Thursday, August 10, 2017

Chapter 28 - Hand Holding & Observing

It is early April and I need to take my Harley down to the motorcycle shop to get my spring tune up.  I start to unhook the battery charger and realize that I did in fact hook it up but never plugged it into the wall.

Damnit

I cross my fingers, turn the key and depress the start button hopefully and only hear click, click, click.  Damnit again, I hope I can get the battery charged enough, so I can drive this to my motorcycle shop by 2PM today.

Right after I plug the battery charger in to the wall socket, I see an incoming call on my cell phone from Mom.  My mom is a creature of habit and does not normally call me this early in the morning.

"Mom!" I said when I answered the phone.  There is rapid breathing on the other end of the phone and is sounds like she is trying to catch her breath.

"Mom, are you OK?  Where are you?"  I am walking to the house phone and thinking I can call 911 and get an ambulance started to her address while I try and figure out what is wrong.  There is a long pause, and she begins to sob on the phone while she is trying to talk to me.  I still cannot make out what she is trying to say or what is wrong.  Mom is a diabetic and has had a couple of minor cardiac events that she has been seeing her doctor for.  

"Peanuts", she is using the childhood nickname of my older brother Philip.  I am at the house phone now and pause.  Something must have happened to my older brother, and she is trying to tell me.  I still have the house phone in one hand, I need to make sure she is OK.  I am at least 45 minutes away from her house. 

I am a rock during times of crisis or when a manageable situation becomes unmanageable.  The Fire Service has taught me to break down a large unmanageable crisis into manageable pieces that firefighters can manage under the toughest circumstances.  Being a spectator is always going to be harder than being one of the people who are working to make a chaotic scene manageable.  Today, I don't have my crew with me, and I am going to have to break this situation down to manageable pieces for people who are not firefighters.

I am thinking a 911call will dispatch police and ambulance to her address in about 20 minutes and that will be the start of making this manageable.  One of the gifts and pitfalls about being a firefighter is that I have never been able to not plan for the worst-case scenario.  I have seen a lot of manageable situations become unmanageable in very narrow time frames because people got complacent or just refused to believe that they found themselves in such a bad situation.

I am thinking something catastrophic happened to my brother.  I am not sure my mom would survive the death of her first born.  Philip, dropped out of college when he was offered a great entry level job at a local company.  He married his high school sweetheart and brought his first home.  He struggled with substance abuse after his new wife left him and he lost the house.  When local authorities caught him in a low-level drug transaction, the judge offered him the option to join the service instead of jail time.  He joined the Navy and stayed for 20+ years.  He married 3 more times during his service career and had 6 children with his wives.  After a long absence, he made peace with mom and came back to her.  

The prodigal son returned home after a very long absence. 

"Mom, sit down and take a deep breath and tell me what happened to Philip" I still have the house phone on the table in front of me.  I grabbed a pencil and an old notebook and started taking notes, along with a timeline.  I am like everyone else during a crisis, I will not remember all of the details I will need to recall to the professionals who will be responding to mom's house.

"Peanuts, had a heart attack!" she sobbed into the phone.

"Mom, are you ok, are you having trouble breathing or having chest pains?"  I ask.  Worst case, I always think of worse case first, but I don't want to ask her if he is alive.  If she is telling me he had a heart attack, he is still alive.  If he would have died, she would have said that first.  I need to keep focusing on mom now.

"Peanuts, had a heart attack!" she says again more urgently.

"OK, sit down and take a minute to catch your breath and then tell me" I said.

After a minute or two she has stopped crying, and her breathing is more regular. She has started to tell me the story.  He was back in Virginia and was visiting his two sons catching up on some lost time. Philip called his ex-wife a little after lunch to say he needed to go to the doctor and that he was having chest pains.  His ex-wife called 911 and paramedics were dispatched to his home.  When the paramedics arrived, they found him down on the floor with a phone in hand and unconscious.  Both boys were rubbing his back and his arm in an attempt to comfort him the only way they knew how. 

Philip's ex-wife called mom to tell her that he was transported emergent to the Naval Hospital in Norfolk, VA.  After she arrived at the hospital, she is given a dire update, the doctors are confirming heart attack, and they are having problems stabilizing him.  Doctors have found in addition to cardiac event he has a bad gallbladder and is septic.  They are continuing to work to stabilize him, and they have advised his ex-wife to reach out to family members.

I am relieved that this is not worse case today, Philip is alive, and mom is starting to sound more like mom.  When mom starts to ask me to help her book a flight out to Virginia, I feel more relieved.  I ask mom to stay on the phone with me for another minute and tell her I need to put her on hold for a minute.  My sister and brother live less that 30 minutes from mom, I call them both and ask them to head over to mom's house.  In less than an hour, the house will fill up with people who can comfort her.

Even with all of my Fire Service training, I am prone to knee jerk reactions.  I want to get into the jeep and go over to her house and put my arms around her.  With my siblings headed over to the house, I get back on the phone and focus getting that flight for mom.  I also need to call Philip's ex-wife and see if I can get some additional information about his condition, so I can understand what mom has in front of her.

One of the toughest lessons I keep having to learn as a firefighter is that there are times when I cannot change the outcome for someone having a really bad day.  There are times when we manage the unmanageable, but we do not get to see or hear how things turned out.    

Today, the very best I can do is book the trip for my mom, make sure she is navigating this in the best way possible and get detailed information from Philip's wife.  I want mom to understand what she is walking into when she lands in Virginia.

When I finish doing all of this today, I will be relegated to being an observer along with my mom and family.  

I hope during my next shift I get to help a complete stranger who is having a really crappy day.  That will take the sting out of being an observer again.

Paramedic School Chronicles

I have completed St Antony Paramedic School and, on my days, off, I am riding shifts with the Weld County Paramedics.  I need to complete the mountain of clinical hours required to complete Paramedic school requirements.  I am about 3 shifts away from completing my 400 hours of field work.  It is very different riding in the back of an ambulance, and it has given me a deep appreciation for what we ask paramedics and EMT's to do.  These guys have been great to me and know that I am balancing these shifts with my shifts at Station 3.  

I am checking the cabinets in the ambulance at the start of a shift working with the Weld County Paramedics at the beginning of the shift. 
  
"We got a transport down to Children's Hospital" my instructor Lisa says.

Children's Hospital is over 90 minutes south of where we are, I am not sure why we would be transporting a child from the level 1 Trauma Center that is within 5 miles of where we are located. 

"OK, almost done here" I said and resumed checking the cabinets.  After a couple of minutes, I realize that she is still standing in the door of the ambulance.

"It's a 2-year-old who was the victim of a very violent abuse incident, you and I will ride in the back, and you will have primary care" she said looking evenly at me.

It is a lot of work not to let my face or hands betray how much of a knot my stomach is in.  I do not have any frame of reference for this kind of patient.  I have seen a wide variety of patients with injuries that were extensive and catastrophic.  I have been the extra set of hands in the back of an ambulance when they have asked for a rider.  I have been a part of a crew that provided emergent care for trauma patients where every minute filled with a needed task or procedure.  I have never been part of a crew that took care of a two-year-old.  I am trying to wrap my head around what kind of care would be provided for a 2-year-old on a 90-minute ambulance ride.

She watches me for a minute more "He will be sedated, we are going to monitor him during the ride, transport is non emergent." 

We go back into the Emergency Room, and we are talking to the doctors and nurses about what to expect during his transport.  Doctors are reviewing the pediatric advance life support we may have to provide if the 2-year-old crashes during the ride.  I am taking notes and Lisa looks over and nods her head approvingly.  She asks me to go back to the ambulance and get ready to go.

"I will bring him out with the Doc, you get everything staged, you will be in the jump seat and will have primary care" she said.

"Done" my hands are steady but my heart is pounding.

After the longest 15 minutes in my life, the back of the ambulance opens, and Lisa steps up in back with the ER doctor and nurse and the 2-year-old is handed up to her.  Everything is quiet except the beep of the cardia monitor and ventilator attached to the child.  The child is secured to the Pram and back of the ambulance is warm.  Lisa double checks the equipment I have staged and nods her head.

I see the 2-year-old for the first time and my stomach hurts.  I take a deep breath to orient myself and look at the swelling and bruises on the child's head, face, arms, and legs.  For every firefighter there is a catalog of pictures that they will retain for an indeterminate amount of time.  The injuries on this small body are extensive and stomach churning.  And as vividly as I remember them, they are impossible to describe in any detail.  Seeing the injuries and the extent of them on this tiny body, assaults every one of my senses.


"We good to go?"  Mark, the EMT says from the driver seat through the opening from the front seat to the back.

Lisa looks at me, I nod my head and she says, "Good to go."

I am looking down at long black eyelashes on really beautiful half open brown eyes.  The ER doctor told us to expect tiny seizures during the ride.  He said they would be upsetting to watch but unless the monitor indicated the child crossed a specific threshold, there were no interventions that we could do.

He did have a couple of those small seizures on the ride down that we monitored closely.  I realized that when he had these small seizures, I would reach down and hold one of his tiny hands.

Holding his hand did was for my benefit and not this tiny patient.

Lisa is explaining in detail the signs and symptoms I should be looking for and assessing.   I am trying to catalog everything I am looking at and trying to put a clinical hat on.  I don't need to know how or why he was injured.  For these 90 minutes, he is our kid, safe, and cared for.

I am relieved when we pull into Children's Hospital, another army of doctors and nurses are waiting when we open the back doors.  Two nurses come out wrap him up and take him into a waiting room. 

I am completely drained, for the 90-minute ride, I did little more than watch this child, hold his hand and watched every monitor closely.  I feel a tug, I know he is in the hands of caring professionals who will treat him like he is their very own kid. 

Strange how things work, in the end this 2-year-old was probably loved and cared for more collectively by strangers than he was in the house that he lived in.  I also suspect that like me, everyone who touched him will keep a extra eye out for the kid that looks like he is falling through the cracks.

One of the toughest lessons I keep having to learn as a firefighter is that there are times when I cannot change the outcome for someone having a really bad day.  The very best thing I did today is that I watched the monitor and held that tiny hand during his small seizures.   There are times that I am simply relegated to the role of an observer.  This small child will stay with me for a period of time that I simply have no control over.

I hope during my next shift I get to help a complete stranger who is having a really crappy day.  

EPILOG
In addition to surviving a cardiac event, septic shock, and is subsequent years hip and knee replacements, Philip is alive and going strong.  The prodigal son returned home to the boundless appreciation and gratitude of my mom.

Out of an abundance of self-care, I did not ask or obtain the status of the young child that we transported that day.  I am grateful I got to hold the hand of a complete stranger who was fighting for their life on a really crappy day.  The gift that young man gave me was that even in retirement, I am more inclined to hold the hand of someone having a really crappy day.

  

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