There is a man in Ignorant Thicket who will not get off the floor. We don’t know if he has fallen, or if he has passed out, or even if he is alive. For all I know, he could just like the view from the floor. What we do know is that our dispatcher, based on her in-depth, thirty-second conversation with the 911 caller, knows exactly what is wrong with him. He will not get up off the floor, that’s what’s wrong with him, and if we will stop calling her and asking stupid questions, and drive to Ignorant Thicket as fast as humanly possible, Everything Will Be All Right.
We arrive at the address right behind Gene and Beth Comeaux of Ignorant Thicket Volunteer EMS. We all approach the mobile home, crowding together on the small porch among the potted ferns and wind chimes. We pound on the door, but no one answers. Someone is obviously home however, because we hear the sound of a vacuum cleaner inside. I open the door and stick my head in.
“Hey!” I shout over the vacuum cleaner. A middle-aged woman looks up from her cleaning, startled. “Did you call an ambulance?” I shout. She nods vigorously and waves us in, still vacuuming.
In the middle of the floor is a thin little man, wearing nothing but his briefs. He is barely breathing, his mouth opening spasmodically like a fish. There is a small puddle of vomit on the floor next to his mouth, and he has a highly suspicious looking brown lump in the seat of his briefs. The woman pays him no mind, calmly vacuuming the floor around him.
“Uh, Ma’am?” I ask. She keeps on vacuuming, so I ask louder, “Ma’am! Could you turn off the vacuum cleaner, please?” She switches off the vacuum and turns to face me. Gene and Beth roll the old man over onto his back and begin BVM ventilation.
“What?” she asks irritably.
What do you mean, ‘what’? You called us, lady!
“Is this the man we were called for?” I ask pointedly. “What happened?”
“Lazy sumbitch won’t get off the floor,” she snaps testily, “and I got cleaning to do.”
“Ma’am, how long has he been like this? For that matter, who is he?”
“He’s my good-for-nothing, alcoholic, lazy husband,” she informs me. “He’s been there since about eight this morning, I’d say.” She gives him a little prod with her foot. “Get the Hell up, you lazy sumbitch!”
“Since 8:00?” I ask incredulously. I check my watch – 4:00 in the afternoon. “You mean he’s been laying here like this for eight hours?” I explode. “What is wrong with you, lady?”
“Ain’t a Goddamned thing wrong with me,” she answers, “except for having to put up with his worthless ass. He’s a lazy sumbitch, that’s what’s wrong with him.”
I kneel next to the man, and check his pulse. Farting Partner has the intubation equipment set up, and is attaching monitor leads. I can’t feel a radial pulse, but the monitor shows an odd rhythm. It looks like ventricular bigemeny, but at second glance, the PVCs seem to be falling very late in the cardiac cycle. I decide that I’m looking at two rhythms, superimposed on one another – a profound sinus bradycardia, and a ventricular escape rhythm. I get the pacemaker pads out of the monitor pouch.
I’ll pace him, and that ought to bring him around. If I can get his pulse and blood pressure up, hopefully his breathing will improve.
I’m in the process of attaching the pads when the woman starts up the vacuum cleaner again. The monitor screen goes haywire.
“LADY, WILL YOU TURN THAT FUCKING THING OFF??” I shout at her. “I AIN’T GONNA TELL YOU AGAIN!”
Shocked, she stares at me but turns off the vacuum cleaner, and the monitor screen clears.
“Looky here, you little-” she starts to say.
“Ma’am, your husband is dying,” I interrupt as I apply the other pad and start dialing up the current. “We need you to get his ID, insurance cards and medications, right now.”
She glares at me a moment longer and stomps off. With the increasing pacing current, the old man’s chest muscles start twitching violently, but eventually I am rewarded with the characteristic wide QRS complexes that indicate electrical capture.
I try to feel a carotid pulse, but I can’t tell if I’m feeling an actual pulse or his neck muscles twitching. FP grins at me though, as he palpates a quick blood pressure.
“Ninety palp,” he says, looking relieved. The man isn’t breathing any better, however. Beth and Gene are doing effective BVM ventilations, but his lungs sound nasty, with coarse crackles in the upper fields and large airways. I consider just transporting and having them ride in with me to ventilate the old man, but decide against it.
He needs a tube now. It’s almost twenty minutes to Big City General Hospital, and it looks as if he’s aspirated already.
I intubate the man without too much trouble, and as I am taping down the tube, I look up to see the old woman handing cards and a bag of medication bottles to FP. She looks a little more concerned than before.
“Is he gonna be all right?” she asks uncertainly. I look her squarely in the eyes.
“I have no idea,” I answer honestly. “He would have had a better chance if you had called eight hours ago.” I don’t even attempt to keep the accusation out of my voice. I want her to realize her callousness probably killed her husband. I want her to be overwhelmed with guilt. I want her to be sorry, but I’m not sure she ever will be.
Gene helps Farting Partner and I load the stretcher, and Beth climbs in the back with me for the trip to the hospital. She ventilates while I attempt to start an IV. He doesn’t have the best veins in the world, and much to my chagrin, I have to stick him three times. I wish I was one of those people who could get blood from a rock, but I’m only average when it comes to IV cannulation.
On the bright side, some times I feel like I could fall down the stairs and accidentally intubate people on the way down.
I rarely have a problem getting a tube, and quite often I’ve intubated the patient when the doctor couldn’t. All those fancy airway skills aren’t doing this old man much good though, and Beth is starting to look a little uncomfortable. I motion for her to switch places with me, and she smiles gratefully.
“Thanks,” she grins. “My hands were getting tired.” Beth Comeaux has tiny hands, and has to use both of them to squeeze a BVM, a task she has been doing for twenty minutes. She had a hard time learning how to ventilate a manikin in EMT class, and she only got her patch three months ago. This may be the first real patient she has ever bagged.
“Check his pupils for me, would you?” I ask, handing her a penlight. She does, and looks up at me, frowning.
“Right pupil is fixed and dilated,” she says grimly. “Left one’s a little sluggish. Does that mean what I think it means?”
“Yep. He probably had a stroke, intracranial hemorrhage, something like that.”
“You suspected that all along, didn’t you?” she asks admiringly.
I taught Beth’s EMT-Basic course, as well as Gene’s EMT-Intermediate course. I wrote their medical protocols, and I browbeat Samir Saleh into agreeing to be their medical director. They think I’m the all-powerful Paramedic God of All I Survey, bless their impressionable little hearts. I hope they never learn the truth.
“Honestly, I had no idea what was wrong with him,” I confess. “Sometimes you never find out, but you do the best you can, and hope it was the right thing.” She looks doubtful, as if this is news she would rather not hear.
“Not quite like class, is it?” I ask her.
“Harder,” she confirms with a rueful grin. “I didn’t think anything could be tougher than your EMT class.”
“Now you know why I gave you those crazy scenarios in class, don’t you?” I challenge. “It was to prepare you for days like these.”
“Nothing can prepare you for days like these,” she retorts. “These people never cease to amaze me.”
“Hell, you grew up there,” I snort. “These folks are your people. You ought to be used to it by now.” I smile, reliving the image of the woman calmly vacuuming the floor around her husband’s body.
It shouldn’t be funny, but I start chuckling and it becomes contagious. Soon Beth and I are laughing hysterically in the back of the rig.
“I can’t believe she just kept vacuuming,” she chortles, “until you yelled at her, ‘Lady, will you turn that fucking thing off?’ She’ll probably file a complaint.”
“Fuck her,” I say cheerfully. “Let her complain. As far as I’m concerned, she was criminally negligent. She ought to be in jail.” Beth nods in agreement.
“Only in Ignorant Thicket…” she muses.
“Yeah,” I agree, “only in Ignorant Thicket. Say, did I ever tell you what a Ignorant Thicket girl says after having sex? She says -… ”
“I know, I know,” Beth says, rolling her eyes. “She says, ‘get off me Daddy, you’re crushing my cigarettes.’ It’s Daddy’s favorite joke.”