Friday, February 12, 2010

This is what I do

Do you ever have that moment of clarity, that confirmation, that you are exactly where you should be, doing exactly what you should be doing?
I wish I had an exciting or paticularly revolting story to tell you about *the moment*, like a critical cardiac or messy trauma where I herotically save a life - it is, after all, what I do - but I don't.
It was, actually, the most unglamorous of calls. A 69 year old male having breathing problems and anxiety. No lights and sirens, please. The address was all too familiar. I had picked Lenny* up many times, and it was almost always the same complaint. What concerns me about Lenny is, too often these episodes of respiratory distress are labeled "panic attacks" and those responding tend to get lack-a-daisy about it, when in reality Lenny is panicking *because* he can't breathe. Lenny has a long history of COPD (congestive obstructive pulmonary disorder) on top of heart disease. During one such call not too long ago, Lenny was having an active MI (heart attack) and the EMTs who picked him up that night didn't treat it because they assumed it was business as usual and simply transported him to the hospital - they didn't know, because they got lazy and didn't do an assessment.
So I'll admit, I'm a little protective of Lenny. When I arrive on-scene I am relived to see the First Responder there ahead of me is a well-seasoned EMT who is one of the most compassionate providers I have ever met. It makes my job so much easier to work with people who get it.
Lenny is in his recliner, wheezing. I can hear the hum of his home oxygen machine in the background as I kneel at his side to get a pulse. Its irregular, too fast. I'm speaking softly to him, knowing he will recognize my voice, while reaching with my free hand to open my O2 bag.
"Oh. Thank. God. It's - you!" Lenny peers at me through red-rimmed eyes and gasps, clutching at my hand. I know its bad when he's only getting one word out at a time. His wife, a wretched, hoarse woman with skin the texture of dust-crusted canvas, is leaning over his shoulder, her strong tabacco breath assaulting me.
"Stop asking him questions, goddamnit! Can't you see he can't breathe?!" Her voice is like gravel. I ignore her, because Lenny is already calming as I soothe him, but in my head I'm telling her off: back up bitch, he could breathe a lot easier if you'd quit blowing smoke in his face 24 hours a day.
The room reeks of stale cigarettes, sweat and other foul body odor. Its enough to make a healthy person wheeze.
Some high-flow O2 by mask and a nebulizer enroute to the hospital only 8 blocks away, and Lenny is noticably breathing easier, although fatigued. And he still won't let go of me. And I'm still talking to him. He knows I don't expect him to answer; we've been through this enough we both know the drill. I have his medical history memorized, right down to what meds he takes, and my voice has an immediate effect on him. I keep it low, even and soft. He sighs like a child as his respirations slow into a more normal rhythm.
And that's when it hits me. I am looking down at my hand in his, my fingertips almost white in his grip, and I'm thinking how impossible it is to get good capillary refill on him because of his prematurely mottled, dusky, cyanotic skin. I am relived he has responded so quickly to my simple treatments this time, and I realize, as he shoots me a grateful look, nodding, that this is what I'm good at. Not the medicine, not my technical skills. I flashed back to a previous call where I had held the hand of a trauma patient as she asked repeatedly what had happened. Then the little boy with the mutilated leg who never shed a tear but gripped my hand tightly the entire 2 1/2 hour transport to the trauma center. The suicidal young woman who survived her purposeful crash off a cliff into a ravine who sobbed into my shoulder, staining my uniform with her blood and tears. So many of them, over the years. Did my interventions help them? Probably. But my touch is what they remember.
How lucky am I? This is what I do, and I am good at it.
Sent from my Verizon Wireless BlackBerry

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