You Cant Make This Shit Up 🚑

Night 2 of this festival, we had two men stumble into our tent carrying another male. They put him on a cot and immediately we could see he was super sick. His respiratory rate was 4x min and oxygen level 77%. Heart rate of 180 that we watched drop as low as 40–50 and a temperature above 105. The friends told us that he had been drinking, took shrooms earlier, then within the last two hours consumed and unknown amount of Ecstasy, GHB, acid, Molly, and possibly cocaine. I swear this guy must’ve had a death wish for combining all of that together. All of the providers in our tent agreed that he needed to go to the “pop-up ER” ASAP.

I often referred to this event as Battlefield medicine because you will see and do things that would never fly in a regular hospital or prehospital setting. We load the patient into an off-road vehicle that had been modified with a flatbed to put patients. In this particular incident we really didn’t think he was going to make it to the other medical tent before going into cardiac arrest. One of us held the patient on the back of this flat bed ATV while holding a bag valve mask to supplement the patient’s oxygenation. The other was ventilating the patient while standing over them and manually feeling for a pulse in case the patient went into Cardiac arrest we could start chest compressions.

When we arrived to the makeshift ER the entire team of doctors nurses and paramedics worked like a perfectly rehearsed team with everyone in their place. It was amazing to witness the calm urgency as everyone seamlessly worked together to help this patient. The doctor made the decision to sedate, and intubate the patient and put them on a ventilator and then “dunk” them into a tub of ice water. The purpose of this is to bring down the core body temperature and induce hypothermia in an effort to prevent neurological deficits. I had a patient from this festival years prior with almost the exact same etiology who unfortunately did not survive so I was having a hard time remaining optimistic about this patient. Before we could move the patient to the ice bath, the patient goes into cardiac arrest. We start CPR and Do one round before we get pulses back. We move the patient and induce hypothermia then sent him to an outside emergency room where he could be admitted and stabilized.

I went home that night feeling a little defeated because none of us thought this patient would have a good outcome. At the bare minimum we assumed he would have lifelong neurological deficits. It’s always hard to participate in events like this where you know everyone is coming for a fun and memorable experience yet some are not going to make it home because of something preventable! The third night of the festival, I approached the lead ER doctor from the night before and asked if he heard how our patient was doing. I was shocked when he told me the patient is being extubated, taken off of life supporting measures, lab work and vital signs were good and he had minimal to no permanent neurological deficits. I was shocked happy proud and amazed that someone so close to death lives to see another day because of the incredible team and innovative medicine we’ve been able to bring to this event.

it’s not very often that you see this kind of miraculous recovery when you work in emergency medicine. There’s a very thin line separating someone from life and death and we don’t get to walk that line very often, but when we do it makes all the stress, heartache, exhaustion, frustration all worth it.

I will end with my favorite quote from Abraham Lincoln which states - “Next to creating life the finest thing a man can do I save one. “

You don’t realize how PTSD can just creep up on you when you’re least expecting it. It will be 5 years in October from the event that completely flipped my world upside down as a first responder and as an attendee of the Route 91 festival. Working the ACMS tonight, 10 mins after the end of the Chris Stapleton tribute for the route 91 victims and survivors they set off fireworks in the allegiant stadium parking lot. They didn’t tell us, they didn’t tell metro. This is what I was looking up at when it happened and a metro police officer grabbed me and two other medics and pulled us to the ground behind a truck until they realized what happened. I’m shaken up. I’m mad at myself for being so shaken up. I’m mad at myself for letting PTSD have this effect on me. I’m mad that almost 5 years later something so small can reduce me to a shaking puddle of tears on the floor in an instant. I feel weak. I feel like an embarrassment.

But Every year things get a little better. Therapy helps. Talking to people who can relate helps. I think this will stick with me forever but I hope as the years go on, it will get better.

This is just your friendly reminder (and a reminder for myself more than anything.) that you are stronger than the demons who haunt you, you’re not weak when you acknowledge those demons or even if you have a hard day because of them. Brush yourself off, push forward and count any progress as another day stronger. Remember, you still haven’t even met all the people who you are gonna love or be loved by yet.

TOGETHER we can beat this…Maybe.

I’ll go first. It was Christmas Day and I was working in the ER and a girl was brought in by her friends for having a psychotic episode. She smoked meth and had mental health history on top of it. Where I live psych patients are always dressed in green gowns if they’re on psych evaluation. I just got this girl changed and locked her possessions in a locker. I round the corner and see her sitting on her bed in the hallway (for Obs purposes) but wasn’t restrained because she wasn’t violent towards anyone. She was just sitting criss cross on the bed rocking back and fourth with her face in her hands. I no sooner look back on her as I walked by and she’s screaming, holy exorcism style, with blood pouring out her face.

⚠️Trigger warning - this gets gnarly.

I thought she clawed her face. I was wrong. I grab her head to pull it out of her hands and she had clawed her eyeballs out of her head and was holding them in each hand. The left was fully detached. The right was still attached just dangling. That was the day I learned that holding pressure for bleeding control really does apply to just about every body system.

A year ago I had a patient who was extremely combative. she slipped her restraints and ended up biting me, my partner and spitting in our faces and kicking me in the stomach. Now usually I never report these things cause I just accept that it’s part of my job! But being pregnant at the time and jeopardizing my baby’s safety, we pressed charges. So a year later (today) we get subpoenaed for this call. Before we even testify the judge asked if she (our patient) was willing to taken the plea deal they offered. The OG charges were felony battery on a protected person and battery with intent to cause bodily harm. She was offered a 500$ fine and have these charges removed from her record. She STILL plead not guilty. Because She didn’t want the fine….🙄 so now the case is continued. My partner and I walked in there to tell the DA that we wanted to drop the charges against her if she was willing to write a sincere apology but unfortunately that wasn’t an option because the state was pressing charges.

Update :

-TW⚠️

When people find out I’m a first responder you can already anticipate that dreaded question and while usually good intentioned, most are not ready for the answer.

Sometimes I try to shrug it off and turn it into a gross but slightly funny scenario. (Reference my Philly side car story 😂😷🥴)

But you know the actual worst thing I’ve seen? It happens all the time.

The look of the family and friends who realize their loved one isn’t going to recover. The shrieks from those loved ones who woke up and found someone dead. The heartbreak of watching someone they love, dying in their arms while awaiting EMS. The slight glimmer of hope they barely hang onto when we arrive thinking “they’re gonna save them.” When we walk in and know there is no chance of survival but have to still make an attempt. Then the crying, begging and pleading to save them when they realize resuscitation efforts are being terminated.

An RN posed this question on Reddit, here are my thoughts.

I think there multiple reasons for this but I’d say one of the biggest factors is burn out associated with the realities we were oblivious to before the pandemic. It brought to light the truly horrific state of American healthcare. It all comes down to liability and monetary gain. Healthcare is run like a business first and the health of our community dead last. We all got into healthcare with the intention of helping people but what you don’t realize is how hard your hands are tied and its hard to accept that reality.

Anyone else ever start recalling a story of something crazy/traumatic that you saw or did as a first responder , Nurse, Doctor etc. and as you’re starting to say these things out loud you begin to question yourself like

“wait did I just make that up? Did it actually happen like that?”

Because as you’re unpacking all this trauma that you had shoved so far down into your cold dead heart that you never even processed and now that you’re speaking it, it seems so crazy that there’s no way that actually be true.

Anyone else? Anyone…

This happened today. I worked with a nurse who’s a traveler. The nicest and coolest girl. She saw my very visible arm tattoo with the Vegas strip skyline and the words Vegas strong underneath. I absolutely love this tattoo and I guess it set me up for these questions but sometimes it really sucks. I don’t mind talking about it because it is therapeutic but recalling those incidents, sometimes you don’t realize just HOW traumatic they until your say it out loud.

TW‼️Talking about the Vegas MCI in October 2017. ⚠️

•••••••••••••••••••••••••••••••••••••••••••

I talked about it like I was just chatting with an old friend over coffee. So nonchalant. I told her how people were doing CPR on their friends/family that was clearly deceased begging EMS to help them. Walking past these people or having to drag them away to a safer location. The constant cell phones ringing on the scene, over and over. Families desperately hoping their loved ones answer and simultaneously knowing they never will. The hospitals that were FLOODED with hundreds of patients. 2-3 “red tags” to a bed. The floor, COVERED in blood, pooling together. The most dehumanizing thing was seeing the deceased victims, dragged in on a sheet or laid on the bare floor, piled together in a back ER room to make space for the continuing onslaught of people coming in with multiple GSW’s.

But at the exact same time, the most humanizing and humbling moments, seeing those who had zero medical knowledge jump in and help where they could. I remember a man walking in with a GSW to the leg. Limping while holding pressure as he helped a young female inside the ER. She was shot in the abdomen. They didn’t know eachother. He put her in the back of a random persons pick up and didn’t even realize he was injured until they pulled up at the ER. He insisted “take her first I’ll be fine. She needs help more than me.”

The pharmacist standing in the hallway telling nurses to grab handfuls of rocephin and morphine. The nurses trailing behind an off duty emt putting IVs in every person one by one. On the floor. In the lobby, in the hallway.

About halfway through that story I look over at the nurse I was with and she has her jaw basically on the floor at this point and that’s when I realized, now that I said that out loud, holy fuck. And even though I clearly remember every part of that night it still felt like a nightmare fuled warzone.

But maybe that’s my brain trying to prevent itself from going into a PTSD induced anxiety attack by tricking me into thinking i made it all up. Sometimes I wish it was made up. I wish I could turn that part of my brain off. Just for a few hours so I can sleep. Maybe I just needed to get it all out.

Death 💀

Today we saw a patient who’s complaint is completely irrelevant to this story. She was staying with her adult daughter who had a 3 month old and 3 year old. The house was beautiful and nicely decorated. My partner and I specifically commented on the nice family portraits on the wall. My partner looked at the photos and then at the 3 year old and said

“oh wow you look just like your daddy!”

Everyone was silent and just nodded in agreement. The mother told us how she was waking up at 3am with the baby to help the daughter out. I jokingly said - Oh man I wish my mom would do that for me. My husband never gets up with the baby. - we had just discussed how our baby’s were only 2 weeks apart in age. The daughter and kids walked into another room and the mother leaned in and started to sob.

Her daughters husband killed him self, in their master bedroom less than a month ago. My heart was shattered and I’ve never felt like a bigger asshole in my life. That was god awful and I didn’t think my day could get worse.

Then I had My next call.

Female with abdominal pain. We pulled up to the house and my heart sank even further if that was possible. I didn’t say anything but the minute I saw the house I Remembered that was the house I ran a 3yo febrial seizure that coded 3 years ago. The child did not survive. There were 3 kids running around downstairs and my partner conversationally asked

“Oh how many kids do you have? “

They replied 4, but one of them had passed away a few years ago.

When we got outside I told my partner about what happened years prior. For years that call haunted me. I finally worked past it and moved on just to have the bandaid ripped off like an old wound. I’m glad I was wearing a mask because had the family recognized me, I would have had absolutely nothing to say.

Anyways - story time - - - -

I started off my shift training with a guy who had no idea I was training with him today. We’ll call him K. We’re getting ready to go out and he hands me his stuff and asked me to take it out to the truck for him while he uses the bathroom. While I’m waiting on him to come out his phone rings. A female with hearts around her name pops up on his phone. He comes out and I tell him I think his wife called. He says thanks and we head out for the day. 3 calls in he says we have to run to his house really quick. We ended up about 20 mins outside our area but I’m new so I keep my mouth shut. We pull up to this super nice house. He says to me and his partner, “Hey why don’t you guys come in. Its gonna be a minute.” I was hesitant at this point because I had no idea what we were doing but his partner gets out and motioned for me to follow her so I do. We walk in the house and there’s a lady that affectionately greets K at the door. We’ll call her L. On first glance I didn’t really notice what she looked like. We walk in and his partner sits down in this lady’s kitchen and is chatting with her like they’re old friends. I just figured at this point they probably knew eachother so it was all good. Two little kids come running up and say hi and ask if I wanna see their fish. - side note it was actually a really dope salt water aquarium with tons of exotic fish. - it took up a whole wall in the adjoining room. I kinda started to look around and there were these family pictures all on the wall around me, but the photos consisted of L, the lady who came to the door, the two kids and a guy who was 100% NOT K. At this point I was throughly confused but I was thinking oh maybe this is his sister or some other family member. The 5 yo boy asks if I can help him put a piece on his legos. I start to try and help him and this huge 6’6” 350lb yoked out dude from the pictures on the wall slams the door as he walks in and yells “you mother fucker, let’s take this outside.” At that point my trainers partner looks at me and goes “let’s go...NOW!” And I hand the legos back to the 5yo and tell him I’m sorry I have to go. I’m trying to get to the door and my trainers partner puts herself between K and the gargantuan mother fucker who I can only assume is this chicks husband. They’re screaming at eachother and L is trying to get in between them saying “you don’t understand. Then K says “I thought he knew. Wtf.” I literally dipped out of there so fast and high taled my ass to the truck where I waited for another 10 mins. Finally K and his partner get in the truck. His partner starts screaming at him saying “what the fuck was that. Why did you put us in that situation. I thought he was at work.” So at this point I can only assume that she knew what we were doing this entire time I sat there while they argued the entire way to the next call and got out on scene not know where the fuck we were or what we were even going on. We finish our shift and head back to station. He phone rings again. It’s his wife on FaceTime. He answers and says “hey babe I’m training someone.” Then turns the camera towards me. I wave and instantly recognize this girl. She’s a nurse that I know from one of the local hospitals here, but most importantly I know her as the GIRLFRIEND to a firefighter buddy of mine. They get off the phone and I ask K, “can I be blunt for a second? Are you guys in an open relationship or is this all behind closed doors.” K replies and says “well one of those doors was opened today.” I said okay. I’ll just keep my mouth shut then.

I don’t think anyone goes into healthcare intentionally thinking they hate people and don’t want to help. That’s just one of the unfortunate realities of burnout. If you’re new to healthcare and wonder why experienced providers (of any level) are so salty, this is why.

We all go into this for the same reason. You hear it from rookies all the time. “I want to help people.”

I remember my first week as an EMT. I was so excited and an instructor/mentor of mine looks at me and says “Remember how you feel in this moment. Hold on to it. When you start to become disgruntled by the bullshit remember this.” And I did. I never forgot that conversation. I revisit that moment often when feeling the effects of burnout.

But The problem isn’t just becoming burned out over time. The problem stems from the buerocratic nuaunces from much higher up and leave providers with their hands tied. A good example for this is privitized insurance. Americans pay and arm and a leg for coverage, which is a legal responsibility for those who live here. The insurance companies can choose weather they want to approve or deny treatments subjectively. The people who make these decisions often have no medical background or experience, instead their experience comes from a business standpoint. Their could be an amazing treatment to save someone’s life or a medication that could be life changing for a patient. The doctor can recommend things all they want but ultimately insurance chooses weather someone lives or dies. Now this doctor is scrambling to find another option for this patient that they genuinely want to help but can’t do. They do this everyday for years with hundreds of patients. After a while it wears on you and that’s where the burn out comes in.

You can be passionate about helping people all you want but at the end of the day, when your hands are tied and you see more suffering than success, I don’t care who you are, that wears on a person.

For me, it’s worst things I’ve heard that are more haunting than any trauma I’ve ever seen. It’s the mom who just lost her baby. It’s the wife who watches her husband drop to the ground and go into cardiac arrest. It’s the sound of 58 cell phones ringing repeatedly on the scene of an MCI, knowing the person on the other line will never hear their loved one again. It’s the conversation with my partner talking to me about the 5 year old we had to pronounce deceased on Christmas Eve and how he almost crumbled when he saw all the presents under the tree for her, that she’ll never open. It’s the sound of the family on the phone asking which hospital you’re taking them to as your partner comes up to tell you they’re 419. And the shaky ness in my voice as I scramble to figure out what to say to the family. It’s the sound of code blue alarms, cardiac monitors, and the rhythmic mechanics of an auto pulse. It’s the emergency tones that mark a channel when a crew is a dangerous situation.

Yeah I think that about covers it.

This and the philly side car story are usually the ones I tell when people ask me about “the craziest thing I’ve seen.”

I was working in the ER and I was covering triage while someone went to lunch. A guy and his wife walk in and you can’t tell he’s in quite a bit of pain. He’s walking bent over and grabbing his lower back. I immediately thought gallbladder or kidney stone. I ask this gentleman to take a seat in the triage chair to assess his vitals. He tells me he can’t sit, it’s too painful so I take his vitals standing up which wasn’t any easy task considering this guy was in quite a bit of pain and couldn’t stay still. I asked about medical history, past surgeries, allergies etc. His wife answers for him and denies everything. I get him moved to a room and leave him in the hands of the nurse in that area. The girl I’m covering for lunch in triage comes back and I’m able to go back to the floor, just in time to get and IV and blood work started for this same gentleman who had come in earlier. The wife kindly greets me and says, “See honey it’s the nice girl from earlier. You’re in good hands.” She then receives a phone call and steps out to the lobby. I get an easy IV on him and start drawing a rainbow. He looks at me like he just had the fear of god put into him and says “So what’s going to happen after this?” He’s literally pouring sweat and shaking at this point. I tell him we’re drawing labs and going to go to CT to look in his abdominal area to check for kidney stones, bowel obstructions, appendicitis, etc. he asks me if when they get the results from his CT if we can make his wife leave the room. I’m dumbfounded at this point because she seemed like a really nice lady and was genuinely concerned for him. But I tell him that he can ask whoever to stay or go from the room. He looks at me and says “I need you to tell her she can’t come back in. I don’t want her to know.” At this point I’m thinking

-Oh god this guys has like end stage cancer or something and doesn’t want his wife to find out.

The CT tech comes around the corner just as the wife is walking down the hall. He grabs my arm and says, please I’m begging you. She cannot be here for this.

I meet his wife halfway down the halls and explain he’s going to radiology for a few tests and ask if she would be willing to wait in the waiting room until he’s finished. She was very kind and said of course then shouted down the hallway at her husband that she’ll be waiting for him to get out.

About 30 mins later he comes back and the CT tech looks at me and says “you’re not gonna believe this shit.” My prior thought of this guy having cancer or some other terminal Disease floods my mind and I say “oh no. It’s bad isn’t it.”

The CT tech laughs and goes, oh yeah it’s definitely bad, as he clicks through my computer to find the imaging.

And there it was, to my complete surprise. It wasn’t cancer. It was a foreign body obstruction. A 16in long 12 in diameter, big black dildo. Lodged so far up this guy’s ass that it’s now perforated his bowel.

I run and grab the ER doc who immediately calls for a surgical consult then we all go to the patients room to talk with him. The doctor asked the patient if he was here alone and he said no, my wife is in the lobby but I don’t want her to know. He explained everything and told him the surgeon would be down shortly and we would be getting his consents filled out in the meantime. As the scrub RN was finishing the last of his paperwork, someone had let the patients wife in and she was running down the hallway. She starts scolding him because he didn’t call her when he was out of CT. I apologized and explained to her we gave him some pain medication and he was very drowsy and probably forgot to call. So she then asks what was going on and where he was being taken. She looks right at him and says “babe just tell me what’s going on.”

At this point it felt like I was in a really awkward episode of Maury waiting for him to answer back. He says

“ah babe you were right. It was my appendix. They gotta take me back right away.”

The scrub RN looks at me shaking her head and I looked right back mouthing the word “N-O.” The wife says her goodbyes and they roll him down to OR. I tell the wife where she can find the surgical waiting area and then they were both gone. I thought that would be the last I was seeing of them but this wouldn’t be a “You can’t make this shit up story.” Unless there was more.

A few hours go by and we’re well into the evening now. I was on a swing shift and the night shift RN’s were about 3 hours in when we hear a page go out over the intercom for a code Grey, in the PACU. I look at my RN friend who was on swings with me and we both simultaneously have the thought, is that our guy from earlier? The pacu would be closed for the evening and the only surgical cases would be emergent ones. Our foreign body obs guy was the only surgical case we’ve sent down there all day. We both take off running towards the pacu. The entire unit is silent until we round a corner and hear yelling. It was the wife and the surgeon standing over the patient.

I see her say “I don’t understand what’s going on here. He said it was his appendix, what do you mean you got the foreign body out.”

The surgeon who had obviously not been informed about the secretive nature of this procedure pulls out a large bio hazard bag and hands it to her. “No ma’am your husband had this inside of him so far that it actually perforated his bowel and he’ll need to be monitored overnight for a few days.

I cringed so hard watching her open that bio bag and knowing she was not going to be happy. She reaches in and pulls it out. All 12 x 16 inches of it. And looks at everyone in the room and then proceeds to beat her already half unconscious husband, with this giant black dildo while screaming at him. Security attempts to restrain her and she starts to hit them with it as well. My RN friend and I looked at eachother and quickly left the unit and swore we would never try to cover for a patient again.

We get dispatched to a call for a 53 year old female C/C of Chest pain, Shortness of breath and dizziness. We walk inside her apartment and it’s one of those “here’s the tiny path I use to get in and out of every room because there is shit piled to the ceiling. Didn’t know we were filming an episode of Hoarders but here we are. Cool. She’s laying half off the couch, pale, cool and diaphoretic. She has basically every medical problem possible. Quad bypass x2, 3 CVA’s, diabetic, end stage renal, CHF and chronic weaping nasty cellulitis. She genuinely looks like a dumpster fire, and ironically shares the same resemblance with her home. But at this point I’m thinking this lady is gonna drop dead in front of me from one thing or another.

We Get her in the ambulance to do an EKG and start an IV. I notice she has a PICC in her left arm. So I ask her, ma’am what do you have this for. She tells me it’s for her antibiotics for her cellulitis. Okay cool. So then she tells me she hasn’t been taking them, or any of her medication for that matter and I asked her why not thinking we just found the problem right there. She said she was treating it with a “naturopathic approach” she read about online. She continues to tell me how she’s been using essential oils but they weren’t really helping.

God bless you if you already know where this story is going because I was shook. Never even expected it.

She tells me using the diffuser and topical wasn’t really helping her chest pain so she decided to try a different way. She drew up peppermint oil and PUSHED IT THROUGH HER PICC LINE! Then she was wondering why she felt like shit and her arm was burning. I wonder the fuck why.

She coded at the hospital. Apparently injecting essential oils is deadly, just and FYI Incase anyone was looking for something to do this weekend. This is not it sis.

When people say “it’s the new normal”

I guess this is what they meant.