I Ain’t Birthin’ No Babies!

“No, Ma’am, for the last time…I cannot just let you smoke near the Helipad. I’m sorry…”

The woman in my chair sighed deeply, crossing her arms over her chest. I shook my head slowly as I looked at her Cheif Complaint:

Chest Pain with Dyspnea.

“Why can’t you just let me smoke? I’ve been here for eight hours!” The leather clad Harpie slammed her fists down on my desk, her chest rattling Smoker’s Cough propelling small flecks of greenish phlegm onto my desk. I pushed away a bit, my upper lip curling up as I felt wet, sticky, and not mine land on the back of my hand.

Reaching for the industrial size bottle of hand sanitizer, I pumped out several judicious squirts into the palm of my hand, rubbing them together.

“Ma’am…we are very busy tonight. If you go outside, which you are more than welcome to do, and we call your name and you don’t answer, we’ll skip over you and move onto the next patient. So, go outside if you want. Also…you’ve been here for less than two hours.”

The woman got up and walked outside. I saw the small orange glow of her cherry bobbing across the parking lot towards the main Hospital entrance. I shrugged deeply and took a sip of my water; I did my best. As I sat at my triage desk, I made a few notes on several patients before I continued with the next one. As I stood up, my phone let out a long, low buzz and I looked at the screen.

Have a good night sweetie. xoxoxo

I grinned stupidly as I touched my phone lightly, then I looked at my list.

“Amanda!”

A very pregnant woman slowly waddled up to me and I smiled, “Are we here for, uh, foot pain?”

Her husband smiled and put his hands on her shoulders, kissing the top of her head. She reached up, holding his hand tightly, “No…I’m ready to have my baby!” I grinned widely as I grabbed a wheelchair. “Well, I’m gonna get you to desk number one and the lovely ladies upstairs will be coming to get you. Has your water broken? How far apart are your contractions?”

“Uhm…they are 5 minutes apart and no. It’s my first. I wasn’t even dilated and I went earlier to see the Doc.” I patted her shoulder, “Well, in any event…congrats!”

I walked back to my desk, picking up the in house cell phone. I habitually looked at the number on my cubicle wall and I dialed 5252 on the phone. “Hey there, it’s Shao in the Bowl. Hey, I have a lovely young lady here who is having contractions about five minutes apart and her water hasn’t broken. She’ll be waiting!” I smiled as Mary acknowledged what I said, then hung up the phone. I looked over my packed waiting room, looking to see if anyone was looking better or worse than when they came in. With my list cleared, I pulled out my Chemistry text and started reading. Within a few minutes, the phone rang.

“ER, this is Shao, how may I help you?”

“Hey, it’s Lewis. How’s everything out there?”

“We’re twenty-four deep, longest wait is two hours. What’s up?”

“We just got a call. A lady is on her way in and she’s having contractions less than two minutes apart, but her water hasn’t broken yet. Can you take her straight upstairs?”

“I can do that. I’ll be waiting for her…” I hung up and walked over to the windows, pulling my jacket on. The February night was getting colder by the minute and I wasn’t looking forward to going outside for anything. Standing quietly, I watched as the security guards started to move around and they started to block off the road leading up to the ER. I watched for a few minutes, hoping to catch sight of the Bird landing; even 13 years into the job and I still got excited when a Helicopter landed. After a while, I wandered back to my desk wondering where the pregnant patient was.

Maybe they pulled over and they called 911 or some unsuspecting Cop got to deliver. That would be a pick me up for the Officer…

Smiling, I got back to work as the gentle whomp whomp whomp of rotor blades filled the waiting room, going from a barely noticeable noise to a loud roar. A throng of kids had gathered by the windows and I gave them each a Lollipop while they stood in amazement over the helicopter landing, still watching eagerly for the patient I was expecting. Wandering back to my desk, I jotted down a few notes from my book when the Valet walked in and over to me.

“Hey…there’s some pregnant lady out front. I think she needs help…”

I got up and walked outside with a wheelchair as a frantic husband waved me down, “Please help me…My wife is going to have her baby!”

“Okay, Sir. Let’s get her out of the car and into the warm…”

“I…I can’t go in.” I cocked my head to the side as I moved around the car, “I have my other baby in the car…I can’t just leave her.” I smiled and nodded, “We’ll get her registered and upstairs, it’s not a big deal…” Parking the chair, I smiled at the young woman in the car. Her blonde hair was matted to her forehead and she let out a gasp, “My water just broke and I’m having a contraction!” I nodded and looked at my watch, “Did it just start?”

“Yeah!”

“Okay. Big deep breaths, just pant…no pushing. I ain’t birthin’ no babies!” We all giggled as she powered through the relatively short contraction. Taking a few sips of water, she collected herself and I smiled, “Let’s get you inside, okay?” She nodded and I helped her stand up. Standing there, she shook out her legs as she began to tell me about their trip.

“We’re out past the 43 interchange. We were trying to make it into town, but I didn’t think…Ooooh!” She grabbed her stomach and crotch, letting out a small yelp, “Oh, Shit!”

“WHAT?!” Her husband and I said in unison.

“He’s here! The baby is here!”

“No, no it’s not!” I helped her waddle towards the wheelchair, “Can you sit?”

“No! The baby is coming! I have to push!”

“No! No! Just pant! Don’t push! Please don’t push!”

The Valet walked up to me, his eyes wide. I pointed at him, “You! Go inside and get me help…NOW!” I turned around and pulled down her pants slightly, using the light from the lamppost to look…

I couldn’t tell if it was an ass or head. She let out another scream, “I NEED TO PUSH!” The Husband looked like he was going to faint. Taking a breath, I ripped off her pants and put my hand on the baby, feeling around; it was a head.

“Okay…okay…uhm…are you ready?” She nodded. I cringed. Dad leaned against the car panting.

“PUSH!” The head slid out, then slipped back in. I felt around and noticed the nose and mouth were still inside the vagina. Cringing harder, I made the little V shape and I slid my fingers in, giving the baby a bit of room.

“STOP! STOP! IT HURTS!”

“I know…but I really, really need you to push! PUSH!” With another push, the head popped out. I felt around quickly and didn’t feel the cord.

“You okay, Mom?” She nodded. “The head is out. One or two more pushes and he’ll be out!” She nodded again as she gripped the arms of the wheelchair, trying to catch her breath. I looked around; we were alone outside in front of the Helipad.

“I’m having a contraction!”

“PUSH!”

With one more push, the shoulders came out, barely giving me time to angle them before…

Before I was holding a brand new infant in my hands. Mom collapsed into the chair and I stayed knelt on the ground. I was covered in amniotic fluid and was frantically trying to wipe the waxy crap off the baby and stimulate it at the same time. It took forever; I frantically rubbed, flicked, and patted the baby.

“Come on…come on Little Dude…” I turned him over to face me and with a deep breath…he started screaming at the top of his lungs.

I’ve never EVER been so happy to hear a baby cry in my life. I cradled the new person who had just dramatically entered the world in my arms while he sobbed his little brains out and I held him to me, trying to keep him warm and rub all the slimy crap off of him. A car pulled up and a woman ran up to me, pulling her shirt off.

“I’m an EMT! Here’s my shirt!” I looked up to see a middle aged woman handing me the shirt off her back, her daughter throwing a coat over her mother’s bare shoulders. I took the shirt and wrapped the baby up, still trying desperately to keep the baby warm when I heard a voice behind me.

“Shao…is everything okay? You’ve been out here for a while.”

“I JUST DELIVERED A FUCKING BABY!” Gretchen, the Triage Nurse stood there, her jaw slack, then she turned around and ran inside. What seemed like ages later, the ENTIRE EMERGENCY DEPARTMENT and OB Nurses were outside with blankets and towels. Dr. Sampson came around the car, a smile on his face.

“Hi, I’m Dr. Sampson…I’m just going to see how far along you are…”

“SHE DELIVERED THREE MINUTES AGO, DOC!!!!!” He looked down to see me cradling a baby that obviously wasn’t mine. OB came running around and they smiled at me, “We’ll finish up…”

“FINISH WHAT?! I HAVE THE BABY!” The message was never relayed that I was actively assisting on the delivery. Gretchen never relayed that I was holding a screaming baby. OB had no idea what was going on. No one had any idea what was going on. We hustled and got everyone inside. I duck walked next to the wheelchair holding the baby since trying to rest the Little Dude on Mom’s belly just wasn’t happening and as we got upstairs, I watched forlornly as they went through the doors, myself not crossing the little yellow line into the OB Unit. Slowly, I trugged downstairs, my phone ringing in my pocket.

“ER, this is Shao.”

“Hey, this is Registration…I have people waiting to get seen…”

“I get that. It’s gonna be a minute, I need to get changed.”

“But there’s a chest pain here…”

“Tell Charge or Triage, I need to get changed. I’m covered in Baby Butter…” The line went dead. I set my jaw and marched to Registration, a wicked smile on my face. The ladies backed up away from me, shocked looks on their face.

“So. I’m going to get changed. Call someone that isn’t me to get the patients seen.”

I stalked to the Locker Room, my hands shaking. I had never done that before. The Hospital just became an OB Hospital, so we had done some deliveries in the ER, but I was surrounded by Doctors and Nurses who knew what they were doing. I even pulled one off in an elevator…but I had Doctors and Nurses who knew what they were doing with me. I looked in the mirror; I was covered in all manners of fluid and goop, my hair was a mess, and I felt sticky. I had a whole world of ‘Wet, Sticky, and not mine’ all over me and it made me cringe. I quickly changed and went back to my desk.

A few hours went by and I felt a tap on my shoulder as I was deeply immersed in a book. I turned around and saw the new Father standing there, a huge smile on his face.

“Can I help you? Is everything okay?”

He nodded, then he grabbed me and hugged me.

“Thank you. Thank you for saving my baby.”

I smiled softly, digging my toe into the carpet. “It was nothing. Just what I was trained to do.”

“Well…thank you. You will always have a place in our hearts and in our family. Thank you.” With that, he walked away.

I watched him go, a smile on my face, then I set back to studying.

 

 

 

 

Just because it’s a duck 99 times in a row, doesn’t mean it won’t be a Zebra for the 100th time.

(As always, to keep the HIPPA monster from coming after me, patient names, dates, and locations have been changed to protect the innocent. Partners names have been changed except for in cases where they gave me their okay to protect the not so innocent…)

The 20 of every month used to come with one guarentee; Ms. Amanda. No matter what day of the week it fell on that month, whomever worked the twenty-four hour shift for the 20th was guarenteed to pick Ms. Amanda up between the hours of 2 and 4 AM. Ms. Amanda would call without fail for the same reason, psychiatric emergency. What we all knew was that she knew how to use and abuse the system. Call 911, have the nice men and women in the big bright white box come and take her to the local ER, and she’d get a months worth of her medication for free. Wash, Rinse, repeat was her game. Sometimes, if she didn’t get what she wanted, she’d hospital shop for the next week until she found someone who wasn’t familiar with her and gave her what she wanted.

The crews became so familiar with her that most of the times the patient information was taken down before the crew arrived on scene. She called from the same place, saying she felt like killing herself, had no plan to, hadn’t talked to her social worker, and heard voices telling her that she’d be better off dead. Every month on the 20th, she’d go, get committed for 72 hours, then leave with free drugs to do it all again.

I know I began to lose my patience with her. One night, we took her over 20 miles away from our district, when a call came in for a possible shooting. The little slice of paradise I worked in only had one ambulance crew on at any given time, so we were running solo. The shooting was confirmed, and another company came in to take the patient while I was stuck taking Ms. Amanda, who had no “true” medical problems in my opinion at that time, to the hospital.

Almost 2 years of dealing with this woman angered many people in the service. Multiple crew members tried speaking to the ER physicians on duty about doing something with her. She was obviously in need of help, psychiatric and otherwise, but no matter what, within 72 hours, she’d be back on the streets.

I’ll admit my own part in this; I became complacent. I just didn’t want to deal with her. To me, she never gave me a challenge, a reason to take her to the hospital. She would just sit on the strecher and take up my precious sleep time. Even for a BLS trip, I’d still have to write a trip sheet on her, and because of the computer system at the station, a simple sheet could take an hour or more if the internet was acting up. If I was getting slammed that day, it was easily an hour or two taken away from my sleep.

The next month approached, and of course, I had the 20th again. This time, I told myself, I had enough. She was going to hear about how taking her was a waste of time; I could be out helping people who needed it instead of taking her to the hospital to just get drugs.

That night, I noticed the locals were out in force. It was a very hot night in the ghetto, and the natives were restless. We ran multiple assaults that day and into the night. Like clockwork, at 3 am, Ms. Amanda had gone out to the pay phone in front of her apartment and dialed 911.

As we pulled up, my partner and I both noticed she wasn’t waiting. Usually we’d see her standing in the wash of the street light giving us a pittiful wave. Odd, but what could I expect from her? In my mind, she did it in spite, something just to piss me off. I noticed movement out of the corner of my eye, and I saw a bunch of people tear off from behind one of the row houses. I locked the doors of the ambulance and asked Dispatch to send PD to the location. Only then did I noticed that Ms. Amandas’ front door was wide open, and the house looked ransacked. I rolled down the window and called out her name, but no one came to the open door.

I turned back to my partner, who was ready to get out of the truck, when I heard a noise. I turned around and jumped three feet out of my skin. Standing next to the truck was Ms. Amanda, covered from head to toe in blood, her clothes torn to shreads, and she was crying.

I jumped from the ambulance and took her into the truck. I began to bandage some of her wounds while trying to figure out what was going on.

“Ms. Amanda…what happened?”

“They beat me!”

She then broke into sobs. After some teeth pulling, she finally relented her story. Her family would take her psych meds from her, the minute she would get off her committment and sell them. Most of the time, they’d pick the drugs up from the pharmacy before she could get there, other times, they would wait until she was sleeping then nab them. In two years, the only time she would actually take her meds was when she would have to stay in hospital.

I felt like shit.

Because I somehow forgot that my own shit stank as much as the next person, I never asked the important question of why? I could ask all I wanted about the pathology of her complaint; What do the voices want? How long have you been feeling this way? Is this normal for you? but I never asked.

“How long has this been going on?”

“For years…”

“Why didn’t you ever tell anyone?” I crooned to her softly. What she said next blew me away.

“No one ever asked. Most people don’t even speak to me, no one, not even medical people care about me.”

My heart broke. I couldn’t believe what I had become. I was the helper; I was supposed to hold hands and help heal all wounds, but because I allowed the woman to become a bother to me, I didn’t do my best to help her. We got her to the hospital, and we relayed exactly what was going on to the nurse and doctor.

I never saw her again after that night, but I do hope that Ms. Amanda finally got the help she needed.

I swear…I DIDN’T DO IT!!!

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.

Anywho…

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?”

“No.”

“Sounds good…”

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?”

“Really?”

“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!