Vignettes From The Bolance

1930 hours

“Howdy,” I say cheerily as we wheel our stretcher into the ER. “Somebody here call for a CCT truck?”

“Bed Four,” the ER nurse yawns disinterestedly, pointing to the curtained area. “DOC inmate going to the Charity Hospital up north.”

I wait patiently for him to elaborate, but apparently ten words are all he can muster in between crossword choices. “With…what?” I prompt.

He flips nonchalantly through the chart and finally recites, verbatim, “transfer to Absurdly Large Charity Hospital for surgical evaluation and treatment of acute pancreatitis.” Delivered, of course, with a condescending smirk.

I ignore the look and ask, “And he can’t get treatment for that here because…why, exactly?

“We no have that specialty here,” the doctor breaks in, not bothering to look up from the game of Spider Solitaire he’s playing on his laptop.

Add that to the list of other things you don’t have, I think but don’t say. Like compassion, work ethic, or talent.

“Fair enough,” I smile. “What’s he got running?”

“Saline at 125 ml/hr through a 20 gauge in his left hand, and the Protonix just got through infusing. He’s got Primaxin 500 mg running at 50 ml/hr through an 18 gauge in his right forearm.”

I nod and flip through the paperwork provided by the nurse. Labs, CT reports, nursing and physician notes, medication record, transfer form…looks like everything’s there. Sure enough, his amylase and lipase are elevated, and the radiologist’s report notes several large gallstones and other findings that are “strongly suspicious for acute obstructive pancreatitis.”

It also includes a paragraph or two of treatment recommendations, because for some reason radiologists these days see fit to not only read the frickin’ films, but also to tell the ER doc how to treat the patient. Quite odd really, to have someone suggesting orders for a patient they’ve never laid eyes on, and for whom the only history they have is a one-sentence justification on the CT request.

But if it bothers the ER doc, he makes no sign. You kinda have to care about what you’re doing to let that sort of thing rankle you, and this particular doc stopped caring a few thousand indigent patients ago. Unless I miss my guess, he’s devoted more time to that game of Spider Solitaire in the past hour than he has the patient.

I fix a reassuring smile on my face and flip back the curtain. There’s a thin, wiry black man lying there in prison coveralls, handcuffed and shackled to the bed, with a burly guard seated nearby. The guard looks up briefly from his dog-eared issue of Handguns magazine, apparently decides I’m not worth acknowledging, and goes back to disinterestedly flipping pages.

The guy on the bed has a thin sheen of sweat on his forehead, and he anxiously shifts about on the bed, as if he can’t get comfortable. He says nothing, just lies there silently with his eyes screwed shut.

“Hey partner,” I say softly, nudging his shoulder. “We’re here to take you to the other hospital. How you feelin’?”

“Bad,” is his one word response, as if a more elaborate answer would require him diverting too much willpower from the effort not to scream.

“How bad, Sir?” I press gently. “Say, on a scale of one to ten.”

He shakes his head, tries to shrug his shoulders. “Bad,” he repeats, and then doubles over, retching in a long, agonizing dry heave.

“Hey, Todd?” I call out, poking my head through the curtain and looking for the nurse. Predictably, he is nowhere to be seen. The doc doesn’t even look up from his laptop screen.

“Hey Doc, has this guy had anything for pain?” I ask. “He’s hurting pretty bad in here.”

“Yes.”

‘Yes?’ Lazy bastard. Why is it that getting any cooperation around here is like pulling teeth?

“Yes…what?” I ask pointedly, no longer bothering to be polite. “What did you give him, and when?”

His head slowly swivels around to regard me, and he says nothing for a few moments, inspecting me as if I were some mildly interesting species of insect. His eyes flicker upward towards the clock on the wall. “Mepergan 50/25,” he yawns. “Maybe four hours ago.” Then, he slowly and deliberately swivels his chair back around to face his laptop screen.

Dismissing me.

“Well, how about some PRN orders for morphine for the trip?” I press, because I’m not the type to be dismissed easily.

“Morphine contraindicated in this type pancreatitis,” he informs me, eyes still glued to his computer screen. “Demerol better.”

“Okay,” I say agreeably. “I’ve got Fentanyl. How about, say 50 mikes of Fentanyl, PRN for pain?”

“No Fentanyl,” he says, cutting me off. He flashes me a warning glance as if to say, “You’re being impertinent. I don’t like impertinent ambulance drivers.”

“Okay, if not Fentanyl or Morphine, how about you guys give him another dose of Mepergan before we load him up?” I press. “It’s been four hours since his last dose, after all.” I couldn’t give a rat’s ass whether he likes me or not anyway.

“He be fine,” he cuts me off with a cruel smile. “He got pain shot already, and they wait for him at Absurdly Large Charity Hospital. Drive safe.”

Fuming, I duck back behind the curtain and motion for Replacement Partner to help me move the poor guy over to our cot. The guard removes the shackles and clucks his tongue, looking at the prisoner with genuine sympathy.

“Doc gonna order another pain shot for him?” he wants to know.

“No,” I say curtly as we clamp IV pumps to the stretcher rails, sort out tubing and monitor leads, and wheel the patient out of the curtained cubicle.

“Why not?” the guard asks as we pass the nurse’s desk where the ER doc remains engrossed in his computer game.

“Because Dr. Mengele over there apparently thinks pain builds character,” I say loudly. “Which, if that’s true, means he’s never experienced pain in his life.”

And I favor the shocked ER nurse with a wink and my most patently insincere smile as we wheel the patient out the doors.

2215 hours

“I ain’t going to no fucking hospital,” the man vows. “I just need some help off the Goddamned floor.”

“Is that the only reason you called an ambulance?” I ask mildly, looking around at the piles of rotten food, overflowing ashtrays, and trash strewn around the tiny apartment.

“Well, you’re the only motherfuckers I can get to come out here and help me this late at night!” he snarls. “I’m a fucking paraplegic! I can’t get off the floor by my fucking self!”

“And as if by magic, two motherfuckers appear, ready to do just that for you, and the motherfucking company they work for won’t even charge you for it,” I point out innocently. “Ain’t customer service fucking grand?”

“You being smart with me?” he asks incredulously.

“Nope,” I shake my head. “I’m here to help you. I just don’t like being called a motherfucker.”

“I’m so sorry,” he smiles nastily. “Will you two gentlemen help me off the fucking floor? Please?”

“Certainly,” I agree, motioning for Replacement Partner to grab his other arm. RP, screwing up his face in disgust at the rancid stench of body odor and stale cigaret
te smoke, places one hand under the man’s left arm and the other on his bicep.

“Hold on a minute!” the man snaps, jerking his arm away. “Don’t fucking manhandle me! I’ll sue you motherfuckers for everything you’re worth!”

“Nobody’s manhandling you, Sir,” I sigh patiently. “Let us know when you’re ready, and we’ll lift you back into your recliner.”

“By the shoulders, Goddamnit!” he snarls, “not by my fucking arms! You motherfuckers are gonna dislocate my shoulders!”

Okay, enough is enough.

“Do you want help off the damned floor or not?” I ask pointedly. The man just glares up at me. “Then stop telling the professional people lifters how to do their job,” I order. “Now we’re gonna lift you off the floor and put you in that recliner. On the count of three…three.“

RP and I lift the man from the floor and deposit him in the soiled recliner. As we swing him around, his dead legs catch a small end table and topple it over, spilling ashes, half-empty beer cans and cigarette butts all over the floor.

Not that it matters much. It kind of blends right in with the rest of the filth.

RP mutters an insincere apology and starts to pick up the trash, and the man snaps,” Just fucking leave it! I got a fucking girlfriend to clean this shit up for me!”

He must have noticed the dubious looks on our faces, because he continued, “What, you don’t think I got a girlfriend? My dick works just fine! I fuck and everything!”

“Good for you, Sir,” I shrug noncomittally. “Technically, The Borg requires me to inform you of the possible injuries you may have sustained by sliding out of your recliner, and offer you treatment and transport to the hospital so that – “

“Fuck you, I ain’t going to the hospital!” he interrupts. “Takes more than a little fucking fall to hurt me! Goddamned VC tried to kill me, and all they managed to do was paralyze me! I’ve lived 38 fucking years in a Goddamned wheelchair without help from – “

” – you can be examined by a physician to make sure you haven’t suffered from any injuries that may not readily be apparent,” I continue gamely, mentally counting to ten. “You are paralyzed, after all. You can’t feel pain that might tell you something is injured.”

“Fuck you!”

“Fair enough,” I shrug. “I’ll need you to sign a form releasing The Borg from any liability from your refusal of care.”

“Fuck you, I ain’t signing anything! Now get out of my apartment!”

Patient verbally abusive, refuses to sign refusal form, and orders us from his apartment. Good enough for me.

“Have a nice night, Sir,” I tell him as we walk out the door. “Thank you for calling The Borg.”

He shouts something in reply, but I close the door on his retort.

RP stands on the stoop for a moment, sighs explosively, clenches and unclenches his fists. “What an asshole!” he observes. “And that nasty bastard supposedly has a girlfriend? I ask you, AD, if you were a chick, would you sleep with that dude?”

“I wouldn’t sleep with that dude if I was that dude,” I answer. “I’d be masturbating, and thinking the whole time ‘geez, I gotta set some higher standards for myself.'”

0325 hours

“…so I told the lady right before I started the IV, ‘I do have some good news,’ and she looks at me with this hopeful look on her face…”

“And you said…” Mrs. Richard prompts.

“I just saved a bunch of money on my car insurance by switching to Geico,” I finish with a wink. “The best part was, she was laughing too hard to notice the needle.”

“That’s a good one,” Mrs. Richard chortles. “I’m afraid my daughter didn’t think it was very funny when you made the joke about dropping me. Personally, I thought it was hilarious.”

Mrs. Richard and I share a similar sense of humor. For the past fifteen minutes, we’ve been yukking it up in the back of my rig on the way to Big City Memorial ER. Unfortunately, her daughter isn’t the laugh riot Mrs. Richard is, which is why we were called out at oh-dawn-thirty to meet Mrs. Richard in the first place.

And were it not for the sour-faced daughter, I’d have been happy to make the acquaintance, even at 3:00 am.

“Whatcha got, AD?” the charge nurse asks me as we wheel our sweet, impishly funny little grandma into the ER.

“Mrs. Richard has a fever,” I explain. “It was 100.9 degrees an hour ago, and it’s 101.2 now.”

“Nursing home resident?” he asks, cocking one eyebrow knowingly.

“Nope,” I shake my head. “She lives at home. Her daughter called us because she believes Mrs. Richard is coming down with a tetch of that nasty pneumonia that’s been going around, and doesn’t want it to get out of hand.”

“What nasty strain of pneumonia that’s going around?”

“The one my daughter heard about, obviously,” Mrs. Richard winks. “You’re a little slow, aren’t you? Try to keep up, young man.”

“Mrs. Richard,” the charge nurse greets her warily, “I’m Kyle, the nurse who will be taking care of you tonight. How are you feeling?”

“Can’t complain,” she chuckles agreeably. “I’m still kickin’.”

“Been having any trouble breathing?” Kyle asks, and Mrs. Richard shakes her head, no. “Any cough, chest pain, fatigue, dizziness? Anything like that?”

“Nope,” she shakes her head. “None of that. Like I said, I feel pretty good.”

Kyles cocks a quizzical eyebrow at me and asks her, “So why are these boys bringing you to the hospital at three in the morning?”

“Because my daughter won’t let me have any peace otherwise?” Mrs. Richard answers innocently. “And this is the only way I can shut her up?”

I wink slyly at Kyle, and behind me Replacement Partner is suddenly beset with a coughing fit.

“Okay, so let me get this straight…” Kyle continues. “She’s running a fever, and otherwise is asymptomatic, and her daughter decides – at 3:30 am – that she needs an ambulance?”

“Well,” I explain, “it was an emergent fever.”

“Did her daughter give her any Tylenol?” Kyle asks. Mrs. Richard shakes her head, no. “Any Ibuprofen?” Again she shakes her head.

“No Tylenol or Motrin,” Kyle mutters darkly, massaging the bridge of his nose.

“Well, she had a fever,” I explain again. “An emergent fever. And when you have a fever, the only prescription…”

“…is more cowbell,” Replacement Partner finishes solemnly.

Kyle groans and orders us from the room.

At least Mrs. Richard thought it was funny.

0600 hours

“Wave at the pretty ambulance,” I order RP as we pass another Borg unit going the other way, all lit up with siren wailing. We’re headed for a non-emergent transport that will take at least an hour to complete.

A transfer leaving from a hospital in the west zone…

…which we have to take, because the unit assigned to that zone just got an emergency call...

…in our zone…

…which we were unavailable to take because we were already assigned a call in the west zone, because the unit assigned to that zone was in the middle of a crew change…

…which has apparently been
completed, because that unit just passed us all lit up, running an emergency call…

…in our zone.

Yeah, it makes my head hurt, too. Not to mention the fact that this is going to make us late getting off shift, by at least thirty minutes.

Thirty minutes while our relief sits at our station, unable to run calls…

…because we’re in their truck, and as a CCT crew, they can’t just hop into any rig.

“Now tell me, how does this make any fucking sense?” RP fumes. “Dispatch couldn’t hold the transfer for ten more minutes? Hold that transfer for ten minutes until the new crew comes on, we’d still be in our zone available for that emergency call, which we’d probably be finished with in plenty of time to get off at 0700. Everybody wins.”

“You just used ‘dispatch’ and ‘sense’ in the same sentence,” I chide. “You know better than that.”

“I wonder what goes through that girl’s mind sometimes,” he wonders.

“Wind,” I answer. “A gentle zephyr. If you stand close enough, you can hear it whistle through her ears.”

“She’s punking us,” he mutters darkly. “Satan hates me.”

“Maybe you shouldn’t have slept with her and dumped her,” I point out. “Besides, she’s not smart enough to punk us. She’s a Type B Dispatcher.”

“Type B?” Replacement Partner muses. “Never heard of it.”

“There are three types of dispatchers. Type A Dispatchers are the evil, malevolent geniuses that constantly figure out new and creative ways to torture us,” I explain. “They do it on purpose, and they’re smart enough to know how to manipulate the system. Never piss off a Type A Dispatcher.”

“And Type B?”

“Type B Dispatchers are the benignly incompetent type,” I continue. “They’re neither smart enough to do their jobs correctly nor smart enough to game the system. You can piss them off with impunity because they’re not smart enough to know how to get you back. But it’s really not fair to take it out on them, because they can’t help being dumb. Plus, they can always whine to the Dispatch Supervisor, who is invariably a Type A Dispatcher.”

“And Type C Dispatchers?” RP asks. “What are they?”

“Type C are the competent, caring dispatchers. They know their jobs, and they take care of their crews. They’re smart, and they’re fair.”

“And they don’t exist,” RP snorts.

“No, they exist,” I disagree. “It’s just that they always work on the shift opposite yours. That’s an EMS axiom.”

“You and your EMS axioms,” he rolls his eyes. “You are full of shit, AD.”

“I try to pass on these little career lessons,” I ask the heavens, “but does he listen? No, because You cursed him with a hard head and ADD, Lord. Please bestow upon him the patience to absorb my wisdom, the humility to realize that he has much to learn, and the gratitude that he should feel at having me for a partner. Amen.”

“Okay, if you’re so smart,” he asks sarcastically, “why is it that we have such idiotic dispatchers?”

“Blame it on our wellness and safety program,” I tell him. “That’s where you hang the blame. That, and hydraulic stretchers.”

RP favors me with a blank stare.

“In my day, we had a lot more back injuries,” I explain. “With the wellness and safety program, and hydraulic stetchers, we have far fewer career-ending back injuries. In my day, when an experienced medic suffered a career-ending back injury, he went to dispatch. Nowadays, that’s where you send the EMTs that have career-ending brain injuries.”