I am not a cretin

Back during EMS Week, EMS1.com held a writing contest.  Kelly Grayson, AKA Ambulance Driver called on us EMS bloggers to make submissions.  The theme was Anytime, Anywhere, We'll be there.  I am not sure who one, but the top 6 can be seen here. Below is my submission. Enjoy...

I am not a cretin

I am but a mere individual amongst a whole world of professionals. I am a thrill seeker, but not the kind that jumps off cliffs with a self-packed parachute attached to his back. I am educated in my craft, and I do it well. Many, even with my hard earned five years of experience, could still consider me a rookie. I am an educator, but not a professor. An expert, but not a scientist. A manager, but I lack a work force. I'm not an athlete, actor, or politician, but I believe I make a difference. I am a paramedic.

As a paramedic, we make many promises. Some are simply shrugged off or overlooked. "I promise I will take care of your father to the best of my abilities", or "I promise, just one little poke". Some of these promises are ever so important, but understood without ever having the need for verbal explanation. Anytime, anywhere, we'll be there. Now that's a promise.

911, the one phone number that you can call and pretty much expect an answer on the other end every time — excluding a few flukes. Jimmy Noolan was hoping that was the case when he dialed that number from a payphone outside of a 7-eleven. You see, Jimmy doesn't get too many voices talking back to him on the other end of calls he often makes. His wife and son tragically left him prior to him being ready to let them go, as if he could ever be ready for that. He chose to drown his pain with his buddy Jack, and built a pretty strong relationship with ‘ole Jack. His drinking problem weighed heavy on his life, and what remaining family members he had, simply gave up on him. Out of a job, family, and home, Jimmy like so many, took to the streets.

A man who seemingly cared so little about his own life had called 911. But this isn't the first time. Jimmy happens to be, what I call a repeat offender. He calls often, usually with the chief complaint of loneliness, hunger, or cold and wet syndrome. Thought by many as a burden to our already busy EMS system, and unfortunately treated as such all too often.

The tones drop back at the station and the call comes in, Medic 7, respond to the 7-11 for a possible heart attack. My partner and I look at each other with grins and scowls due to the premature diagnosis made by our illustrious dispatcher. We know it isn't the dispatcher's fault, but give us the symptoms, and let us tell you what it is. We also throw the possibility back and forth of this just being another transient at a payphone — of course keeping the worst possible case scenario in the back of our heads. This is a training truck, and we have enjoyed the three-person crew all day, running these calls smoother than our freshly shaved faces.

We don't kill ourselves getting there, taking the lights and sirens response easy. If anything, it will give the local fire guys time to practice their BLS skills. We already had our dinner in us, and there was no rush to get this over with. As we pull up, the red truck with the flashing lights gave us a good idea where the patient was located. A group of well-trained, firefighters were huddled around what looked to be a patient. A familiar face was finally visible as we approached, and I could hear my partner whisper "oh gosh, it's Jimmy". Yep, there he was in his usual getup, a tattered dirt-stained blue flannel and similarly filthy ripped jeans with his sock-less feet in a pair of unlaced brown construction boots.

The firefighters gave me the typical report: "O2, aspirin, and vital signs, he wants to go downtown." Going downtown was fine with me, it was right around the corner from the station, and they were use to Jimmy by now. Sure, it isn't a cardiac facility, but this was Jimmy, not a real patient — right?

We packaged Jimmy on the stretcher, and wheeled him to the truck. My partner hollered up front to our EMT, "downtown, kill the lights". Something happened at this very moment, something I had heard of, but never experienced. My gut was disagreeing with my lackluster treatment. Another glimpse at Jimmy told me something was wrong. He was seemingly pretty sober. He was not his normal sad, and lonely self. He was scared, and from the looks of his pale, damp skin, he was sick too! I gave my partner a look only understood by fellow EMS-ers. He asked what was wrong, and I replied, "Just let me get the 12-lead done before we start heading that way".

Sure enough, Jimmy was having an anteroseptal myocardial infarction — or a heart attack represented by ST-elevation in leads V1 thru V4. Looks like the dispatcher was right. The face on my partner when I showed him the ECG was indescribable. Pucker factor had now set in due to us being behind the ball. Humbled, a new gear was locked in, and our treatment strategy quickly changed. Obviously, so did our destination. STEMI center, here we come, only thirty some-odd minutes to go.

On the way to the hospital, new modalities were added to Jimmy's usual treatment of choice — compassion. Jimmy went into a short-lived lethal arrhythmia during the ride. Luckily Jimmy had the paramedics that he called for, not those guys that were about to take him downtown. He was quickly stabilized with our new sense of preparedness. We activated the cath-lab to facilitate quicker treatment on the way. Had two IV lines in him, some nitroglycerine, and a little morphine.

I held Jimmy's hand and told him he was going to be okay. Something I had told him so many times before, only this time I think I was listening to my words more than he was.

Jimmy had a massive occlusion to one of his coronary arteries. He underwent cardiac angiography and recovered well. It was a longer road than usual to the cardiac hospital that night. I thank God for that moment of realization, without it; his lifesaving treatment would have been delayed. I haven't seen or heard about Jimmy since, but I am sure he is still around, and you better believe that the next time he calls — anytime, anywhere, we'll be there. Only this time, without any preconceived notions — because I am a paramedic.

Names and events have been altered to protect the patient's privacy.