Here's a good story from the archives of my mind....(insert Twillight Zone theme song here with wavy squiggly lines notating a dream sequence)
It's late, I'm tired, and it's fricking cold. In February, 2002, I sat in the ambulance base freezing my non-existant clackers off. I had the immense pleasure of working with Byron; he was and still is my favorite Medic of all time. He taught me things that my 16 year old mind could barely wrap around. With a charismatic smile that never faded no matter what, he was my Johnny Gage. I ate up everything he said to me. If he told me the sky was purple, then by all rights it was, and I was going to tell EVERYONE that the sky was purple.
It was also Valentines' Day. I made dinner for "my boys" as I called them. I was third person volunteer for Byron, Matt, and Jason, and we were having a pretty non eventfull night. I was putting in time for my Senior Project. The bean counters at my high school decided that, to get more state and federal funding, that all classes must do a "Senior Project" which was supposed to take up the 4 years of High school. Most did it in the last 3 months, but I was all on it from the beginning. Becoming an EMT and volunteering for 100+ hours was my project.
I had finished my hours up months ago, but I was having way too much fun to quit.
We were watching some movie on television, can't tell you what, when the tones dropped for a female with chest pains. As I moved to the truck, I noticed the hairs on the back of my neck were standing on end, and I just had that sensation that something bad was going to happen. I satiated myself saying, because the roads were bad, I was in fear of our multi ton sled was going to tip over and entrap us all, turning the box of the ambulance into a large oven in which to roast me. (Thank you ambulance safety films from EMT class)
When we got to the location, it was a nice little house set a ways back from the road. I carried in the jump bag and monitor, while Byron carried the oxygen tank. This was my first chest pain call, so I ran over the particulars with Byron, figuring out what I'd need to get for him while still in the house. As we walked in, we were met by no less than twenty family members ranging in age from at most eight, up to our patient, who was in her late sixties. Byron let me ask the fun questions and do documentation while he took vitals. Our conversation went something like this.
"So, Ma'am, do you have any pain anywhere?"
"Not really, I just feel like I have heart burn. I get it after I eat strawberries, and I had a chocolate covered one a little bit ago. My son-in-law got nervous and called 911 to get the ambulance drivers to come out and check on me..."
"Not dizzy or light headed?"
I turned and looked at Byron, a smile on my face. He showed me the monitor and asked me if I felt if they were in the normal range. Everything looked perfect to me. Looking back on it (I still have the strip after all these years) the strip showed the prettiest Normal sinus rhythm. Byron took over and started asking the more medic oriented questions, and everything was in line for a refusal. I started taking information, and I got to the part about past medical history. The patient stated that she had "sugar" and Byron asked me to take a blood sugar.
Now, I have never done it before on a live patient before this. I knew how to, but had never done it in practice. I knelt down, swabbed my site, and I stuck her finger. The minute I did, she went into convulsions with God awful snoring noises coming from her throat. The first thing I did, like any self respecting EMT would, was I stood up, cleared my throat and stated so that EVERYONE in the Eastern Hemisphere could hear:
"I swear to GOD I didn't do it!!! I just stuck her finger is all!!!"
And I screamed like a bitch. Not a loud one, I just punctuated the end of my sentance with a girly little squeel. Yeah, true picture of professionalism and decorum here.
Byron and Matt both took control while Jason ran out to the ambulance to call in for backup. We got her on the floor, and the first thing we all did was look over at the screaching monitor. What replaced the most perfect Normal Sinus Rhythm ever was the even straighter looking Asystole. I mean it was a complete laser trace.
Remember me saying I had never worked an arrest before?
I was told to get on the chest and start CPR. What they failed to say in EMT school was that, ribs will break when you do CPR. That first hard push, I felt the ribs break...and there I went squeeling like a bitch...again. We worked her, and hard. Drugs were flying every where. She had IVs in places I didn't know you could do one. After the perfect application of ACLS, while doing a pulse check, I felt something. It was very small, very light, but I felt it; it was a pulse.
The womans' eyes opened very slowly, and she blinked a few times, then she began vomiting...everywhere.
Did I forget to mention I'm a sympathy vomiter as well? At that time, even someone spitting could make the purge rise in my throat.
We had her in the ambulance by now, and we rolled her, on the back board, on her left side. I was sitting in the airway seat, my feet firmly planted on the floor. With one good heave, she proceeded to redecorate the inside of my boots. I had on these crazy boots that the tops weren't flush against my leg. They had a little gap in them, and that was all that was needed for her to fill my boot to the brim. Amazingly, I managed to not throw up. I talked to this woman the whole way to the ER.
We talked about her kids, her grand kids, her pets...anything I could think of to keep her talking. It became rhythmic. With the pitch and sway of the truck, Byron calling in the report, Matt driving...well...he was driving like he was trying to qualify, and Jason trying not to puke in the back because of motion sickness, these two little voices were playing a duet with each other.
"Ma'am...stay awake, please! Uh, tell me 'bout your kids."
"I have three, the oldest is..." and she'd trail off, going back into Lala land. I had her face cupped between my hands, and as she'd trail off, I'd hurridly speak to her, my voice rising a bit.
"No no no! Come on now, wake up for me!"
"Oh! *quietly* I'm so sorry dear, where was I?"
And that's how it played out. I can't tell you how long the trip was, I don't remember. To me, it was just the two of us. I couldn't tell you what else anyone did after she woke up. She was my whole world then. Every once in a while, Byron would throw me a bone, gently cheering me on for talking to her. I didn't know at the time, but that had the same theraputic value as doing all the ALS crap. In that moment I proved just how important BLS was. I may not have been pushing drugs or interpreting rhythms, but I was helping.
When we got to the ER, I remember standing just at the entrance to the room they put her in. The flurry of activity was incredible; doctors spewing out commands and everyone followed them. It was an organized symphony, and even though all I did was play the Triangle a few measures back for a few beats, I still had my part.
I will always remember the round of thanks we got from the family and even the patient. I felt odd, knowing I was getting the same kudos that everyone else was getting, when all I did was talk to the patient. After returning to base, I cornered Byron in the ambulance garage while he was restocking the truck.
"Hey. Why didn't you tell them that I wasn't involved. I mean, all I did was let her puke in my shoe and talked to her. You, Matt, and even Jason did all the hard work..."
"Hand me that saline, will you?" He gestured to the bag of saline on the stretcher. I handed it to him obediantly, waiting for an answer.
"Kari, what did they teach you in EMT class...about the difference between EMT's and Medics?"
"Uhm...you guys get to do IV's, push drugs, save lives, you know, the good stuff. EMT's drive the truck and are just over trained stretcher-fetchers."
He shook his head and closed the drug box. What he said next impacted my career, and I preach the same message to any EMT I've ever worked with who doubted themselves as having any impact on a patient.
"That is the function of your job. Yes, I do the drugs and all that other crap, but you deal with the bigger problem. I can push all the drugs I want, but if the patient doesn't feel that everything is going to be okay, it almost turns into a self-fulling prophecy. You sat there, through everything, and made the patient believe that she was going to be okay. I watched her smile at you every time you told her it would be okay. The bit where you talked about playing with her grandson in a week or so was brilliant. You gave her that drive, that focus that there was going to be a tomorrow, and you were going to help her get there."
I know I had the dumb dog look on my face as I went to change the portable oxygen tank. What could I say to that?
"Also, look at my patch, what does it say?"
"Emergency Medical Technician...Paramedic..."
"Exactly. What does yours say?"
"Emergency Medical Technician..."
"Exactly. I am an EMT-Paramedic...my EMT skills, the BLS stuff, always comes before the ALS crap. I can push all the drugs I want, but if the basic stuff...the Airway, the Breathing, and the Circulation are left behind, nothing I do ALS will fix that. You kept the BVM going even though I could've shoved a lump of coal up your ass and you could've produced a diamond on demand. When she started yacking, you helped roll her over and then suctioned it out. If she would've aspirated, I would've been dealing with a mess. You were on the compressions for the CPR for a while. If the blood ain't goin' around in a circle, the drugs can't get to the heart."
He double checked the regulator, making sure it was on tight before putting it back in the sleeve.
"Just because you didn't do the IV doesn't mean you didn't help save that life. Just because you don't have those nine little red letters doesn't mean you deserve less credit. You did great, especially since it was your first time. Now, let's go reheat dinner, and I'll show you how to write a tripsheet."
I grinned happily. I could honestly say I saved a life, and on Valentine's Day, no less. As I started to go back in the crew room, I found the strip from the monitor, the code summary showing every rhythm change. I handed it to Byron.
"Hey, you dropped this..."
"I don't need it. Why don't you keep it and use it for your project?"
"Sure, why not? By the way, Happy Valentine's Day, and thanks for everything. I couldn'tve done it without you..."
Eight years later, I still feel all warm and fuzzy when I think about that night. The patient made it, fortunately, and as far as I know she's still alive and kicking, playing with her grandson. I've had many cardiac arrests since then, some with me as Medic, others as an EMT. I've saved as many as I've lost, but nothing can compare to that first save. That night, I was bitten by the bug, the EMS bug. It was barely six months into my life as an EMT, but I draw on that strenght I had then.
I hope the EMT's I have worked with over the years know that, even though I had my nine little letters on my patch, I respected them with everything I had. I was there once. I was where you are or were; a fledgling EMT who wanted nothing more than to make my mark on the world. You made your mark on my world at least. I thank you from the bottom of my heart.
Have a good one, and Be Safe!