A New Path
Our ambulance had been summoned to help a woman tripping on mushrooms—activated by a midnight 911 call about a possible assault and death. The police arrived at the location ahead of us to ensure safety. We walked inside to find a woman sobbing and holding a blood-soaked towel against her mangled hand. She had huge, dilated pupils from mushrooms she’d ingested with her boyfriend. Her story unraveled as we listened in horror.
Shock and Awe
My ambulance partner and I responded to a 9-1-1 call for a person with difficulty breathing at a department store, but we couldn’t find anybody needing medical attention. A worker pointed to the metal ladder at the back, saying there was a guy working on the roof, and they hadn’t seen him in a while.
Speed Eating
Eating is always an adventure in the mad rush of 9-1-1 shift work. I once inhaled an entire steak I had just barbequed in four giant bites because we were getting sent on a rural call forty minutes away. It was my only chance to eat before midnight.
Coffee has become a religious experience, both getting a cup in before the first action of the day and rebolstering in the afternoon. Some of the younger EMTs constantly sip on energy drinks but that puts me in SVT. (Supraventricular tachycardia refers to a racing heartbeat that is uncomfortable and potentially dangerous.)
Boss
I was on the 36th hour of a 48-hour ambulance shift. We had been up all night and had remained busy all day. I was starving, so I ran into a deli for a quick fix. The kid behind the counter told me they were closed. I paused, jaw dropping in disbelief.
“Just kidding, boss,” he cackled.
Back of the Bus
When the ambulance doors shut, a fertile silence is wrought as patient and paramedic situate into the tight, mobile quarters. The patient, strapped backwards on the gurney like a carnival ride, stares upward at bright lights and cabinetry chock-full of colorful medication boxes. As the ambulance takes off toward the hospital, the paramedic begins an ataxic dance, hopping and twisting over blood pressure cords, pulse oximetry, heart monitor leads and IV tubing.
Patients may not be as forthcoming around large numbers of family, bystanders or medical personnel, but the atmosphere in the back of the ambulance is made for intimacy and truthful candor. I make sure they’re comfortable as can be, and then I continue the interview. Chief complaint, SAMPLE history, secondary issues, reassessing everything. Once it’s just the two of us on what can best be described as an awkward first date, we both open book and overshare.
Some joke or express their deepest pain and fears. Anxiety, stresses, regrets. The alcohol and pills they imbibed. The nagging injuries, traumas and diseases. I stay nonjudgmental.
COVID patients speak about the shame and small mistakes they made to contract it. One man on high-flow oxygen being transferred to the ICU
Differential Diagnoses
When their ambulance is dispatched to a 9-1-1 call, paramedics attempt to cherry-pick a diagnosis based on the age and the one-sentence description they get of the patient’s complaint. We occasionally nail it, most times not, with humor, sarcasm, gloom or fatal cheer. There are often curveballs; it’s hard to streamline individual patients and their array of needs with our quick-and-dirty prehospital tools.
Differential Diagnoses Read More »
Being Human
I work as an ambulance paramedic. Nowadays, on every call that meets the criteria for COVID-19, my colleagues and I wear masks, gloves, eye shields and gowns. We stand six feet away from our patients as we interrogate them about the presence of fever, cough, body aches, or breathing problems.
Our overall 9-1-1 volume is down, as people stay home instead of driving drunk, as they decide to stay away from hospitals, as most of them (minus the over-advertised outliers) shelter in place. But I notice more secondary symptoms: domestic abuse, assault, anxiety, mental illness, loss of sobriety.
Protea caffra
Beverly called the ambulance because she couldn’t walk anymore. Her feet were edematous after ten days of radiation treatment for metastatic lung cancer, and her heart was slowly overfilling with fluid, backlogging into her body. She was stoically resigned to her pain and newfound infirmity, but she kept a wry sense of humor, cracking jokes about being waited upon and the “magic carpet ride” sling we lifted her onto.
During transport to the hospital, Beverly told me she grew protea: pale red, pink and cream-colored flowers native to South Africa. Her family sells them at local farmer’s markets in bouquets. When I inquired further, Beverly perked up and gave me the rundown:
A Perceived Snub
I ambled with squirrels and rabbits on an urban trail overflowing with chaparral and mossy oak. Early morning bird chatter, drone of bugs in rays of sun, and the crackle of underbrush beneath my feet kept me company. My thoughts wandered brisk as the sound of river water on rock.
A man wearing a holey T-shirt and sweatpants approached me, accompanied by a large German Shepherd. The dog was off leash but seemed friendly. The man had a vacant stare, and as I passed him I gave a perfunctory smile and “Good morning.”
He didn’t even note my existence nor change his faraway gaze, and I immediately snickered at his lack of basic human decency. Shaking my head, I glanced back at him. He had stopped, looking up at the cloud-threshed sky, and suddenly emitted an unearthly wail.
Pre-Surgical
The old woman bends forward, rubbing life into her putrid socks to ease the black pain emanating from her gangrenous toes. All the while, she coughs, calling it “the other person inside of me.”
Comfort Care
The hospital-style bed lurks emptily alive in the pale living room. Rust flecks along its silver rails pock my distorted reflection. Cold sheets triangulate like sagging tepees, housing the smell of long-term illness. These are the ghostly remains of hospice care.
