Sunday, December 20, 2009

Ammoniac reveries

When I became a firefighter, I had a rough idea of what the job entailed. I knew that Minneapolis, like most cities, had drastically fewer fires than in the past. I knew Mpls firefighters responded to medical calls.
It takes a long time to really learn how to fight fires. Truly a hands-on job, with the caveat that to learn well, one should also get good, instructive post-fire explanations and evaluations to better understand what exactly happened in the dark and the smoke. This is not often the case, so there are many people very skilled at doing the same thing they've always done: floundering about in the dark. I have many extensive thoughts and opinions about this crucial flaw in the traditionalist learning process. Another entry...

During rookie school we went on ride-alongs with Hennepin County paramedics. My first one, on Friday night, 1 April, 2000, we had a range of calls. One was a young Latina who was pregnant and scared. Neither of the medics spoke any Spanish. I do/did, but I wasn't up on my Spanish medical vocabulary. 'Pre-natal care'? 'Months since last menstrual period?' 'Complications?' 'Allergies?' etc. It was comic and painful. After a decade, I'll still have catastrophically inept conversations, generally at middle-of-night calls when I'm barely coherent enough to make clear English sentences, let alone wrap my salty tongue around Spanish idiomatic expressions.

We toured the ER, too. Learning about how it worked and interacting with patients. It's important to be able to touch people in this type of work. You wouldn't necessarily think about it, but we spend a lot of time in people's personal space, pulling up or off their clothes, helping them when they've fallen in the bathroom, etc. In the STAB room that day there were a couple acute cases. The STAB room is where critical or marginal calls come before either being dead or going to surgery or ICU. There were a couple heart attack people, and a mother-daughter pair who'd been in a car accident. The mother hadn't been seat-belted and had tossed around the car when it rolled, resulting in neck and head injuries & lacerations, teeth knocked out through her lips, and a broken ankle. Her daughter was belted. She had trauma from her mother smashing her as the car rolled. If both had been belted, this wouldn't have happened. The daughter's left arm had been snapped, however, when the car rolled--caught in the open window and the ground. We were watching through the overhead monitors as the doctors and nurses work on it, and I was looking at her arm as they cleared the blood and broken skin away, showing the protruding top half of her broken humerus bone (upper arm). I turned very, very pale. I stepped back and sat on a chair. The paramedic leading our tour did a double-take, grinned, and got me some water. My two classmates were utterly supportive. Not.
So, I know I don't like to see exposed bone without preparation. On calls, at least, we have a general idea of what we're going to, so there's a chance to anticipate all the potential things that have happened to the body.

We learn quickly--or we should--how to assess scenes. Asking the standardized list of medical information questions, sure, but also taking in myriad other--often more telling--clues and cues. Unlike the paramedics, our face-time with patients is relatively brief on most calls, allowing us to maintain a warmer, more-compassionate, or at least tolerant, disposition to the endless non-emergency 911 calls. The force of energy shifting from the medics and Fire when we respond to a 'possible heart attack' call and a guy is sitting in his armchair, breathing fine, full of healthy, oxygenated blood (but for his smoking habit) and says he's had a cold for a week and had a pain in his back, near his heart, ie, on the left side of his body, for about a week. And then he says it's about a nine on the 1-10 pain scale.

We have seen horrible trauma. I NEVER NEVER NEVER want to get to a real-scale level nine or ten. Never. When I strained my lower back at work and couldn't bend w/o a sharp, shooting pain, I told them it was about five. When I dislocated my shoulder, sabotaged by physics and gravity while biking in the snow, I was gasping with the surges of pain, but that was about four. I'm superstitious like that.

Blood, open wounds, viscera aren't as bad for me as the bone playing peek-a-boo through the ruptured flesh.

What they didn't prepare us for in rookie school was the smell. Or, smells.

Gastrointestinal bleeds involve the body turning septic from within, and the patient vomiting and shitting rancid bloody liquid. That has a singular, potent odor.
Nursing homes smell of old people, urine, and bleach.
Drunks can smell really rank, and we get Listerine or paint thinner mixed with that.
Vomit is vomit is vomit.
Shit is shit, by the way. A drunk on a binge who's been drinking and shitting herself for three or four days is going to smell similar to the poor old fellow who fell and couldn't crawl to the phone so lay on the floor for three days, shitting himself.
Incense that covers dope smoking.
Pungent spices of ethnic food; those same spices and foods when the stove has been forgotten and the entire building is choking with acrid burned whatever.
Septic wounds.
Decomposing bodies discovered after a couple days, of course.

The smell that made me want to demand a training warning in rookie school is this: the accumulated reek of long-time urine soaked into clothing, skin, furniture. There's a heavy tang of ammonia that digs deep into one's eyes, nose, and stomach. The stench comes from everywhere, not just the person or his/her clothes, but the rug, the couch you're leaning on to help lift the person up, the air is heavy with this. Which is why nursing homes use so much bleach.

There are many, many calls we return from with sour expressions and unshakeable visceral sensations in our noses, mouths, minds.

And we sit back down and eat our dinner.

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