I took a city shift yesterday. I try to work at least two city shifts a week, but the last couple weeks I’ve been busy with my triathlon training, plus it’s been harder to pick up overtime shifts lately. I get my 40 hours in the suburbs, but city overtime time is scarce. It’s a cyclical thing. They hire new classes, college students are home trying to make some money, the schedule fills up. But then people don’t work out or they leave and the schedule has openings again. Even being away just a couple weeks seems like a long time. There are many new faces and sometimes old ones – we have a new supervisor who used to work for us years ago, left to work for other companies and has returned, which is good because he’s a good guy. We chat a little, getting caught up while I sit down and look through the schedule book for open shifts for the next two weeks, but there are no openings. I pick up my paycheck and find I am short 16 hours. I must have missed a punch out on my long day. I make a note to call payroll on Monday. I check out my gear and then the ambulance which is one of the new ones. Over the years it seems the ambulances are getting smaller and smaller in the front and I have to sit with knees bend and angled against the dash. In the back the narc lock box is in a cabinet above the monitor shelf by the side door. It requires two odd shaped keys to open, and is impossible to open from standing outside the open side doors. I have to stand up in the back of the ambulance and fiddle in poor light with the keys to get it to open. Now I always open it at the beginning of the shift, take out one set of narcs – a sealed kit containing two 10 mg syringes of morphine, two 5 mg vials of Versed and two 2 mg of Ativan – a put the kit in my left side pants pocket – I wear those pants that have the big pockets sewn on the side of the legs. This way I don’t have to bother with the lock if I need them. My partner and I start out for a post in the city, but we haven’t gone two miles before the windshield wipers stop working and the dashboard starts shaking with a loud humming sound. We return to base and the supervisor puts us in another ambulance. I replace the narcs from the one ambulance and then get a set out from the next one. Like the other ambulance, it is new one, so no relief for my knees. At least I am able to use the same medic gear so I don’t have to check out a new pack and monitor. Our first call is a priority one to a suburban town to stage for a domestic disturbance. I question the dispatcher whether we heard priority one right. He acknowledges, saying the town wants us on a one. Unless they know something they are not telling us sending us on a one really torques me. It is pouring rain now and “the town” wants us lights and sirens and they aren’t even ready for us to take care of anyone. Maybe they heard shots fired or know someone is badly hurt, but if that is the case, they ought to relay that. I have just put a new battery into my pager so now I am hearing this aggravating high pitched beep, coming out of my pocket, as the call page finally comes over. I fumble for the pager, and then try to remember how to set the silent vibrate alarm on the pager. I keep hitting the wrong buttons and it is getting very frustrating as it beeps again. I finally fix it, and as I start to look up, I feel a sudden sway and slip in the ambulance, hear my partner cuss, and see an oncoming car veer out of our traffic lane, cutting back around a car pulled to the side of the road. It is over before I can even appreciate the danger we have just survived. My partner is trembling. “He almost hit us. Did you see that?” “Good job,” I say, meaning it. “I’m glad I was looking down when he made his move. I didn’t need to see that.” I have a feeling then that I have had a few times before in my life. Boy, am I glad she swerved and we didn’t hydroplane and that I am not in a smashed rolled over ambulance with both my patellas and femor fractured against the dash, and my head brain-injured. I must immediately start loving life more and not complaining about the small stuff. I am alive! ALIVE! Just then I feel my pager vibrate and I look down to read the messaged. “**elled by police.” “I think we just got cancelled,” I say. “It’s garbled, but I think it means we’re cancelled.” We call dispatch and they confirm. “919, you’re cancelled by PD.” “I guess there wasn’t anything to the call.” “And we were just talking about how we shouldn’t be going on a priority to a standby.” We turn around and head back to the city. A moment later we are sent for an unresponsive child, but are soon cancelled as another car says they are closer. Two other cars are sent to a cardiac arrest. The arrest turns out to be a presumption and the unresponsive child is a refusal. We post in our location when another car clears and asks for a different post than the one they are given, so the dispatcher moves them to our area and we are sent where they didn’t want to go. I’m tired of driving and wish just to be stopped so I can open the door and stick my legs out and read my magazine. The other car (Ha!) gets sent to a wreck on the highway, and once we get to the area we are posted to, we finally get to stop and I get to stretch and read my magazine and all is good. While we are sitting there a car pulls up and a man gets out and walks over to me. He is a Hispanic man in his middle twenties. He shows me his arm and points to the bicep. “Is this infected? It’s a bite – a human bite.” Sure enough there is nice round set of upper and lower teeth marks deep in the arm. No feeble bite. The skin is bruised and red and yellow. “Have you had a tetanus shot?” I ask. “No.” “You need to go to the hospital or a walk-in clinic and get a tetanus shot and probably antibiotics. Human bites are worse than dog bites. That one is infected.” He nods grimly and gets back in his car and drives off. My partner tells me I should have charged him. I shrug. We get sent for an assault, which is nothing more than a police officer who wants us to clean up the face of a man who was punched in the face and is now in custody along with his assailant. He wasn’t knocked out, has no neck or back pain, just a mashed bloody nose. I ask him if he wants to go to the hospital. He says no and then spits on the pavement. I offer him transport X 3 as if required and he says he doesn’t want to go. I wipe the blood off his nose and then ask the cop to sign as a witness to the refusal. The request seems to make him uncomfortable. Instead he offers to uncuff the man so the man can sign, which he does. I then ask the cop to sign as witness to the prisoner’s refusal. He looks at me like I have just faked him out in some way, but signs anyway, and asks “Is this a new policy or something?” I shake my head. “It’s how we’re supposed to do it.” The next call is for a fractured foot. It is in an expensive high-rise near one of the hospitals. We find an elderly couple. The man with a cast on his foot and wearing a plush bathrobe is walking rather freely about with his walker. His wife is fretting with her pocketbook. Niether seem to be in any hurry to tell us why we are there. The man wants to put his hearing aids in first. It takes a long to time to sort everything out. The man it seems broke his foot six weeks ago and has been slow to heal and has had several different casts on. He was in pain earlier, but he took one of his pills and feels better now. But is worried about when the pill stops working. The wife shows us some other pills he was given on another occasion for stomach pain. She says she gave him one yesterday when his first pill wore off and the stomach pain pill made him feel better. The pill for his foot is Vicodin. The stomach pain med is darvocet. I ask if they have talked to their doctor for his advice, but they say it is the weekend and his office is closed. I look at the meds and read the label. It says he can take one Vicodin four times a day as needed. Really, I can take more than one a day? he says, I didn’t know that. But it makes him constipated, the wife say. Yes, yes, I get quite constipated, he says. It’s your choice. Constipation or pain? We are there a long time. We are told to transport anyone who wants to go to the hospital, and we make clear that we are more than willing to take him, but… He already knows his foot is broken, he is under a doctor’s care, he is not in pain right now, and he has more pain medicine that he can take if the pain comes back. There are four pills left in the bottle. I explain that they should perhaps call his doctor’s office and that the answering service will put the on-call doctor in touch with them and they can discuss it with him. He may want him to go to the hospital. He may just tell him to take his medicine as prescribed and then go see his regular doctor on Monday at his office. This all takes a very long time to explain. He gets constipated sometimes, the wife says when I am done explaining the options. I end up end up calling his doctor’s office for them – the answering service says the on-call doctor will call back within fifteen minutes. I look at the old couple and after all the time it took us to get the story out of them, I think I should probably stay and wait to explain it to the doctor. So we wait. He calls back and I explain the situation. He agrees that an ER trip is not necessary and promises to call in another pain script to the pharmacy so the man will have enough to make it until Monday. He says he should take only the Vicodin and not any of the Darvocet. Everyone seems happy with the solution, and we get a signed refusal and a promise to call us if the pain comes back and the medicine doesn’t help. We are there almost an hour. We then go from their beautiful apartment to a dirty apartment in a beaten down building where we find a middle-aged man with swollen legs sitting in his own shit on a bare mattress. His cousin tells us he’s been like this for two weeks. I ask him what kind of medical history he has, but I just get a shrug. I ask the patient and he doesn’t answer. The only meds I can find are lasix and spiraldactone. We clean him up and get him in a wheel chair we find in the living room and wheel him out to the hall and into the tiny elevator and then down to the first floor where we get him on our stretcher. His vitals and room air SAT are good, but he has severe ascites, says he hurts all over, and just looks sick. His arms are tattooed and lined with track marks. I am lucky to get a 20 into his wrist. His sugar is good. I try to get some demographics from him, but his answers are nonsensical. I have this happen periodically. You get a patient, they tell you their name, they answer your basic questions and you think well, they can give me all their demographics in the ambulance and then when you have them out there, you realize they are not right in their mind. I can’t even get his date of birth or social out of him. He is just babbling a seemingly random number. He denies taking any drugs, not that I find his answer reliable. We go to the hospital in nonemergency mode. En route he begins to complain of severe pain, but first it is in his legs, then his side, then he says, in his butt. While he remains alert with warm, dry skin, I am finding it very difficult to have any kind of conversation with him. At the hospital, I tell the nurse, I have no idea what is up with the guy. Just as I am finishing my paperwork, we get called out to intercept with a basic crew on a diabetic. Man from a nursing home found unresponsive with a sugar of 40, got some glucagon from the home and is now responsive, but groggy. I check his sugar – its 200. The man can answer my questions, but he is still clammy, and his lungs are very rhocorous. The W10 says he has had pneumonia and just finished a course of Zithromax. His vitals are stable and with 02 by canuala, his Sat is 96. He has Alzheimers, a CHF history in addition to the pneumonia and is an insulin-dependent diabetic. I don’t do much more than put in an IV and pop him on the monitor. While his lungs are nasty sounding, he seems to be breathing okay, even laying supine. I’m pretty certain it is pneumonia. Being sick and not eating probably knocked his sugar down. At the hospital, we put the patient in the room next to our last patient. I ask the nurse if they have figured out what is wrong with him yet and she says he has septic emboli throughout his body. Septic emboli is a term I haven’t heard before. Septic emboli are emboli made up of pus and bacteria that travel through the bloodstream from one site in the body to others, spreading the infection, often ending up lodged in the lungs, heart and brain, which explains his mental status. It turns out he also has an extensive history of the usual chronic diseases that plague IV drug abusers. He may not be dying right now, but he is a very sick man in the latter stages of his diseases. After we clear the hospital, we are posted on another corner when a pretty young woman – maybe 18 — comes up to my side window and shows me her hand and points to a vein, which is bruised and reddened. “I just shot up and it really hurts,” she says. “Is there anything I can do for it?” “You’re damaging the tissue,” I said. “Ice will make it feel better, but you are definitely going to have to stop using that vein. It’s only going to get worse. Go see a doctor.” She nods and thanks me without much enthusiasm, and then walks back across the street and stands next to a man drinking a liter bottle of orange soda. Together they watch traffic. “Does this happen to you all the time?” my partner asks. “You should open a clinic.” “I tell them to go to the hospital,” I say. They send us in on the early side, and after gassing, washing and resupplying the rig, and finishing up our paperwork, I punch out for the night.