Ghosts: A Tale of a Career Paramedic.

Ghosts

I'm sure most of us are aware of the famous quote; "I see dead people" from the movie with Bruce Willis and Haley Joel Osment. Its a quote that has been overly used in many situations and parodied just as much. But there is a truth to it. I do see dead people, both in reality and in my mind. I see the dead that we get called to, the ones we either work on or leave them in peace as they lie because they are already to far gone. But the ones Id like to focus on in this chapter are the ones that haunt my memories almost everyday. There are those calls that just stick with you, that are burned and etched into your brain, like a bad stain on carpet that never really came out. I've worked in the same area now for the better part of 10 plus years, so it's not uncommon to drive by a house, or business, or even a public spot where I've had one of those calls. Driving by or even being in the area digs up the memory from it's closet. Calls that have similar circumstances also have a way of bringing back those awful memories. I've shared this with other Paramedics and for some they have shared similar feelings. But on the whole, as far as I've encountered, I'm amoung the few that are haunted by them. I don't mean haunted in the classical sense, that they are premenissions of ethereal ghosts wandering about my house. I'm also not kept awake all night unable to sleep because the memories won't leave my mind. I have been told now by a few partners that I care to much. Not that it's considered negative to care to much, but it has it's drawbacks. Because of my life changing moment, a desire to always want to help those in need, I tend to give my all to every patient I meet. I take pride in the fact that no matter who is in my care, they all get the same treatment. I'm also my toughest critic, which is what my partners have meant when they say I care to much. We all make mistakes in this industry, to error is human as they say. I had a new kid walking around the station once, and he was looking quite nervous. Realizing he was new and looking like a puppy encountering stairs for the first time, I walk up and introduced myself. I asked him of he was nervous and he immediately replied "Yes", as if the answer was rehearsed. He said he was afraid of making a mistake. I reassured him with; "Don't worry about that, you are going to make mistakes, we all do. The key is to avoid the big ones." I told him the key was to always pay attention to your patient, and to never become complacent. Complacency is something I have stirved to avoid for my entire career. I learned very early on, even before I had my BLS license, when I was still third riding along with crews, that complacency was bad. I witnessed "medical professionals" utilizing visual vitals on almost every call. Visual vitals are when you look at a patient and make up a set of vitals that are normal based off the presentation of the patient. A very nad habbit to pick up. I saw patients that had actual issues not being taken seriously because the EMT didn't want to have to work, or worse didn't care. For me, I can't comprehend that some of my fellows don't care. How can you not care?! Isn't that what the foundation of medicine is, what this industry was built on?! Why would you put up with the laughable pay, the long hours, the constant risk of illness or injury and not care? I've never understood it and I never will. For me, this isn't a standard 9-5 job, one that ends when you punch out. It's much more, it's a lifestyle. When I leave work after my 24hr shift, I don't stop being a paramedic, I just stop getting paid to be one. I have had 2 failed marriages, and another failed long term relationship; but I have always been married to my career. My father told me when finding my next wife that I need to find someone you love as much as your job. He said that no matter how shitty of a day you've had, no matter how horrible a thing you see, you always put on your boots again, and go to work. It's true, no matter the day, the call, or the long hours have ever deterred me from coming back. I love it, I breathe it, I sleep it. It is a part of my very being. So it's no surprise that when I make a small mistake that I chastise myself for hours if not days. For instance; A young lady was having a really bad asthma attack. To the point she was no longer wheezing, which means her bronchial passeges were so tight ahe lacked the ablity to wheeze. Not good, trust me. From her house to hospital was a mere distance of 2.1 miles, and going about 70mph on surface streets is about a 3 minute journey. Add to that a less than 10 minute scene time becuse me and my partner gel really well and we've been together awhile and know what eachother is thinking. So in total, about 13-14 minutes to do a boat load of stuff. First we have to apply oxygene via a Non-Rebreather mask, basically a mask that has a reservoir bag and flutyer valves that allow the patient to breathe only oxygen in and not their exhaled CO2. Second due to her condition of impending respiratory failure we need to extricate rapidly from the house to start the process of getting to the hospital. Once in truck and already enroute to the hospital, alone in the back of the truck I had to put her on a CPAP mask (A mask that covers the face and delivers high flow O2 and constant positive pressure to force open the closed off bronchial passages), main line into the CPAP two different nebulized medicines, Albuterol and Atrovent. Albuterol dialates the bronchi and Atrovent acts a smooth muscle to reduce irration and further open up her airway. After that I had to start an IV (18ga, paramedic standard) while bumping along at 70mph so I could give Methyprednisone, another steroid. All of that plus a set of baseline vitals and a follow up set to determine a trend in 3 minutes of a 2.1 mile journey. Any Paramedic or EMT that is reading this will tell you that is a lot to do if not almost impossible to get done by yourself. It's not a famous line from a well know pirate movie, but I often think about it when I'm alone in the back of a truck on these critical calls. "I can't bring this ship to tortuga all by my onesie's eh..." By the time we had reached the hospital she was remarkably better. She was now better enough to start wheezing again, she sounded like she swallowed a dogs chew toy, best rest assured she was much better. I was not. When we arrived I gave the report to the attending physician and he was pleased to hear all that I had gotten done, but he asked if I had given Mag Sulfate. I had not. In my protocols I have a few other options for people that are not responding to the standard asthma treatment line. Thers are two options for drugs, Magnesium Sulfate and Epinephrine. Epi is easy to give, .3 mg IV at 1:10,000 concentration. Mag Sulfate is a bit trickier to give. 2g in a 250cc bag infused over 10 minutes. I didn't give Epi because quite honesty in the midst of the chaos it slipped my mind, but I was thinking about doing Mag Sulfate. I had about 30 to 45 seconds left before arriving at the hospital where everything was done and I just had to wait the journey out and keep my patient alive. I debated if she was bad enough to give it at that point. Mag Sulfate is not a commonly used drug in field, at least where I work. Inner city where I'm no more than 5 miles from the closet hospital, which doesn't leave that much time to go that deep into the treatments. Usually patients respond well to Albuterol, Atrovent, oxygene, and Methyprednisone. A true Status Asthmatics patient is a rare occurance in of itself. Also Mag Sulfate is a drug I have not given in the field, so I was unsure of how she would respond to it or if she was bad enough to need it. I tried to justify to the Dr. why I had not given it, explaining I was only out 2.1 miles and we were here in no time flat along with all of the other stuff I had done. He wasn't mad at all, he even commended me on a job well done. He did say that 2g of Mag Sulfate wouldn't hurt anybody, and for future reference that my patient was a candidate for it and any future patients that presented like her would be also. Good advice for a future call. I still wasn't happy, I hadn't done something I could have. For the next 10hrs of my shift I kicked myself in the ass. I kept thinking what if she would have died because I had not given it, what if she would have been 10x better at the hospital had I given it. Now remember, I had 13 minutes to all that I did, most of that was spent extracting her from the house. Also, Mag Sulfate is delivered over 10 minutes. Which means Id had to pull it from the drug box, spike a 250cc bag, empty the Mag into said bag and the eyeball it over 10 minutes. All of that in 45 seconds I had left after doing all of the most important critical stuff. When I told my partner that I was writing this book I asked if if it was safe to say I was my biggest critic, he simply said; "Absolutely. You meassure your sucsess based not off the results, but based off perfection." A profound statement, but a true one. I demand perfection from myself for this job, which is an unobtainable goal. Perfection is a trait no human is capable of, yet I expect it from myself constantly. So when I say I care to much, you can take it to heart. Which is why I'm haunted by so many ghosts. I have ghosts that I see that haunt me not because I made a mistake, but because the call was just bad. I remember my first suicide. A young man in his mid to late 30's, GSW to the head. A few things stick with me. The note left on the door; "Do not enter, call 911" signed with his name at the bottom. It was a rather small house, a vaction cottage remodeled into a home for modern living. He was in the living room, he had pulled his mattress out into the living room amd he was laying on in, head "rested" on a pillow. The small TV on a cart was still on, not sure what was playing, basic daytime TV programs. I was told to watch what I touched as it was considered an active crime scene, as are all suicides. So I was mindful of where my hands were, but apparently not my feet. I felt like what I thought was a rock beneath my boot... Nope, a small piece of human skull. Directly above him on the celling was the tale tell sign of a in through the mouth out the back of the head GSW, big red chunky splatter. I approached his side and surveyed the carnage. In his right hand that was resting awkwardly and loosely on his stomach was a 357 magnum revolver pointed right at me, his finger still placed on the trigger. A mess of clotted blood had pooled behind his head and shoulders into the mattress, the origin was a softball size hole in the back of his head. What is permanently etched into my brain was his face. If you were to draw an imaginary circle starting at your eyebrows following the natural curve of your face to your upper lip, thays where the most grotesque of the damage was. It had caved inward. If you can imagine what being punched in the face by the hulk, thays what it would have looked like. As the bullet left the barrel faster than the speed of sound it tore through the fragile structures that is your nasal and basilar bones. Without those intact your face has no support, and with the help of gravity falls inward. It was by far the trippest thing I had seen up to that point. My youngest suicide was a 16 year old child that hung himself in his parents garage. I remember the tight and well dressed knot of the noose he had formed just a few minutes prior. The look of absoulte shock and grief on the parents face. The mom had come into the garage to find her son hanging from the rafter, she was the one that cut him down with a steak knife. He ws a straight A student, and he took his life because his girlfriend had broke up with him. So many things he has missed out on, experiences that he will never have because he took his life at such a young age. Most of the dead people I have were dead before I got there or die shortly after arriving at the hospital. I've only had a few that died in front of me, one of which is my worst call. The first person to die in front of me was a middle aged man, late night in a small industrial shop. I lnew going there it was gonna be bad. The tone in the dispatchers voice, the time of day and the location of the call. It didn't add up, that area only had  industrial buildings, all of which should be closed. And the nature of call was for chest pain, just didn't feel right. We arrived with fire and walked in. On the floor of the little shop was our patient. From the doorway looked like shit. There is an unofficial assessment we use, called the doorway assessment. We all do it, unknowingly most of the time. We walk in and locate our patient and make an immediate judgement wether they are sick/injured or are they not. Well he was sick, very sick. He was beyond pale, as we took off his shirt to put on the leads for the cardiac monitor, his trunk was blotchy. Patches of no color and small patches of red. Which indicated to me that he had very poor perfusion (cirulation). He looked like he should be dead, but he was still alive. Another thing that sticks with me about this call, was when got to his side he looked at me with his glossed over eyes and put his phone back onto a clip on his hip, as if to say, help is here and I dont need this any longer. It's weird what you remember on these calls. I knew he was moments from death, I could see it. If he looked dead now, surely he would be there soon. Either before or after calling 911 he called his wife. She arrived on scene almost the same time as we did. I quickly ran over to her and aked for his medical history. She rambled off a few things until she said he had had a AAA a few years ago... Bingo. Abdominal Aortic Aneurysm, or AAA is a ballooning of the Aorta in the abdominal cavity. It's of particular concern because the ballooning of the largest artery in body can often leak through the thinning wall, or worse disect or tear open, which what was happening with my patient. I later found out from the doctor at the hospital that they found in his autopsy that his aorta had torn from the bottom of the aortic arch (just south of the heart) to his naval. Even if it had happened on the operating table there was little chance of survival. As we rolled out on the cot passed his wife she said a quick I love you and he gave a quiter weaker one back. It would be the last time they spoke. I jumped into the back of my vanbulance (A derogatory term for a van style ambulance, famous for its non workable tight con fined space) as he was loaded in behind me. I was working with my angel of death partner, I call him that because he attracted death and mayhem. I was barking out orders and I happened to look down into my patients face. I saw it happen, before my very eyes. The little life he had left escaped rapidly out of them. He was starring straight up at me, I was most likely the last person he saw before leaving this earth. It's a humbling feeling, knowing that you, a compmete stranger, was the last thing that person saw before dying. The people you called for help, that showed up to deliever help. Thats who he saw last. I wasn't upset over that one, not at myself at least. There was nothing I could have done, nothing a surgeon could have done either given the severity of his dissection. It's always sad for me to lose a patient, but in those cases, I know I did everything I could. My worst call, another person who died in front of me, well... That's a story for another chapter.