Tuesday, April 14, 2009

so gross

"what's the grossest thing you ever saw?"

i think that's every paramedic's most popular question. it does get annoying, but i've asked that same question before i got into this field. i get it. whenever people ask me that a rolodex of images start snapping through my head like a thumb on the corner of a book. i don't even know what the answer is to that.

back when i was an emt i had to transfer patients from one facility to another. they didn't need anything medically advanced, but they also couldn't go by personal vehicle as they may have had an iv hanging, or perhaps they had to lay flat... maybe they just needed monitoring. so i get a call to pick up a 10 year old boy, transfer him from one children's hospital to another. that's all the info i had.

i went up to to the pediatric floor at this hospital, grabbed the patient's paperwork from the nurse, and entered the room. inside was a 13 year-old boy lying in bed watching cartoons. he was laughing. he was happy. he was infantile. he was wearing a diaper.

i spoke to the mom, she only spoke spanish. my spanish is good enough for simple conversation so we started to small talk. she was young, positive. we transferred the patient onto the gurney and rolled him downstairs and into the ambulance. it was my partner's turn to tech this call, so i drove the 25 miles to the other hospital and had the mom sit up in the passenger seat next to me.

along the way we were chatting, me in my almost capable spanish. i asked her what happened to her son. she told me that on cinco de mayo her son and his friend went out roller blading. her son came back around 7pm telling his mom that he had fallen and struck his head on the street. she felt a large bump and gave her son some ice to put on his head. pretty much a good choice of treatment, i'd say. he felt tired and went to bed. during his sleep he started making some odd noises.

his mom went into his room to find him convulsing. she called 911 and the child was rushed to the hospital. while in the hospital the medical staff had found after a ct scan that the child had a bleed in his brain which stopped the flow of oxygen to critical areas, causing him to seize, and causing permanent brain damage.

the patient's mom's spirits were good. she was telling me how she felt that her son was going to get better and that this would all be in the past. i nodded, smiled, and wished her good luck. thing is, that patient was never going to be the same. one night he's out with his buddy, doing kid stuff, roller blading, falling, getting hurt. the next day, he's in diapers, cooing at cartoons, and acting like a two year old.

acting like a two year old for life is pretty gross.

going back to my emt days... we spent a lot of time in convalescent homes transferring patients from there to dialysis, or from the er to there. very basic life support, just a bus with a gurney on it taking patients to appointments or wherever else they needed to go.

these places, for the most part, are atrocious. there's often the smell of shit from dirty linens or diapers, the nurses are often cold with thick accents, and the patients are invariably depressed and hoping to die. it's an incredibly unhealthy place to spend any time in as you begin to fear your last days. every emt in this capacity always talks about how they're going to off themselves with a pistol before they spend any days in a place like this.

the food... it comes on plastic trays with plastic bowls and plastic cups. plastic plates, plastic food. and some of these people have soft food requirements so that their beef is now pureed beef, and their carrots are carrot mush surpise. and food could be the only pleasure that these people might have and these fucking places do nothing to insure that for them. that is, if you are fortunate to be able to eat with your mouth. many of these patients are tube fed with this sweet white viscous liquid. very satisfying, i'm sure.

family? no... family is somewhere else tending to their healthy children at their soccer games in another city. maybe they stop by on holidays, maybe they don't. who would know? it's sincerely the most depressing situation one could spend their last days in.

convalescent homes are pretty gross.

okay okay... now you want a gross story... one with blood and shit and piss and vomit. i'll give you the first three fluids.

i ride a motorcycle. a lot of people ask if i'm insane because i'm a paramedic and i must be crazy to ride one after seeing so many accidents. well, to answer that one, i've seen a lot of respiratory therapists smoke, so what's worse?

so i get a call for a motorcycle vs. auto in a tunnel that we have here in our city. i enter the tunnel and have to turn around to get to the westbound section to get to my patient. when we arrive on scene the leutenant from the engine comes up to me and says, "this guy's arm is torn off."

"do i need a biohazard bag?," i asked. he told me to take a look. i approached the patient... he was sitting against the wall of the tunnel, dazed look, sweaty. i looked at his right arm and it was completely ripped off at the shoulder, save for about five inches of skin at his back which was keeping it barely attached. there's really no protocol on how to deal with this so you just have to make do with what you have. i cut his shirt and leather jacket off and grabbed a few rolls of kerlix. i essentially wrapped this kerlix around his shoulder and arm, securing it to his torso, wrapping it around his entire upper body like a tight, white sleeping bag with reddish designs at the shoulder. he kept asking me if he was okay, and i said, "oh yeah, you're fine buddy." he said, "my hand really hurts."

"yeah, man, you did a little damage to your hand, but you'll be fine." his hand was perfectly okay.

after securing his arm to his torso, we loaded him up and went code three to the trauma center. this guy was getting really shocky... sweaty, nervous, cool and clammy, and his blood pressure was fairly low... he needed fluids. so my partner and i were looking for some veins, and there weren't any. i think that his body was beginning to shunt blood to keep as much as it could for his heart and brain. his extremities were a not a concern for his survival, and his veins were collapsing.

no iv access on his left arm, so i go to his feet and legs to see if i could find anything there. i pull off his boots, and as i'm fishing for a foot vein, the patient shits and pisses his pants. so if you can imagine, im basically right there, at his feet, and he takes a crap. it was such an awful smell. i was pretty sure that the guy wasn't all that health conscious.

so we arrive at the hospital, i tell the guy that he's going to be okay and not to worry. i never did follow up on this patient... i don't follow up on most of them. i assume that with today's technology that his arm was reattached just fine and that maybe he's back on a motorcycle.

having your arm ripped off is only kind of gross. having your arm ripped off and shitting your pants... now THAT'S gross.

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