What About The Dog?

The call came across as a “possible ETOH party, patient stated to the call taker that he didn’t know his name, he needed an ambulance, and you will find him in the back yard.” This seemed like an odd call to me, but my preceptor and his EMT partner didn’t seem too alarmed.

“Probably a drunk, maybe drunk and crazy, who knows,” he said. This seemed to be the running theme of the evening tonight, as we had transported a few psych patients and more than a few drunks already. It was nearing the end of our shift, about 4 am, and we were all tired and running out of patience.

The calm and emotionless voice of the dispatcher once again came over the radio advising us that police was responding and that we should stage in the area with the fire department. This is routine for any crazy person, as you never know who might be wielding a gun and shoot you as soon as you walk in the door. This type of apprehension and precaution is a little unfamiliar to me. My small town EMS and fire experience have been pleasantly free of gun-toting psychos for the most part. Aside from the occasional bar fight I have been fairly shielded from the more outrageous crazy people of the big city.

We arrived on scene at the same time as police and fire, all of us rolling up into this sleepy suburban area of town, probably drawing attention from neighbors within three blocks. We watched the officer go up to the door, knock and walk in, hand on his holster. He disappeared for few minutes then waved us in from the upstairs window. We grabbed our mountain of stuff; the monitor, red bag, blue bag, and cot and walked up the driveway with the firemen. It always strikes me as funny when we all arrive together, seven people total (four firemen and the three of us on the ambulance). It just seems like overkill sometimes.

We all squeeze up the stairs. I was expecting to hear some drunken asshole screaming from the back yard but it was quiet. We were immediately greeted by the cutest dog I had seen in a long time; a very light yellow lab, wagging his tail. He was looking for a good pat on the head and scratch behind the ears. He ran up to me to say hello and immediately struck me as a good dog, friendly and well trained; obviously well cared for. It eased my mind a little, as I fall under the school of thought that your pet is a reflection of you; that if your pet is friendly, smart, and well cared for then you probably are as well.

The dog was running from fireman to fireman getting petted and loved by each one. We had still not seen a patient. As usual, being the student, I was pushed up front to take control of the scene. I asked the officer what was going on. “Well, come on out back and take a look,” he said with that same sarcastic smirk that I seem to get from everyone as a student. More experienced emergency response types seem to delight in toying with students for some reason. I walked out the back door onto the deck which overlooked the back yard and “made patient contact” so to speak.

Laying in the back yard was our patient, shotgun by his side. What was left of his head was, to say the least, not anatomically correct. There was a significant amount of skull fragment and brain matter scattered throughout the back yard. I found the whole scene surreal and disturbing. My preceptor came out on the deck along with the firemen and his partner. “Is that what I think it is? Oh, yup it is.”

This was not my first exposure to what the textbooks call “obvious signs of death” but it shook me a little. It must have done the same to everyone else because the firemen all said they didn’t need to see that and went back inside. Since this was now a crime scene, we all went back inside so as not disturb the scene. The officer and the fire lieutenant went down to make sure the guy was dead, as expected he was.

Back inside was the dog, still looking for some attention. My first thought was why would this guy do this if he had such a great dog? Perhaps his problems outweighed the love his dog had for him or vice-versa. I was concerned for the dog, so I asked what would happen to him. The firemen had obviously been thinking the same thing and one of them said, “We’ve been talking, and if there is no family, we’ll have the officer bring it by the station, one of our guys will take him home. He’s too cool to go to the pound.” I felt relieved.

Suicide is sad, but it doesn’t really bother me. At least the guy did a thorough job and didn’t botch it, leaving himself permanently disabled and a drain on his family. I was genuinely more concerned about the dog. You would think that if I was going to be bothered by something, it would be the missing half of this guy’s head that was all over the yard, but instead it was the welfare of the dog. Is it wrong to be more worried about the dog? I don’t think so. The patient removed the need to worry about him quite effectively.

Madness In The Big City

The apartment was in a shitty part of town, was small, and smelled funny. As we approached the living room where our patient was to be found my preceptor encountered "the room mate."

"I don't know what's wrong with him, he's acting funny and talking crazy," said the room mate as he sucked the life out of a cheap cigarette and blew the smoke in our general direction.

We walked in the living room and found two largish police men with annoyed smirks on their faces. As I am the student, I was pushed forward by my preceptor; I approached the patient while taking on my slowly developing compassionate yet authoritative stance and asked, "What's going on tonight?"

He nervously looked up at the cop that was nearest him and asked, "Should I tell them the whole story?"

"Sure, I think you should," said the cop as he gave me a knowing look and tried not to snicker. I immediately suspected that he was attempting to make me work harder than I should have to.

"The long version or the short version?" The patient was obviously nervous and had some sort of altered mental status. I was thinking some sort of amphetamine or other stimulant like cocaine or crack or all of the above. This was bound to be interesting.

"These are medical professionals, I would definitely go for the long version. My preceptor looked and me and rolled her eyes. It was now obvious that the cops were infinitely amused by our patient and felt it was important for us to participate in this amusement.

"Well, you see," our patient nervously continued, "when I was in high school, I was good looking, blond hair and blue eyes you know... I had all the girls, girlfriends all the time you see... I was pretty popular." I immediately began to wonder what any of this had to do with what was going on tonight. I tried to steer him into talking about what was going on right now but met with little success. "Let me tell you my story and you will see," the patient continued. I could see that he probably was in fact a pretty good looking guy at one point, but these good looks had left him long ago with hard living and excessive drug use.

"I had all the girls you see, but I always had this deep secret, this fantasy. I have always wanted to have sex with two large black... I mean, you know, African-American men. Always had this fantasy. It made me crazy with sexual feelings this fantasy you see. So, I did cocaine. Cocaine makes you crazy sexual you see, intense and crazy. I used cocaine to fulfill this fantasy, it's wrong to have sex with men like that but I always wanted it." My preceptor now had the funniest expression on her face. She is seven months pregnant, it just seemed funny that she had this quizzical expression on her face. Moms-to-be shouldn't have to listen to some coked up dude open up like this.

"So I would smoke it, shoot it, snort it, whatever. Well, I have been clean for 90 days now, but I just couldn't take it anymore, the longing, the sex. I had to do some meth tonight to get away from the feelings, but I am fine, really, I don't have any problems, I don't want any trouble." His pupils were huge and sharp. The guy couldn't hold still, he was obviously tuned up to the max, but he seemed fairly ok. Other than his burning desire to open up to total strangers, I wasn't exactly sure what his problem was.

The rest of the call went smoothly. He was actually a pretty nice guy. My preceptor let me handle the whole call, I am pretty sure she was laughing inside by the looks she kept giving. I guess it takes all kinds... but really.

Back In The Fast Lane

So here I am again, back in the big city getting ready to begin the last phase of my field clinicals. I am excited and apprehensive at the same time, but I feel I am ready. Mostly I am ready to be done with this paramedic program, but also I am ready to see and do some really cool stuff.

The city itself is a little crazy. I didn't mention this after my last visit down here, but I have to say that the city is no longer the place for me. I have lived in big cities, small cities, totally huge cities... I am done with them. I think I am from now on at most a town kinda guy. Towns are small, often they are cute, and usually you know everyone from the post man to the police man.

I actually get a bit of anxiety being in a city now. I feel like I need to be wary for some reason. I guess it is just a function of being around so many people again, but I don't know. I was never wary when I lived in New York City, nor was I wary when I lived in San Francisco (well, I was wary one time but that is another story). Now, from lack of exposure I suppose, I have become wary.

Hopefully the big city will prove my wariness to be unfounded. Just may take a little time to get used to people, traffic, fast food, and all that stuff again.

The First Round

Geez, I just realized how long it has been since I last posted. As you may have guessed, I have been mucho busy. I passed all my last exams, finished my hospital internship, and have just returned from my first foray into my field internship (FI).

Intimidated, unprepared, downright flustered at times; these words only nick the surface of my first 120 hours of FI. Sitting in class and passing tests, playing on dummies for practice... these things hardly prepare you for the real patient in the field with an experienced paramedic or two looking over your shoulder. It is difficult, but I learned more in the first 120 hours of my FI than I think I did in 2 years of class time and 600 hours of hospital internship. It was good, it was exciting, and boy howdy was it challenging.

My next 120 hours will undoubtedly be more challenging as I am supposed to move into the team leader role full time and actually be 100% in charge of the patient and the care they recieve. I am anxious, but I am ready; I think I will do well.

I will try to post here throughout, but I can't make any promises as I usually have to read constantly when not on the ambulance. There are about a million little tidbits of information jammed somewhere in my brain that I just don't know well enough to provide for total recall, so I read and read and read and read. Hopefully I haven't lost any of my two or three loyal readers. Hang in there, I promise to be back soon!