The Smelly Man

Recently I was reminded of a call through the winces and moans of another crew while we were at the hospital.  If the firehouse is where you bond with the other guys on your crew, then the ER and the report room is where you catch up with the rest of the EMS folks in your area.  Information on classes, gossip and “Whatcha just run” stories are exchanged as crews write reports, restock and clean units and equipment.  Often, the report room is the first line of defense for frayed nerves or emotional decompression after a tough call as well.  If nothing else, you know that everyone there, wherever they are from, are there because they just ran a call too, and they’ve been where you are, or will be someday.

I was in the report room, pulling times for my report from the computer, when an EMT from a neighboring department came in bemoaning the smell of feet that was going to be with her for a while.  I had not seen her in a while, but consider her a friend, and it wasn’t until after a hello hug that she clarified what had happened.  They had gone out to pick up a guy, from a local shelter I believe, for some benign reason or another and to hear the crew tell it, he had some of the most foul feet ever to be found on the ends of a live human.  Now I knew he was tall right away, and they quickly confirmed that he was.  Now, I’m not maligning tall people and saying they have rancid feet, this is just a deep understanding of Murphy’s role in EMS.  You see, tall people’s feet extend to, or over, the end of the cot.  This just makes sense.  So, when you are lifting them into or out of the unit, you will tend to have them brushing your chest as you do it.  And it is safe to say that for this particular EMT, that is a more likely risk than it is for say…me.  So, knowing the way Murphy owns us in EMS, clearly the more fetid the toe cheese, the more certain to be a foot-hanger as well.  So, she pulls him out of the back and gets herself a good dose of foot-jam smear on herself, insuring that that while the patient is gone, his essence remained.  She was anxious to get back to her station to change to say the least.  Now, you and I both know that Murphy’s follow-on is that this crew is about to run their butts off and won’t see the station for HOURS…and of course that is what happened to them.  I’ll admit, I heard them dispatched time and again that day, often right from the hospital and I chuckled.  I felt bad for her, but not bad enough to not enjoy the situation.

So, her plight that day reminded me of a call that our crew know simply as “Smelly man”.  I’m not sure I’ll be able to do justice to this guy in words, but if you’ve run EMS for any time, you have surely had your smelly patients, as have we.  However, given all those runs, understand that this guy is know at The Smelly Man and no other description is required.

It was a weekend duty and it was sunny and hot, a real mid-atlantic summer day where the temperature and the humidity raced each other into the 90’s every morning.  It had been that way for a few days in fact; typical for this area.  We get punched on a call for a sickness I think, maybe it went as an overdose, but it is us and the Engine from our second due.  Wayne, as always is there, and in the back I have Jen and Kelly is with me getting some medic precept time for class.  So, it was a fun group and a group of solid providers.  I was feeling good about the day.

We arrive on scene at a middle of the row townhouse and I notice a pretty good police presence right away.  This is not the best neighborhood, so that doesn’t key me up too much as we roll into the house.  There are kids in the front room and all the activity is clearly out the back.  The engine was in ahead of us and I’m getting looks that could best be described as “not good”.  It wasn’t the amped up, “uh oh” look, just a bad look I could not place…that started to concern me.  As I exited out the back door, I see several folks looking down at a Hispanic male, late 20’s I’d guess, marginally responsive laying on the cement slab at the back of the house.  There is this little shed thing attached to the back of the house, like many townhomes.  The shed is like 4’ x 4’ in size and opens to the outside patio area.  The door is open and it looks like this guy had been in there and flowed out when the door was opened.  I say ‘flowed’ because there was also a good flow of a noxious, foul liquidy stuff also flowing out of the doorway and over to where this guy is.  About this time it hits me.  There is a wall of stench that sucks the oxygen out of your lungs.  I recognize it as human waste, but there is more to it that I can’t place.  My eyes almost water and I notice the fire guys already starting to rotate from the patient to the rear of the yard for air.  The guy is kinda responding to questions, but is in a bad way, perhaps even worse than he looks is my thought.  I ask what happened and the story I get explains a lot.
     
This guy had been reported as missing to the police about 2-3 days prior, by his wife.  Turns out, he was living in the shed on a bender.  He’d been in this little hot box, drinking alcohol, drunk out of his mind and oh yeah, all he’d been eating was the Turtle Wax car wax they had stored in there.  The ooze was his two day baked urine and poo cocktail that he’d been sitting/laying in.  That was the smell: old, baked excrement, sweat and stale alcohol, box for 48-72 hrs and serve hot.  Oh man.  This was one of those times I did not want to be the medic on the call.  There was nobody else to fix this one and I just wanted to run.  It did occur to me that the lady crying just inside the door was the wife, and most likely the kids in the front room were his…nice.  At least they weren’t coming back here.  Okay, let’s just get through this and do what we can to help this nipple head.  I ask the fire guys to get the cot brought around back and they are more than happy to GO do anything.  The fire officer and I agree that we are NOT going through the house, but will take him out the back yard and around the side to the unit.  I don’t want to parade Dad past the kids like that, and he is literally dripping this ooze still and I’m not looking to leave that trail in there either.  At least I didn’t have to tell anyone to glove up on this one.  I try to get some information while the cot is coming and I’m trying to hold this guy up while I assess him.  Jen is starting to dry heave and is not going to make it.  Now the smell is repulsive, and the thing that is my personal puke-trigger is not a patient usually, but if another provider loses it, I’m in trouble.  Jen is turning green and it is going to be an issue I can tell.  

We get the cot around, pour him into it, and start to move.  On the way to the unit, the engine officer asks if we should decon him prior to loading him in the unit.  Damn Fine Idea I think to myself and agree.  I don’t want to delay his transport much as I know that the heat and alcohol alone are really bad, his level of consciousness is severely depressed and he is flat unresponsive at times and the last dude on the planet I want to have to code is this one.  (The thought of that intubation, even today, has me gagging).  I figure I can keep his head clear and on oxygen while they hose him and the time spent is going to be minimal.  I’m concerned that we are just going to create a big, wet, dripping, sloppy mess, but then I see that we have already achieved that so there is not much to lose.  (the Solution to Pollution is, after all, Dilution).  We stop just outside the ambulance, and right there in the street, in front of God and the neighbors he gets a shower from the water can off the engine.  Frankly, he could have used a few minutes under the inch and a half attack line, but I was glad for what we did.  I hoped that it would cut down the stench.  As we loaded him into the unit, I quickly learned that it was not to be.  Jen was in a really bad way and we had to send her up front for the ride.  She simply was not going to be able to stand it.  I pulled my Vick’s out of my gear pocket and spread a layer of it under my nose.  I’ve never had to do that before, and I was just hoping it worked.  We opened all the windows in the unit, turned on the blower, had Wayne and Jen open the front windows and run the fan full tilt up front to try to create a rear-ward airflow.  Jen tells me that it didn’t help, they were still feeling it up front.  

In the back Kelly and I are doing our best to do what little we can for this guy.  He’s covered in his slime, now dripping and somewhat diluted but still creating a challenge.  We towel him down some, and as I recall the little alcohol prep pads were not close to up to the job.  We ended up spraying the alcohol foam we carry on his arm for an IV site and on his chest to dry him enough for the ECG pads.  The whole time we are fighting dry heaves, at least I know I was.  I tried not to look at Kelly directly, just in case she was looking bad too.  She got her line, and his vitals were not remarkable I believe (don’t recall now, so must not have been THAT out of whack), but his heart rhythm was a bit irregular.  I think his sugar was elevated too, we didn’t give him any en route.  O2, IV, Monitor and transport…there wasn’t much else to do.  He was in a very lowered level of consciousness, but protecting his own airway.  He looked BAD, and not just from the slime he was covered in.  My gut was telling me that, smell aside, we were in a “You may die at anytime, and there is not a damn thing I can do to fend that off, just hang on to the hospital, and I hope you haven’t screwed yourself too bad” situation.  

Wayne takes off for the hospital and the breeze through the windows is welcome, but not enough.  We monitor the patient, keep taping to secure the line over a very wet and slippery patient and try to get as much fresh air as we can on the way.  I call in the report over the phone on the way and I try to give the hospital fair warning.  I get a chuckle and an Okay.  “Hear me now, believe me later” I think as we hang up.  Every couple of breaths or so I try to sniff up some of the Vicks..it helps, but only for that breath.  I hear you are supposed to lose a smell after four minutes or so…didn’t happen.  I picture this cartoonish image of the unit flying down the street, Jen hanging her head out the window like a dog getting wind, and a noxious green cloud pumping from the back and sides like we are on fire, plants wilting in our wake.

We get to the ER and Kelly and I bust out of the unit.  She dives out the back, and I shoot out the side.  We must have looked bad, because a couple of the techs and nurses sitting out side on break start laughing when they see us.  I’m sure the dry heaves didn’t help our cause much.  “Laugh it up, we’re bringing him to you.” I tell them as we recoop and start to pull him out.  They are still chuckling as the go to open the door for us.  Then we pass by them and head for the Trauma and Cardiac bays.  “Oh God….oh no” I hear one say as we pass.  Yeah, you were warned I think.  I find the charge nurse and tell her we are here,  I ask about stopping in the decon room, but she poo-poos that and sends us to a cardiac bay.  Your call lady.  We pour him over to their bed, and there are puddles waiting for us on our cot after.  The crew quickly heads out to start hosing down everything and I give report.  I see the nurse in charge here has the same dilemmas I did.  He’s bad and there is a lot that needs to be done, but he has got to be cleaned the rest of the way too.  She gets lots of help as he slips even deeper and is fully unconscious.  I give report, and go out for some fresh air on the way to the report room.

It took the better part of the day to get that smell out of my nose.  No matter how much you wash, change clothes whatever, you still smell it.  I think they did eventually decon him again in their room, I can’t imagine that they did not.  I do know that they quickly got him moved from the ER to the ICU…and that he coded in the hall on the way.  Had to figure that was possible, and it was a big concern of mine while he was with us.  His blood work was all screwed up, turns out you shouldn’t live on Turtle Wax.  He eventually made it, and so did we.  Jen works as an autopsy tech now and deals with dead people and decomps all day.  She confirmed, at the time of this writing that he is the worst smelling live person she’s ever encountered.  Some of the worst decomps beat him, but not all of them.  So, now I have a scale on which to base “Smells bad” and also one for the biggest alcohol bender.  I still carry that Vicks too, just in case.