Sometimes its all give and take

So, it’s been a week since my last posting, and it has been busy at that.  I’ll have to post on the goings on around the firehouse/trailer park soon, and give more of a picture of the family environment that really makes the firehouse a special place to be.  But for tonight, there is a call that I have been reminded of recently…and no, it’s not an open homicide investigation.

EMS is often as much about relating to people as it is relating to their issue, and with that comes knowing how to relate to everyone at their own level.  On most calls, that means remembering to translate what you are saying to your crew from medical to English, or making sure you let the patient know everything you are going to do before you do it.  Often, it’s just holding a hand, and letting them know you are there.  Sometimes it’s cutting through the crap, and getting their attention.  I’ll tell you a hand-holding story another time.  

It was a Saturday morning, something like 9 or 10 am.  We’d had a quick breakfast and were just getting into the day.  The full crew was there and we were looking forward to a fun day around the firehouse.  The call came out as a Chest Pains call, the address was for a townhouse development not far from the station at all.  We get sent with the engine in tow.  Chest Pains and Difficulty Breathing calls are the bread and butter of our call volume, and can range from truly routine, to true emergency calls.  So, we head down the road, grateful for the morning coffee, not really knowing how bad things are, or are not.

We come to a stop at the middle townhome, grab the bags and the LifePak and head for the door.  The door is cracked open, so I stick my head in first.  “Rescue!” “Yeah, in here” is the response, kinda gruff sounding, but if it’s the patient, then he’s breathing okay.  Opening up and walking in, I see the home of a man who clearly lives alone.  To say it was missing a woman’s touch would be an understatement.  I notice mail and papers piled on the stairs, the kitchen counters and floors.  Books and old take out are on the carpets and tables.  In retrospect, I’m surprised I noticed that first, because the patient was standing at the end of the first floor hall, in the back.  He’s standing there, left hand clutching his chest, right at his sternum – the classic no-kidding heart attack stand.  He’s kinda pale, a little sweaty, and fully possessed of that “I’m sick” look that you learn to recognize from across a room as an EMT or Medic.  In his right hand, is a cigarette, that goes right to his mouth as I work my way into the house.  I immediately think to myself that the “Those things will kill you” argument is right out the window at this point, dude is smoking through a possible MI.  That’s world class resistance to education.

My gut is telling me that he could be bad, like right here, right now bad, and I note that there is no room on the floor anywhere for us to work if he goes down.  “You gotta put that out sir.”  He gives me the usual slight resistance, and I explain to him that I’m bringing him oxygen for his pain, and that fire and oxygen do bad things in a house.  To his credit, that works, and still standing he stubs it out.  Wayne was coming with the cot to the door behind me, and I’m thinking we should get to it.  It’s not recommended, nor is it my practice to walk a possible cardiac patient to the door, but he did make it to the hall on his own, and if he goes down, we are going to have to drag his butt all the way through the house before we can do anything because of the clutter.  “Why don’t we get you to the cot here…”  He says something about shoes, and before I can promise to get them for him, he has turned and gone back into the back room.  Doh.  Entering the back room I see posters for imagery, and a haphazard work area setup in the middle of the room.  He’s got computers on a folding table right in the middle, and all of the rubbish seems to surround this area.  Clearly, this is his realm.  And kinda suddenly, I can place him.  “You an Imagery analyst?” I ask.  “Yeah, Was.  And a DAMN good one too.”  More bluster.  He sits on a chair to get his shoes, and my heart sinks.  Doh, here we go.  Change of plans, assess quick here, and probably end up doing the carry…somehow.  But, at least I know who I’m dealing with.  He’s not going to be mean, but he’s gonna bluster, and harrumph and be crabby like an old sailor.  I know many old analysts and this is a personality type.  As he does battle with his shoes, I try to get a bit of a history.  Yes, he woke up in pain, yes he has a cardiac history.  In fact, he was seen just about 10 days ago for a procedure.  (I don’t remember now the exact one, but it was cardiac.  Maybe a stint, but don’t quote me.)  As we talk about medications and allergies, I get a chance to look around a bit more.  I catch a look from Matt and turn to see the morning eye-opener next to the sofa which clearly served as the bed last night.  Next to the cup, is the rest of the bottle.  I believe Mr. Daniels was spending time with our patient this morning.  Apparently, the smell was the first clue for the rest of the crew, but I was a bit stuffy, and didn’t pick up on it.  I start to explain to the patient the things we will be doing for him, and expressing the need to get the process started.  He responds by telling me he knows what he should and should not do, and he has a couple things to get done before we can go.  Now, what we have here….  So, I’m thinking to myself that perhaps he’s actually concerned, but is acting the hard case with me out of habit or fear.  Knowing that different people are reached in different ways I make an attempt to achieve a common understanding.  “You know, we can do this any way you want. But I gotta tell you, there is almost no chance that I’M going to die this morning.”  The thump I heard behind me was Jen’s jaw hitting the floor.  I glanced over and saw her staring wide-eyed at me.  I guess they don’t teach THAT one in EMT class.  Cat was unphased, and setting about vitals and getting moving, can’t tell she’s been there and done that.  I look the patient in the eye as I say it, and after a quick flash, I see it.  We have achieved Quan (to borrow from Jerry McGuire).  We have connected, and a slight upturn in the corner of his mouth lets me know that there will be no more resistance or bluster this morning.  We got the vitals done quick and get things moving.  He seems to be stable right now, but still looks pretty not good, and the engine crew is in sync with that.  We get him to the cot, and as we are loading to the unit, Matt asks me if we want him to hang out a bit.  I’m all for that.  Normally, the patient entering the unit is the cue for us to release them, and there is not too much that we can’t run with just our crew.  But, I know that Cat had just recently run a heart attack turned sudden cardiac death and I’m really not sure that is not what we are seeing here.  Matt’s been around a while, and even ran EMS in the days of Johnny and Roy, and he’s thinking along the same lines.  At least we have room to work now.  We didn’t have the ideal in house situation, and I really would have had a little more information by now, but we do what we have to.  

Climbing aboard, things get going.  We get an ECG, and the 12-lead going.  The IV is already hung in my unit and I get started looking for access.  We ask about ED medications, and get the usual raised eyebrow.  I explain the mix of Nitro and those meds is bad and get a smile.  He’s good to go there he says.  The 12-lead does not show any elevations, and the rhythm was okay as I recall, though there was a bit more PVC activity than normal.  He had some inverted T-waves as well.  Okay, heart is unhappy, may be an MI, may not, but we are running an ACS protocol for him regardless.  (ACS is Acute Coronary Syndrome.  Basically, we are treating it as an MI even though the classic, diagnostic ST elevations are not seen right then.)  He’s on oxygen by mask, and I’m figuring that will do as much as anything else for what we are seeing.  But, based on the stable vitals and this reading I’m feeling a bit better about his condition and I stick my head out and wave on the engine.  The line goes in right away, and we give him Aspirin and his first Nitro as we get rolling.  He’s calmer now, and starting to look better too.  The pain is easing, and the PVCs are settling down.  All good.  I give report over the phone, and get the ER ready for our arrival.  As I turn to the patient to see how he’s doing, he tells me that he hears that we are part of the best volunteer department in the state, and he’s really glad that we were the ones that came.  I tell him, “Well thank you, I like to believe that reputation is just this crew.” And give him an ironic grin.  I can bluster too.  He gives me a full grin and, “That must be it.”  I know he’s a hard case, and will soon be back to arguing, drinking and smoking through chest pain, but for now he’s doing better, and that’s why we came.

I hear he was released the next day, but don’t know what the diagnosis was.  I’m sure I’ll be seeing him again though.  And I’ll be sure to let you all know.