Hospice
First call of the day was for respiratory distress. The page was an ASAP, but we were told to run hot. I knew the area well-we were responding to a home address in my turf near the firehouse. I got the story from the hospice nurse. Our patient was a 49 year old female with end stage lung cancer. She was going to the hospital because she is getting worse. She gave our patient 120 mg of morphine in the last hour and wanted me to give her roxenol on the way (which I am not allowed to administer). I could hear her breathing once I got into the house; she was in the rear bedroom. The lady was very sick, but I guess this is where I get confused. The lady has been sick for a while, she is in hospice care, and has a DNR. I always thought the whole point of hospice care was so the person can die peacefully at home-not in a hospital. The nurse said we were not to do any interventions-no monitor, no IV, just oxygen. She said they would get a central line at the hospital. Okay...here's the kicker. We weren't even bringing her to the ER. She was going directly to a room. Yeah...I felt pretty silly running hot to the hospital only to unload the patient and bypass the ER. Whatever. I got the wierdest looks from the ER staff. I am walking by with a patient in obvious respiratory distress-tripod position, her lips were a little blue, her skin pale, eyes closed, monitor furiously beeping around 150-and not stopping at the ER. They must have thought I was really stupid. We got her settled in her bed and spoke with the nurse on the floor. I figured our patient would survive maybe a couple more hours.
These are my least favorite calls. Actually, I hate them. I felt terrible for the lady. She was suffering and all I could offer her was a hand to hold. Half of the ride I felt like I was torturing her. She kept pulling off her mask because she was struggling so much to breathe and probably thought the mask was the cause; and I kept putting it back on. I found out from a friend that works at the hospital that she died that evening-alone. Her family was back at home, where she should have been in her last moments, where her hospice care was taking place until we whisked her to the hospital for no reason. Damn it.
I did a call for "wound care." Our patient was non compliant with her care and turning herself at the nursing home, and now her wound was getting worse. Not a big deal, just a little drop off in the ER and off I go. My partner had me start driving while she got vitals. The blood pressure cuff was acting up. I was two miles down the road when it finally worked. Our patient's blood pressure was only 78 systolic. I was at a red light, so I turned on my lights and turned around (this road is hard to explain. You have to drive north to go back south towards the hospital) and pulled over to the side of the road so I could hop in back and see what was going on. Normally, I would let my partner do her thing and just drive, but we weren't going to the closest facility-we still had about 20 miles to go. I must have looked pretty silly. I was just driving along with no lights or sirens. Then I get to a light, put on my lights and sirens, turn back south, pull off the road, get out of the driver's seat and hop in back. Let's just say I had a whole bunch of people staring at me.
Once in back, I took a manual blood pressure (the last pressure we got was with the monitor). I got 98 systolic. Not especially critical, so we could still go to the desired hospital. The patient refused any care-she didn't want an IV. So, basically I got back in front and started driving. By the time the hospital picked up the tele line I was about 4 miles passed our "closest facility" and well on my way to being screwed if our patient started to crap out. The nurse on tele had no choice but to let us come because we were passed the closest hospital, and besides that it would take me longer to get off the highway, turn around, get back on, and go to the closest, our patient was relatively stable (besides the fact that we didn't have IV access). I ran hot to the hospital just for good measure. I didn't want to be caught in this situation if it went sour-especially since our patient was not a DNR. She was still doing okay when we pulled up in the ER-another job done.
I did a psych transfer for a guy that said he was suicidal. According to the ER staff he was playing the system-he needed a good meal and a warm place to stay. This wasn't his first visit. When we arrived in the ER to take him he was wandering around the ER, walking up to patients, sitting on their beds and trying to hold conversations. We got him going as quickly as possible. He kept saying he didn't want to go but he was cooperative for the most part. He told me that he almost tried out for American Idol, but he got bored standing in line. He told me I have to watch next season, because he will be the next American Idol. I told him I would be watching for him.
I did a call from a nursing home for a patient with diarrhea x2 days. She wanted to go to a hospital about 15 miles away. We tried to call report, but they were on full bypass. We took her to the closest hospital. Not an eventful call at all. She complained the whole way about how tight the blanket was and that she didn't like being tied up.
We took a psych out of the same ER as soon as we finished paperwork for the lady with diarrhea. They were pretty busy and the paperwork wasn't ready yet. I was standing chatting with a security guard when a patient stuck her head out of a nearby curtain. She said she wanted a nurse and opened the curtain a bit wider. I was shocked at what I saw. The lady was standing in a pool of blood-her gown was soaked, the bed was soaked, and blood was running down her legs in streams. I figured she was having a miscarriage, judging by the amount of blood. It took a while for the nurse to get to the room, and all the while this girl was standing in a pool of her own blood like it was no big deal. She didn't look scared or upset. She just said she was sick of sitting on a wet bed. Go figure. She was whisked up to L+D shortly there after.
Our psych was finally ready. She was lashing out. She kept screaming to "open the f***ing curtain" and yelling at nobody in particular. She was four months pregnant. Before we arrived, she was standing in the hallway, lifting up her gown and yelling, "that baby's coming! The baby's coming!" We got her moved over to the cot, put her back in four points. That was when I got the first whiff of her B.O. I also learned what I was taking her for-homicidal ideations. Great. She didn't create a scene until we got her to the psych hospital. The only thing she did on the way was hum the song from the Popeye's chicken commercial. Since she was in restraints we took her directly to the locked wing and to a room. The staff made the mistake of telling her she was going to the "quiet room." That started the yelling again. She screamed, "you can't put me in the quiet room! I ain't going there! I have two kids, and you know who they are! I'm four months pregnant, and it's not good for the baby! I need a cigarette! I want to eat everything-ice cream, cookies, candy, chips....I'm not going in there alone!" After a few minutes of listening to this we lowered the cot, undid the restraints and got her on the bed. She stopped making a scene. That was enough for me.
I layed down at 0200.
These are my least favorite calls. Actually, I hate them. I felt terrible for the lady. She was suffering and all I could offer her was a hand to hold. Half of the ride I felt like I was torturing her. She kept pulling off her mask because she was struggling so much to breathe and probably thought the mask was the cause; and I kept putting it back on. I found out from a friend that works at the hospital that she died that evening-alone. Her family was back at home, where she should have been in her last moments, where her hospice care was taking place until we whisked her to the hospital for no reason. Damn it.
I did a call for "wound care." Our patient was non compliant with her care and turning herself at the nursing home, and now her wound was getting worse. Not a big deal, just a little drop off in the ER and off I go. My partner had me start driving while she got vitals. The blood pressure cuff was acting up. I was two miles down the road when it finally worked. Our patient's blood pressure was only 78 systolic. I was at a red light, so I turned on my lights and turned around (this road is hard to explain. You have to drive north to go back south towards the hospital) and pulled over to the side of the road so I could hop in back and see what was going on. Normally, I would let my partner do her thing and just drive, but we weren't going to the closest facility-we still had about 20 miles to go. I must have looked pretty silly. I was just driving along with no lights or sirens. Then I get to a light, put on my lights and sirens, turn back south, pull off the road, get out of the driver's seat and hop in back. Let's just say I had a whole bunch of people staring at me.
Once in back, I took a manual blood pressure (the last pressure we got was with the monitor). I got 98 systolic. Not especially critical, so we could still go to the desired hospital. The patient refused any care-she didn't want an IV. So, basically I got back in front and started driving. By the time the hospital picked up the tele line I was about 4 miles passed our "closest facility" and well on my way to being screwed if our patient started to crap out. The nurse on tele had no choice but to let us come because we were passed the closest hospital, and besides that it would take me longer to get off the highway, turn around, get back on, and go to the closest, our patient was relatively stable (besides the fact that we didn't have IV access). I ran hot to the hospital just for good measure. I didn't want to be caught in this situation if it went sour-especially since our patient was not a DNR. She was still doing okay when we pulled up in the ER-another job done.
I did a psych transfer for a guy that said he was suicidal. According to the ER staff he was playing the system-he needed a good meal and a warm place to stay. This wasn't his first visit. When we arrived in the ER to take him he was wandering around the ER, walking up to patients, sitting on their beds and trying to hold conversations. We got him going as quickly as possible. He kept saying he didn't want to go but he was cooperative for the most part. He told me that he almost tried out for American Idol, but he got bored standing in line. He told me I have to watch next season, because he will be the next American Idol. I told him I would be watching for him.
I did a call from a nursing home for a patient with diarrhea x2 days. She wanted to go to a hospital about 15 miles away. We tried to call report, but they were on full bypass. We took her to the closest hospital. Not an eventful call at all. She complained the whole way about how tight the blanket was and that she didn't like being tied up.
We took a psych out of the same ER as soon as we finished paperwork for the lady with diarrhea. They were pretty busy and the paperwork wasn't ready yet. I was standing chatting with a security guard when a patient stuck her head out of a nearby curtain. She said she wanted a nurse and opened the curtain a bit wider. I was shocked at what I saw. The lady was standing in a pool of blood-her gown was soaked, the bed was soaked, and blood was running down her legs in streams. I figured she was having a miscarriage, judging by the amount of blood. It took a while for the nurse to get to the room, and all the while this girl was standing in a pool of her own blood like it was no big deal. She didn't look scared or upset. She just said she was sick of sitting on a wet bed. Go figure. She was whisked up to L+D shortly there after.
Our psych was finally ready. She was lashing out. She kept screaming to "open the f***ing curtain" and yelling at nobody in particular. She was four months pregnant. Before we arrived, she was standing in the hallway, lifting up her gown and yelling, "that baby's coming! The baby's coming!" We got her moved over to the cot, put her back in four points. That was when I got the first whiff of her B.O. I also learned what I was taking her for-homicidal ideations. Great. She didn't create a scene until we got her to the psych hospital. The only thing she did on the way was hum the song from the Popeye's chicken commercial. Since she was in restraints we took her directly to the locked wing and to a room. The staff made the mistake of telling her she was going to the "quiet room." That started the yelling again. She screamed, "you can't put me in the quiet room! I ain't going there! I have two kids, and you know who they are! I'm four months pregnant, and it's not good for the baby! I need a cigarette! I want to eat everything-ice cream, cookies, candy, chips....I'm not going in there alone!" After a few minutes of listening to this we lowered the cot, undid the restraints and got her on the bed. She stopped making a scene. That was enough for me.
I layed down at 0200.
posted by Ambulance Girl at 08:19
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