The radio squawked, "medic 107, respond to dogwood dr for general illness." This type of call is all too common, and not everything is a life and death emergency when 911 is activated. In fact very little of it ever is. You just never know, and one thing you learn as a paramedic is to never assume anything. Assumptions are the mother of all failures. Arriving on scene we find a modest home with a cadillac parked outside. A dog in the distance was barking as we came up to the front door and knocked. Nothing, not footsteps coming to the door, not screams for help, not anything. Silence could be a good thing; as in the victim may have left for the hospital, or a bad thing, as in the victim was dead. We were tired, it was late, and since medics are typically quite morbid we were agreeable with either one. But one thing we can't do is "assume." And since the doors were locked we were faced with a challenge, how do we get inside to eliminate the possibility the victim is still inside and either dead or incapacitated? We can't just bash down the door or bust a window out, although that might be the easiest, it's not particularly acceptable for legal reasons. We're not cops. Request was made to dispatch that we needed a deputy out at the home to make entry. One by one we circled the house to check each window while we waited for a deputy to arrive. Just as he was pulling up we found one by the ac unit in the back bedroom that was open enough to wiggle the frame and provide an entry. The deputy was a good friend of ours and a frequent accomplice to zoo like calls we get on the many nights where the natives are restless, where the drunks run off the road and into the woods, and the teens swallow pill bottles. He sees it all too.
Calling for a victim the deputy pulled himself up through the opening while handing us his utility belt with holstered gun to pull the whole maneuver off. No point in shooting himself in the foot or us as we hoisted him above us. If there was no one inside it would turn into alot of effort for nothing, and god knows we were tired, having spent the last 28 hrs dealing with other emergencies. But then if there was no one inside we could document "no pt found" and return to the station and to our quarters where our lonely beds were. No, we couldn't think like that, we had to know. Searching room to room we called for a victim and there was nothing. The deputy and his mag lite scanned the corners and shadows finding nothing. Minutes went by and it felt surreal to be inside someones house digging around like a bunch thieves looking at pictures of people we didn't know and nick knacks that had zero meaning to us. "Guess no one is here," said the deputy. "Yep......" but then I spot a door that looked like a closet that was outlined and traced in light. Someone had a light on inside. But why would they be in the closet? Maybe it was something else, and there was certainly no where else to check so I slowly open the door; which opened in, and hit something. I can't get door the door open enough to get in, but I look down and see the reason why. An elderly woman was lying face down in a pool of vomit. She looked dead at first glance but then she groaned and snored a breath or two. She was all wet and clammy, her face pale and mottled, and the gruel of death hung tentatively in the air.
Rather than being a closet, our victim was stuck in a half bath and her body was now decisively blocking the door and our ability to get in and help her. Another challenge that needed a simple solution. I don't know if it was one of those light bulb moments in cartoons, or this lady's guardian angel whispering little tricks in my ear, but the thought came to me that I could pull the pins on the door hinges and just take the door off. The solution was so simple. Our old lady was in bad shape and unresponsive. Defecation and vomit was everywhere and our gloves slide across her stretchy old skin trying to find grip. The foul smell of it stressed our efforts as we pulled her out into the living room and then onto our stretcher. Had to be a stroke I was thinking. She was aphasic, that is, unable to speak, but just stares blankly at nothing. I've seen it hundreds of times. Bounding distal pulses and pupils that react little. Out to the unit we had her on low dose oxygen, a modified therapy that once called for hiflo oxygen but was found most recently to be causing harm rather than good. Giving large amounts of oxygen causes the cerebral arteries to dilate and that's the last thing you want to do with a clot wedge in somewhere up in her brain. My EMT fiddled with the nasal cannula while I spiked a bag of normal saline and searched her old veins for one to poke. I had one pretty quick and gained venous access. We weren't looking to hydrate her but to provide a portal to her systemic circulation in case medications were called for. I didn't waste time thinking about where I was going to take her, it had to be a prioritized stroke center, so I got on the state net line and called a helicopter in. We affectionately call it the whirly bird, and the bird was invaluable in these rural parts where anything definitive is at least an hour away. So off we went with our lights flickering among the piney woods. Enroute our lady took a turn for the worse and began to seize on me, but the seizure didn't last much longer than ten seconds or so. Not enough time for me pull the narcotics out of their locked gun case situated among the cabinets, but what followed required more immediate action anyway. She had a breathing pattern we medically define as agonal and insufficient for respiration. After updating the inbound flight team I pulled our giant green bag that normally sits wedged above the cabinet with the suction out from it's cramped quarters. Popping seals along the zipper line I pulled out the intubation roll and selected some endotracheal tubes, stylet, 10 ml syringe, and my personal larygnscopic blade, a number four miller. Our victim was still breathing so visualize her vocal cords would prove difficult as she chumped down periodically while this big metal blade attempted to displace her tongue enough to see what I had to see, and what I had to see was a tiny narrow passage into her trachea - her windpipe. Finding it and timing it just right, I slid the endotracheal tube into its proper position, not too far, and too short or otherwise it wouldn't effectively distribute air into both lungs. A messy affair at best when the ambulance is bumping down the back roads of Mississippi's highways. It's been twenty years since I first started doing this so it wasn't a challenge I couldn't adapt to. Airway in place and effective ventilation restored we pulled up to our landing zone, a point halfway between where we were and where she had to go, to offload and hand over further care to a flight team and off she went.
We were left like wet sweaty dogs that had been in a fight to clean a ambulance now filled with blood, puke, shit, and various medical supply wrappers. Ah, the perks of the job, and still 20 hrs more to go in my 48 hr shift. A cherry lime-aid at the local Sonic for a reward and we were back in station an hour later. Oh, but the challenges were just beginning.
"Medic 107 respond to a medical unknown on the interstate. MHP is out with a person that is acting funny." So what does acting funny look like I thought as we zipped up our boots and headed out to the unit. We pull up to a scene in which a highway patrolman has a 18 wheeler pulled over on the shoulder. One of the local volunteer firefighters was on scene who is known as the "pastor," a elderly firefighter with a heart of gold. "Got a big one." "How big?" I ask. Probably four hundred pounds or more. Just great we say to each other while slipping into our yellow reflective vests that are required up on the interstate. They want us to be safe and all, but sometimes it would be safer to either stay in bed or come prepared with a forklift. I swear, people are getting bigger each day, but what I found high above me in the semi's cab I was unprepared for. This man was no four hundred pounds, he had to be 600 plus. Whoa nelly and riddle me this, "how do you get a 600 pounder down out of semi cab, which if you didn't know is situated eight or more feet above the ground, and onto a stretcher with myself, a female partner, and a couple of elderly compassionate first responders? A victim that was acting confused and disoriented, and unable to even get up from the drivers chair. This man's legs were as big as my whole 280 lb body and every bit of them was wedged under the steering wheel. Our man was struggling to breath and would not tolerate a prolonged fooling around at the scene. I felt stumped and my partner and I looked at each other with that look that says, "this call sucks, why did we choose this profession?" Finally, after looking at the situation for several minutes and realizing there simply was no easy or perfect way it was going to get done, but by god this man was coming out of there one way or the other. Sometimes you just have to plunge right in and see what happens when a solution doesn't present itself. So I grabbed the handles attached to outside of the cab and pulled myself into position while directing my partner to go around and snag the other side of this huge man. I then directed the firefighters and enlisting the begrudging patrolmen into position below me with the stretcher set to receiving said victim or perhaps to break a sudden fall. My biggest fear was the victim would just crumple coming out and we would be too few in strength to slow his fall.
So here this big guy cometh as we pulled and pushed for many agonizing minutes while shouting various instructions to either him or the pushee's. The effort was more out of will than any mechanical advantage, and little by little he made his way to the door and the moment of truth had arrived. Ah, but to make the situation even more delectably interesting, the man had shit diarrhea all down his 600 lb backside which was now evenly and disastrously right in my face. We have a frequent saying in EMS down here, "it is what it is," in other words there was nothing I could do about it. Trying my best not to soil my uniform I pushed with all my might on his butt to keep him from coming down hard on the stretcher below. I can remember thinking what motorist were saying when they past by during all this to see this giant of a human being with his crack showing, and poo dripping, while a few old men scaffolded everything from certain disaster. Surprisingly this victim didn't come down with a sudden crash and take all of us out, but rather came down in doable position on the waiting stretcher, not perfect mind you, but good enough. We certainly weren't going to be doing any repositioning. The guy was so big the handles on the stretcher could not close and his width was spread from one wall to the next. Even with six people now at each point it took 3 tries to load him into the back as we fought to fit round flesh into a square hole. My left bicep throbbed as if I had tried to go for a world record in dead lifting and my partner ended up pulling her neck from all the strain. Sadly, no one wants to go on workman's comp around here for how little it pays. We were no exception, but by god we did it. We managed to get a 600 plus pound man out of a 18 wheeler and to definitive care. After an IV line en route, some blood sugar tests, and ECG monitoring we had him to a hospital that would later go on to diagnose an infection that was making him confused. Sometimes you just have to "getter done," and see what happens. But one must take action to affect anything and Jane Heard once said, "a well adjusted person is one who makes the same mistake twice without getting nervous."
The shift over I come home for some R&R and take care of some home projects I had been meaning to do. Cutting drywall and hanging it. Another chance at being adaptable arose when my utility knife broke into pieces. Keeping it simple and following my philosophy of "gett'er done," I grabbed a pair of vice grips and clamped them to a razor and thereby making a fine what-cha-macall-it and a crude utility knife. Good enough to carry on with my project without any hitches.
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