I roll out of the lumpy futon, standing up and stretching.
"Serg, get up. We have a call," I mumble. Sergio sits up as if on command and comes stumbling down from the top bunk.
Silently, methodically, like robots, we quickly throw on our scratchy uniform shirts over our comfy tees, tucking them in. We walk into our boots and grab the items we will be needing: the radio, keys to the ambulance, the clipboard. I open the door, exiting the station, and am slapped in the cheeks by the crisp air. I am instantly struck by the idea that I should have taken my jacket with me, but almost as instantaneously, I remind myself that every time that I have taken my jacket, as soon as we get to the patient and my adrenaline kicks in, I am sweating and wondering why in God's name I had taken the jacket in the first place!
Serg climbs into the driver's seat and I sit in the passenger's seat. During night calls, Serg usually drives to wherever we are going and then we will take turns driving to the ER. I pull my hair back into a looped ponytail and turn on the XM radio. First I look for Frank's Place, a station that plays all old school 1930-40s music; I'd be willing to listen to anything, but Sergio hates "anything in the top 40," so Frank's seems like a good compromise. It's now time to program our desination into the GPS. Quickly moving through each screen, I find the facility and push on the "go to" button. The GPS system takes less than a second to find it; then a map of our surroundings pops up and within moments we are en route with street by street directions to light our way.
Pulling up to the facilitiy, we decide that I will run this call. We jump out of the rig and walk over to the back, popping the back doors open. I grab the jump bag and Serg grabs the gurney. I pull out four gloves out of the box and automatically hand him two. Within a minute we are headed inside.
It is the middle of the night and the hallways of the convalescent home are eerily quiet. As we pass by the rooms, soft sounds coming from mutiple television sets wander out into the hall. Pine scented cleaning agents mingle with the smell of soiled linens, a smell that I cringe at, but have grown quiet familiar with. It's strange how certain smells creep up into your nostrils and grab onto your olfaction, not letting go for hours or days...this smell definitely falls into that category.
My mind wanders as we walk toward the nurses' station. I am sure that I will never put my parents in a place like this. I am sure that I will always be able to care for my parents without putting the burden on someone else. They took care of me for the first twenty years; the least that I can do is care for them in their last twenty.
My day (or rather-night) dreaming is interrupted by our arrival at the nurses' station. Three tired looking ladies sit, chatting, and writing. "Hello ladies, we're here to pick up Ms. Soandso."
A chubby faced Filipina in a gorgeous, long braid starts walking down the hall, indicating that we should follow her. She probably just came on duty because the air the tails her smells like soapy heaven. I long for a shower and am reminded that it has been almost 18 hours since I started my shift, hence, almost 19 hours since I last showered. I wonder how I smell. The most that I can hope for is that I don't smell like anything at all. Nurse Filipina has one of our envelopes with her, filled with all of the patient's information. She briefly describes the problems that her patient has been having: shortness of breath, congestion, with a slight fever.
We round the corner and walk into the patient's room. In the second bed is a tiny, elderly black lady who is curled up into a ball. She looks so little in the middle of that bed. I immediately walk up and grab her hand gently. I gauge her pulse while I try to get a general impression of how she is doing. Her pulse is fast, too fast, fluttering irregularly beneath her skin like a baby bird caught below. Her breathing is rapid and shallow, her nightshirt soaked with perspiration. I nudge her shoulder, calling out her name. When she doesn't respond, I do a trap pinch, squeezing the area between her shoulder and neck, using my thumb and four fingers. On a person who is awake, a trap pinch is very painful and almost always invokes a response, even in people who are playing oppossum. Nothing. I call out her name and repeat the process. Again, nothing. Worry begins to creep in.
I ask Sergio to get her blood pressure while I continue talking to the nurse, trying to get a more clear history. As we talk I unzip the jump bag. I grab a non-rebreather mask and undo the curled tubing. The nurse tells me that Ms. Soandso was doing fine this afternoon, but when she came to check on her this evening to give her the scheduled meds, she was in a bad state, and it looks like she has gotten even worse since we were called. I attach the tubing to the oxygen tank and inflate the bag on the NRB.
"Resps at 36 times per minute," Serg calls out to me, brow furrowed. Normal breathing is between 12-20 breaths per minute. This patient is in obvious distress; it's time to get her going. I lift her head as I try to put the rubberband attaching the mask to her face on. Her head is dead weight and when I take my hand away, my glove is wet with sweat. I turn the NRB up to 12LPM. We position the gurney next to Ms. Soandso's bed. It's always a struggle to try and move the bed or the gurney so that they are fairly level; that way, when you're moving a patient, you're working with a more stable environment. This time, Fate works in our favor and the two line up almost perfectly in only one try. We strip the bed, pulling the bedsheets away from the corners. We gather up the slack underneath her and on-the-count-of-three, we slide her over to the gurney. We quickly buckle her. I pick up the jump bag as Serg grabs our paperwork from the nurse, who thanks us and waves.
Once outside of the doors of the ambulance, we get the rig open and get the gurney inside. The smell of ambulance floats out. How can I explain what that smell is like? A combination of what the hallways in hospitals smell like and the smell of an old car combined. Not pleasant, but familiar. I toss the radio to Serg, who will call the ER and give them a ringdown, a report of who we are bringing in and what state she is in. Sergio closes the back doors and as he runs over to the front, just for a brief second, I am left alone with a very sick lady in the back of a very lonely, dark ambulance.
The darkness is broken as Serg climbs in and starts the engine. Automatically, the lights and power come on in the back of the ambulance and I am in business! I switch the NRB tubing to the main tank on the rig, turning off the portable gurney tank as I go. I reevaluate the patient's breathing to see if the treatment that I have given her so far is helping. Her respirations have gone down to 32, but although the oxygen seems to be helping, she is still wheezing and breathing way too fast. I tilt her chin up and increase her oxygen up to 15LPM (the maximum allowed). I take her pulse and blood pressure again, yelling them out over the sound of driving to Serg, who is in the process of driving and giving his hospital ringdown to whichever nurse happened to be lucky enough to pick up the phone in the ER.
I continue to nudge her and do trap pinches, as I call out her name. I ask her to open her eyes for me. I readjust her airway again and am stunned when she begins to ever-so-slightly move her eyebrows up and down; she's trying to open her eyes. I'm reaching her; my heart speeds up even faster as I realize that my treatment is helping this woman. I wipe the sweat that is rolling off my brow onto my sleeve, as I encourage her to open her eyes or squeeze my hand.
"Good job, honey! Keep trying to open your eyes for me! You're doing great. We're almost at the hospital and they're going to take real good care of you there!" I continue to talk to her as the time seems to roll along lazily. I do a quick physical exam and sift through her paperwork, trying to find the list of medications that she is on and what her medical history is. I have to have all this information, including her social security number, date of birth, any known allergies, primary care physician, and any other information that the admitting nurse may want when we arrive at the hospital and I better have any and all that info written down on my glove or memorized or I know I will feel the wrath of an annoyed nurse (there is almost nothing worse, besides the wrath of an annoyed doctor).
I am just shining a penlight into her eyes to check her pupils, as Sergio pulls into the ambulance bay of the ER. I look up momentarily and immediately come back down to her face, as I continue coaching her, all the while I'm trying to gather up the necessary paperwork that I will need in a matter of moments, while I take another reading of her respirations (which are down to 28 per minute now).
Sergio's grinning face greets me as he opens the double doors to the back of the ambulance. "You alright? Lookin' a little frazzled," he says as he pulls the gurney out.
"How's she doing?" he asks, as we wheel her in and I give him a shortened rundown of her improvement. I leave him in the hallway to watch her, as I head over to yet another nurses' station.
DISCLAIMER: Although this story is based on memories and experiences, it is a work of fiction. The patients and facilities are ones of my own mind's creation, molded by a combination of calls, dates, and places.
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