Greetings a.t.'ers - old and new!
My sincerest apologies for not posting for quite some time. But, as luck would have it, I have a few minutes to spare, and have successfully dislocated my wrist enough so that I can wriggle one arm out my straight-jacket and type. Bear with me.
Fitchburg, Massachusetts.
The 'hilliest' city in the United States - sorry San Francisco. You want hills - Fitchburg's got 'em. Another mill town victim of the post-industrial textile decline and the lack of major highway access. How sad.
My tour starts off with the usual diff breathers and heroin overdoses. Not much to 'em, really. The hot, humid summer night, with no breeze to speak of, is usually an indicator of multiple responses for asthmatics, and people with chronic bronchitis and emphysema. We arrive usually to find some variation of the same theme: elderly, overweight - the women wearing faded pink polyester house coats with food stains of various ages; the men wearing undershirts gone grey with concentric circles of dried and re-dried sweat stains radiating from their arm-pits.
You find them sitting in the kitchen or the living room, hunkered over rusty card-tables, using all their chest and _neck_ muscles to draw in a deeper breath. The floor is littered with empty medication inhalers, greasy paper plates, cups, newspapers. Every cup and dish in the place is filled-to-overflowing with cigarette butts. Most of the time, if they have cats, they have _many_ cats. I once started counting the number of cats in a woman's apartment, and stopped at ten. The place was literally _crawling_ with cats. With so many cats, it gets to be kind of a pain to change the litter-box. So the cats shit all over the floor, and a new layer of newspaper gets placed on top of the old. Ever enter an apartment with a floor that's uneven and lumpy - and 'squishes' when you walk over it? Take my advice: don't lift up the edge of the newspaper - you won't have to pay for lunch again. But I digress.
They've usually run out of their medication, or are sucking the last puffs of it from their inhaler like it was goddamn mother's milk. Everyone's sweating like crazy - me and my partner, 'cause our uniform's made of the same shit as Saran Wrap, the firefighters, 'cause they're too fucking stupid to take off their turn-out coats, the patient, 'cause it maximizes their 'digusto quotient' and makes my job that much more *pleasant*.
Tea and crumpets? I think not.
Trying to put cardiac monitor electrodes on wet skin simply doesn't happen. The damn things always seem to slip off at the worst times. Using tincture of benzoin - which makes even wet skin sticky, works some of time. But sometimes the 'trode will come off anyway - with a nice layer of dead, grey, benzoin-coated skin. Next bright idea?
We give up trying to get a decent tracing - it's just not worth it. 'Sides, that abberrant cardiac rhythm we briefly saw was there before we were born. We hope.
Give 'em a little oxygen, start an IV, and administer a nebulized bronchodilator, and they're good to go.
'Needle and 'neb - that's all we do.
The heroin overdoses are pretty much the same: some guy in a back-alley, or in some flop-house, found unconscious with his 'works' in a sloppy pile next to him. Some people get pretty fancy with their 'works' - bent spoon with a lighter taped to the handle, etc, but most people eventually get too fucked-up to care. Your standard 'works' assortment:
- bent spoon
- disposable lighter
- alcohol swab
- insulin syringe
Once I had a guy come up to me and ask me for a 'clean needle' - 'cause his was 'dirty'. Where are we - in fucking Amsterdam? So, I take his tiny, little insulin needle, reach into my equipment bag, and pull out the longest, biggest needle I could find - four inches long and about the thickness of a pencil-lead, and give it to him. Hey, what the fuck - it was sterile. But again, I digress.
It's the same old story: you show up and and there's some guy with pinpoint pupils snoring away. You note the scarred criss-cross of veins on each arm - hardened and dark from the caustic injections and site infections, and count yourself lucky if you find some tiny vein between his thumb and forefinger. You start an IV; and before you 'push' the meds through the IV to reverse the overdose, you give a coupla' mgs of the stuff intramuscularly. Otherwise, if you push the IV meds first, you'll end up wrestling with the guy to give him the shot in the arm - all the while denying he took anything; that he isn't a heroin user; that yeah - sometimes he passes out in back-alleys and pisses himself for no apparent reason - what the fuck's it to 'ya? He denies that that's *his* bent spoon and needle that you're dumping into a bio-hazard box; all the while looking at it longingly as you close the cover. The scarred veins? 'Old accident.' Sure, pal. I've heard it all. Just shut the fuck up.
That was the extent of it for most of the evening. That is, until we got a call for a 'suicide attempt with a knife'.
All the way to the call, my partner and I bitch about the heat, the paperwork that's piling up, the lack of a decent air conditioner, the heat. We arrive just after the fire department. Several police cruisers are parked outside of an apartment complex. We walk towards several cops standing near their cruisers. The sergeant looks over and sees us - he tells us that some guy slashed his own arm and was bleeding heavily.
I turn to the entrance of the apartment building, and notice a large, congealing puddle of blood on the front steps. No patient.
"Sarge - where's the patient?" I ask.
"He's still up in his apartment."
"Did someone notice him walking around outside and call you guys?"
"Nah - he called it in himself - fucking pussy."
"Uh, so if he never left his apartment, why is there a big puddle of blood _outside_?"
The cop just points to the third floor - and I see a man holding his arm outside an apartment window. I look carefully at the puddle on the first floor - every so often drops of blood fall from the man's arm and lands in the puddle. I now see that the outer edges of the blood puddle are darker and congealed; while the center of the puddle is brighter and still liquid. Silly me, what was I thinking?
The walk up three flights of stairs is slow and tiring. At every landing, apartment doors are slightly ajar; with eyes peering out. The smell of paella; the sound of blaring TV sets; crying babies; the occasional screaming-match - all from behind these doors. When I reach the third floor, I am *completely* drenched in sweat. The tight weave of the polyester monkey-suit I wear doesn't permit my sweat to evaporate, so I stew in my own juices. I can actually feel beads of sweat running down my leg - only to be absorbed by my socks. It's too damn hot.
I make my way to the right apartment by following the crackle of portable radios. I enter the apartment - several cops are milling inside, all talking about their pending divorces. I recognize a couple of them, and nod as I make my way past them and into the bedroom where someone is shouting incoherently. My guess is that's the patient.
There's the guy alright - still holding his arm out the window. Still bleeding like crazy. I pause a moment to take in the entire room: cheesy brown carpet littered with long-empty bottles of beer - again filled with cigarette butts and an almost-black liquid slurry of ashes and flat beer. There's an equally impressive-sized puddle of blood in the middle of the carpet. The walls have blood spattered over them in lazy horizontal lines - as if the guy had stood in the center of the room, held his bleeding arm out, and spun around in a circle several times. The most impressive thing was the mirror over the headboard of the bed. A large, rectangular mirror, with the words "My girlfriend's a fucking whore. I hate her," - presumably written by the man by dipping his fingers in his own blood and smearing it on the mirror. Correct spelling and punctuation - I'm impressed.
Finally, I walk over to the man - who's still shouting something about his girlfriend, and tell him to shut the fuck up so I can look at his arm. He thrusts his almost entirely red arm towards me, forcefully enough for several drops of blood to spatter on my shoe, as if he were proud of his achievement. Looking at the wound, I must say _I_ was impressed: a clean, four-inch cut _across_ the bend of his arm. It looked pretty deep, too, as I could clearly see layers of fat and tendon in the wound. From the elbow down, his arm was paler than the rest of him. I felt his hand - cool to the touch. No circulation.
I tried to stauch the flow of blood by taking a large piece of gauze and pressing down _hard_ over the wound. Within seconds the white gauze turned red and was soaked through. Time to get creative. Pulling a blood-pressure cuff from my bag, I first place several more layers of gauze over the wound, then wrapped the cuff over that. I inflated the cuff until the needle of the pressure gauge almost reached the 300 mm Hg mark. It slowed the bleeding a bit - but not by much. Time to go.
"My fucking girlfriend - this'll show her," he told me; his speech slurred with booze and blood-loss.
"Uh - what?" I asked, trying to navigate him from the bedroom into the living room.
"I did this to punish _her_, man. She fucked around on me."
"Okay, I see, you're punishing her, but you're the one that's bleeding. Hmm."
"She'll think twice about doing that to me again, man."
The logic escapes me.
As we passed through the living room, I glanced into kitchen, and saw a stringy-looking woman smoking a cigarette while talking in tired, hushed tones to a cop. As we passed-by, she gave a quick glance to the man, who was still obviously proud of what he'd accomplished. Her eyes showed no concern for him; only a relief that he was finally leaving the apartment.
I led him down the stairs to the waiting ambulance, where my partner had already set up two IV's. We started both of them, and I was working on a third, when we pulled into the hospital ambulance bay. We wheeled him into one of the trauma rooms. A surgeon came in to examine the wound.
After removing the cuff, the layers of gauze were peeled back. It began to bleed freely again - this time a translucent pink flow emerged.
"Shit, this guy has more saline than blood in him. Type and cross a couple of units for him - stat."
I walked out into the humid night, to help my partner restock the ambulance. The back of the ambulance was a mess - bloody gauze, gloves, towels. The floor of the ambulance had zig-zagged line of blood; each change in direction an indicator of a left or right turn. Shit.
"You know what?" my partner asked.
"No, tell me."
"We could really use a working air conditioner back here."
"I hear that."
After calling in-service, we drove to the Dairy Queen to get raspberry-lime rickeys. God, the line was long...
- Tae (Paramedic '90 - Present, Tax Evader '91 - '93, Mr. Alt.Tasteless '94)
(Originally posted on 1 Jul 1995)
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