Category Archives: Medical Aid

yeah, yeah…ok, ok

The brain works in amazing ways.  Our understanding of what is happening around us can be completely distorted by chemicals we ingest or otherwise introduce into our bodies for a variety of reasons.  Be it medicinal or recreational, habitual or experimental, the brain interprets it’s surroundings as best it can and adapts actions based on those signals it receives.  The signals, however, are often changed by the substances we have ingested.

Case in point:

“Scooter Dude.”

 

THE EMERGENCY

I’ve been special called as the Paramedic Captain to a “Major MVA” involving a cycle.

 

THE ACTION

As I arrive first on scene, since this occurred not far from my favorite coffee shop (MC would be proud), I find a man slumped over the remains of the windshield of the scooter in the middle of traffic on a rather busy 2 lane road.  The engine is not far behind and we approach the scooter, which is still running to assess what has happened.

I’ve been to more than my fair share of “man slumped over steering wheel” calls but this is a first.  I have to pull my sunglasses down my nose just to be sure what I’m seeing isn’t a reflection or other distortion from my $25 Target glasses.

Sure enough, he’s balancing the scooter and unresponsive over the shattered windscreen, helmet on the ground nearby.  The front of the scooter is also smashed and the engine driver has discovered a few nearby cars with damage consistent with a run away scooter.

Our initial interventions were obvious, get him off the scooter, but as we grabbed under his arms he suddenly awoke.

Confused and clearly under the influence of something you would find on a pool table, his 6’2″ 225lb frame is rigid and mimicking trying to start a motorcycle.

Our calm introductions are met with a diaphoretic face, lip licking and a simple phrase repeated over and over again, “Yeah, yeah, ok, ok,” all the while his brain is convinced he is trying to make an escape on a motorcycle.

As the police arrive our friend is convinced he will remain on the cycle and even our basic interventions to lift him away are putting us in danger of not only a physical altercation we would surely lose, but the concern the scooter will drive off or fall over onto us during his extrication.

Seeing no visible trauma I instruct the officers, who are allowed to fight back when needed and have training in forcibly moving people, to move him to the ground.

That’s when his brain suddenly realized he was not on  a Harley, but in hand cuffs on the pavement.

Panic.

It takes 6 of us to restrain him and apply a spit sock since he has taken to trying to show his displeasure with saliva mixed in with creative verbage regarding my mother and a slew of other relations.

As the ambulance arrived my hero leaped out with a dose of  IM Versed that brought our new friend back into the realm of the moderately co-operative.

It was an interesting presentation that later allowed us to discover, from witnesses, that he seemed to be confused and riding the scooter in circles in the narrow street, crashing into a number of cars before inexplicably stopping in the middle of the street, looking all around as if he was hidden, then slumped over the handle bars, seemingly asleep.

It was also a reminder to work carefully and clearly with law enforcement since their end game is a person unable to fight back and ours is being able to treat them safely.  Talking through your plan ahead of time with the officers to ensure your plan matches their concerns is key to making sure a handcuffed recumbent patient becomes a properly restrained supine patient with no injury to any party.

And although chemical sedation was indicated and used, be sure to follow your local protocols when encountering agitated people who could mop the floor with you on any given day.

Engine 99 in Pursuit!

I do love how some of our clients seem to have life threatening illnesses and injuries, then seem to have the energy and nimbleness of a child avoiding bed time.  Recently we had yet another client who thinks we’re not paying attention.

 

THE EMERGENCY

A man is reporting he is unconscious.

 

THE ACTION

No, seriously, that’s what the screen says.  “The problem is: Unconscious, breathing status unknown. This is a first party caller.”  Dispatch inefficiency aside, this always makes me smile.

Being only a few blocks away, we’re on the scene and indoors faster than he expected.  Just past the lobby where the only phone in the building is kept behind a desk, the clerk is pointing up an open staircase and we hear her voice trailing off “…6th floor…”

We mount the stairs and look up only to see a tiny face behind an unkept beard looking back at us.  He picks up his pace, but we do this all the time.  Closing the gap, he ducks down a hallway and is hobbling with impressive speed despite all our calls to stop and wait for us.

He closes the door just as we catch him.  Opening the door we find him, you guessed it, on the floor, eyes closed and completely out of breath.  As we assess him he spins a yarn about having been so weak he can’t walk.  Even after chasing him up almost 3 flights of stairs after he walked the first 3, then running down the hall, he tells us he can not walk and demands the chair.

We load him onto it and carry him down the same stairs where the girl at the desk is apologizing for letting him use the phone.

“No, never deny him the phone,” I tell her, “but next time see if you can talk him into waiting downstairs.”

Day Tripper

A friendly reminder to all my clients:  There is no point in lying to me, I already know what happened.  Your event is nothing new, no matter what it is.  You act like a 14 year old trying to hide porn under your mattress or cigarettes in your sock drawer thinking you’re the first to ever think of it.  So when I ask you a question, and you lie, and I ask the question again, take the hint.

 

THE EMERGENCY

A fall victim is bleeding.

 

THE ACTION

OK, I’ll leave the reasoning for a code 3 response to a “possible broken nose” aside for this once because what happened when we got there was too much fun.

Arriving in the parking lot of the local market early in our shift we find a man seated awkwardly on the ground, keys and a small shopping bag nearby.  Also nearby is a half circle of a half dozen private security people from a nearby landmark who are all waving us over.  Thanks, fellas, never would have found you.

As I approach none of them breaks formation to come give me a candid run down of events, they just stand as if waiting for the show.

That was my first indication this would be interesting.

HM: Hi there, I’m Justin, are you OK down there? What happened?

DT (Day Tripper): I just want to go home, but they won’t let me.

HM: Who won’t let you? These folks? (As I motion to the security guards)

DT: Yeah, they called the cops.

HM:(as I’m completing my primary and beginning my secondary) Well, I’m not the cops, how did you end up on the ground and where are your glasses?

The 1cm laceration on his nose and cheek give away we was wearing glasses when his face hit the pavement, he has no other injuries.

DT: They took them.  Can I go now?

I helped him to his feet and we brushed him off, which is when his lack of balance gave away that the odor I smell is not crappy cologne that smells like vodka.  He stumbles into me as I’m holding his hand and the ambulance has pulled up about 12 feet away and opened their doors.

We walk (Oh. My. God.) to the rig and he’s looking over his shoulder at something behind us with a new fear in his eyes.

The police are now on the scene and one of MC’s buddies is off his bike and notices our new friend’s keys on the ground.  For now he keeps his distance.

DT: I don’t want to go to the hospital, I don’t need a hospital.

HM: That may be so, but lets just get a few things sorted out first here in the ambulance where there’s less of a crowd. How much have you had to drink today?

DT: I’m not drunk.

HM: That’s not what I asked.  Let’s start all over again, shall we? My name is Justin and I’m here to help you.  How much have you had to drink today?

DT: Nothing.  Who do you think you are asking me that?  I want your badge number.

HM: I just told you, my name is Justin and I’m here to help you.  Now, we’ll start over again keeping in mind I do this all day long.  This is how I feed my family, so when I think something is going on, chances are it is. Alright?  Hi, I’m Justin.  How much have you had to drink today?

DT: (Looking over my shoulder at the motor officer) a few shots.

HM: Thank you.  See, that was so much easier than lying to another man in the face.  Don’t you feel better?

DT: yeah. (almost proud of himself)

HM: Great! now, how many is a few? To me a few is 4.

DT: Yeah 4. (Now he begins to smile)

After establishing the time frame of the ingestion and the type of beverage and checking our other metrics for assessment the decision is made that the patient does not meet criteria for refusal of transport.  Myself and the transport medic agree it may not be necessary, but he fails 3 of the 10 requirements to refuse.

DT is not thrilled and begins to tell us all about how to do our jobs.  He was about to climb out of the ambulance when our friendly neighborhood motor officer stepped to the tailboard and peeked in.

MC: (Not the real MC, but the boots were nice.) If you step out of this ambulance and reach for your keys we’ll be speaking to one another.

DT sat back silent.

DT: OK, I’ll go.

Almost in a whisper he agreed to be transported because the other option suddenly seemed more complicated.

Likely story Pal. I call your bluff.

On a recent job at the PD Station (Looking at you MC) we were confronted with the standard clearly exaggerated complaint without clinical signs.

A man arrested for possession of a controlled substance has suddenly developed asthma, or as AmboDriver calls it, Acute Incarceritis.  Since our boys in blue have zero medical training it is thought that by calling me in it covers their bases.  What it does do is screw with 2 emergency agencies instead of 1, especially since he’ll be medically cleared by an RN at County.

But enough of that, let’s get back to Bubba.  Bubba was arrested off site and developed asthma after they searched his car.  When I assessed him and was unable to find any sign and catch him in confusion about what asthma is and how it is treated, he tried something new.  New to me at least.

Like out of a movie he scrambled, looked around the holding cell and cried out, “I left the stove on!  You have to let me go or else my house will burn down!”

I smiled, my EMT partner smiled and the cops frowned.  They knew exactly what the next 20 minutes would entail.

“Are you sure you left the stove on?” I asked him.

“Yes, let me go! Let me go!” He shouted.

So I called it in.  I then informed him that in the next 4 minutes firefighters will be breaking down the door to ensure the fire on the stove does not spread.  Then, when finished, the police will enter the house to take custody since the door will be destroyed.  They’ll likely take a look around to make sure there are no other hazards.

The color drained from his face as he likely recalled what was left in plain sight in the home.  I’m no legal expert, but I’m pretty sure he just got himself in a ton more trouble.

Minutes later we hear the first engine on scene with nothing showing, force entry and immediately call for PD.

I never did hear what they found or if there was even food on the stove or not, but if you lie to me I will call your bluff.  Then smile when it all falls apart, because in the off chance you do win, I still have to take you in, just like they made me take him in to get “checked out.”

It’s a Building Alarm! No, it’s a Psych Eval…It’s Both!

Nothing gives me greater pleasure than gearing up for a building alarm only to have to sit someone down on the running boards and evaluate them for a medical complaint!

THE EMERGENCY

The Boys in Blue have requested a full alarm assignment for an odor of natural gas in an apartment.  That they are on scene at. Inside.  Inside the unit with the odor.  Ahem…

THE ACTION

Nothing showing on first arrival and we’re packed up and I’ve got the can on my back up towards the second floor.  At the doorway, the Officers are walking out the occupant of the unit, who is rather embarrassed we’re there.  Well, in descending order I’d say he is, intoxicated, high, in trouble, confused, lying, then embarrassed.

On the landing we can smell the gas and I’m told the occupant appears altered from exposure to the gas.  Not seeing any indication of this in the bright lights of the hallway, we head down into the night air outside and the running board of the fire engine.

PD has been kind enough to keep me out of the complicated loop of ordering an ambulance, but I quickly slow them to code 2 when the story begins to take shape.

The story is one I’ve heard thousands of times in as many variations.  A tale about seeking treatment at an ER and being turned away without being able to see a doctor.  Nurses spitting in their faces, ambulances taking them to the bus terminal, all the things that if they did happen, we would surely know about.

No, my new friend is the picture of health except for the alcohol and prescription sleep aids that don’t seem to be doing the trick.

“So why turn on the gas?” I ask as the ambulance rolls up and I confirm another ECG is normal.

“No one will help me so I figured I had to go out and get it myself.”

“You do realize you made us come to you, right?” says the voice over my shoulder and the EMT from the ambulance has got a straight forward BLS transport ahead of him.

So what was the disposition of the call for the official record?  Well, building alarms have no section code for “Psych eval” and the ePCR, while coding for life preservers available but not deployed, has no entry for police overreaction.

Glad it isn’t my report.

A dream within a dream within a dream

Before I get into the details of a fictional event, let me mention that the Black Diamond X Boot I reviewed did not go through a test I would have imagined until just recently.  I can now confidently say that if I ever have to walk 100 meters in sand, this boot is not bad to have on.

Now into my dream, partially inspired by the Motion Picture Inception, featuring the lovely Marion Cotillard.

The alarms ring and I’m in the new firehouse.  The bells sound different, but the feeling is the same, “Where am I and where am I going?”

Lights flashing, the engine winds it’s way around the access roads until we reach the parking lot of the beach and the ambulance responding with us is close behind.  We pull into the empty lot expecting to see someone looking for us but no one is there.

The screen tells us the person is conscious and able to walk, but has yet to present themselves to where they said they were going to be.  As we sit, lights flashing, clearly visible for at least a half mile, my mind wanders back to the nice warm bed back at the firehouse.  Perhaps I’m still in my bed and this is all a dream?

Just then the PD come roaring into the parking lot, open a locked gate and wave us through.  Even in my dreams we don’t take the engine into questionable places.  Good for us.

The ambulance crew, my EMT and I grab the gear and begin to hike down to the point where a wide staircase awaits us.

Still no one visible despite our flashlight beams and calls in all directions.

We are met with only silence and darkness.

“We’ll go this way,” the officer motions to the west, “You go that way.”

“In your dreams” is what I meant to say and, in fact, deeper I went into this new dream, now walking east, seeing another officer’s flashlight many meters ahead.  I suddenly notice I’m in heavy boots.  Looking down, the reflective stripe on my pants is now blinking and I wonder why.  Looking back up the officer ahead is doing the signature “over here” wave with his light.  It sparkles like a star in the night sky above.

The crew follows as we radio ahead to see if extra equipment is needed.  The response is vague, stating only “He OD’d.”

This deep into the second dream, time is slower.  Each step seems to get me 1/2 step closer to the victim, but we’re all traveling at the same speed.  Almost like when you try to escape in a dream, but your legs won’t respond.

Finally reaching the small bon fire 3 fellows sit, arms on legs, talking to the officer who now uses his flashlight to take notes.

“Someone laced my weed, man, I need help,” one of them says, standing and brushing the sand off of his pants.

Turning to the ambulance crew I mutter, “I have to be dreaming,” and I fall deeper into the dream this man is having, where smoking weed for 3 days straight, running out and realizing it is cold and a long walk home merits a 911 call.  Trapped in his dream I have limited options and have to do what he wants.  It’s his dream.

The walk through the darkness is aided by flashlights and a comforting arm under his, making the trek easier by far.  For him anyways.

We complete the 100 meter walk back to the flight of stairs, when he changes his mind and wants us to leave him alone.  It seems his dream is beginning to unravel at the seams.  The arm he has been leaning on through the sand and up the stairs is now forcing him forward, up to the ambulance.  What began as a simple question and answer session surrounding his health and well being has now devolved into a shouting match.  The beach disappears in a flash of bright light and he now lays calmly on a stretcher in the back of an ambulance, trying to regain the nice dream he had been having, leaning on another and borrowing light to make the trek back to the parking lot.

I’m back in the Officer’s dream now, his hand on his cuffs, ready to spring into the back of the ambulance and restrain the uncooperative man with any means necessary.  From my vantage point outside looking in, he can use all manner of holds, strikes and language to make the situation safe, whereas if I even use colorful tone I could get in trouble.  If this was my dream…

…I’m back in the engine, returning to the station.  The sun will be rising soon and I can feel the warmth of my sleeping bag as if I was in it…

…and then I awake.  In bed.  At work.

It seemed so real, but it was only a dream.

When I took my boots off the engine however, they were covered in sand.  How is that possible?

Peek a boo I see you

blog engineOne of my 101 things your Fire Department wishes you knew widget is one about lying to me.  I do this all day long, I have seen it all and what you’re saying isn’t stirring the kool aid.

Oh how I love to have these kinds of conversations with my clients.

THE EMERGENCY

Just like you saw in Episode 1 of CoEMS, Chest pain at the pay phone.

THE ACTION

Although our company is most often in quarters when the bells ring, we were on our way home from shopping this particular morning and it was raining.

When the call came in we were amazed we were not only a block away, but could see the pay phone in question.  But alas, there is no one at the phone to receive my assessment.  But he saw us alright.

You see, the pay phone does not have shelter from the rain, but the gas station across the street does and he’s running as fast as his little legs can get him, almost getting hit by cars as he goes, and dives into the dirt and bushes near the edge of the gas station, amidst a number of recyclables.

We pull up and exit, wondering why he ran, but knowing why.

“Sir! Sir, did you call 911 just now?” I ask.

He remains still, curled up into the fetal position and holding his eyes shut tightly.

“We saw you run from the phone to here, we know you’re awake.”

Silence.

At least we’re not in the rain.  I suggest to the officer that we better have the police dog come by and make sure this man is alright, something I’ve always wanted to try, but the opportunity never presented itself.

Knowing how I think the Officer lifted the radio to his mouth, but didn’t key the mic.

“Yeah control, we need the K9 unit at this location,”

“NO DOGS!” He’s awake and shouting at us.

“Hi there, did you call 911 from that pay phone?” I ask noting he is in no distress I can see.

“I need my medications, they were st-I took them all.  All at once, I need a psych hold.” His mouth is racing faster than his mind and all the magic words come flying out in one quick blurb.

Great.

He refuses the free ride to a shelter we provide and also refuses to tell me where he is from, “Here” is how I know him to be lying, and he insists he took all his medicine at once in an attempt to hurt himself.  But this is when a good practitioner goes down that road, because you never really know.

“What did you take?”

“Morphine, a lot of morphine.”

“How much is a lot?” Comes the voice of the transport unit, now approaching from over his shoulder, listening to the conversation.

“1600 milligrams.”

I would be lying if I said we all kept a straight face.

“I’m sorry, I didn’t get that.  Could you repeat it please?”

“I took 23 60 milligram capsules, I could drop dead any minute.”

Gathering my composure, and watching the others do the same, I asked him when he took all these super morphine capsules and his answer will not surprise you.

“Yesterday.”

After 5 minutes of trying to convince him to get into a shelter, the transport unit decided there was no way to rule out the ingestion so away they went.

We gathered our things and went back in service just in time to catch a run for someone who needed ALS interventions right away.  And that’s no lie.

Well, isn’t that what you paid for?

blog engineSometimes when I feel like everything is going right in the universe my clients pull me back down to earth kicking and screaming.  I never doubt what they tell me, good heavens no, but I always wonder…if they purposely seek out, pay for/barter, then ingest “speed,” what did they think was going to happen?  Sleep?

THE EMERGENCY

First job of the morning has us responding to a reported shortness of breath at a restaurant.

THE ACTION

Anaphalaxis, my first thought too.  I had only just checked the jump bag, knew I had 4 good doses and three needles ready to go.  Benadryl also at the ready, we park in front of the somewhat questionable eatery and are waved to the rear entrance.

O…K…?

A few twists and turns into the kitchen and I’m asking my usual questions,

“Did you report a life or death emergency?”

No response, only a wave to follow.

“Did you call? What’s going on?”

Come on, come on, over here, over here he waves.  It would have been cooler if he went to one knee and did some of that cool Navy Seal hand gesture stuff.  I totally would have done the same.

“Employee or customer?”

“Is no employee no customer, he come running in.”

And it is then we find our client wearing a new hole in the carpet running back and forth ringing his hands together.

“Are you alright Sir?” i ask trying to slow him down enough to assess him.

“I can’t, can’t, breath, I’m going to die.” He tells me in clear, yet quick breaths.  The decision is made to guide our almost olympic sprinter towards the cool morning air.

Outside he’s grabbing onto my jacket arm asking me to help him.  With our almost embrace I can see his pulse racing at the carotid, easily over 150.

Finally giving him something else to grab onto, a dumpster nearby, so I can actually assess him properly.  It’s then that the lies start to fly.

“I’m dying.” He screams.

“When was the last time this happened to you?” I ask while listening to clear lung sounds and making a safe assumption (educated guess).

His eyes shot to mine with a hint of anger and more than enough embarrassment.

“What? Um, never.  What do you mean?” He’s scrambling, looking all around trying to think of something to explain away his condition.

“When did you take it?  About 20 minutes ago is my guess.  Slow down your breathing, you’re going to be just fine.” I turn him to me, man to man, and try to show him how to take deep breaths.  That so rarely works, but I always try.

“Yesterday.” He suddenly speaks slowly, relaxing.

Turning his shoulders back towards me I call him on it.

“How about just before you ran into the restaurant?  Yeah?” Was my response, then I just let him wonder how I knew.

The ambulance arrived shortly after our discussion and he of course requested transport to discover what on earth could have caused his heart to suddenly race, nay, hurry, no, speed.

Gee, I wonder.

From the Archives…Bubba’s Bad Temper Pt II

The pre-Chronicles retrospect of favorite posts continues with part 2 of the 3 part posts about a patient who didn’t exactly behave himself.  My partner on this job recently went light duty and pulled strings to let me keep her spot warm while she’s gone.

Originally Published June 25th, 2009

blog medicRound 1 seemed normal enough, at least as normal as things get in the big scary City some nights.

Round 2 begins as I’m assisting Bubba down the stairs and he decides an elbow to my face would make his night better.
Luckily, I watch a lot of movies. Not fighting movies or martial arts movies, Happy is a lover, not a fighter, but I enjoy a good strategy and tactics film when I can.

I had 3 options as Bubba took his first of many swings.
Option 1 – Let him hit me. Um, no.
Option 2 – Try to duck or dodge out of the way. I’m not one for choosing the direction of an assault and I figured I had a 1 in 3 chance of moving the correct way.
Option 3 – Close the range to target.

What came to my mind in a flash was the Hunt for Red October. When he turns into the path of the torpedo before it can arm itself. My reasoning after the fact seems perfect, in the moment I just needed him to chill.

The bottom of the stairs had along it’s side a large wrought iron ornamental security gate, the kind we have to force open most days.

As Bubba moved with the elbow, I forced my shoulder into his, jamming him into the gate. My right leg got up under him to throw him off balance while my left hand dropped the computer and squeezed Bubba against that gate. I knew if he got me off balance and I went to the ground I was going to get hurt.

My partner was already on the radio screaming for police assistance. She had to scream to be heard over the screaming of, in ascending order of volume, Me, Bubba, the girlfriend:and mom, who’s voice had found new heights.

Bubba was my height and had at least 20 pounds on me. I was tired and sober, he was drunk and rested. My only hope was to keep him against that gate until the cavalry arrived. All I wanted to hear was the screaming of the police sirens.

I was able to get his right hand into mine and forced behind his back, now near my waist. His left arm, the one that swung the first time was pinned between him and the gate, not moving for now.

The scene from Pulp Fiction when Julius is telling Honey Bunny to be cool was playing over and over in my head and I’m sure lines from the scene were coming out of my mouth. All I remember is wanting to keep his 230 pound frame off balance and against the gate which was almost more than my one leg could do.

After what seemed like hours of holding him he began to calm and still no sirens filling the night air, only screaming. He promised he was “OK,”and I reminded him that I had no problem keeping him there all night if I had to, a thought my leg would most certainly disagree with.

I decided, possibly foolishly, to let him back down to the ground, partly for a rest and partly because he had indeed calmed. I kept his right hand behind him and made a reach for the left wrist, controlling both rather well considering the circumstances, I thought, and we slowly made the drunken, angry stumble towards the ambulance, feeling him squirming and trying to get free the whole time.

There in the middle of the street, mother still screaming and us now screaming at her to go back inside, Bubba sees an opportunity to try knocking me down again. He’s got one leg up on the rear step of the ambulance and one hand on the rail to climb in when, I’m told later by my partner, Bubba takes a swing. All I recall was seeing him shift his weight and losing my cheerful disposition.

He quickly found himself flat on the cot as I tackled him into the ambulance, landing one leg on his hip and one arm on his chest. I’m not entirely sure it was one maneuver but I would have loved to see the video.

As we’re struggling now in the ambulance, as if by stealth, a sea of blue rushes the back and there are no less than 3 boys in blue saying and doing things that I can not. They have him four pointed and are able to clearly shout over the rest of the commotion outside where I can make out at lest 2 more officers dealing with mom and the girlfriend.

I look at my partner and share a look of, “Holy s*it, did that just happen?”

I took off my duty jacket and took a deep breath throwing it to the bench seat in frustration, suddenly feeling the strain in my shoulders and legs from holding him for what turned out to be 4 minutes against that gate.

The officer looked to me and told me he was impressed I didn’t fight back. What I had taken as staggering towards the ambulance, they had seen from afar as him struggling and swinging elbows, all while I’m walking behind him.

The final part of our tale, Round 3, will be covered tomorrow morning, Friday as a perfect You Make the Call.

From the Archives…Bubba’s Bad Temper

Another co-worker recently reminded me of when she and I met Bubba one night, leg wrapped in a towel, tied with twine and an attitude.

Originally published June 25th, 2009

The next 3 posts will cover 3 distinct parts of a rather interesting job.

Round 1 – Tblog mediche Dispatch

1:15 AM and the MDT tells me you’ve cut your hand. It also tells me you’re in your twenties. It doesn’t tell me if you’re seriously calling 911 for this. I assume you know more than I do about who needs an ambulance and away we go.

THE EMERGENCY

A man has accidentally cut his hand.

THE ACTION

This was a perfect storm of mystery, intrigue, alcohol and lies. The building is older and has a large partial S staircase leading from the street level to the first floor door. So when we start our trek up the dark staircase, the front door is out of our sight above us and to the right. I stood there at the bottom of the stairs, tired already from the first 16 hours of the shift, waving my arms at the motion sensor light that, apparently, has yet to be installed. Warning flag #1.

The door is open and I hear high pitched voices speaking, nay shouting, in a language I do not understand. As is habit I scanned the floor for blood. I see none. In the next room is Bubba. (See Glossary of Terms)

Bubba has his pants half way down and has a towel tied to his thigh with twine.

“Hi there.”I say, hesitant to put anything down quite yet.
He mumbles in response. Even just this slight mumble sends a waft of alcohol breath my way that would have caused me to fail the brethalyzer right then and there.

He’s telling a story about opening a can of oysters and missing, hitting his leg. Then, after a few questions he tells a different story about how he got cut. All the while I’m telling him I know he is lying. And all the while the mother and the girlfriend are shouting and won’t leave the room until my associate for the day finally convinces them to give us peace and quiet.

His leg is cut, not his hand:warning flag #2.

Using my Happy Medic skills we’ve convinced Bubba to come to the hospital to have the 5cm wide 2-3 cm deep wound from the chef’s knife examined.
Oh, did I skip that part? After arguing with the landlord Bubba thought it would be a good idea to get wasted drunk, grab a couple of knives from the kitchen and wave them around like a child demanding more dinner. Darn it if those things are sharp when you get a little too animated.

His mother and his girlfriend, who hovered over my discussion with Bubba in the room are still shrieking in their native tongue and Bubba is trying to shout back at them as I’m guiding him towards the front door and down the stairs.
Quick aside, the wound is wrapped, not bleeding and he flat out got angry when we tried the chair. Warning flag #3.

Halfway down the dark stairs I have my hand under his arm to help him balance, as I offer to everyone I treat. I have Bubba in my right hand, one step ahead of him and the electronic PCR in my left. I looked away to check the bottom steps. When I looked back up:warning flag #4, a swinging elbow coming my way.

Coming soon – Round 2 – the Struggle