Thursday, May 07, 2009


Martha and I have been married since July 26, 2003. We’ve been together a bit longer than that (we met in May 2002) and we are unique among most married couples in that we have a relationship that works incredibly well. On many levels.

First and foremost, we share a great love. We are also each other’s best friend and muse. And we collaborate on a considerable number of things.

I trust her with my life.

But the main reason for this post is to talk about one time we worked together on the back of a critical care truck. She and I were talking about this, and I thought it would be interesting to share a story about getting an opportunity to work with her. We knew we were good together for a great many things, but we didn’t realize how well we actually worked together until we did this particular call.

A couple of years ago (2006, I think) I was working on ALS-9 out of Manchester with my friend Squid. Now, a little bit about ALS-9: it has a reputation for being a difficult truck to work on, not just because of the types of calls that get sent to it but also because of the schedule. At the time it was shut down on Mondays, ran 0900-1900 Monday and Tuesday, and 1000-2200 Wednesday-Sunday. It is a swing truck, and consequently when bad things happen ALS-9 gets the tough jobs.

It also has many names, none of which I can share here because they are all really, really bad...

Anyway, we were working on a Friday, and during the day we got dispatched to one of the two hospitals in Nashua – the Southern New Hampshire Medical Center – to transport a patient to the Lahey Clinic in Burlington, Massachusetts. It was for a multi-system trauma patient and we were to take a nurse with us.

I knew that Martha was working a shift at the SNHMC that day, but I didn’t expect to see her. However, when we arrived, I discovered that Martha was the nurse that would be going with us.

Pleasant surprise was an understatement. I was very happy to see her, to say the least. And it was a good thing, because our patient turned out to be a handful.

A 47 year-old female riding a motor scooter. Helmeted. Somehow she managed to go over the handle bars and crash head first into the pavement. She had both head and facial injuries that were quite significant. When we arrived, we got a report of what was going on, and I got an opportunity to look at the patient’s helmet. The inside was seriously remodeled.

This patient was sedated and intubated, but the ED physician who was sending the patient would not order Propofol. Apparently he didn’t think this patient needed it. Or he never ordered it as a matter of course. Or some other nonsense; I’m not sure what the right answer to this question was.

He was a stupid physician. And I’m being kind as could say many other things.

All we had to work with was Midazolam and Fentanyl. He sent 6 vials with Martha, plus we carry 3 on the truck. In addition, we carry 300 mcg of Fentanyl and he sent another 300 with Martha, as well as orders to do what was necessary to keep this patient sedated. She was already fully immobilized but chewing on the ET tube to the point where I thought she would bite right through it. And once we got going with her, things that could have gone wrong did, at the worst possible time. Sort of like what happens when Murphy’s Law is applied. This turned out to be a classic example of it.

We got her moved onto our stretcher and secured, and we brought her out and loaded her aboard the ambulance. By this time she’s doing everything she can to get off of the board, so before we could do anything else, she got both Versed and Fentanyl. Once we got under way, we started assessing her. Martha took care of dealing with keeping her medicated and watching her vitals, and I took care of protecting the tube. One of the big problems we had was that at the beginning of the shift we discovered that the Life-Pak 12 monitor we were supposed to have on board our truck had been pulled off and replaced with a different one. This turned out to be an issue; ours had a BP cuff that we could set to retrieve a pressure automatically at an interval we could set. The one we had for that day did not. Because of this, it became incredibly difficult to deal with monitoring her vitals and keeping her medicated and ensuring she didn’t destroy the tube and making sure she continued to be secured to the board...

Without a doubt it was the longest 30 minute ride either of us ever had.

We managed to do all of those things. Between Martha’s and my efforts – as well as all of the drugs we brought with us – the patient stayed safe and medicated. Her vitals were stable (actually, as I recall her pressure had been a little bit elevated due to the head injury and the resultant inter-cranial pressure) and as long as we kept the drugs flowing, our patient didn’t try to become acrobatic.

We arrived at the Lahey, and because the patient wasn’t in their system yet they had no orders for anything, including medications. So as we were bringing her through the doors of the ED Martha was pushing the last of the Versed. As it turned out, this patient got a boatload of medication. Pretty much all of what Martha had brought as well as almost all of what we carried on our truck for both Versed and Fentanyl.

Once a doc got to us and we gave report and transferred care, I suspect it wasn’t long before she got put on a Propofol drip. And I am pretty sure that the doc up at SNHMC got spoken to about the lack of willingness to sedate this patient properly.

We did our best, and Martha had certainly advocated for the Propofol. But the doc was being a supreme idiot. Hopefully he is smarter about situations like this one now.

I never thought it would be so much fun to work with my wife. But it was. And until then I had no idea how good she was at what she did until that time. I mean, I knew she was good, but it was so cool to get to work with her.

Someday in the future I hope I get to again.


Epijunky said...

This post...

I dont know what to say. I just loved it. It's the epitome of what the word "Partner" means.

Michael Morse said...

Well done Walt and Mrs. Walt! tHANKS FOR SENDING.

Susie Hemingway said...

"Partners in life" - Partners "in love" just the very best combination. I enjoyed this post.