A tragic denial

Holidays, like Easter, are usually very quiet and slow for EMS except for New Years and the 4th of July. Oh, I've had the van full of kids flipped over killing everyone on Christmas Eve night, or Grand paw having a heart attack after Turkey dinner, but as a whole it's regularly slow because everyone is home, off the roads, off work, and generally not in the mood to sit at a hospital. Who would, right? Hospitals aren't the best of places to go at any time, much less when a spread of turkey and gravy is layed out, when there's mistle toe and a sweetie to kiss under, or watching toddlers in their Sunday dresses search in the Azalea bushes for colored eggs. No, that is not the time to go to the hospital. But sometimes it is.

So it was with this woman in her fifties. After spending two hours decorating eggs and smoking a pack of cig's while keeping three kids from pulling their sister's hair out, and a wailing toddler who was trying to put the cat in the dryer she was suddenly hit with a horrible headache, trouble speaking, and the inability to stand up. "Oh my god," said the brother and Uncle before calling 911. It was Easter eve, a full bright moon, and Jupiter and Venus pointing like an arrow over it like a celestial curse. The kids cried like a pack of wolves baying to the moon, instinctively frightened. "Mama, what's wrong?" the older kids asked. "Ammmm dkkk, a dkkk," her speech slurring badly. The volunteer first responders were hit with the call first, their station down the road from the lady's house. My partner and I had just been shifted north to cover the area as the previous unit was transporting a heart attack to the hospital. Running on two hours of sleep in the last 30 hrs, my eyes burned and my caffeine receptors were shot, but I managed to plug in the address into the GPS and my EMT hit the master switch for lights, flashers, and various blinky things before we rolled down the dark roads of rural MS. Looking for a address in which the numeric's are typically black and only 3" tall is much harder than it would seem to be. Unlit country streets don't improve the odds and we pass the address up. Not a infrequent occurrence, and we always hate it when it happens, but GPS isn't always right. It seems accuracy is afforded to battleships and tanks, toys for the ultra rich, but a 50 year old mother....not so much.

The on scene first responders gave us a update on her condition. "Yep, that'll be a stroke....get the helicopter en route." I told my partner. A hospital capable of dealing with a stroke is over a hour away and our victims have to be identified quickly. A prescription for a nursing home and long term disability was practically guaranteed if she was transported by ambulance. Thank goodness the weather allowed. Come thunder, rain, and fog we're forced to treat with diesel and make the best of it. Out here where everyone has a deer head on the wall, there's a lot of time to play before passing the baton to nurses and doctors. I like that in a way, but there's only so much that can be done out on the street. There's no CT scan, x-ray machine, or specimen lab in ambulance tow. Just a wore out old medic with a bag filled with airway stuff, oxygen, IV fluids, a defibrillator/pacer and a bunch medications to treat a wide range of emergency problems. Stuff to keep you alive until we can get you under the operating room lights. With strokes our goal is to get a victim inside a time window of a few hours the necessary thromblytics (clot busting drugs if indicated) or the relief of hemorrhagic intracranial pressure. Course there are all sorts of contraindications that can make every medical effort futile. Just a few reasons why strokes are best described as "life destroying." I hate them. I hate seeing the consequences of them in the misery faced by the multitude that are stricken. Like god mischievously coming down and plucking the puppet strings that allow Pinocchio to move. I know all things have to die, but why so incompletely? Like chopping someones leg off and asking them to hobble a few miles to the chopping block. One cripple step at a time. Either it's a test or downright cruel.

We arrive at a home that looked like a small plantation, tall white columns, two stories, and beautiful brick veneer. Not a particularly wealthy estate, just a miniature facsimile they call the plantation style. Two rain stained miniature lions usher our stretcher into the foyer as we begin asking our questions and seeing what kind of stroke victim we have. The uncle had the kids off at one end of the living room while we conducted a test called the Cincinnati stroke scale/others use the Miami scale, both required to document neurological deficits. "Can you smile for me?" is usually the first question we ask and pt's typically look at us dumbfounded. "Why on earth are you asking me to smile at a time like this?" they're thinking. That thought is written in the face they give me. This lady was no different but she edged out a half cocked smile that would make the Joker on batman envious. We call it right sided facial drooping, and it was very obvious. I then ask her to repeat after me, "you can't teach an old dog new tricks." The phrase is designed to test their neuromechanical

I felt like it was time to get deadly serious with her. I knelt down in front of her, fortified my countenance, and looked her straight in the eyes. Pretty blue eyes too. "You are having a stroke. It is very serious and we must get you to a neuro center to prevent permanent disability or death." I then follow it, and gauging by her shocked expression, with "you must listen to us and allow us to take care of you." It was like a spell had been cast, and all she could do was nod affirmatively. I went on to check her blood pressure, which I expected to be high, was confirmed with a reading of 220/110. Nothing unusual there. Pipes get clogged, pressure goes up. If a pipe bursts and has no where to go....same result. A clogged pipe is preferred to one that is burst, we call those "the kiss of death" (hemorrhage strokes). I was praying for the latter.

Wig-wag, wig-wag, wig-wag, the crystalline flickers of light reflected in the piney canopy as we raced to the landing zone miles north of us. Ah the joy of starting an IV while bouncing down the roads attempting to steady myself from rolling one side to the other and surgically poking a needle into someones arm for venous cannulation. One service I worked for called me "the IV sniper." The woman grimaced from the sting, but her misery was still better than the ghostly silence given by many others. The helicopter's medic came over the radio requesting a report while I perform a practiced acrobatic maneuver to clear the web of wires stretching from the monitor to the pt. The microphone was always too far from the pt's side. "Rescue 9, I have a 58 year old female........." When I was finished she gave me that look that said, "what did all that mean?" Best you not know, I'm thinking, but I offer something reassuring while holding her hand. Given that she was experiencing a severe sharp headache over the left side of her head, and her deficits were on the right, and that her symptoms began acutely I was very suspicious she was having a hemorrhagic stroke. I did my other checks as we grew closer to the landing zone - blood glucose, EKG, oxygen saturation's, etc. Nothing critical so I was hopeful. Arriving at the landing zone the rescue helicopter was waiting with rotors spinning. We call it a "hot load." Dispatch dropped another call on us before we could even get our stroke victim off the stretcher. There were no other available units. With that to look forward to we rolled her to the side door of the helicopter, and she panicked. A particular dangerous thing for pt's to do is grab things while lying on the stretcher. As we were attempting to slide her into the helicopter's cot she gripped the door with one good hand which almost sent her tumbling down onto the skids. The helicopter's rotors were loud and washed out our instructions. I was forced to get close and personal, lips at the ear canal telling her to "let go, keep your hands in, we have you." Between the raging flying machine and the now bug eyed woman my stress levels soared. Certain death whipped a mere foot over my head. I hate that feeling. It leaves my instincts throbbing as I retreat to calmer winds. She was off.........headed towards her fate.

Our attentions were quickly focused on our new mission, a man who had just shot himself in the head. Deputies on scene were saying he was "still breathing," but for how long? We were a considerable ways from the address and there were several bridges out - for construction - between us and the scene. The cops seemed desperate on the radio. "Y'all need to hurry!" garbled through the radio in a deep southern MS drawl. A sea of blue lights made spotting the address easy through a stand of magnolia and live oak. A small crowd of neighbors stood outside gawking, some with their hands to their mouth, others arms crossed and curious, and still others on their cell phones spreading the news far and wide throughout the community. The whole town will know before it ever shows up in the morning paper. We grab our equipment and run in. The victims mother was unaware of what had happened, just that there was something seriously wrong with her son in the other room. The deputies had kept her out and while remaining silent on the matter. The air in the house seemed thick, a bad feeling hung in the hall hiding dark secrets. I turned the corner to greet a deputy who I knew well, "hey Billy, what'cha got?" He pointed to a middle aged man sitting in a recliner, a large caliber hand gun lying on his left shoulder, and a thick pool of blood grossly recessing across his back and shoulders. The odor of traumatic death was strong, like a butcher yard. A single bullet hole was at his left temple with powder burns etched neatly at the point of contact. Bits of brain bulged and protruded through the small hole and oozed down his ghostly white face. Purple swollen eye sockets and a gaping mouth. I took meticulous note of my findings and began documenting them on my computer tablet/electronic pt care report. I instructed my partner to attached ECG leads and run a strip. Asystole (flat line ) in 3 leads from each perspective. Death.....at 12:30am. On scenes like this I always wonder if "they" are still in the room....watching. Was that the heavy presence I felt?

When I was done, I came back out into the living room to tell the mother. She looked at me as if I could still offer hope and a fleetly chance that her son was alive. I had done this before, it's not what I really wanted to say, "I'm so sorry mam, he is dead from his injuries." Her reaction was immediate. Every inch of her cried out as if her flesh could not contain her souls sorrow. I looked around....pictures of him in pretty ornate frames hung on the walls, mementos of the past decorated the shelves, and many other things reminded me of his humanity. Physically, he was no more. To be bagged and pawed over by morticians, and added to the states suicide statistics. I put my hand on the mothers shoulder to show that I wasn't one of those cold robots come to simply pronounce. But then dispatch was calling for us to get clear and take another since we weren't transporting.

Like fast food death, we move on to another. Each of these leaving their mark on my soul. I hear later in the night that our stroke victim was intubated on arrival at the hospital and scanned. Massive brain bleed. If she lives she'll be permanently disabled with tremendous deficits.....if she lives.

"I'm not having a stroke," she said.