PTSD

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“You can’t help him” said the guy stoically, leaning on the fence of the garden. He had a cigarette in one hand, a smart phone in the other – both things I abhor.

“And a good day to you too”, said I, whilst utilizing my government bestowed grace to park on the sidewalk.

Don’t you guys do that though; not the smoking, that’s obvious – I mean parking on sidewalk.

Privilege and responsibility are two sides of one coin, you see. I won’t deny that we, ambucycle or ambulance drivers have certain privileges, four to be exact, but they come with awesome responsibility and even obligation.

Many assume that to drive an ambulance one need only a keen sense of erratic driving, boundless energy and an understanding wife. Untrue. To drive an ambulance one needs a special driving license. To get that prized license, an applicant must take a special course and then pass both written and practical exams.

Once qualified, the driver of an emergency vehicle can do several otherwise unforgivable road sins, but, should an accident occur, G-d forbid, the driver is responsible regardless.

Like I said earlier, an awesome responsibility.

“I mean, thanks for coming, but you might as well leave” continued the unruffled youngster.

“Only He can help now,” he said pointing his cigarette laden finger to the heavens.

And on that day and indeed on many a day since, I utilized my heavenly bestowed common sense, and rushed, through the garden, into the street level apartment, whose door was wide open.

Inside, I beheld the following.

A bare chested, tattoo covered, mid-twenties, shivering in the summer, sitting up in bed, ex special services, drug addict.

But I was wrong and he told me so, through chattering teeth, before I had the chance to press my radio’s transmission button.

“It’s not what it looks like,” he said.

I inched closer.

“I know what you’re thinking, and you’ve got it all wrong.”

“I’m no druggie – never in my life – I’m a soldier.”

Unit #68 walks in behind me and catches this last interjection. Brilliant luck. He too is ex-army, but was honorably discharged and is now married with a handful of kids.

“Which unit and where were you stationed?” asks #68.

IDF jargon follows of which I glean, that he was in the elite “Duvdevan” unit and that he spent time in fun sounding places like Halhul, AlFawqa, Juhazm and Ubeidiya.

#68 figures it out before me, because he’s been there and done that.

“PTSD” he whispers in my ear. (Post-Traumatic Stress Disorder)

The patient sways, eyes darting from side to side, and all the while spouting depictions only nightmares are made off. Murky stories of pitch darkness, immense fear, impending doom and indescribable fright.

“Please, please, please help me!” cries our patient again and again, but stoic roommate was right, there was nothing we could do.

We took basic vitals, but t’was for naught. This man’s body was healthy; it’s his mind that was indisposed and that is a science in which I am untrained.

The ambulance came – whisked him away and I thought the story ended there. It didn’t…

Fast forward 6 months.

Same address, alternate season, different patient. On this occasion I learn that the building is a dormitory for a BT Yeshiva, and my patient this time, is a student who collapsed.

He had been jogging, and hadn’t drunk all day.

Diagnosis: Vasovagal Syncope.

Treatment: Fluid Resuscitation.

Conclusion: Drink water – it’s good for you.

But what grabbed my attention on the way out was my previous client, sitting on a swing seat in the garden. He was reading a book, and was a picture of composure and calm. He looked up and recognized me immediately.

“I’m healed,” he said smiling. I hadn’t asked, but certainly wondered.

“No meds whatsoever – just cognitive Emuna Therapy and lots of help from above”

He pointed to the heavens and in his hand a book entitled The Garden of Emuna.

“You should read it,” he said enthusiastically.

I did.

 

Postscript – Also available on Amazon.com

 

Bamba !

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You know sometimes you get a feeling of impending doom, like something bad is about to transpire.

That’s not what happened that fateful Shabbat afternoon. On the contrary, driving to the address, I was ever so relaxed, and for good reason. The call was for an infant choking and statistically I was supposed to arrive to find relieved parents and a smiling baby – having already coughed out the foreign object.

I have responded to hundreds of “chokings” and thankfully the patient is mostly not choking once I arrive. The Heimlich is important and does save lives, but even a veteran EMT will have only experienced a handful of “the real thing” in his career. A complete airway obstruction is a rarity, thankfully.

Unit#22 was sitting behind me on my Ambucycle, getting an earful of how I desperately wanted to return to my wife’s London broil. We are neighbors and often respond together on Shabbat. I drive and he navigates, as would a wingman in the air force. I say navigate but I mean pray – both for the patient that we are about to greet and for us, that G-d take us to our destination safely.

And in case you were wondering, I am a stupendous pilot.

We were both mid-meal and looking forward to returning to our families with the good news that all was well. But thoughts of serenity flew out of the window visor, as we turned the corner. A handful of neighbors were manning the curb, screaming and waving hysterically. Screaming to the heavens and waving at us – His messengers.

Oops, pressure’s on – this is it – the real deal.

Huge adrenaline rush, quick revision of protocols, and five seconds later we land on location; #22 jumps off mid-park and runs gloriously to the rescue. I follow 15 seconds behind laden with my equipment and defibrillator, looking slightly less glamorous. People shove/point me in the direction of the apartment, but I don’t really need much guidance – #22’s blaring voice comes from the first floor and says, with absolute conviction;

“Shmeel – CPR on location – I need you NOW.”

This is where autopilot kicks in; when a medic’s mind makes split second decisions based on both training and experience.

I know it’s a respiratory arrest. I know it’s a baby. I know what I need to do.

I know what equipment I’ll need. I know what my job is and #22, far my senior, certainly knows his.

Almighty G-d – please, please help.

I run inside and in the doorway behold the scene in an instant. Baby is blue lying on the couch. My partner is doing compressions. Mum is sobbing violently. Granddad is saying Psalms. Grandma is screaming BAMBA! And Dad is nowhere to be seen.

I throw my stuff on the other side of the couch and take out my BVM (bag valve mask) or as we call it in the field, AMBU (Artificial Manual Breathing Unit). I’ll use this to force oxygen into the toddler’s lungs. I glance up at the child – I need to know what size ‘airway’ to use. An Oropharyngeal airway is a rigid plastic curved device, which, in laymen’s terms, ensures the airway remains unobstructed by the tongue. There are several sizes (color coded) depending on the size of the patient. In the classroom you measure this in slow motion, but now I instinctively reached for the black and insert it carefully into the two year olds mouth.

AMBU covers face and I squeeze a bag-full of O2 into her lungs.

On cue in run #74 and his ambulance team. He is a sweetheart and a solid professional to match; definitely someone you want around in an emergency. He too does an assessment and decides on the next two items on the ‘to-do’ list.

One: move this scene to somewhere less soft. A couch is no place for a CPR; it lessens the efficiency of the compressions. He chooses the dining room table, counts to three and all of us move in sync to the new venue. He wants to better position himself and so he jumps onto the table and kneels amongst Shabbat delicacies, with the baby’s head in between his legs. From this vantage point he can control the scene, his teammate’s actions and also manage the airway properly.

Two: he shouts for someone to connect defibrillator pads. There is hardly any room on her tiny body for the stickers. The AED does its automatic assessment and decides “No Shock Advised.” Bad News.

#22 continues compressions. #74 holds the mask with both hands snugly to the face and shouts commands. #44 looks for a vein to start a line. #76 prepares suction and its accessories. #18 breathes air into the lungs every few seconds. That’s me.

Three minutes pass although her mother later told us it felt like thirty. The baby moves. Or is it my imagination. Nope she moves again and this time tries to breathe as well. Cautious optimism now. Everyone continues what they’re doing but now in silence and in that complete silence we hear it, a squeal or perhaps a sob, doesn’t matter – there’s a pulse. She’s alive.

The Advanced Life Support team walk in and the baby starts crying weakly, though still with eyes closed and not completely conscious.

“The baby has a pulse and is breathing spontaneously,” Chief Paramedic bellows authoritatively, “What’s all the fuss about?”

Clueless.

Someone attaches an oxygen mask and the ALS team carry the patient to the ambulance for immediate transport. This seemed very much like a happy ending, but she wasn’t out of danger yet.

We stayed upstairs to pack up and offer a not so silent prayer that there would be no permanent brain damage and that Malka return to her absolute self.

He heard our prayer.

Sunday: Malka is discharged from the hospital and the family is reunited back home.

Monday: Malka is her normal bubbly self and does a photo shoot, to boot.

Tuesday: I get a ‘Thank You’ package that includes wine, treats, and a picture of a smiling Malka.

Wednesday: Extended family, friends, and EMTs are reunited at a gala event to recount, remember, and thank G-d for the Miracle.

The miracle of life.

 

Postscript: There aren’t enough words in any language, or any lexicon, to thank G-d for happy and healthy kids. If your kids are well and healthy but are screaming, fighting, jumping, and generally causing you to tear your hair out on a Shabbat afternoon. Take a deep breath and say;

THANK YOU!

And if you want to invite me for a Shabbat meal, by all means, but no Bamba please.

Lights, Camera, Action!

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And the ‘Actor of the Year’ award goes to…

The lady from number ten with the dizzy spells!

 

Everyone puts on a show. Absolutely all my patients bar none. I’m not implying that they don’t / didn’t feel well. I’m suggesting that people don’t say “the whole truth and nothing but the truth, so help me G-d.”

Some put on more of a show; some less – depending entirely on their self-esteem and emotional stability.

Some put on an impeccable show; some put on an inferior show – depending entirely on their acting skills.

The only patient that doesn’t perform is an unconscious one. It is then and only then, that one can see the person as they actually are – making the initial diagnosis thankfully, remarkably simple:

Unconsciousness!

For all my other clients, accurate diagnosis is more difficult and is, essentially, a labor of love; separating the wheat from the chaff. ‘Tis an art form – of which I am the artist. Theatre – wherein my patients are actors. In the early days it was near impossible, but ultimately, I have become somewhat of an expert in distinguishing the percentage of the ‘illness’ that is life threatening and the fraction that belongs to Bollywood.

Nothing against Bollywood – it’s a perfectly nice place, sunny, music, dance and all. I just want to know who hails from there. Please.

 

“Why is it?” you ask.

“Why is it that everyone becomes a red carpet actor when it comes to emergency medical situations?”

The answer, or answers, brings us to the core of the human condition and the psychological or perhaps psychosomatic heart of operations beating within all of us.

Do please come inside for a closer look.

 

The Why, Who and How

The reasoning is remarkably simple. We can all relate to it, and if but perfectly honest with ourselves, are guilty of it.

Hint – Ever pull out your Iphone and scroll aimlessly through decade old whatsapp history when someone joins you in an empty elevator.

No!?

You must not have an Iphone, whatsapp or elevator!

 

WHY

The inner emotional mechanism goes something like “I’m embarrassed, I feel silly, I feel insecure.” Translated into real-time: “I made a fuss and initiated an emergency medical response. There are lights flashing, sirens blazing, and ambulances speeding through the streets towards me; they can’t land here to find me well and healthy!”

This quickly turns into – “Oops, they’re here now; someone’s taking my pulse, another’s unwrapping a non-rebreather mask; I can’t just stand up, dust myself off and go buy a bagel.” It becomes a snowball situation, once started, nigh impossible to stop.

 

WHO

The more immature the person, the longer the spiel goes on. And in case you were wondering, maturity in these matters is in no way correlated to age. On the contrary. It’ll very often be the younger ones that say, “Hey, it doesn’t hurt anymore – See ya later!” before whizzing off like a speeding bullet.

Forgive the cynicism, but my lamentable, ineluctable and yes, cruel deduction is that:

  • The younger the child, the less room there is in his life for falsehood and inflated ego. Gimme a toddler’s honesty over an adult’s artifice anyday.
  • Tweenhood is a time of businesslike deliberation, “Go back to the skatepark, or milk this for all its worth?” Better yet, “Will this buy me time off school, or a reprimand from Dad?!”
  • Late teens, early twenties – same type of considerations, except higher stakes and more intense social pressures; chicanery in full bloom.
  • Forty, Fifty, Sixty year olds – Ladies and Gentlemen, take your seats and pray silence for an all-out performance of Phantom of the Opera.

 

HOW

It all starts with eyes shut tight. This allows the patient to slip, quite seamlessly, into the fictitious world of sirens wailing, people encircling, bystanders observing, someone trying to get my Mum on the line, and then eventually the quintessential desperately anxious shouts of “Will somebody get some water ASAP?!”

And now, deep into the first half and nearing the intermission one can’t expect the leading actor to sit up and say “Thanks everyone for your help – and that’s a Wrap!”

N’est pas possible.

And so therein begins a particularly problematic escalation that can continue ad infinitum. Bystander to Teacher – Teacher to EMT – EMT to Ambulance – Ambulance to ER Nurse – Nurse to Doc – Doc to Surgeon. A lie; perpetuated with no foreseeable end in sight.

Why’s this all happening?

Oh that’s right, feelings of insecurity.

Pity.

 

Postscript

Of course not all patients behave in this manner; stay tuned for another post with detailed case studies and examples. Oh and if you’re looking for the trusting, undoubting, believing, optimistic Shmeel – He’ll be back in the office on Thursday.

A Tale of Two Newborns

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They had entirely different responses, one sobbing quietly, the other remarkably calm – the mothers.

They were crying insistently and incessantly and with definite purpose – the patients.

The patients in both stories were newborns, one but a week old.

Brand new souls entrusted to brand new mothers.

New mothers who made good and sometimes preposterous decisions.

Decisions that would have unfortunate consequences.

Consequences that would involve – you guessed it – yours truly.

 

One would hope that the most serious calls would get the fastest response. But that’s not always the case. In fact in the forthcoming tales I was on scene in mere seconds, when the emergency was, well, not really an emergency.

 

Tale 1 – Good Judgment

I was literally sitting on my bike, talking on the phone, immediately outside the building wherein the emergency occurred. Lightning fast response, for an absolutely immaterial call. What a waste.

Murphy’s Law 1 – The Desperate and Needy 0

 

The beeper said:

2 Week old Baby – Miscellaneous medical problems – Ingrown Toenail.

I know – I did a double take as well – how could that possibly be true? Don’t ingrown toenails take weeks to develop and involve some fault on behalf of the subject, such as cutting too close?

I was on location before the mother had put down with Control.

 

Act One:

“Hello Madam – what seems to be the problem?” I asked the stoically calm Kimpeturin.

“My baby had an ingrown toenail – treated several days ago by a podiatrist – and is now behaving curiously,” was the ‘matter of fact’ response.

Still no wiser – neither about the toe nor about the baby.

I asked the same question again, phrased differently – and got the same response, phrased differently.

 

Act Two:

Do a once over of the infant.

Get a comprehensive medical history.

Procure a complete set of vitals.

 

This was sure to uncover the underlying problem. But – it didn’t.

 

Act Three:

Pretend you understand the whole situation.

Make believe everything is under control.

Get the baby to a hospital.

 

Worked like a charm.

 

I had now been on scene for about 3 minutes when Unit #22 joined the baby shower, bearing a heavy EMT knapsack, instead of gifts.

“What’s going on?” he asks, breathless from the 2 flights and his decade seniority.

“Her baby had an ingrown toenail – treated several days ago by a podiatrist – and is now behaving curiously,” I repeat verbatim, with a hundredth of a tinge of sarcasm in my voice. #22 immediately knows what I am insinuating and takes the mothers side.

I could sense the speech coming. My mentor had lectured me tens of times on this matter. And so it begins…

“A Mother always knows best. If a mother says that something is wrong with her child, you have to trust her unconditionally, irrespective of your clinical findings!”

Aye Aye Captain.

Ambulance comes, transports mum and child, and, if you must know, there was something awry with the baby and she spent several days in hospital recovering.

From what? Only Mum knows.

 

Tale 2 – Bad Judgment

No I don’t normally sit around on my bike, on my phone, waiting for calls, but;

I was literally sitting on my bike, talking on the phone, immediately outside the building wherein the emergency occurred. Lightning fast response, for an absolutely immaterial call. What a waste.

Murphy’s Law 2 – The Desperate and Needy 0

The Beeper said:

1 Week old Baby – Miscellaneous medical problems – Too Relaxed.

I know – I did a double take as well – how could that possibly be true? Don’t mothers hope and pray that they give birth to children who remain calm and relaxed and sleep through the night?

I jog to the door of the building and meet the mother in the hallway coming towards me from her apartment located at entrance level. She hands me the baby, as is the custom in times of panic, and for good measure yelped “Help!”

I do a one second observation. Infant Conscious – Yes. Infant Breathing – Yes. Great; let’s move to the couch in the house please, its pitch black in the hallway.

 

Act One:

“Hello Madam – what seems to be the problem?” I asked the uncontrollably hysterical mother.

“My baby was crying, and so I gave her a few drops of ‘RELAX’ to calm her down,” she said between sobs.

“And…”

“And now she is too relaxed. Look at her, she is barely moving!”

 

Several Important Pointers:

  1. She was right – the baby was hardly moving. Not quite unconscious, but certainly dispirited.
  2. ‘RELAX’ is a herbal concoction so strong, it could make an elephant count sheep whilst lying wistfully on its back.
  3. The mother had given the newborn several drops of this innocent concoction in the hopes of having a quiet night.
  4. She would now not have a quiet night.
  5. I have a wild imagination, but could never ever make something like this up.

 

Act Two:

Do a once over of the infant.

Get a comprehensive medical history.

Procure a complete set of vitals.

 

Vitals were thankfully normal:

Pulse: 150

Sats: 97%

Respirations: 26

Blood Pressure: No chance on an arm that small

 

Act Three:

Baby is transported to hospital and makes complete recovery. No charges filed against the new mother. RELAX is pleased to learn that their product does indeed work, but adds a caution to the label:

“Not for use on Restless Newborns”

Always wanted to know how those absurd warnings get onto product labels?

Now you know!

 

 

Postscript

Not all Mothers always know best – but mine certainly does. Happy 27th Birthday Mum!