Leave the Sneakers: Another, older LJ repost

I'm not yet sure what the life lessons were, but I'm certain there was something profound about an experience I had recently. I got called for a male patient, sick, at a burnt-down carwash.

Usually a "patient sick" call is a crappy call where some old guy has the flu or some kid has a stomachache and is puking (which was precisely what we got two calls later). Then you've got to take the dude into the hospital while you miss the season finale of Third Watch, and your Chinese takeout gets cold. However, the 'crappy' we expereinced in this particular call was a whole 'nother flavor of crappy.

I had a bit of a gut feeling from the location of the call- as soon as we got the page, I said to my driver, "Gotta love the calls where the address is 'next to the abandoned carwash.'" And I climbed into the bus, getting mentally ready for the various treats one typically finds at the abode of a homeless person. When we pulled up, there were two other homeless guys flagging us down frantically. Our patient was laying on his bed at the edge of the sooty threshold to the pre-soak section of the carwash. I grabbed the monitor/defibrillator and oxygen on my way over.

"You're gonna need lots of gloves." said another medic who had arrived earlier.

"Is he alive?" I asked.

"I didn't get that close." was his answer as I continued past him. From just about where the attendants usually soak your tires and undercarriage, I could see that the man was breathing and moving about. I could also see that there were piles of chunky congealed blood placed randomly about under the faded awning of the carwash entrance.

I figured we wouldn't be needing the monitor immediately... best to keep it clean of blood. I ran the equipment back to the ambulance. In a moment of clarity I also tossed my rather expensive Littman Master Classic stethescope into the front seat of the ambulance. I grabbed a backboard this time. As I went under the faded red and yellow plastic awning, I started to smell the foul, slightly metallic odor of blood mixed with the acrid smell of vomit, urine, and diarrhea. The piles of bloody vommit looked like raw blended liver from this close. And the stool was oily and black. Of course this was not was was flashing though my mind... what I was thinking was 'GI bleed.' When I saw the man, jandiced, icteric, blood at his mouth, extremely obtunded, I was thinking, "ruptured a varix."

Then when I saw that he was lying in various pools of black diarrhea, I thought, "how am I going to keep this crap off of my clothes?" As I got even closer, my main concern was trying to keep from vomitting myself. "Is this all diarrhea?" I asked as if hoping some of the fluid might have been the result of a freak accident with a case of motor oil. His response was, "yeah, it's coming out my ass right now."

"We're going to take you to the hopsital." I said, "I need to take off your shoes." This was not so much because I needed to see his feet or check his pedal pulse, but because they were covered in diarrhea, and removing the shoes would lower the chances I would ruin the fleece that my siblings bought me for Christmas.

"Can you save them? They're all I've got." he said. My medic partner shakes his head. I concur: The sneakers stay on his bed in the carwash. In the back of the bus we start a line and the monitor. He's sweatty and the leads won't stick. I look at the monitor. It's a lot of artifact for a little while, and then a scary looking rhythm comes into view. "Bill, please tell me he's got big T waves." My partner sticks his nose up to the screen and squints, "yeah, I think it's just sinus tachy." I look a little more... yes! He had a little qrs before each huge T wave. "Looked a lot like V-Tach for a bit there." We print a strip and save it. I take off my fleece and toss it in the clean haven of the front seat with my stethoscope. His bloodpressure is nonetheless low and he is taching away at 120 beats a minute. He does not look hot at all. And there is crap all down my left leg. We need to start a line. "Listen buddy, we need you to take off your jacket. You need to help us, or we're going to have to cut it off." We get the jacket off. We cut the next sweater off. I start on the white hooded sweatshirt underneath. "Not the white one, please." He pleads between moans.

"Sorry man, I've got to get it off. We need to start an IV and get your blood pressure." I cut through the shirt. We start a line. I call medical control for a bolus of saline. The man on the other end tells me to wait while he checks with a doc. Wait?! My patient is circling the drain and the man wants me to wait. We get the order. Bill squeezes the saline bag as we ride in.
The nurse at the hopsital takes report and tells us to put him in a treatment room. My driver says, "I think you want him in the trauma room." She looks a little annoyed and says, "Listen, I've got to keep an eye on him. I can't do that if he's in the trauma room." We put him in the treatment room. He's complaining of difficulty breathing now. Probably his acites pushing on his lungs. Another nurse asks, "does he have to be on a board? I can't sit him up if he's on it." I
say, "I guess not, we just used it to move him from where he was laying." In the back of my mind, I'm thinking he does not have fluid in his lungs and he might be just doing crappy enough that it may be good to have a solid surface underneath him. We move him over to the bed.
And he suddenly looks acutely unwell. The IV has stopped flowing. The nurse and my partner try to find another vein. Some other nurse walks by and points out his breathing has gotten very shallow and he has stopped moaning. He still looks a little responsive. He wasn't really a
big talker in the ambulance either... the doctor shows up and starts to give orders. Order O neg. get a blood type. get an ekg. For Gods sake, get a line. The monitor is put on. 120. just like when I left him. They futz around with the IV some more. I wander around a little bit, once
in a while handing someone an IV catheter. I look at the screen. Oh boy. "Hey doc-" I point at the monitor. "He was at 120 when we got him and now he's at 90." She glances up. Before our eyes his pulse goes down from 90 to 72 to 40. The blood pressure monitor is blinking no
reading. A look of revelation appears in a nurses eyes, "This is a code. We need to get the cart." She and a colleague go to the cart and start pulling. A loud bang. The equipment is still attached to the wall. They managed to unplug everything. At this point, Bill had finally suggested the doc to put an IV in the jugular vein and she gets it. Respiratory had arrived. Two attempts at intubation only succeeded in causing him to vomit blood into his mask. The monitor now showed
V-Tach for real- no pulse confirms a nurse. "Doc- he's got big T waves," I warn her. She shocks him twice once the nurses figure out how to charge the defibrillator. I think he converts. She shocks him a few more times before someone points out he has a pulse. This continues on.
I start doing paperwork and chatting to the EMT students in the room. I stress to them the importance of telling nurses what you think is going on. If he needs a trauma room, get him into a trauma room. It still does not occur to me that he might not survive this ordeal. We take to
paperwork to the EMS room. I walk back to get a signature on my run report. To my surprise, they called the code. My crew is just as surprised. I go to clean up the stretcher while they finish up the paperwork. I ask a nurse for some paper scrubs. My jeans are garbage. They close all the doors in the hall before wheeling the body out. The stretcher's straps are trash- soaked in tarry stool. I take great care not to get any on my shirt. The doctor asks.
"What was his name?" I give it.

"Address?"

"We picked him up from a burnt-out carwash."
"What was he doing there?" I look at her, hopefully not too incredulously, "He lived there."

LJ Repost: On the Economy

I have been pondering over various things since the last time I've been actually active on LJ, and figured I would write some of these things down.

Firstly, I think that the ecomony has become a huge self-perpetuating illusion. It's completely demand driven at this point, which is a weird thing to think about because it is not intuititve. What would be intuitive would be that you have a good or a service to provide, and someone else would need what you make and pay you for it- I'll grow oranges and you go fishing, if we trade, together we will neither get scurvy nor kwashikor. But in this system, all we would ever accomplish is having necessities like food, water, housing, guns, and TIVO. Somehow we have expanded our concept of "need" to include things like flat screen televisions, automobiles, granite kitchen counters, crown moulding, and I-Pods. And our need for (and subsequent purchase of) these things is how the people who make the TVs and I-Pods are able to themselves buy jet skis and sneakers with LEDs for their kids. We even need things like garlic roasters and George Foreman grills which basically only serve to occupy space in our cherry cabinets. There are a multitude of useless things that people are willing to pay good money for- things that would never be missed, though they might provide a product with a marginal increase in value. For instance, the rivets in jeans or the foil on gum wrappers.

Intuitively, the most successful economy ought to be the most efficient one. The one who is able to get the most iron and coal from the ground and make effective frying pans with the fewest people at the lowest cost ought to become dominant. This is true of an individual company. However, looking at our economy, it would seem that the most successful would be the one who convinces the consumer that they need the hugest stainless steel frying pan with a non-stick surface, a pretty box, a pink bow, and matching balloon. In fact, if you could make a rule that all frying pans needed to be free from asbestos as well, then you could generate hundreds of jobs for people to test frying pans for asbestos and then these people could afford to buy asbestos-free frying pans of their own. But some smart-ass would inevitably ask the question, "why would there every be asbestos in frying pans?" and then the inspectors would all be out of jobs and on unemployment. On unemployment, all they can buy is an orange and a fish to avoid geting scurvy and kwashikor, and they cannot listen to an I-Pod or watch a plasma screen TV at home.
Soon, you will have a broken economy that is barely able to even prevent scurvy or kwashikor.

I think this is why centralized economies could never become as successful as a free-market economy. You can't think this crap up. It just happens.

Cards

So, Kbels and I are writing out X-Mas cards, and I suddenly has a nostalgic moment. Remember those cards that would print from your dot matrix on a quarter sheet of that perforated paper and you would have to fold it twice for the card to come out right? At some point in the early 90's, it was perfectly ok to use cards! In fact, not only was it ok... for a brief second, it was like really COOL! (Or maybe I was just a dork... any hoo...) It's interesting how our tastes change so quickly; and how pervasive it can be. I wonder how much of our economy is dependent on this phenomenon and if there is some sort of Mastermind behind it all. Spooky.