“So anyway,” Rookie Partner is saying, “chick was old, like my Mom’s age. That’d just be too weird.”
“That’s nice, RP,” I mutter distractedly. The ‘net connection at Borg Hive North is unbearably slow, and I’ve tried, without success, to upload the same page on my electronic PCR three times now. If the system times out again, I’m considering the “hit any key to continue” solution. With a very large hammer.
“You ever been with an older woman, AD?”
“Define ‘older’, RP,” I sigh in resignation as the connection times out a fourth time. “When I was 25, I got drunk at a Christmas party and went home with the assistant DON at the hospital. She was 40, or close to it.”
Fuckit. I’ve got 24 hours before The Borg considers me a bad drone for turning in late tickets.
“I dunno,” he shrugs. “Like, older. Forty-five or something.”
“Dude, I’m forty,” I retort. “Forty-five ain’t old at all.”
“It is when your mother is forty-five,” RP counters.
“Your mother is forty-five?” I tease. “Is she single? More importantly, is she hot?”
By way of reply, RP shows me a picture on his IPhone.
“Dude, she is hot! Can you hook a brutha up?”
RP’s only response is to glower darkly.
“Seriously,” I grin, sinking the needle even further, “If we hit it off, you’ll only have to call me Daddy when we’re working on the ambulance, just like we do now. Whaddaya say?”
RP scowls and gives me the finger.
“If I wind up being your stepfather, we’re gonna have to work on your social skills,” I chide. “You can’t just –”
“Headquarters to CCT Four,” the radio interrupts.
“Why are they calling us on the radio?” RP wonders. “Don’t they know we’re at the station?”
“Goldfish dispatchers,” I remind him as I reach for the radio. “Their memory resets every three seconds.” I wait for RP to stop laughing, and then key the mike.
“CCT Four,” I reply. “Gourd head.”
“CCT Four, you have an emergency at 1512 Fydalla Ho Expressway. 22-year-old female having a seizure.”
“Tin foil,” I sigh. “We’re en route.”
I close my EPCR window and gather my gear, and follow RP to the rig. Seven minutes into my shift, and it’s already starting.
“Which way?” RP grunts as he starts the truck and engages the emergency lights.
“Uuhhh… left,” I point, rolling my eyes. “Same place Fydallo Ho Expressway has been since, well, forever.” RP has the makings of a good partner, but his navigational skills need some work.
Actually, it’s more than just navigation. He still seeks my direction on many things, and I think he should be past that by now. So when he asks for directions, or asks where he should park the rig, or asks what equipment I want to bring to the scene, I’ve taken to replying with a raised eyebrow and a pointed look. Or, as in this case, sarcasm.
Sheepishly, RP hits the siren and turns left out of the driveway. As we approach the on-ramp of Fydalla Ho Expressway, RP clears his throat. “Reason I asked,” he ventures, “is I don’t know whether we need to go north or south. And if it’s south, we’d probably get there quicker if we turned right and took the surface streets to the Sadler Street on-ramp.”
“Well, 1512 is gonna be Methamphetamine Acres Trailer Park,” I remind him. “And that’s north of here.”
“Why didn’t they just say it was at Meth Acres?” RP asks in exasperation.
“Apparently, you weren’t listening before,” I chide. “They’re goldfish, and you can’t expect them to – “
” – remember anything more than five minutes ago, or predict anything more than five minutes from now, or use common sense,” RP finishes with a rueful grin. “I get it now.”
“Still, that was good thinking before,” I admit. “When you hook me up with your Mom, we can double date with you and the cougar from the bar. I’ll even let you drive.”
RP, in direct contravention of Borg emergency driving policy, removes one hand from the wheel and renders a middle-finger salute as the entrance to Meth Acres flashes by on the right. RP flashes a chagrined look, and starts to open his mouth. I raise one eyebrow and say nothing.
“I’ll just, uh, make the block,” he says apologetically.
By the time we loop back around to the entrance, our siren has drawn several members of the International Bystander Society outside, flashing their characteristic gang sign: one hand waving frantically in the air, the other pointing to the trailer in question.
“Where do you want me to…” RP starts to ask, trailing off as I fold my arms across my chest and give him The Look. Again. “Uh, yeah. Guess I’ll just park down there by all the frantic people,” he decides.
Works for me.
One of the bystanders, a woman so large she has her own gravitational pull, takes a break from her tachylawdia episode long enough to accuse, “Y’all drove right past us!”
Did I mention that IBS members are also prone to stating the obvious?
I ignore her as RP and I haul the gear up the stairs to the sweltering trailer. She lumbers up the steps behind us, still bitching mightily in between praising Jesus for our arrival. “Ain’t you heard what I said?” she demands. “Y’all drove right past us da first time!”
“It’s a NASCAR ambulance, Ma’am,” I explain. “It only turns left.”
That shuts her up for a minute as she stares at me blankly, still jiggling from her jaunt up the steps like a big, sweaty perpetual motion machine.
“Why don’t you point out the patient we were called for, Ma’am,” I suggest gently. “Someone having a seizure?”
“Thass her outside,” the woman grunts, jerking her thumb toward the door. “She done had three of ’em.”
Outside, one of the moons orbiting our lead bystander identifies herself as our patient. Rather than ask her why she allowed us to walk right past her, I decide to focus on questions less likely to make my head explode.
“What’s your name, Ma’am?” I ask politely as she holds out her left arm for the BP cuff Rookie Partner is holding in his hands. Apparently, this ain’t her first rodeo. “Do you have a history of seizures?”
“Taketha,” she answers, “I been havin’ seizures three or four years.” Helpfully, Taketha holds out her left index finger for RP to check her blood sugar.
Damn, she’s good. If she anticipates the pulse oximeter, I’m offering her a job.
“What kind of seizures do you have, Ma’am? Grand mal? Absence seizures, maybe?”
“Dunno,” she shrugs. “I takes medicine for ’em, though.” She thrusts a small change purse into my hands, and I sort through the medication bottles stuffed in it.
Antidepressants… anxiety meds… not a damned anticonvulsant in the bunch. Lurvely.
“Did you witness the seizure?” I ask the other woman, who nods eagerly and launches into a windy narrative beginning somewhere around the patient’s mother’s car accident in 1977 when she was pregnant with our patient’s older brother and how she got a bad womb from all that and that’s how Taketha got cursed with the seizures in the first place and ain’t no doctor been able to fix her and –Lawdy! – we just gots to put all our faith in Jaysus! and…
… hopefully her story will catch up to present day pretty soon and will include some relevant information about the current episode. Then again, I’ve always been a starry-eyed optimist.
I let her ramble for perhaps twenty seconds and then interject. “Did she convulse?” I ask. “Muscle twitches and such? And how long did it last?”
“Lawd, she was shakin’ all over!”
“For how long?” I press.
She pauses a moment, thinking. “I called 911 right off! So… maybe twenty minutes? She stopped right befoah y’all got here!”
Okay, so seizing maybe five minutes, using the standard 1:4 panicky bystander time conversion ratio… wait a minute. Stopped right before we drove up!? And walking around and talking almost immediately?
“She stopped seizing right before we drove up?” I ask suspiciously.
“Befoah ya’ll drove past da first time,” she clarifies spitefully.
Actively seizing for five minutes, no bladder incontinence, and completely alert and walking around less than sixty seconds after the seizure stopped? I think I detect the unmistakable aroma of bullshit.
“Okay,” I sigh resignedly. “To what hospital would you like to go, Taketha?”
“I ain’t goin’ to no hospital,” Taketha demurs. “I be all right now.”
Well, that’s a new one.
“You sure?” I ask skeptically? “Seizures are nothing to mess around with. You should at least have your medication levels checked.”
“I be all right,” she insists. “My Momma gonna be here any minute. They done called her.”
As if on cue, a cell phone rings. The woman masquerading as a small planet startles, then fishes between her breasts, retrieving her cell phone from somewhere deep within the recesses of her muumuu. “Oh heeeeeeyyyy girl!” she brays. “No, the ammalance here now… girl, now she say she ain’t goin’… naw, she ackin’ aight now…”
I listen to her side of the conversation for a few moments, then motion impatiently for her to hand me the phone. “Hello, this is AD of Borg,” I say politely once Mrs. Jupiter forks over her Razr. “To whom am I speaking?”
“Is she really having a seizure?” a tired voice says without preamble.
“Um, the neighbors witnessed what they described as a seizure,” I hedge. “Is this Taketha’s mother?”
“Yeah, dis her Mama,” the voice says. “So how she ackin now?”
“Well, she seems to be okay now,” I allow, “but she doesn’t want to go to the hospital. Given her history of seizures, I think it’s a good idea that she – “
“She had one seizure when she was sixteen, and a whole buncha bullshit ever since,” the voice cuts me off. “She don’t need no hospital.”
Music to my ears. I knew this smelled like bullshit.
I motion for RP to pack it up. “Grab my clipboard from the rig, would you?” I ask. “Looks like we’ll be getting a refusal.”
While RP is lugging the gear back to the rig, I start jotting Taketha’s particulars on the back of my gloved hand. “Taketha,” I begin, “we’re just gonna have you sign a form stating that we offered you medical treatment and you – “
I watch as Taketha puts her hands to her temples and begins moaning, louder and louder, and finally begins shaking violently all over, provoking another fit of tachylawdia from her neighbor.
“Lawdy lawdy lawdy –Jesus! –lawdy lawdy lawdy – Jesus, she done caught another seizure! – lawdy lawdy lawdy…”
I watch dispassionately for a few moments more, observing her faux myoclonus. It’s the closed eyes that finally do it for me.
“Taketha,” I call out, “I know you’re busy seizing, but it’s time to go to the hospital. Get up and let’s walk over to the stretcher.”
And to the amazement of her planetary neighbor, Taketha obediently gets up and walks to the stretcher, moaning and shaking like a dog shitting tacks the whole time.
“Try not to convulse too hard until we get you in the truck, dear,” I instruct. “The stretcher’s kinda top heavy, and you could tip it over and hurt yourself.” Obediently, Taketha tones down her convulsions to a mild, whole-body shiver.
By the time RP returns with my clipboard, I have Taketha secured on the stretcher. “Change of plans,” I tell him. “She had another seizure, so we’re taking her to Charity.”
“Not Charity,” Taketha corrects, taking a break from her convulsion. “I don’t wanna sit in the waiting room. Take me to Big City Regional instead.” And with that, she resumes her twitching.
RP stares at me in consternation, and I reply with a shrug. As we wheel Taketha to the rig, I watch in amusement as realization dawns on Rookie Partner’s face, and indignation threatens to boil out of his ears like steam from a kettle. He slams the stretcher in the rig with none of his characteristic gentleness, and climbs in behind me.
“You want a line?” he asks eagerly. “How about a fourteen?”
“Nah, just a smooth ride,” I demur. Much as I’d like to practice a little punitive ALS, it never makes the faker hurt as much as it should, and it never makes me feel as good as I’d want. RP looks crestfallen, but climbs out of the rig and closes the doors behind him. As we pull out of the trailer park, the partition window slides open and RP snaps his fingers.
“Does it have to be a smooth ride?” he asks plaintively.
“Hit all the potholes you want,” I chuckle. “Just get us there in one piece.”
“So how did you know she was faking it?” RP asks, an hour later. We’re on our way to stand by at one of our outlying stations while the truck normally posted there finishes up a run at the local hospital. Never mind the fact that by the time we get there, the other truck will have cleared from the call, and we’ll only turn back around and go home. It does us no good to point out that the dispatch emperor is wearing no clothes.
“Closed eyes,” I answer. “That was the big giveaway. Plus, the fact that she could actively control the degree of her myoclonus tends to peg the bullshit-o-meter, too.”
“And she didn’t even pee her pants,” RP points out.
“That doesn’t always happen, RP. Sometimes the seizure is brief. Sometimes it’s only a partial seizure, and they have no alteration in level of consciousness. Sometimes, it’s a generalized tonic-clonic seizure, but they already have an empty bladder.”
“I thought something was up when they said she woke right up after her seizure. That never happens.”
“Almost never happens,” I correct. “Seizures are a lot more complicated than what you were taught in EMT school. Not every seizure is followed by a postictal period. But yeah, most of the time when they actually convulse, you’d expect to see at least a brief postictal state. Certainly more than sixty seconds, anyway.”
“So is there any difference in how they’re treated?” RP wants to know.
“Why are we wasting time talking about seizures?” I wonder. “Let’s get back to the original topic of me dating your hot-assed Mom. You were just about to give me her digits before we got that call.”
“Was not,” RP retorts.
“Are you worried that I might wind up being your new stepfather?” I tease. “I already told you that I won’t make you call me Daddy.”
“Dude, you’re not dating my Mom,” RP vows.
“Because if that’s what you’re worried about, don’t be,” I reassure him. “I assure you my interest in your Mom is purely physical.”
“Look, can we just change the subject?”
“I understand,” I needle. “The prospect of me spanking your Mom’s ass weirds you out a little bit. I’ll give you some time to get used to the idea, and then you can hook me up with her. Tell me something, though. Are her boobs really as big as they look in that picture?”
RP’s face reddens, and he turns in his seat, livid. I can’t hold a straight face any longer.
“Keep your eyes on the road, hero,” I chortle. “I’m just yanking your chain.”
RP glares at me suspiciously for a moment, but dispatch interrupts before he can reply. “Headquarters to CCT 4,” the radio crackles.
turn to Borg Hive North,” RP predicts.
“CCT 4, gourd head,” I reply.
“We have an emergency call for you at the intersection of Highway 317 and Parish Line Road,” dispatch orders.
“En route,” I sigh in acknowledgment as the call information comes up on our mobile data terminal. Another seizure.
“Looks like seizure night,” RP groans as he cranks the wheel to turn us around.
“They always come in threes,” I tell him as I hit the lights and sirens.
“No, not really,” I wink. “But if you’re gonna get the complete EMS education, I might as well pass on the myths as well as the street lessons. You may want to torture a rookie partner of your own one day.”
When we arrive at the Quickie Mart at the intersection of 317 and Parish Line Road, another gaggle of IBS members beckons frantically, pointing to a man lying in the ditch. As we approach, I take a closer look and groan, banging my head against the window.
“What?” RP asks, concerned. “You want me to call for backup?”
“No,” I sigh, “I don’t even want you to stop the truck. Can we just drive off and pretend we never saw him?”
RP’s only reply is to stare at me in open-mouthed consternation.
“Okay, okay,” I relent. “But this one is yours, not mine. Pull up alongside the guy in the ditch.” As RP puts the rig into park, I roll down the window and bellow, “JUNIOR! Get your worthless ass outta that ditch!”
Junior stops seizing and cracks one eye open. “Oh it’s you, Mista AD.”
“Get in the truck, Junior,” I order.
“I cain’t move, Mista AD. I just had me a seizure.”
“I don’t have time for this, Junior,” I warn. “If you make me get out of this truck, I’m calling the cops on you for another false 911 call. Get your bag, and get in the rig, and you’d better not give my partner any shit.”
“Ummmm… frequent flier?” RP surmises.
“Yep, and he’s all yours,” I grin evilly. “Alcoholism, Hep C, paranoid schizophrenic. And try not to get too close. He’s probably got lice, too.”
“I’m not supposed to take any seizure calls,” RP protests.
“That’s only if it actually turns out to be a seizure call,” I correct, “which in this case is simply the ruse Junior used to get someone else to call 911. Get a history and vitals, and don’t take any shit from him. If he thinks he can play you, he will.”
“So how do we write it up?” RP wants to know, eyeing Junior distastefully in the rear-view mirror.
“That’s up to Junior,” I shrug. “Demonic possession, hearing voices, thinks he’s Liberace… he’ll come up with something that will get him committed for seventy-two hours. And by the time his stay in the booby hatch is complete, the shelter will take him again.”
“Thanks so much,” RP says acidly.
“You’re welcome,” I say graciously, blowing him a kiss. “I’ll be sure to drive slowly, so you have plenty of time to get to know each other.”
“I think that dude did have lice,” RP observes sourly an hour later, idly scratching the back of his neck. “I can’t stop itching.”
“You didn’t have enough close contact to pick up lice,” I reassure him. “Now scabies, on the other hand…”
“Scabies?” he asks, shuddering in revulsion. “What are scabies?”
“Tiny little mites,” I say offhandedly. “Damned sight harder to get rid of than lice.”
“That’s just fucking great,” RP mutters acidly, finding yet another itchy spot on his left forearm.
“Yeah, tiny little mites…burrowing under your skin… laying eggs right below the surface… spreading wherever you scratch… making themselves at home on your body, setting up house… depositing eggs and little mite droppings…”
RP squirms uncomfortably in his seat, trying unsuccessfully to reach a particularly itchy spot between his shoulders.
“… eating your dead skin, using some of it as nesting material, some of it as food for their clutch of eggs, burrowing deeper as they need more room… you know they say that each adult mite is capable of laying ten thousand eggs…”
RP whimpers and scratches furiously at his scalp. “Dude, would you just shut up?!?” he begs.
“Oh, I’m sorry!” I say innocently. “Does that bother you?”
Before he can reply, the MDT chirps in its clipped electronic voice, “Incident assigned.” I sigh and pivot the screen to where I can read it, and then tap the screen to log us en route to the call.
“1000 Shoreline Boulevard, Room 212,” I order. “Three guesses as to what kind of call it is.”
“Damn, another seizure?” RP asks wonderingly.
“Got it on the first try! Maybe we can get you on a game show or something.”
RP, still scratching at psychosomatic itches, just shakes his head as he merges onto the interstate and almost immediately gets off at the Shoreline Drive exit. Behind us, three Big City Police cruisers follow us down the off ramp, lights flashing.
“Reckon they’re going to the same place we are?” RP muses, and as if in answer, the cops swing around us and pull into the Shoreline Drive Motor Court.
“Look like it,” I grunt. “Must be something more than a seizure. Tell dispatch we’re staging outside until pee dee calls us in.”
RP obediently relays the message, receiving a bewildered “Unit calling?” in reply.
I lay a hand on his arm before he can repeat the traffic. “Let Mr. ‘Unit Calling’ figure it out for himself,” I order. “You gave our unit number, the transmission went through just fine, and he only has six units to keep track of. He doesn’t even have to answer 911 calls, because someone else does that for him. He wants to know bad enough, he’ll call us again, or start paying closer attention to his radio traffic.”
A flashlight blinks at us from within the courtyard, and beckons us in with big, sweeping arcs.
“Guess that’s our cue,” I sigh. “Let’s go see what we’ve got.” Before exiting the rig, I key the radio and advise dispatch that we’re on scene.
“Ten four, CCT 4,” comes the immediate reply. Looks like he finally figured out who was calling him, and why.
The cops are clustered around an open door on the second floor, and predictably, the Shoreline Drive Motor Court doesn’t have elevators. RP sighs and starts to lug the stretcher up to the second floor landing, and stops in surprise when he sees I am not helping.
“Remember the ABCs,” I remind him.
He stares at me uncomprehendingly for a moment, then brightens in understanding. “Ambulate Before Carry, right?” he grins.
“Perzackly right,” I wink. “If the patient can walk, we’ll walk him. If not, we can send a cop for the stair chair.”
“Howdy, Foster,” I greet the junior officer amiably. “You look a little out of breath. Did they call us for you?” Foster’s shift sergeant tries, unsuccessfully, to suppress a grin.
“Funny,” Foster answers in a tone that say he thinks I’m anything but. “Nah, we were called for a noise disturbance, said a bunch of drunks were fighting on the balcony. Looks like your boy was actually having a seizure.”
“Nobody was fighting,” one of the drunks says defensively. “My friend just had a seizure, and everybody was scared, yelling for help.”
“So who saw this seizure?” I ask, kneeling next to the man whose head he held cradled in his lap. The guy is somnolent, ice cold and soaking wet.
“I did!” several voices chime in at once, and all of them proceed to deliver a long, drunken narrative of the events, punctuated by rambling non-sequiturs and solemn declarations that no, they weren’t drunk at all, especially not our patient, who as far as they knew, didn’t even drink alcohol, much less abuse drugs, because you know, that would be
illegal, immoral, and maybe even fattening.
I listen for perhaps thirty seconds, bark “QUIET!” and then nod politely at the drunk holding his buddy’s head in his lap. “You first,” I suggest, “without all the embellishment.”
“Well dude, he was kinda fightin’ with his girlfriend, cuz she said he’d been drinking too much, and he’s all ‘fuck you, beeyotch, I ain’t even close to being drunk enough’ and she’s all ‘fuck this, I’m leaving’ and he’s beggin’ her not to leave and shit and she ain’t paying any attention and she goes ‘Mikey, will you take me home?’ and I’m all ‘hey don’t put me all up in the middle of this shit’ and all of a sudden he’s all laid out on the balcony, floppin’ like a fish!”
“Anyone know if he has a history of seizures?” I ask the crowd.
“Never had one before,” one reasonably sober individual answers as he pushes his way into the room, “and I’d know. I’m his little brother.”
RP busies himself getting vital signs and a blood glucose while I take the brother to the side and ask a few discreet questions. The patient’s name is Frank, and no, he’s never had a seizure, and yes, he’s as drunk as a boiled owl, and no, he doesn’t do drugs, and yes, the brother is pretty sure of that, and no, he doesn’t have any other medical conditions or take any medications that his brother is aware of, and no, he’s been with him for the past 24 hours and he can safely say that he hasn’t fallen or suffered any head trauma, and yes, he’d like us to take him to the closest hospital to be checked out.
“BP 116/72, pulse 64 and regular, respirations 14 and clear, glucose is 78,” RP informs me when I step back to the patient. “Why the hell is he soaking wet, though?”
“Because we put him in a cold shower, dude,” the drunken friend Mikey sighs. “Don’t you know anything?”
RP ignores our bystander medical expert and just looks at me quizzically.
“Sometimes junkies or drunks pass out,” I explain, “and their dumbass friends throw them into a cold shower because they saw it work on tee vee once. And it really doesn’t do anything other than make the patient wet and slippery, and potentially hypothermic, but it tends to make the dumbass friends feel like they’ve done something useful.”
Mikey glares at me as the cops break out into guffaws.
“Can one of you guys get the stair chair for us?” I ask the cops. “Lower rear driver’s side compartment of our rig.” Foster makes no move to comply, mainly because fetching my stair chair would involve the physical exertion of walking fifty feet, and Foster abhors walking any distance further than the distance from his cruiser to the counter of the donut shop. Well, and probably because he wouldn’t piss in my mouth even if my teeth were on fire. But that’s okay, because the feeling is entirely mutual.
“Coming right up,” one of his fellow officers says amiably. Two minutes later, he’s back with our stair chair, fumbling with the mechanism to unfold it.
“We’ve got it from here, thanks,” I tell the cop sincerely. I position the chair next to the patient and motion for RP to grab the guy under the knees. I’ve got under his arms, where thankfully most of the water on his torso has dried or evaporated in the warm night air. His pants, however, are still soggy, but that is RP’s end of the patient. Rank hath its privileges.
“So what hospital are you taking him to?” the shift sergeant wants to know as we buckle our patient into the chair.
At the word “hospital,” our patient sits bolt upright and says, quite clearly, “Hospital? I ain’t going to no fucking hospital. Just leave me right here.”
Well now. Aren’t we awfully damned lucid for someone who just had a grand mal seizure.
“Okay,” I say agreeably. “Mind telling us why you don’t want to go to the hospital?”
“I didn’t have no seizure,” he declares vehemently. “I just need some sleep, that’s all. You sumbitches ain’t taking me anywhere against my will.” His speech is clear, not slurred at all.
Oh, he’s speaking my language now. Preach it, Refusal Boy!
“Your friends say you did have a seizure,” I point out. “Why not go to the hospital and try to find out why?” I’m trying my best here to sound reasonable and friendly, hoping against hope that my body language isn’t screaming BULLSHIT! in big, red letters.
“I ain’t going to no hospital,” he says stubbornly. “Y’all can’t make me.”
I can’t legally take you anywhere against your will,” I assure him, “provided I can document that you understand the consequences of your decision. So demonstrate to me that you know what’s going on around you and that you understand the risk you’re taking by refusing care. Do that, and sign my little form, and we’ll be on our way. Party on, dude.”
“Bring it on, motherfucker,” he sneers. “I know my rights.”
“Watch your mouth!” the shift sergeant snaps. “The man’s here to help your ignorant ass, so shut up and do what he says.”
I sigh inwardly, and go through the steps of an abbreviated Folstein mini mental exam. It’s not the full, ten-minute questionnaire, but the questions I ask, and the answers to them, do a helluva lot better job at documenting present mental capacity than scrawling “AAOx4” in their chart. His buddies interrupt with impatient, put-upon sighs, and the patient goes through the entire exam rolling his eyes and making jerking-off motions at every question, but in the end, I have enough documentation to demonstrate that not only is Frank Quibodeaux an obnoxious asshole, he is also in full possession of his mental faculties.
And thusly, fully capable of signing my refusal form without getting me or The Borg sued. Of course, The Borg probably won’t see it that way. Refusals of care don’t generate revenue.
Frank signs my refusal form with a flourish, and I turn to the shift sergeant for his signature as an impartial witness to the refusal of care. As I do, Frank unbuckles the stair chair straps, stands up, and promptly does a credible impression of a marionette with half his strings cut. He flops over at the waist, arms and neck limp. He flops his arms several times, as if he’s Morris Day doing The Bird.
That is, if Morris Day were a skinny, tattooed white boy with a negative tooth:tattoo ratio, and executed his dance moves with his face six inches from his shoelaces. Frank looks for all the world like one of those children’s toys of the giraffe on a pedestal that, when you press a button, the giraffe goes completely limp. All except for the legs, that is. He’s still standing upright while he’s doing this.
“Well, that has to be the poorest excuse for a fake seizure that I’ve ever seen,” I observe wryly, “but if you continue to do it, we don’t have much choice other than take you to the hospital.”
On cue, God releases Frank’s little button, and he stands erect, perfectly lucid once again. “Already told you sumbitches I ain’t goin’ to no hospital,” he vows.
The shift sergeant, rapidly tiring of our patient’s antics, plants his nose about six inches from Frank’s and growls, “I don’t know what your malfunction is, son, but if you want to go to jail tonight, you’re on the right track. Now you might be having seizures or you might not, but we can’t leave you here like this. So you either sit your ass in that chair, or you go to jail.“
At that, Frank smiles defiantly and holds out his hands for the cuffs. “Bring it on, motherfucker,” he challenges.
“Said the magic words,” the shift sergeant smiles grimly, pulling his cuffs from their belt pouch. He gets as far as locking the second cuff before Frank’s bravado runs squealing into the night like a little bitch.
“W-w-w-wait a minute,” he begs. “I’m sorry, man. I’ll be good, I promise.”
“Nope,” the cop answers without a trace of sympathy
. “You said ‘bring it on, motherfucker’. I’m bringing it. After you get checked out at the ER, you’re mine.”
“Awww man, don’t take me to jail!” Frank whines. “I won’t do it no more, I promise!”
“Take his ass to the ER,” he orders, ignoring our patient’s unseemly begging. “Consider him in custody.”
“We need someone to ride with us if he’s still in cuffs, Sarge,” I remind him apologetically. “Borg policy.”
“No problem,” he waves it off. “Foster, your rookie rides in with the ambulance crew, and you can follow them to the hospital.”
Foster doesn’t look pleased with the order, but then again, Foster isn’t usually pleased by anything other than shift change. All the way down the stairs, Frank bellows drunkenly, “Miserable cocksuckers! Fuckin’ pigs! I smelllll BACONNNNNN!”
For his part, Frank’s little brother cuffs him soundly on the back of the head and snarls, “Shaddup, dumbass! It’s bad enough I gotta ruin my night by coming along to bail your ignorant ass outta jail, but you gotta act like a little bitch with all the fake drama!”
RP and I package Frank on our stretcher, stow the stair chair and gear, and I motion to the brother and the rookie cop to climb in, pointing to where they should sit. Frank continues with the drunken braying while the rookie cop discovers how difficult it is to get a drunk to listen to reason, and I perch in the captain’s chair and entertain thoughts of very large IV catheters in very sensitive vascular spaces, like the corpus cavernosum, for example. I hit the speed dial number for Big City Heart Hospital and thumb the SEND button.
“Howdy, Jeff,” I greet the voice that answers, “AD with CCT 4, two-minute ETA with a male, late twenties, looks to have ETOH-induced supratentorial high-intensity tremors. Vitals all stable, see you in a couple minutes.”
“Whoa, wait a minute,” Jeff splutters. “Supra what? And he’s got ETOH on board?”
“Supratentorial high intensity tremors,” I repeat, grinning into the handset. “Figure it out. We’ll be there in a couple of minutes.”
“Room assignment on arrival,” Jeff sighs resignedly before I thumb the END button.
“Never heard ’em called that before,” muses the rookie cop. “In EMT school we always called it status dramaticus.”
“That’s another name for it,” I allow. “So you’re an EMT, too? Better not let Foster know. He hates EMTs.”
“Does Foster like anybody?” the rookie wonders. “Won’t matter much anyway. I’m only riding with him for tonight. My FTO called in sick.”
“Who’s your FTO?”
“Rita Menendez,” he answers. “She’s pretty good.”
“Better than good,” I grunt. “She’s hardcore. If she’d been here tonight, our little friend here would have gotten zero latitude.”
“Fuckin’ female cop,” our drunk patient sneers. “Wished they had a dick, that’s all. Tell ya what, I’ll give ’em some dick!” He winks lewdly, grabbing his crotch.
“I really wish she was on duty tonight,” I tell him sincerely. “You outweigh her by thirty pounds, but if you screwed with her, she’d show you what the other end of that little wanger looked like. She’d snap your little ass in half.”
“No doubt,” the rookie chuckles. “She doesn’t play around.”
“While we’re on the subject of little wangers and bad behavior,” I tell our patient, “let me caution you about showing your ass to the ER staff. Things will go much easier for you if you shut your mouth and adopt a friendly attitude. You never know when some pissed-off nurse may decide to see exactly how large a Foley catheter you can tolerate.”
“Sumbitches ain’t gonna do shit but let me outta these – hey, what’s a Foley?” Frank mumbles.
“Keep up the hollering and threats,” I warn him, “and you’ll find out.”
Jeff stops us at the triage desk as we wheel Frank into the ER. “Supratentorial High Intensity Tremors,” he grins. “SHIT, right?”
“You got it,” I wink. “Where do you want him?”
“Psych 2, AD,” he points. “Is he under arrest?”
“Yep. After you’ve determined he can safely spend a night in jail, the cops are gonna want him back.”
“Wonderful,” Jim says agreeably. “Saves me from having to be his travel agent, finding him a ride home.”
We wheel Frank into the psych room, unceremoniously deposit him in the bed, raise the rails and pull the curtains closed. Five minutes later, he is still braying drunkenly when the nurse walks into the room, carrying a chart and a urine cup. I can’t quite make out what is said, but presently the nurse stalks out of the room with a determined look on her face.
“What’d he do?” I ask.
“Called me a cunt and kicked the urine cup out of my hand,” she says matter-of-factly. “Now we’ll see how much he likes a Foley.”
I wink at the rookie cop as she walks back into the room, trailed by a burly security guard and an equally large ER tech. We stand just outside the door and giggle fiendishly as we listen to Frank squeal.
“Haven’t we seen enough of you guys tonight?” I grin at the shift sergeant as I climb out of the rig. “What have we got?”
“Girlfriend called 911,” he grunts. “Said she needed help, and hung up. That’s why we’re here. Looks like this guy had a seizure, a real one for a change.”
“Jesus H. Christ!” blurts RP as he rounds the back of the rig. “Another one?”
“Did you wish for a seizure call before I got to the station tonight?” I ask RP suspiciously. “Maybe mention, out loud, that it’s been quiet or slow lately?”
“Yeah, right,” he snorts. “I thought you said all that was superstitious bullshit.”
“After the fourth seizure call in six hours, I reserve the right to change my mind. Actually, the fifth seizure call, if you count the refusal on the casino guard.”
“Guy’s lying on the couch inside,” the cop jerks his thumb toward an open apartment door. “Still kinda out of it, though.”
We enter the apartment to find the guy’s girlfriend standing watch over him, nervously smoking a cigarette. She’s not hysterical, but she wastes no time telling us that he ain’t staying in her apartment, not after no seizure. Uh uh, naw suh. She ain’t been knowin’ him all that long anyway, and she ain’t gonna deal wif him when he like dis. We can brang him back when he ackin’ right.
I gently tell her that we’ll take care of him, but brangin’ him back to the apartment after he start ackin’ right is an arrangement she’ll have to make herself. We generally only take people to the hospital.
As the girlfriend harumphs her displeasure at that news to the cop, I kneel next to the couch and feel for a radial pulse. RP maneuvers around me and wraps a blood pressure cuff around the guy’s left arm. He’s pumping up the cuff when our patient’s eyes snap open. He recoils, ripping off the blood pressure cuff and scrambling up the back of the couch, eyes darting wildly.
“Easy, buddy,” the cop says placatingly. “They’re just trying to help you.”
“Yeah,” RP smiles reassuringly, edging closer. “I just want to check your vital signs.”
“Ya’ll leave me the fuck alone!” the guy yells.
“Latrell, let the people take care of you!” the girlfriend urges.
“Just gonna take your blood pressure, okay buddy?” RP asks, warily trying to wrap the cuff around the man’s arm. He reacts by batting RP’s hand away and cocking a fist.
“All right now,” the cop interjects sternly, taking a step forward. “Just calm down and – “
“Latrell, let the people do they job!” his girlfriend screams.
“Y’all leave me the fuck alone!” Latrel
l replies, even more loudly.
“Watch your mouth and lower your voice!” the cop snaps, “These people are just here to help you!”
“Everybody shut up and back away.”
The cop looks at me incredulously. RP stares. The girlfriend favors me with an indignant glare.
“The guy’s just had a seizure,” I say reasonably. “He’s postictal. He wakes up disoriented, and suddenly there are four faces crowding in on him. We’re overstimulating him. Let’s give him some space.”
RP and the girlfriend visibly relax and take a step back, but the cop just stands there, looking speculatively, back and forth, at me and the patient. “Sure,” he shrugs dismissively. “Why the hell not?”
I lay the oxygen tank I am holding in the seat of an armchair, and take a seat on an ottoman near the couch. “Hey, Latrell,” I say with my most disarming smile. “My name’s AD. How you doin’, man?”
“You motherfuckers better leave me alone!’ Latrell yells menacingly. “I ain’t going to no hospital!”
“Nobody’s gonna take you anywhere you don’t want to go,” I say evenly. “Just let us make sure you’re okay, and we’ll be on our way. Your girlfriend’s concerned about you, man.”
Latrell stares at me for a moment, and then his gaze flickers to the armchair across the room. Without warning, he launches himself from the couch, bounds across the coffee table, and picks up my oxygen cylinder, cocking it like a baseball bat.
“Y’all better leave me the fuck alone, or I’m gonna – ooofff.”
“Go to jail, or to the hospital in handcuffs,” I finish for him grimly, knee planted firmly in his back as I force his face into the carpet.
It was his eyes that betrayed him. I saw him tense, and when he leapt I was right behind him. I’m twice Latrell’s size, and God knows I can’t move as quickly. But I was closer to his target than he was, and like I said, his eyes telegraphed his move. By the time he cocked that oxygen cylinder to swing, I was already inside its arc. I grabbed his right wrist, swept his feet from under him, and landed atop him when he fell. Knocked the wind out of him, it did.
And right now, Latrell is lying on the floor with a 285-pound man kneeling on his back, surrounded by an atmosphere made up of 21% oxygen, and wishing fervently that he could buy even one molecule of it.
“Thought you said he was just postictal,” the shift sergeant grunts as he applies the handcuffs.
“Thought he was,” I reply. “Now he’s just a belligerent asshole.”
“What’s the difference?”
“For me, it was having the presence of mind to seek out a weapon, and then trying to use it. That ain’t postictal. That’s just being a prick.”
“Motherfucker, let me up!” Latrell yells. “I ain’t did nuthin’!”
“Shaddup!” barks the shift sergeant as he hauls him to his feet. “If you’d have behaved yourself, this wouldn’t be necessary!”
“Is he under arrest?” I ask.
“Nah, I’ll follow you to the hospital. If he behaves himself in the ER, I’ll take the cuffs off.”
“Technically, Sarge, we’re supposed to – “
“I’ll be right behind your rig,” he repeats, then grins evilly. “Unless you’d like to wait here with him until I can get Foster and his rookie over here.”
“Uh, nope,” I say hastily. “I think we can deviate from protocol just this once.”
“Hey man,” Latrell yells indignantly, “when y’all gonna take the motherfuckin’ cuffs off me? I ain’t did nuthin’!”
“After you get to the ER,” the sergeant answers, “and you prove that you’re not gonna give the medics and the ER staff any trouble.”
“Y’all git these cuffs off me right now,” Latrell threatens, “or I’ll whoop all yo motherfuckin’ asses.” He swells up to his greatest height, all 140 pounds and 5’6″ of him, as if that will make the threat more credible.
“Word of advice, Latrell,” I say drily as we strap him to the cot, “if you want these cuffs off as soon as possible, ‘I’ma whoop all yo muhfuckin’ asses if you don’t’ isn’t the most convincing way to go about it.”
“Incident assigned,” our data terminal chirps a couple of hours later. RP and I are sitting outside an all-night Burger King, hoping that the act of ordering food won’t induce another seizure somewhere within our coverage district. Obviously, it is not to be.
“Wonderful,” RP snarls. “And I’m frickin’ starving!”
“Go see if you can hurry things up,” I say soothingly. “I’ll mark us en route.”
Thankfully, they were bagging up our order as the call came in, so at least we have our food. I say as much to RP as he stashes the takeout bags behind our seats.
“Not like it matters,” he grouses. “It’ll be cold by the time we get to eat anyway.” For a kid so skinny you could x-ray him by holding him up to a strong light bulb, RP loves his food. He eats more than I can. I’m beginning to think the boy may have a tapeworm.
“That’s what they make microwaves for,” I say placidly. “Welcome to EMS. If we never took the time to shit or eat, no one would ever get sick.”
“Are we the only unit in the city?” he snarls, not mollified one little bit. “How many is that for us tonight, seven?”
“Nine,” I correct. “You forget the two transfers, and the refusal on the casino guard. And only five were seizures. This one’s an unknown medical emergency.”
“So what’s your point?” RP grumbles, savagely stabbing a straw into his drink with one hand and taking a sip.
“EMS is lak a box a chawklits,” I drawl in my best Forrest Gump voice, “You nevah know what yew gonna git.”
Normally, we don’t have to do much to clean the front of the rig at shift change. Dr. Pepper sprayed on the inside of the windshield, however, requires a little extra elbow grease to remove. You’d think I’d learn not to say such things while my partner’s mouth is full.
“So what do they mean by ‘unknown medical emergency’?” RP asks, tapping the MDT screen.
“That’s a secret code phrase known to all dispatchers,” I answer. “As near as I can tell, it either means ‘riot in progress’ or ‘please respond to the thermonuclear detonation’.”
“CCT 4 to headquarters,” RP radios, shaking his head. “Do we have any further info on this unknown medical emergency?”
“Stand by, CCT 4,” comes the reply. Disgusted, RP savagely slams the mike back into its holder.
“Stand By is his middle name,” I needle. “Unit Calling Stand By Arceneaux. Better get used to him, because he works our shift.”
“God, but that guy annoys me!”
“Cut him some slack,” I advise. “Dude’s only got three functioning neurons; one’s infected, one’s infarcted and the other’s inhibitory. Kinda hard to multitask when you’re like that.”
RP turns left onto Meadowbrook Circle, and slows down. “What’s the address again?”
“834,” I answer. “This is 706 over here. Should be on my side, on the next block.” The neighborhood is a new one, filled with spacious homes abutting a golf course. You’d think that the residents would be well-to-do, but that isn’t the case. Most of them bought homes they couldn’t afford with their Katrina and Rita insurance settlements, and half of them have already gone into foreclosure for non-payment. With the housing market the way it is, it’ll soon be a very affluent ghost town.
“None of ’em have house numbers!” RP bitches, slowing to a crawl and playing our spotlight over porches and front doors. “You’d think that if they could buy a $350,000 house, they could afford to stick some reflective numbers on the curb!”
“You’d think,” I agree mildly as we pass several people standing around a black Suburban parked at the curb, its driver’s rear door ajar. I make eye contact with them and nod politely as we creep past. We’re halfway down the
block before one of them decides to wave us back.
Now, why the hell didn’t they flag us down when we were ten feet away? Some people I’ll never figure out.
“Behind us, RP,” I grunt. “That was them back there.”
Cursing, he throws the rig into park as I step behind the box and press the backup button. I spot for RP as he backs our rig the couple hundred yards back to 834 Meadowbrook Circle.
“My Mama is having a stroke!” one woman greets me, panicked.
“Okay,” I smile reassuringly. “Where is she?”
“In the back seat!” she points. “We were going to take her to the ER ourselves, but we can’t get her into the truck!”
“Forget the equipment, RP,” I call out. “Just get the stretcher.”
There is a knot of concerned children and grandchildren gathered around the rear door of the Suburban. I politely say, “Excuse me,” several times, to no avail, and finally shoulder my way through to find a pleasant-looking elderly lady, leaning against the passenger seat of the Suburban, both feet still firmly planted on the ground. She looks very bewildered.
“Howdy Ma’am,” I say gently. “I’m AD of Borg. What seems to be the problem tonight?” The woman doesn’t answer, just alternates between looking at me in bewilderment and smiling uncertainly at her family.
“Anyone see what happened?” I ask. “And what’s her name?”
“Annalise Comeaux,” answers says the woman who flagged us down. “She complained of a headache. I went to fetch her some Tylenol, and when I came back downstairs, I found her on the floor!”
“Did she complain of blurred vision, weakness, anything like that?” I ask. “Was her speech slurred?”
“Nothing like that,” the woman shakes her head. “Just a headache. She takes medicine for high blood pressure.”
“Miss Annalise,” I say, taking the woman’s hands. “I’m going to lift your hands up, and I want you to close your eyes and hold them up while I count to ten.” When I release her hands, both of them flop back down onto her lap. She doesn’t close her eyes, either.
Well, so much for doing the stroke assessment when the patient can’t follow commands. Guess we’ll have to do this another way.
“Miss Annalise, let’s get you to the hospital,” I tell her. “See if you can stand up, and we’ll walk you over to the stretcher.” Obediently, she allows us to lead her to the stretcher and sit her on it. She doesn’t limp, nor does one arm seem weaker than the other. When she flashes that uncertain smile at her family, there is no Elvis sneer. It’s even on both sides.
“Get some vitals and a blood sugar while I talk to the family,” I order as RP loads the stretcher. He nods in understanding and climbs into the back of the rig, closing the doors behind him.
I briefly question her daughter about Mrs. Comeaux’s medical history. She isn’t a diabetic, never had a seizure, hasn’t taken any new medication, hasn’t fallen or struck her head. She’s generally healthy, her daughter tells me, other than the aforementioned high blood pressure. And that’s well controlled with her daily dose of Lopressor, I’m also told.
I assure the family that we’ll take good care of their mother, and make sure someone will follow us to the hospital. “Not too closely,” I warn them. “Don’t turn on your hazard lights, and don’t try to keep up with the ambulance. We’re going to take it safe and slow, so y’all make sure to do the same.”
“Blood sugar’s 128, pupils equal and reactive,” RP tells me as I open the rear doors. “Vital signs all good, too. You need anything else?”
“Nah, I’ve got it from here,” I wink, seeing that he’s already laid out a saline lock and IV start kit, and has Mrs. Comeaux hooked to the cardiac monitor. “Just get us to Big City Memorial, non-emergent. And good job, RP.”
Rookie Partner beams proudly as he strips off his gloves and climbs out of the box. Presently, I feel the rig lurch beneath me as we get underway. I busy myself with starting an IV and drawing blood, and Mrs. Comeaux flinches when she feels the bite of the needle.
“Ouch!” she exclaims indignantly.
“Welcome back,” I grin, extending a hand. “My name’s AD. What’s yours?”
“Annalise,” she smiles sweetly, shaking my hand.
Good grip strength in that one at least.
“Do you remember what happened, Miss Annalise? Do you know where you are right now?”
And now we’re back to that uncertain smile, and no answers forthcoming.
I recheck her vital signs, check her pupillary responses again, check her cardiac rhythm. Put her on oxygen at a couple of liters, just for shits and giggles. She’s hemodynamically stable, but she definitely ain’t with it. I keep trying to communicate with her, though, and gradually I am rewarded by better and better responses. By the time we reach Big City Memorial ER, I’ve managed to complete a full stroke assessment. She’s by no means oriented, but she follows commands well, and she’s otherwise neurologically intact.
“Whatcha got, AD?” the triage nurse asks as we wheel her past the desk.
“Dunno,” I shrug. “Guess you could call it altered mental status. Blood sugar and vital signs all normal, neuro exam’s unremarkable. No facial droop, no arm drift, no dysarthria. No limb ataxia, extraocular movements and visual fields all intact. It’s almost as if she’s – “
“Seizure,” RP interjects.
“Well actually, I was gonna say she acts like she’s postictal from a seizure,” I correct. “But I suppose that’s close enough for – “
“No, seizure,” he says urgently, tugging at my arm and pointing. I turn to see Mrs. Comeaux arching her back, eyes open and staring vacantly, her mouth open and twisted in spasm, right arm stiffened and curling toward her chest.
“Well, then,” I observe lamely. “Guess that explains the altered mental status. What room, guys?”
We hustle her into a room, transfer her over, and make room for the swarm of nurses descending upon her bedside. Outside the room, I repeat the story to the ER doc. Fascinated, RP cranes his head to watch as Mrs. Comeaux bucks on the ER stretcher, and one nurse injects a dose of Ativan through the IV. Less than a minute later, the seizure wanes, and the crisis has passed.
“Fucking cool,” RP grins as we walk the stretcher back to the rig.
“First seizure you’ve ever seen?” I smile tiredly. Sometimes it’s neat, having a sparky new rookie for a partner.
“Yeah, unless you count the other ones tonight.”
“I don’t,” I reply. “Well, at least you finally got to see what a real one looks like.”