Another day in the boonies

[Kaisu]

Hey y'all (just kidding, I still have diction. It kinda makes me stand apart from the crowd but heck, I'm used to it.)

So we get this call for a domestic assault. This is in the valley, where they send us to rest at the rural low call volume station after we take our pounding in town. (that's the theory - last night we had a winter storm and were slammed with MVA's from midnight to shift change at 8:00am. Winter storms are a bugger at these elevations.)

Be that as it may, we jump in the rig and are advised to stage at a location away from the scene until it is cleared by law enforcement. Paved roads end minutes into the response, and progressively deteriorate from gravel to washboard to big huge bumps. Rain on Christmas day has left huge puddles and mudholes. The rig is getting pretty dirty. We stage, wait for 5 minutes or so, are cancelled by sherrifs, then uncancelled and told to go in.

We drive to the "residence" but cannot get into it. We are on tracks that would give ATV riders pause. A washout on the only access to the "home" forces us to park across a wash approximately half a mile out. We hike in, going down the gully, across the wash and up the other side. Thank God for my orthopedic surgeon. This is rough work for old lady knees. Rocks and cactus (and the rain slippery slopes) make it interesting.

Fire goes in with us. Normally first response, we arrive together and hike in together. As first response, they get to carry the gear. There is NO way a gurney is going there so all my partner and I had to carry was our butts. It was enough.

On arrival in proximity to the trailer, we are greeted approximately 100 yards from the tin box that is shelter for these people by the sherrif, the patient, the patient's son and what appears to be about a hundred dogs. The patient is 56 years old, appears 76 and with no visible tattoos still manages to have a pretty low tooth to tattoo ratio. She has visible swelling and bruising to the PIJ of the left little finger. The miscreant that caused this damage is nowhere to be found, taking off across the desert when the po po were summoned. The hair on the back of my neck is standing up. "Is your husband armed?" I ask her. "Nah, its locked up in the trailer" she replies. The sherrif assures me that two of his guys are out there looking for him and its all good. Those of you who think the desert is flat have never walked in it. There are so many dips, gullies and hollows that someone could be hiding 10 yards away and as long as they are quiet, you would never know they were there.

The patient decides she wants to go to the hospital to get the finger xrayed and splinted. It seems like a good decision to me as the numerous vehicles dotting the "yard" all appear to be without vital working parts and even if operable, the wash out would prevent them from driving out. Before we leave, the patient wants to go into the trailer to get her purse, jacket, etc. She is smoking a filterless homemade, her fingers are black with tar and nicotine, and I am pretty sure this lady is going nowhere without her tobacco pouch and rolling papers. As the only ALS provider on the scene, even though this sure looks like an isolated minor injury, I have made patient contact and must follow her into the hovel. A blanket is hanging in the door way "to keep out the draft" she says. She moves it aside and like the 100s of dogs that ran out into the yard, we now have hundreds of cats scattering everywhere. The reek of cat urine almost overpowers me. Balls of cat hair fly in the air. The ill-fed progeny of the patient is running around looking for Ma's coat and Ma's purse and Ma's drug box (filthy thing... almost afraid to take it from him) and of course, Ma's tobacco and rolling papers.

We spend another few minutes lamenting over the probable fate of the puppies out in the yard. I feel for the kid. His Dad just kicked the crap out of his mother, and it is pretty certain the puppies will be feeding the cyotes.

Now begins the trek back across the desert, this time with patient in tow. It is slow going. Junior knows where the gully is not as steep and pretty soon starts leading us on a zigzag trek that probably takes twice as long as it should have. At one point, where the going gets pretty steep, I support/carry Ma. I had to get a little sharp with her to get her to drop the cigarette. We finally reach the side of the "road". Surprise - triple string barbed wire fence. Ma says - "now how are you going to get me over that?" The ambulance is only about 50 yards away - so close and yet so far. Did I mention it was cold cold cold? and that it was getting dark fast? There is an opening about 150 yards away. We head for that. The patient's son is on the cell phone. "Ma" he says, "David says we can stay at their house for as long as we need to." Ma shakes her head. "I can't stand the smell of his cologne" she demurs. "He starts spraying that Axe on himself and it almost makes me sick". I guess they have no friends or family willing to take them in that use Eau-de-cat piss.

We get on the ambulance side of the wire, my partner backs the ambulance closer to us, the patient is transferred into the attendant's chair and Junior jumps into the passenger seat with the driver. The fire department medic sits down on one side of the patient and I sit on the other. I put O2 on Ma. The trek has her breathing pretty hard. I decide to wait for the heat to kick in before I start peeling layers off Ma and get a glucose stick - BGS 124. I uses about 3 alcohol preps to get a small clean spot on the finger for the lancet poke. In all fairness, that tin box she lives in would not provide any really good opportunities for personal hygene. She bleeds like a stuck pig. No anti-coagulants in her drug box. Hmm she says "I wonder why my blood is so thin?"

I clean her up cause I sure don't want ANY of her bodily fluids on me. Things are nice and toasty now in the back of the rig. The fire department medic is waiting for vital signs to complete his paper work. I realize that everyone else on scene is standing out in the cold waiting for me. (even my partner would rather freeze than sit in the ambulance with Ma and her miasma). Every layer of clothing I peel off provides a new experience for my olfactory nerves. Vitals are assessed, the FD gets the little boxes on the form all filled out, and my partner, the ride along, the patient and I head for the hospital.

The patient has a BP of 120/71, pulse rate of 120 and is satting at 98% on 4 lpm via nasal canula. Along with assorted other flotsam and jetsam, I had spied an O2 tank complete with regulator and cannula under the trailer. Ma disavows using it and mumbles something about some illness at sometime where someone needed it. Her lungs are clear and equal and she is moving good quantities of air, surprisingly so for the amount she apparantly smokes. I figure after that trek we are all a bit tachy, and decide to let her rest for a while before I assess her vitals again. I see no evidence of ETOH and she denies drinking that day. She says "social" drinker. Her pupils are quite constricted and there are serious prescription narcotics in her drug stash. I elicit a history of rheumatoid arthritis and degenerative bone disease.

The patient is still tachycardic after 15 minutes of bouncing along the ruts. I find out that she drinks 2 to 3 liters of diet cola per day. "My diet cola and cigarettes are my two addictions" she cackles. We begin to talk about her life. She weeps about the fact that her husband is in all likelihood, going to go to jail. I am concerned for the boy. "He's got problems" she says. I tell her that living in the situation he is, he would be abnormal if he didn't have problems. Pretty blunt, but she responds to it. Crying more, she says that the boy has attempted suicide and that they now have a social worker. She states that the social worker has been paying weekly visits to the trailer and is due out again in a few days. I am astounded. "She has come to your home?" I clarify. "Oh yes" says Ma, "4 or 5 times now". I cannot believe that a child would be left by the state in that environment, but with the dearth of social services in this county, I guess there is literally no place for him to go.

I get Ma talking about the incident. Dad had grabbed the boy by the throat and punched him. "Your son was hit?" I ask. "Does he need medical attention". "Aw no" she says dismissively "He's OK". I consider stopping the ambulance to examine the child, but he certainly appeared fine on the scene. I poke my head into the front and do a quick visual on the boy. I tell my partner that the child had been hit. He nods, having ascertained that while I was in the back with the mother. I decide to keep moving.

My patient states that after the initial assault on the boy, she moved between them and pushed her husband away. That was when he dragged her across the room by the hair. The ensuing struggle resulted in her injury. "It's the damn booze" she wails. I find out that the police do not know the boy was hit. I also get the name of their social worker. We arrive at the hospital. The son is directed to the waiting room, Ma is sent to fast track. I advise the nurse of the assault on the boy. She is relieved when I tell her I will follow up with social services. (It takes tons of phone calls to get any kind of action on any social issue here.) The sheriff pulls up to the ED as we are getting our rig back together. I inform him of the fact that he has two domestic assault victims. At the station, I document all of this extensively, including the name of the social worker. I will give her a call on Monday. I will probably never know what happens to this family and I know this boy will be on my mind for a while.

PS.. it took hours with all the doors open to air out the ambulance.

[spenac]

Hey I've been there. OK probably not that exact one but we have several like that here on the border.

As far as blood thinner does she use vanilla from Mexico? Best tasting vanilla anywhere but it is diluted with blood thinner, so if they use it very much it will not clot no matter what you do.

Glad you got her and the boy to a safe place at least for a night.

[Chief1C]

Sounds like the state of life and living environment that more that half of our patients live in. Had a few that made me vomit in my mouth, or down into my shirt. Stuffing balls of tissue, covered in globs of vapor rub up my nares, if I knew what we'd be dealing with ahead of time. One lady had this problem, where she would save things in glass canning jars, for the doctors. Once, she peeled off warts and moles by putting cider on them for weeks. She saved them in baby food jars, and the resulting scabs in larger jars. I seen her take a jar from her purse while writing my PCR, and she went to hand it to me, and says, this is what I need looked at, my moles. She had a jar full of moles she cut off, and cauterized with a cigarette lighter. The smell, between rotting flesh, vinegar and the odor of pus was too much, I almost puked on her. I had the driver pull over, I got out and got sick. So, we switched; I drove, he teched. We had the lady walk into the ER, leaving her moles in the jar. My partner insisted he didn't want to see, smell, or look at them. I sat outside, still getting sick, almost crying; someone came out and sat with me. It was the most horrific, revolting, lip curling odor. It was in the ambulance, on our clothes. We sat with the doors shut, clorox poured out by the gallon, air freshener. Every time I thought it was okay, I started gagging.

Frequent flier, the home was a 1950's trailer, no power, no plumbing, but they used the bathroom still. Filled the tank with water, piped in from a spring up on a hill, flushed, and out it went, onto the ground outside. There was a sharp drop off, and in the snow at the base, was everything from the toilet.

I doubt they bathed, ever, four of them living there with at least 30 cats INSIDE, no litter facilities. The first time I went there, I excused myself and went across the road and vomited for a good two minutes solid, returning with dry heaves. I put a mask on, but it took a week to get rid of the odor, and my clothes, I took them off at the station, and went home in boxers with bare feet. I see places like that too often, children playing with dog feces on the floor, or eating in a kitchen with brown stains on the walls. I never complain about taking patients from places like this.. Because anything has to be better.

I never realized how people in my own community live. Some people have never had electric, plumbing, running water, an indoor bathroom. Some never bathe, and suffer from infections with odors so overpowering, they won't let us in the ER. It would be different if it was infrequent, but on the thousands of calls I've been on, there has to be more than half, with deplorable living conditions. I don't see how people can live like that, or think it's normal to live in such filth, that it alone is responsible for their health. It has definitly hardened me, I don't get bothered by it that much anymore, but I still get worn down seeing children growing up in those homes. They really have no choice in the matter.. and you're right, social services, should be convicted of some sort of criminal act. They visit these families that are on welfare, public assistance, food card (stamps).. But they leave, and the child stays. They even have a program here, where the state will send someone to clean their home.. or buy them cleaning supplies. I've seen dozens of animals, that eat better than their children. Hell, living in a barn, would be better conditions. Society has really dropped the ball on lower class citizenry. Some people live no better today, than their family did in the 1880's, or the great depression. Almost as if time has forgotten them.

[mediccjh]

It's everywhere.

As a return to my annual tradition of having a Christmas DOA, I had one Christmas Eve in a trailer. Had to climb over garbage, newspapers, birdcages, and lots of other things in a trailer to get into the unlit back room in the trailer to pronounce the 400+ lb woman who was dead. And of course, the smell. Bird droppings everywhere, and the Whiskey Tango smell. One of the cops looked at me afterwords and said "If you ever need anything, let us know. I don't know how the hell you did that; you're a better man than I."

And people wonder why I obsessively clean my apartment. I see the filth at work; I don't want to come home to it.

[Happiness]

One of saddest call I had was a older gentleman who had died in house on a hot summer evening. He was a member of the local people who drank something called sherry 74 hence they were call the sherry 74 gang. His common law wife had woken up to find him on the edge of bed dead. She had walked around town that day telling people that he was at home dead. Not one person she had told took her seriously and he was in that house for another 24 hrs until the RCMP had gotten wind of it and went to check it out.

When we got there the VFM were outside and they said the RCMP were inside, they didn't know what was going on and refused to enter the house (one of the guys had gone in and came out running and puking at the same time). As we entered the shack my foot slipped alittle and when I looked down I had stepped in green slime of something. Looking around I saw dishes piled so high and covered with slime and mold. There was garbage and bottles everywhere and this slime (still have no idea what it was and don't want to know). I had my paramedic nose turned off and the smell didn't really bother me to much at this time. My partner all of a sudden said Oh poor Simon. When I looked in her direction I saw Simon laying back on his bed (more slime) with his mouth open and a swarm of small fruit flies swarming his head. Then it hit me the smell, I started to gag and said I have to go outside for the stretcher and off I went. As I was comming back in I noticed the RCMP officer looking around and the fridge open and the smell. They had been using the fridge as if it was a working appliance. Then I saw the slime again at the bottom of the fridge just dripping out of it. The fridge was full of rotting deer meat, and what ever else could rot. The smell was even worse that the rotting corpse that was on the bed. The coroner released the body and we had to take him to the morgue. I had to convince the fire guys to come and help and a couple put vicks under their noses and we got him out in the fasted of time ever.

It is hard to imagine in this day and age that people do actually live in those conditions but it is everywhere. Sometimes you just have to grin and bare it.

happy

[firedoc5]

Been there, done that. We have a lot of boonies but no desert. I don't know how many times we wished for a 4x4 ambulance. Kaisu, I don't know how many times we had nearly the same kind of scenarios you just explained. I feel for ya.

We had an area known only as "Paper Town". No town, but still on plat maps. Get down in there it's where the men are rednecks and the horses are nervous.