Surprises

I work in a high volume system.  It is not unusual to do 10 transports in a 12-hour shift.  I’m lucky if one of the calls is a good call.  By “good” I mean a call where I get to be a paramedic in a way more than routine.  Routine paramedic is asthma (duoneb), abd pain (maybe fentanyl), vomiting (zofran), chest pain with normal ECG (ASA), hip fracture (fentanyl), psych (versed only if violent or extremely anxious) type of call.  While these normal calls can all be rewarding in their own way, they are not memorable and are not worthy of a response when someone says, “Do anything good?”  A “good” call is one where when someone asks you that question, you can respond with “Yes, I did.” Sometimes a good call can be summed up in just a few words.  I did a code, used CPAP on a CHFer, gave 10 of Versed to take a duster down, did an open tib fib.  Good calls, but not worth elaborating on because the story is a known.  We have all done these calls.  The true good calls are ones that are more than a sentence fragment for a response.  True good calls are worth another paramedic’s listen.

Recently I had two calls that fell into the good category, and within that category, I would tag them with the surprise label.  Surprise is a special category of good call that I particularly enjoy doing and telling about.  By surprise I mean they turned out to be good when my expectations were for same old same old.  You can be dispatched to a shooting to the head or a CPR in progress and know you will likely have a call where you will have to earn your pay, but when you get dispatched to a city chest pain or a simple bee sting without initial symptoms of an allergic reaction, you are most likely going to end up with a routine call.

So I get dispatched to a chest pain a couple blocks from hospital.  The address is a rundown apartment building.  Our patient – a large fortyish woman wearing a do-rag — comes out of the front door with her boy friend who is wearing a New York Knicks jacket and a Yankee baseball cap with a shiny round sticker on the bill.  (I do not mean to stereotype by this description, but in my mind at the time I am making judgments based on the stereotype which is based on experience). The woman says she has been having chest pain for about five days, and she answers my first question by saying yes she has been coughing up green phlegm.  Same old story, right?

I have a hard time getting a pulse — she does have fat wrists,  I but think nothing of it.  When I put her on the monitor — just part of the routine — I do the classic double take.  Say what?  She is cranking at 220.  Holy Moly!

Later, I get dispatched for a 60 year old man stung by a bee.  He too walks over to the ambulance as we pull to the curb.  The first responders say the only reason he called is his wife got stung by a bee once and had an anaphylactic reaction.  He was stung by bees once ten years ago, and remembers some swelling at the time. He has no itching or hives.  No dyspnea.  His lungs are clear.  The first responder tells me his blood pressure is 140/90.  I feel his forehead and note it is clammy, but it is also humid out, and he was working in his garden  In the ambulance, I take his blood pressure.  100/60.  I ask him what his pressure normally runs and he says around 130.  I ask about meds and hear he is on beta blockers.  I tell him, I will be rechecking his pressure periodically on the way to the hospital.  I retake his pressure a few minutes later.  It is 82/40.  He is looking a little grey and he tells me he feels nauseous.  I check the monitor.  Heart rate is in the 60’s still.  He looks very grey now and says he is nauseous.  I take my the med bag out of my gear and set it next to me on the bench.  Interesting, I am thinking.  I take his pressure again.  I can’t hear anything.  He has delayed cap refill and is starting to look motley.  I’ll be…

What made these two calls “good” was for all the bullshit and boring repetition of many calls, sometimes someone actually turns out to be having a real problem.  We are supposed to put chest pains, even ones we think are muskuloskeletal,  on the monitor.  We are supposed to take repeat vitals signs.  9 out of 10 patients, maybe even 39 out of 40 show no change at all.  But you do your job, your routine and all of a sudden, there it is before you.  Paramedic time.

I wonder if this is how bird watchers feel when all of a sudden their binoculars focus on a rare speckled breasted winged creature or how antiquers feel when they discover a rare treasure at a neighborhood garage sale.  Or how a seven year soccer player feels when suddenly the ball is on her foot and the goal is open and she is unguarded and she kicks it straight and it goes in the goal and the team explodes with cheer.

Sometimes I love my job!

So instead of, the nurse saying hey did you know that BS chest pain patient you brought in was in a rapid afib at 200, or your BLS partner screaming up to you from the back that the bee sting dude just went into cardiac arrest, you actually get to be the one controlling the narrative.  Patient one gets 25 of Cardizem, which works like a charm.  The 190-220 rate comes down to the 70s, and she feels much better.  Patient 2 gets 0.3 epi IM, 50 Benadryl,  4 Zofran and 125 Solumedrol IV, along with a 300 cc fluid bolus.  And while he still feels a little nauseous, his pressure comes back and the mottling goes away.  His face is no longer grey.  His skin is warm and dry..

And I have two calls that are worth a listen, and a job that constantly reminds me it is never as boring as it can sometimes seem.

 

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