I’m Clear, You’re Clear, The Chihuahua Is Clear…

A story from back in the day…

They say that the measure of a man’s intelligence is the degree to which he agrees with you. By that standard, Medical Director and I now regard each other as certified geniuses. Not that we interact a great deal in the clinical environment; being a lowly EMT Basic, I simply drop off my patients at the hospital, bow respectfully, and back slowly out of his presence.

But today is a different story. Today the all-powerful physician and the lowly EMT are on an even footing, because when it comes to Trivial Pursuit, I bow to no man. I am the “King of Obscure and Arcane Facts.” , and Medical Director, if not my equal, is at least good enough to sit at my right hand. We have been paired off as partners in a game of Trivial Pursuit, and we are spanking some serious ass. We are humiliating people. For six games straight now, we have run the board, winning with nary a question missed. For the past two games, it’s been everybody versus us.

We’re hanging out at the ambulance station, celebrating Podunk Ambulance’s third month of business, and things are looking good. Call volume is increasing, we’ve upgraded our capabilities, and rumor has it that we’ll even be getting paychecks any day now. Life is sweet. Since I’ve been getting paid in promises, I’ve moved into the Podunk station to save money. The only drawback to living in the station is that I am perpetually on duty. Every morning, I wake up and stumble to The Boss’ office and knock on the door.

“Am I on duty today?” I’ll ask, and wait patiently as Boss becomes lost in thought, shuffling through the duty roster he keeps in his head.

“Yep,” he invariably says. “We can use you.” I will then obediently trudge to the bathroom, shower and put on a jumpsuit, but I don’t mind. This stuff is so fun, I’d do it for free.

Well actually, I am doing it for free right now.

The emergency line rings, interrupting our game and sparing the rest of the crew further humiliation from at the hands of my M.D. partner and myself.

“Cardiac arrest at 137 Owl Creek Road,” Boss calls. “Let’s go.” I am Boss’ partner today. After two months spent as the attendant on most of our calls, our upgrade to EMT-Intermediate service has seen me demoted back to driver. I don’t like it; I start paramedic school in two months, and I need the patient care experience.

“I think I’ll ride with you on this one,” Medical Director muses as we get up from the table.

Oh shit, just what I needed.

I say nothing, just sprint to the rig with Medical Director in tow. On the way to the call, I can hear him curse softly from the back as I make a few hard turns.

“Hang on, Doc!” I call unnecessarily. “Rough road ahead!” In the rearview mirror, I can see him hanging onto the overhead bar for dear life. “Why don’t you toss the suction, the jump bag and the AED on the stretcher?” I call back to him, adding, “and spike a bag of saline, too!” Boss looks over at me and grins, shaking his head.

At the house, there is a woman doing CPR on a fifty-ish man lying on the living room floor. Several other relatives are standing around sobbing quietly, and a hyperactive little Chihuahua is bouncing from the couch to the chair to the floor, yapping excitedly. The woman doing CPR is crying as she goes about doing chest compressions and ventilations. There is snot running from her nose, which she absently wipes away as Boss places the AED on the floor next to the man.
“Ma’am,” he asks gently, “what happened?” The woman doesn’t answer, just stares vacantly and cries, wiping her nose with her sleeve. There is a smear of bloody vomit on her lip. Delicately, I move her to one side and hand her off to Medical Director, who is standing around looking lost.

“Hey Doc,” I suggest, “why don’t you find out what happened, and have someone gather up his medications? Hand me the suction before you go.” Medical Director hurriedly hands me the suction unit and escorts the woman into the other room, talking quietly to her. The Chihuaha snaps at my hand as I suction the vomitus from the man’s mouth and Boss attaches the AED pads. I swat impatiently at the dog, who returns the favor by snapping at my fingers again and growling ferociously.

“Uh, can one of you corral the dog?” I ask pointedly at the group of relatives standing nearby. A young woman, perhaps the victim’s daughter, snaps out of her reverie.

“Sweetie! Stop that! Stop it this instant!” she scolds, snapping her fingers. “He’s really a sweet puppy,” she apologizes.

Sure he is, lady. Why is it that every psychotic little ankle-biter has a name like Sweetie or Sugarpuss, instead of something that fits, like Tasmanian Devil or Charles Manson?

For his part, Sweetie ignores her, jumping from the couch to his master’s chest and back. Irritated, I bat the dog off the man’s chest as I begin chest compressions. I hit him a little harder than I intended, sending him somersaulting across the rug all the way to the fireplace. Sweetie bounces back up like nothing happened, and contents himself with jumping back and forth from the couch to my back, nipping at my hair and shirt collar with each circuit.

“Sweetie!” the woman cries, anguished. “Please leave the nice man alone!” I ignore them both, moving up to the man’s head to ventilate as Boss presses the ANALYZE button on the AED.
Shock indicated!” the AED announces.

“Everybody clear!” Boss shouts, looking at the AED and pressing the SHOCK button… …just as Sweetie completes another pinball circuit, landing squarely on his master’s chest, right between the AED pads.

“POP!” goes the AED, accompanied by an agonized yelp and the stench of burning dog hair. Sweetie ricochets across the couch and retreats for safer parts, yelping piteously all the while.

What was that?” Boss asks, turning back to the patient with a frightened expression.

“If the dog wasn’t in v-fib, he probably is now,” I comment dryly. “Apparently, ‘clear’ is not a command in his vocabulary.”

The AED interrupts any further conversation by reminding us in its telephone-operator voice that the patient is still in v-fib, and one of us should press the SHOCK button. Boss just shakes his head wonderingly and, looking at the patient this time, presses the button again.

Kachunk!” the defibrillator discharges, causing the man to arch his back in a prolonged spasm. Within a few moments,
the man coughs and starts breathing raggedly. Boss and I share a triumphant look.

No shock advised,” the AED tells us unnecessarily. “It is safe to touch the patient. Check breathing. Check pulse. If no pulse…

There is no need to check breathing or pulse, or begin CPR as the AED politely suggests. Dead people do not vomit and roll their eyes wildly. I quickly stick the suction catheter in his mouth to clear his airway. Soon, the man is breathing better, but still coughing and retching. I switch the oxygen tank to a non-rebreather mask and place it over his face.

“What happened to the dog?” Medical Director asks as he escorts the patient’s wife back into the room. “He came through here like his tail was on fire or something…” he trails off as he sees our patient.

“Ma’am?” he nudges the woman, who looks up, startled. He just smiles, gesturing toward her husband. She gasps and kneels at his side, sobbing again, but in a different way than before. The man says nothing, just closes his eyes and squeezes her hand as he coughs and sucks deep, shuddering breaths of pure oxygen. I take a little time gathering up our equipment. The woman continues holding her husband’s hand all the way to the ambulance, disengaging only briefly as we load him on the stretcher.

Since Medical Director is with us, Boss lets me ride in the back on the way to the hospital. MD has a bit of trouble getting an IV. “Goddamn! Can you ask Boss to take it easy for the next couple of minutes?” he asks, frustrated. There is sweat dripping from his nose as he makes his second stick at a vein.

“He is taking it easy,” I tell him. The ambulance is barely moving forty miles an hour, and I can see Boss’ eyes in the rearview mirror, watching Medical Director as he makes his second, successful attempt. “Besides, we’ll be at the hospital in two minutes.”

Medical Director has his eyes closed, concentrating as he auscultates heart and breath sounds. “Shit,” he mutters disgustedly. “I can barely hear. Lungs sound clear, I guess. He may have a systolic murmur.”

“They call it ‘diesel engine,’ Doc,” I tell him wryly. “Now you know why we palpate so many blood pressures.”

“This machine doesn’t even have a printer or a screen!” MD mutters in frustration. “We need a real cardiac monitor, and some lidocaine, and maybe some dopamine…” he looks around in frustration for a drug box that isn’t there.

“We’re not a paramedic service yet,” I remind him. “But the AED does have some interesting features. For instance, it has a voice recorder that activates when you turn the unit on. Where do you think we get the tapes you review?”

“You mean that…” Medical Director asks, looking suspiciously at the AED. “Yep,” I confirm with an evil grin, “everything is recorded for posterity, including Sweetie’s electrocution.”

“Good Lord,” he breathes. “Well, at least no one will hear it but me.”

“Well, we could make copies of the tapes before you get them,” I muse. “Purely for record keeping purposes of course.”

“You do that,” he threatens with a grin, “and I’ll withdraw my recommendation for paramedic school.”

Until next time…