Sunday, October 28, 2007

The Haldol Lady....

Everyone that works in EMS knows that you talk with your co-workers in a certain language. You reference the calls that you ran by the circumstances surrounding it and not the patients name. This is the story of "The Haldol Lady".

We were having a pretty good day, not too many calls. We had taken a patient to the little hospital that we have in-county and were cleaning up after. Dispatch comes over the radio with a transfer for a "routine medical" at a nursing home, no other info. The call is all the way on the other side of the county so we get in and get on the road.

We pull up at the facility and there are two CNA's waiting outside for us. Hmmm...they don't usually do that. Normally we have to hunt them down them down to glean the small amount of info that they have. I get out, yank the stretcher from the back and Another New Partner (ANP) and me start towards them. I notice that one of the young CNAs has a nice fresh bruise on her cheek.

As we approach one of them says that they are glad that we were finally there to get her off their hands.

"She's been beating the crap out of us and we are fed up with it", the other one says with a motion towards her bruised cheek.

"You guys shouldn't have any problems, she likes men". Great, I think, another transport trying to keep away from a groping old lady.

We wheel the cot down the hall to the room where a few other CNA's and nurses are standing. I get the report. Elderly female, over 80 years old, getting increasingly belligerent and combative. History of frequent UTI's, arthritis and mild Alzheimer's but she had never been violent before.

As I step tentatively into the room I see the woman in question. She is laying on her side, facing away from me.

"Hey I'm BRM from such-and-such EMS, what's going on today?"

"Fuck you, you sumbitch! Get the hell outta my room!"

Hhmmm....not the response I was looking for.

I turn and look at ANP to see if he has any thoughts on the subject at hand. To make a long story a little shorter, he doesn't have any bright ideas either. All our Paramedic charms don't work. Nothing that we can say or do will get her to get on the cot and ride with us.

We start to ask her the "legal" questions. You know them, "Do you know where you are? What day/month/week/year it is? Who is the President of the United States? How many quarters are in a dollar? She had answers to all of them, just not the right ones. (I had to look at one of the nurses on the day of the week question, because I didn't know that one either.....)

So we declare her not competent to make her own decisions and take her welfare in our hands. I went ahead and called for the local cops to come. I knew that we were in the right legally, but it's nice to have some law enforcement witnesses and eventually a sheriff''s deputy arrives. He doesn't do anything but watch, which is OK, that's all I wanted him there for anyways.

I decide to take a blood sugar because of her altered mental status and the fact that she hasn't eaten anything in a while. It takes six of us to hold her down while ANP pricks her finger for the drop of blood we need for the glucometer. 15 seconds later we rule that out, her glucose level is normal. The end result of that was to make her even madder.

There is no way we can take vitals, she won't sit still long enough. She does have a good strong, regular radial pulse and for now that's good enough for me. I deduce that she's not having any difficulty breathing, being as she's able to curse full sentences at everyone in the room. Plus she had no complaints other than us at the moment.

Me and ANP walk out into the hall and both of us say "Haldol" at the same time. So no discussing about further treatment. I get on the horn and call Medical Control and give my report and ask for 5mg of Haldol intramuscular (IM). I get what I asked for and go out to the truck to draw it up. On the way back in I recruit help from the nursing station. They do a semi-formal dog pile on her and I jab her in the hip. We all stand back and wait for the medication to take effect.

And we wait and we wait and we wait. It has no effect at all. Well, I think...she is about 250 on the hoof, maybe we need more. I call back to Med Control and ask for another 5mg. I get it and we go through the whole process again in the other hip. And we wait, again, to no avail. 10mg of Haldol and she is still pissed, maybe even more so now that she's had a needle stuck in each hip.

We all wipe the sweat off our brow and look at each other. I am out of ideas at this point. ANP doesn't have any light bulbs above his head either. And all the staff is looking at us to solve this particular problem.

We walk back out into the hall and talk. The only thing I know to do is to call back to Med Control and let them figure it out. I do and then an order for another 10mg of Haldol, in two 5 mg injections each. The only problem with this is the fact that we only carry 10 mg on the truck. We are fresh out.

I ask the nurse if they have any and she says yes. She pulls out this great big multi-dose vial with 50 mg in 10cc and starts to try to figure out how much she should draw up. After about 5 minutes watching her do her calculations and another nurse giving her well meant, but incorrect advise I give her the correct answer 1cc. She gives me this skeptical look over her glasses. You know the one that says "Who the hell are you to tell me anything? I'm a registered nurse with 4 years of education at an accredited college, countless years walking these halls medicating the sick, plus I'm at least 30 years your elder".

I give her the calculation so she can check for herself. She scribbles some more and finally draws up 2 syringes with 1cc of the medication in each one and hands them both to me with a huff. I also hear her say as I turn to go back to my patients room, "Ain't my ass if he's wrong". I pretend I didn't hear it and keep walking.

When I enter the room I find that my patient is no longer in her bed. There is a gaggle of facility employees and my partner in the adjoining bathroom. I peek my head in and see her sitting on the john. Apparently a new CNA came in and thought that she could do what no one else could and get her on the stretcher. She made it exactly half way before the patient made a pit stop and now she wasn't moving.

At this point my patients is wearing thin. I elbow my way into the doorway and let everyone know the plan. We are going to bodily get her up and put her on the cot. I have moved her bed out of the way and placed the stretcher in its place. So hopefully she won't really know the difference until it's too late.

It worked, in a way. We had to force her legs up once she sat down. After that we placed a sheet around her and tucked it under the mattress, then placed the straps and cinched them down so that she couldn't move but could still take a breath.

I got one shoulder free and jabbed her with one of the 5mg syringes. Then we roll her out and into the truck. At this point she is struggling something fierce. Shouting curses that would make a sailor blush and wriggling like a snake on coke. It took everything I had to keep her on the cot. Then she used the only weapon she had left, her mouth. She started spitting at me and that put me over the top. If she hadn't been old enough to be my grandmother I think that she would have started to have trouble breathing due to great pressure on her airway. As it was, I couldn't bring myself to do that. I just wiped the spittle off of my face and placed a non-rebreather on her with the appropriate O2 settings.

I gave her the other 5 mg and again, as expected, it had absolutely no effect. That was a total of 20 mg of Haldol and she was still just as feisty as when I first laid eyes on her. We made it to the hospital and put her in a bed. I gave my report to a stunned nurse and went to the bathroom to get myself back together again. My shirt was untucked, spit on my face and sweat dripping from my nose.

This was the first time I had ever given Haldol in the field. The first time ever, even in clinicals when I was going through medic class. And it didn't work. If I never have to give it again, it will be too soon.


Tuesday, October 9, 2007


I've read Peter Canning's books, both of them. In one he describes his school reunion. I'm not going to get into detail, if you want that go read his books. Recently I went to my own high school reunion.

I don't think that I had as hard of a time as Mr. Canning, but it wasn't easy. We didn't have a lot of money and I wasn't a great sports star. Needless to say, I wasn't popular and got picked on quite often. I stood up for myself when I'd had enough, but that never solved anything. My grades weren't the best and I hung around with the wrong crowd. Sounds like a lot of high school kids huh?

Anyway, I get this invitation for the reunion and am immediately indecisive on whether or not to go. My wife is supportive and says that either way is fine with her. No help there.

In the end I went, with Wife in tow. We had an OK time. I saw a few of my old friends and we had some laughs. By far the biggest topic of the night was how many times who had been divorced and how many kids did everyone have. The gossip of high school rears its ugly head.

It was interesting to see all of the old popular people migrate to one another. And to see how they had fared. Most had gained much weight and topped the divorce list if they had even married at all. Call me a grudge holding bastard, but I found it extremely funny to see them in their drunken revelry. Just like old times....

The next biggest question was "What are you doing now?" Closely followed by "Where are you living?"

The look in people's eyes was one of fascination when I told them I was a Paramedic and that I had moved away from the place of my upbringing. I'd had feelings of inadequacy going in. The feelings that most others would be doctors and lawyers and successful businessmen. That I would pale in comparison. Boy was I wrong.

The president of our class is installing security systems, door to door. Another popular guy is literally digging ditches. The prom queen is an assistant manager at a drug store. Not that these aren't honorable jobs. Trust me, I know that in these times, whatever will put food on the table is good enough. But I would have expected more from these once-prominent people of my school. Those that had went on to the big and expensive universities, while I went straight to work and then finally to a community college on my own dime.

It's funny how things go. The "nerdy" ones of the past are the successful ones of today, with the best looking spouses and lovely families. While the rich and popular of yesterday are the average joes of the present.

We left early, with promises to keep in touch. Scribbling phone numbers and email addresses on napkins. I doubt if I'll ever hear from most of them again, at least not until the next reunion.


Monday, October 8, 2007

Don't Fear the Reaper....

I turned the radio on as I drove home from work this morning. I tuned the FM band to an oldies rock station and "Don't Fear the Reaper" was playing. Fitting, I thought. For the past week I've been seeing dead people.

I've run more code blue's this week than any other in my short history in EMS. The total is up to 11 I think, but really, who's counting? Only three of them have been actual working codes. The rest have been a mix of different varieties of suicides, fatal wrecks and the others were just found dead.

Two of the codes were a hopeless cause. Both were unwitnessed arrests and both were asystolic when we got there. I worked them both because I felt like I needed to and other than the flat green line on the monitor there was no other reason not to. I didn't even get any Epi blips with either one.

It's a statistical fact that there are more suicides attempts in the county that I live and work than in any other in my state. I don't know why, but the people here just hate to live. I think I've seen just about every kind of suicide attempt that there is.

A man hanged himself naked in the front yard, his kids found him while they were going out the door to catch the bus to school. Another man put a hose from the tailpipe of his car into the interior and gunned the engine until he fell asleep and woke up dead. His wife of 23 years found him. A troubled woman ran her brand new Mustang at over 90 miles an hour straight into a concrete bridge pillar. A 16 year old kid put his hunting rifle under his chin and pulled the trigger with his toe. A 70 year old woman put her pearl handled revolver to her temple. All her affairs were neatly laid out on the couch in the front room. And pills....Jesus, the people around here love their bottled death.

The man with COPD found dead in his living room. His O2 and neb treatments almost within reach. The diabetic dead on his cold kitchen floor. His power had been turned off and someone had noticed the smell. The list goes on and on.

The other code that I ran actually had a shot. His was a witnessed arrest in his front yard. We were just around the corner and found him in V-fib. Shock, drugs, pump. Loaded him up, tube down the throat, more drugs, sirens, lights and diesel. A rhythm came back but it was way too slow, drugs wouldn't raise it. Gave him some juice through the pads, just enough. Bump. Bump. Bump. That's it, just to 60 beats a minute. Pulse check, yep, there they are, nice and regular. We got capture. He died anyway. Not long after we got him on the table in the ER.

The song goes off and something else comes on by the Beatles. I'm not a big fan of the Beatles so I turn it off and drive on in silence. I glance up in the rear-view mirror and see Him. He and His black hood and grim stare. Him with His cold hands and fathomless heart.

"I don't fear you", I say out loud to him....


Tuesday, October 2, 2007


I worked with an EMT yesterday. My partner went home sick early in the morning and the EMT in question was the only one that could come in on short notice. I've seen him around a few times. He's about done with Medic school but he's not arrogant about it. Many of the students that are at the end of the class think that they know it all. I wonder if I was like that... I suppose I was. It's funny, I've not had my patch long, on one hand it seems like yesterday, on the other it seems like years....

Anyway, we had a few good runs and the call volume was back to normal. Which is good because with the baby and 2 toddlers at home, sleep is a thing of the past.

I got woke up from a nap by a call for a pedestrian struck. At first I thought I was dreaming, well dream is too nice of a term. I thought I was having another
nightmare. The dispatch info was almost the same: Pedestrian struck, small child, no other information at this time. As I realized that I wasn't dreaming I got up and started for the truck and then I started sweating.

When we got there, I took one look and I knew it wasn't going to be as bad as last time. The child was laying on the ground, screaming. His mother was kneeling over him and the whole family was there as well.

The kid had no real major threats. He had ran out behind a car and his lower leg had been run over. He had an obvious tib/fib fracture and a possible hip as well. We stabilized the leg and loaded him up. With the mother on board and the rest of the family in tow, we made our way to the hospital. And that was that. I breathed a sigh of relief once care had been transferred to the nurse.

In the early hours just before dawn I was woken up again for a possible code blue, our talk for a person down and not breathing. We arrive and go inside. There is a middle aged woman lying face down in the bed. Her two small children are there and looking scared. The oldest one had called 911 just like she had been taught in school. There is a bottle of pills scattered across the floor below the bed. I roll her over and note the purple face, cool extremities and slight rigor. She has been down for a while. My EMT partner, the fire department and a cop all look at me.

"What do you want to do?" their eyes ask.

I almost turned around to look for someone else, someone else besides me that they are looking at. I know there is no one else. It's my decision and mine alone. This is the responsibility at its best and worst that my patch provides.

Anyone that has been in this business for even a short time has probably had to decide not to work a code. This was my first. Due to the condition of the body, I knew it was pointless. I also knew that it would only traumatize the children even more to see their mother being put through that.

I'm not ashamed to say that I hesitated in my response to all those eyes. I knew what I should do. I should just attach the wires, run my strip, call the Medical Examiner, etc. etc. All this happened in the space of about 2 seconds in real time. But in my head it stretched out for what seemed like an eternity.

I made my decision. I told a few of the first responders to get the kids out of there. I attached my wires and ran my strip. I called my supervisor and then put in my call to the Medical Examiner. I had taken a look at the pill bottle on the floor and it wasn't something she would have taken in an emergency. Also there was an empty alcohol bottle on the night table and a piece of paper tucked under it. I'd call this an open and shut overdose.

Since I was in charge, it's also my responsibility to talk to the survivors. There is no other adult in the house. There was only the deceased and the 2 kids. The question I began asking myself is, How do you tell two kids less than 10 years old that their mother is dead?

I did it. I did it with tears on my cheeks, but I did it.... I don't know what else to say about that.

As family members were called and friends and neighbors start to arrive. I got the rest of the story. The husband and father had died not a month earlier, car accident somewhere in the mid-west while he was away on business. The woman didn't take it well her sister said. How do you take it well I wanted to ask her. I didn't, I kept my mouth shut and noted down all the pertinent information for my report.

How does someone do that? How does someone get so far down to swallow their own death with a bunch of cheap wine and their kids are in the next room?

I don't know about anyone else that was there. But I went home and picked up my kid and didn't let go for a long time...