Holes

"Okay, gonna be a poke here," I said, as the ambulance bumped down the road.

"Is it going to hurt?" he asked, apprehensively, looking at the IV needle in my hand.

I lowered it for a second, looked him in the eye, grinned wryly. "Bro," I said, "You just got shot."

"Oh yeah," he replied, carefully supporting his bandaged, grazed hand, adjusting his legs to avoid putting pressure on the superficial, in-and-out wound on his calf.

"Alright," he muttered to himself as the needle went in. "I'm strong. I'm strong."

"Yeah," I told him, smiling, trying to put him at ease, attaching the IV tubing. "Yeah, you are, and you're gonna be just fine."

Headaches

When the tones went off I'd been asleep for maybe an hour, in the recliner. "Ladder 12, Medic 38, an unconscious unresponsive..."

Goddamn. We already worked one code tonight.

Outside, my partner is sitting in the ambulance, doing his crossword. I look at the computer as I hop in the driver's seat. Female, unconscious, heavy breathing, the notes said. Good. Not a code.

When we get there a quietly anxious man in his thirties leads us back to a bedroom, where a woman about the same age is in bed, barely awake.

The husband describes, while trying to wrangle a pair of small children, what sounds like a seizure, and she's acting like someone who's just had one. Vital signs are fine, and she's starting to come around. We wave off the sleepy firemen who come trailing in after us.

History, we ask? None, he says, shrugging, a kid on each hip. No medical problems. Oh, but she's had these headaches, real bad, for the past week. Nothing else, though.

Well.

I take the gear outside, bring the stretcher in. She's awake and halfway alert now, and gets dressed enough to go.

The house is the kind of happy shambles a young family makes, with clothes and legos on the floor. The older kid bounces around a bit, pointing to her younger sibling and saying, "Baby!" and then to us and saying, "Medic!"

It's adorable.

The father loads them up in his car as we load her in the ambulance. I walk back over to the front door. You know how to get to the hospital? Okay. We're not using lights and sirens; you can drive easy too.

On the way, as I drive, my partner does the necessary procedures and checks -- IV, EKG, etc -- and talks to the woman. She wants to know what's going on, and he explains she's probably had a seizure. Why? Could be a lot of different things, he says. Maybe a metabolic imbalance, blood chemistry off, something like that.

He says that and I want so hard, so much, to believe it, to believe that it's just a little metabolic imbalance, that she'll get checked out and ok'd and sent home in a few hours.

I want to believe that a week of headaches and a new-onset seizure at thirty doesn't scream brain tumor, malignancy.

I also want to believe that the little bit of welling in the corners of my eyes is just exhaustion, the end of a long night, but I can't fool myself there, either.

De Profundis

They say you become cynical, working nights.

They say that you get tired and worn around the edges, trying to sleep fitfully through hot summer days and the lives of everyone else, waking up for dinner, saying goodnight to your kids as you leave for work.

They say that nights are ninety percent bullshit and ten percent ohshit, and that the former makes you tired and bitter towards humanity while the latter takes years off your life and puts white in your hair.

They say, they say, and all of them are correct. (With apologies to David Drake.)

And yet ... every night you get to watch the sun rise.

And for every drunk who wants to fight, for every idiot who needs an ambulance for a tummyache at 3am, for every stupid nursing home that has to "send one out" at the end of your shift, there is a poor dumb scared kid who just wrecked dad's car and just needs their hand held. There is a sick, sick, bad sick old man who has been waiting and waiting, hoping his chest will stop hurting or his breathing will get better.

And sometimes, usually when you least expect it, there is someone who truly needs an ambulance and truly needs advanced life support; not just a ride to the ER but all the care you and your partner can give them.

And that, I suppose, makes the cynicism and trying to sleep in the light and the endless parade of big white taxi rides -- it makes all that okay.


(Welcome back, folks.)

Epic

Saturday morning. The whole call is like a movie.

*BEEP* *BEEP* *BEEP* "Engine 401, Squad 402, 4809, Engine 95, Medic 105, an echo response, cardiac arrest, across from Fargone Park, 49600 Wayout Road. Map page 6295-D, working Tac 2, time out eight thirty two."

We're a block from the fire station, going on a non-emergent walk-in sick person. My partner grabs the radio microphone. "Medic 105, we're diverting to the echo response at Fargone Park."

I hit the red EMERG MASTER switch, twist the siren knob to WAIL, and off we go. It takes us about eight or nine minutes to get there, hauling butt, and we beat all the fire responders (volunteers and paid from two rural departments).

About halfway there we get the expected update that CPR is in progress.

It's an area I don't know well at all, but my partner directs me; left turn, right turn. I drive hard -- either the gas or brake is all the way to the floor, the whole time.

We scream across a bridge, and we can see three or four people gathered around a man lying half in a mud puddle, doing CPR.

My partner bails out almost before the car is stopped, shouting to the bystanders, "Don't stop!" He grabs the monitor. I grab the hard plastic medkit and skid it across the pavement towards the patient, then sling the airway bag over my shoulder and run over. My partner drags the patient out of the mud puddle and the bystanders start compressions again.

They're doing good CPR, damn good in fact. They've taken a class recently and know the new standards.

Great. Keep going.

I pop an OPA in and start bagging. My partner gets the patches on -- "Check a pulse! None? Okay, we're in PEA. Continue CPR!" and starts getting stuff ready for a line.

I hear a growler siren and glance over to see the first of the calvary -- the squad and the duty officer -- pulling across the bridge. Brilliant.

A moment later we've got four or five firefighters eager to help. They take over compressions and bagging. My partner has an IV in, and starts pushing drugs. I rip open the airway roll and get my stuff set for a tube.

When I'm ready, I nudge the fireman aside, twisting my baseball cap backwards so the bill is out of the way. Drop to my knees in the mud, wipe rain off my face. Everything tunnels down to the narrow world of laryngoscope and mouth.

Suction.

Slip the blade in.

Look. See the cords. Lose them when I go to pass the tube.

Esophageal. Crap. Out.

Fireman bags. Adjust the tube.

Suction again.

Look again. A hint, a glimpse.

Lift his head all the way off the ground with my other hand. There. Bullseye.

Get a fireman to support the head. Cric pressure from my partner.

Perfect. Pass the tube, pull the stylette, inflate the cuff. Attach the BVM.

I bag as my partner listens. Good tube. My first in the field, after a frustrating series of misses and failures.

And the code goes on. I drop a second line and we start a fluid challenge. The PEA goes to v-fib and we start shocking him. We push the drugs: amiodarone, lidocaine. The v-fib continues. At some point the two engines, from different departments, show up. We keep rotating compressors for good CPR. At some point I run to the car for more epi.

The v-fib keeps going, and we've got to transport. Load him on a board, to the gurney, to the car. I get an escort by the duty officer's SUV out to roads I know. Manage not to throw my partner and the firefighters around too much.

By the time we're at the hospital he's in asystole, and been down over an hour. I code-surf the gurney in to the ED, doing good hard compressions. About eight minutes after we arrive the doc calls it.

My partner, running out immense code summaries, tells me they pushed twelve rounds of epi. We have to go out of service to quarters to get more drugs.

As we're leaving, I note that one of the bystanders seemed very emotional, on scene. "Yeah," my partner says, "it was his brother." They were enjoying some Saturday morning fishing.

I don't know if I could do CPR on my sibling.

And it was good CPR, too.

The Apartment Fire

It was about 9am, on a quiet morning just before the winter holidays. I was driving. My co-trainee rode shotgun. Our field training officer (FTO) sat in the jump seat in back. We were headed for a station in the southeast part of the city. Then the radio crackled to life.

"This is fire dispatch calling box 8513, report of an apartment fire..."

East of us, in a large suburb. We heard the assignment go out and clicked our second radio over to the operations channel. The first-in engine arrived and sized up what sounded like a decent fire. More apparatus arrived, and then --

"Dispatch from Command, start us a code 3 ambulance."

My co-trainee and I looked at each other. "Are we closest?" I asked.

"I don't know," he said. "Maybe? Levels are low..."

A few more seconds went by. "Huh," I said. "We must not be--"

Five things happened at once. Both of our radios alerted, an unmistakable BEEP BEEP BEEP BEEP. The computer bleeped a priority tone, doo-doo-doo-DEEP. Three pagers started vibrating. A screenful of information came up on the computer with the highlighted text ASSIGNED in the middle. And the dispatcher told us we were going out to the fire.

I looked at the address, asked over my shoulder to my FTO, "Straight out this street, right?"

"Yup," he said. A second later he added, "Only about a hundred and ten blocks away." The gas pedal was flat to the floor before I even hit the switch.

Forty blocks later, fire command updated us: "You have one patient, he'll be in front of the truck company on the east side of the complex."

Oh good, we thought. One patient. Three of us, we should be able to handle it, even if he's badly burned and needs tubed, or whatever. We got it.

"Additional for the medic unit, your patient has lacerations to his arms from glass."

Oh, jeez, we think. No problem at all. We're golden. We got it.

In thinking this we forgot the cardinal rule of emergency medical services, and indeed any 911 response: The radio always, always lies.

* * *

It wasn't hard to find the complex. Usually we respond to medical calls with a single piece of fire apparatus, and if they've arrived first the last directions from the crew member with the mapbook go something like, "Turn right on 42nd and look for the marker truck." A thirty-thousand-pound red truck covered with flashing lights is an excellent indicator of where the call might be.

In this case, there were six or seven such vehicles (five engine companies, two truck companies), plus a few command SUVs. We found the specified truck company and parked behind it. It was beginning to rain a bit. As we're climbing out, a firefighter comes hustling up. In all his turnouts. With his airpack on.

"Hey," he said, sounding a bit worked up, "we need your airway kit over here!"

Airway kit? I thought. For lacerations? Maybe he got some smoke too... I asked my co-trainee to grab the kit and I followed the firefighter. He led me right past the truck, and across the parking lot to a small SUV with the back hatch open.

Standing next to it, wrapped in a blanket, in pajamas, was a woman in her twenties, with soot on her face, darker under her nostrils and around her mouth. Tear streaks cut across the black.

Inside the back hatch, also wrapped up in blankets, were three kids -- a two year old, a four year old, and a six year old -- all with soot-darkened faces. One had a cut on his forehead, and dried blood streaked his face.

I'd like to say that in the five seconds before my partners caught up with me I thought something like, okay, four patients, we'll need at least one and maybe three more ambulances, and we'll need them all on high-flow O2 for CO poisoning, and we need to first off evaluate them for airway burns because we may need to tube them early, and we should probably declare a Multiple Patient Scene and get fire medics to help...

But the truth is, in the first few seconds, I could only stare at them and think, very loudly inside my head: Oh, sh*t.

* * *

My training officer took one look and came to all the conclusions I didn't. "Give me your radio," he said to me, "and get them to the car." He turned away, looking for the command officer for the fire, and said over his shoulder, "High flow o's, and check their airways!"

I looked over my shoulder. It's just me and my partner trainee. I ask the kids, "Are you okay?" and get solemn nods in return. "Okay," I say. "We're going to go over to the car now." I picked up the smallest one and handed him to mom. We got the other two, and all of us walked in the light rain to the ambulance.

We got everyone settled inside, and then it really got fun. A firemedic hopped in (fortunately she'd ditched most of her gear) and so there were now 3 paramedics and 4 patients in the back of the ambulance. Thank god we have the Type III boxes, but even so it was cramped. Everyone's airway got evaluated. Things looked pretty good for the kids, but mom had some soot in her throat. Everyone got on oxygen (just imagine the hoses snaking from two wall-mount ports and two portable tanks).

At some point my training officer stuck his head in the door and told us, "I declared a Multiple Patient Scene [sort of a low-grade Mass Casualty Incident] and we have a second ambulance coming. Do we need more?" My trainee partner and I looked at each other, looked at the kids, and shook our heads.

The denouement of the story is sadly -- or rather, happily -- quite boring. The other ambulance (coincidentally our sister car, working the same hours as us) took the two older kids, and we took mom and the youngest. I drove, with my partner trainee and FTO in the back. They thought about tubing mom -- apparently in the right sniffing position you could see soot all the way to her epiglottis -- but decided to hold off.

Everyone did fine at the hospital. Mom never did get tubed, and everyone's carbon monoxide levels came back low enough that they didn't need hyperbaric oxygen or even to be admitted. They left the hospital before we were off shift.

And our original patient that we never actually saw, with the lacerations? The heroic neighbor kid who discovered the fire, and punched out a plate-glass window to alert the family when he couldn't get in the door. He went by personal car to the hospital, and got all the media attention.

Well, almost all -- there was a lovely shot of our FTO's butt on the 6pm news. You'd better believe he heard about that.

Glimpses

Friday, noon: We crouch and kneel and stand, six of us, around a middle aged woman sitting on a chair in a department store. "I took a bunch of my anxiety pills," she says, sleepily, with pinpoint pupils. We struggle to start an IV, and eventually give her IM narcan. She perks up, and as we take her out to the ambulance she asks me, all of a sudden, "How long ago did you narcan me?" In the back of the ambulance she gets upset with my partner. Shouting, screaming, cursing, she admits to using heroin. She rips out the line we'd finally established, and tries to get off the gurney. A flexcuff keeps her down. As we take her into the hospital, she asks, "Why'd you have to f***ing narcan me, you a**holes? Why don't you just put a f***ing bullet in my brain? Just put a bullet in my brain!"

* * *

Friday, sunset: I sit in the cab of the ambulance, at a post that is close to huge bluffs overlooking the shipyards. It's unseasonably warm and smells like spring. I turn up the radio, roll down the window, pick up my book, and marvel that they're paying me for this.

* * *

Friday, night: She looks up at us sleepily. "I don't want to be here anymore," she says. As the firefighters try and get vitals, and the fire officer and some cops try and make sense of the pill bottles, I ask what she took. Something. Everything. We finally get a good list of the empty bottles: Atenolol. Xanax. Prozac. Nifedipine. Digoxin. We take her to the nearest hospital, code 1, no lights but a quick trip. They put her down, tube her, muttering urgently about the Digoxin in particular. I listen to a nurse talk on the phone as she draws blood. "We need ten vials of Digibind. ... What? You've only got five in the whole hospital? ... Well, get more! I don't care where from."

* * *

Saturday, evening: The three huge beers he had only compounded the pre-existing brain injury from a long-ago trauma. Somehow he set his hair and head on fire with a lighter. His wife, anxious, says he told her the lighter exploded. I look the offending implement over with the fire officer. "What do you think?" I ask him. He looks at the patient, looks at me. "Operator error," he says, sotto voce. We take him to the hospital with a burn center. On the way my partner pulls up his shirt to look for burns elsewhere, and he laughingly accuses her of getting fresh. His wife tells him to behave, and we all chuckle.

* * *

Saturday, after midnight: I agreed to work a double. Now we go code 1 to a club downtown. As we pull up we spot five or six cop cars, all lit up. "This must be us," I quip. Our patient is sitting on the curb, in handcuffs. Nasty cut above his eye. "I wasn't even involved!" he protests. We ask him which hospital he wants to go to. "None!" he says. "I want to go home!" We talk to the cops. I crouch next to him, touch his shoulder briefly. "Look," I say, trying to be kind and not condescending. "You've basically got two choices. Go in the ambulance, no handcuffs, a citation for the charges, and go to whatever hospital you want. They'll fix you up and send you home. Choice two, go in a cop car, still go to the hospital, and then go to jail." He eventually agrees, and falls asleep on the way up to the hospital.

Hey, Is That ... ?

Friday morning, we're dispatched to a sick person. Not many details on the computer beyond "80s female, flu-like symptoms." We're a few minutes out when the fire engine slows us to code 1 (no lights/siren). Must not be anything serious.

* * *

We walk in to find the engine company (three EMTs, one paramedic) standing around a woman in a wheelchair. She looks a little out of it, but not bad on first glance. The fire medic says that she's been lethargic, a bit confused, weak. Seen at the ER yesterday for flu. Looks like it just got worse today.

Right then the last sticker for the heart monitor goes on.

My partner starts, as do I. We saw the rhythm from the second it appeared -- and that's a scary thing to see pop out at you! The fire medic is still talking to the patient, and my partner taps him on the shoulder.

"I don't know about you," he says with the hint of a grin, "but I'd call that v-tach."

The fire medic's face goes white.

* * *

We Georgia her to the stretcher in the living room. I get the patches on her chest. My partner looks for IV access, doesn't see anything good for the big line we may need, and goes to his favorite fallback: an external jugular. I draw up 150 of amiodarone for an infusion in a minute as my partner and a couple of the fire EMTs get BLS airway gear set.

When we're all ready, my partner pushes 5 of versed into the line. We've been talking to the patient and her husband all along, and now I turn to him.

"Basically, sir, like we've said, her heart is in a pretty unhealthy rhythm. We need to get that fixed, and how we're going to do that is by shocking her -- basically pushing the reset button and letting her heart start back up in a normal rhythm. So that's what you're going to see, in a second."

He seems taken aback -- who wouldn't be? -- but nods. We sync up, charge to a hundred, and I say "everyone clear," calmly but firmly.



Beautiful. I announce in the same calm voice -- at least, I hope it sounded calm -- "Looks like normal sinus, guys." I go to get the amio infusion ready, and the fire medic starts getting 12 lead stickers on, when my partner pipes up from the head.

"I think we've got a bit of a problem." All three of us medics huddle up. "The versed took her down too far, which isn't a bad thing, since we shocked her -- but now she's not really protecting her airway." The fire medic and I nod, and I rip the intubation roll out of the airway kit and start getting set up. She's a moderately difficult tube, and I've had issues with tubes lately, but a little help from my partner and we've got it in.

Back to what we were doing. I get the amio infusion -- 150mg over 10 minutes -- running, and the fire medic and my partner get a 12 lead going. She's not having a STEMI, which is one concern down. She has a heart history, we've found out, and in fact was already on oral amiodarone.

Just as it looks like everything is calming down, the faithful Lifepak cycles a pressure again -- 90/40. Crap. Down from what it was a few minutes ago. We open the line wide for a fluid challenge, but it's obviously cardiogenic shock, and my partner asks me to go get the dopamine out and call for orders. About the time they get her out to the ambulance, I've got orders from a doc, and I'm on the way to having the pump ready.

It was my partner's patient, so I give them a quick, smooth code 3 ride to the hospital. Her pressure goes up, and then back down again, to a low of 70/30, and they do end up starting the dopamine just before we get to the hospital. We turn her over to the ED staff, and she looks to be doing pretty good.

Outside, the fire medic apologizes -- "I never would have slowed you guys if I'd known!" and my partner (who's been a medic for twenty years) says, "Dude, never in a million years, I'd never have guessed. No worries. No worries at all."

* * *

Eight hours later we're in the ICU at the same hospital, and we check in on her. She's extubated. We talk to the nurse for a few minutes. The patient is tired, but awake enough to say hi briefly when we poke our heads in the room. She doesn't remember us, and we both agree later that this is a very, very good thing.

Talking later, we get laughing. My partner says maybe he'll quit being a training officer and just work with me. "After all," he quips, "I may be a sh*t magnet" -- something he told me on my first day with him, which has seemed pretty true -- "but together we're a storm."

ROSC

My white cloud gave out on the last four-day rotation. We had four cardiac arrest patients in two rotations, 8 days (and an apartment fire with a total of five patients, but I'll save that story for later). Surprisingly enough, we got return of spontaneous circulation (ROSC) on all four, and three have survived past the 24-hour mark.

I was planning to write up three, and then we had the fourth, and the stories are just too long to tell. I'll try and summarize briefly.

* * *

Patient #1 was an unwitnessed arrest in a parking lot, very brady on arrival, v-fib soon after, transported immediately (work a code in a mud puddle in a parking lot? no thanks), tubed and everything enroute, shocked three times, the third shock at the hospital driveway ended up getting pulses back. He was very sick, however -- a primary respiratory arrest -- and died 20 hours later in ICU.

* * *

Patient #2 was a witnessed arrest at home, v-fib on arrival. Fire shocked him once, put in an EZ-IO, and had started CPR when we arrived. We worked him for 20 minutes onscene, going from fib to asystole to fib to v-tach to ugly sinus tach with pulses. He got lots of drugs, including early bicarb and amiodarone after pulses were back to try and get things working a bit better.

We did a 12-lead in the driveway -- massive STEMI. Code 3 to a cath lab hospital, transmitted the 12-lead. He started to have some spontaneous breaths, and then coughed the balloon of the tube out. Crap. We pulled over, got him reintubated.

He went up to the cath lab soon after we arrived, and after a successful cath went to the ICU, where at last report he remained in critical condition.

* * *

Patient #3 was a witnessed arrest in a bar on Christmas day. Complained of acid reflux and just plain dropped. Bystander CPR in progress. We start CPR, get him on the monitor. V-fib. Shock once. Converts. Get him tubed.

He has a perfusing rhythm and blood pressure almost immediately. Do a 12-lead right there on the bar floor. I should scan the strips, but the monitor reads "Inferior-posterior infarct" and "anterior infarct" on one shot, and then told us "septal infarct," "anterolateral injury pattern," and "inferior injury pattern" a few minutes later. I thought it just looked all bad.

Transmitted the strip -- I actually called the inital report from the bar, bagging with one hand. STEMI activation. We gave him an antiarrythmic -- I honestly can't remember if it was amio or lidocaine, I was on the airway -- and some versed because he was bucking the tube, and transported.

He coded again in the ED. Shocked 4 or 5 times. More drugs. Taken up to the cath lab. 100% occlusion of the LAD. Ballooned, stented. Called the ICU the next day. He'd been shocked twice more there, probably reperfusion ischemia. Then we had four days off.

Come back on New Year's Eve. Call the ICU. Not there. Dead, or to a floor, I wonder. To a floor would be cool. Call registration to check. Not in the hospital, they say.

Discharged, they say.

To home.

Unbelievable.

* * *

Patient #4 was after New Year's. Taking a cold shower. Family heard him drop. We found him in the bathtub. Agonal brady rhythm. CPR, IV, epi. What do you know, his heart kicked right back over and got going again. 12 lead was unremarkable. He tried to tank his pressure on the way in, but the fastest med control consult later by my lead paramedic and we had dopamine orders. That perked him right up.

The consensus among us was that the cold water stimulated his mammalian diving reflex, which caused him to brady down, which caused either a hypoxic bradycardic spiral, or a syncopal event which closed off his airway. Either way it wasn't a big cardiac event and I'm hopeful for his prognosis. Haven't heard anything yet, however.

* * *

So, statistically, having saved had 4 field ROSC patients in 2 weeks, I won't have any other saves for a long, long time. We'll see about that, though. I've got four shiny little Code Save pins coming, and some Starbucks cards for sending in tubes of blood for a Sudden Unexplained Death study.

Oh, and I've got a few other stories to write up, like the apartment fire and the patient who Should Not Have Refused.

At this rate, I'll get those out by February.

Noxious Stimuli

He was in his 80s, chronically ill with something -- I don't recall exactly what -- and barely breathing.

The house was up in the hills, tucked back on a windy side street. My training officer drove while I looked at the Thomas Guide and the fire mapbook and the MDC and tried to make sense of the streets. As we pulled up behind the fire truck, we saw a firefighter run out, grab the suction unit, and run back in.

"Huh," I said. My training officer was less reserved.

"They're gonna tube someone. Let's get in there."

* * *

He was all the way in the back, on the bed, flat on his back. Gurgling respirations. Didn't respond to voice or painful stimuli. His son was there, visibly upset. A DNR was taped to the wall next to the bed. We explained to the son what the DNR meant. No mechanical ventilation, no intubation. No, no, the son said, the DNR is for the underlying condition, this is different, I want him helped, and I signed the DNR, I'm power of attorney!

My training officer pulled out his phone and called medical control. I suctioned him out, dropped an OPA in and started bagging. Not a twitch at the OPA. His sat was initially 68%. A few minutes of good assisted ventilations later, he was in the high 90s. BLS works.

The training officer came back in. Said the doc agreed that if the son signed the DNR, then he could waive it, and we should do what he wanted. The son asked what we thought needed to happen. We told him that his father needed a breathing tube inserted.

"Okay, are you good at doing that?" he asked nervously.

"It's what we do," my training officer said.

* * *

The fire guys passed me the stuff I'd need. A grandview blade on the scope, the first time I'd used one -- they work great on the mannequins, though, and why not? We moved him around, got a pillow under his head. I put the blade in, saw nothing but secretions. Suctioned. Looked again. Suctioned again. Saw the epiglottis, moved the tip of the blade towards it ...

The training officer tapped my shoulder. "Uh, he's looking at you."

I looked straight down. The man's eyes were open. He started to close his mouth on the blade. I yanked it out like it was electrified.

"Whoa there."

"I guess," the firemedic said wryly, "he just needed a more noxious stimulus."

* * *

We took him to the hospital without lights and sirens, a nasal airway in place, bagging him. Probably a stroke. It seemed like a laryngoscope blade in the throat was the level of stimuli he needed to wake up, but less noxious stimuli did help.

Ten seconds more and I would have had the tube, but in the end BLS airway management kept his sats up and seemed to get the job done. Never heard about an outcome.

* * *

Working Christmas Eve, Christmas day, New Year's Eve, New Year's day. Probably be some stories come out of that. Also some interesting developments with the wilderness ALS unit -- more on that depending on what happens.

Oh, and so far my white cloud is winning.

A Shift, In Haiku

Your Audi: totalled.
My IV: A bloody mess.
Bad day for us both.

* * * * *

First radiation,
Then dizzy, fall, cut your head.
Cancer is bad news.

* * * * *

Too drunk to stand up?
But you don't want medic help.
Go in handcuffs, then.

* * * * *

You said it's asthma.
But we can tell the diff'rence.
What a drama queen.

With apologies to the inventors of the art form, and thanks to EMS Haiku for the inspiration to describe my day like this.