This, obviously, did not happen overnight. The man practically admits to being a heavy drinker. [Surprise! Surprise!] His blood alcohol was 4 times the legal limit. So, you’ve got a man with kidneys that have probably shrunk to the size of peas, potassium in his blood that is probably about the same dose that is given to a death inmate to kill him, and blood alcohol level to make a horse see stars. How, may I ask, did he get on his motorcycle in the first place? See, these are the mysteries of humans that I will never get.

I am still processing this information and quite dumbstruck with disbelief when someone asked: “Don’t you get pretty sick when you’re kidneys fail? Don’t you start feeling pretty weird?”

Well, yes, but the man is drunk every day. He probably thought he was just having the worst hangover ever . . . every day . . . for a week or so . . .

Last night, he was out late again, partying with friends. He was intoxicated, high on cocaine, marijuana, and oxycontin. It’s just another night out of seven years since he started using drugs. Except that it wasn’t just another night. Last night, he remembered getting in the shower, woke up lying on the tub unable to move his legs and felt numb from the mid-chest down to his toes. His arms worked, but the sensation in them was dulled. His left hand barely able to grasp mine. I see the panic in his eyes, his anxiety escalating.

I wondered what my life would be like if I followed the same path he’s walking. I wondered what his life would be like if he never discovered drugs. As I held his hand giving him as much reassurance and comfort I could give him in the time I had to care for him, I wondered if he would ever walk again. I imagined that he must have a beautiful smile and an engaging laugh and I wondered if anyone will be fortunate enough to see those in the coming days.

I watched his eyelids flutter, his long eyelashes dancing as they met and my heart felt heavy wondering about his life barely lived, his potential unattained, the possibility of a life spent in wheelchairs or in long-term care dependent on others to live. I relinquished care to the ICU nurse and bade him good luck. He held onto my hand and thanked me. I left his room and as the elevator doors closed and the lifting mechanisms started their steady whirring, I stood silent and wondered. . .

Report starts at 0800, then daily equipment checks. Yeah, that’s not too hard . . . once you learn the equipment. Because, there’s the cardiac monitor – all three of them. Two, at least, are the same. All three have all these buttons and features and lights that blink at you, then they alarm if you don’t do anything within a specified amount of time. It can be very intimidating.

I pressed the Print button accidentally on the MRL and almost used up all the paper. Oh, yeah. That’s one more thing. One has to remember all the terms and names of the equipment. Like the MRL. What the heck does that stand for? I don’t know. It’s the cardiac monitor/defibrillator we use. Okay. Then, there’s the Propaq. It’s a heart monitor but NOT a defibrillator, so therefore, if we have to use that for any reason, we have to remember to take the Zoll with us. See what I mean? Lots to remember.

Then, there’s the LTV. That is our ventilator. Talk about buttons. And dials. More lights. More alarms. It has this really annoying beep. I’ve heard it in my sleep when I’m having a nightmare. OH MY GOSH!!!! <sigh> . Of course, you have to know stuff like Volume settings, or Pressure settings, PEEP, PIP, VTe, SIMV, TV, FiO2, etc. I am not talking about just knowing what they stand for. I mean, like, what they mean and when to use them and if it’s appropriate to change the settings and, aaaahhh! Yeah, then you have to learn to push the stupid buttons. Then you have to figure out how to configure the tubing and plug the ends to the right holes, then you have the connectors for monitoring stuff like EtCO2. Oh, yeah, there’s a little dial on one side, too, that you have to learn which way to turn. See? More stuff to know.

And then the Minimed. What the heck is a minimimed? Why can’t we simply call it an IV pump? Every nurse knows what that is. Anyway, that is the most annoying piece of equipment ever. That damn Air in Line alarm!!! One night, we accidentally used one of our IV pumps as a basketball. Oops. I wanted to feel bad, but maybe it was the best thing for it. I’m just kidding. Those stupid minimeds! I hate them but, at the same time, I love having an IV pump for all my infusions. <sigh again> Oh well. . .

So, there’s learning all the equipment, then there’s learning aviation-related things, too. You know, I always say this because it’s true. My knowledge of aviation is I know the difference between a helicopter and an airplane; and I mean, by what they look like. Anything else after that, I have no idea. Have you ever looked at the control panel of an airplane? The entire pilot cabin area is full of dials, and gauges, and levers, and buttons, and arrows pointing . . . directions . . . Then there’s the foot pedals. You use them to turn left or right or brake. How confusing is that? If I had to go from flying an airplane to driving my car, I’d get confused and try to turn with my feet while in my car. That’s great! Instant rejection from every car insurance. And the steering wheel (oops, yoke) . . . it goes right or left or up or down . . . yeah, that’s not confusing. . .

Oh, yeah. The levers, too. I have enough trouble remembering B, R, D on my car’s steering wheel. Sometimes, I screw those up, too.

I finally learned to not walk into a propeller. Not that I have, but I probably would have. Thank goodness for the pilots. They’re really good at steering me in the right direction – like away from the propellers. Yeah, those spinny things.

Then there’s the clinical stuff to learn, and protocols, policies, etc. My brain is exhausted. I might have killed all my brain cells.

How totally weird is that?

During the course of a patient run, we introduce ourselves to so many people – ambulance crews, other nurses, doctors, patients, patient families. The list grows. So, I worked with Ruth again the other day. When Ruth and I are working, our usual introduction run: “Hi, I’m Ruthie and this is my partner Ruth.” We get the usual, ‘oh, how cool!’ smiles.

We went to a small little town in the northern tip of California a couple of days ago. While loading our gear onto the ambulance gurney, the EMTs introduced themselves and, what do you know. One of them is Ruthie. Going up to the patient’s room, we introduce ourselves and, imagine, the amusement on everyone’s faces. Then the unit manager came in to say hi and her name is Ruth. So, now, in the tiny little room, there were two Ruths and two Ruthies. How totally weird is that?

Our patient, who was pregnant, suddenly felt obligated to name her baby Ruth.

Sheesh! Just when I was feeling so unique to the world . . .

A quiet airport?

We were in a tiny airport one morning. On our way in, I noticed that there were houses along the sides of the runway. The pilot and I sort of joked about the values of real estate these days. On our way out, I noticed a sign on the side of the runway. It said: Please fly quietly. Fly quietly? I looked at the pilot and asked if that was possible. He said, ‘Sure. Would you like to go outside and push the aircraft? Point taken. Well, what’s up with the sign then?

Calling the kettle black

We went to pick up a 2-year old this morning (like at 1 am, when I had just fallen asleep). I was told that someone wanted to ride along with us down to the receiving hospital. I thought it would be mom. As I approach the door to the patient’s room, someone comes out and I cheerfully asked if she was mom and if she was the one who will be riding in the airplane with us. Whoever this person was, she venomously said, ‘No. Mom’s at home passed out drunk.’ Whoa! Oh-kay! As I go in the room, I am met by another person and, undaunted, I ask her if she was the one who will be riding in the aircraft with the patient. When she said, yes, I asked how she was related. I found out she’s grandma. So, I got that settled.

I found out that my angry greeter was the aunt. I mulled over that because her tone suggested she did not approve of the patient’s mother and it was certainly full of judgment and resentment. It was perplexing to me because the mixed toxic fumes of alcohol and cigarettes on her breath and skin made me nauseous. It made me wonder why she was so angry. Maybe she was having a bad hair day. I know I was. The stupid headsets we have to wear really craps out one’s hair style.

Pilot joke

I was at the bookstore one day and, while I was browsing, some guy comes over and tries to make small talk. (Okay, he was trying to make a move). It wasn’t working out for him, so for his final run, he tells me he’s a pilot and he’d like to take me flying one day. Yeah, ok. Thaaat’s nice. I work with pilots so it’s not like I’ve never seen one. I went out with a guy who piloted his own airplane. So, what makes you special???

Anyway, not to be a b*tch or anything, I said a polite ‘No, thanks’ and continued looking at the book I was holding: “The bullsh*t men say to get you on a date” (Okay, I made that one up, but, well, there should be a book like that. Maybe I’ll write one.)

So, here’s the joke: How do you know there’s a pilot in the room? Answer: No worries. He’ll tell you.

Okay, one of the nurses and I laughed at it, but at the risk of hurting the feelings of our pilots at work. We didn’t want to do that, so we just giggled to ourselves. I like all our pilots. They’re so calm and laid back. And they’re fun to work with. The thing I admire about them is that they are on such even keel in any situation. I love even-tempered, positive people.

I was on a flight with a couple of neonatal nurses. One was a nurse practitioner. She was a total grumpous. Our pilot that day was one you want to work with when you’re feeling blue. He can cheer up Eeyore. That takes some talent. It was a beautiful day. The weather was perfect. The view all around was majestic. Our pilot comments on how very pretty the day was and what a wonderful day it was to fly. The nurse practitioner comes back with, “Yeah, it would be even better if we can see through these dirty windows.” I turned and told her to turn the little knob on the inside window. The windows are tinted. When you turn them one way, they go dark. You turn them the other way and it clears up. It’s actually pretty cool. It’s like a built-in visor for your windshield.

She turns the knob, looks out, and says, “Oh. It’s still not clear enough.” Wow! Speak about glass half-empty people, huh? Maybe she has PMS. Maybe.

When we got to the airport, the EMTs who picked us up were grumpy and defensive. What is up with that???? It took a little bit longer to be at the bedside with the baby. The EMTs came in the room and told us they were leaving for ‘a little bit.’ I asked where they were going, only because I noticed it was lunch time and I thought they probably wanted to go and eat lunch. Since we still had a couple of procedures we had to do, I asked where they were going only to find out if they were going to lunch so I can tell them not to rush. Instead, when I asked, the girl EMT said and not too nicely, “We’re just going to the cafeteria. We’re not far.” Wow! Why so defensive? Go have lunch already. Maybe it will help your disposition.

As an aside: sometimes, it’s just a question. Don’t be so freaking defensive. Maybe someone asked you a question for your benefit, not to question YOU per se. Get a grip.

Anyway, between the nurse practitioner and the EMTs, the day was becoming bleak and dreary. For them, though. For me? Whatever. I had many more hours to go before my shift was over so I couldn’t let those negative people ruin my day. They have bigger issues. I had Hawaiian barbecue dinner to look forward to. Yummy!

Stay away from grumpy and negative people. They are toxic and contagious.

You know, that is one way to conserve oxygen. How thoughtful of the guy who designed that. I mean, that’s keeping it very simple, right? No breathing equals dead person. Dead person equals no oxygen needs. Yeah, makes sense to me.

For some reason, that is not comforting to me.

Sometimes I laugh at the most inopportune times

I recall a transport I went on with my manager who was my partner that day. The patient had a nasogastric tube or NGT in (for lay people, it’s a tube that goes through the nose to the stomach used for things like feeding, removing accumulating gastric fluids, giving medications, etc). In the air transport environment, it is used mostly for venting the stomach so gases do not build up and cause a tummy ache. The strongest motivation for air transport crew is to prevent the tummy contents in making itself be visible.

So on this transport, we capped the NGT meaning to vent it or open it to air when we got to the aircraft. During flight, lots of stuff interfered with that plan. The patient’s blood pressure dropped, his lungs filled up with fluid, he was in pain and anxious. Needless to say, venting the NGT never got done. When we got on the ground and were en route to the receiving facility via ambulance, the patient’s stomach decided to join the fray of his other malfunctioning anatomy parts and he vomited.

I nearly fell over laughing (I tried to hold it in, believe me). I was laughing so hard that I had trouble hanging on. Remember, we were in a moving ambulance on the pockmarked streets of San Francisco. What was so funny? My manager looked greener that our patient. She was trying so hard to hold her nausea in that her eyes welled up in tears. All this while trying to grab suction and get to the patient’s mouth. Why was that so funny? I don’t know. For some reason, the whole picture was comical to me at that moment. The patient was covered in ‘yukk’, my manager was fumbling with the suction looking green and close to fainting, the EMS girl trying to hand us a square of paper towel, me examining my boots for vomit (they were newly buffed and shining).

Sometimes I laugh at the most inopportune times.

This reminds me of another call with another partner when we picked up a baby. The baby was crying so hard that it vomited. Fearing that it might seize (the baby looked like it was going to), my partner took it out of the isolette, held it, while I cleaned up. While I was doing that, the baby decided it was time to cleanse its system down below also. Unfortunately, the diaper was inadequate in holding its contents and it overflowed onto my partner’s lap (luckily, we had baby blankets covering it) and flightsuit sleeves. I know that was gross and disgusting, but the scene was, again, comical to me. Baby crying angrily after having vomited its oh-so-yummy milk, baby diaper overflowing like lava out of a volcano, my partner’s face with a worried expression mixed with disgust, the EMT up front asking if we wanted to go Code 3 (meaning lights and sirens). Flashback in my head: me explaining why we had to go Code 3 to the doctor – ‘yes, doctor, we absolutely had to rush in here. The baby crapped on my partner.’

Giggling and grinning, I cleaned up the baby, changed its diaper, and cleaned up my partner. All in a day’s work.

Come on. You gotta laugh.

Test what?

I was watching TV with my partner and our pilot tonight. Some guy got his leg ripped apart by a shark. He was testing a shark protective suit. My guess is – it failed the test. Then it got me thinking. We wear a protective suit of some sort. Our flightsuits are made of Nomex – some flame-resistant material. What if they require us to test those? The guy was wearing a shark protective suit, so he had to test it against sharks. Our flightsuits are flame-resistant, so to test it, we would have to test it against . . . that’s just not right. I am not volunteering for that. That cannot be in my job description.

Now, THAT is NOT funny.

So, I’m sure you’re asking the same question. Isn’t it cheaper to buy and use contraceptives? You think, right? Exactly. You’re thinking.

Her uterus is pretty thin by now. On her 4^th pregnancy, she miscarries. Now, with this pregnancy, her uterus is so thin and her cervix is weak that she may lose her baby. For those of you who are interested, the medical term for “weak cervix” is incompetent cervix. Weird, huh? But appropriate. The cervix is not strong enough to stay closed to keep the baby in the uterus. Any contractions can bust it open and out comes baby no matter what gestational age it is. Her baby is only 24 weeks. If it comes out, it will not be viable. The development is not quite complete for a fetus that age to survive in the world. Ironically, she really, really wants to keep this pregnancy. She cried a lot.

While scanning her labs, her drug screen catches my eye. She is positive for cannabinoids (for the naïve out there, that means she’s been smoking marijuana). That means she’s been using marijuana while she’s pregnant. Now, you’ve heard people say, “Oh, it’s been a while since I did that. It stays in your system for weeks.” Really? She’s 24-weeks pregnant. If she makes a case of saying that she used it when she wasn’t pregnant, do you think she’ll win? Yeah, exactly.

I’m not being unkind here. I quite sympathize with her and I genuinely hope and pray that she keeps her baby. It’s a little girl. We took her to the best hospital for high-risk pregnancies and she will get the best care there. I took care of her like she was my sister and my best friend. I have this nagging and, sometimes inconvenient, characteristic of empathizing with people so much that I can physically feel their pain. I felt for her. Her guilt weighed in the back of her mind and it will always be there and it will only get worse with another miscarriage.

Often in this job, however, some people truly confuse me. It makes me wonder why people act the way they do, then wonder why they are the way they are today. Even that statement confuses me.

I walked back down the hall again, said hello to Mardi, and asked politely if she was the nurse assigned to Room 132. She looked at me with eyes ablaze (felt my eyebrows singe a little) and said, “Yeah!” I smiled again, pretending not to notice the smell of burning eyebrows and asked if she wanted report. With gritted teeth, she said, “I guess so.” I gave her my best smile and proceeded with report. In the middle of it, she stops me and says, “I don’t need to know that.” Her gravelly voice curt and abrupt. I think I saw a forked tongue retreat in her mouth.

My level of annoyance suddenly goes up. I am now thinking, Well, the reason I am telling you that his heart rhythm was irregular is because he might just pass out on you and you might want to know some reasons why he did that. The reason I’m telling you that he needs oxygen when he exerts himself is so you are not surprised when he turns blue after walking down the hall like he is insisting on doing without your help. Instead, I gave her another smile and said, “I’m sorry. I just thought you might want to know all this since you are going to be taking care of him.” Ah, yes. The art of sarcasm is a fine one, indeed. I think she wanted to wring my neck for that, but the patient’s family was watching.

I would hate to be her patient all day.

The use of a ground ambulance is expensive. They show up without doing anything and you’ve already spent $500. So, imagine how much it cost to take an air ambulance . . . I hear those gears spinning. Yes, you’re right. Pretty darned expensive. Very expensive. Like more than $15,000 expensive. Yup! That expensive.

If it was you and I, we would be calling American Airlines or some commercial airline for tickets. What can you get me for my measly $200? Don’t worry about my lips turning blue. I’ll do a little hyperventilating in flight and I should be fine. If you could give me a discount for coughing my lungs out, that would be great.

The patient went from a long-term care facility (as in ‘nursing home’) to another long-term care facility (as in another ‘nursing home’). So, no, he wasn’t critically ill; but he needed a ride nonetheless. We were, in essence, an air taxi, know what I mean? Conclusion: no insurance in their insane minds will pay for that. So, the patient and/or his family paid for our air ambulance. How? On someone’s credit card.

So, I’m just the regular worker bee. All my credit cards together don’t even go that high. I’m totally blown away at how casually someone whips out the dollars for an air ambulance. Goodness! The family met us at the airport and followed us to the hospital on our ground transport. They had two cars – both were the most expensive models of Mercedes Benz.

Even with my open-mouthed astonishment, I was able to enjoy the patient and his family. They were such wonderful and nice people. Very rich nice people.

I know. Don’t mind me. I’m just being ignorant.