Sunday, May 27, 2007

You were dead, you know!

As the rain fell from the large, white, ominous clouds above, we weaved in and out of traffic. The oily streets created soapy puddles in the intersections as we crossed. The large wiper blades worked overtime, slapping the windshield from left to right. As I floored the accelerator peddle on the stained, carpeted floor, the turbo diesel engine pulled the large box forward. The large disc brakes reined it back into control.

It was a straight shot down the Avenue. Drivers, still confused by the sudden rainstorm, debated with themselves whether to pull over or not. Most, although in a large, congested, traffic jam, isolated themselves from every other driver on the road. Radios played loudly inside some of the sedans. Some drivers chatted on the cell phones propped precariously between their necks and ears, and some, with both hands clasped onto the leather steering wheels, focused straight ahead, hoping to maintain their course in this worsening storm.

The lights of the ambulance deflected off the falling raindrops. A prism of colors reflected off the newly dampened streets. And the siren echoed off the large, glass windows of the downtown buildings.

We approached the scene and I slid the ambulance to a stop in the number one lane of the one-way street. Already tending to the patient was a group of helmeted firemen, deflecting the drops of rain off their large brimmed plastic hats. Their bunker gear beading the raindrops on their lapels like a newly waxed car.

Outstretched on the pavement of the sidewalk, resting flat on her back under a public payphone, was an unconscious female. Like the Wicked Witch of the East, her black boots protruded from the round, reflective huddle of firemen. Her black leggings soaked the rain drops like a sponge, her knee high maroon skirt and velvet top looked straight from a Steely Dan street vendor. She had a hand woven bag interlaced between her arms and sterling silver rings matched her bracelet and necklace. If you were standing next to her in line at the grocery store, as I'm sure many people have before, you would have never thought she was high on heroin. She looked like an aging hippie from the seventies.

As we approached, I saw she was barely breathing. The plastic mask pressed against her face billowed oxygen into her lungs with each forceful squeeze. The bag providing the oxygen, manned by the fireman, whistled each time the large bulb reinflated.

Next to her, in the small stream of water creating its own eroding force down the sidewalk into the gutter, were some broken sunglasses, a saturated cigarette swollen twice its normal size, and some various papers.

We loaded her onto the bed and wheeled her into the back of the ambulance. Rain danced on the square rooftop with the rhythm of a Vaudeville tap dancer. The side door remained closed and at the open back doors firemen stood sopping up the rain from the slow-moving rainstorm.

I moved the handmade Santa-Fe jewelry up her forearm so I could palpate a radial pulse. Her wrist was wet and her hands cold. As I felt around her radius I noticed bruises on her wrists and arms. One, close to where I was searching for a pulse, was grape-purple in color and seemed very fresh.

We restrained her arms and began our work. Both, my partner and myself, began our duties as we talked with one another. I agreed, it had been a long time since I've run a decent call like this.

IV's were started, blood pressures acquired, heart rates counted and blood glucoses registered. As my partner worked his way down his "unconscious / altered mentation" protocol, I rummaged through one of her three handbags.

I unzipped the large, black, faux leather bag and carefully examined its contents. Like a child searching for the right colored M&M, I shuffled papers, compacts, and condoms around the inside. Then, tucked under a pair of worn, soiled, K-mart panties, I found a small black, zippered bag. Without looking inside I knew what I had found.

I pulled it out and sat it on the bench next to me. Like a NBC game show host on a Friday night, I dramatically announced that this could be the million-dollar case. My partner paused drawing blood from the hub of the IV in her neck and smiled.

As if booby-trapped, I unzipped the small black case. Inside was a businessman's card, folded haphazardly upon itself so it could carry her precious recent purchases. Black, chalky residue imbedded itself into the raised font of the unknown businessman's card. It was what was left of the heroin she had just bought from some shady, downtown corner, drug-dealer.

I poked around more. A couple of lighters, a small plastic bottle of clear liquid, the cotton from the filters of cigarettes. And then, hidden at the bottom of this small, black case of paraphernalia, was a loaded syringe of heroin. The small 1cc syringe was, thankfully, capped and tucked into a plastic wrapper. I pulled it out carefully examined it closely. The black heroin floated like the lava in a lava lamp in the clear, unknown liquid. It sat there, its toxins prepared to alter her consciousness, ready to be injected into her blood system.

As I made this discovery she was steadily awakening from her comatose state. The medicine in the peach-colored box had worked its magic and taken away her high. Her pupils dilated, her breathing increased, her color pinkened, and she slowly awoke from the cold clutches of impending death. Her stomach turned, and as she became nauseated, she instantly went into withdrawals.

I leaned in front of her and asked her to pay close attention.

"How much heroin did you do?" I asked.

She, like every other addict in the world, adamantly, and expectedly, denied that she had used any drugs at all.

Again, I asked her the same question. This time producing the capped syringe found in her bag.

"How much heroin did you use?"

"You were dead, you know!" reinforced my partner sitting at the head of the bed.

She fell silent. Shaking and shivering, as she vomited into the yellow basin, she repeatedly denied that she had used.

I opened the back doors and exited the ambulance. The rain had stopped. Sun broke through the dense clouds above and illuminated the wet streets. I closed the back doors, walked to the front of the ambulance, and drove us all to the hospital.

Sunday, May 20, 2007

The Fax. (part one)

I sit, again, cramped in the front of the ambulance. A red light at the large intersection steadily pulsates its constant amber glow at the impatient, eager, road-raged drivers. Engines idle and clutches burn as cars position themselves at the thick, white pedestrian crosswalk on the street. Tethered like fighter jets on the deck of an aircraft carrier, they are cocked and ready to race to the next bright, red light, to start the process all over again.

I squirm in the uncomfortable seat of the ambulance and watch every one of God's little creatures scurry about in the radiating heat of the glowing sun. My left knee aches. Not hurting, but constantly reminding me that ten hours cramped in this box is going to be a chore, both for me, and my joints. I try to outstretch and hope it pops, relieving me of the mildly uncomfortable feeling of a sore joint. No luck.

The solid white, two-inch man on the crosswalk light disappears. Replacing the pleasant action figure is a bright red, flashing hand. The pedestrians, only a quarter of the way across the street, are in absolutely no hurry. The majority of them have no idea what those benign figures on the pole mean, they just watch the crowd they are with and do what they do.

As the slumped, disgruntled, silhouettes of humans shuffle across the street, my ambulance slowly eases into an appropriate lane on my favorite street in Denver. The street that runs all the way across the city, east to west. The street where on one corner you might be witness to a suit-clad politician carrying a briefcase to the capital and then, not but a block away, an unconscious homeless man, incontinent of all bodily fluids, resting peacefully on the concrete next to a tipped over garbage can.

Colfax Avenue. The fax. Where with one simple trip along a latitudinal traverse you can quickly witness how beautiful life can be, or how beautifully cruel it actually is.

We are heading to our post. And instead of taking the more direct, efficient route, we chose to slowly motor up this avenue. Windows rolled down and eyes wide open, we begin our trek through the kaleidoscope of life.

The gold dome of the capital is to my right. The beautifully manicured lawn slopes downward towards the row of yellow school buses. Children climb the concrete steps, not interested in what all the poster-board signs say and why those people are shouting. Suits scuttle around the grounds and each follows one another like lemmings on a field trip.

The rows of lights ahead are all red. This is the only street where one hopes to get caught at a red light. Because at each block, something new is sure to astound.

We sit. Crossing the street in front of us, heading towards the bus bench in front of the McDonalds, are figures clad in every outfit imaginable. Some wear coats and hats and have bundled themselves up on this warm spring day. Some barely wear any clothes at all. Tattooed backs and chests clothe them as their baggy pants hang precariously from their lower buttock, of course their boxers visible to the entire world.

Like zombies, they all shuffle across the street. I wait for the moment for one of them to turn and look at me with their empty eyes, grunting and slobbering as they rigidly walk to the ambulance with outstretched arms.

Green light.

We continue east. To my left is a line wrapping around the block. Pre-teens, with painted faces, stand on the sidewalk shuffling their newest pairs of skater shoes. Black shirts and black pants. Black hair and piercings. The motley crew has been standing on the soiled sidewalk for hours hoping to catch a glimpse of one of their favorite members of the band. Insane Clown Posse seems to really like this venue. And not but a block away, greasy-haired men exit a concrete building with black plastic sacks. The porn magazines they just bought secretly secured under their arms. They melt back into the scenery and are gone in the blink of an eye.

To my right, Volvos and Saabs enter the congested parking lot of the local liquor store. High heels and jeans click on the stained pavement as women from the other side of town fill their trunks with expensive bottles of wine and scotch for their dinner party that night. On the corner, with an outstretched hand, sits the alcoholic hoping to get enough change so he can too enter the same store and exit with a bottle of Night Train.

Red light.

A cop sits in his running car, the windows down as he fills out paperwork from the arrest of the drug dealer in the 7-11 parking lot. Congregating behind the car wash are the remainder of his crew, waiting for the moment that white squad car pulls out of the parking lot so they can continue their business.

A stain runs from the bus stop bench to the curb. Connecting the dots, I see a homeless man curled up under the wooden bus stop bench. Urine soaked pants are obviously the source of the already evaporated urine on the sidewalk. His buddies continue to slur at one another and work as hard as they can to get as drunk as possible.

Green light.

The street opens up. A hole in the wall chicken joint, Arbys, another 7-11, and bar after bar line both sides of the street. At this intersection, children play with one another as they cross the street. The church's basketball court is packed and skins versus shirts are running back and forth, full court. The chain net rattles as the jump shot bounces of the doubled-casted iron rim onto the metal backboard. Teens do their hair and talk on their phones as the world passes by them.

Moving from hole-in-the-wall bars and fast-food joints, I now witness more restaurants and pubs. Places that, with their neon beer signs, entice all who pass to come in and try the new fare. Catchy names and valets are now becoming more and more.

Saturday, May 12, 2007

Miles away.

The cool, crisp wind blows on my warm, sunburned face. High above the peaks of the Rocky Mountains, the warm glow of the sun creates shadows that fall behind the large Aspen trees like toothpicks scattered on a dirt floor. Above my head an eagle, with its wingspan fluttering in the current as it circles the tree tops, soars in the distance. Birds sing and chirp at one another as ripples on the blue lake float peacefully towards my feet submerged in the cool, clear, river water.

My orange fly line whips behind my head, the tiny handmade fly following the arc of my line as it passes my brow. The river is flowing slowly, and although it is murky from the runoff of the peaks in the Continental Divide, it slowly streams past my feet and invites me to wade in deeper. The air is clean and crisp and my breath seems at ease. Everything slows down into a dream-like trance.

"F*ck you! Untie me, you a**hole! You're only doing this because..."

"Because you're drunk and mean"

"I am not," is slurred from the bearded, crusty mouth.

In front of me sits reality. Black shoes, untied and knotted, have been slipped on over multiple layers of socks and plastic grocery sacks. The uncoordinated colors of the stained socks carry pieces of feces and vomit from nights before. Multiple pairs of waxy jeans, encrusted in dirt and grime, are secured at the waistline by an oversized, woven brown belt. Its tag end dangles from the loose knot at waistline down to the groin. Under the heavy, black sweatshirt rests a couple of undershirts. Soiled patches, like half moons, show evidence of dripping sweat rings turned white over time. A bearded chin, with various street artifact embedded deep within, attempts to overgrow and overtake the pot-marked, scarred face.

"I'm (slur) kill you! You (slur) (slur) man. I am not (slur) (slur) detox! I'm gonna (slur) (slur)."

I lean my head down.

And open my eyes. The green leaves whistle in the breeze and small mayflies chase each other on the surface of the water. My orange fly line floats slowly down the river like Huck Finn's homemade raft on the great Mississippi. At the very tip, laced to the hair-thin tippet, floats my handmade fly. It's white parachute wings bobbing up and down with every bump in the current. It nearly floats out of site, and with no bite witnessed, I reel the line, and the fly, back towards the rocky bank I'm standing on. Another attempt will shortly be made.

"I was in Vietnam. I'm a SEAL!" slurs more lies from the aging face in front of me.

"I can kill you with one hand," he threatens as the pungent odor of digested alcohol wafts from his chapped lips.

"Talk to me, you a**hole! I'm sick and you have to take care of me."

"You're not sick. You're drunk. And you're wasting my..."

I stop midsentence. I almost took the bait. Like that fish in the river, he casted his trap and dangled it in front of me. I swam near and was enticed by the colorful language, ready to bite and stoop down to his level and start exchanging profanities. I nibbled and quickly realized what it was, a trap.

He was too late to set the hook and my mind, again, resumed wandering.

I'm sitting right next to him, but I am miles away.

Wednesday, May 9, 2007

Speechless.

The click click click of the rotating sprinkler head sang a welcoming song as we made our way from the ambulance to the opened front door of her house. I walked up the paved driveway, spied a deragotory bumper sticker in the back window of an aging Buick, and turned left behind the large pine tree being soaked with water from the automatic sprinkler system in the front yard. Three large flat rocks, resting peacefully on a bed of smaller pebbles, led the way to the front door of the small, yellow house. The crooked house numbers above the screen door welcomed all who entered this warm home.

Inside, directly in front of me, sat a woman in red shorts and a white T-shirt. Red blood, matching her shorts like a paint sample from Home Depot, polka-dotted her white T-shirt with a remarkable style. The elevated hand had been cut while doing the dishes. And the blood seeping from the small gauze provided by the fire department was doing little to prevent its path down her arm and onto her shirt. Soap bubbles still perched on her fingers as if she had been blowing bubbles with a grandchild.

I knelt beside her and introduced myself. She awkwardly attempted to shake my hand. Behind her, and out of her line of sight, the firefighter gave me a brief report. Like in a game of charades, he contorted his face and his fingers to relay a point contrary to what was coming out of his mouth. How many syllables? I thought to myself.

"She said she had a stroke eight years ago," he said clearly expressing only four digits on his hand.

"She said she is 78," he articulated like a robot as he shook his head back and forth in dramatic disagreeance.

Being as sharp as I am, most of the time, I did my best "I understand what you are saying" look and made him feel like the grand prize winner of the family game of charades.

I knelt beside her and started talking. I asked her to explain what had happened and how, exactly, she cut herself.

She took a few small breaths and began speaking. Choppy sentences, like a two year old repeating the cuss words Dad said earlier with his friends, fell from her mouth. She, like the fireman, resorted to body language and began moving her arms and coiling her lips as she tried to express what was happening. Her mind was working, her lips were not.

I immediately slowed down my questions. Someone from the corner of the room shouted she had had a stroke before. I gently touched her knee and had her look only at me so she could reset, so she could calm down and start over. I began talking to her as though she were trapped in a well. I saw a person, and I saw she wanted to communicate, but the exterior shell wouldn't allow her.

"I know you can understand me. I know this is frustrating and very scary. I promise to take good care of you," I calmy told her as the firemen and my partner scurried to get the bed.

"Do you hurt anywhere?" I asked.

She nodded no, then yes. She stammered a few seconds and then blurted out "hand".

She began crying and as tears filled her swollen, red eyes I moved her to my bed and told her what I was going to do.

I barraged her with questions like a nervous prom date and slowly came to the conclusion she was not having a stroke. Her eyes desperately wanted to tell me something and her brain wouldn't allow it. Her words were being held hostage and no amount of ransom could set them free.

As the firemen closed the two doors on the back of the ambulance I sat next to her and did nothing. Everything came to a halt and the hurried actions of everyone around her seized. She slowed her breathing down and attempted to talk, stuttering more than before but successfully articulating words.

"I don't think you are having a stroke," I said as I nonchalantly put the stained blood pressure cough on her left arm, hoping my poker face would work. "I think this is a defecit from your previous stroke."

She nodded emphatically up and down. Her eyes swelled even more, like a teenage girl realizing she got a brand new car for her sixteenth birthday.

"Becuase of all the excitement, you cutting your hand, the firemen coming to your house, the paramedics putting you in their ambulance; your difficulty speaking is more pronounced than usual," I guessed outloud.

She grabbed my hand and squeezed it. She rested her head back and visible weight off her shoulders disappeared. She closed her eyes and slowed her breathing. Words were beginning to form.

"We're just going to sit here for a moment and see if it clears up. I want you to relax and use the oxygen in your nose."

My partner shifted uncomfortably. I knew what was being processed in that other paramedic mind and quickly doubted myself. What if she is having another stroke? What is what I'm doing is wasting time and hurting her even more?

I removed the blood pressure cuff with a quick jerk and tossed it behind my back. I leaned forward and was about to speak when I was interrupted.

"Thank you," she said.

I stared at her and took that opportunity to quiz her more, making sure this wasn't a transient blood clot in her brain and that I was actually correct in my medical assumption.

I asked, she answered.

My suspicions were right on. She told me that due to her stroke she has, at times, difficulty speaking. When she is tired, it is much worse. And when she is scared, it is really really bad. And when she is tired, scared, and overwhelmed with firemen and paramedics in her house, her speech just shuts off.

We pulled into the ambulance bay of the ED and she grabbed my hand.

"Thank you," she said. "Thank you for taking a little time and slowing everything down. If not for that, I'd still be stuttering to you, trying to tell you this is normal."

I stuttered.

She smiled at me, "You see, now you know how it feels."

I was the one that was speechless now.

Wednesday, May 2, 2007

Rat in a cage.

Sometimes I feel like a rat in a cage, with the world peering over the cardboard sides of the shoebox as I run frantically, and furiously, on the revolving wheel of life, only to break a sweat and end up where I started.

It ain't easy, sometimes. And it's even harder when you least suspect it.

The best way I can explain it is like this:

Go find yourself a large clear, Plexiglas box six feet wide by twelve feet long. In it, place yourself and two assistants. These two assistants need to have less training than yourself and should be half asleep, but will have the loyalty of a Golden Retriever and the eagerness to help like a excited student on the first day of his first clinical.

Strategically place in this box all the tools you need in awkwardly arranged cabinets. Then, as you attempt to perform possibly life-saving maneuvers, have an intoxicated loved one leer through the thin glass screaming at you to save her life. Have it shake and rattle violently, tossing you left to right, front to back, up to down as you attempt to interview the medically uncooperative, extremely short of breath patient restrained on the bed in front of you, doing her very best not to die in front of you.

You have no idea what has happened. And no one around you has the ability, or the faculties, or the breath, to explain the circumstances leading up to this event. All you see is a woman struggling to breathe, an intoxicated husband who won't let you do your job, and five other guys not realizing the urgency in your step; but want more than anything to help the best they can.

What do you do?

What is it? Is it asthma? Is it hyperventilation? Is it an assault? A choking, and the bruises on her neck are from the forefinger and thumb of the angry assailant? Is her throat crushed and her vocal chords spasming? Is it nothing? Or, is she dieing in front of you?

Quick, you need to make a decision.

But don't make the wrong one. You have a reputation to uphold, you know.

You can put her on continuous positive airway pressure (CPAP); an oxygen delivery device reserved for only the truly sick that forces air into her lungs like a jet turbine. Then give her subcutaneous epinephrine and nebulized medicine mixed with the oxygen, as you quickly start large bore IV's and think of the next line of drugs to give her.

That is if it's asthma.

Or do you hold off, and wait on the sideline to see if it's anxiety and she is severely hyperventilating?

You don't want to make the wrong decision. If you sway to the extreme; do all the invasive medical procedures and nothing is wrong, you look like that new guy in the corner with the white, pressed shirt and new blue cargo pants. The one with too many tools on his belt and pockets full of medical guides. The guy who wants to be a hero but has yet fought a day in the trenches.

Or, you can do nothing. Let your years of experience and nonchalance influence everyone into believing that this is no emergency and that you know exactly what is going on with her -you hope. You can go with your gut reaction and hope she is hyperventilating, praying it isn't a fatal asthma attack, or reactive airway disease, induced by the trauma of prolonged hyperventilation.

You can't calm her, if you can't calm yourself.

So, if you're like me, you think of the worst-case scenario and try to fix that problem. Toss the ego out the window and hope that you're making a wise decision. Better to over treat someone than let them die right in front of you.

And all this happens in a span of three minutes.

On a good day, it takes me all afternoon to decide what to eat for lunch!