Peaceful Warrior 2/3

Walking towards the exam room in the doctor’s office I’m almost knocked down by a short woman in a white coat who is leaving the room in a hurry. There are three firefighters standing in the hallway and I hear continuous coughing coming from the exam room where the fire medic is attempting to talk to the patient.

I’m in the suburban part of the county where there are many clinics and urgent care extensions of the regular hospitals. Fortunately, people in this part of the county actually use these resources and it alleviates a lot of traffic to the ED. That’s usually a good thing but as today is Friday and people seem to want to get checked out prior to the weekend, it seems to be the only call I’m running today. This is the third time in as many hours that I’ve walked into a clinic to pick up a patient and take them to the ED. It tends to be a boring call as there is usually already a diagnosis and all of the initial work up has been done prior to my arrival.

As I poke my head in the exam room I see the fire medic walking towards me. “So that white coat that just tore out of here was the doctor. She says he’s been sick for six months and isn’t responding to the antibiotics. He needs a chest x-ray and blood work done at the ED. That’s about all I’ve got, this guy is coughing so much he really can’t answer any questions. Are you guys good?”

“Yeah, I got it, thanks guys.” The firefighters grab their bags and head out of the clinic. This seems like an easy call; basically he’s sick. It’s just a little more than the clinic can handle so they are off-loading him to the ED. I’m sure that the fact that it’s 1730 on a Friday has nothing to do with it.

I grab the stack of papers, check to make sure my new patient is wearing a mask, and push the gurney through the empty waiting room to the rig. It’s a rainy day with a bit of wind. The winter has finally started in this part of the country and, as we live in a temperate climate zone, this is about as bad as it gets. Although mild by comparison to other parts of the country it’s enough to set off the noticeable increase in calls for “flu-like symptoms.”

Once in the rig I go straight to my cabinet that holds the masks. I put on a very solid mask and eye protection and switch out the flimsy clinic mask for one that offers more protection on my patient along with a nasal cannula for oxygen that also reads end tidal CO2. He’s been coughing every few seconds and actually seems to be in a bit of distress. His skin signs are pretty crappy: diaphoretic and pale, but hot to the touch.

Scottie comes around the back of the rig with the computer and I tell him I’m good, we can just drive to the ED that is less than a mile from here. As the rig starts moving I’m trying to take vital signs on my new patient yet he’s constantly coughing, grabbing tissues, lifting his mask, and unable to talk to me because of the coughing. I’d really like to give him an IV, a 12-lead, and listen to lung sounds. But his constant agitation and coughing prevent even the basic assessment. Just about the only thing I can get him to hold still for is a tape on pulse oximetry which comes back at 84% and a heart rate of 122 beats per minute.

I decide to just bring him in with the minimal assessment and apologize to the receiving RN later. So I focus on the paperwork that I grabbed at the clinic, but find it to be absolutely useless! It’s a six month old blood work up – basically no help to me at the moment.

My patient, Habib, is blowing snot everywhere and has a productive yellow cough that is quite disturbing. After every cough he apologizes to me. Sometimes he has to take the mask off to clean his face. “Habib, put the mask back on!”

“Sorry, sorry.”

I’m a little stern with him but it’s warranted; I’m in an enclosed space with someone who may have a communicable illness and I certainly don’t want to catch it from him.

I’m looking at the minimal paperwork and notice his last name is a classic Sikh name and he has the identifiable iron ring on his wrist. He has short hair and a clean shave; both signs that he is not following Sikhism to the absolute letter. Sikhism is no different than other religions – it’s up to the individual to define their level of devotion. He is well mannered yet clearly having a bad day.

It’s a short ride to the ED and I’m happy to open the back doors and roll him into the receiving bay. I park the gurney right next to the administrative desk. There’s no better way to get a bed faster than to sit in front of the desk with a patient who’s hacking up a lung.

It’s a short wait and I get him transferred over to a bed. I go to the EMS desk and start typing up my report after a quick hand off to a nurse where I apologize for having almost no information and having done practically nothing for him other than a taxi service. Of course I stopped by the restroom to do a scrub down of all my exposed skin and a wipe down of my uniform with some toxic smelling wipes.

Ten minutes later the nurse walks up. “I hope you used universal precautions because he’s HIV positive.”

“Yeah, I’m good, eye protection and everything. Thanks for the heads up.”

I later come to find out he has streptococcus pneumonia; a particularly bad strain of bacterial pneumonia that is common in HIV patients with compromised immune systems and low white blood cell count. It presents with: fever, hypotension, productive cough, and remarkably low oxygen saturation. It’s a drug resistant strain that often leads to bacterial meningitis as the bacterium transfers from the lungs into the blood stream. Habib was transferred to the ICU a few hours later.

 

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~ by KC on February 5, 2011.

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