Ridealong

I cannot keep building up blog material in my head to be written down just because I still have two Vegas days waiting in the line.

That's why I'm going to start "backwards" right now, beginning with last night, which was our scheduled ambulance ridealong. Despite Mayor Bloomberg's warning, we used the amply-filled A and D trains from Port Authority Bus Terminal at 6pm last night to come to the hospital at 7pm, when we were to start our ridealongs. After some confusion about where to go (Dr. G and Dr. A, the EMS-expert attending, were both on shift luckily) we met paramedics outside. We learned there are 3 BLS (basic life support) and 1 paramedic cars that belong to the hospital roaming the streets outside. The paramedics had a laptop, wireless internet, a movie on DVD and they were going to get pizza. Skriehma and I played rock-paper-scissors for going with them first and naturally, as always, I lost. I waited for the first BLS crew to come to the hospital, which consisted of two big African-American gentlemen who did welcome me very nicely. Yet, they weren't my EMTs for long, we started right around their shift change. Another black guy, originally from Nigeria, grown up in Manchester, England replaced one of the EMTs. Before the second one was relieved, we got a call for assistance from another ambulance. The patient, a 43 y/o F (non-obese!), had apparently slipped and fallen down a couple of stairs. We helped the other unit put a collar on her and place her on a spine-board. Only two of us ended up carrying the lady, since I was going backwards I got some nice co-piloting from one of "my" EMTs, one hand in my back constantly warning me of every little step and/or danger on the way. Not sure whether he was more concerned I'd drop the patient or fall myself. I do think the latter though.

After that, this other EMT was relieved as well by a guy who had immigrated from Peru at age 10. He apparently had a migraine headache in the beginning but after that turned out rather talkative and nice. Our next call was a stand-by for FDNY (fire department) who were responding to a transforming station that had exploded. Since no one got hurt (you know I'd never ever ask for that to happen, right?), the experience was limited to looking at five big fire-trucks and one police car on that road all giving an amazingly intense light-show until we left after about 30 minutes when there was no more fire and they were just waiting for the company to shut the power off.

Next call was a "broken arm" on the fourth floor of an apartment building. 16 y/o M s/p (status post) trying to put his fist through the wall. More interesting than the patient himself was the apartment and the "family" in there. The place mom, dad and about five teenage kids lived in was not much more than a few poorly-lit empty rooms that hadn't had a paint job in decades, one shelf and a table with fold-up chairs, a ripped couch and an exercise bench. The inside doors had big holes in them, looking like people have been punching through them regularly. A familiar sweet-sour aroma of urine was in the air, rather big bugs were running around the place while grossly obese mom was sitting at the table, never moving an inch. Dad had opened the door but after that didn't concern himself much with us and wandered around the apartment. The "patient" was sitting on the couch, his 18-y/o brother on the exercise bench. The 16-y/o claimed he couldn't move the fingers of his right hand and he at least pretended to be extremely sensitive to touch from the wrist on. The pulse was fine and there was no swelling we could discern. We put an ice pack on it and splinted the arm. Mom, sitting on the strained chair, legs spread apart, belly sogging between them, could not offer any more reply to the question why her son punched the wall than "he was mad". She also did not know what medication he was on, only knew he had "some mental problems". The older son got the discharge papers of his brother, he had recently been released from the psych ward. He was on olanzapine. We did ask her about allergies but the answer "I don't know" really didn't surprise any of us anymore. We brought the boy to the ED, accompanied by his 18-y/o brother, his mom obviously couldn't be bothered with that. The EMT from Peru later said the majority of people around there spent their time sitting and "hanging out" on the streets waiting for "something to happen", not knowing more of the world than the corner of 187th and 3rd or wherever else they happen to be growing up. They call an ambulance for something like this "broken arm" because they don't have a car, no money for a cab and since they have Medicaid the state pays for the ambulance ride.

A bit later it was 2am, the time when skriehma and I were to switch rides. The two teams met and we made the switch. Naturally, the paramedics had to tell me "dude, (edit)skriehma(edit) just decompressed a GSW to the chest". I went through the first phase of grief: denial, and replied "you are f'ing with me". "No, seriously dude, it was awesome". We stopped by the hospital and they said that the patient was still in the trauma bay. And lo and behold there was a patient with a GSW lying on the stretcher. I ripped the record from the hands of the resident and read in disbelief - GSW to the shoulder. Shoulder! Not chest! Hahah! The paramedic just shrugged and we went back to the rig. I still didn't believe him but the thought that skriehma may actually have been doing another needle thoracostomy while I was putting ice on fist-through-wall-guy. We then drove to a Starbuck's to get coffee for a nurse that obviously had to be cute. And you know what happened? Radio chimed in, calling ambulance 18E to a "pedestrian struck". Skriehma got a movie ("Alexander"), pizza (obvious from the trashcan), a possible needle thoracostomy (they even claimed he asked to put in a chest tube) and now he'd get a MVA (motor vehicle accident) on MY ambulance just ten minutes after I got off? The paramedic in the front started laughing hysterically while I was using my seat in the back as a punching bag. He did have some mercy and told me upon another request from me that the GSW never happened, the only job they had apparently turned out to be a panic attack. And the pedestrian struck was a short time later clarified over the radio to be an intox case, in other words a drunk. I spent the rest of the night watching half of Alexander myself and sleeping for the last hour in the back of the ambulance.

All in all, the ambulance ridealong was rather disappointing. It was also pretty much the only time it was actually raining while we were outside. The whole time. We did pick a Friday night in the Bronx - yet according to the EMTs people don't go out and shoot and stab each other when it rains. Rats.

Let me also use this opportunity to talk about the past two days before I further continue the novel on Vegas.

Sooooo .. as Trillian already told you, we were out on Wednesday night. Dr. F., a. k. a. Chris Tucker, invited us to watch the Yankees game with the residents during conference in the morning. I did what any good American would do - say "oh sure, that'd be nice" and not even consider going. After all, we'd be working 14 hours before we got off making us awake x16h + another 2 to get home. What's more, I had slept very little that evening. But it turned out that most residents from that shift, two attendings and even a nurse would come and chief resident Dr. S., a. k. a. the cute resident, would "give us off" at regular sign-out 7pm instead of our 9pm. That actually consisted of her going to the attending coming in on our side and telling him "We're taking the Germans out to drink and watch the game", his reply being "yeah, whatever". They were right in saying it was probably the first and last time we'd go out together and it did allow for skriehma and me to shave 2 hours off our crazy Wednesday late shift. So I agreed to go, being quite tired and really not caring much about baseball.

What ensued was a wild 80mph-ride on the freeway up the Bronx until we arrived in a sports bar with TVs all around the place. Attending Dr. S. arrived about an hour after us, an extremely sociable and enthusiastic indian guy who immediately said "this night is on me", even though the Yankees later went on to lose the game. The evening was OK, after sitting around not much interested in smalltalk for the first hour, after the third beer and when the game started I started enjoying myself a bit more. I did start calling our place, at least the number we seemed to remember, every 45 minutes starting 9:30pm, since neither of us had any of the girls' cell phone numbers with us (nope, not on my PDA either). We then got a ride from one of the residents kind enough to take us (skriehma, Dr. F/Chris Tucker and myself) to the subway, which obviously at this time of night had to be a local train making every single stop from the north Bronx down. Chris Tucker actually offered to accompany us from Central Station to Times Square since he assumed we'd be scared in NYC in the dark. When we claimed we'd be fine he at least wanted us to call someone, anyone, in the morning to tell them we're allright. It was very touching. We met him in the residents' lounge on the next day, when we started our shifts.

And that shift started wildly. Even before I was officially on I was helping to pry a crazy woman off an IV-cart, we had to force every single finger off that thing, stuff flying off of it wildly in the process. We were about eight people, residents, attendings, security and me throwing her face down on the stretcher, while she was trying to writhe, scratch, spit and bite her way out of our grips. While one of the residents tried to secure her face, we put soft restraints on her limbs, put an IV into her, relieved her of her agitation and flipped her on her back to tie the restraints to the bed. Before we were quite done with that, another patient that I also didn't know since I was just about to start my shift jumped out of bed. She was a well-built black girl, 22 y/o as I later found out, wearing nothing but a bra that only held one of her breasts while she wildly charged the security guard posted at the only exit out of ED1. She took several big swings at the poor guy and actually hit him a couple of times in the head while he desperately tried to fend her off. At that time I felt very sorry for him since it was his damn job to stand in the way of the crazy savage woman who fought an unfair fight, since he had to be afraid of her scratching, biting and kicking while she didn't. Then I realized I was the one closest to the wrestling couple and he would probably like some help. I really didn't know what to do between all the fists, elbows, nails and teeth flying about until more of the staff converged on the brawl and pinned the second madwoman down. She was dealt with in the same manner as her colleague, I later read she was apparently having a reaction to the THC in her system just like the girl several weeks ago that I was supposed to do my first LP on that ended up biting Chris Tucker.

And then I don't know what happened .. was it the attending not moving the meat? Or just one of those days? My side of ED1 was overrun. All areas were filled with two or three patients, as many as would fit, and patients were piling up double-file in the hallways, it was hard to squeeze through. All this happened in the last 1.5 hours before sign-out, so we signed out 25 patients and 6 to be seen, the following shift was not amused.

We are also supposed to sign out our patients to the medstudents coming after us, if any, and that day there was one. I had actually been sharing my shift with another student, so the newcomer was going to be getting five patients. While those girls were still signing out, I strolled over to skriehma's side to chat with him and his new student when she made me aware that three people sitting on a patient's bed on this side were trying to attract my attention. They waved me over and a girl about my age asked me whether I remembered her sister who apparently had been my patient two weeks before. I asked for the last name and it did sound familiar but there was no way I could remember her case and/or face. Anyway, the sister said she had been looking "all over the hospital" for me during the past week (strange, since I have been working in the same place during all that time) and she wanted to get my number or give me hers now. Since I didn't remember what she looked like I chose to play it safe and said that I was going back to Germany the following week and that it just wouldn't work out. Heheh.

Allright, now I'm up for 25 hours minus one of sleep, so I won't write more on Vegas day 2 right now. But it does feel good to have gotten at least some stuff of the past days off my chest.

Good night everyone