At Bay

4:00 A.M. Twenty-two hours into a twenty-four hour shift. The tones go off for the third time that night.

They send us for an unconcious man. It is an address we were at the previous afternoon — a lift assist for a man who’s wife needed help lifting him off the toilet because he felt to weak to lift himself up using his walker as support, and he was too much dead weight for her to help as she sometimes had to do.

At the time I was thinking I see this all the time, a person living at home, who just reaches the point where they are too weak to live in their house. They can no longer transfer themselves from their wheelchair to their bed, or standup from the toilet with their walker in front of them. And for a few days we get called over and over to give them a lift assist until they either go to a nursing home or get some better help in, or get a hospital bed from which they now spend their day. As I left I wondered when we would be back — a couple hours later, that night, the next day. I had even said to his wife. If he can’t get up now by himself, he’s not going to be able to do it later. You can’t hold the inevitable off forever.

But “unconcious” — I wasn’t expecting that. The problem with doing a lift assist, and not transporting is if the patient happens to die in the next twenty-four hours — related or unrelated to the fall — you are in the stew. I know a medic, picked an old lady up who said she’d slipped out of bed. He put her back in. An hour later another crew was doing CPR. Not good, but what are you going to do. We do lift assists all the time. People slip or fall — they’re not hurt, they don’t want to go to the hospital — they just need help getting up. Thank you very much. Sign here. Call us again if you need us. You have our number. What’s that agian. 911.

On the way to this call — the cops update us — keep coming lights and sirens. I am thinking maybe I should have really pressed him on going, maybe something else major is going on.

We find him now on his bed — his skin is pale and yellow, almost opaque. His eyes are glassy, open, not blinking. He looks dead, except there is some movement when I touch him, and he says a few words slowly. I have to keep nudging him to see that he is still alive.

I ask the wife about his medical history. She says he has a heart history. I ask for the list of medications. His pressure is a little low. 100/60. His heart rate is in the 60’s. I do a twelve lead — he’s in a bifasicular block — Right Bundle Branch with a left posterior hemiblock. Could be normal for him. I don’t know.

Given how he looks I am sort of suprised his vitals aren’t worse. He is Satting at 93%. He is acting almost like he is drugged. His grips are equal but very weak, he can’t even hold his arms up. His abdomen is distended. His capillary refill is a little delayed.

I ask again about medical history. The wife repeats he has a bad heart with many blockages. She is very distraught. I ask my partner to see that she finds all the meds and writes them down.

A police officer and I carry him down on the stairchair, which is hard because he is a big man and dead weight, plus the stair chair is an old old model, and one of the pins comes loose, so I am holding tight and pressing at the same time to keep it together. I keep looking at the patient to make certain he is still alive. I have had many patients code on me while I was carrying them in a stair chair. He is still there.

Finally in the ambulance, I get a line, then get out the glucometer. My partner checks the sugar for me.

“83,” she said, then adds “Last result.”

I’m not so sleepy that I don’t remember 83 was the number of the last patient I checked a sugar on — the pedi seizure I had the prior morning.

“Give me that,” I say. I put a new strip in the machine, then apply a drop of blood to it. She must have hit the botton on the machine, thinking the button was what turned it on. Instead, you just put in a strip, then the machine reads, “apply blood now.”

The result comes up — 27.

“You can shut off the sirens,” I call to my partner, who is bombing us toward the hospital now. “And do you have the list of medicine?”

She reaches into her pocket, unwrinkles the paper and holds it out for me. I run through the list. There’s glyburide. What do you know — he’s a diabetic.

I give him an amp of D50, and he comes around to the point he says he feels better, his grips are strong, and he even knows where he is. He says this has never happened to him before. He only had a small lunch — no dinner.

I think there is something else going on with him — nothing that will kill him tonight, but some disease process or something working on him. I’m glad he’s going in to the hospital. I recheck his sugar — 200. By the time we are at the hospital, we are actually having a decent conversation.

I wonder if I knew he was diabetic when I was there earlier, if I would have checked his sugar, and what would it have been? It seemed just like a simple lift assist, with a mandated persuade him to go to the hospital. I don’t think it would have been too low — he was fully alert then, just feeling weak. I’ll be curious to see if we go to his house again, or if his name shows up in the obits sometime in the near future. When I reviewed his medical history after he came around, I found he had been on diaylsis in the past. Not a well man.

***

We stop at Dunkin Doughnuts on the way back. My partner gets a doughnut and a coffee. The day before someone left a dozen doughnuts for us, and I ate one — one with pink frosting and sprinkles on it. I ate it in four parts over a course of two hours. It was good. Doughnuts are one thing I don’t eat. About ten- fifteen years ago when I had a coat and tie job, I ate two doughnuts every morning and I must have weighed a soft 240. I stopped cold turkey. Now I’m 215. Lean and Mean. I really want a doughnut.

As I write this I am eating All-Bran. I went home and went to bed for about three hours, sleeping with a blanket draped over the curtains to better darken the room, and with a black sock strapped to my eyes under some swim goggles. In a few hours I will go to the gym. I need to stay strong, need to be able to lift myself off the toilet when I am old, need to hold diabetes and other diseases at bay.

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