Monday, July 11, 2011

Not Because I’ve Wanted To…

I’ve been away from this venue for a few weeks.

As usual, it’s the same sort of thing where I’ve been too busy to even talk with my family. I’m not sure it’s ever really going to get better, but at least I had a little bit of down time yesterday where I could spend a little time with Martha, and I even got to cook dinner. She appreciated that as she has been pretty busy and wiped out herself. And next week is the Komen walk. I’m going to attempt to get photos and post them, but we’ll see how that all goes as in the midst of the event things can get really busy. And they usually do.

So, what’s been going on over the past few weeks? Well, my grand-daughter is growing like a weed. I don’t mean that in a negative way, of course, but she is definitely coming into her own as a human being. She knows her mind (and lets everyone else know it as well), she is rampantly mobile, which in principle is a wonderful thing but sometimes it can be really tiring, and she is very, very smart. She learns really quickly. And she is simply a wonderful child.

I have to admit that I laugh at some of the things she does which could be construed as misbehavior. I watched my kids do the same things when they were that age – I didn’t have the pleasure of Kerry in my life until she was 10, but Martha has told me about some of her antics, and it is funny to watch Peyton do some of the same things now. It drives Kerry crazy. Scotty, on the other hand, is much more patient than Kerry is, and he handles things so much more in stride than Kerry does. As I write this, I can hear the back and forth going on in the other room and I am chuckling quietly because I know the apple simply doesn’t fall far from the tree.

As for other things… I’ve been undergoing treatment for tendonitis in the flexor tendon in my left hip, also known as the Iliopsoas tendon. For months I hadn’t been able to flex my hip up without pain, and I couldn’t figure out why. When I followed up in early June with my Primary Care physician regarding the blood work I’d had done in March, I asked him for a referral to a Physiatrist that I have been a patient of off and on over the past 5 years. Considering this is the sort of thing that a Physiatrist does, he was more than happy to set that up.

I have to put a shameless plug in at this juncture of the post. I don’t do this often, but I think it’s worth doing now. Kathy Leahy, DO, is the Physiatrist I see. She and her colleague, David Lewis, DO, are really good at dealing with issues like these. I first saw Kathy a little over 5 years ago when I wrecked my back on a 575 pound patient. She had me up and going in a little less than 6 weeks, and I was extremely pleased about that. She set me on a treatment plan for this issue, and it has worked well. I have a follow-up with her tomorrow, and I expect she’ll discharge me from her care. As it never affected my ability to do my job, that never came into question, so I don’t have to worry about that.

Speaking of work-related issues… This past Wednesday/Thursday was a busy and nasty tour. On the evening and overnight I worked with Mike, one of my absolute favorite people. He is a young guy, all of 22 years of age. But he is a solid human being, a really nice person, and a damned good medic for someone as young as he is. I have been consistently impressed by his skill level, and he works at a place that many experienced medics I see don’t work at.

I almost wish I could have him as a permanent partner. But I’m happy with my lot right now as Jason, the person who is my permanent Wednesday partner is doing fine. He is also proving himself to be a good, solid performer when it counts. I can’t ask for much more than that. Plus he’s doing a good job learning Newton. I think once he’s got the city figured out he’ll be fine.

Back to the story. Two calls that happened almost back-to-back were enough to mess the whole night up. As it turned out, we did five between midnight and 6:00AM, and we transported three of them – all sick or injured people. The first was for a fight at one of the hotels in the city. Arrived on scene, two people, on a 26 year-old female, the other a 51 year-old male. Together. Decided to ingest a whole lot of substances. I was told between the two of them they consumed a 12-pack of beer each and did a total of 5-6 lines of Cocaine.

Then they started fighting. The cops figured out that she started the festivities. He punched her in the face to defend himself, but he ended up with a broken nose and what we suspect is a closed skull fracture due to the depression we found at his occipital-parietal line. She ended up with facial injuries and a pair of silver bracelets on her wrists when she was taken into police custody and arrested for assault and battery.

As stupid as this guy was, I felt kind of sorry for him. He was certainly nice enough, and he was incredibly polite. He was just in a bad situation of his own making, and he knew it. But he needed to be treated for his injuries, so we did what we were supposed to do. Our job.

The second one, which pissed me off incredibly, was a call to one of the local favorite nursing homes of mine for the unresponsive female. We arrived on scene to find the district engine company present (we spent a lot of time with these poor guys during the course of the tour; as much as we all get along as well as we do, the joke was that we had to simply stop meeting like this). They informed us that we had a 56 year-old female, known diabetic, with a glucose of 17. We got into the room, found our patient totally unconscious and really gorked out. One of the nurses was there as well – the charge nurse for the floor who I’ve had to deal with in the past and is a real challenge. She is from the West Indies – I think she is from Haiti, but I’m not certain – and her attitude is rather, for lack of a better word, indifferent. We started to assess her ourselves and found some disturbing and alarming things.

First, when we re-checked her sugar, our glucometer read “low”, which indicated to me a glucose lower than 20. Second, she was hypotensive with a pressure of 56/38. And she had a heart rate of approximately 50. She also was recovering from a fractured right tibia/fibula, she had an episode of compartment syndrome in her left leg, cause unknown, and she had grafts all over both of her arms from all of the times she had cut-down access done on her. Plus, she was a known diabetic (big surprise there – staff put her to bed with a glucose of 89 and did nothing about it) and she was in end-stage renal disease and was going to dialysis three times each week. No fistula noted on either of her arms, and we found the Hickman catheter implanted in her chest wall. To top off everything else, she was incredibly obese. We put her weight at between 375 and 425 lbs, and she was maybe 5’4” tall at the most.

So we tried to get access on her – no good. The cut-downs were all over the place and in the way. Because of her legs we couldn’t use an IO gun to drill either tibia, and she had no neck – no access to her external jugular veins. And she’d gotten two doses of Glucagon prior to our arrival.

It was a bad situation. The best we could do was to package her, rapidly extricate her, and get to the hospital as quickly as possible. We took a driver from the engine company and Mike and I did everything else we could in the back, in terms of managing her airway and getting another dose of Glucagon into her. The third brought her glucose up to 42, which under the circumstances was an improvement but it was still not nearly enough.

When we arrived at the emergency room, as we expected, the staff was not happy with what we brought. The attending doc who was working gave us (specifically me) the third degree about what we had and why we didn’t do more. I didn’t say much, but I was pretty upset. Considering how frustrating it was to deal with this patient and not be able to do much for her, you would think that she would have seen that and not been so bitchy about it. I wouldn’t be surprised if she files a complaint with her medical director. And if she does, I’ll simply tell him what happened.

Under the circumstances it’s the best we could do. But it’s still frustrating.


Karen Brook Westhaver said...

SO glad the work on the tendonitis issue is turning out so well, Walt! :-) But the call you had with the woman only 56, in renal failure, bradycardic and almost no level of blood glucose scares me. As someone who now lives alone, I don't think I've got to worry about that amazing weight issue, and I have my own decisions/thoughts about long term dialysis at various stages of life (meaning way older), but the idea of potentially ending up alone in a place like she was, in her situation is downright frightening. She was so fortunate to have you (sorry the ER doc was belligerent with, there was more you could do about this terribly disintegrated situation how?) taking the call. I'm sure you shared some enligtening facts with the ER doc which hopefully might ease this poor lady's situation....if she gets back to that so called nursing home. (shudder). You're a blessing to so many people. I'm glad some calls are really downright funny...there's got to be some laughter in this work or one goes batty.

TOTWTYTR said...

The attending doc who was working gave us (specifically me) the third degree about what we had and why we didn’t do more.

Let me translate for the non EMS oriented,

Why did you bring my this patient not all fixed up and smiling like you usually do? Now, I have to actually do some doctor type work and figure out what the hell is going on here.

But that reminds me of an incident a couple of weeks ago about which I can put up a real EMS post.