OD (2)

Everyone wants to talk about overdoses these days.  My job is now not known for daring rescues and fiery crashes, but our menial contribution to a disease that has finally caught public attention.  I am baited upon meeting new people and I fall for it.  "What's your most common type of call?"  "Have you ever been on a heroin overdose?"  "Do you carry narcan?" Ah, damn!  Next thing I know I am in a conversation about the good old days, how kids are spoiled, or 'why don't they all just quit?'.

One of my first calls as a student was for an overdose.  My first.  My preceptors 5000th. "Pump the brakes"  I am told. No, you won't get to intubate this patient. At best you will finish this call and not have been punched or yelled at.

So, no, giving narcan is not news to me. Giving it on the regular in a town of 6000 residents, that is noteworthy.  That is something we've all noticed. 

One thing I resolved to do was not "allow" these patients to refuse. Any patient who is alert and oriented may refuse care and transport to the hospital. The opposite of that is kidnapping and I'm not into that.
These overdoses, while they start out unconscious, rapidly improve and are then often quite fervent in their desire to stay home and be left alone.  This poses a problem for me.  Firstly, I have to allow a drug addled (but oriented) person to stay home. They are not arrested, scared, charged, or even mildly inconvenienced, a fact that annoys me.  They are all but rewarded for their keen overdosing skills. Secondly, the half life of narcotics is much longer than that of the reversal agent. These people could find themselves unconscious again even without taking more drugs.  And I always worry that when they are found dead the next day, that will quite easily fall on me, both emotionally and legally.

One colleague shares my sentiment but takes his tactics to the extreme, and doesn't treat these people until they are already in the ambulance.  This has caused him to have to summon police, get into fights and twice have a patient jump from an all but moving ambulance in the middle of the street. This tactic does not work.
I prefer to gently wake these people up, gather them up and walk them swiftly to the ambulance. As they begin to feel more normal they can be (usually) easily convinced to not jump out of the ambulance and to do everyone (especially themselves) a favor and just come on down to the ER.  So far so good. No messes have been made.
Once they get to the ER, are they suddenly compelled to give up the drugs and reform? No. But do they have the chance?  Yes.  This is pretty idealistic, I know, but I have to feel like I am doing something. Anything to never see another dead 25 year old.


(way overdue but who cares?!)
Everyone needs a set of friends whom move all over the country to new places and are the picture of kind and generous hosts.  Mine moved to Texas last year, a place I had never been, nor had more than a passing interest in until my favorite family was there.
It took a while to get myself together, but headed to Texas for a week in April.  This was the first time I did anything remotely interesting with a spring break.  I think everyone else in the world is really onto something.
I got a wonderful personal tour of Ft. Hood, Killeen, Waco and the surrounding area.  I went to my first real rodeo, but lasted only 7 seconds.  I really was happy to drive around a chase blue bonnets, the Texas state flower. 

Texas in the spring spoiled me.  It is (allegedly) the only time when the weather is perfect and things are lush and green and flowers are in bloom.  A week or so in any direction on the calendar turns the Texan landscape back into the harsh and dry desert seen in movies.  So, I'd say...go in April.
Sadly, I did not find the basement of the Alamo, nor Pee Wee's bike anywhere despite being set to the task about 20 years ago.  Pedro and Inez, both sadly missing as well.  Possibly on bike.  If you followed all of that, I may want to marry you.
San Antonio was a charming place with a beautiful river, well preserved 18th century Spanish missions.  All with their own characteristics and charm.  I also visited the market square where I was transported to Mexico so convincingly that I kept trying to converse in Spanish as well as convert the prices from pesos.  Accidentally, I found a cool candy store Alamo Candy where I tried some weird and wonderful things and stocked up on souvenirs.

On the drive back from San Antonio, I did spot a real Texas longhorn, stopped a Buckees (the most insane and delightful gas station I've ever seen), and tasted some Texas made bourbon.

Later, in a flying trip to Houston, I learned what this space race thing was all about and saw the room where Houston learned that it had a problem. Also...Space ships!

I found Texas to be surprising and diverse and full of life. I loved all of the decidedly "Everything is bigger in Texas" things and the fierce, what I can only call nationalism shared by Texans.

Call Round Up

A lovely old man who fell down. We had to break into his house. Twice.

A patient with sepsis. Nursing home claims she was 'just fine an hour ago'.

A patient fell down the steps and died. On thanksgiving.

Lady whom needed us to fetch and pack the entire contents of her closet and living room before she was ready to go.

Dear oldie who gets picked up off the floor at least once a week by EMS. When you know the names of your patients' pets, it should be a red flag.

Nursing home patient who had the worlds smallest laceration. “Everything must go!”

Same nursing home gives patient three nitros within 10 minutes. Blood pressure changes seem to be a surprise.

Woman noticed a problem. Called 911 eight hours later. WHY? So much why.