. I’ll ask you some more questions in a minute.” We load the gurney into the rig and I turn to Kevin before jumping in. “Code-3 trauma to Big City Trauma Center, I’ll get you vitals on the way.” Kevin nods and goes up front to drive.

I turn to the officer that was holding pressure on the wound. “She started talking just a second ago. Do you want to come with us?”

The officer gives me a big smile as she pulls off bloody gloves and tells her sergeant that she’s going to ride with us to the ED. There are usually only two reasons to take an officer with me: to get suspect information, or to witness a dying declaration. As we pull away from the apartment complex I’m hoping it’s the former. I’d really rather Maria didn’t die on me.

 

T3 2/2

Since the drive to the ED will take a while, I strike up a conversation with Mrs. Duval to pass the time.

“They built this place maybe three years ago, how long have you lived here?”

“We moved here after the hurricane sir.” She has a polite manner and a southern twang. – apparently a transplant after hurricane Katrina. I’ve run into a lot of people who have relocated here after the hurricane. There are no definitive numbers because of the chaos at the time, but estimates are that over one million people were scattered around the country. Some have since gone back, some are still displaced.

“Do you like it here?” This area is a destination for many across the US who would love to move here, although not necessarily to the Projects – but to this general area. I’m curious about here perspective.

“It’s okay sir, but we don’t fit in so well.” I wish she wouldn’t call me sir but something tells me I couldn’t stop her.

“There’s a lot of crime in this area – are you guys doing okay?” The city PD call this area Beat-55x; it’s one of the worst in the city.

“Oh yes sir, we do fine, don’t no one bother us too much. It’s just not what we used to you know?” I’ve spent some time in the south and I know that our version of the hood is a lot different than their version. For starters no one in my hood has ever called me sir except for this charming lady.

“Do you have family here?” I’m curious to know what kind of support structure she may have.

“No sir. They all over the place after the hurricane.” Families were broken up, support structures destroyed, people displaced. Some never reconnected – it’s not like they are on Facebook and can post a status update to their wall.

“Your husband’s pretty sick. Does he always go to the emergency room or does he see a regular doctor?” I already know the answer.

“We don’t have a car sir. This the only way we can get there. I don’t understand though, he gets betta for a few day, then he has to go back. They jus can’ seem to make him betta.” It’s common – we see it all the time. It’s the other trifecta: poverty, location, and lack of education.

“You know, it’s the high blood pressure that’s the big problem right now. Is he taking his medication?” It may not be his biggest problem but you have to start somewhere.

“Yes sir. I make sure he take it every day.” She obviously loves him and she’s worried about him. But the care that they get from an emergency room will never fix this. Emergency rooms just treat them and street them. They seldom take the time to explain the overall condition, much less the causality and eventual complications. The mechanism for continuing care is non existent – there is no such thing as a house call.

“I’ve spent a lot of time in the south; that’s where my mother’s people are from. I know what y’all eat down there – lotsa fried food and salt. You know he can’t be eat’n that.” Possibly gaining a little rapport with the remnants of a southern twang that never really stuck with me.

“Oh, yes sir, I know but he like to taste his food. He always put the salt on.” No wonder his blood pressure is into gasket-blowing range.

“How bout the sweet tea, I know y’all like some sweet tea. How much sugar you put in a sweet tea?”

“Oh yes sir, he love the sweet tea. I put ‘bout a cup in a pitcha.” Yikes! A diabetic drinking that much sugar??

“You ever hear of Splenda? He’s got the diabetes, he can’t be takin’ that much sugar.” I can see the headlines now; Paramedic prescribes Splenda; man dies of cancer. Hell, but what else can I do at this point?

As I’m explaining sugar and salt substitutes I realize that Kevin has been having an almost identical conversation in the back of the rig. There’s nothing emergent to treat here – it’s their lifestyle that needs treatment and they’re not going to get it from the hospital. She tells me that she tries to help him but he won’t listen to her. She pleads with me to tell him these things because maybe he’ll hear it coming from a man.

Once at the hospital Kevin gives a report to the charge nurse and I’ve got a minute to lay it on thick for him. I cover all the points that we talked about: limiting salt, no sugar, no fried foods, eat a vegetable for God’s sake.

“Do you think this could kill me sir?” He’s a little scared with a small voice on the verge of tearing up.

“It will if you don’t fix it. Look at it like this: you didn’t have diabetes when you were a kid right?” He shakes his head. “Well, now you do and you take a pill every day to control it, but right now your blood sugar is super high. In a year you’ll have to take a shot twice a day to control it. That means sticking a needle in your belly every morning and every night. You don’t want that do you?”

“No sir, I don’t ever want to do that. Thank you sir, thank you for explaining it to me.” I didn’t give him an explanation, really, I just gave him some precautions and scared him with some possible results. It’s not enough and I know it. I even went to the EMS break room and grabbed a hand full of Splenda and gave it to the wife. They were both so appreciative and thanked me repeatedly, but still I know it’s not enough. Ultimately they escaped a hurricane and landed in the perfect storm.

—

After cleaning up the rig I went back in and had a conversation with the charge nurse. I learned that they have no one in the hospital for dietary consultation. Maybe, if he was admitted to the floor, they could call in a consult from their network of hospitals. I also learned that the county hospital has better dietary consults than this private hospital. Apparently they’ve cut all the “non-essential” programs. The Governator has already laid the ground work for further cuts to police, firefighters, hospitals, home health care, and education. Unbelievable!

I don’t pretend to have the answers yet I see the problems every day. This man needs a dietary consultation and someone to check on him once a week. Someone to go through the cabinets and suggest substitutes for poor eating habits. Someone to take him on a field trip to a dialysis center and see the sad people sitting in their chairs for three and four hours at a time – watching their blood get siphoned off and returned. The answer is not to spend more on health care. We need to give people the health care that they need and stop passing the responsibilities off to the next shift and by extrapolation passing the responsibilities off to the next generation.

Two days later I’m headed to a post in the hood and I hear another unit get dispatched to Mr. Duval’s apartment for the same nebulous complaints. I check my location compared to the other unit and see that I’m too far away to jump the call. I figured if I was closer I could have another go at talking with them and maybe get him to the county hospital where his underlying concerns may be addressed. But today they will get four different firefighters, two different paramedics, a different nurse, and a two minute talk from a different doctor. Maybe I’ll be closer next week.

—

This is the Trifecta cubed: T3

Hypertension –> Diabetes + Heart Disease

Location –> Lack of Education + Poverty

Poor Economy –> Unemployment + Cuts to Social Services

The perfect storm…the only question is which horse comes in first?

 

T3 1/2

T3

1 : trifecta; horse racing terminology – a parimutuel bet in which the bettor must predict which horses will finish first, second, and third in exact order

2 : trifecta; a situation when three elements come together at the same time and the synergistic effect is greater than the sum of the individual parts

3 : Terminator 3; a film from 2003, starring Arnold Schwartzenegger, in which humanity is brought to the brink of destruction

—

Ot volka bezhal, da na medvedya popal.

I ran from the wolf but ran into a bear.

Russian Proverb

—

I’m talking with two firefighters as we walk up the exterior stairs to a small apartment deep in the projects. One of them points to the door in front of us, “Yeah, we run on this guy at least twice a week – always the same thing: multiple complaints, all of them chronic.” We call them frequent flyers.

As we wait for the door to open I look around at the surrounding buildings from the vantage point of a second floor patio. The housing development is the size of five city blocks – 12 huge apartment buildings, 30 smaller six unit buildings, all surrounding a scraggly play field and basketball court. Built just a few years ago it’s still in good condition with strong security gates and pastel colors on the exterior walls. This is a community development project (The Projects) which differs from Section-8 housing in that local and state government pays for the project as opposed to private investors.

My medic partner, Kevin, is going to tech this call – I’ll help out if needed. A woman answers the door and only three of us walk in – the apartment is too small for all six of us and its residents.

Kevin’s new patient, Mr. Duval, has a number of chronic complaints and wants to get to the hospital so they will make him feel better. He’s a heavy guy, maybe 240 pounds, and moves very slowly – every step he takes is deliberate. Slowly he makes it down the stairs and onto the gurney. Once loaded into the ambulance I get his wife settled in the passenger seat for the ten mile drive to the ED. Four hospitals are closer than this one but we are obliged to honor his request for the hospital that he says has all of his records.

The resources that are being spent on this call are staggering: one fire engine with three fire fighters and a paramedic, one ambulance with two paramedics, a half hour ride in city traffic to a distant ED, and one hospital bed for six to eight hours minimum. The cost for all of this will undoubtedly be covered by the American tax payer through federal and state programs. It’s not even the direct cost that bothers me – it’s the extended cost to the fire departments, the EMS providers, and the hospitals. At any given time 50% of the resources in these agencies are handling calls just like this. Therefore we are 50% larger than we should be just to handle the call volume.

Being Kevin’s call I’m tuned in just enough to confirm that it’s a non-emergent call and the patient basically has chronic complaints. He has the trifecta: hypertension, diabetes, and heart disease. It’s basically a horse race to see which one kills him first. The progression up to this point is a common one that we see every day. Bad diet and no exercise lead to uncontrolled hypertension, which affects the liver, the kidneys, and heart. As a result he gets Type II diabetes and heart disease. The final outcome of this will depend on which horse wins: heart attack, stroke, or renal failure.

As Kevin calls up the vitals to me for the ring-down to the hospital, I put my money on stroke – his blood pressure is 220/140 (normal is 120/80). My guess is that renal failure will come in second given his blood sugar of 286 (normal is 80-120). Heart attack will come in third – the enlarged left ventricle of the heart is obvious on the 12-lead EKG.

Paralanguage 3/3

Six hours later.

“Medic-40, respond code-3 for the unknown. You’ll need to stage out for this.”

“Medic-40 copies we’re en-route and we’ll stage.”

Kevin had the last tech so this is my call. Kevin is driving us through the suburban neighborhood as I navigate using my iPad. I find the location on the map, “Hey, this is the same section-8 complex we went to three weeks ago for the 18 year old who was hyperventilating. Remember – it was your tech and we found her collapsed in the stairway?” Kevin had that call – I was just the driver on that one. It was a ridiculous situation for a girl that had nothing wrong with her yet felt she needed to take an ambulance to the ED. It’s unfortunate but that’s what we deal with some days and we just strike it up to an easy call as we escort the patient to the lobby of the receiving ED. I really wish there was more I could do to help alleviate the system from abusive calls.

Kevin pulls over maybe three blocks shy of the complex as I’m pulling up the satellite view on Google maps to refresh my memory on the apartment complex layout. Trying to get my bearings I’m looking in the direction of the complex. Three police cars pass us on the main arterial with their lights on and running fast. Then, with the windows cracked, I hear multiple fire engines and trucks approaching the same block. We can see the apartment complex roof from our staging post and I can see flames coming off the roof. A few seconds later I pick up the mic; “Medic-40, it looks like this is a structure fire, PD and FD are on scene. We’re going in.” The dispatcher acknowledges and tells us to advise on conditions.

As we pull up to the complex we have to park on the street as the fire engines/trucks/police cruisers are taking up the whole parking lot. We walk up to see what’s going on and to check in with the BC to tell him where we are and help out if there are injuries. I can see the building where the fire fighters are attempting to put out a third story apartment that seems fully engulfed in flames. There’s a woman trapped on a balcony right next to the fire-engulfed corner apartment. A fire crew is tilting up a very tall ladder to attempt a rescue.

Just then a woman runs out of the building next to us and literally throws her three year old son into Kevin’s arms. “He was in the fire, it started in the living room, please help him!” Then she runs back inside the building. The only problem is that it’s not the same building that’s on fire. This is a confusing fire scene with all of the people standing around, presumably evacuated from the burning building. The police are holding a perimeter to limit access to the area and and fire crews are clearing apartments, fighting a fire, and attempting to do a rescue. I’ve got to get to the BC – he’s the one calling the shots here and he needs to know where we are.

I turn to Kevin, “Take him back to the rig and check him out, I’ll check in with the BC.” As Kevin is carrying the kid back to the rig I keep going to look for the white hat that signifies the BC.

I finally find the BC and his two helpers on this scene – three white hats standing at the epicenter of all of the commotion. As I’m approaching them I see that one is a captain and two are lieutenants – one of which is LT from earlier in the day. So this is a three alarm fire and they brought out the more experienced captain to run the fire scene.

I acknowledge the two lieutenants and address the captain. “Captain, I’ve got one unit doing stand by on…” He cuts me off by holding up his hand as he heard something on his radio.

Speaking into his microphone. “Truck 5, cut a vent above unit 306, and one above the hallway. Engine 12, clear the first floor starting from the west. Engine 18 clear the second floor starting from the west.” Looking back at me. “I’m sorry, you were saying?”

He’s a busy man, I need to keep it short. “I’ve got Medic-40 doing a stand by on Halcyon with two medics on board. So far we have one possible patient but he came out of an adjacent building. Not sure what’s going on with that, my partner is checking him out.” Looking over at the ladder against the building I see that they are half way down with the victim. “I’ll take her back to the rig and check her out. If we have any transports I’ll handle calling in other units. I’ll be on-scene until you tell me different.”

“Perfect, thank you.” He’s a man of few words. Then back to his mic, “Engine 8, lay supply lines from Halcyon to the north exposure. Truck 3 – you’re clear to cut power.” As I’m walking closer to the ladder a fire fighter is escorting the rescued woman towards me. I’m thinking about the job that the captain is doing: coordinating six teams involved in fighting the fire, rescuing people, searching for victims, overhauling burned out buildings. It’s overwhelming to me – I’ll stick with paramedicine.

The firefighter hands off the woman to me and goes back to the fire. As I’m walking her towards the rig I’m having a hard time communicating with her. She has a thick Indian accent and shakes her head when I ask some questions. She seems to have very limited understanding of English. Another woman from the crowd runs up to us as I get closer to the ambulance and starts talking with her in Hindi.

“Hey, do you know her?” I ask the young woman.

“Yes, she’s my neighbor, I was just asking if she’s ok.”

“Can you walk with us and translate for a little while?” She agrees and I hand the old lady off to Kevin in the rig along with a translator.

Looking up at Kevin, “Hey, where’s the kid?”

“His family came by and took him. He was totally fine, no soot in the nares or mouth, no burns. He wasn’t anywhere near the fire. Either his mother was just flipping out or she was setting up a lawsuit. Whatever…”

“Weird. So, this lady was just taken off of the balcony adjacent to the fire. Maybe 15 minutes of smoke exposure. She doesn’t speak English but I brought you a translator. If you can check her out I’ll see if there are any more victims.”

I walk back through the police perimeter to check in with the BC. Looking up at the building I see there are no more flames and just a few apartments seem to be burned with black soot ringing the windows like mascara. The rolling black smoke from before has turned to lighter wispy smoke coming from smoldering burnt wood that’s saturated with water.

Standing near the three BCs I quietly take in the sights: firefighters walking around with tanks on their back and carrying tools, ladders being taken down, hoses being drained and stowed on trucks. The captain is still coordinating things on his radio. “Truck 5 you’re clear to begin overhaul in unit 306. Engine 8 and Truck 3 are clear for station.” It’s looking like they’re just about finished.

The Captain turns to me. “We just had the one rescue from the balcony – no other vics. What do you have?”

“The kid wasn’t involved and checked out fine. His family took him. My partner is working up the woman from the balcony for minor smoke inhalation. We’ll get her transported but it’s just precautionary – she looks good. I can continue to stand by during overhaul if you want us here.”

“No, that’s ok – you’re clear to transport.” He comes up to shake my hand. “I just want to say that I appreciate you’re professionalism – you guys did a good job, and that helped us do our job. Thank you.”

“Thank you sir, that means a lot to me.” I’m at a loss for any more words. That was high praise from a very competent man.

He turns to LT. “Can you go out to the rig and get information on the woman?” LT nods and we start walking back to the rig together. They need patient info for their paperwork.

We talk about the fire, the crowd, and the fire that we both went to together this morning. It’s a good conversation and it seems that we’re past the point of having any bad feelings between us. We are both showing relaxed body posture with a comfortable conversation during the post adrenaline high after a potentially bad fire. I’m sure the high praise from his Captain reminded him that even good people make mistakes and our world is too small to let bad feelings continue.

We’re two colleagues having a water-cooler conversation in the aftermath of a fire – quietly walking through the crowds of evacuated people, police officers, firefighters in smoky turn out gear, and the ever present street vendor selling popsicles and churros.

 

Paralanguage 2/3

Six weeks later.

“Dispatch, Medic-40, do you have anything working on Halcyon and Winston? We just got passed by two engines and a truck running code-3.” The fire department just flew past us as we’re sitting at a red light and I figure it’s possible they could use some EMS on scene wherever they are headed. Besides, dispatch was about to move us up to the Big City and anything to keep us here in the quiet suburbs is a good thing. So I’m basically fishing for a call.

“Medic-40, stand by, I’m checking.” Fifteen seconds later. “Medic-40, yeah, respond code-3 to the fire stand-by at 104 Garden St.”

“Medic-40 copies, we’re en-route.”

Fire stand-by calls are some of my favorite calls. Basically we sit in the ambulance and watch the firefighters put out a fire and if anyone gets hurt we take care of them. Most times no one gets hurt so it’s basically dinner theater EMS style – we get a chance to eat lunch and watch something interesting.

I’m driving as this is Kevin’s tech. We’re both Paramedics so when one person is in the back taking care of a patient they are said to be “teching” the call. We switch up on every call so I’m the driver/helper on this call. I catch up to the fire truck and pull in behind them at the apartment building. I didn’t see any significant smoke as we pulled up so I suspect it’s not that big of a blaze.

The EMS personnel in this county are usually well outside of the fire department command structure, yet when we enter into a situation like this we become the medical branch connected to the battalion chief (BC) – the BC calls the shots on a fire scene. Kevin and I walk up to make contact with the BC and let him know we are here and where to direct patients if any should turn up.

As we get close I realize that it’s the LT from six weeks ago working as acting BC. Crap! Kevin and I have run into him maybe five times in the last six weeks since my indiscretion and every time he’s been cold to us – and to me in particular. It’s not like we have a few minutes at the water-cooler to work things out between us – every time we see each other we have a job to do. We’re under public scrutiny and the patient takes priority. It makes it hard to work out things like this.

Kevin tells him where we are and that we’ll stand by if he needs anything. LT ignores me and tells Kevin that it’s probably nothing but wants us to hang out until he can confirm the extent of the damage. Looks like it was a small kitchen fire in an apartment on the top floor with minimal damage to adjacent units.

The parking lot is full of families that were told to leave the building until things are under control. There are street vendors selling popsicles and churros in the parking lot as LT comes back to tell us we are clear from the scene. No injuries and no need for EMS. I happily drive off to the next call.