Clean Undies

One of the myths of EMS is that clean underwear is required before calling. 'Be sure to put on clean underwear in case you're in an accident!' your mother may advise. But, to be fair, I am not the least bit interested in the contents or quality of your underwear. That said, we do appreciate the presence of underwear, as opposed to none at all. And yeah, I've seen plenty of underwear, and most of it is extremely forgettable.

But, I did hear a good story lately.

They were called to a motorcycle accident. The patient had stopped short and layed the bike over. Annoyingly, the weight of the bike had snapped his leg. They arrived to find him sprawled on the ground cursing between clenched teeth, clearly trying to master his pain with careful breathing.
After assessing the patient and getting the backboard ready, it was time to cut his pants off to get a good look at the leg and likely set it with a traction splint. The crew were met with loud objections from the patient. This was unsurprising as most motorcyclists covet their expensive chaps and don't want them to be cut off.
"No, no no. You can't cut them off! You just can't!" He repeated.
"Yes, sir, I know these are expensive, but they've got to come off sooner or later."
"I don't care. You're not taking them off!"
"But if you let us take them off, we'll splint your leg properly and I promise you will be more comfortable."
"I don't care."
"The drugs will only do so much and we've got a little ride to the hospital. I just don't want you to suffer more than you have to."
"I can take it."
"It's your choice."
There was a long pause as the patient thought. "There's no way of avoiding this, is there?"
"Not really. We'll take them off and splint you up, or the hospital will. It's your choice. But if it were me, I'd rather have the splint now."
"Okay then, dammit, I'll just take them off." he said with fresh determination.
"Okay." The EMT stepped back to watch. The patient struggled for a few painful minutes to wiggle out of his pants. He soon gave up and gave in.
"I can't get the goddamn things off! Just cut them then!"
"Great.  Listen, I'll cut along the seam so maybe they can be fixed."
"That doesn't even matter!" The patient groaned his resignation, and laid back, closing his eyes.

The EMT carefully cut up the side of the pants, his partner cutting the other leg.  They met at the waist where they were met with a surprise.  Under the patients black leather pants and black jeans were a pair of women's lacy, hot pink panties.  It was quite a shock for both of them, but they adhered to the unspoken EMS rule of 'no eye contact in the presence of something amusing and inappropriate.'  They swiftly removed his pants, covered him with a sheet, then deftly applied the traction splint, alleviating the pressure on his broken leg.

"Does your leg feel a bit better now?"
The patient, clearly wishing he were anywhere else was slow to answer a quiet "Yes."
They got through the whole rest of the call, transport, transfer, and paperwork and were back in the ambulance before simultaneously bursting into a fit of hysterical laughter that lasted the rest of the shift. 

House Guest

In this job we come into people lives when they least expect it, and trust me, no one bothers to tidy up before we get there. It is a fascinating privilege to be invited into patients' houses. We are seeing them not only at their most vulnerable and sick, but we are seeing them in their own private spaces. I've picked people out of every room in a house, including and quite often, the bathroom.

What prompted my thoughts on this subject was a recent call, of course. I hate to be fooled, especially by a house. I went to a call in a pretty nice neighborhood and as I was finding the house, I remarked to myself how glad I was to be in this particular area. How nice it will be to go into one of these houses. Undoubtedly it will be clean and bright and well kept. But one might think I would have learned by now that every time I think this, I'm wrong. I should probably stop counting my unsmelly and well-lit eggs before they hatch.

The last time I assumed tidiness, I was met with the most horrible stale smokey house I've ever encountered. I think I acquired asthma, dirty teeth, and my hair turned brown just from being in the living room. This time, it was the perennial foe of EMS: cats. Well, any pets can be a problem, but this house was clearly full of cats. Or at least, I think we could have created one from all of the hair around the house. Now, I probably shouldn't be telling tales about houses, but they are too much of an interesting part of the job to ignore.

I think you can tell a lot about a person by their house.  From the barren and unkempt drug addicts' house, to the house that has clearly been loved for decades. When I was a student in the city I learned in which houses to deploy the roach shuffle so that we didn't leave with anything we didn't come with. 
I also learned what a beautiful dichotomy it is to go from the most squalid rented room on one call and then step into a high society million dollar house on the next.

Some houses I want to stay in all day.  I want to know these people, get a tour, and hear their stories, because I know they'll be interesting. If the patient isn't too sick, I'll ask about some things. It shows I'm paying attention and am interested in them.  Besides, I enjoy non sequitur conversation starters. "How did you come by that cigar store indian, anyway?"

Though it is getting rare, I am still surprised by houses and their owners.  Usually, it's a bad surprise, when I expect greatness and find something horrible.  But sometimes, it's a good surprise, and like all good surprises in this job, they slowly work to restore my faith in humanity. 


Sometimes in this work, things are timed perfectly. Too often people wait too long to call. I can't blame them, no one really wants to see us. Also too often, people call too early.  I mean, they probably shouldn't call at all, but that's a different post.

Recently I had a perfectly timed call. I arrived after the ambulance and peeked in the door, I was advised to set up in the truck while they got the patient out of the house. Sweet. As I was pulling cords out of the monitor and opening an IV start kit, I saw someone running out of the corner of my eye. The back doors were suddenly flung open and they pushed the now unconscious patient right in front of me.
"He just went unconscious when we got outside." the EMT hurriedly told me. Well, shit. But how convenient to go unconscious just as you are being loaded into an ambulance where a paramedic is standing with EKG cables in her hand. So, I threw him on the monitor and he was v-fib (a lethal but treatable heart rhythm). Sweet, light him up! Or, give him some 'edison medicine' as my medical director puts it.
So, we shocked him, and he got a pulse back and it was high fives all around. But within minutes, he was back at it, so we shocked him again, and again, and this happened six times before I had time to get an IV in him to give him some medicine.  I hadn't shocked someone that much in a very long time.  And I've never had someone all but come back to total life after a shock. This poor guy would come back enough to groan and confuse us, as I guess his heart couldn't decide what to do. At one point, I thought we'd lit him on fire.  I'm sure it was a good feeling to look up after being violently dragged back from the bright light in a post-shock haze and hear your paramedic say "Is something on fire?!" (Nothing was on fire, of course, but a few singed hairs never hurt anyone.)  His heart finally submitted to working thanks to the amiodarone.

The patient was talking (but not too chatty) by the time we got to the hospital and was swiftly transferred out and then it really was high fives all around. I'd never had a patient actually come back from a cardiac arrest and to be honest it really was a really amazing feeling. He's the one patient who mattered in a sea of recent mediocre calls.  A bright spot in my day, my month, my year, my career.  Most importantly, he is a reminder of why I do this strange job, and of just how strange it is.  He is all of these wonderful things to me, and yet, a stranger.  I wouldn't recognize him if he fell down dead in front of me (again).  And weirdly, that's okay.  I don't need a better ending than the one I already have.    

Rules of the Road

When I ride my bike on the road, I wear a high-vis vest, I have a blinking tailight, and I chose roads very carefully based on speed limit, shoulder width, and of course, hilliness. I ride in the road as that is what I am supposed to do. I obey traffic laws and signal my intent at intersections.

This morning, while riding along, minding my own business, I was honked at. Confused, I looked over and saw a woman in a van nobly gesturing to me and then forcefully pointing at the parallel sidewalk.  Her implication was clear that she wanted me to be on the sidewalk despite my shoulder riding and despite the fact that she had the width of two lanes in which to get around me.  I immediately went crazy, at least by my standards, and shouted at her.  I remember repeating "no" quite a bit, and then pointed to myself and shouting "I am a vehicle!"  I didn't even curse, which was surprising to me, and I didn't do any rude gestures in her direction.
Despite my anger, I didn't stop to lecture her further at the red light, but merely made a point of signaling and turned away, secretly hoping that she was also turning.  She didn't, thankfully.  I do wonder if she thought she was doing a public service and hoped that I would immediately stop and move to the sidewalk?  Did she think that I had arrived on the side of the road by accident?  I don't know, but I'm not sure she thought I would start flying off the handle. This thought amuses me.

So, I just want to have, for the blogging record, some biking ground rules written down.

Firstly, I am well within my rights as a cyclist to be in the road. I can take the whole lane if I want.

I am not within my rights as a cyclist to be on the sidewalk as this woman suggested. That is because the sidewalk is aptly named and is for walking. You would not suggest to a motorcyclist to ride on the sidewalk. That would be absurd.

It is more than a courtesy to give three feet of birth to a cyclist. In fact, in my state, it is a law. And, for the record, three feet is a whole yard stick. This is a tricky concept sometimes.

It is legal to slow down to pass me. It is also legal to wait until it is safe to pass me.

Now, this morning I found I was so angry that I was literally shouting "I am full of rage!" as I rode down the next road. Despite my mantra of not bearing her ignorance on my shoulders, I was having a hard time calming down. Then I briefly wished that I had stopped and had a chat with her at the red light. But, then I figured it would have been less public education and more me shouting at a stranger which would have been counterproductive to say the least. But I might have felt better! Damn conscience. No I wouldn't have, but thanks to the blog, I do feel better now.

Please respect cyclists.  We know we're a pain in the ass.