I think EMS is a lot like baseball. It can be fairly slow-paced (boring, if you prefer), but it has its moments of excitement. You have your days when you don’t even remember the calls you did they were so routine. Like in baseball, you can stand around all game in the outfield waiting for them to hit you a ball, and maybe on a typical day, you get a couple easy flys you can catch, or maybe a couple singles come out your way that you retrieve, and return to the infield with a crisp throw. Every so often you get a chance to make a spectacular play, and even rarer, you get a chance to make a spectacular play with the game and the season on the line. Same with at the plate, you bat your average for the season, and every now and then you get a chance to win the game in the last of the ninth, but that chance is rare. It’s a long season, and, just like in EMS, the trick is to stay ready on every play, never knowing when you will be truly tested.

The above, translated, means, its been pretty slow and non-exiting lately at the ambulance ballpark. Some days it is more like a six year old girl’s softball game than the major leagues. (In girl’s youth softball everyone bats and there are a lot of walks). (Today I’ve transported three kids from a school bus accident who had no injuries, a two day old fall and I did a dialysis transfer). The highlight of my days has been finding good things to eat. While I love a Fenway Frank as well as the next guy, after awhile regular ballpark food can taste pretty bland. One good thing about the city I work in is the food is varied, multiethnic and generally awesome. Instead of writing about calls, I have been collecting notes on restaurants. I found an excellent plantain porridge at Mr. Snapper’s on Albany Avenue last week for $2.50, some great crispy roast duck from the A Dong Supermarket on Shield Street, and later had the best jerk pork I’ve had outside of Jamaica at the Jerk Pit Café out north on Main Street just past where Windsor Street hooks back up with Main. Today, I ate the Bem Brasil Buffett on South Whitney for lunch where you pay $4.99 a pound for food. I had chicken simmered with potatoes, short ribs, rice with vegetables, and a fried stuffed green pepper. It was great. As soon as I’d finished, I wanted to go back for me, but by then we had been moved to area 16. I’m hoping later to get posted to area 10 where on the way there I can get a pizza empanada at Aqui Me Quedo on Park Street.

Oh, yeah, and I’m listening to the Red Sox on the radio right now. Unfortunately, they are down 4-1 early in the game and unless they get their act together in the next couple games, they are in jeopardy of missing the playoffs.

Heroics may be needed.

***

Postscript: The Sox lost the first game of their double-header 6-5. They rallied to win the nightcap 18-9, and they remain two games in the wildcard lead. I did another transfer, a crash with leg deformity, and a shooting to the arm. The MVA and the GSW were stable enough to get pain management (Fentanyl) from me. I didn’t get to Aqui Me Quedo, but did get a most excellent Jamaican chicken patty (chicken in a light pastry) for $1.80 at the Golden Crust Bakery at the corner of Woodland and Albany.

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The call is for an unresponsive in a wheelchair on a street corner in front of a social services agency.

A woman who works at the agency flags us down. She says she has a man in a wheelchair who is unresponsive. She does not know him. He is not a client there. She says a stranger wheeled him up in the chair, said he was on some heavy duty drugs, and then bolted.

The man in the wheelchair’s eyes are closed, his head is tilted all the way back and his mouth is wide open. He is about forty years old with long dirty hair to his shoulders. He is wearing an army jacket. He is breathing, but you have to watch him for several moments to see that he is his rate is so slow. His pupils are pinpoint. I give him a shake. He opens his eyes, mutters, and then he falls back asleep.

This appears to be a narcotic overdose. We lift him out of the wheelchair and place him on our stretcher, and then get him in the back of the ambulance. While I assess him further, my partner opens the ambulance’s side door, and puts his wheelchair in.

When I started in EMS we always gave narcan to heroin overdoses. You had pinpoint pupils, you got narcan. Nowadays narcan is limited to suspected opiate overdoses who are hypoventilating — low respiratory rate and/or high ETCO2.

I debate what to do about this guy. If I stimulate him enough I can keep his respiratory rate up, but he can’t talk to me. I don’t know his name or anything about him. And I have to keep stimulating him or else he’ll drop back off to hardly breathing at all. I put him on the capnography and I get an ETCO2 of 57, which is high, and suggests he is not effectively ventilating. If I stimulate him, I can get him to breathe more and the number drops down. I leave him alone, and it goes back up. His respiratory rate is 4. The end tidal climbs back up into the 50s. I finally decide to just give him a tiny dose of Narcan — 0.4 mg to wake him up just enough that I won’t have to keep shaking him every two minutes.

No sooner do I give the 0.4 mg, then he opens his eyes, looks right at me and curses. “Shit, you just gave me that narcan shit, motherfucker.” He tries to undo his straps. “Now I have to go out and start all the fuck over again.”

“Whoa, Whoa,” I say. “You were barely breathing. I had to give it to you.”

“No, if you left me alone, I would have been fine.”

“Left you alone? I didn’t go looking for you. You want to get high and not have anyone bother you, lock yourself in a room and put a do not disturb sign on your door. You OD in public, someone is bound to call us, and if you are not breathing effectively, I hate to break it to you, but you will get narcan.”

“Where am I?”

“You were out and barely breathing. So you are in the ambulance now, headed to the hospital.”

“Where’s my money? Did you take my money?”

He frantically reaches for his pockets and is relieved when he pulls out some crumpled bills including at least a twenty.

“And we have your wheelchair with us, so don’t worry about that.”

“Wheelchair?” he says.

“Yeah, your wheelchair. Your buddy wheeled you over to the agency and they called 911. We put your wheelchair in the side. It’s right here, behind you. Safe and sound.”

“I don’t have a wheelchair.”

“Huh?”

“I don’t have a wheelchair.”

“You can walk?”

“Fuck, yeah.”

“Well, you were in a wheelchair.”

He looks puzzled, and then he says, “Wait a minute, does it say, “Property of Sam Thorpe’ on it?”

“I don’t know. Maybe.”

“My roommate has a wheelchair.”

I slide over and look at the wheelchair. “Property of Sam Thorpe,” I say.

“That’s it. It’s my roommate’s wheelchair.”

“What’s wrong with your roommate?”

“He doesn’t have any legs.”

***

At the hospital, the patient continues to bitch that I gave him narcan. We put him on a bed in the hallway and tuck the wheelchair in next to the bed. No sooner have I started down the hall when a nurse takes the wheelchair and starts wheeling it away.

“Whooa, whoa,” I say. “That’s his roommate’s wheelchair?”

“Where’s his roommate?” she says.

I hold my hands out. “If only I had a crystal ball.”

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So how did my day (Tomorrow) turn out?

Too busy to get the netbook out. We did 9 transports. An asthma, a heroin OD, an ETOH, a lethargic 90 year old with leg edema, a woman feeling dizzy at work, a woman with hypertension from her doctor’s office, two neck and back pains from a motor vehicle accident, and an out of town transfer for a hospice patient. 5 ALS calls. I gave the asthmatic 2 breathing treatments and solumedrol. The heroin OD got 0.4 mg Narcan, the lethargy, dizzy and HTN patients got the routine IV, monitor. (The heroin OD and the double MVA had some humorous elements which I hope to write up this week.)

I was assigned the tiniest EMT in the company as a partner, which made for much joking, but she handled her lifts like a pro, and we had a great day together, the Mutt and Jeff jokes asides. It was funny the constant repositioning of the driver’s seat from as close to the wheel as possible to as far from the wheel as possible.

I didn’t get to my Brazilian Buffet, but I got to try a new Indian Buffet downtown. Unfortunately, no sooner had I loaded my Styrofoam carton with tandoori chicken, curry goat and some other delicacies that I couldn’t tell you what kind of food they were much less the names, my pager went off and I had to hustle to pay and get out the door. Fortunately it was for the ETOH who was just a few blocks from the hospital. My partner teched the call, so as soon as I changed the stretcher and secured it in the back of the ambulance, I was able to get back in the front seat and chow down on the food that was still hot. I plan to visit that restaurant again, and then include it in my still in planning Paramedic Zagats.

I did manage about an hour’s worth of reading during the shift. As I mentioned before, I am trying to read only books that make Best of Lists. I figure if book reviewers who read so many books can highly recommend these books, then they may be worth reading. I have been so impressed with so many of the books I have read lately. Reading good writing makes me want to write so much better, although I tell you, some of these are so good, I find it hard to imagine I could ever accomplish what these authors are doing. But then I remind myself, the trick is to write honestly and fully about what you know, and rewrite until you have it the way you want it. Blog writing isn’t quite like that. For me, it is more one draft and then a quick rewrite and edit, although sometimes I labor longer on a particular piece. I do need to orient my time so I can start writing seriously again.

We got off an hour late due to a late call. I got a text that the family wanted Chinese food for dinner, so I stopped at an Asian Buffet on the way home and got $15 worth of assorted chicken, shrimp, pork, fish, vegetables, which everyone was happy with aside from the cheese baked fake crab.

Saturday I am off, doing a mile and half open water swim in a spring-fed lake and possibly taking the family to an amusement park. Back to work on Sunday.

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I am excited to go to work tomorrow on the ambulance. No, there is nothing special going on tomorrow that isn’t going on any other day. I am just looking forward to going to work. The last three days I have been at work on my clinic coordinator job reading other responders’s run forms, reading research papers, and putting together CMEs (which included getting to hear an awesome lecture by one our cardiologists about ECG interpretation). Tomorrow is my turn to play paramedic again, and I love being a paramedic.

My last “tour” or week of work was last Friday, Saturday and Monday. This week I am working Friday, Sunday and Monday. My last two days at work I did three transfers each day in addition to about the same number of 911s. Three is a high number of transfers for a medic to do in a shift. I usually do at least one, sometimes none. I don’t know what it was those two days. I weigh the reasons. The dispatchers didn’t know we were a medic car (which sometimes happens if we get entered in the system wrong), we were heavy medic cars (the most likely possibility), the dispatchers were boning either me or my partner or both of us, or we just happened to be in the wrong place at the wrong time. In other words when the transfers came in, we were the closest cars to the transfer’s location. As I have written before, I don’t mind doing transfers, I only mind when I am doing a transfer and a basic car is sent on a 911 and calls for a medic and there are none available because the medics are doing transfers. Sometimes, it can’t be helped, other times it can. At its worst, I feel demeaned like what is the worth to being a paramedic if it doesn’t matter if a medic does a wait and return while a BLS car stays online and does the cardiac arrest or bad CHF. I guess the way I feel about it now is: it is what it is. I don’t want get too aggravated complaining about it. If it is a wait and return, I get to pull my Kindle out and read. If it is pouring rain, I don’t have to be out there getting drenched doing a minor motor vehicle. If the Red Sox game is on, I get to listen to it while I drive.

But enough about transfers, I did get to one awesome call last week. 25 year-old female ate a cookie that had a peanut in it. Two minutes later she felt her throat closing up, was wheezing and then was unresponsive. By the time we got there, she had no palpable pulse and was so out of it the first responder was getting out an oral airway to drop. She was cold, diaphoretic, responded only to deep pain, and while her torso was red, when I touched her with my hand and then moved my hand, her skin was white where I had touched her, a perfect hand print.

I wrote a while back about the various drugs we carry and I rated epinephrine 1:1000 as my number one essential drug. This call only confirmed it. I cracked open a vial, drew up 0.3 mg and injected it deep IM in her deltoid. Another medic had arrived by then and we lifted her up onto the stretcher (she had collapsed on the sidewalk in front of her house) and got her in the back of the ambulance, where we still at first couldn’t get a blood pressure, but we did get two large bore IVs (a 14 and a 16). I did the 16, the other medic who I had once precepted and who to this day remains one of my favorite preceptees, grabbed a 14, smiled at me and sunk it cleanly in the patient’s opposite AC. The patient got 50 mg of Benadryl IV, 500 cc of saline, an albuterol treatment via mask and 125 mg of Solumedrol. By the time we hit the hospital she had a decent blood pressure, her skin was dry, and while she still had considerable redness and some distal mottling, she was alert and talking and breathing without wheezes.

“Would I have died if you hadn’t gotten there?” she asked. “Ah, yes,” we both said. And that was the truth. There aren’t many calls where you can say that, but anaphylaxis is one of them.

I am not expecting to save a life this week, although I would love to do some interesting calls. I just think of all the possibilities the roulette wheel of EMS can spin our way. I know somewhere in the week, I will get some chances to be test my medic abilities, get some good stories to tell, have some good laughs, and in general, get to hang out and shoot the breeze with my co-workers who I consider my friends, many who I have known for almost twenty years.

I also hope to have some down time to type away on my netbook, some time to take my Kindle out and read – I am reading a great book now – Just Kids—a memoir by poet and early punker Patti Smith. I have also discovered a new restaurant – a Brazilian Buffet– where I hope to grab some quick and delicious food when posted in area 9, and possibly write a review. I am considering doing A Paramedic’s Guide to Good, Fast Eats in the Hartford Area.

Life as a medic is good.

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